Full Transcript: Erica Ramos, President of National Society of Genetic Counselors, interviewed by Turna Ray of GenomeWeb
On this episode of Sequenced, Erica Ramos, the 2018 President of National Society of Genetic Counselors, talks to GenomeWeb’s Senior Editor Turna Ray about the growing field of genetic testing and role that genetic counselors can play in helping people make the most of their health information.
Curious to learn more about public awareness of personalized medicine? You can find GenomeWeb and Personalized Medicine Coalition’s report, “Public Perspectives on Personalized Medicine: A Survey of U.S. Public Opinion”, here.
We’ve posted the complete transcript of the podcast below. You can subscribe to Sequenced on Apple Podcasts, SoundCloud, Stitcher, and Google Play.
Note: This podcast is not an endorsement of Color by the National Society of Genetic Counselors.
Turna: Hello, my name is Turna Ray, and I’m Senior Editor at GenomeWeb. Today, I will be speaking with Erica Ramos, the 2018 President for the National Society of Genetic Counselors (NSGC). Hi, Erica.
Erica: Hi, Turna, it’s great to talk to you.
Turna: Same. Last year, on November 9th, the genetic counseling community celebrated the first Genetic Counselor Awareness Day. Why did NSGC decide to start this day?
Erica: Well, we know that genetics is booming, and we feel that it’s really important that genetic counseling booms along with that. We want to make sure that not only our colleagues and clinicians know that genetic counselors can contribute in a valuable way to the care of their patients, but that everybody in the U.S. is aware of genetic counseling so that they can reach out to us directly when needed. The goal of the day was really to empower genetic counselors to go out and raise awareness and interest about their profession in their communities both, again, within the general public, and within their institutions.
Turna: There’s this alarming statistic that gets thrown around a lot that there are only 4,000 genetic counselors in the U.S. In contrast, a recent report showed that there are 14 new genetic testing products coming on the market daily. In light of this rapid growth, industry tea leaf readers have predicted a genetic counseling crisis that in the coming years, there will be this huge demand for genetic counseling, and there simply won’t be enough counselors to meet the demand. But NSGC has looked into the statistic and concluded that the maybe the future isn’t so grim. Can you discuss those findings?
Erica: Yeah, definitely. We’ve truly tried to look and we don’t really know exactly where the sort of alarmist reaction sort of got started. But it’s definitely something that’s often repeated. It’s a great opportunity to clarify what that looks like in reality. We are going to have close to 5,000 genetic counselors by the end of this year. There are currently 43 accredited training programs who are actively training students or will be accepting their first classes, so the growth of training has really expanded dramatically. We are consistently as one of the fastest growing jobs in the U.S. We do recognize that it’s important to keep up with the demand. One of the things that NSGC has done was to do a workforce analysis. That really showed us that really within the next probably five years, we’re expected to be at a good equilibrium with patient care for what the experts said that we should be at which is fantastic. The other thing though is really around access to genetic counselors. It’s great that we’re growing quickly, it’s great that we’re training were more students and that we’re getting more people into the field regularly. But the other big thing is really how quickly are people able to see us.
NSGC also does something called the Professional Status Survey. Every two years, we survey our members. We ask them all sorts of questions about their practices and their professional lives. One of those things is how long do people wait to see a genetic counselor. I just got the data back for our 2018 survey. We had what I think are impressive statistics for cancer genetic counselors: 31% reported that they’re 3rd next available appointment. Accounting for people maybe not to be able to come right away — 31% said that was in a week, 49% said that was in 2 weeks. And what that means is that, stat cases can also be accommodated very quickly usually within one to two days. For prenatal, which is another big area for genetic counselors, 80% said that their 3rd next available appointment was with a week, and 88% said that was within 2 weeks.
We can see patients in many areas. There are going to be parts of the country like with any specialty profession or any specialty clinician where access is more limited. The great thing there is that we’re seeing a really big surge in telegenetic counseling. Both hospitals and private practices are offering telegenetic counseling for people who may not have as easy access.
Workforce is a huge priority for NSGC and for the genetic counseling community. We want to make sure we’re keeping up with growth. And, as you said, we’re seeing more genetic testing in many places, but we also want to make sure that the conversation is being had reasonably, and that we are recognizing that genetic counselors can see patients frequently if the patients are getting referred to us. That’s really another issue that has to be addressed.
Turna: Right. You mentioned that genetic testing is booming. I cited the statistic that kind of confirmed that as well. One way that people are getting more access to genetic tests is through consumer genetics companies. People can order tests online to learn about their ancestry, sleep patterns, about their ability to process certain foods, there are tests that claim to show you what two people’s children might look like, predict what wines you like. Of course, through companies like Color and 23andMe, people can also learn their risks for serious diseases like cancer and heart conditions. How has this ability of consumers to order genetic testing online impacted the work of genetic counselors?
Erica: Well, I think first, it’s really important to differentiate between the genetic tests that are sort of for fun and things that are more health-related. Although, it is also important to recognize that some tests like Ancestry can sort of bridge both of those areas. Most people go into things like Ancestry testing just for fun because they think it’s interesting. But as we’ve heard often, it can reveal some family secrets, and maybe some other things that they weren’t expecting. Your ancestry does have ties to your health. We know that people who have come from different backgrounds can have a higher risk for certain genetic disorders.
So the Ancestry, is a little bit of a bridge, and it’s important for people to be aware of what they can find there, and that it is more than maybe just a fun test all the time. But when it comes to the health-related test, I think what’s really critical is that genetic counselors can step in and help at multiple different stages of the testing process. Ideally, we know that, everybody might want to get some information before they consider testing. And testing labs are working hard to try to provide people with what we would consider to be informed consent and really helping them to understand what they’re gonna get out of the test. That can be complicated, and some people may have questions around that, and they may be concerned about what they’ll find out. If you are one of those people, then talking to a genetic counselor before proceeding with testing can be really important.
The other concern that I always have when thinking about people doing health-related testing in a sort of direct-to-consumer way is whether they’re getting the right test for them, things like hereditary cancer, cardiac risk, things like that. If people have a family history, then it’s very likely that a direct-to-consumer test is not the right test for them. That makes it even more important that they’d consider talking to a genetic counselor in advance because that person can then guide them to the right test, and make sure that they’re getting the information that they need, and doing it in as cost-effective of way as possible. That doesn’t mean they can’t go ahead and do the fun genetic tests or do the other health-related tests, it just means that they really should be coming in informed that there might be something better out there for them, and that something might need to be in a clinical lab or in a clinical setting.
Turna: One of the things that I’m hearing you say is that not everybody has an okay response to getting information through these companies. I’ve written about studies that claim that there’s really no harm from learning this information. But I imagine genetic counselors see a much more complicated picture.
Erica: Yeah. I am the first person to admit that I think that geneticists and genetic counselors may get more worked up about telling people about their ApoE and Alzheimer’s risk for instance, than the individuals themselves do. And there have been really good studies around ApoE in some of these other areas. I do think it’s important to recognize that a lot of those studies have been done on early adopters of this technology. So the people, even though now there are millions of people who’ve been tested through 23andMe, and Ancestry, and other direct-to-consumer companies, we’re still really talking about a fairly narrow slice of the population.
We have to recognize that not everybody is going to fit into that same perspective that early adopters do because those are the “knowledge is power” people. Those are the people who want to know everything. And there are plenty of other people out there that we talk to that say, “No way do I want to know if I’m gonna get Alzheimer’s or not.” And certainly, they don’t want to know if there’s just a chance that they’ll get it, and there’s nothing they can do about it. So absolutely, people are very resilient, and we have to recognize that people are resilient, and that there are plenty of people out there who really do have that “knowledge is power” perspective, and will do very well with this information regardless of what it says. But we also have to know that not everyone is going to fit that mold.
Especially as more and more people start getting access to this type of testing, either through direct to consumers, opportunities, or through research projects like All of Us, or through health systems, sequencing patients, all of those people are gonna have to be addressed in different ways. Some of them may really value the interaction with the genetic counselor and may really need that perspective.
Turna: The FDA’s job is to kind of balance that access to different innovations with concern about public health. I think it was the more when these direct-to-consumer genetic testing companies first started coming on the market, I think they were more concerned about the impact that it would have on the public health, and they did move to regulate a lot of these companies. In response, a lot of the proponents of the direct-to-consumer model accused the FDA of paternalism and hindering people’s right to access their own DNA information. To what extent of genetic counselors gotten caught up in this controversy? Do you think they’re perceived as barriers?
Erica: I think they can be certainly. One of the important things to know, as we’ve learned more about the FDA and when they’ve authorized companies to market their tests that are health-related, is that they’ve flat out said that particularly with things like BRCA, that these are high-risk endeavors in the absence of clinical care including genetic counseling. That’s built into their statements in their approval on this. So it is true that the FDA is becoming more flexible, and I don’t think that’s a bad thing. But it’s also important that we recognize that they have specifically called out that the optimal situation or the less risky situation for patients is to have a clinician involved, a genetic counselor, or somebody who really understands that information.
There are lots of reasons why we want to make sure that people get access to genetic testing and not have any barriers. I will say that I think there’s been a lot of situations that have put genetic counselors in what is perceived to be a gatekeeper position when that’s not necessarily where we want to be. One thing that we’ve seen a lot of lately is requirements for prior authorizations for genetic testing and even requirements that genetic testing will only be ordered in the context of genetic counseling by a genetic counselor. And a lot of those policies were not built in with our collaboration, we didn’t ask for those policies to be put into place.
And really, what happened is it was a response to a lot of inappropriate genetic testing that was being offered and ordered by other providers. I think in a lot of ways, put us in a perception of being gatekeepers for clinical testing. And really that was a payer decision, and it was in response to poor test ordering from other providers.
I don’t think that the right solution is to require genetic counseling in every case. I think the right solution is for us to start doing a better job educating clinicians and making sure that they are able to order the right tests for the right patient at the right time. But I think there’s a lot of misconceptions about how genetic counselors feel about access to testing as opposed to what we really want to support.
Turna: And I’m definitely going to ask you about the prior authorization programs a little later. But I wanted to first ask you… This type of consumer-initiated testing, it’s important to point out that the majority of people will not get a positive result but a lot more healthy people who don’t have a family or personal history of illness will learn their genetic risks for serious diseases. How important do you think it is that people get genetic counseling in this context?
Erica: I think any time you’re doing sort of a general screen and you don’t know what you’re going to get, genetic counseling before testing becomes less feasible for many reasons. I’ll use newborn screening as an example. We sequence or test, 4 million babies born in the U.S. every year for genetic disorders, and not every parent has genetic counseling before that happens. It’s because we don’t know what we’re going to find in those people. There is still an informed consent process, those people do you still have to consent to testing, and the same thing is true with direct-to-consumer testing. When we don’t really know what we’re gonna be finding exactly, then I think that the ability to provide genetic counseling universally becomes less feasible.
However, one of the big differences between something like newborn screening and something like hereditary cancer direct-to-consumer testing where only a handful of mutations are looked at, is that with newborn screening, a negative result is really pretty much a negative result. It’s very infrequent that you have false negatives in those situations, and we’re not telling people that they have residual risks for those diseases. When we’re only looking at three BRCA mutations, if somebody comes in with a family history of cancer, the concern is that, sure, we’re gonna pick up more people who didn’t know they had a family history or didn’t know they were at risk, but we might also mislead people who think that they’ve now been tested for everything.
Turna: Right. Now, earlier you mentioned that one of the ways to meet the demand for genetic counseling is through telegenetics, and in the consumer genomics realm, you really see a lot of different strategies kind of coming out for educating consumers. There are some companies that are using videos to tell people about their risks and limitations associated with the tests that they’re taking. And some companies are exploring using counseling bots. How is technology impacting the genetic counseling profession?
Erica: That’s a great question. There’s certainly a lot of impact of technology as a whole, both in how we deliver our services and how we interact with patients, and then also just how we’re able to work in making us more efficient. So I am a big believer in technology for all of those things. The biggest issues that we just have to make sure that we know the limits of the technology and the best situations to apply it in. Videos and education is an area where clinical labs have been very innovative, and they’ve created these really great systems to provide education to their patients.
I do think that education is one area where the technology can be very helpful, particularly since videos are a tool that people can keep going back to after over and over again. And that can be really helpful in reinforcing key messages from a counseling session or key messages about the testing. But there are limits to that, they’re static. So they can only address the issues that they were designed to. Whereas, obviously, a genetic counseling session is not a static interaction, and it also can be a long-term interaction.
Bot technology — I think is really interesting and exciting. I’ve followed it a little bit in the general psychology and counseling space, not necessarily tied to genetic counseling. And certainly, when you start getting into human emotion, bots are a little bit more complicated and not probably very good yet. I don’t think that we’re going to get to a place where that replaces human-to-human interactions at all. But I think that we can all be open to the idea of using different technologies, and the idea that we’re in a new world now. Lots of people do connect via video conference. People do connect in different ways than they used to. I think we need to make sure we’re considering that when we try to do the best job we can of practicing medicine.
Turna: Then there are, of course, consumer genomics companies that don’t provide genetic counseling as part of the service, but then just provide a link to the NSGC, find a genetic counselor service. Do you think that’s sufficient?
Erica: Obviously, we’d love to have more genetic counselors employed by these companies and to have it more of a service where people didn’t necessarily have to go outside and try to find somebody on their own just because we know that that could be a barrier for them to get the services that they need. That being said, we know that not every single person who has direct to consumer testing will need genetic counseling. I think we’re going to have to look at at addressing those particular consumers in lots of different ways. Hopefully, the companies will be a part of that and will help to provide those services as much as possible and collaborate with groups like NSGC and many of them have.
But I do think that there is an advantage for people to know that they can see somebody that’s in their community, they can work with somebody who has ties to the clinicians that they work with, and maybe their primary care doctors that it’s somebody that they can reach out to over and over. So certainly, making sure that people also know that they can find a local genetic counselor and use findageneticcounselor.com to do that is fantastic. Then we can hopefully continue to provide a wider range of services both direct from the companies and in people’s backyards.
Turna: Do you ultimately think that even though technological solutions are the way of the future even in the genetic counseling realm that it could possibly be ever as good as face to face genetic counseling?
Erica: I think if we include telegenetics in face to face, then those two things certainly. There’s been some good studies that have shown that there’s really not any inferiority that patients experience when they’re doing telegenetics or video counseling. I think that’s the best use of technology to get sort of the best of both worlds — taking advantage of the technology, taking advantage of people who may not have easy access to genetic counselors, but then also really having them connect one on one with somebody.
I think that videos, and chat bots, and those types of things where I feel like the biggest advantage there is, is in really education, reinforcing key messages from counseling sessions, preparing people for counseling sessions, and really allowing that face to face time to be addressing the very unique issues that that individual has, and not some of the very general things that we want them to know about and we want them to understand, but it’s basically the same message over and over.
Turna: Right. So let’s now turn to the topic of insurance. You mentioned previously that with genetic testing accessibility increasing, insurers have gotten concerned about overuse and inappropriate use of these tests. And recently, some large commercial payers employed genetic benefits management companies to track and manage utilization of the tests. Can you talk about how genetic counselors are impacted by these changes, and what challenges they’re facing?
Erica: Sure. You know, it’s definitely justified. There have been data presented and published about the inappropriate use of genetic testing. And I have very vivid recollections of when I was a cancer genetic counselor about 10 years ago, and we used to get sort of greenlit for any test that we would order, and it was great. And I would send in a test and I would say, “Oh, well, if it’s United Healthcare or whatever the company was, I know for sure this will get covered. So we’ll have your results back quickly.”
Suddenly, there was one month where that came to a screeching halt. Really what happened was that suddenly, these tests had sort of tripped these levels internally where suddenly, they were spending huge amounts of money that they had never spent before. I think the payers really recognized that they needed to take a close look at how that testing was being used.
So that had an impact, when all of a sudden, you can’t get the testing ordered for your patients that need it and it’s appropriate testing, then that really puts up a big barrier for the access for those individuals to make sure that the right people are getting testing when they need it. That being said, I think that we do need to make sure that people don’t have trouble getting access to genetic testing. So if they can’t have genetic counseling, if there are other people who are educated and good at talking about genetic testing, and really understand the testing technology, and can address the issues that those people are facing, then I think we need to be able to make sure that they can provide access to their patients as well. Unfortunately, that’s just not really been what’s been demonstrated to insures over a large variety of different types of clinicians.
I think we’re in a tough spot right now is that payers have somewhat reasonably put the brakes to all of this testing. But now, a lot of people are getting caught in the crossfire there. We need to make sure that people can get as much access as possible in an appropriate way. I think one way to do that is to make sure that genetic counselors are providing advice, and training, and other types of education when possible to the specialty professions. I think that if there are people who are interested in ordering genetic testing and want to do it as part of their practices, then they need to have access to appropriate education and continuing education that addresses their particular issues in their particular area of specialty. I also think that those people who don’t necessarily want to be going down that path need to know that genetic counselors are accessible to them.
Turna: When I spoke with genetic counselors about some of these programs prior authorization programs when they were first launched, a lot of the counselors were telling me that they were spending hours sometimes trying to justify why, with some of these pairs, why their patients needed them. A lot of the times, they were being told that they couldn’t do that, that the physician, the patient’s physician had to do it. Can you talk a little bit about those kind of administrative problems that showed up? And have those kind of gone away?
Erica: Yeah. So there were definitely a couple of those issues. And this is one of those challenging things that genetic counselors have encountered is that on one hand, insurers are saying we want our covered beneficiaries to have genetic counseling, but they’re not necessarily recognizing genetic counselors as the experts in that particular area. So we did have some challenges where for instance, genetic counselors couldn’t request a peer-to-peer review when something was denied. Or if the genetic counselor had a justified reason for ordering a test and the insurer said, “Well, it doesn’t fit in the box of things that we will approve. And despite your expert opinion, we’re going to say no.”
I think those things have started to get better. Any time you have benefit management, I think the goal is probably to make things as automated as possible. For the very cut-and-dry cases, it’s great. And hopefully, that’s becoming easier to do.
But even getting genetic counselors registered on the platforms was a challenge for a while. We had a lot of genetic counselors who were reaching out to NSGC because they were saying, “Well, we can’t even, register on the platform so that we can request an authorization.” We’ve had some good success working with payers who implemented those things.
We have heard back from a lot of counselors that they now are up and running that they are able to request peer-to-peer reviews. And so there has been some improvement along those lines. It doesn’t mean we’re all the way there yet. And it is an important message that we need to make sure that payers across the board really do look at genetic counselors as the experts and treat their interactions with them in that same way.
Turna: I think what this experience, genetic counselors experienced with prior authorization programs shows, is that there are much bigger problems in the healthcare system with recognizing the expertise that genetic counselors provide. In fact, genetic counselors aren’t even able to bill Medicare for their services, isn’t that right? How do counselors get paid?
Erica: So I’ll address Medicare first. You’re right, genetic counselors are not currently recognized as providers by the centers for Medicare and Medicaid. Currently, we are not able to bill Medicare for any services. That is something another major priority of NSGC because we know that Medicare recognition will open a lot of doors for other payers. It also helps convince hospital systems to make sure that their counselors are contracted and credentialed so that they can bill. A lot of private payers will reimburse genetic counselors, and genetic counselors can even bill directly. But because hospitals have very specific policies and procedures around how they bill, there are challenges when there’s no Medicare recognition. A lot of times, the sense is, well, if you can’t bill Medicare, it’s not worth billing at all.
We need to work on it on different fronts and we need to work on getting Medicare recognition. NSGC has supported a bill there and we have a bill drafted and are ready to introduce that bill. We are waiting for a score from the CBO office, so that’s gonna take a little bit of time possibly. But the great thing is that when we’ve done analyses around how genetic counselors add value, pretty universally, what we’ve been told is that we’re expected to be a pretty significant cost saver to Medicare, so we will help Medicare save money.
Not surprisingly, right now that should be a pretty positive thing for us to be able to do. We’re very optimistic that that bill will move forward, and assuming that we get scored as a cost saver that will have a really good response from Congress around that.
In addition, we’ve been working really hard to make sure that genetic counselors are aware when they can bill. We were looking at licensing and lots of different states. Iowa just became the 24th state in the U.S. to license genetic counselors, which is fantastic. Then we need to educate hospitals. We need to make sure that they know that they can bill for genetic counseling services, and make sure that they’re aware that we can bring in revenue to their facilities, and that it is worth billing directly for genetic counseling services.
Turna: Shifting gears just a little bit, I did want to get your thoughts on a survey that GenomeWeb and Personalized Medicine Coalition (PMC) did on public perceptions of personalized medicine. What the survey generally showed was that the public is actually not very aware of personalized and precision medicine. And to boot, their awareness is not really increasing, it hasn’t increased compared to a similar survey PMC did in 2014.
The survey also showed that most people are not aware of the All of Us Research Program at the NIH, which of course plans to enroll one million Americans to study diseases and advanced precision medicine. Not many are aware of the Genetic Information Non-discrimination Act. Despite the excitement around consumer genomics, not many have ordered this type of testing online. And importantly, very few know what genetic counselors do or have ever spoken to one. What do you make of that?
Erica: I think it’s a great example of how it’s easy for us to get stuck in a bubble when we see all these people who are doing direct-to-consumer testing and all these other things, we’re seeing these incredible numbers about uptake for all these different genetic tests. At the same time, a huge portion of the population is not actually using them.
We know that those results, in terms of how many people are pursuing things like genetic testing, are very skewed to certain populations. In order for us to really make big improvements and make sure that everyone has access to the benefits of personalized medicine, we really need to start addressing it from a lot more angles so that everybody is aware, and we’re educating people in a way that actually works for them.
As I said before, we can’t just take the tools that work in the early adopters of direct-to-consumer testing and assume that those will work for everybody. Obviously, the launch date for All of Us was just announced, and it’s next week, that hopefully will be a big part of that.
I can talk to a little bit of experience that we had here in San Diego. One of the efforts that I was participating in was actually with our local blood bank. So the San Diego blood bank has a really phenomenal CEO, David Wellis, and he had really come to us and proposed this idea that blood donors are really fantastic potential research participants and partners for genomic research. These are people who are by definition altruistic. They’re coming in every seven, eight weeks and sticking out their arm and giving blood, they’re filling out forms, they’re doing all of these different things not for their own benefit, but for the benefit of their community. One of the interesting facts that I didn’t know is that blood donors and blood banks are very representative of the population at large.
So we did sort of abbreviated All of Us study, and we got very quick responses. If people were interested and potentially participating in a research project where they could get genomic sequencing, and get results from their testing. And literally within 5 minutes, we had 300 responses that said yes. We ended up with more than 7,000 responses in total that said that not only were they willing to participate and in this research study, but that they would even make time out of their schedule to come to a very specific blood drive in the middle of the week to do so and to participate.
That was really fascinating to me. I think one of the great things about that is that the San Diego blood bank is now part of the direct-to-volunteer research effort for all of us. And they will be recruiting blood donors and other people in the community to help to advance the All of Us research initiative. That to me is one example of reaching people in a different way. You know, these are people who want to help, they’re people who want to be part of the community. And this is one way to reach them where they live. You know, there have been some efforts to do outreach in churches and with community organizations. And all of those are the ways that I think will do a better job of reaching more people and getting more diversity in who we reach and really helping to up some of those numbers.
Turna: Right. So you’re optimistic then that public awareness will increase in the coming years?
Erica: I am, yeah. I think certainly, the best way for people to be aware is when it has a direct benefit to the. When this happens in the healthcare system, when people see that, you know, genetic testing benefited their mother, or their sister, or their cousin. Those are great ways for us to make sure that people can see where the benefits are. Obviously, a lot of work was done around GINA and other laws to make sure that people can pursue those types of tests without risk of any, you know, discrimination or other issues.
Now that we have more ability to do genetic testing, faster, cheaper, better, I think my hope is that we will be able to reach more people. If we’re willing to really have the right conversations with them and really learn, number one, why they’re not aware and how we can fix that, but number two, what we need to do to really make them feel comfortable with genetic testing, genetic counseling, and integrating these technologies into their care.
Turna: One positive finding from the survey that we did was that once people find out what personalized medicine is and it aims to do, they’re pretty excited about it and they want to know more. I don’t think that enthusiasm has ever been a problem for this field. But still, given that public awareness is still low, what do you think the field should be doing differently in terms of education and outreach?
Erica: I think we need to do a really good job of making sure that everybody in the healthcare system that people touch have a good awareness of genetic counseling and genetic testing. And we know that this is a tough area, it’s growing incredibly quickly, and it’s very hard to keep up with all of issues and things that come up with genetics.
But I think number one is the more times that people interact with genetics within their healthcare system, there’s going to be more comfort level. That means that nurses, that doctors need to know that genetic counseling is available, they need to at least have some idea when genetic testing might be beneficial to their patients. Even if they don’t take on the ordering of the testing or the counseling of those patients that they can make those connections because really from the genetic counselor perspective, we can only help the people who get to us.
The reason we have Genetic Counselor Awareness Day, and we’ll have it again this year on November 8th, is to make sure that we’re doing our diligence in reaching out, and making sure that people understand directly from us what we can offer and what we can do to help them.
I think that we have to look at it reasonably as well. We know that it has been a lot of hype around genetics in genetic testing, and we know that that can lead to some disappointment and unrealistic expectations. We need to make sure that we’re talking about genetics in a reasonable way. Absolutely, it’s exciting. Absolutely, I think we’re at a great point in medicine where we can do a better job of tailoring medicine to individuals based on their genetics. But we still have a ways to go in some areas.
Turna: Well, thank you, Erica. That’s been lovely chatting with you.
