If I had my way, every primary care patient in my office would have a genomic test. But, I can’t: the 23andMe contract explicitly forbids its medical use.

Again: I run a medical office. I can’t even legally use my own 23andMe report in my own medical office for my own health —let alone endorse its use for patients.

Imagine this scenario: a patient comes into the medical office with a 23andMe report. The doctor uses the report to, for example, prescribe an alternative to Plavix because the patient is at risk for thrombosis but —like 17% of people and as warned by the FDA— the patient does not metabolize Plavix to its active form according to 23andMe.

BOOM! That patient coerced that doctor into malpractice liability. Section 3 of 23andMe Terms of Service: “The Services Content is not to be used, and is not intended to be used, by you or any other person to diagnose, cure, treat, mitigate, or prevent a disease or other impairment or condition, or to ascertain your health.”

The worst of this is that 23andMe ACTIVELY INSTRUCTS its users to violate this clause —not only personally, but to also implicate their medical doctors in crime.

And the doctor is trapped: he can respect the law and alienate the patient, or ignore the law and appease the patient.

That’s your “health empowerment revolution”: more kafkaesque legal games, more parasitic licensing contests, more marketing, more wasteful testing, and more money to a few celebrities while the people who actually learn the science and do the work get the blame and the bill.

You know, I’m all for the hacker ethic. But if you hack the system, it has to be for the greater good —the greater system. Otherwise, that hack is just called “evil” —and that’s what this entire 23andMe adventure looks like to me: garden-variety, ordinary, boring, stupid evil.

23andMe: We trusted you with beautiful work, and you mashed it into useless noise. That’s the real crime here.

In fact, that’s why I’m in this horrible business of medical practice management at all. Years ago, I trusted you to do the right thing. I thought that genomics would be obvious common practice for sure, and I wanted to be there when it was. But no. You had to play popular and fuck it up for everybody.