Can a genome test tell me how long I will live?

No. Longevity is weakly predicted by common genetic variants; studies of lifespan heritability put the genetic contribution well under a third, and much of what the scores capture overlaps with ordinary risk factors you can already measure. Your ApoB, blood pressure, fitness, and smoking status say more about your next 30 years than a longevity score, and all of them respond to treatment.

Does Fishtown Medicine order genetic testing?

Yes. Fishtown Medicine orders targeted clinical genetic testing when history warrants it, uses pharmacogenomic results in prescribing, and reviews consumer genome reports that patients bring in. Serious findings get clinical confirmation and genetic counseling; useful findings get built into your long-term plan; noise gets named as noise so it stops costing you sleep.

Will genome test results affect my insurance?

Under the federal law GINA, health insurers and employers cannot use your genetic results against you. The protection does not extend to life insurance, disability insurance, or long-term care insurance, which may ask about known results when you apply. That gap is worth weighing before testing, and it is one more reason to test with a plan rather than out of curiosity alone.

Can a genome test tell me how long I will live?

No. Longevity is weakly predicted by common genetic variants; studies of lifespan heritability put the genetic contribution well under a third, and much of what the scores capture overlaps with ordinary risk factors you can already measure. Your ApoB, blood pressure, fitness, and smoking status say more about your next 30 years than a longevity score, and all of them respond to treatment.

Does Fishtown Medicine order genetic testing?

Yes. Fishtown Medicine orders targeted clinical genetic testing when history warrants it, uses pharmacogenomic results in prescribing, and reviews consumer genome reports that patients bring in. Serious findings get clinical confirmation and genetic counseling; useful findings get built into your long-term plan; noise gets named as noise so it stops costing you sleep.

Will genome test results affect my insurance?

Under the federal law GINA, health insurers and employers cannot use your genetic results against you. The protection does not extend to life insurance, disability insurance, or long-term care insurance, which may ask about known results when you apply. That gap is worth weighing before testing, and it is one more reason to test with a plan rather than out of curiosity alone.

Is Whole Genome Sequencing Worth It? A Doctor's Honest Read | Philadelphia

TL;DR30-second take

Whole genome sequencing is worth it for a small set of people and a small set of findings: inherited cancer syndromes, familial hypercholesterolemia, hemochromatosis, and drug-metabolism variants that change prescribing. Most of the report is probability scores that should never drive a medical decision alone. Fishtown Medicine helps patients decide whether to sequence, and folds the results into care with genetic counseling when a finding is serious.

TL;DR: A consumer whole genome test reads all of your DNA for a few hundred dollars. For most people it changes little, because common diseases come mostly from how you live rather than from one gene. For a few people it changes everything: genes like BRCA (breast and ovarian cancer), Lynch syndrome (colon cancer), familial hypercholesterolemia (very high cholesterol from birth), and hemochromatosis (iron overload) are rare but treatable when found early. Before you buy, write down your family health history. It is free, and it is still the best genetic test there is. If you sequence, have a doctor confirm any serious finding in a clinical lab before acting on it.

The kits have become impressively cheap. A cheek swab in the mail, and a few weeks later you hold a report scoring your genetic risk for hundreds of conditions, from heart disease to how you metabolize coffee. If you are the kind of person who wants to see problems coming, and most of my patients are, the appeal is obvious: this is the one dataset about you that will never change.

Genetics is the G in GER·O·SPAN, the framework I use for healthspan medicine, so I take this territory seriously. The honest answer about consumer sequencing is that the report contains 2 very different products stapled together, and knowing which is which decides whether the purchase was worth it.

What can a genome report change about your medical care?

The first product is the small set of findings medicine calls actionable, and for these the test earns its keep. They are single-gene variants where the risk is large, the science is settled, and a plan exists:

Hereditary cancer syndromes. BRCA1 and BRCA2 raise lifetime breast and ovarian cancer risk several-fold; Lynch syndrome does the same for colon and uterine cancer. A confirmed finding moves screening up by decades and opens options from MRI surveillance to preventive surgery.
Familial hypercholesterolemia (FH). About 1 in 250 people carries a variant that keeps LDL cholesterol very high from birth. Most never know, and the first symptom is too often a heart attack in someone's 40s. Found early, FH is very treatable.
Hereditary hemochromatosis. Iron overload that damages the liver, heart, and joints for decades without announcing itself, and one of the most satisfying diagnoses in medicine because the treatment is simply removing blood on a schedule.
Pharmacogenomics (PGx). Variants in drug-metabolism genes change how you respond to specific antidepressants, blood thinners like clopidogrel, and statins. When I know them, some prescriptions start at a different dose or skip a drug that was going to fail.

Findings on this list deserve 2 things: confirmation in a clinical-grade laboratory before any decision, and a session with a genetic counselor, which I arrange for patients whenever a report crosses that line.

What do the risk scores in the report mean?

The second product is the long tail of the report: polygenic risk scores. For common conditions like heart disease, type 2 diabetes, and depression, thousands of genetic variants each nudge risk a tiny amount, and the score sums the nudges into a percentile.

The fair way to read a polygenic score is as a weather forecast. A high score for heart disease means the odds tilt against you somewhat, the way "70% chance of rain" means bring a jacket. It is not a diagnosis, and a reassuring score is not a pass. Most of these scores also predict less well for people of non-European ancestry, because of who the underlying studies enrolled, a limitation the sleek dashboards rarely mention.

Here is the part I most want you to have. For the common diseases, the levers that decide your outcome are overwhelmingly the ones you can measure and move: ApoB, blood pressure, fasting insulin, fitness, sleep, smoking. A high polygenic score for heart disease changes how early and how hard we work those levers. It does not change what the levers are. Your ApoB matters more than your percentile, and unlike your genome, it responds to treatment.

One blood test bridges the 2 worlds and deserves a special mention: Lp(a), a cholesterol particle set mostly by your genes. It is a $30 blood test you check once in your life, and 1 in 5 people carry a level that meaningfully raises cardiovascular risk. If genetic risk interests you enough to consider sequencing, make sure this simpler test is not the one you skip.

What should you do before buying a genome test?

Write down your family health history first. Who had cancer and at what age, heart attacks before 60, diabetes, and anyone who died young of anything. That history is free, and it remains the most powerful genetic instrument in medicine: it captures the combined effect of your variants plus the environment your family shares, which no sequencer can. It also tells us whether targeted clinical testing, often covered by insurance when criteria are met, makes more sense than a consumer product.

Longevity Medicine

A personalized longevity strategy starts with knowing your real baselines.

Start Your Longevity Assessment

A few practical realities belong in the decision too. In the United States, the law known as GINA protects you from health-insurance and employment discrimination based on genetic results, but it does not cover life, disability, or long-term care insurance, which is worth understanding before data exists. Beyond privacy, the sharpest risk of consumer sequencing is emotional: a report that names a variant of uncertain significance can cost months of dread over something that changes nothing. The counterweight to both is simple and the same: never act on a consumer result, in either direction, without clinical confirmation and a person across the table.

At Fishtown Medicine the genome conversation runs in both directions. Some patients arrive with a report, and we confirm what is serious, retire what is noise, and wire the useful parts, PGx above all, into their ongoing care. Others ask whether to sequence at all, and sometimes the family history makes the answer a clinical test instead, or a simple "your money does more good in a DEXA scan and a year of strength coaching." Both answers are medicine.

Actionable Steps Before You Sequence

Get the high-yield genetics for the lowest cost, in order.

Build the family tree. 3 generations, ages at diagnosis, ages and causes of death where known. 30 minutes with a parent on the phone outperforms most of the report.
Check Lp(a) once. A standard blood draw, often insurance-covered, that captures one of the most consequential inherited risks directly.
Decide what you would do with a bad answer. If a BRCA or Lynch finding would not change your screening or choices, sequencing can wait. If it would, test with support around you.
Route serious findings through confirmation. Clinical-grade re-test plus genetic counseling before any medical decision. Tell Dr. Ash what's going on and bring the report; the plan starts from there.

Key Takeaways

Whole genome sequencing delivers 2 different products: a short list of actionable single-gene findings, and a long tail of probability scores that should not drive decisions alone.
BRCA, Lynch syndrome, familial hypercholesterolemia, hemochromatosis, and pharmacogenomic variants are the findings that reliably change care, and they affect a few percent of people.
Family history remains the highest-yield genetic test, and it costs nothing. Lp(a), checked once, captures a major inherited cardiovascular risk directly.
Serious consumer findings need clinical-lab confirmation and genetic counseling before any medical decision.
Fishtown Medicine folds genetics into whole-person care: deciding whether to test, confirming what matters, and putting PGx to work in your prescriptions.

GER·O·SPAN - where genetics fits in the healthspan framework.
Lp(a): The Inherited Risk Factor - the once-in-a-lifetime blood test.
Longevity Medicine in Philadelphia - the practice built around prevention.
The MTHFR Clinical Guide - a case study in separating genetic signal from noise.
At-Home Lab Testing Memberships - the same decision framework for biomarker panels.

Scientific References

Khera AV, Chaffin M, Aragam KG, et al. Genome-wide polygenic scores for common diseases identify individuals with risk equivalent to monogenic mutations. Nature Genetics. 2018;50(9):1219-1224.
Nordestgaard BG, Chapman MJ, Humphries SE, et al. Familial hypercholesterolaemia is underdiagnosed and undertreated in the general population. European Heart Journal. 2013;34(45):3478-3490.
Miller DT, Lee K, Abul-Husn NS, et al. ACMG SF v3.2 list for reporting of secondary findings in clinical exome and genome sequencing. Genetics in Medicine. 2023;25(8):100866.
Tsimikas S. A Test in Context: Lipoprotein(a). Journal of the American College of Cardiology. 2017;69(6):692-711.
Martin AR, Kanai M, Kamatani Y, et al. Clinical use of current polygenic risk scores may exacerbate health disparities. Nature Genetics. 2019;51(4):584-591.

Fishtown Medicine | Longevity

2418 E York St, Philadelphia, PA 19125(267) 360-7927 hello@fishtownmedicine.comHSA/FSA Eligible

Start your intake

Frequently Asked Questions

Common Questions

For most healthy people, whole genome sequencing is optional rather than essential: the actionable-finding rate is a few percent, and the polygenic scores that fill the rest of the report should not drive medical decisions on their own. It becomes clearly worth it when family history suggests an inherited syndrome, when prescribing decisions would benefit from pharmacogenomics, or when you have decided in advance what you would do with a serious finding.

A consumer genome test is ordered by you, reads broadly, and reports both confirmed variants and probability scores; a clinical genetic test is ordered by a physician for a specific question, run in a certified laboratory, and comes with formal interpretation and counseling. Medicine treats consumer findings as leads, not diagnoses: anything serious gets confirmed clinically before it changes care. Insurance often covers clinical testing when criteria are met, which can make it the cheaper route for the findings that matter.

A variant of uncertain significance (VUS) is a genetic change whose effect on health is not yet known: too rare or too little studied to call benign or harmful. Most VUS results are eventually reclassified as benign. The correct response to a VUS is usually surveillance appropriate to your family history, and never surgery or major treatment. A genetic counselor is the right person to walk through one, and Fishtown Medicine arranges that when a report raises the question.

Deep-Dive Questions

Because a family history integrates everything at once: rare high-impact variants that polygenic scores ignore, the combined weight of common variants, and the shared environment and habits that genes express themselves inside. A father and an uncle with heart attacks at 50 is a louder, better-validated signal than a 90th-percentile score, and medicine already knows what to do with it: earlier screening, earlier treatment, and specific tests like Lp(a). The score adds refinement at the margins; the history sets the strategy.

Timing and intensity change; the playbook stays the same. The levers remain ApoB, blood pressure, insulin sensitivity, fitness, and not smoking; a high score argues for measuring them earlier, treating them at lower thresholds, and considering a coronary calcium scan sooner to see whether the risk is being realized in your arteries. Handled that way, a high score is useful pressure rather than a sentence. The mistake in both directions is letting the percentile substitute for the measurements.

A few well-validated gene-drug pairs earn their place in the chart. CYP2C19 status changes whether clopidogrel will work after a stent; CYP2D6 and CYP2C19 variants shift dosing or drug choice for several common antidepressants; SLCO1B1 flags people prone to statin muscle aches, which usually means choosing a different statin rather than abandoning the class. None of it replaces starting carefully and following response. What it removes is a specific kind of trial-and-error that used to cost patients months.

For most adults the measurable present beats the probabilistic future: an advanced lipid panel with ApoB, Lp(a) once, fasting insulin, blood pressure done right, a DEXA scan, and for the right person a coronary calcium score will change more decisions this year than a genome report. Sequence when family history points somewhere specific, when PGx would guide active prescribing, or when the actionable-finding question keeps you up at night. The genome can wait; it will read the same next year.

Ready when you are