How did the origin of Mimamsia come about?
Over years, we have had an exponential increase in the knowledge of clinical genetics, particularly with the advancement of high throughput NGS technologies like Whole Exome Sequencing (WES) and Whole Genome Sequencing (WGS). This is somewhat visible in the increased diagnostic rates when one performs a fresh WES/WGS. However, these technologies have been around for quite some time, we have not seen a similar increase in the positive diagnosis rate on cases that were negative at some point of time. Patients are often left with performing yet another WES/WGS, perhaps from a different genetic diagnostic company. Not only do I see this as a loss of money, but also valuable time for the patient who are left undiagnosed between so called claims of "quality" differences between different providers. In this age, particularly when one performs WGS, the quality from one lab to the other is nearly the same, however the rate at which the "cold cases" are being solved is not reflective of the growth in clinical knowledge. This left me pondering, if the tightening market and price competition in the current genetic testing arena has diluted our commitment for the patients. This was where the vision of Mimamsia was conceived.
Is there a story behind the unconventional name?
Yes, Mimamsia is derived from an old Sanskrit word "Mimamsa" that implies reflection and critical thinking. This critical thinking approach is based on 6 tenets:
Pratyakṣa or perception;
Anumāṇa or inference;
Upamāṇa implying comparison and analogy;
Arthāpatti meaning postulation, derivation from circumstances;
Anupalabdi referring to non-perception, negative/cognitive proof; and
Śabda or relying on word, testimony of past or present reliable experts.
This still holds true in the modern day concept and our own approach. Hence, the name.
How is Mimamsia different than the other companies offering clinical diagnostics?
We have two strong unique aspects, amongst many others:
1. We focus primarily on unsolved or so-called "cold" cases, where a diagnosis was not found even after doing WES/WGS. This is the most challenging part, and this is also the part that is extremely gratifying. Large providers, who can scale up the process beautifully and bring about the economy of scales, can do the sequencing and the first analysis more effectively. What remains unsolved is where we come into picture. This increases our understanding of the technology and the genetics laterally. This also allows us to focus on challenging tasks, and not dilute our resources by doing somewhat "easier" aspects. This is more challenging to our brains, and smart organizations thrive on this kind of challenge.
2. We believe in outcome-based billing. Which is perhaps a bold and a very innovative approach in this field. We are committed to our patients, and it is our obligation to bring them a solution. If we are sincere in our commitment and believe in our vision and strengths, then the financial risk should be on our side and not on the side of the patient. Obviously, we are in a far more fortunate situation than the patients who are suffering for years and who else should morally shoulder the burden?
Is Mimamsia in some ways challenging the authority and expertise of large clinical diagnostic labs?
Not at all. We actually see this as a great opportunity for synergy. We are focusing on complex and challenging cases, and once we have the know-how, the referring physician will consult with the lab where initial analysis was performed. In cases, where the variant had slipped through the cracks in the pipeline, this will allow the labs to improve their quality such that future cases are avoided. For us, our model is to learn new things, rather than doing repetitive things. So, next cases, we encounter will be a step up, that will be more thrilling and will push our boundaries even further.
More importantly, it is helping not only the patient at hand, but also many other patients in future, as the overall standards of genetic testing will go higher. We don't claim that we will change the approach of whole industry in a flash, but every small step from us and from like-minded teams will be a contributing factor towards a brighter future for our patients.
Is Mimamsia also issuing a clinical report of the findings?
The findings will be reviewed by a clinical geneticist, however, only research reports will be issued in the initial phases. This may change in the near future but this has two advantages for us at the moment.
1. It reduces the clinical and regulatory burden for a young company like ours and allows us time to focus on our core strengths in the beginning.
2. We expect the referring physician to consult the clinical lab where the negative findings were reported to validate our claims. The parent clinical lab has the obligation to issue a so called "amendment" report, that will allow the patient and the referring physician to have access to a final updated clinical report.
Why do you think someone would refer their case to you, while there are so many other capable and expert labs around the globe?
Obviously, if a diagnosis has not been found, only the patient is suffering. The other involved parties are not much affected. The patients have the right to know what is going on with their genes. They can opt to wait and re-perform the analysis at the same or other clinical lab, but we see this has a huge burden on patients and also on finances. If there is someone willing to help, we don't see a reason why the medical community and the patients would see this as a barrier. There has been a positive resonance for this approach, and since there is no invoice for negative findings, this is completely risk-free for the patients and physicians alike. We can only make things better.
Do you think this business model will work, especially, when you only are looking at filtered out negative cases that other clinical labs have already analyzed?
First of all, we don't aim to be the world's biggest in terms of size or largest in terms of commercials, we do want to be the best in what we are doing. The values of Mimamsia lies in reaching the extra inch that is the hardest step and perhaps not the most attractive to pursue. On the other hand, we are not a completely philanthropic organization. Most of the efforts for genetic re-analysis of Mimamsia will be supported by other initiatives as advisory and consulting roles for medium sized to large industries.
As individuals and as a team, we feel very privileged and grateful to be living in a comfortable world, where the basic necessities are fulfilled. Its our duty to give it back to society that needs us more than ever. The aim is to take small steps each day, and to make little changes in the world around us. The rest will follow.