Kate Wilson has spent over twenty years watching the genetics field move faster than the people it was built to serve — patients in rural communities who didn't know their tumor could be tested, payers drowning in $60,000 EOBs with no answers, and clinicians too overwhelmed to keep up with next-gen sequencing as it was happening in real time. In this episode, Kate — certified genetic counselor, former product director at Quest Diagnostics, clinical instructor at Emory, and host of the award-winning All Access DNA podcast — joins Dr. Jeremy Koenig to pull back the curtain on what genomic medicine access actually looks like on the ground, why the research-to-clinic handoff still takes up to 17 years, and why the future of genetic counseling lives in primary care, not specialty clinics. From the Angelina Jolie BRCA moment that shifted public awareness overnight, to the quiet dismantling of the CDC's public genomics program, Kate traces the thread most people in the field haven't noticed — and makes the case that data alone has never changed a life. Story does.
🧬 Key Takeaways
🧵 The thread nobody's pulling — Kate spent 20+ years connecting clinical genetics, industry, payers, and the general public — a role that barely had a name when she started
💸 The $60K EOB moment — a single panel test, a patient in shock, and a lab with no answers — the story that pushed Kate out of clinic and into industry to fix the system upstream
🧪 Sanger → NGS → panels → AI — how the pace of genomic innovation outran clinician education, payer policy, and patient awareness all at once
📣 Why data doesn't move people — stories do — Kate's philosophy on science communication and why All Access DNA was built around human narratives, not lecture slides
🏥 The primary care gap — why genetic counselors belong in your family doctor's office, not just specialty clinics, and what a few pioneering practices are already proving
🌍 Access isn't just about cost — rural communities, under-informed clinicians, and outdated insurance guidelines are the real barriers to genomic medicine reaching everyone
⚖️ ELSI in practice — the ethical, legal, and social implications of DNA testing including life insurance blind spots and why Huntington's disease is still the clearest test case for voluntary genetic testing
🤝 The three-legged stool — why academics, industry, and government genomics programs have to work together — and what's at stake now that the CDC's public genomics group has been cut
🔬 Genetic counselors in industry — the surprising skill that makes GCs invaluable in boardrooms: translating between bioinformatics, C-suite, and payer policy in the same room
✨ Room for miracles — why Kate, after 20+ years of reading genetic data, still believes a result is never the whole story
LINKS:
https://www.drjeremykoenig.com/
https://www.instagram.com/drjeremykoenig/
https://www.youtube.com/@drjeremykoenig
Here's the link for this week's episode: https://drjeremykoenig.substack.com/.