[Paleopsych] Reason: Ronald Bailey: The Genetic Insurance Racket: Will genetic testing destroy the insurance market?

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Ronald Bailey: The Genetic Insurance Racket: Will genetic testing destroy 
the insurance market?
http://www.reason.com/rb/rb022305.shtml
February 23, 2005

    The U.S. Senate passed the [2]Genetic Information Non-Discrimination
    Act of 2005 on February 17, 98 to 0. This proposed law, which now goes
    to the House for consideration, would prohibit health insurers from
    requiring or using information from genetic tests when issuing health
    insurance or setting premiums.

    Although advocacy groups like the [3]Coaliton for Genetic Fairness can
    point to a small set of [4]recycled horror stories (and they are truly
    horrible), there is little evidence that genetic discrimination is a
    pervasive problem requiring swift federal action. For example, the
    Congressional Budget Office estimated that the number of people who,
    without the Genetic Information Non-Discrimination Act, would be
    denied health insurance based on genetic tests is about [5]1,000 per
    year. Nevertheless, polls show that [6]nine out of 10 Americans favor
    legislation to prohibit genetic discrimination in health insurance and
    employment.

    And progress in genetic testing is happening very rapidly. In 2003,
    the U.S. Centers for Disease Control estimated that genetic tests had
    been developed for about [7]1,000 health conditions and that 600 of
    them were available for clinical use. Most of these tests look at
    single gene variations that contribute to disease risk. For example,
    physicians can now test for gene variations that predispose people to
    [8]breast cancer, [9]Alzheimers disease, [10]deep vein thrombosis, and
    [11]colon cancer. And in less than a decade, physicians are expected
    to be able to offer patients a full scan of all their genes for less
    than $1,000.

    However, most common diseases--diabetes, heart disease,
    Alzheimers--are not the result of single genes interacting with the
    environment. For example, a genetic test might show that you and a
    neighbor have two different versions of the same gene, differing only
    by single [12]base pair of DNA. These variations in base pairs are
    called "single nucleotide polymorphisms" (SNPs, pronounced "snips").
    SNPs often travel in packs called haplotypes--sets of closely linked
    genes that tend to be inherited as a unit. Although more than [13]1
    million SNPs have been identified so far, researchers have discovered
    that most human genetic variation is the result of a small number of
    SNPs, and that these genetic variants cluster into a limited number of
    haplotype combinations. Your haplotype version might make you less
    likely to suffer heart disease than does your neighbor's version.
    Therefore, future genetic tests will look for common haplotypes that
    predispose various people to heart disease or diabetes or different
    mental illnesses.

    Researchers believe that understanding these differences will lead to
    better medical outcomes. For example, the Connecticut biotech company
    [14]Genaissance has developed tests for response to the asthma drug
    albuterol. These tests check patients for genetic variations in a
    particular receptor on cell surfaces. Genaissance found that they
    could divide patients into four different haplotypes, two of which
    simply did not respond to albuterol. One day doctors will be able to
    test for these haplotypes and avoid prescribing albuterol to those who
    will not benefit from it.

    In December 2004, the U.S. Food and Drug Administration approved the
    first diagnostic test allowing physicians to test patients for genetic
    differences in the way they metabolize various drugs for cardiac
    disease, psychiatric diseases, and cancer. The new AmpliChip
    Cytochrome P450 Genotyping Test is made by Roche Molecular Systems,
    Inc., of Pleasanton, California. That test analyzes one of the genes
    from a family called cytochrome P450 genes, which produce liver
    enzymes that break down certain drugs and other compounds. People are
    born with different forms of this gene, and some metabolize certain
    drugs more quickly or more slowly than average, or in some cases not
    at all. This difference in the rate of drug metabolism may explain why
    some people respond well to anti-depressants like Prozac, whereas
    others do not. With this test in hand, physicians will be able to
    tailor dosages for many drugs to fit each patients genetic profile.

    By 2015, pervasive genetic testing will also show that everyone is
    predisposed to some kind of disease or other--there is no perfect
    genome. "Since all of us have dozens of genetic glitches that put us
    at risk for disease, we all have a reason to be concerned about the
    possible misuse of genetic information, [15]warns Francis Collins,
    director of the National Human Genome Research Institute.

    Will increasingly extensive genetic testing produce some sort of
    insurance crisis? Will Americans protected by the Genetic Information
    Non-Discrimination Act of 2005 have themselves tested and then rush
    out to buy gold-plated insurance if it turns out that they are
    particularly prone to some nasty disease? Will this adverse selection
    then drive relatively healthy people out of the health insurance
    market as premiums skyrocket to cover those who know that they are at
    greater risk of genetic disease?

    Perhaps.

    Proponents of [16]nationalized health care have already argued that
    the advent of genetic testing means that the United States will have
    to scrap private insurance and adopt some kind of government health
    care system. But that doesn't necessarily follow. If every person has
    genetic glitches, then it seems that insurance companies should be
    able to come up with general rates that apply to the majority of
    people. In other words, insurance rates will come to be set on a
    community basis rather than on an individual basis. Ultimately, it may
    well be that pervasive genetic testing will tend to push policymakers
    to adopt proposals for [17]mandatory health insurance, but theres no
    reason such insurance must be run by the government.
    -------------------------------------

    Ronald Bailey is Reason's science correspondent. His new book,
    Liberation Biology: A Moral and Scientific Defense of the Biotech
    Revolution will be published in spring 2005.

References

    2. http://rpc.senate.gov/_files/L2GeneticNondisDBJS021605.pdf
    3. http://www.geneticfairness.org/pages/1/index.htm
    4. http://www.nationalpartnership.org/portals/p3/library/GeneticDiscrimination/FacesofGeneticDiscrimination.pdf
    5. http://www.cbo.gov/showdoc.cfm?index=6110&sequence=0
    6. http://www.nationalpartnership.org/portals/p3/library/GeneticDiscrimination/FacesofGeneticDiscrimination.pdf
    7. http://www.cdc.gov/genomics/activities/ogdp/2003/chap10.htm
    8. http://cis.nci.nih.gov/fact/3_62.htm
    9. http://www.alz-nca.org/aboutalz/genetics.asp
   10. http://www.dnadirect.com/resource/conditions/thrombophilia/GH_Thr_What_Is_Venous.jsp
   11. http://www.mdsdx.com/MDS_Diagnostic_Services/Patients/TestInfo/Special/COLARIS.asp
   12. http://www.google.com/search?hl=en&lr=&oi=defmore&q=define:Base+Pair
   13. http://www.genome.gov/13014173
   14. http://www.genaissance.com/
   15. http://www.genome.gov/13014311
   16. http://www.pnhp.org/news/2001/august/the_doubleedged_heli.php
   17. http://www.reason.com/0411/fe.rb.mandatory.shtml