Debating the Incidental

Arthur Caplan and Robert Green discuss the ACMG recommendations during two different On The Takeaway segments.

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Relevant to Dr. Caplan's

Relevant to Dr. Caplan's comment, patient's who do not want to receive incidental findings should be counseled to pursue other testing strategies, such as disease specific next-generation testing panels or more traditional diagnostic approaches as opposed to whole genome/exome testing. Also, it's important to note that in the ACMG's points to consider document from last year, laboratories are encouraged to have a written policy on how they will handle incidental findings. The current guidelines do not require laboratories to investigate incidental findings, but are meant to provide recommendations about what genes should be included if the laboratory includes analysis of incidental findings. Thus patients also have the option of asking the ordering physician to use a laboratory that does not report incidental findings. The recommendations, in light of these clarifications preserve patient autonomy at the point of order.
I also wish to reinforce Dr. Green's point that these recommendations are intended to reduce genetic exceptionalism, as in all other areas of medicine incidental findings are reported to clinicians who then engage with patients to determine if and how best to return these findings--an approach that these recommendations support.