A pair of university professors in the United Kingdom urge that results from genetic tests ought to be disclosed to insurance companies, and that non-genetic data — smoking, family medical history — creates disparity between individuals trying to obtain life or long-term disability insurance in Britain.
In the UK, physicians “routinely report” to life-insurance and disability-insurance providers results from patient histories, medical and clinical examinations, and results from traditional assays. But genetic tests “usually cause doctors and [insurance] applicants apprehension,” Nick Raithatha and Richard Smith, of the University of East Anglia, wrote in last week’s Lancet.
The reason behind this apprehension, the authors claim, is a broad — and unfounded — belief that results from genetic tests might influence premiums. In fact, the authors contend, that risk is backward: Individuals in whom physicians uncover a family history of a potentially expensive disease are shouldered with higher insurance premiums, while patients whose confidential genetic tests demonstrate similar risk are by default shielded from similarly costly premiums.
“What we are saying is that insurance companies should use genetic tests just like they use any other tests,” Raithatha told SNPtech Pharmacogenomics Reporter last week.
“Our viewpoint is, in terms of fairness to our patients, our patients should be treated equally and fairly,” said Raithatha. “Are these non-genetic tests really any different than genetic tests? What we are arguing is that genetic tests are fundamentally and ethically no different from biochemical tests, which are de facto markers for genetic tests.”
Asked if he thinks his idea of making genetic data available to insurance companies might deepen the distrust some individuals already have toward insurance companies, Raithatha said the opposite is true. “The process has been, ‘Let’s shove it under the carpet; let’s not talk about it and have a moratorium about disclosing the data,’” he said. “I think that creates more dread and fear.”
“Fear breeds irrational decision, and we should not see genetic tests as a taboo, but as something that needs to be used as other tests,” said Raithatha.
Moreover, the argument that “an individual’s genetic makeup is not under his or her control,” so that “he or she should not be discriminated against as a result of a genetic test,” is also flawed, the authors contend. The authors wrote: “First, genetic information is presently used to discriminate in setting of premiums. For example, sex — for which females on the whole pay more for disability insurance — and disclosure of family medical history of disease as a proxy for genetic susceptibility.
“Indeed,” they wrote, “the ethics of family history as a surrogate genetic test, for which premiums are based on the health of people other than the [patient], may themselves be questioned.”
They added: “If disclosure of a genetic test result is prohibited, then any information that might be related to genetics (eg, family history) should logically be subject to the same rule.”
Neither Raithatha nor Smith have ever been employed by an insurance company. In fact, said Raithatha, the authors declined even to discuss this issue with the insurance industry “because we don’t want to be seen as advocates” for them.