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risk might seek earlier and more advanced predictive testing. This includes hereditary unsustainable complexity and intelligence to
surveillance than she would otherwise have breast cancer – for instance, a faulty BRCA gene accurately pick out risk and associated cost, and
done. can mean a higher risk of breast and ovarian I think that there could only be a reversion to
cancer. But medical insurers are not interested the more simple risk pooling methods that we
The Human Genome Project in this for the same reason that we’re not rely on currently.
We have come so far in our knowledge of interested in your family history. Having a gene,
genetics that scientists today have access to the or a positive family history, for a condition The Ethical Issue
complete DNA sequence for the entire human doesn’t confer certainty of that condition The most important aspect of the issue is the
genome (the whole set of DNA that every one developing. Despite a 50% to 80% greater ethical one. Insurance is essentially about the
of us possesses), thanks to the Human Genome chance of developing the disease with a mutated human desire to confer protection to ourselves
Project. The project, completed in 2003, BRCA gene, the controlling factors are mostly and those around us. By pooling resources, a
brought about a revolution in the science of environmental, such as your age at first full community can pull together to look after its
genetics, with the result that more than 1,800 term pregnancy, whether you breastfeed and members in times of need, and the insurer is
possible disease genes have now been identified, whether you’re a smoker. tasked with responsibly, and ethically, collecting
and more than 1000 genetic tests are available Furthermore, genetic profiles assign a and dispensing those resources.
for human conditions. prediction against a number of variables, one of And so by looking at genetic risk profiles, the
Despite all this success, it’s still a challenge to which is time. There is no genetic test that can insurer is going against the very ethic of the
determine how the many complex parts of the identify when the disease will strike. What we community, by selecting only the fortunate and
genome work together in human health and do know is that your risk of disease generally prejudicing against the unfortunate. If we, as
disease. While early genetic tests looked at increases as you get older, and accordingly insurers, take this stance then surely the essence
specific mutations in single genes, research has premiums rise. But genetic tests are age and therefore the business model of insurance is
now turned to the association between several agnostic, and so even if you do have a faulty deeply flawed, if not entirely broken?
groups of weak genes and how these interact gene, your age to risk profile only changes as Increasingly, more insurers are partaking in
together and with lifestyle factors. much as the next person’s. agreements and codes of conduct which bind us
to the correct ethical position for the long-term
Do genes really predict your Developments for the future future.
risk? Of course, most medical problems in adults But what insurers will, quite rightly, look at
Medical insurance premiums are calculated by aren’t determined by a single gene, but rather by with increased focus, are the parameters which
predicting your risk of claiming. That’s why groups of genes interacting together and with we can control and which exercise the greatest
your premium may vary depending on what lifestyle factors. Various projects are ongoing influence on our health – our lifestyles.
your health is like. With more genes now being around the world to identify the combinations Those of us who choose to pursue healthy
identified as potentially having a role in the responsible for common diseases. As medical lifestyles, or indeed moderate their activity
development of some common diseases, surely research uncovers increasingly accurate ways to based on the genetic profile they inherit, are
medical insurance companies must be predict disease, will medical insurers change taking greater responsibility for their health,
chomping at the bit to get their hands on your their position on genetic tests? and so should get financial reward in the form
genetic profile? From a personal perspective, I don’t predict of discount. Those who choose to ignore
It may come as a surprise to find that the great changes in the foreseeable future. It’s likely healthy lifestyles carry the risk for the
answer is actually no. The reasoning behind this to be at least 15 to 20 years before medical community, and should therefore carry a
is mostly that the genetic predictors are just not science is able to fully interpret these links and greater proportion of the financial burden.
accurate enough for us to be able to understand come anywhere near to being able to predict
the risk associated with them. The other reason what conditions an individual is likely to The Final Word
is that it is just not ethical. develop. The clarity, I feel, will be further So where will the genetics debate go to next?
compounded by the realisation that our genetic Well, with the almost daily emergence of new
The Single Gene Tests determinants are influenced to a much larger technologies and techniques, who knows? It’s
It is becoming clearer that many of the extent by environmental factors, including the certainly not easy to predict.
conditions diagnosed by the simpler ‘single- lifestyles that we choose to pursue. But given the arguments above, it seems very
gene’ tests become manifest at birth or in early Furthermore, it’s becoming apparent that much to me that when it comes to genetics and
childhood. And so the significance of the genes that may confer risk for one condition insurance, it is not the companies who are in
genetic tests to insurers becomes less, because may actually be protective for another. It can control, but the individuals whose health lies in
the disease has already appeared by the time even be said that those who know about their their own hands.
taking insurance becomes an issue. genetic profile (for instance, know that they are
There are only a few conditions that develop susceptible to cancer or heart problems), may
in adulthood for which single genes have been be more likely to make lifestyle changes to Dr Sneh Khemka, MBChB MRCOphth
identified, and for which young adults with a prevent them – thereby reducing their risk. The Medical Director
family history of the condition might want insurance industry would have to develop an Bupa International
September 2009 Investment International www.investmentinternational.com7
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