1
|
Shapiro AJ, Kroener L, Quinn MM. Expanded carrier screening for recessively inherited disorders: economic burden and factors in decision-making when one individual in a couple is identified as a carrier. J Assist Reprod Genet 2021; 38:957-963. [PMID: 33501564 DOI: 10.1007/s10815-021-02084-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/20/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE When undergoing expanded carrier screening (ECS), couples are often screened sequentially to reduce need for a second individual's test. It is unknown how often partners of individuals found to be carriers complete the recommended testing with a sequential approach and what factors contribute to decision-making regarding partner testing. Additionally, the economic burden placed on individuals by ECS testing and its effect on partner testing has not been evaluated. METHODS In part 1, all individuals at a university-affiliated reproductive endocrinology and infertility practice identified to be carriers of a recessively inherited mutation using the Counsyl/Foresight ECS were included. Conditions were categorized by severity according to a previously described classification system. In part 2, all individuals who underwent ECS with a single test provider between September 1, 2013 and February 1, 2020 were contacted via email to complete a confidential and anonymized online survey. RESULTS In part 1, a total of 2061 patients were screened. 36.9% were carriers of one or more recessively inherited disorders. Twenty-seven percent of positively screened individuals did not have their partner screened. Carriers of a moderate condition had a trend towards a reduced odds for having their partner screened compared to a profound condition (OR 0.36, 95% CI 0.12-1.05, p = 0.06). Number of conditions was not predictive of subsequent partner screening (OR 0.95, 95% CI 0.72-1.25, p = 0.72). In part 2, the cost of ECS was not covered by insurance for 54.5% (103/189) and most paid over $300 out-of-pocket for testing (47.6%). The most common reason for not completing partner testing was that the results would not alter their course when seeking conception (33.3%). 73.5% of patients knew that the largest benefit of ECS comes from knowing a partner's results as well as their own. CONCLUSIONS Not all carriers of recessively inherited disorders choose to undergo partner screening. Patients found to be carrier of more debilitating genetic disorders may be more likely to screen their reproductive partners. For many, ECS testing is not covered by insurance, and this test may impose a significant economic burden. For some patients, the results of ECS would not change what they would do when seeking conception. Providers should evaluate whether a patient's ECS result would change their treatment course prior to testing.
Collapse
Affiliation(s)
- Alice J Shapiro
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Lindsay Kroener
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Molly M Quinn
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
2
|
Fahr P, Buchanan J, Wordsworth S. A Review of Health Economic Studies Comparing Traditional and Massively Parallel Sequencing Diagnostic Pathways for Suspected Genetic Disorders. Pharmacoeconomics 2020; 38:143-158. [PMID: 31741314 DOI: 10.1007/s40273-019-00856-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Genetic disorders are clinically diverse and genetically heterogeneous, and are traditionally diagnosed based on an iterative phenotype-guided genetic assessment. However, such diagnostic approaches are long (diagnostic odysseys are common), misdiagnoses occur frequently, and diagnostic rates are low. Massively parallel sequencing (MPS) technologies may improve diagnostic rates and reduce the time to diagnosis for patients with suspected genetic disorders; however, MPS technologies are expensive and the health economic evidence base to support their use is limited. Several studies have compared the costs of traditional and MPS diagnostic pathways for patients with suspected genetic disorders, however costing methods and diagnostic scenarios are heterogeneous across studies. We conducted a literature review to identify and summarise information on these costing methods and diagnostic scenarios. Relevant studies were identified in MEDLINE, EMBASE, EconLit, University of York Centre for Reviews and Dissemination and the Cochrane Library, from 2010 to 2018. Twenty-four articles were included in the review. We observed considerable heterogeneity across studies with respect to the selection of items of resource use used to derive total diagnostic pathway cost estimates. We also observed structural differences in the diagnostic scenarios used to compare the traditional and MPS diagnostic pathways. There is a need for guidelines on the costing of diagnostic pathways to encourage the use of consistent methods. More micro-costing studies that evaluate diagnostic service delivery are also required. Greater homogeneity in costing approaches would facilitate more reliable comparisons between studies and improve the transferability of cost estimates across countries.
Collapse
Affiliation(s)
- Patrick Fahr
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK.
| | - James Buchanan
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
- National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Sarah Wordsworth
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK
- National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| |
Collapse
|
3
|
Abstract
The identification of cell-free fetal DNA (cffDNA) in maternal plasma in 1997 heralded the most significant change in obstetric care for decades, with the advent of safer screening and diagnosis based on analysis of maternal blood. Here, we describe how the technological advances offered by next-generation sequencing have allowed for the development of a highly sensitive screening test for aneuploidies as well as definitive prenatal molecular diagnosis for some monogenic disorders.
Collapse
Affiliation(s)
- Lyn S Chitty
- UCL Institute of Child Health, Genetics and Genomic Medicine, London WC1N 1EH, United Kingdom; University College London Hospitals NHS Foundation Trust, London NW1 2PG, United Kingdom; NE Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, 37 Queen Square, London WC1N 3BH, United Kingdom
| | - Y M Dennis Lo
- Centre for Research into Circulating Fetal Nucleic Acids, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China; Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR, China
| |
Collapse
|
4
|
D'Andrea E, Marzuillo C, Pelone F, De Vito C, Villari P. Genetic testing and economic evaluations: a systematic review of the literature. Epidemiol Prev 2015; 39:45-50. [PMID: 26499415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To identify those studies in which economic analysis of predictive genetic and pharmacogenetic testing programs have been carried out. Since the Italian National Prevention Plan 2014-2018 foresees the implementation of genetic testing for inherited breast cancer, special attention was given to the cost-effectiveness of BRCA1/2 testing programs. METHODS A systematic review of primary economic evaluations (EEs) of predictive genetic and pharmacogenetic testing programs and an overview of previously published systematic reviews of economic evaluations (ERs) was performed. RESULTS Overall 128 EEs and 11 ERs were identified. The methodological quality of both EEs and ERs was good on average. Both predictive genetic and pharmacogenetic testing programs were mainly concerned with oncological diseases. Seventeen percent of genetic testing programs are cost-saving, while a further 44% of cost/QALY ratios fall under the commonly used threshold of €37,000 per QALY. For BRCA1/2 testing, only cascade genetic screening programs, targeted to close relatives of carriers, show clear evidence of cost-effectiveness. CONCLUSION Despite some limitations, EEs and ERs are powerful tools that provide indications to policy-makers on which genetic testing programs might be introduced into health care systems and public health practice.
Collapse
Affiliation(s)
- Elvira D'Andrea
- Dip. Sanità pubblica e malattie infettive, Sapienza Università di Roma, Italy
| | - Carolina Marzuillo
- Dip. Sanità pubblica e malattie infettive, Sapienza Università di Roma, Italy
| | - Ferruccio Pelone
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Corrado De Vito
- Dip. Sanità pubblica e malattie infettive, Sapienza Università di Roma, Italy
| | - Paolo Villari
- Dip. Sanità pubblica e malattie infettive, Sapienza Università di Roma, Italy.
| |
Collapse
|
5
|
Filipova-Neumann L, Hoy M. Managing genetic tests, surveillance, and preventive medicine under a public health insurance system. J Health Econ 2014; 34:31-41. [PMID: 24463140 DOI: 10.1016/j.jhealeco.2013.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 11/12/2013] [Accepted: 12/03/2013] [Indexed: 06/03/2023]
Abstract
There is a prospect in the medium to long term future of substantial advancements in the understanding of the relationship between disease and genetics. We consider the implications of increased information from genetic tests about predisposition to diseases from the perspective of managing health care provision under a public health insurance scheme. In particular, we consider how such information may potentially improve the targeting of medical surveillance (or prevention) activities to improve the chances of early detection of disease onset. We show that the moral hazard implications inherent in surveillance and prevention decisions that are chosen to be privately rather than socially optimal may be exacerbated by increased information about person-specific predisposition to disease.
Collapse
Affiliation(s)
- Lilia Filipova-Neumann
- Faculty of Business Administration and Economics, University of Augsburg, Universitätsstr. 2, 86159 Augsburg, Deutschland
| | - Michael Hoy
- Department of Economics and Finance, University of Guelph, Guelph, Ontario N1G 2W1, Canada.
| |
Collapse
|
6
|
Abstract
Are there some newborn infants whose short- and long-term care costs are so great that treatment should not be provided and they should be allowed to die? Public discourse and academic debate about the ethics of newborn intensive care has often shied away from this question. There has been enough ink spilt over whether or when for the infant's sake it might be better not to provide life-saving treatment. The further question of not saving infants because of inadequate resources has seemed too difficult, too controversial, or perhaps too outrageous to even consider. However, Roman Catholic ethicist Charles Camosy has recently challenged this, arguing that costs should be a primary consideration in decision-making in neonatal intensive care. In the first part of this paper I will outline and critique Camosy's central argument, which he calls the 'social quality of life (sQOL)' model. Although there are some conceptual problems with the way the argument is presented, even those who do not share Camosy's Catholic background have good reason to accept his key point that resources should be considered in intensive care treatment decisions for all patients. In the second part of the paper, I explore the ways in which we might identify which infants are too expensive to treat. I argue that both traditional personal 'quality of life' and Camosy's 'sQOL' should factor into these decisions, and I outline two practical proposals.
Collapse
Affiliation(s)
- Dominic Wilkinson
- Robinson Institute, Discipline of Obstetrics and Gynecology, University of Adelaide, North Adelaide, South Australia, Australia.
| |
Collapse
|
7
|
Amagwula T, Chang PL, Hossain A, Tyner J, Rivers AL, Phelps JY. Preimplantation genetic diagnosis: a systematic review of litigation in the face of new technology. Fertil Steril 2012; 98:1277-82. [PMID: 22901852 DOI: 10.1016/j.fertnstert.2012.07.1100] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 06/29/2012] [Accepted: 07/10/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To study legal cases against IVF facilities pertaining to preimplantation genetic diagnosis (PGD) misdiagnosis. DESIGN Systematic case law review. SETTING University medical center using US legal databases. PATIENT(S) The IVF recipients using PGD services. INTERVENTION(S) Lawsuits pertaining to PGD against IVF facilities. MAIN OUTCOME MEASURE(S) Lawsuits, court rulings, damage awards, and settlements pertaining to PGD after the birth of a child with a genetic defect. RESULT(S) Causes of action pertaining to PGD arise from negligence in performing the procedure as well as failure to properly inform patients of key information, such as inherent errors associated with the PGD process, a facility's minimal experience in performing PGD, and the option of obtaining PGD. Courts have sympathized with the financial burden involved in caring for children with disabilities. Monetary damage awards are based on the costs of caring for children with debilitating defects, including lifetime medical and custodial care. CONCLUSION(S) Facilities offering PGD services expose themselves to a new realm of liability in which damage awards can easily exceed the limits of a facility's insurance policy. Competent laboratory personnel and proper informed consent--with particular care to inform patients of the inherent inaccuracies of PGD--are crucial in helping deter liability.
Collapse
Affiliation(s)
- Tochi Amagwula
- School of Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas 77555-0587, USA
| | | | | | | | | | | |
Collapse
|
8
|
Antoñanzas F, Rodríguez-Ibeas R, Hutter MF, Lorente R, Juárez C, Pinillos M. Genetic testing in the European Union: does economic evaluation matter? Eur J Health Econ 2012; 13:651-661. [PMID: 21598012 DOI: 10.1007/s10198-011-0319-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 04/27/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE We review the published economic evaluation studies applied to genetic technologies in the EU to know the main diseases addressed by these studies, the ways the studies were conducted and to assess the efficiency of these new technologies. The final aim of this review was to understand the possibilities of the economic evaluations performed up to date as a tool to contribute to decision making in this area. METHODS We have reviewed a set of articles found in several databases until March 2010. Literature searches were made in the following databases: PubMed; Euronheed; Centre for Reviews and Dissemination of the University of York-Health Technology Assessment, Database of Abstracts of Reviews of Effects, NHS Economic Evaluation Database; and Scopus. The algorithm was "(screening or diagnosis) and genetic and (cost or economic) and (country EU27)". We included studies if they met the following criteria: (1) a genetic technology was analysed; (2) human DNA must be tested for; (3) the analysis was a real economic evaluation or a cost study, and (4) the articles had to be related to any EU Member State. RESULTS We initially found 3,559 papers on genetic testing but only 92 articles of economic analysis referred to a wide range of genetic diseases matched the inclusion criteria. The most studied diseases were as follows: cystic fibrosis (12), breast and ovarian cancer (8), hereditary hemochromatosis (6), Down's syndrome (7), colorectal cancer (5), familial hypercholesterolaemia (5), prostate cancer (4), and thrombophilia (4). Genetic tests were mostly used for screening purposes, and cost-effectiveness analysis is the most common type of economic study. The analysed gene technologies are deemed to be efficient for some specific population groups and screening algorithms according to the values of their cost-effectiveness ratios that were below the commonly accepted threshold of 30,000€. CONCLUSIONS Economic evaluation of genetic technologies matters but the number of published studies is still rather low as to be widely used for most of the decisions in different jurisdictions across the EU. Further, the decision bodies across EU27 are fragmented and the responsibilities are located at different levels of the decision process for what it is difficult to find out whether a given decision on genetic tests was somehow supported by the economic evaluation results.
Collapse
Affiliation(s)
- Fernando Antoñanzas
- Department of Economics, University of La Rioja, La Cigüeña 60, 26004, Logroño, Spain.
| | | | | | | | | | | |
Collapse
|
9
|
Izquierdo LA, Berkshire S. Access, quality and costs of prenatal diagnosis. Bol Asoc Med P R 2010; 102:25-29. [PMID: 21766544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The background risk of birth defects ranges from 2 to 5%. These birth defects are responsible for 30% of all admissions to pediatric hospitals and are responsible for a large proportion of neonatal and infant deaths. Medicine and Genetics have taken giant steps in their ability to detect and treat genetic disorders in utero. Screening tests for prenatal diagnosis should be offered to all pregnant women to assess their risk of having a baby with a birth defect or genetic disorder. Psychosocial and financial factors, inadequate insurance coverage, and the inability to pay for health care services are some of the known barriers to healthcare. These barriers are particularly magnified when there is a language barrier. From an economical standpoint it has been demonstrated that prenatal diagnosis has the potential of saving millions of dollars to our healthcare system. But when patients do not have the resources to access prenatal care and prenatal diagnosis cost shifting occurs, escalating healthcare costs. Our current healthcare system promotes inequalities in its delivery. With the existing barriers to access, quality, and costs of prenatal diagnosis we are confronted with an inefficient and flawed system.
Collapse
Affiliation(s)
- Luis A Izquierdo
- Regis University College of Professional Studies, Healthcare Services Administration, Westminster, CO, USA.
| | | |
Collapse
|
10
|
Gu XF, Han LS, Ye J. [Both social and economic benefits should be considered simultaneously in prevention and treatment of hereditary metabolic diseases]. Zhonghua Er Ke Za Zhi 2005; 43:793-4. [PMID: 16255865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
|
11
|
Raeburn S. Genetics and Global Health Care. Public Health Genomics 2005; 8:12-6. [PMID: 15767748 DOI: 10.1159/000083331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<i>Objectives:</i> To examine an alternative model for funding genetic health care, on a global basis. <i>Methods:</i> Internet-based national data on gross domestic product (GDP) per capita, health care funding, and public and private elements of health care costs. <i>Results:</i> Wide variation in GDP per capita and in the proportion available for health care funding. Insufficient funds are available in developing countries. <i>Conclusions:</i> Health care provision for people with genetic disorders is unlikely to be fully funded unless a different approach to management costs is undertaken. Rare genetic disorders could be funded by an insurance model which may be more equitable and which could be developed to cover the total global health care costs of the genetic disorder.
Collapse
Affiliation(s)
- S Raeburn
- Genetic Unit, College of Medicine and Health Sciences, Sultan Qaboos University, POB 35, Muscat 123, Sultanate of Oman.
| |
Collapse
|
12
|
McCandless SE, Brunger JW, Cassidy SB. The burden of genetic disease on inpatient care in a children's hospital. Am J Hum Genet 2004; 74:121-7. [PMID: 14681831 PMCID: PMC1181899 DOI: 10.1086/381053] [Citation(s) in RCA: 166] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2003] [Accepted: 10/27/2003] [Indexed: 11/04/2022] Open
Abstract
The important role of genetics in pediatric illness has been increasingly recognized, but the true impact has not been well delineated. An important study of pediatric inpatient admissions to a children's hospital in 1978 found a genetic basis for disease in just less than half of admitted patients. We sought to update this study in light of current hospitalization practices and new knowledge about genetics. We systematically reviewed the records of 5,747 consecutive admissions (4,224 individuals), representing 98% of patients admitted in 1996 to Rainbow Babies and Children's Hospital (Cleveland, OH). Each patient was assigned to one of five groups on the basis of the presence or absence of an underlying chronic medical condition and whether that condition had a genetic basis or susceptibility. An underlying disorder with a significant genetic component was found in 71% of admitted children. The vast majority (96%) of underlying chronic disorders in children in this study were either clearly genetic or had a genetic susceptibility. Total charges for 1996 were >$62 million, of which $50 million (81%) was accounted for by disorders with a genetic determinant. The 34% of admissions with clearly genetic underlying disorders accounted for 50% (>$31 million) of the total hospital charges. The mean length of stay was 40% longer for individuals with an underlying disease with a genetic basis than for those with no underlying disease. Charges and length of stay were similar for children with underlying chronic disorders, regardless of the cause. This study begins to quantify the enormous impact of genetic disease on inpatient pediatrics and the health care system. Additional study and frank public discourse are needed to understand the implications on the future health care workforce and on the utilization of health care resources.
Collapse
Affiliation(s)
- Shawn E McCandless
- Department of Genetics, Case Western Reserve University, Cleveland, OH, 44106, USA.
| | | | | |
Collapse
|
13
|
Frank RE, Bartholomew DW. Cystic fibrosis--a genetic dilemma. J Insur Med 2004; 36:158-61. [PMID: 15301229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Cystic fibrosis is a common genetic disease that usually presents in early childhood as a devastating disease affecting pulmonary function and at times gastrointestinal functioning and nutritional status. Variant forms of this disease have been described, which may have a delayed age of onset or a milder clinical course. Numerous genetic mutations have been described in cystic fibrosis. There are several mutations that are known to be associated with late onset disease or mild clinical disease. Research continues into these genetic mutations and various modifiers that may help to more accurately predict the final phenotypic presentation.
Collapse
Affiliation(s)
- Robert E Frank
- Union Central Life Insurance Company, Cincinnati, OH 45240, USA.
| | | |
Collapse
|
14
|
Mulvihill JJ, Blackett PR, Palmer SE. Expanding metabolic screening of newborns: can the health care industry do better than public health? J Okla State Med Assoc 2003; 96:477-81. [PMID: 14619602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
In Oklahoma since the early 1990s, all newborns have been screened for four metabolic conditions: phenylketonuria, hypothyroidism, galactosemia and hemoglobinopathies. In 2002, 38 affected babies were diagnosed and one expects they are saved from the complications of late diagnosis such as mental retardation or death from sepsis. With advances in genetics and improved biochemical assays, 86% of states now screen for more disorders than Oklahoma, up to 37 in Mississippi. Six recent patient vignettes illustrate the mortality and morbidity of conditions that are screened for elsewhere but not in Oklahoma. In 2001, the Oklahoma Genetics Advisory Council recommended adding three disorders and the State Health Department forecasts that implementation may be complete in 2007. For now, when a patient asks, "Will my baby be screened for as many metabolic conditions as possible?", two answers represent either the public health or the private health care view. The public health answer is, "The state requires screening for four conditions." The health care system answer is, "We can work with you to get 44 conditions tested for, but it will cost money, may not be reimbursed, and has not been proven effective when done on an individual basis." This dilemma, not unique to newborn screening, might be resolved if professional and public opinion strongly supported early expansion.
Collapse
Affiliation(s)
- John J Mulvihill
- Human Genetics Program, University of Oklahoma Health Sciences Center, USA.
| | | | | |
Collapse
|
15
|
Rakowski E. Who should pay for bad genes? Calif Law Rev 2002; 90:1345-1414. [PMID: 12436972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Parents have long been able to influence the genetic composition of their children through their choice of a reproductive partner, if only very approximately. They are, however, increasingly able to determine the genetic make-up of their children in other, more precise ways, such as by selecting a particular gamete or embryo or by genetically modifying an embryo prior to artificial implantation. This Article discusses parents' obligations to their children and other members of the community stemming from their children's genes. In a just state, it argues, parents would be responsible for redressing any genetic disadvantage their children suffer as a result of parents' voluntary actions. Within the context of a liberal egalitarian account of distributive justice, this responsibility might most fairly be discharged through a compulsory insurance plan that provides compensation to genetically disadvantaged children when they might have had non-disadvantaged children instead would in some circumstances incur greater liability, because they could not fairly push the cost of their choices off on other members of the insurance pool. The Article also asks whether parents wrong a child by allowing it to be born with a genetic impairment when, had they taken steps to remove the impairment, the unimpaired child they had would have been a different person from the genetically disadvantaged child because the better-off child's capacities and experiences differed considerably from those that the disadvantaged child would have had. Contrary to many people's moral intuitions, the Article argues that parents do not wrong such a child. Nevertheless, parents remain morally obligated to bear any added costs occasioned by the child's impairment. Any other approach would allow them unjustly to shift the burden of their choices to other parents. Finally, the Article takes up the much debated question of whether parents harm a child by allowing it to be born with a life not worth living when they could have prevented its birth. It suggests that the answer to this question should be irrelevant to parents' legal liability. Acting on behalf of the parental insurance pool, the state may nonetheless adopt a variety of measures to help potential parents avoid giving birth to such children, which one can assume virtually all would prefer.
Collapse
Affiliation(s)
- Eric Rakowski
- School of Law, University of California, Berkeley (Boalt Hall), USA
| |
Collapse
|
16
|
Abstract
Genetic endowments play a fundamental role in the production of health. At birth individuals have different capacities to be healthy, largely due to genetic dispositions. Whether or not individuals realize this health depends on their choice of health behaviours. Previous research has linked negative factors beyond the individual's control, which include genetic endowments, to both poor health and poor health behaviours. The health economics literature proposes that behaviours and genetic (or family health) endowments can be either substitutes or complements in the production of health. The goal of this paper is to investigate the behavioural consequences of changes in knowledge about one's genetic endowment. Using two waves of the National Health and Nutrition Examination Survey I Epidemiologic Followup Study, I find that for smokers, smoking intensity substitutes for newly diagnosed smoking-related family cancers, while smoking intensity is complementary to newly diagnosed non-smoking-related family cancers. I find no evidence for the hypothesized relationships with respect to alcohol consumption among drinkers. These results have implications for the growing field of genetic testing and test development. These results also reinforce current practices of ascertaining family health histories in the context of medical history taking.
Collapse
Affiliation(s)
- M L Ganz
- Department of Maternal and Child Health, Harvard School of Public Health, Boston, MA 02115, USA.
| |
Collapse
|
17
|
|
18
|
Watson MS, Greene CL. Points to consider in preventing unfair discrimination based on genetic disease risk: a position statement of the American College of Medical Genetics. Genet Med 2001; 3:436-7. [PMID: 11715011 DOI: 10.1097/00125817-200111000-00011] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
MESH Headings
- Confidentiality
- Decision Making
- Education, Medical
- Employment/legislation & jurisprudence
- Employment/standards
- Genetic Diseases, Inborn/diagnosis
- Genetic Diseases, Inborn/economics
- Genetic Diseases, Inborn/genetics
- Genetic Predisposition to Disease
- Genetic Testing/legislation & jurisprudence
- Genetic Testing/standards
- Genetics, Medical
- Humans
- Insurance, Health/legislation & jurisprudence
- Insurance, Health/standards
- Legislation, Medical
- Organizational Policy
- Practice Guidelines as Topic
- Prejudice
- Social Control, Formal
- Societies, Medical
- United States
Collapse
Affiliation(s)
- M S Watson
- American College of Medical Genetics, 9650 Rockville Pike, Bethesda, MD 20814, USA
| | | |
Collapse
|
19
|
Goldie SJ, Levin AR. msJAMA. Genomics in medicine and public health: role of cost-effectiveness analysis. JAMA 2001; 286:1637-8. [PMID: 11585493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- S J Goldie
- Harvard School of Public Health, Boston, MA, USA
| | | |
Collapse
|
20
|
Abstract
A systematic review of recent economic evaluations of antenatal screening was conducted. Relevant studies were identified from a number of sources including computerised databases, bibliographies of economic evaluations, and searches of unpublished manuscripts. Each study identified by the literature searches was categorised on the basis of its title and abstract. Studies considered relevant to the systematic review were obtained from libraries. The methodology, results, and policy implications of studies categorised as economic evaluations upon full review were documented. A total of 566 studies were identified by the literature searches, 41 of which were categorised as economic evaluations upon full review. The economic evaluations covered a range of antenatal screening practices, aimed mainly at the prevention of infectious diseases and fetal anomalies. The review highlighted the poor methodological quality of the bulk of economic evaluations of antenatal screening. The study design, data collection methods, and analysis and interpretation of results frequently violated methodological guidelines adopted by health economists. The review also highlighted the narrow definition of benefits adopted by this body of literature, with most studies reporting outcomes in terms of cases detected, cases of particular disorders prevented or, most often, costs averted. The conclusions arrived at differed by area of antenatal screening. There appeared to be clear economic arguments in favour of some forms of antenatal screening, for example, triple test screening for Down's syndrome. Other economic evaluations pertained to specific locations, which suggests that the results may not necessarily be generalizable to different settings. For all areas of antenatal screening, an updating of published economic evaluations may be required to account for evolving economic, epidemiological, and clinical effectiveness evidence.
Collapse
Affiliation(s)
- S Petrou
- National Perinatal Epidemiology Unit, University of Oxford.
| | | | | | | |
Collapse
|
21
|
Weiland AJ. The challenges of genetic advances. Healthplan 2000; 41:24-30. [PMID: 11185806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- A J Weiland
- Kaiser Permanente Northwest, Portland, Ore., USA
| |
Collapse
|
22
|
el-Hazmi MA. Genetic diseases in Arab populations. East Mediterr Health J 1999; 5:1102-3. [PMID: 11924096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
|
23
|
el-Hazmi MA. Spectrum of genetic disorders and the impact on health care delivery: an introduction. East Mediterr Health J 1999; 5:1104-13. [PMID: 11924097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Until recently, infectious diseases and malnutrition-related disorders constituted the major cause of ill health and mortality in the world population. However, advances in treatment of such disorders and increased understanding of the molecular basis of heredity have led to genetically transmitted conditions becoming a major cause of morbidity and mortality. Several disorders, including chromosomal (Down syndrome, Turner syndrome), single-gene (sickle-cell disease, thalassaemia, glucose-6-phosphate dehydrogenase deficiency, haemophilia, inborn errors of metabolism) and multifactorial disorders (coronary artery disease, arteriosclerosis, diabetes mellitus, hypertension, obesity) are common and becoming increasingly important. As there is no agreed-upon definitive cure with acceptable risk, these disorders are a significant burden on the health care delivery system. This is because the chronic nature of genetic diseases requires lifelong medical attention, expensive supportive and symptomatic therapy and specialist care. This review outlines the genetic disorders, their impact on health care delivery systems and the general framework required to prevent and control these disorders.
Collapse
Affiliation(s)
- M A el-Hazmi
- Medical Biochemistry Department, WHO Collaborating Centre for Haemoglobinopathies, Thalassaemias and Enzymopathies, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
24
|
Affiliation(s)
- P R Reilly
- Shriver Center for Mental Retardation, Inc., Waltham, MA 02254, USA
| |
Collapse
|
25
|
Ballmaier M. Italy promises to increase focus on rare diseases. Nat Med 1999; 5:472-3. [PMID: 10229215 DOI: 10.1038/8343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
26
|
Abstract
A nationwide investigation of congenital malformations and genetic diseases in Korea was conducted by analyzing Medical Insurance data for infants aged under 1 year. Medical Insurance data were obtained for 1993 and 1994 and the ICD-9 (International Classification of Diseases, Ninth Revision) code was used to classify the diseases. The coverage rate of medical insurance was approximately 95% of the total population. Anomalies of the cardiovascular, musculoskeletal, and gastrointestinal systems, in descending order of frequency, were more frequent than anomalies in other systems. The average prevalence of cardiovascular anomalies for 1993 and 1994 was 15 per 1000 infants, and ventricular septal defect, with an average prevalence of about 3.50 per 1000 for 1993 and 1994, was the most frequent cardiovascular anomaly in infants. Polydactyly was the most frequent musculoskeletal anomaly, with an average prevalence, for 1993 and 1994, of about 1.20 per 1000 infants. Anencephaly had the highest frequency of nervous system anomalies. Congenital hypertrophic pyloric stenosis was the most common of the gastrointestinal anomalies. The prevalence of the congenital malformations and genetic diseases examined was similar to that reported in other countries. Total medical expenses for the care of patients with each disease entity were also estimated. The highest medical expenses were incurred for ventricular septal defect, congenital coagulation factor VIII disorders, atrial septal defect, tetralogy of Fallot, and spinal anomalies, in descending order of magnitude. This investigation could be helpful in planning social welfare systems, as well as for elucidating the current status of congenital malformations and genetic diseases in Korea, and in other Asian countries.
Collapse
Affiliation(s)
- S C Jung
- Division of Genetic Disease, National Institute of Health, Seoul, Korea.
| | | | | | | |
Collapse
|
27
|
Turner RD. Economics of genetics from a health commissioning point of view. Dis Markers 1999; 15:175-6. [PMID: 10595274 PMCID: PMC3851632 DOI: 10.1155/1999/753674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R D Turner
- East Riding Health Authority, Willerby, Hull, UK
| |
Collapse
|
28
|
Low L, King S, Wilkie T. Genetic discrimination in life insurance: empirical evidence from a cross sectional survey of genetic support groups in the United Kingdom. BMJ 1998; 317:1632-5. [PMID: 9848905 PMCID: PMC28743 DOI: 10.1136/bmj.317.7173.1632] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To gather empirical evidence on any discrimination based on genetic information shown by the insurance industry in the United Kingdom and to assess how society is likely to handle future genetic information from tests for polygenic multifactorial conditions. DESIGN Postal questionnaire survey. SUBJECTS Sample (n=7000) of members from seven British support groups for families with genetic disorders and a representative sample (n=1033) of the general public who answered questions on applying for life insurance as part of an omnibus survey. MAIN OUTCOME MEASURES Subjects were asked about their experiences with insurers, the medical profession, employers, and social services. Experiences with insurers are reported here. RESULTS Altogether 33.4% of the study group had problems when applying for life insurance compared with 5% of applicants in the omnibus survey. Thirteen per cent of study respondents from subgroups who represented no adverse actuarial risk on genetic grounds reported that their treatment by insurers seemed to represent unjustified genetic discrimination. CONCLUSIONS Life insurers may not be operating a consistent policy for assessing genetic information or acting in accord with the actuarial risks brought to them. The inconsistency suggests error rather than a corporate policy of discrimination based on genetic characteristics. Any future proposals for genetic testing for common or multifactorial disorders should be examined carefully.
Collapse
Affiliation(s)
- L Low
- Unit for Policy Research in Science and Medicine, Wellcome Trust, London NW1 2BE
| | | | | |
Collapse
|
29
|
Abstract
A "wrongful life" suit is based on the purported tortious liability of a genetic counsellor towards an infant with hereditary defects, with the latter asserting that he or she would not have been born at all if not for the counsellor's negligence. This negligence allegedly lies in the failure on the part of the defendant adequately to advice the parents or to conduct properly the relevant testing and thereby prevent the child's conception or birth (where unimpaired life was not possible). This paper will offer support for the thesis that it would be both feasible and desirable to endorse "wrongful life" compensation actions. The genetic counsellor owed a duty of due professional care to the impaired newborn who now claims that but for the counsellor's negligence, he or she would not have been born at all. The plaintiff's defective life (where healthy life was never an option) constitutes a compensable injury. A sufficient causal link may exist between the plaintiff's injury and the defendant's breach of duty of due professional care and an appropriate measure of damages can be allocated to the disabled newborn. Sanctioning a "wrongful life" cause of action does not necessarily entail abandoning valuable constraints with regard to abortion and euthanasia. Nor does it inevitably lead to an uncontrolled slide down a "slippery slope".
Collapse
|
30
|
|
31
|
Jayaraman KS. Will new guidelines protect or expose the Indian gene pool? Nat Med 1998; 4:653. [PMID: 9623963 DOI: 10.1038/nm0698-653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
32
|
Allen GE. The social and economic origins of genetic determinism: a case history of the American Eugenics Movement, 1900-1940 and its lessons for today. Genetica 1998; 99:77-88. [PMID: 9463076 DOI: 10.1007/bf02259511] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Eugenics, the attempt to improve the genetic quality of the human species by 'better breeding', developed as a worldwide movement between 1900 and 1940. It was particularly prominent in the United States, Britain and Germany, and in those countries was based on the then-new science of Mendelian genetics. Eugenicists developed research programs to determine the degree in which traits such as Huntington's chorea, blindness, deafness, mental retardation (feeblemindedness), intelligence, alcoholism, schizophrenia, manic depression, rebelliousness, nomadism, prostitution and feeble inhibition were genetically determined. Eugenicists were also active in the political arena, lobbying in the United States for immigration restriction and compulsory sterilization laws for those deemed genetically unfit; in Britain they lobbied for incarceration of genetically unfit and in Germany for sterilization and eventually euthanasia. In all these countries one of the major arguments was that of efficiency: that it was inefficient to allow genetic defects to be multiplied and then have to try and deal with the consequences of state care for the offspring. National socialists called genetically defective individuals 'useless eaters' and argued for sterilization or euthanasia on economic grounds. Similar arguments appeared in the United States and Britain as well. At the present time (1997) much research and publicity is being given to claims about a genetic basis for all the same behaviors (alcoholism, manic depression, etc.), again in an economic context--care for people with such diseases is costing too much. There is an important lesson to learn from the past: genetic arguments are put forward to mask the true--social and economic--causes of human behavioral defects.
Collapse
Affiliation(s)
- G E Allen
- Department of Biology, Washington University, St. Louis, MO 63130-4899, USA
| |
Collapse
|
33
|
Abstract
What are the aims of genetic services? Do any of these aims deserve to be labeled "eugenics"? Answers to these strenuously debated questions depend not just on the facts about genetic testing and screening but also on what is understood by "eugenics," a term with multiple and contested meanings. This paper explores the impact of efforts to label genetic services "eugenics" and argues that attempts to protect against the charge have seriously distorted discussion about their purpose(s). Following Ruth Chadwick, I argue that the existence of genetic services presupposes that genetic disease is undesirable and that means should be offered to reduce it. I further argue that the economic cost of such disease is one reason why governments and health care providers deem such services worthwhile. The important question is not whether such cost considerations constitute "eugenics," but whether they foster practices that are undesirable and, if so, what to do about them The wielding of the term "eugenics" as a weapon in a war over the expansion of genetic services, conjoined with efforts to dissociate such services from the abortion controversy, has produced a rhetoric about the aims of these services that is increasingly divorced from reality. Candor about these aims is a sine qua non of any useful debate over the legitimacy of the methods used to advance them.
Collapse
|
34
|
Kuska B. Genetic tests for many rare diseases headed for orphan status. J Natl Cancer Inst 1997; 89:1748-9. [PMID: 9392610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
|
35
|
Yoon PW, Olney RS, Khoury MJ, Sappenfield WM, Chavez GF, Taylor D. Contribution of birth defects and genetic diseases to pediatric hospitalizations. A population-based study. Arch Pediatr Adolesc Med 1997; 151:1096-103. [PMID: 9369870 DOI: 10.1001/archpedi.1997.02170480026004] [Citation(s) in RCA: 147] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To estimate the contribution of birth defects and genetic diseases to pediatric hospitalizations by use of population-based data. DESIGN Hospital discharges were categorized according to the diagnostic codes of The International Classification of Diseases, Ninth Revision, Clinical Modification. Hospitalizations that were related to birth defects and genetic diseases were compared with hospitalizations for other reasons, with respect to age, race/ethnicity, sex, length of stay, charges, source of payment, and mortality rate. Hospitalization rates and per capita charges were computed with the use of population estimates from 1990 census data. MATERIALS The 1991 population-based hospital discharge data from California and South Carolina. RESULTS Nearly 12% of pediatric hospitalizations in the 2 states combined were related to birth defects and genetic diseases. These children were, on average, about 3 years younger, stayed 3 days longer in a hospital, incurred 184% higher charges, and had a 4 1/2 times greater in-hospital mortality rate than children who were hospitalized for other reasons. The rate of hospitalizations that were related to birth defects and genetic diseases was 4 per 1000 children in both states, but these rates varied by age and race. CONCLUSION These population-based data are the first contemporary findings to show the substantial morbidity rate and hospitalization charges associated with birth defects and genetic diseases in the pediatric population. IMPLICATIONS This information is important for planning effective health care strategies, especially as the causes, treatments, and prevention of these disorders are being further elucidated by findings from human genome research and epidemiologic studies.
Collapse
Affiliation(s)
- P W Yoon
- Division of Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Ga., USA
| | | | | | | | | | | |
Collapse
|
36
|
|
37
|
|
38
|
Abstract
In this paper I look at the financial implications of genetic testing, particularly in the employment and pensions fields. I have generally not covered life insurance, as that is covered in other papers in this Discussion Meeting. However, the issues are similar, although the emphasis is different. Inevitably there is an element of speculation involved; genetic testing is in its infancy and so we cannot predict either what information we will be able to obtain through genetic testing, nor the uses that may be devised for this information.
Collapse
Affiliation(s)
- T Ross
- Alexander Clay Consulting Actuaries, London, UK
| |
Collapse
|
39
|
Abstract
In the UK the majority of life insurers employ relatively liberal underwriting standards so that people can easily gain access to life assurance cover. Up to 95% of applicants are accepted at standard terms. If genetic testing becomes widespread then the buying habits of the public may change. Proportionately more people with a predisposition to major types of disease may take life assurance cover while people with no predisposition may take proportionately less. A model is used to show the possible effect. However, the time-scales are long and the mortality of assured people is steadily improving. The change in buying habits may result in the rate of improvement slowing down. In the whole population, the improvement in mortality is likely to continue and could improve faster if widespread genetic testing results in earlier diagnosis and treatment. Life insurers would not call for genetic tests and need not see the results of previous tests except for very large sums assured. In the UK, life insurers are unlikely to change their underwriting standards, and are extremely unlikely to bring in basic premium rating systems that give discounts on the premium or penalty points according to peoples genetic profile. The implications of widespread genetic testing on medical insurance and some health insurance covers may be more extreme.
Collapse
Affiliation(s)
- D J Le Grys
- Munich Reinsurance Company (Life), London, UK
| |
Collapse
|
40
|
Abstract
The combined effects of underwriting and adverse selection among heterogeneous populations are considered, using a simple Markov model. I illustrate the possible extent of the costs of adverse selection; in all cases, above-average sums assured is the most significant factor.
Collapse
|
41
|
Lawrence J. Should insurance pay for preventive services suggested by genetics? Manag Care 1997; 6:42-6. [PMID: 10164532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Physicians, plans and patients are discovering that the promise of genetic testing will be hard to fulfill. Even when a test can show predisposition toward a disease, performing it can't necessarily improve medical outcomes. Unfortunately, doing these tests can have some unintended negative effects.
Collapse
|
42
|
Cowley G. Flunk the gene test and lose your insurance. Newsweek 1996; 128:48-50. [PMID: 10163863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
|
43
|
Affiliation(s)
- J Buitkamp
- Molecular Human Genetics, Ruhr-University, Bochum, Germany
| | | |
Collapse
|
44
|
|
45
|
Abstract
Medical researchers are rapidly identifying the genetic causes of many diseases. Genes that increase the risk of contracting Alzheimer's, colon and breast cancer, Huntington's, cystic fibrosis and numerous other diseases have been identified. Genetic tests can reveal an individual's probable health status many years in advance of sickness. Many fear that this will lead to 'genetic discrimination' in the employment and health insurance markets. Solutions such as consent laws are impractical and create adverse selection problems. A new form of insurance, genetic insurance, can eliminate these problems and allow everyone to be insured.
Collapse
Affiliation(s)
- A Tabarrok
- Economics Department, George Mason University, Fairfax, VA 22030
| |
Collapse
|
46
|
Ostrer H, Allen W. Equal Employment Opportunities Commission issues new interim enforcement guidance on Americans with Disabilities Act. Am J Hum Genet 1993; 53:541-2. [PMID: 8328472 PMCID: PMC1682356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
|
47
|
Geller LN, Ahn AH, Beckwith J, Barash C. Insurance commissioners and genetic discrimination. Am J Hum Genet 1993; 52:1018. [PMID: 8488834 PMCID: PMC1682034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
|
48
|
Pokorski RJ. Use of genetic information by private insurers. Genetic advances: the perspective of an insurance medical director. J Insur Med 1993; 24:60-8. [PMID: 10148476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- R J Pokorski
- North American Reassurance Company, Westport, Connecticut
| |
Collapse
|
49
|
MESH Headings
- Actuarial Analysis
- Anonymous Testing
- Civil Rights
- Disclosure
- Employment
- Ethics, Medical
- Forecasting
- Genetic Carrier Screening
- Genetic Counseling/legislation & jurisprudence
- Genetic Diseases, Inborn/economics
- Genetic Diseases, Inborn/genetics
- Genetic Diseases, Inborn/prevention & control
- Genetic Diseases, Inborn/therapy
- Genetic Services
- Genetics, Medical
- Government Regulation
- Humans
- Insurance, Health/economics
- Insurance, Health/legislation & jurisprudence
- Insurance, Life/economics
- Insurance, Life/legislation & jurisprudence
- Personal Autonomy
- Prejudice
- Social Justice
- Truth Disclosure
Collapse
Affiliation(s)
- M A Rothstein
- Health Law and Policy Institute, University of Houston, Texas 77204
| |
Collapse
|
50
|
Hook EB. Muddling genetic discrimination. Am J Hum Genet 1992; 51:899-901; author reply 903-5. [PMID: 1415235 PMCID: PMC1682810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
|