THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Monday, April 3, 1995 TAG: 9503310033
SECTION: FRONT PAGE: A4 EDITION: FINAL
TYPE: Editorial
LENGTH: Medium: 55 lines
New tests seem to become available almost daily that can tell people if they are genetically predisposed to a host of ills, notably cancers of the breast, colon, brain, thyroid and skin.
It is pointless to ask if such tests should be used; they will be. People will want to know if they are at risk. Yet the tests are so new that the level of risk is often not yet known.
Where useful treatments exist, the argument for testing would seem unassailable. Those at greater risk due to their heredity will want to maintain greater vigilance. But in cases where no treatment exists, knowing the worst may be no blessing.
Ideally, the decision to test or not to test should remain between patients and physicians. But the economics of such testing will introduce a third party, the insurer. The full array of cancer tests may cost $800, for example. Since the availability of tests will create demand, billions could be added to the nation's health-care bill.
Would this money be well-spent? In cases where early detection makes more expensive later treatment unnecessary, certainly. Will insurers be willing to cover such tests? That seems more dubious. The long fight to get the cost of mammograms covered shows how reluctant insurers can be to provide benefits even if they have been shown to be useful in catching disease early and reducing treatment costs. Mere risk assessment may be even harder to sell.
Does that mean the well-to-do will have a chance to detect disease early and fight it while the poor will fail to learn the worst until too late? That's not a pretty picture. And there's an even uglier issue waiting in the wings.
Medical ethicists have long worried that the ability to predict who might be at risk of various diseases might help insurers decide which patients to deny coverage. Now that such tests are becoming widespread, the worry becomes less and less academic.
Not for the first time in the 20th century, science is running ahead of our ability to deal with the consequences - ethical, economic and social. But the tests are here, the knowledge will be sought, and society is going to have to figure out how to deal with the results.
For starters, doctors need to be gatekeepers. These tests aren't for everyone and probably shouldn't be available on demand. Coverage for the cost of tests for diseases where treatment is feasible will be hard to deny. Paying to test people for diseases that presently lack a cure is harder to justify. Of course, there's plenty of gray area in between.
Finally, access to test results must be restricted to medical personnel and patients. And any attempts to discriminate against people on the basis of their genetic heritage must be unacceptable. by CNB