AS THE first rough draft of the human genome nears completion, the trickle of
new tests for identifying genes that cause disease could turn into a flood.
People who take these tests may well find they鈥檙e not the only ones who care
about the outcome鈥攊nsurance companies may also demand the right to know
the results.
Many people are appalled by this prospect. They fear that science is marching
us into a brave new world of genetic discrimination, in which companies offering
life insurance and health insurance will shun people with 鈥渂ad鈥� genes while
offering ultra-cheap cover to the genetically well endowed. Like breeding cattle
and racehorses, we will be brutally ranked according to the quality of our DNA.
Some will be coveted, others excluded.
Well, the pessimists who believe this should look at the facts. Anyone who
works with the insurance industry, as I do, will know that this nightmare is
implausible. It is based on the false notion that insurers will force people to
take genetic tests so they can reject those likely to prematurely become
seriously ill or die, or make them pay higher premiums.
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In reality, insurers have nothing to gain from forcing people to take genetic
tests. What matters to them is that those people who do choose to have a test
disclose the result. This is because insurance companies worry that if they
didn鈥檛 have access to the results of a genetic test, they could lose a lot of
money from applicants hiding information about a potential illness. Insurers
also point out that information from genetic tests would save healthy people
from paying large premiums.
Sceptical? Let me explain. Huntington鈥檚 disease, for example, is a rare,
entirely genetic disorder, which involves a slow and eventually fatal
degeneration of the brain. In Britain, people whose families have a history of
the disease are asked to pay more for life insurance or long-term care
insurance. The difference genetic testing could make is that if potential
victims find they are in the clear, their premiums would go down to the
standard. This is a far cry from the nightmare, but we obviously need a clearly
agreed financial safety net for those shown to be at risk.
But most of us don鈥檛 suffer from rare diseases. We are far more likely to
succumb to the biggest causes of ill-health and premature death, such as cancer
and heart disease. In many cases, the relative roles of genes and lifestyle are
not yet clear. But one day they may be, and then we could see tests predicting
how long a person will live, or their likely state of health over time. Genetic
tests for hereditary breast and colon cancer already exist. Soon scientists may
be able to predict the onset of other cancers, diabetes and osteoporosis.
The industry has two options when it comes to genetic testing for common
diseases. It could insist on knowing test results and charging people with
troublesome genes more. The same principle is used in motor insurance: if you
are 50 and drive a Toyota Corolla you will pay a lot less than an 18-year-old
with eyes on a Toyota MR2.
Or it could continue as it is, issuing policies framed so that someone at
risk from, say, a heart attack pays broadly the same as other people, with
allowance for family history. This way, healthier applicants subsidise those who
will need long-term care, or those who die young.
I favour this approach. Some in the insurance industry may not agree, but in
the long term, genetic tests for common diseases will have limited relevance
when assessing how much people should pay. There are several reasons for
this.
First, the costs to the industry could decline if people who discover that
they are genetically predisposed to a certain illness change their lifestyle or
take medication to ward off the disease. Secondly, as scientists develop genetic
tests for common diseases, we will all discover a genetic susceptibility to
something. There will be no winners and no losers. And it will be unfair to
raise premiums for those predisposed to conditions where the genetics are
understood sooner rather than later.
This scenario is not certain, however. It depends on there being a
wide enough range of genetic tests to produce a level playing field for
everyone, which would put insurance companies back where they are today. But
things may not work out like this. For example, we could end up with a lot more
tests for debilitating diseases that are expensive to treat than for milder, but
more common conditions. Then the industry could make major losses from
applicants who discover they have troublesome genes but hide the information
when applying for insurance.
This is why, if the industry is to be persuaded to ignore the results of
genetic tests, an important condition must be met: governments must ban
over-the-counter testing. In Britain, having asked for your consent, insurers
can learn the results of any genetic tests through your doctor. But people who
obtain a test by mail order or over the Internet can hide the results. If my
prediction about the level playing field turns out to be wrong, then this
practice could be bad news for insurers and for the honest majority of
policyholders, who would have to pay more to compensate.
Forget the nightmare scenario. Insurance companies will not be asking
governments to agree to mandatory testing. All they want is the right to know
the results of any genetic tests that are carried out. That is not only fair, it
is actually the best chance we have of ensuring that the industry does not use
the fruits of the genome project in a discriminatory way.