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We were all thrilled last spring when the Genetic Information Nondiscrimination Act passed the House by a vote of 420 to 3. When GINA gets through the Senate, this act will protect individuals against discrimination based on their genetic information with health insurance and employment. The promise of genomic project won't ever be achieved until individuals (besides Watson and Venter) can use their own genetic information to benefit their own health, without fear of insurance repercussions.
Passing this act seems like a no-brainer.
But I glanced at Nature last night and noticed that the US Department of Defense has managed to change the Senate's version of the act and make military people exempt from protection.
How can that be ethical?
How can we ask people to sacrifice our lives for us and then say, "uh sorry, you're not insured"
I can understand that the military might place some restrictions on jobs based on physical abilities. There are good reasons, I think, for not having people with narcolepsy flying airplanes, or someone with a heart condition defusing bombs.
But I don't think that's a good reason to deny health insurance protections to people simply because they're employed in the military side of our government rather than the civilian branch.
Jonah Lehrer, fellow ScienceBlogger, has written about a case of appalling treatment for someone who's served our country.
Nature follows suit and reminds us that:
The civilian branches of the government, like every other US employer apart from the Pentagon, will be barred under the legislation from terminating employment or health coverage on the basis of results from genetic tests.
In other words, civilians working for the government will be protected from discrimination.
Military personnel will not.
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Surely this patients diagnosis was done on clinical grounds rather than genetic tests ? I would have thought his situation would be similar to any other soldier that joined the military and later developed cancer. In other words it probably wasn't caused by his military service but developed and was diagnosed during this time. In that sense should it be looked upon differently to something like a congenital heart, kidney or liver condition that only comes to light some time after joining?
On a related matter, is the Genetic Information Nondiscrimination Act time limited?
I ask the question since it will be a few years before the sort of whole genome SNP tests or Venter style complete genomic sequencing options are going to available to the public. If that is the case then there is little incentive at present for health insurance companies to push for thse sort of tests as part of their coverage. If the bill runs out in five years time however, that is another question.
Undoubtedly this information will be very valuable in determining actuarial calculations. To be able to dismiss a claim based on genetic factors -risky alleles etc- will have huge implications for the profitability of insurance companies. No doubt they will try whatever means they can to push for access and the ability to use this information in assessing claims. In purely business terms they would be mad not to (in human terms and the cost to society in general, that is a different question but these are for profit corporations we are talking about, not charities).
Posted by: MartinC | September 5, 2007 5:35 AM
This guy - Eric Miller- had a series of tumors in his brain. The tumors occured because he has a mutation in the VHL gene, which was diagnosed by genetic testing. This mutation causes Von Hippel-Lindau syndrome.
From OMIM:
The Army decided that, since he had the mutation before he joined the army, that his problem was a "pre-existing" condition and not covered by Army insurance.
I didn't see anything about a time limit in the GINA text, but genetic tests are already available for quite a few conditions. We can do tests now for many cancer-related mutations - things that lead to breast cancer, prostate cancer, colon cancer, and other medical conditions. We can also test for Alzheimer's-related genes, your ability to metabolize certain drugs, and many other inherited conditions. Plus there are at least 50 different inherited conditions that we test in newborns.
Whole-genome scans are a ways off, but many genetics tests are available now.
Posted by: Sandra Porter | September 5, 2007 7:37 AM
Wait a sec though, does it actually say that the DOD is going to use this information to raise the rates of health insurance. Couldn't they be using for just the reasons you discussed in your post, like not sending men into combat with congential deteriorating hip disorders? Maybe the info will be used to put people into positions where they are more likely to succeed based on that genetic profile.
Posted by: Organic Chemistry Help | September 7, 2007 7:35 AM
The DoD isn't planning to use genetic information for setting insurance costs, as far as I can tell.
The DoD wants to be able to avoid insuring people all together, as they did recently in the case of Eric Miller.
Posted by: Sandra Porter | September 7, 2007 9:00 AM