Should genetic testing be a routine part of a medical checkup? According to an opinion piece published in the journal ‘Annals of Internal Medicine’ this year, the answer in the long-term should be ‘yes’.
It’s the sort of screening that could identify people who are at risk for diseases like cancer and heart disease that can then be targeted with preventive care. The reason for that ‘long-term’ rider is that doctors still don’t know what most genes in the body actually do, limiting the benefits of genetic testing for your typical patient. On top of this, although we might be able to figure out that a given gene marginally increases the risk for a given disease, without knowing how that gene interacts with other genes or with important environmental factors, just knowing someone has a specific gene might not tell you much about the individual’s likely health outcomes. A mature screening science will arrive when we can mix large levels of computing power with data in genetic and public health databases, to examine biological, environmental and situational interactions.
The big problem with genomic screening comes down to whose interests it serves. On the negative side, some of the first genes ever to be associated with a risk of cancer, BRCA1 and BRCA2, were patented by a private company attempting to capitalise on patient data. That patent was later overturned but it raised a big red flag. On the plus side, people with those markers can now get tested to contemplate an alternative, longer-lived future. On the ethically problematic side, parents will be able to screen and manipulate for such genetic problems – and potentially select for positive markers. It is these sorts of questions that have lit the big ethical debates.
As such tests evolve, should people be allowed to choose or refuse, or should they be mandatory? Imagine a world in which diseases could be screened out. For those of us already here, if we do have markers for disease, should we be able to control access to the results of our tests? If test results are released to third parties such as employers or insurers, what – if any – protections could be put in place to make sure that we aren’t treated unfairly because of our genotype? If nothing could be done, would you even want to know what you were likely to die of? It’s all a questions of ethics.
Are you clear where you draw your line?