A reader pointed me to this article in the Australian news: it appears that a major Australian insurance company, NIB, is planning to offer half-price genome scans from personal genomics company Navigenics to 5,000 of its customers.
The catch is in the fine print: those who take up the offer "may have to give the information to life insurance or superannuation providers", according to the article. In a letter to customers, the chief executive of the company explicitly says that this information could be used to alter the premiums people pay for their life insurance:> The chief executive of NIB, Mark Fitzgibbon, said in the letter to customers that he had used genetic testing himself as a way of preparing for possible health problems in the future.
You can expect to see some reflexive outrage following this announcement; people have a visceral dislike of the notion of insurance companies using genetic information to make decisions about policy. Indeed, this dislike has been enshrined in law in the US via GINA , which prohibits the use of genetic information by health insurance providers and employers (although it's worth noting that the law doesn't apply to life, disability or long-term care insurance policies). Australia has no such law.But is the idea of an insurance provider using genetic data really worthy of such instinctive distaste? Is there anything more fundamentally outrageous about using genetic data to calculate premiums than other inborn traits - such as, for instance, sex?It's worth bearing in mind that banning insurance companies from using genetic data undermines the entire premise that insurance is based on, by giving customers access to more accurate predictions of their future health than insurance companies. As genetic data begin to offer more and more useful health predictions, this will allow customers to purchase higher coverage if they find they are at higher risk. If insurance companies are banned from using the same information to calculate premiums the entire system will eventually collapse.Is this collapse a bad thing? Probably less so in Australia than in the US, given that Australia has a (reasonably) functional public health system; so it's ironic that the US has created anti-genetic discrimination laws for insurance companies while Australia continues to sit on the fence.I'm personally pretty ambiguous about the need for bans on the use of genetic information by insurance companies, and tend towards opposing them. However, I do accept that there is a genuine danger that insurance companies will weight genetic information more highly in their premium calculations than is warranted, thus unfairly discriminating against potential customers. Especially in these early days, it is crucial that companies get the science right when they perform these calculations.Another intriguing question is whether a Navigenics genome scan will actually produce information of any real value to insurance companies. I'm pretty dubious in general terms - Navigenics, like most other personal genomics companies, looks at common variants of individually small effects with overall weak predictive power for disease risk - but there will be some diseases where the test proves somewhat useful for a small fraction of individuals. It's only as we start to move into the next stage of complex disease genetics - finding and testing for much rarer, larger-effect risk variants with much stronger predictive power for individual health - that this argument will really start to bite.Finally, I expect one unambiguously positive outcome from this: the controversy resulting from this move may well force the Australian government to finally take a position on the use of genetic information by insurers, something they have shamefully dodged so far.HT for the link: thanks Sari!
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