Current “pre-existing conditions” would mean nothing when complete genomic sequences enter the health insurance world

Sir, Gillian Tett writes “most consumers have not fully considered the consequences of genetic profiling: is it a good idea, say, to discover through a genetic profile a vulnerability to Alzheimer’s? What will that mean for life insurance policies and data privacy?”, “The importance of socks in the genomic revolution” March 17.

Indeed, imagine if a full genomic sequence is obtainable at a really low price, what stops then insurance companies from offering two plans, one for those who want to present their full DNA result, and one for those who prefer to keep these confidential? What would the differences in premiums be?

In 2000, in the now extinct Daily Journal of Caracas, I wrote an Op-Ed titled “Human genetics made inhuman”. In it I tackled some of the problems to which Ms. Tett refers.

I ended that article with: “suggesting that all insurance companies design a plan which obligates them to issue policies for all of those who undertake a genetic examination. This policy should cover the negative impact and consequence that could arise from anyone getting access to such information.”

Would that suffice? Clearly not, but just the existence of such an insurance, and seeing the premiums charged, could be a smart way for us to allow the market indicate us what kind of social troubles we are getting into. This because clearly what we currently refer to the problems in health insurance with “pre-existing conditions”, would all be baby talk when compared to the societal impacts of genomic sequencing.

I worried about this in 2000, as others must have been worrying earlier, and here Gillian Tett brings it up in 2017. What has happened in this respect during that interval? Has someone somewhere been thinking on how to tackle this formidable societal challenge? Probably not! If so, why? Or is this just another question of those that should not be asked?

PS. In 2015, in a letter to FT, I asked: “What would Gillian Tett say if one of her health record entrepreneurs, by means of an innocent mistake, entered a data that for instance hindered one of her children to enter a university that had decided that the expected longevity of students was good for its funding drives?

If those with good “3bn biochemical letters of human genome” ask insurance companies for rebates, what about the bad?

Sir, in screaming silence I read what Clive Cookson writes about “technologies advancing at extraordinary speed to make possible ultra-precise manipulation of the genome” “Engineered evolution takes another step forward” January 18.

In March 2000, after reading “the government plans to allow insurance companies to use DNA testing to assess whether people are at risk of inheriting serious illness and should pay higher premiums”, I wrote an Op-Ed titled “Human genetics made inhuman”.

In it I expressed many of the concerns about the discriminatory implications of DNA mapping and expressed the view that something needed to be done before any release of DNA information caused irreversible damage. I there suggested “that all insurance companies design a plan which obligates them to issue policies for all of those who undertake a genetic examination. This policy should cover the negative impact and consequence that could arise from anyone getting access to such information.”

But I also admitted: “I know this is only a Band-Aid, but what else can I do? I am not among those that resign and lie down to cry, even though this matter actually would justify just that.”

Now, 17 years later, I have no idea on whether something, anything, has been done to save humans from a release of the information contained in a “DNA sequencing, which reads out all 3bn biochemical letters of an individual human genome [and which can be done] in a few hours for less than $1,000”.

Sir, I ask, if with only $1,000 investment, I can get a test testifying I have a good DNA, and which perhaps allows me to for instance negotiate special favored rates with an insurance company, how will that affect those whose tests indicate a not so good or even a very risky DNA, something that in fact could include me or the ones I love?

Environmental challenges, 1st class robots, 3rd class robots, intelligent artificial intelligence, dumb artificial intelligence, terrorism, nuclear weapons, fast and cheap DNA testing, crazy bank regulators, structural unemployment… and the list of challenges goes on and on. How will a world that spends so much of its very scarce attention span glued to so very attractive juicy fake/irrelevant news stories cope?

@PerKurowski

“What technology can do for your health”, besides very good things, might also include some very bad things

Sir, I refer to Gillian Tett’s “What technology can do for your health” October 3.

The only problem I have with the article is how she brushes over the problem of privacy: “To be sure there are issues of data privacy; and sometimes records get lost. But…”

In March 2000 I wrote an Op-Ed in Venezuela titled “Human genetics made inhuman” and in which I expressed concerns about how medical data could be used to make it more difficult for some to obtain health insurance.

That was before I really began to understand how data was so massively been put to use in so many aspects of our lives… and not always even correct data.

What would Gillian Tett say if one of her health record entrepreneurs, by means of an innocent mistake, entered a data that for instance hindered one of her children to enter a university that had decided that the expected longevity of students was good for its funding drives?

@PerKurowski

We all need an insurance against what they are going to think they have discovered in our DNA

Sir in “The fallacy of the ‛choice agenda’”, July 18, Sir Samuel Brittan enters briefly into asking what will happen to health insurance when DNA records come to provide detailed health prognosis. I would answer, just what happens when credit records provide detailed information to lenders, that the borrowers often get bunched together into small groups of misfortunate outcasts that have to take care of each other. For instance, among the subprime we find those who are not able to serve a loan at very high interests, and therefore lose out, and those who by being able to serve their loan de-facto evidence they deserved a lower rate, and therefore also lost, making it truly hard to distinguish a winner.

Since Brittan also correctly states that “insurance is well suited to covering events that are unpredictable at the individual level” let me say that for over a decade I have held that the most important new insurance coverage we all need is that of the risks derived from what they are going to think they have discovered in our DNA.

What we first need is an insurance that covers the risks of the discoveries.

Sir, Stephen Cechetti argues in “A future of public healthcare for all” July 3 that the advances in genetics and that will be able to provide for better individualized projections of expected health costs will translate into a market failure that will force the private health insurance system into the arms of the public sector. Actually it is not a market failure that will do so since in fact the market could only benefit from knowing more about the risks, it is the market results that will be unacceptable, or at least let us hope so, since if those prognosed as much healthier sneak out from sharing the risks, society could turn much much nastier. For instance, there is nothing to stop a good health prognosis to also influence such variables as the admittance to universities.

Before we put any new safeguard system in place, which will certainly only happen when it is much too late for many, what we most need is an insurance that covers the risks of whatever extra costs we could suffer because of what they discover in our genes, and have everyone subscribe such an insurance, before they are allowed to take any genetic samples

We need an insurance for what could be discovered mapping our genes.

Sir, Patti Waldmeir in “The Dangerous new age of the genome”, May 9, writes about some legislative initiatives in the US that look to combat the “genetic discrimination” that might result from mapping the genes. This might be a good start but as I wrote in an article titled “Human genetics made inhuman” that I published in 2000, I submit that a better, or at least a more practical approach, might be to ask the insurance companies to come up with an insurance that covers any increased health insurance costs that can result from such a mapping when compared to an average citizen, and then require evidence that such an insurance has been contracted for before allowing at least any young person to have his or her genes mapped.

In a state of continued perplexity

Sir, Christopher Caldwell with his “On parenthood and perplexity”, February 24, leaves us perplexed about the need of the late Anna Nicole Smith to serve as an excuse to discuss some of the most fundamental issues of our time, or perhaps that’s just the way it goes, the more important the issue the sillier the excuse needed.

That said let me compliment and complement the article by slipping by two comments that might help to keep us perplexed and attentive. First since the issue of genetic testing to “determine whether you have a pre-existing medical condition” was briefly touched upon, on passé, and these tests risk to exclude anyone of us from the pool of normal insurable and shared risks, leaving us out in the cold, what now any individual, and indeed the whole society most need, is an insurance against whatever could be discovered in those tests. Second, and as any honest right-to-life conviction cannot go hand in hand with any further-delay-of-life action there are some groups pushing for the adoption of frozen-embryos, which could then lead us into a discussion of primary, secondary, and perhaps even of intellectual fathers.