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Muller C, Gallacher L, Keogh L, McInerney-Leo A, Boughtwood T, Gleeson P, Barlow-Stewart K, Delatycki MB, Winship I, Nowak KJ, Otlowski M, Lacaze P, Tiller J. "Uninsurable because of a genetic test": a qualitative study of consumer views about the use of genetic test results in Australian life insurance. Eur J Hum Genet 2024; 32:827-836. [PMID: 38637700 PMCID: PMC11219861 DOI: 10.1038/s41431-024-01602-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/22/2024] [Accepted: 03/20/2024] [Indexed: 04/20/2024] Open
Abstract
Genetic testing can provide valuable information to mitigate personal disease risk, but the use of genetic results in life insurance underwriting is known to deter many consumers from pursuing genetic testing. In 2019, following Australian Federal Parliamentary Inquiry recommendations, the Financial Services Council (FSC) introduced an industry-led partial moratorium, prohibiting life insurance companies from using genetic test results for policies up to $AUD500,000. We used semi-structured interviews to explore genetic test consumers' experiences and views about the FSC moratorium and the use of genetic results by life insurers. Individuals who participated in an online survey and agreed to be re-contacted to discuss the issue further were invited. Interviews were 20-30-min long, conducted via video conference, transcribed verbatim and analysed using inductive content analysis. Twenty-seven participants were interviewed. Despite the moratorium, concerns about genetic discrimination in life insurance were prevalent. Participants reported instances where life insurers did not consider risk mitigation when assessing risk for policies based on genetic results, contrary to legal requirements. Most participants felt that the moratorium provided inadequate protection against discrimination, and that government legislation regulating life insurers' use of genetic results is necessary. Many participants perceived the financial limits to be inadequate, given the cost-of-living in Australia. Our findings indicate that from the perspective of participants, the moratorium has not been effective in allaying fears about genetic discrimination or ensuring adequate access to life insurance products. Concern about genetic discrimination in life insurance remains prevalent in Australia.
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Affiliation(s)
| | - Lyndon Gallacher
- University of Melbourne, Parkville, VIC, Australia
- Victorian Clinical Genetics Services, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Louise Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Aideen McInerney-Leo
- Frazer Institute, The University of Queensland, Dermatology Research Centre, Brisbane, QLD, Australia
| | - Tiffany Boughtwood
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Australian Genomics, Melbourne, VIC, Australia
| | | | - Kristine Barlow-Stewart
- Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, VIC, Australia
| | - Martin B Delatycki
- Victorian Clinical Genetics Services, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Ingrid Winship
- Department of Medicine, the University of Melbourne, Melbourne, VIC, Australia
- Genomic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Kristen J Nowak
- Office of Population Health Genomics, Western Australia Department of Health, Perth, WA, Australia
| | - Margaret Otlowski
- Faculty of Law and Centre for Law and Genetics, University of Tasmania, Hobart, TAS, Australia
| | - Paul Lacaze
- Public Health Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jane Tiller
- Murdoch Children's Research Institute, Parkville, VIC, Australia.
- Australian Genomics, Melbourne, VIC, Australia.
- Public Health Genomics, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
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Cowan JS, Kagedan BL, Graham GE, Heim-Myers B, Bombard Y. Implications pour les soins de santé de la Loi sur la non-discrimination génétique. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:e252-e255. [PMID: 36100382 PMCID: PMC9470198 DOI: 10.46747/cfp.6809e252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
| | | | - Gail E Graham
- Chef du Département de génétique au Centre hospitalier pour enfants de l'est de l'Ontario à Ottawa, maintenant à la retraite
| | - Bev Heim-Myers
- Ancienne présidente-directrice générale de la Huntington Society of Canada et présidente de la Canadian Coalition for Genetic Fairness à Waterloo (Ontario)
| | - Yvonne Bombard
- Professeure agrégée à l'Institute of Health Policy, Management and Evaluation de l'Université de Toronto (Ontario) et scientifique au Unity Health Toronto du Li Ka Shing Knowledge Institute de l'Hôpital St Michael's.
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Cowan JS, Kagedan BL, Graham GE, Heim-Myers B, Bombard Y. Health care implications of the Genetic Non-Discrimination Act: Protection for Canadians' genetic information. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:643-646. [PMID: 36100377 PMCID: PMC9470184 DOI: 10.46747/cfp.6809643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
| | | | - Gail E Graham
- Retired Chief of the Department of Genetics at the Children's Hospital of Eastern Ontario in Ottawa
| | - Bev Heim-Myers
- Past Chief Executive Officer of the Huntington Society of Canada and Chair of the Canadian Coalition for Genetic Fairness in Waterloo, Ont
| | - Yvonne Bombard
- Associate Professor in the Institute of Health Policy, Management and Evaluation at the University of Toronto in Ontario and Scientist at the Li Ka Shing Knowledge Institute of St Michael's Hospital Unity Health Toronto
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Prince AE, Uhlmann WR, Suter SM, Scherer AM. Genetic testing and insurance implications: Surveying the US general population about discrimination concerns and knowledge of the Genetic Information Nondiscrimination Act (GINA). RISK MANAGEMENT AND INSURANCE REVIEW 2021; 24:341-365. [PMID: 35663290 PMCID: PMC9165621 DOI: 10.1111/rmir.12195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 11/05/2021] [Indexed: 06/15/2023]
Abstract
Globally, due to public concerns of genetic discrimination, some countries and insurance industries have adopted policies restricting insurer use of genetic information, such as the US Genetic Information Nondiscrimination Act (GINA). This study reports on combined analysis of two surveys assessing public knowledge of GINA and concerns of genetic discrimination in a diverse U.S. sample (N=1616). We focus on whether occupation, genetic testing history, and insurance status are correlated with knowledge of GINA or concerns of discrimination. While bivariate analysis identified some populations with higher subjective/objective knowledge and concern relative to counterparts, multivariable regression identified very few significant associations with outcomes of interest. Overall, this study highlights lack of awareness and understanding of GINA, even among subpopulations hypothesized to have greater knowledge of the law. These findings have implications for the broader debate around insurer use of genetic information.
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Affiliation(s)
| | - Wendy R. Uhlmann
- Department of Internal Medicine, Division of Genetic Medicine; Department of Human Genetics; Center for Bioethics and Social Sciences in Medicine, University of Michigan School of Medicine
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Bélisle-Pipon JC, Vayena E, Green RC, Cohen IG. Genetic testing, insurance discrimination and medical research: what the United States can learn from peer countries. Nat Med 2019; 25:1198-1204. [PMID: 31388181 DOI: 10.1038/s41591-019-0534-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 06/25/2019] [Indexed: 12/29/2022]
Abstract
While genetic testing may be the gateway to the future of medicine, it also poses challenges for individuals, especially in terms of differentiated treatments on the basis of their genetic characteristics. The fear of unwanted disclosure to insurers and the possibility of genetic discrimination can hamper the recruitment of individuals for clinical research that involves genetic testing. Precision medicine initiatives, such as All of Us, are proliferating in the United States. In order to succeed, however, they must ensure that the millions of Americans recruited to share their genetic data are not penalized with regard to life, disability and long-term insurance coverage. In this Perspective, we discuss several initiatives adopted by countries around the world, such as the United Kingdom and France, that better balance the interests of insurers and research subjects, and explain how the United States might learn from them. We call for regulatory and industry leadership to come together to establish a voluntary moratorium on insurance pricing with the aim of protecting research participants.
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Affiliation(s)
| | - Effy Vayena
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Robert C Green
- Brigham and Women's Hospital, Broad Institute and Harvard Medical School, Boston, MA, USA
| | - I Glenn Cohen
- Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard Law School, Cambridge, MA, USA.
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Thorogood A. Canada: will privacy rules continue to favour open science? Hum Genet 2018; 137:595-602. [PMID: 30014188 PMCID: PMC6132649 DOI: 10.1007/s00439-018-1905-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 07/05/2018] [Indexed: 12/03/2022]
Abstract
Canada’s regulatory frameworks governing privacy and research are generally permissive of genomic data sharing, though they may soon be tightened in response to public concerns over commercial data handling practices and the strengthening of influential European privacy laws. Regulation can seem complex and uncertain, in part because of the constitutional division of power between federal and provincial governments over both privacy and health care. Broad consent is commonly practiced in genomic research, but without explicit regulatory recognition, it is often scrutinized by research or privacy oversight bodies. Secondary use of health-care data is legally permissible under limited circumstances. A new federal law prohibits genetic discrimination, but is subject to a constitutional challenge. Privacy laws require security safeguards proportionate to the data sensitivity, including breach notification. Special categories of data are not defined a priori. With some exceptions, Canadian researchers are permitted to share personal information internationally but are held accountable for safeguarding the privacy and security of these data. Cloud computing to store and share large scale data sets is permitted, if shared responsibilities for access, responsible use, and security are carefully articulated. For the moment, Canada’s commercial sector is recognized as “adequate” by Europe, facilitating import of European data. Maintaining adequacy status under the new European General Data Protection Regulation (GDPR) is a concern because of Canada’s weaker individual rights, privacy protections, and regulatory enforcement. Researchers must stay attuned to shifting international and national regulations to ensure a sustainable future for responsible genomic data sharing.
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Affiliation(s)
- Adrian Thorogood
- BCL/LLB, Centre of Genomics and Policy, McGill University, Montreal, Canada.
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Dupras C, Song L, Saulnier KM, Joly Y. Epigenetic Discrimination: Emerging Applications of Epigenetics Pointing to the Limitations of Policies Against Genetic Discrimination. Front Genet 2018; 9:202. [PMID: 29937773 PMCID: PMC6002493 DOI: 10.3389/fgene.2018.00202] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/22/2018] [Indexed: 12/14/2022] Open
Abstract
Over more than two decades, various policies have been adopted worldwide to restrict the use of individual genetic information for non-medical reasons by third parties and prevent ‘genetic discrimination’. In this paper, we bring attention to the growing interest for individual epigenetic information by insurers and forensic scientists. We question whether such interest could lead to ‘epigenetic discrimination’ – the differential adverse treatment or abusive profiling of individuals or groups based on their actual or presumed epigenetic characteristics – and argue that we might already be facing the limitations of recently adopted normative approaches against genetic discrimination. First, we highlight some similarities and differences between genetic and epigenetic modifications, and stress potential challenges to regulating epigenetic discrimination. Second, we argue that most existing normative approaches against genetic discrimination fall short in providing oversight into the field of epigenetics. We conclude with a call for discussion on the issue, and the development of comprehensive and forward-looking preventive strategies against epigenetic discrimination.
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Affiliation(s)
- Charles Dupras
- Centre of Genomics and Policy, McGill University and Genome Quebec Innovation Centre, Montreal, QC, Canada
| | - Lingqiao Song
- Centre of Genomics and Policy, McGill University and Genome Quebec Innovation Centre, Montreal, QC, Canada
| | - Katie M Saulnier
- Centre of Genomics and Policy, McGill University and Genome Quebec Innovation Centre, Montreal, QC, Canada
| | - Yann Joly
- Centre of Genomics and Policy, McGill University and Genome Quebec Innovation Centre, Montreal, QC, Canada
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