If their results are accurate to a degree, why are their tests not being subsidized by insurance companies. How much would an insurance co save by alerting a patient to her chances of getting diabetes, not to mention the money the patient would itself save.
1. Genetic disorder. Tay–Sachs, etc. This stuff is priceless, because in the past, you had to pay thousands of dollars to get these same tests tone. These are accurate and very worthwhile ... but the majority of people will come back with all negative results, which is actually a good thing.
2. Your "increased risk" to certain diseases, like heart disease, etc. IMHO, these aren't worth much. A substantial portion of the risk for these types of diseases is related to lifestyle, so take it with a grain of salt.
3. Fun info, like telling you your eye color, where your ancestors came from, etc.
> why are their tests not being subsidized by insurance companies.
Insurance companies really only want #1. And guess what? That's info that I really don't want them to have.
4. You're (nearly) immune to an infectious disease. It's good to know when a friend is puking their guts out that I can help take care of them since I'm one of the lucky 20% of white people with wonky fucosyltransferase that won't act as a receptor for the virus.
And knowing (2) lets channel potential anxiety about salt consumption into anxiety about fat consumption, letting me stay healthier on a given anxiety budget.
For #1 if you have any Ashkenazi Jewish blood or suspect you do, it's really worth it for peace of mind. A lot of people say they don't get interesting results, but as someone who is 25% Ashkenazi I was pretty happy at the lack of "interesting" findings- to find I carry only a minor form of hemophilia among the Ashkenazi-related genetic disorders 23andme tracks.
"This stuff is priceless, because in the past, you had to pay thousands of dollars to get these same tests"
You still have to pay thousands of dollars if you need the results for actual medical purposes. 23andme only tests for a few of the common SNPs that can cause each disease, but the testing isn't as comprehensive as what you'd get from a doctor.
Actually there is a startup called Counsyl that tests for about 1000 of those genetic diseases for about $350. I think you have to get it through a doctor though.
Yes , but wouldn't Nbr 2 in itself be worth a lot if the patient would make lifestyle changes in response to increased risks highlighted in their genetic profile. Suppose you have a genetic proclivity for alcoholism, wouldn't most people watch their consumption a lot more if provided with that information.
But if one is predisposed to alcoholism, they might think, "Why even try to fight it? I'm going to succumb at some point anyway, might as well give up now and just enjoy it."
This is just to say that that sword has two edges.
EDIT: Made it abundantly clear that this is not my own personal fatalistic perspective.
This is clearly not my perspective. I'm just illustrating the opposite viewpoint of the one you espoused for the purpose of reminding you that there is an unhappy alternative viewpoint.
predisposed: make someone liable or inclined to a specified attitude, action, or condition.
Just because you're more inclined to do something, doesn't mean you're likely to do something. See the other comment about a 50% increased likelihood moving someone from 1% to 1.5% risk of succumbing to alcoholism.
That said, a lot of people may make the same mistake and succumb to alcoholism erroneously based on the tests.
What you are saying is so true that it becomes almost irrelevant to the discussion. Or, rather, if people understand what you are saying then the rest of the discussion is moot. So the discussion is premised on the fact that many people don't have enough statistical understanding to consider things through that lens.
Let us assume that the absolute risk is non-negligible, and that the predisposition is also non-negligible. Even then, the way that an individual responds to knowledge of genetic risk is idiosyncratic. Some will fight the predisposition even harder, others will succumb even quicker, still others won't know or care.
Because we are talking about the psychology of the individual, and because people do not understand statistics, much less the difference between absolute and relative risk, the fact that the absolute risk for virtually every disease is very small will not matter when an individual considers the issue psychologically.
"The heritability of prostate cancer is estimated to be 42-57%." My chance of prostate cancer is 25% instead of 17% for baseline european-ancestry males. I eat even more fruits and veggies and avoid animal fats now.
Category 2 appears to be worthless for me. For many of the risks there, I have conflicting results (i.e., 5 studies were done on this disease and according to 2 of them, I'm at increased risk while the other 3 indicate that I'm at decreased risk).
That's not how insurance works now; if you already have insurance for your family, they don't render family members ineligible for therapy based on evidence of predisposition to illness.
And as of 2014, regardless of the nature of the evidence, insurance companies will no longer be allowed to exclude customers based on predisposition to illness or preexisting conditions.
It's not just privacy or human rights; it's an apparently pervasive misconception about what insurance is.
The premise of insurance is that you are insuring against the unknown. If you know that something is the matter with you, then it's no longer insurance. It's getting someone to pay for a treatment that you know you will need. Whether other people should be paying for that is another discussion.
While I think it is important for people to understand the difference between health insurance and a health care plan, there's no actual problem with people banding together and creating health care plans that are no longer, strictly speaking, insurance.
I do think a nontrivial amount of the mess in the health care system is the confusion between the two. People want to create health care plans, but they are trying to make it out of insurance companies, which is going to be problematic at best. Further, people want health care plans but don't want to think about it from an actuarial perspective... because they don't like the answers that come out. That doesn't prevent the answer from coming out, but it does mean we end up trying to build glorious systems that seal themselves away from reality from the get go, and that also can only be problematic at best, total failures at worst.
I think that the more certainty people have about their future medical issues the less likely health care plan groups are to work. What incentive does a future-healthy person have to join with someone who is certain to have high expenses? And why would you trust someone to tell you that they haven't been tested and know what lies ahead?
That's what I'm getting at. The more knowledge all the participants have (and that's both insurance and users), the more the fundamental contradictions between "insurance" and "health care plans" emerge. But closing your eyes and just remaining ignorant is a terrible choice too, because in the medical domain, knowledge isn't just power, it's life.
Why not ? laws could be passed to forbid the use of genetic profiles in establishing premium rates the same way gender or ethnicity are not allowed for use when calculating credit scores. We're talking about a win-win-win (consumer, insurance company, state/ fed) situation for everybody if only we could learn to trust a lil bit. Why does every relationship between a consumer & a service provider has to be rooted in mistrust ?
EDIT : Why is this being down-voted ?
"`(A) IN GENERAL- For purposes of this section, a group health plan, and a health insurance issuer offering group health insurance coverage in connection with a group health plan, may not adjust premium or contribution amounts for the group covered under such plan on the basis of genetic information."
This might be the way we're going even if people don't want to share their genetic profile with their insurance company.. what if 23AndMe and UHC (insurance co.) get into a deal where they provide this service for free? And what if UHC raises premiums on everyone that does not take this test? What if employers require their employees to do this much like drug / background checks?
Sure, and you say no. Just like you say no to the checkout clerk asking for your phone number when you make a purchase. Same way you so no to a cop when he asks to search your vehicle.
I don't disagree, and that is an easily imaginable scenario. But much like the cop they can still make things at best, uncomfortable, or at worst, nearly intolerable, for you. Creating that sort of de facto requirement is where the real problem lies (there's no legal obligation, but most of those vehicle search requests are performed anyway).
We already have employers requesting "voluntary" disclosure of health information (e.g., cholesterol check) as a condition of continuing group insurance coverage. Since it's illegal to require this information, they make it voluntary - but anyone who opts-out also opts-out of a hefty premium "discount". In reality, the "discounted" rate is closer to what employers would expect to pay for comparable group plans, while the non-discounted premium is high enough that 99% of employees line right up to have their blood drawn by the visiting nurse (conveniently stationed in the conference room down the hall).
It depends what you mean by "results". The genetic results are very accurate (a >99% call rate and >99.9% reproducibility rate).
However, medical knowledge isn't at a high enough level for these accurate genetic results to translate into truly meaningful medical results except for a handful of conditions. What does a 10% increased risk of getting diabetes mean to the average person? In practice, it means nothing, because you would act the same with or without this risk.
Second, 23andMe is already walking the fine line of not needing FDA approval. If insurance companies were to pay for it, there's a good chance it would require this. There are several conditions that can be self diagnosed through 23andMe that require genetic tests that cost more than $99 through your doctor, but each of those tests has gone through a medical approval process.
What are the chances my current insurance company has to pay for treatment many years down the line? If I change jobs there is a good chance I will change insurance.
