Genomics: Brave New Twists In ‘Nature vs. Nurture’ Debate

John A. Marcille

There is every reason to think that the growing development of genetic tests and therapies will have a remarkable effect on health care. Who can help but feel a thrill at such possibilities as restoring the body’s ability to create insulin, or preventing Alzheimer’s disease, or identifying people who are most susceptible to various types of cancer — and then correcting that susceptibility?

Wonderful stuff, no doubt about it.

But this biotechnology revolution — I don’t think that term is an overstatement — will produce some collateral damage, as the military might put it. In this month’s cover story Managing Editor Mike Dalzell has put together a thoughtful and provocative report on the knotty problems that biotech advances are posing to physicians and health plan administrators. Take privacy of medical records, an issue that is buzzing around Washington in other contexts. Did you know that genetic assays sometimes may not be, technically, part of the medical record and not privileged? What if a medical group or an HMO declined to hire you because it knew that you had a greater-than-average chance of getting breast or colon cancer?

The great promise genomics brings to health care provides grist for the health policy mill, when you consider what demand for genetic services is likely to be. There aren’t enough trained medical professionals who know this field. Genetic therapies will be expensive. Some hard decisions lay ahead.

Another provocative article on benefit design (which, as with everything we publish, is presented for the sake of discussion, not advocacy), can be found in this issue. Cyril F. Chang, Ph.D., of the University of Memphis, discusses health plan and employer attitudes toward smoking cessation programs, and proposes ways to consider — societally and at the employer and plan level — how such programs should be funded. And if that’s not enough provocation for you, see our assessment of the present state of the hospitalist movement.

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