How genetic testing is changing medicine

As genetics becomes more a part of medical practice, illness will be redefined, and the nature of health insurance will be altered.

By Victoria Stagg Elliott, AMNews staff. Nov. 19, 2001.

Since the completion of the Human Genome Project last year, announcements of new gene-related discoveries have accelerated.

New predictive and diagnostic tests have been manufactured. The Food and Drug Administration has approved novel drugs targeting the molecular basis of disease. And this is only the beginning. But the question remains: Who will pay for the genetic revolution?

"I have no answers," said Alan H. Spiro, MD, a health and welfare consultant with the management firm Towers Perrin. "I have only questions. But the Human Genome Project is going to have profound effects on health insurance as it will medicine in general. It may redefine what we consider benefits to be, how we manage the plans and how employers manage benefits." Dr. Spiro spoke at the BlueCross BlueShield Assn.'s Best Practices in Medical and Pharmacy Management Conference in Chicago in October.

At the moment, clinicians who deal with genetic issues in their practice complain that reimbursement is spotty at best. Some insurance companies pay. Some don't. Others require proof of medical necessity and still others require genetic counseling accompany any tests.

Still, genetics has made some inroads in very specific situations. Children with leukemia are now more often tested for genetic abnormalities that determine how they react to treatment with mercaptopurine. And testing for BRCA1 and BRCA2, genes that account for some breast cancers, is becoming more common.

"For high-risk women, those tests have a lot of value," said Morris Mellion, MD, chief medical officer of Blue Cross and Blue Shield of Nebraska. [...]