Just a few months after the press wrongly reported that insurance companies planned to make DNA tests compulsory, the genetics beast has returned to bite the industry once again. But this time, the trigger for column inches and public panic was the recent completion of the mapping stage of the human genome project.
As scientists announced they have the draft blueprint for human life, newspapers tapped into ongoing speculation that genetic testing could lead to an underclass of uninsurable, unemployable people. One unnamed IFA was even quoted in The Times
advising people to buy life insurance immediately, before being reduced to a DNA profile.
Politicians have also been quick to recognise the headline-grabbing potential of genetics. Health secretary Alan Milburn recently used the subject as ammunition in his ongoing battle with Conservative shadow health secretary Liam Fox. Speaking against PMI, Milburn claimed that as genome technology advances, PMI will play less and less of a role in the health of the nation.
But while advancing the cause of genetics in such areas, the government has also recognised that it must reassure the public about some aspects of genetics. As a result, it set up the Genetics and Insurance Committee (GAIC) last April.
This body has just finalised its evaluation criteria for the use of genetic test results in an insurance context. Any company wishing to use such test results for risk assessment must now submit an application to the GAIC stating why this result is relevant.
Despite the depiction, in some of the press, of insurers lining up with swabs and syringes to take advantage of genetic testing, the Association of British Insurers (ABI) has always said it will abide by GAIC decisions. And, in light of the new evaluation criteria, the` trade body has also announced it will reassess affected premiums if any genetic test is not approved by the GAIC.
“Depending on what the GAIC concludes about the reliability of certain tests, the insurance industry is prepared to re-underwrite policies and reimburse people if they have lost out,” says ABI spokesperson Suzanne Moore. “We don’t think this will be a huge exercise as we only use results from a small number of tests, and our own code of practice already imposes stringent restrictions on using this information. But if there are differences between our code and what the GAIC decides, we will ensure that no one loses out.”
Understandably, the ABI has become increasingly frustrated that, despite constant denials, the press is still speculating on whether the insurance industry will introduce compulsory genetic testing. The issue for insurers has always been about access to results from tests that people have already taken, and industry insiders are adamant that they will never make genetic tests a condition of buying insurance.
“Having a genetic test is an extremely personal issue,” says ABI-nominated GAIC member and ERC Frankona Reassurance deputy managing director Tony O’Leary. “It’s often something people decide to do if they want to get married or start a family, and the insurance industry has no wish to influence that decision – it would be inappropriate to do so. But if someone has already taken a test, then, according to the basic proposition of equal knowledge for insurer and insured, companies feel they have a right to that information.”
GAIC chairman and assistant director of the Science Museum, Professor John Durant, says that the committee is now in “response mode”, waiting for applications from insurers for the test results already used to calculate risks. But, as of a month after the GAIC finalised its evaluation criteria, it was still yet to receive a detailed application from any provider.
“When applications do come in, we will investigate whether insurers have used genetic test results properly, accurately and fairly – that is, whether the result reliably indicates the presence of genes that will have an actuarially significant impact on life or health insurance,” says Durant.
The ABI code of practice covers 10 genetic tests for seven conditions – including Huntingdon’s chorea, myotonic dystrophy, the early onset form of Alzheimer’s disease and some rare inherited cancers. And despite the recent breakthrough in human genome technology, the Association says it has no plans at the present time to push for the inclusion of further tests. One reason for this, according to Durant, is the sheer complexity of our genetic make-up.
“As soon as you get beyond the simple tests that identify dominant genetic characteristics, the situation becomes far more complicated,” he explains. “With multi-factorial or polygenic disorders, having a certain gene might only mean a person is slightly more predisposed to that condition than normal – so an insurer would have to consider how worthwhile the test is. There are plenty of ways that insurance companies could waste time and money when dealing with genetics and only a few in which they could get useful information.”
Scottish Provident product marketing manager (protection) Roger Edwards says that the high cost of genetic testing will also prevent its wider use for insurance purposes. “For me, that’s one reason why providers will never ask people to take genetic tests,” he says. “Why spend a huge amount of money on something that, in my view, is no more reliable an indicator of potential conditions than family history? And even if the tests become more accurate, there are still so many environmental factors that can influence health.”
Specialist critical illness (CI) intermediary John Joseph, from John Joseph Financial Services, has much the same opinion. “I don’t think genetics will ever reach the stage where it can predict whether or not someone will definitely have a heart attack,” he says. “Genetic testing will indicate someone’s predisposition to certain conditions, but that’s not necessarily any more accurate than blood screening or family history.”
While health insurance players recognise that genetics will eventually have a major impact on the industry, most approach the subject with extreme caution.
Bupa does not currently ask for access to genetic information even if people have already taken a test. This is because the company believes there are many other factors that can influence mortality, such as general lifestyle or smoking. Bupa Health Assurance managing director Geoff Brown says: “If we receive this type of test result inadvertently from a GP, we will only take it into consideration if it means a reduction in premiums. If someone with a family history of a certain condition wants CI cover, for example, they would usually face loaded premiums. But if a genetic test reveals that they are not predisposed to the condition, they can avoid this.”
As for the future, Brown says the health insurance market will evolve in relation to the reliability and validity of genetic tests and providers will obviously monitor the situation closely. “Some people believe that the completion of the genome project will drive down insurance costs on the basis that new ways of treating genes will cure currently incurable diseases and reduce claims,” he says. “Insurance will be cheaper because there will be less risk. But, on the other hand, new gene therapy treatments will almost certainly be expensive, which could push premiums up to cover service provision, increasing overheads.”
So, despite the talk of a genetic minefield, the insurance industry seems to have adopted a sensible approach to something that will inevitably change its landscape.
Market analysis company Datamonitor says that the lure of massively profitable underwriting will eventually force insurers to make genetic tests compulsory, but providers maintain that this is simply not the case. Most believe that genetic testing will never be entirely accurate in predicting the onset of specific conditions – however advanced testing becomes, there will always be environmental factors – and realise that introducing mandatory tests would amount to public relations suicide.
But however well the insurance industry deals with forthcoming genetic advances, anything that carries the slightest suggestion of discrimination will always face hostility.
As Datamonitor senior analyst Muriel Oatham says, any medical advances that come from genetics will always be years away from the hospital environment, so the more negative `underclass’ side of the subject will always be more in the public eye.
O’Leary adds: “People are afraid of genetics because we’ve all heard so much about eugenics and the master race concept, and the thought of one person being better than another simply because of their genes goes against our fundamental notion of individuality. Add that to the insurance industry’s less than perfect reputation and you can see why we need to put people’s minds at rest.
“Bodies like the ABI Genetics Commission, GAIC and the Human Genetics Commission are looking at the wider social and ethical implication of genetics from all angles to find the best way forward, and I think it’s unfortunate that the press never seems to report that.”
Brown feels that some united action from health insurers may be necessary if the media storm over genetics carries on. “If there is still talk of underclasses by the time GAIC reports on the reliability of various genetic tests later this year, some industry response may be necessary to reassure the public of our intentions,” he says.