Direct-to-consumer personal genetic profiling services that claim to predict people’s health risks by analysing their DNA are often inconclusive and companies that sell them should provide better information about the evidence on which the results are based, says the Nuffield Council on Bioethics, in a new report on the ethics of so-called personalised healthcare services.
The report says that claims that these services are leading to a new era of ‘personalised healthcare’ are overstated and should be treated with caution. The Council recommends that regulators of these services and advertising regulators should request evidence to back up the claims made by companies.
The services are marketed to healthy people as a way of finding out their risk of developing serious conditions such as diabetes, heart disease, Parkinson’s disease and some cancers. But people taking the tests are faced with complicated risk data in their results and may experience undue anxiety, or be falsely reassured, says the Council.
Professor Christopher Hood, chair of the Working Party that produced the report, said:
“Commercial genetic profiling services may seem to be providing more choice to consumers, but the test results can be unreliable and difficult to interpret and they are often offered to people with little or no genetic counselling or support”.
“People should be aware that other than prompting obvious healthy lifestyle choices such as taking more exercise, eating a balanced diet and reducing alcohol consumption, the tests are unlikely to inform them of any specific disease risks that can be significantly changed by their behaviour,” added Professor Hood.
Currently there is no overarching system of regulation for personal genetic profiling. The tests are mainly provided by companies based in the US, and they can cost up to US $2,000. During its inquiry, the Council wrote to providers of genetic profiling services to try to find out how many people are currently using them, but the companies were not willing to share this information.
The Council recommends that genetic profiling companies should provide more information about their services to consumers before they buy, such as their limitations, the fact that the results may require interpretation by a doctor or geneticist, and which other third parties may have access to the data arising from the test. Government-run health websites should provide information about the risks and benefits associated with personal genetic profiling services, including whether or not it could be necessary for people to inform insurance companies of the results.
Professor Nikolas Rose, one of the authors of the report, said:
“Genetic profiling services come with the promise that people will be able to take more responsibility for their health – but it is not clear what that responsibility would imply.”
“You may feel a responsibility to change your lifestyle on the basis of your results, without the help of a doctor to interpret the ambiguous risk statistics. You may feel a responsibility to inform family members, insurers or potential employers of your risks, even though you may never develop the conditions in question,” added Professor Rose.
To make these recommendations, the Working Party weighed up whether the need to reduce harm was strong enough to propose interventions that compromised people’s freedom to pursue their own interests.
The report also considers another so-called personalised healthcare service – direct-to-consumer CT, MRI and ultrasound body scans as a form of ‘health check-up’ for people without pre-existing symptoms, a service which some companies offer at a cost of more than £1,000.
CT scans carry serious physical risks from the radiation involved, especially if whole body scans are used, and carried out on repeated occasions.
The Council says that the commercial sale of whole body CT scans as a health check for people without prior symptoms of illness should be banned, as any potential benefits do not justify the potential harms caused by the radiation. It also suggests that companies offering scans as part of a health check should be regulated to ensure they are meeting standards of quality and safety.
The Council recommends that doctors should receive specific training on giving advice to patients about direct-to-consumer genetic profiling and body imaging services, and about making referral decisions on the basis of these tests.
“It would be unfair for people to be referred unnecessarily for specialist treatment on the NHS as a result of their genetic profiling or body imaging service that they have purchased, ahead of others who have not done so, or don’t have the means to. On the other hand, it would be unfair for a publicly-funded healthcare system to turn away people who are worried about their health as a result of a privately bought service. This raises a difficult dilemma, and doctors therefore must be supported in advising patients about, the limitations of the tests and any lifestyle changes that are being considered,” said Professor Rose.
NOTES TO EDITORS
1 For further information contact:
Nuffield Council on Bioethics
28 Bedford Square, London WC1B 3JS
Tel: +44 (0)20 7681 9619
Mob: +44 (0)7821 449 725
The Nuffield Council on Bioethics established a Working Party in 2008 to examine the ethical issues raised by new developments and technologies that promise us more personalised healthcare. The group included members with expertise in medicine, science, law, philosophy, ethics, and health policy.
To inform its deliberations, the Working Party:
- held a public consultation to gather views from a wide range of people including those using or contemplating using these services, those involved in providing them in the public and private context, researchers, academics, regulators, policy makers and other
- held a series of ‘fact-finding meetings’ with scientists, providers of healthcare services and regulatory bodies, including a joint workshop with the Harvard University Program in Ethics and Health
The Working Party developed an ethical framework consisting of five ethical principles against which each of these new developments were examined, and on which the recommendations are based. The principles are:
1. private information should be safeguarded
2. individuals should have freedom to make their own choices
3. the state should act to reduce harm
4. public resources should be used fairly and efficiently
5. social solidarity (the sharing of risks and protection of the vulnerable)
The Working Party also looked at the implications of consumerisation in healthcare and of people being encouraged to take more personal responsibility for their health.
The Working Party’s conclusions and recommendations are published today in the report Medical profiling and online medicine: the ethics of ‘personalised’ healthcare in a consumer age.
3 The report
Copies of the report Medical profiling and online medicine: the ethics of ‘personalised’ healthcare in a consumer age will be available to download from Tuesday 12 October 2010. To request an advance copy on 11 October please contact Sarah Bougourd (see above).
4 Video footage
A video interview with Professor Christopher Hood and Professor Nikolas Rose is available on request, for more information please contact Sarah Bougourd (see above).
5 Working Party members
Professor Christopher Hood FBA (Chair)
Gladstone Professor of Government and Fellow, All Souls College, University of Oxford
Professor Kay-Tee Khaw CBE FRCP
Professor of Clinical Gerontology, University of Cambridge School of Clinical Medicine, Addenbrooke’s Hospital
Dr Kathleen Liddell
Senior Lecturer, Faculty of Law, University of Cambridge
Professor Susan Mendus FBA
Professor of Political Philosophy, University of York
Professor Nikolas Rose
Martin White Professor of Sociology, BIOS Centre for the Study of Bioscience, London School of Economics and Political Science
Professor Peter C Smith
Professor of Health Policy, Imperial College Business School, London
Professor Sir John Sulston FRS
Chair, Institute of Science, Ethics and Innovation, University of Manchester
Professor Jonathan Wolff
Professor of Philosophy, University College London
Professor Richard Wootton
Director of Research, Norwegian Centre for Telemedicine and Integrated Care, Tromsø, Norway
6 About the Nuffield Council on Bioethics
The Nuffield Council on Bioethics examines ethical issues raised by new developments in biology and medicine. Established by the Nuffield Foundation in 1991, the Council is an independent body, funded jointly by the Foundation, the Medical Research Council and the Wellcome Trust. The Council has achieved an international reputation for addressing public concerns, and providing independent advice to assist policy makers and stimulate debate in bioethics.
The Council has previously reported on the ethical issues raised by pharmacogenetics, the study of the effects of genetic differences between individuals in their response to medicines. See: Pharmacogenetics: ethical issues (published September 2003) available at http://nuffieldbioethics.org/project/pharmacogenetics/