Genetic Testing Boom Ahead?

After 13 years of Congressional debate, the Genetic Information Nondiscrimination Act (GINA) finally was signed into law last month.

This landmark legislation removes a significant barrier to genetic testing by protecting Americans from discrimination based on their individual genetic profiles.

Health insurers will be prohibited from denying coverage or increasing premiums based solely on genetic predisposition toward a specific disease. Employers will not be allowed to consider genetic information when making decisions about hiring, placement, promotion and firing.

"Americans can finally take advantage of the tremendous potential of genetic research without the fear that their own genetic information will be used against them," said Representative Louise Slaughter (D-NY), who first introduced the legislation in 1995. Cosponsor of the bill, Senator Edward Kennedy (D-MA), said, "This bill paves the way for every American to benefit from the vast potential of this new age of personalized medicine."

Will GINA unleash a boom of genetic testing and therapies?

Not immediately. GINA's health-insurance provisions are predicted to take effect in about one year, followed by the employer provisions six months later.

In the meantime, commercial genetic testing labs and manufacturers of in vitro diagnostic (IVD) products may accelerate their efforts in anticipation. The most recent issue of IVD Technology stated, "Industry analysts believe GINA will remove public apprehension about getting genetic tests, which will encourage IVD manufacturers to continue developing such tests."

According to the Genetics and Public Policy Center at Johns Hopkins University, tests currently exist for nearly 1,500 diseases and conditions. Many are available to consumers on the Internet. 

That raises the question as to what people can actually do with the information they gain from genetic testing. Doctors can monitor patients and begin diagnostic and preventive care earlier to save lives. They can also more accurate determine dosages of certain medications, such as blood thinners.  Couples with hereditary conditions can make decisions about having children. And people genetically predisposed toward a disease can learn about it and make long-term medical, personal, legal and financial plans.

The present value of genetic testing has been put in perspective by Francis Collins, director of the Human Genome Project. He explained, "Genetic testing offers us a great opportunity to practice preventive medicine in a way that focuses more specifically on what each of us ought to do for our health. It is a great new model, but right now we don't quite know how to implement it."

Do I believe that GINA will generate a genetic testing boom? Not yet. In the short term I predict:

• A bit of a "gold rush" by companies selling direct-to-consumer tests

• More scrutiny and regulation of genetic test procedures and results

• Continuing debate over "civil rights" regarding genetic information

• More doctors prescribing and more patients accepting genetic tests

• Optimism and opportunity to strengthen the emerging IVD industry

• Healthcare organizations touting their capabilities in genetic testing

GINA is a great leap forward on the road to personalized medicine and the wondrous possibilities of genetic therapies. 

—Tom DeSanto

Photo: www.whitehouse.gov

Vacations and Morbidity

Often we're dying to go on vacation. But can vacations actually help us from dying? Maybe so.

Are Vacations Good for Your Health? The 9-Year Mortality Experience After the Multiple Risk Factor Intervention Trial by Brook B. Gump, PhD, MPH,  Karen A. Matthews, PhD

"There are a few possible mechanisms through which vacationing might have protective effects on health."

"First, vacations may reduce stress by removing ongoing stressors (e.g., avoidance). The health benefits of stress reduction are well documented..." [especially for cornary heart disease]

"Second, vacation may reduce stress by reducing potential stressors and anticipated threats, providing a period of "signaled safety." Anticipated threats are known to have adverse effects as great as, if not greater than the threat itself."

"Finally, annual vacations may provide a unique opportunity for behaviors having restorative effects on anabolic physiological processes, such as social contact with family and friends and physical activity, in the context of reduction of stress-initiated metabolic effects."

It's official. And yes, I'm on vacation now. Off to the beach! (And a healthier life)

— Tom DeSanto

Health Care Expectancy

"Life expectancy" brings to mind the idea of "healthcare expectancy." How long we expect to live has a lot to do with what we expect from our healthcare system.

Yesterday the National Center for Health Statistics released the latest life expectancy estimates. A child born in the U.S. in 2006 is likely to live approximately 78 years if mortality trends remain consistent. It's a new American record for predicted longevity, but as everything in healthcare goes, there's a flip side.

The U.S. still ranks behind about 30 other countries in estimated life span. (Japan holds first place with 83 years.)

Disparities remain: white women lead the list with 81 years, followed by black women with 77, white men with 76 and black men with 70.

These new statistics will stir debate over our return on investment as the nation that spends the most, by far, on healthcare. But the verdict depends on what we expect.

Overall, I believe our nation does not receive the level of care merited by our enormous expenditure. In individual cases, however, such as my nephew who overcame childhood cancer and is now a remarkable, robust 20-something, we receive priceless miracles.

Our "expectancy" for life and healthcare is skewed. We expect a long and healthy life. If that isn't our lot, we expect medical miracles to save us, restore our vitality and preserve us from serious illness. For ourselves and loved ones, we're all too willing to go to extraordinary measures to prolong life, even in its last days and against very steep odds.

As long as we insist on expecting so much from life and healthcare, our healthcare system will continue to fall short of our expectations. We will not lead the world in life expectancy. And all our citizens will not get the care and support they need to have long healthy lives.

We're at yet another crossroads for healthcare reform. As we examine the system, we'll also need to examine our expectations.

 — Tom DeSanto

Boomers: Crisis or Catalyst?

We all know that the Boomer generation, by its sheer numbers and projected utilization, will change our healthcare system forever.

But will Boomer's burgeoning medical demands foment a healthcare crisis? Or will they use their clout to demand and drive much-needed reform?

Recently I saw a television commercial for "Divided We Fail." It led me to a grassroots campaign that's growing rapidly right under our feet. 

AARP has joined forces with organizations that represent 53 million Americans to fight bipartisan gridlock over healthcare reform. They've put together a communications arsenal that includes everything you'd expect and  a lot more. A distinctive brand and icon. Invitations to sign a pledge. Town meetings. Personal stories of healthcare strife. A stirring anthem sung by Aretha Franklin. Voter registration. Opt-in for e-newsletters. YouTube. V-cards. E-cards. And links galore, all at www.DividedWeFail.org.

The July/August issue of AARP: The Magazine shouts a battle cry for healthcare reform. The article calls out provocative statistics on American healthcare:

• $500 billion is spent annually on unnecessary care.
• 30,00 Medicare recipients die each year as the result of unneeded care.
• 50% of surgeries, test and procedures are not backed by scientific evidence.

They're rallying the readers of the "world's largest circulation magazine" to take a stand and make a difference.

As the presidential election approaches, the Divided We Fail movement will surely spread like wildfire. The other half of their motto is "together we can do anything."

I agree. Intuition tells me that collectively the Boomers will become a catalyst for change long before they become a burden of catastrophic proportions. 

What do you think? Will the Boomers help sink the system or save it?

— Tom DeSanto