scholarly journals Genetic Tests and Inter-Temporal Screening in Competitive Insurance Markets

2009 ◽  
Vol 9 (1) ◽  
Author(s):  
Winand Emons
Keyword(s):  
Finite Number ◽  
Genetic Test ◽  
Insurance Markets ◽  
Genetic Tests ◽  
Gene Carriers ◽  
Genetic Status ◽  
Successive Generations

Abstract We consider successive generations of non-altruistic individuals carrying either a good or bad gene. Daughters are more likely to inherit their mother's gene. Competitive insurers can perform a genetic test revealing an agent's gene. They can condition their quotes on the agent's or on her ancestors' genetic status. In equilibrium, generation one is bribed to take the test with an unconditional premium. The insurer uses this information to profitably screen a finite number of generations of their offspring. The offspring of good-gene carriers subsidize the tested generation.

Cancer specialists in the VA as early adopters of clinical genetic services.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 11029-11029
Author(s):  
Maren Theresa Scheuner ◽  
Paloma Sales ◽  
Mary Whooley ◽  
Katherine Hoggatt ◽  
Michael Kelley
Keyword(s):  
Risk Assessment ◽  
Genetic Testing ◽  
Genetic Test ◽  
Primary Care Providers ◽  
Precision Oncology ◽  
Genetic Tests ◽  
The Past ◽  
Cancer Specialists ◽  
Genetics Referral ◽  
Test Ordering

11029 Background: Genetic testing has become essential to delivery of cancer treatment, risk assessment, surveillance, and prevention. We sought to understand the use of genetic tests by clinicians in the Department of Veterans Affairs (VA). Methods: We administered a web-based survey to clinicians at 20 VA facilities with precision oncology programs. We excluded respondents if they were: not at one of the 20 VA facilities; not seeing patients in VA; not a physician, nurse practitioner (NP), physician assistant (PA), or pharmacist; a medical geneticist or specialty was not reported; or if the survey was incomplete. Using multiple logistic regression, we assessed the association between genetic test ordering, genetics referral, and clinician characteristics. Results: There were 909 (909/11,442, 8%) eligible respondents with 61% women and 64% under age 55. There were 571 physicians (63%), 200 NPs (22%), 93 pharmacists (10%), and 45 PAs 5(%). There were 361 (40%) primary care providers (PCPs), 90 (10%) cancer specialists, and 458 (50%) non-cancer specialists. Only 21% of clinicians reported feeling prepared to use genetic tests in their practice. In the past year, only 8% had ordered at least one multi-gene cancer test (germline, tumor or both), 12% a pharmacogenetic test, and 0.2%, an exome. Compared to physicians, NPs were 60% less likely (OR = 0.42, 0.23-0.77, p = 0.005), pharmacists, 80% less likely (OR = 0.22, 0.08-0.62, p = 0.005), and PAs, 90% less likely (OR = 0.08, 0.01-0.58, p = 0.01) to have ordered a genetic test. Compared to PCPs, cancer specialists were almost 5 times more likely to order a genetic test (OR = 4.74, 2.57-8.73, p < 0.0001); there was no difference in genetic test ordering between PCPs and non-cancer specialists. Among clinicians (n = 72) who had ordered cancer genetic tests, only about two-thirds were confident in knowing the indications for testing; discussing the potential benefits, harms and limitations of testing; understanding the test report; and knowing implications of results on disease management and prevention. Clinicians (n = 106) who had ordered pharmacogenetic tests had lower frequencies of confidence in these tasks. About half (52%) of the cancer specialists had referred patients to genetics in the past year; they were 1.8 times more likely than PCPs to refer (OR = 1.82, 1.10-3.03, p = 0.02), and non-cancer specialists were about 50% less likely than PCPs to refer (OR = 0.46, 0.33-0.64, p < 0.0001). Conclusions: In the VA, cancer specialists are integrating genetic testing and genetics referral into their practice more than PCPs and other specialists. However, genetic testing is underutilized, and many clinicians remain unprepared to use genetic tests in their practice. These results will inform workforce planning, clinician education, and development of clinical decision support to facilitate genetic risk assessment, informed consent, and ordering of genetic tests.

“What About Your Genes?” Ethical, Legal, and Policy Dimensions of Genetics in the Workplace

1997 ◽  
Vol 16 (1) ◽  
pp. 57-75 ◽  
Author(s):  
Trudo Lemmens
Keyword(s):  
Genetic Testing ◽  
Bargaining Power ◽  
Ethical Issues ◽  
Genetic Test ◽  
Genetic Data ◽  
Scientific Validity ◽  
Genetic Tests ◽  
Antidiscrimination Law ◽  
Harm To Others

Although few companies are currently applying genetic tests or using genetic data, further developments in genetics will likely increase the role of genetics in the workplace. This article discusses the complex ethical issues raised by the variety of genetic tests that could become available and proposes guidelines for dealing with genetics in the workplace. It discusses how the results of genetic testing could be used for employment purposes, and argues that the existence of unequal bargaining power in the workplace limits the validity of consent as a basis for policymaking. Instead, two specific justifications for genetic testing in the workplace are proposed: the protection of health and the avoidance of harm to others. The author suggests that genetic testing should be permitted only in exceptional circumstances and that every genetic test should be evaluated on its scientific validity and submitted to rigorous review. Existing antidiscrimination law proves to be a useful model for examining the rationality and proportionality of genetic testing in the workplace.

scholarly journals Genetic testing for Parkinson disease

2020 ◽  
pp. 10.1212/CPJ.0000000000000831
Author(s):  
Lola Cook ◽  
Jeanine Schulze ◽  
Catherine Kopil ◽  
Tara Hastings ◽  
Anna Naito ◽  
...  
Keyword(s):  
Genetic Testing ◽  
Parkinson Disease ◽  
Clinical Utility ◽  
Genetic Test ◽  
Genomic Testing ◽  
Test Results ◽  
Genetic Test Results ◽  
Genetic Status ◽  
Genetic Landscape ◽  
Busy Clinician

Purpose of reviewWith the advent of precision medicine and demand for genomic testing information, we may question whether it is time to offer genetic testing to our patients with Parkinson disease (PD). This review updates the current genetic landscape of PD, describes what genetic testing may offer, provides strategies for evaluating whom to test, and provides resources for the busy clinician.Recent findingsPatients with PD and their relatives, in various settings, have expressed an interest in learning their PD genetic status; however, physicians may be hesitant to widely offer testing due to the perceived low clinical utility of PD genetic test results. The rise of clinical trials available for patients with gene-specific PD and emerging information on genotype-phenotype correlations are starting to shift this discussion about testing.SummaryBy learning more about the various genetic testing options for PD and utility of results for patients and their care, clinicians may become more comfortable with widespread PD genetic testing in the research and clinical setting.

Impact of genetic tests on survivors of paediatric sudden cardiac arrest

2021 ◽  
pp. archdischild-2020-321532
Author(s):  
Shuenn-Nan Chiu ◽  
Jyh-Ming Jimmy Juang ◽  
Wei-Chieh Tseng ◽  
Wen-Pin Chen ◽  
Ni-Chung Lee ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Genetic Test ◽  
Age At Onset ◽  
Disease Onset ◽  
Sudden Cardiac Arrest ◽  
Shock Rate ◽  
Composite Panel ◽  
Long Qt ◽  
Genetic Tests ◽  
Pathogenic Variants

ObjectiveTo retrospectively investigate the clinical spectrum, genetic profiles and outcomes of survivors of paediatric sudden cardiac arrest (SCA).Design and patientsAll 66 patients (aged 1–20 years), with unexpected SCA or syncope related to ventricular tachycardia (VT)/fibrillation and who survived to discharge from a tertiary centre, were enrolled from 1995 to 2018. Of these, 30 with underlying diseases prior to the events were excluded. Whole-exome sequencing targeting 384 channelopathy and cardiomyopathy-related genes (composite panel) was conducted to identify the possible genetic variants/mutations.ResultsA total of 36 patients were enrolled. Male adolescents predominated (66.7%), and the median age at onset was 13.3 years. Events occurred most often during exercise and daily activities. The yield rate of the genetic test was 84.6% (22/26); 14 had pathogenic variants; and 8 had likely pathogenic variants. The most common diagnoses were long QT in nine (25%), catecholaminergic polymorphic VT in six patients (16.7%), but other long QT and cardiomyopathy genes were also detected in eight patients (30.7%). The 10-year transplantation-free survival rate was 87.8% and was better for those who received genetic tests initially at the disease onset. An implantable cardioverter–defibrillator was implanted in 55.6% of the patients, with an appropriate shock rate of 61.1%. The defibrillator shock rate was lower for those who received composite panel initially.ConclusionSurvivors of SCA in the paediatric population had favourable long-term outcomes aided by genetic test. A broad composite genetic panel brings extra diagnostic value in the investigation of ventricular fibrillation/sudden cardiac death.

Veterinarians’ Competence in Applying Basic Genetic Principles and Daily Implementation of Clinical Genetics: A Study in a University Environment

2021 ◽  
pp. e20210029
Author(s):  
Evelien Bogaerts ◽  
Else den Boer ◽  
Luc Peelman ◽  
Filip Van Nieuwerburgh ◽  
Hille Fieten ◽  
...  
Keyword(s):  
Genetic Test ◽  
Diagnostic Testing ◽  
Autosomal Recessive Inheritance ◽  
Clinical Genetics ◽  
Genetic Tests ◽  
University Environment ◽  
Daily Work ◽  
Electronic Survey ◽  
Apply Genetic ◽  
Future Education

Veterinarian competency in genetics is vital for a meaningful application of the rapidly growing number of genetic tests available for animals. We evaluated the use of genetic tests in the daily veterinary practice and the competency of university-employed veterinarians in applying basic principles of genetics in a clinical setting through an electronic survey with 14 cases and 7 statements on genetics. Ninety-one non-geneticist veterinarians from two veterinary faculties in two different countries responded. Almost half of the participants apply genetic tests during their daily work, with frequencies varying between weekly and once a year. The most common indication to request a genetic test was diagnostic testing of clinically ill patients. Although 80% of the veterinarians communicated the result of a genetic test themselves, only 56% of them found it “very to rather easy” to find the correct test, and only 32% of them always felt competent to interpret the result of the test. The number of correctly answered questions varied widely, with median scores of 9/14 (range 0–14) and 5/7 (range 0–7) for the cases and statements, respectively. Most difficulties were seen with recognition of pedigree inheritance patterns, while veterinarians scored better in breeding advice and probability of disease estimations. Veterinarians scored best on questions related to autosomal recessive inheritance, followed by complex, autosomal dominant, X-linked recessive, and X-linked dominant inheritance. This study exposed pain points in veterinarians’ knowledge and has led to the formulation of recommendations for future education and communication between laboratories, geneticists, and veterinarians.

scholarly journals Knowledge and awareness of genetic test available for risk of breast cancer among female students in UiTM

2021 ◽  
Vol 1 ◽  
pp. 14-18
Author(s):  
Sharifah Norliana Syed Hussin
Keyword(s):  
Breast Cancer ◽  
Genetic Testing ◽  
Genetic Test ◽  
Developed Countries ◽  
Genetic Tests ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Medical Undergraduate ◽  
University Technology ◽  
Level Of Knowledge

Background: Malaysians are less likely to be highly exposed of the information regarding genetic tests as compared to citizens of developed countries in the world. In addition to that, little is known about the level of knowledge and awareness of the genetic testing for risk of breast cancer detection among the students in University Technology Mara (UiTM). Materials and methods: A cross-sectional with correlational design study using a self-administered questionnaire was conducted among medical and non-medical undergraduate students of University Technology Mara (UiTM). The population from which the convenience sample gathered were those who fulfilled the inclusion criteria of this study. Results: Three hundred and eighty six (386) respondents were involved in present study, (50.8%) of them were familiar with the existence of the test while the remaining (49.2%) did not know about the genetic tests available for detecting gene mutations. Regards their interest in genetic testing to detect inheritable mutations, (35.8%) of them were definitely interest in the test, (38.3%) of them were probably interest in the test, (20.7%) of them were considering the test and the remaining (5.2%) have no interest in the test at all. About their awareness of the genetic test available for mutations detections, majority of them, (67.9%), agreed to get tested in order to learn of their own risk in getting breast cancer. In terms of their reason to avoid being tested, many of them, (40.7%) mentioned that the main reason is if the result comes out positive for genetic mutations, it will disrupt their daily lives. Conclusion: There were mild level of knowledge and moderate level of awareness about breast cancer genetic tests, but the respondents showed high level of interest towards genetic test available for breast cancer risk detection. Educational materials and programs may increase knowledge and awareness about the genetic test available for detection of inheritable mutations. The effectiveness of the educational strategies shall be tested in the future.

scholarly journals Consumer preferences for the predictive genetic tests for Alzheimer’s disease

2012 ◽  
Vol 13 (2) ◽  
pp. 61-67 ◽  
Author(s):  
Ming-Yi Huang ◽  
Matthew Perri III
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Genetic Testing ◽  
Genetic Test ◽  
Public Awareness ◽  
False Negative ◽  
Consumer Preference ◽  
Predictive Genetic Testing ◽  
Genetic Tests ◽  
Predictive Genetic Tests

With the advent of predictive genetic tests, individuals will have the option to investigate their future risk of developing diseases like Alzheimer’s disease (AD). This knowledge can benefit people as they start to prepare themselves as well as their families for the disease process. The use of predictive genetic tests will likely increase as technology and genetic marker identification continues to advance. Thus, aligning the clinical practice of predictive genetic testing for Alzheimer’s disease with patient values and preferences has the potential to improve healthcare delivery. Several issues have been identified in this review regarding people’s preference when making a decision to test for AD, which include prediction value (i.e. false-positive/false-negative results), availability of treatments that would prevent or delay onset of AD, and anonymity/confidentiality. Literature indicates the most relevant issues regarding consumer preference for AD genetic testing is predictive value (accuracy). While fewer studies have discussed the effects of treatment availability or anonymity on consumer preference, these issues may become more important as technology continues to advance and public awareness of these issues increases. Future research in the area of consumer behavior with regard to predictive genetic testing is suggested.Most previous studies regarding consumer intent and preference for AD genetic tests have used small samples, convenience samples, or samples which were predominantly Caucasian, female and high socioeconomic status. Additionally, effects of most socio-demographics on the preference for AD genetic test are unclear in the literature. Conflicting results have been found regarding gender, education, income, and culture. An extension of the previous work using a larger and randomized sample may help to provide clearer relationship between these socio-demographics and consumer preference for AD genetic test.

scholarly journals Genetic testing, life insurance, and adverse selection

1997 ◽  
Vol 352 (1357) ◽  
pp. 1063-1066 ◽  
Author(s):  
P. S. Harper
Keyword(s):  
Genetic Testing ◽  
Adverse Selection ◽  
Life Insurance ◽  
Genetic Test ◽  
Genetic Disorders ◽  
Commercial Activity ◽  
Genetic Tests ◽  
Test Information ◽  
Insurance Policies ◽  
The Uk

Life insurance is a key element of the UK social structure in terms of family protection and house purchase; it thus needs to be viewed in this broad context, rather that solely as a commercial activity. Insurers have not so far actively requested genetic tests for life insurance, but have insisted on knowing of and being able to act on existing genetic test information. The main reason given for this has been to avoid servious adverse selection; however, this has never been adequately estimated. Review of the different major categories of Medelian genetic disorders suggests that the scope for adverse selection is extremely limited and that insurers would lose little, and possibly gain more, by foregoing the disclosure and use of this information in relation to life insurance policies of ‘normal’ size and nature. The likely future use in service of genetic tests based on susceptibility or population screening makes it especially important that the issue is rapidly resolved for Menelian disorders; so far there is no sign that insurers are willing to achieve this.

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