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Dr. John Chevers (PHG Foundation – guest contributor)
Insurers understand better than most that predicting ill health is more about probability than certainty. The industry’s predictive expertise is developed from objective analysis of medical reports and claim histories. Underwriters never have definitive clinical information, but rather make sensible and balanced decisions about risk, based on context more than scientific validation.
In many markets, insurers’ use of genetic test information is precluded or restricted by legislation. Concerning how insurers use genetic information in the UK, the Association of British Insurers (ABI) has a long-standing agreement with the Department of Health, called the Concordat and Moratorium on Genetics and Insurance, established in 2001 and currently extending until 2019.1 The government’s Chief Medical Officer recently endorsed this status quo, saying that the “flexible semi-voluntary regulatory structure” is appropriate.2 It avoids not only concern over individual insurability but the need for legislation that could set potentially awkward precedents for the use of non-genetic predictors.
Effectively uncoupling genomics from insurance (except in exceptional circumstances) allows to access insurance based solely on his or her medical and family history, plus some lifestyle data. It makes sense because the belief that DNA is a categoric determinant of fate is a misconception. For most diseases, a genetic variant is an indicator of disease predisposition, relevant only in the context of lifestyle or other environmental and genetic factors that also affect risk.
Whilst genomic sequencing is now widely available at relatively low cost, the relationships between genetic variants and common diseases are difficult to determine, requiring data from vast numbers of people. Only once genomics becomes routine in clinical settings - and the data generated is shared freely - will we realise its full statistical potential in relation to disease causation.
Knowledge of a significant genetic predisposition to disease could potentially influence individuals aware of this risk to increase their coverage in a way that could undermine insurance principles. Whilst it might therefore seem that consumers and insurers are naturally at odds when it comes to genomics, this is not necessarily so. Both parties share a common interest: neither wishes for ill health, disablement or death from a preventable or curable disorder.
Forward-thinking insurers understand the benefits and application of genomic techniques. This could mean personalised prevention, where an individual’s DNA profile is used along with other relevant information to more accurately predict risk. Deploying genomic testing is, for some, a golden opportunity to personalise advice and preventative care to prevent or delay disease onset and severity.
Other emerging technologies also offer opportunities for better health monitoring and earlier diagnoses; self-care apps within holistic health packages look likely to form some future insurance offerings. Encouraging policyholders to take personal responsibility for health choices could even see medicine and insurance playing parallel roles in proactively managing risk.
The Council of Europe has left open the possibility of the use of genomic data by the insurance industry, provided that it is non-discriminatory, suggesting a willingness to adopt a position that would allow mutual advantage for both insurers and their customers to jointly benefit from genomics. A conscientious approach to client consent and scrupulous data management, as well as scientifically and clinically robust justification for particular uses of genomic information, are likely to be critical in ensuring that genomics will provide widespread benefits.
Dr. John Chevers is Head of Business Development at PHG Foundation, an independent health policy think-tank with long-standing expertise in genomics and related technologies.
