The coming explosion in heath inequality, cont'd
A reader writes in:
Just read your post on genomics and health inequalities. As a concrete and very worrying example of how genomics has the potential to increase health disparities, I’ve attached a paper that was published at the beginning of the year that shows that we can now detect and sequence fetal DNA directly from maternal blood samples. The paper is focused on trisomy 21 (Down’s Syndrome) and is a pretty huge deal, since it means that we’ll be able to non-invasively test for it rather than conducting an amniocentesis (which is painful for the mother and risky for the fetus). The Chiu paper just looks at trisomy 21 but the technique should allow for testing of every genetic disease.
Currently, amniocentesis or chorionic villi sampling is done on about 2% of pregnancies, whereas once this starts being rolled out, usage may reach as high as 70 or 80% of pregnancies (Hank Greely at Stanford thinks it will be that high). Here’s the kicker though: insurance companies are probably going to be very happy to cover this, since reducing the numbers of neonates with severe chronic disease will save them a lot of money. However, about 50% of pregnancies in the US are covered by Medicaid, not private insurance, and since the implication of a positive test for a severe genetic disease is termination of the pregnancy, the anti-abortion lobby and the GOP pro-lifers are almost certainly going to pitch a fit if CMS considers covering the test, with the end result being possibly eradicating these diseases among the affluent and concentrating them among the poorest of society.