Tuesday, August 28, 2007

Announcing PredictER News Brief: A Digest of Predictive Health and Ethics Research News

The first three issues of PredictER News Brief are now publically available from the “Resources” page of PredictER’s information portal. This news digest reports predictive health press releases, headlines, events, and recent academic publications. These include the following topics: human genetic research, genetic testing and counseling, longitudinal health research, personal health records, pharmacogenomics, translational medical research, public attitudes toward predictive health research, and recent developments in public policy.

PredictER News Brief is a tool for readers interested in the ethical, legal, and social implications of predictive health research. In the near future PredictER News Brief will offer RSS feeds. At this time requests for email subscriptions from PredictER’s Gmail account are welcomed; the digest is published biweekly on PredictER’s web site; visit the tab.
“News Digest”. Additional information services and research tools (including: web accessible research databases, subject guides, custom search engines, and a full-text digital library) are currently under development.

Sunday, August 19, 2007

Health Risk Assessments in the Workplace: Clarian Health, Indianapolis.

At the end of last month Clarian Health of Indianapolis announced a new direction in its wellness and health mission for its 13,000 employees. To enroll for their benefits employees will be required to complete health risk appraisals. Those who fail to meet the employer’s minimum standards for blood pressure, BMI, blood glucose, LDL cholesterol and tobacco use will be fined $5 per condition per paycheck.

Clarian joins many large employers who are attempting to cut health care expenses by offering or requiring health appraisals and incentive-based health promotion measures. As reported by Jessica Marquez in “Being healthy may be its own reward, but a little cash can also help keep works fit” companies (including Delta, Sprint and IBM) are discovering that merely offering a wellness program does not change employee behavior (
Workforce Management, September 2005, pp. 66-69 [link requires login]). In fact, as of 2002, Hewitt Associates found that health risk appraisals are increasingly used to refer employees to health intervention programs and 40% of the 960 companies offered financial incentives for participation and/or progress.

Clarian’s announcement drew national attention; negative incentives (docked paychecks) are seldom reported. Coverage in the
IndyStar, the La Times and on MSNBC’s TODAY prompted comments from some of the most widely read health and bioethics blogs. Some of these posts, like Kelly Hill’s “Shape Up or Pay Up” (Women’s Bioethics Blog, 30 July 2007), point to the genetic factors in many health conditions and question the fairness of financial disincentives. Hill writes:

    [S]hould obesity, high blood pressure, and high cholesterol – things that can be genetic—be looked at with the same light [as smoking]? Should you have to pay $60 a month because your father gave you his high cholesterol?

Arthur Caplan, in “Privacy is the true price of healthy worker discounts” (blog.bioethics.net, 16 August 2007 and MSNBC’s Breaking Bioethics, 15 August 2007), echoes Hills concerns about genetics in the context of personal responsibility:

    Who will be next? The guy who skis on the weekends? The woman who wears high heels? What about the family that decides to have a baby, knowing the child may have sickle-cell disease or cystic fibrosis? Will companies be willing to put up with that sort of personal “irresponsibility”?

Caplan’s comment points to an interesting question for the ethics of predictive health. What are the “responsibilities,” personal or social, that accompany a predictive appraisal of one’s health risks? Do individuals with a family history of heart disease have a personal obligation (for the good of the community) to eat well and exercise? If so, who will define and adjudicate these “responsibilities”? Government agencies? Employers? Physicians?

Sunday, August 5, 2007

PredictER Blog on Break This Week


PredictER Blog will not post during the week of August 5. If you are interested in other blogs on bioethics, genetics research, predictive and personalized medicine, visit PredictER's Blog Roll:

Friday, August 3, 2007

Prediction and Addiction

Pediatrics and Nicotine -

A recent publication on pediatric genetic testing for nicotine addiction reported the results of an attitudes survey of 232 health providers attending a conference on adolescent health. In "Interest in Genetic Counseling and Testing for Adolescent Nicotine Addiction Susceptibility ... ", the authors from the Lombardi Comprehensive Cancer Center at Georgetown University (Kenneth Tercyak, Beth Peshkin, Anisha Abraham and Leslie Walker) examined correlates in providers' interests:
    Providers who engaged in more regular tobacco screening behaviors with their adolescent patients ... and those who were more optimistic that biobehavioral research would lead to significant improvements in adolescent smoking prevention and treatment ... , were more interested in counseling and testing.
Although the genetic test is not yet clinically available, the authors conclude that "future, adolescent wellness visits may present an opportunity to offer genetic counseling and testing for nicotine addiction susceptibility.
    Tercyak KP, Peshkin BN, Abraham A, Wine L, Walker LR. Interest in genetic counseling and testing for adolescent nicotine addiction susceptibility among a sample of adolescent medicine providers attending a scientific conference on adolescent health. J Adolesc Health. 2007 Jul;41(1):42-50. [Abstract at PredictER Connotea.]
Criminal Justice and Addiction Risks -

Genetic testing for addiction could have far reaching implications in the criminal justice system. A press release from The University of Texas Health Center at Tyler ("Four researchers at UT Health Center receive grants ... ".News & Information. Thursday, July 19, 2007) announced a four year of $1.76 million from the NIH to study the ethical, legal, and social implications of the non-health use of personal genetic data. Genetic tests could be used, for example, in determining the length of sentences for offenders with genetic risks for addiction. The project will:
    · Create an open-access online database of the current criminal and sentencing laws employing drug addiction information;
    · Survey the attitudes and information needs of drug-court judges, corrections officers, and drug treatment professionals regarding genetic research and the science of addiction;
    · Engage these stakeholders in public discussions of the issues;
    · Develop an open access, online resource for training, education, and reference materials on the subject.
In describing the need for the program, the director, T. Howard Stone, Associate Professor of Bioethics, remarked:
    We hope that our findings have some influence on the development of state laws and policies for the use of this genetic data in these settings. Right now there’s no uniformity. Jurisdictions may treat this information very differently.
Other institutions involved in this study include the Mayo Clinic Foundation, Stanford University, University of Louisville, St. Louis University (MO), The Hastings Center, and the Pacific Institute for Research and Evaluation (Louisville, KY).