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Helen Salisbury: Should patients pay for genetic tests?

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l461 (Published 06 February 2019) Cite this as: BMJ 2019;364:l461

Can patients pay for good quality genetic screening through the NHS?

The Helen Salisbury article discussing NHS facilitated genome analysis certainly suggests some strong arguments against genetic testing without need, suggesting that there may be no obvious, immediate benefit to patients with respect to conditions which have no preventative action available. (1)

As well as this, the article also references a meta-analysis that suggests that patients knowing about their genetic risk did not affect their behaviour. (2)

However, it also worth mentioning the presence of private companies offering genetic screening. Although these companies and their genetic screening products have risen in popularity, and hence their use, there may be concerns regarding their accuracy. For example, in 2013 a company specialising in genetic screening through saliva sample kits had been ordered to suspend their marketing by the US FDA over concerns of public health concerns regarding inaccurate results.(3, 4)

There may also be concerns regarding unintended consequences that result from the ancestry components of these tests, when they are offered in conjunction, such as the accidental discovery of parental infidelity.(5)

Therefore, there may be some argument to support the NHS-mediated system of genomic analysis However, this argument relies on the assumption that this paid for system would include high accuracy, ideally greater than that of private firms, and as much impartiality as possible from a semi-private system. Should the NHS genetic screening be deemed feasible, it may protect patients from potentially problematic companies which may provide inaccurate results and potentially propagate public health problems, but the plausibility of this system in the broad picture warrants further investigation.

1. Helen Salisbury: Should patients pay for genetic tests?, Helen Salisbury, BMJ 2019;364:l461
2. Hollands GJ, French DP, Griffin SJ, Prevost AT, Sutton S, King S, et al. The impact of communicating genetic risks of disease on risk-reducing health behaviour: systematic review with meta-analysis. BMJ. 2016 Mar 15,;352:i1102.
3. FDA bans 23andme personal genetic tests [Internet].; 2013 [updated Nov 26,; cited 07/02/2019]. Available from: https://www.bbc.co.uk/news/technology-25100878.
4. 23andMe, Inc. 11/22/13 [Internet].; 2013 [updated Nov 22,; cited 07/02/2019]. Available from: https://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2013/ucm3762....
5. The Christmas present that could tear your family apart [Internet].; 2018 [updated Dec 20,; cited 07/02/2019]. Available from: https://www.bbc.co.uk/news/stories-46600325.

Competing interests: No competing interests

07 February 2019
Ajay N. Mistry
Medical Student
Leicester Medical School