"The Ethics of Advice"

Today's New York Times, on page 1 of the Business Section, has an article  entitled "The Ethics of Advice" by Andrew Polack. The general thrust of the article is that some genetic counselors are beginning to discuss whether a conflict of interest is created when genetic counselors are employed by DNA testing labs:

Now, as the number of tests and the money to be made from them are exploding, another question is being asked by professionals in the field themselves. Is it ethical for genetic counselors, who advise patients of whether to undergo testing, to be paid be the companies that perform the tests?

...in some cases "the line between genetic counselor and sales representative is blurred." 

Of course it is a conflict of interest. That does not necessarily make it unethical. Full disclosure and informed consent certainly have a role here. We certainly are going to need many times our current number of genetic counselors as with increasing speed we move into the brave new age personalized genetic medicine. The current number of accredited educational programs for genetic counselors is so small that they can only create a bottleneck in this pipeline. 


Genetic counselors need to be paid by some one. I see no ethical problem if some are paid by the labs as long as that relationship is fully disclosed and customers are advised that they may wish to seek their own independent counselor. 


Is this relationship between supposed impartial adviser and company representative really that different from the relationship of physicians recommending medical tests or other procedures from which they or their employers benefit? Bending the upward spiral of health care cost curve may require us to rethink the ethics of many players. There are so many vested interests intersecting in the health care marketplace that the best interests of individual patients can easily get lost. Let the dialog about ethics begin; and step one is to make sure individual patients are well represented in the discussion.