"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.

Genetics provide cancer insight

Today's Tennessean carries an interesting article about medical screening through DNA testing:

Genetics provide cancer insight | The Tennessean | tennessean.com

In the article

Dr. Joann Boughman, executive vice president of the American Society of Human Genetics in Bethesda, Md., said genetic counselors can provide context and help with decision-making.

"It’s important for individuals to know their family medical history, which may require some detective work to gather, Boughman said.

“It’s an engagement process, and it isn’t always rapid, and it can be very uncomfortable,” she said. But “once you start talking to your family in a reasonable way about this and explain, ‘Everybody is at risk for something; let’s figure out if, as a group, we’re at risk for something special,’ that people will start to open up.”

Dr. Boughman advocates having your results sent to your physician for help in interpretation and context. If this is going to work, more physicians are going to have to become much more conversant in genomic medicine.

You may also wish to consult:
www.talkhealthhistory.org 
familyhistory.hhs.gov 
Whatever you to do be proactive and take charge of your medical treatment planning. Your medical providers may or may not be prepared to do so on your behalf. Hopefully, you can be equal partners in deciding what is best for you and your family.
 

Masters In Genetic Counseling Established | The Emory Wheel

Masters In Genetic Counseling Established | The Emory Wheel:


'via Blog this'


The Emory University program linked above sounds interesting. There is really a need for this for physicians and others. However, a class of 10 students in a 22 month program will hardly supply the demand. A 2008 study stated that only about 10% of physicians claimed to know how to order a genetic test.


Guess I'm going to have to explore what other programs exist. Below is what I have found so far.



Other programs that meet the rigorous accreditation criteria established by the American Board of Genetic Counseling (ABGC):


United States - Programs with Full Accreditation:

Arcadia University (Beaver College before 7/16/01), Glenside, PA
Boston University School of Medicine, Boston, MA
Brandeis University, Waltham, MA
California State University, Stanislaus, CA
Case Western Reserve University, Cleveland, OH
Howard University, Washington, DC
Indiana University Medical Center, Indianapolis, IN
Johns Hopkins Univ. / National Center for Human Genome Research, Bethesda, MD
Medical College of Virginia, Virginia Commonwealth University, Richmond, VA
Mt. Sinai School of Medicine, New York, NY
Northwestern University Medical School, Chicago, IL
Sarah Lawrence College, Bronxville, NY
University of California, Irvine, Orange, CA
University of Cincinnati College of Allied Health Sciences, Cincinnati, OH
University of Colorado Health Science Center, Denver, CO
University of Maryland School of Medicine, Baltimore, MD
University of Michigan, Ann Arbor, MI
University of Minnesota, Minneapolis, MN
University of North Carolina, Greensboro, NC
University of Pittsburgh, PA
University of South Carolina, Columbia, SC
University of Texas Graduate School of Biomedical Sciences, Houston, TX
University of Utah Health Sciences Center, Salt Lake City, Utah
University of Wisconsin, Madison, WI
Wayne State University, Detroit, MI
Canada - Programs with Full Accreditation

McGill University, Montreal, Quebec, Canada
University of Toronto, Toronto, Canada
University of British Columbia, Vancouver, Canada

United States - Programs with Provisional Accreditation Status

Long Island University - CW Post, Brookville, NY
Stanford University, Palo Alto, CA
University of Alabama, Bimingham, AL

United States- Program with Probation Status

University of Arkansas, Little Rock, AR