15 July 2012


An article by Andrew Pollack in this weekend's New York Times asks "it ethical for genetic counselors, who advise patients on whether to undergo testing, to be paid by the companies that perform the tests?".

Unsurprisingly Pollack notes criticism that where counselors in hospitals and doctors’ offices work for the commercial genetic testing companies (rather than for the hospitals or practitioners) there -
 is a potential conflict of interest, in that the company-employed counselors might have an incentive to recommend more testing than necessary or not to recommend a test offered by a rival laboratory. The practice, they contend, could undermine trust in the profession just as genetic counselors are poised to play a growing role in medicine, helping patients sift through an ever-increasing array of available genetic tests. 
Pollack goes on to comment that -
There are genetic tests for more than 2,500 diseases, up from fewer than 800 diseases in 2001, according to GeneTests, a database supported by the federal government. UnitedHealth, the big insurer, recently projected that spending on genetic testing in the United States would grow to as much as $25 billion in 2012, up from $5 billion in 2010. 
Some leaders in the genetic counseling profession say that testing companies have supplied counselors to medical practices for more than 10 years with no evidence that patients have been harmed. .... 
Doctors who defend the arrangement say that they cannot afford to hire counselors on their own because reimbursement for counseling is low. 
While Medicaid, Medicare and private insurers often pay for genetic tests, they are less likely to pay for the counseling sessions, sometimes lasting an hour or longer, that can precede and follow such testing. Most states do not license genetic counselors, and it can be hard for a nonlicensed practitioner to obtain reimbursement. 
But testing companies can subsidize the typical $65,000 annual salary of the genetic counselors from testing revenues. 
Supposedly around 9% of the approximately 3,000 genetic counselors in the US work for testing laboratories, up from 2% in 1990.
A representative for what used to be Genzyme Genetics is reported by Pollack as stating that its counselors were not rewarded on the basis of how many tests were ordered. “Genetic counselors are not sales people. Our counselors are trained professionals that are looking to provide appropriate care, period.”