ACP: Genetic testing ‘have to be clinically indicated’

August 02, 2022

2 min learn

Disclosures: Lehmann stories being employed by Google and being part of the ACP Ethics, Professionalism and Human Rights Committee. Please see the place paper for all different authors’ related monetary disclosures.

Physicians should rigorously contemplate the dangers and advantages of genetic testing and focus on the moral challenges of the observe with their sufferers, based on a place paper from the ACP.

“The fast advances in genetic testing and precision medication have raised the flexibility and potential to enhance well being take care of our sufferers,” Ryan D. Mire, MD, FACP, the president of ACP, mentioned in a press launch. “However as we all know, know-how and genomic advances include extra obligations, moral challenges and potential unintended penalties for our sufferers, their households and their physicians.”

Genetic Drugs
“As we all know, know-how and genomic advances include extra obligations, moral challenges and potential unintended penalties for our sufferers, their households and their physicians,” Ryan D. Mire, MD, FACP, president of the ACP, mentioned. Supply: Adobe Inventory.

Genetic testing is only one facet of precision medication, which ACP defines as “individualized care primarily based on information of an individual’s genetics, way of life and surroundings.” It consists of a wide range of makes use of for genetic data, like diagnostic testing, threat evaluation, predictive threat testing and inhabitants screening.

It additionally consists of direct-to-consumer genetic testing, though ACP discourages the strategy “and advises that testing must be completed within the context of a patient-physician relationship, with applicable counseling,” Lisa Soleymani Lehmann, MD, PhD, MSc, director of the Heart for Bioethics at Brigham and Girls’s Hospital and affiliate professor of drugs and medical ethics at Harvard Medical College, and colleagues within the ACP Ethics, Professionalism and Human Rights Committee wrote within the paper.

The paper serves to offer extra specificity to the ACP Ethics Handbook’s steering, based on Lehmann and colleagues. The preliminary steering famous that precision medication presents various points like prices, discovery of undesirable data, counseling wants, attainable discrimination and the required schooling for physicians and sufferers.

Now, ACP has targeted on the usage of genetics and precision medication normally observe, noting within the paper that genetic data could information therapy selections for sufferers who could also be in danger for situations that may be inherited, those that may have a drug related to a recognized pharmacogenomic variant, and extra.

There are different main issues to contemplate, based on Lehmann and colleagues, like privateness points and the safety of affected person data. For instance, the authors famous that sufferers might not be conscious that information from direct-to-consumer genetic testing will be disclosed to legislation enforcement in sure circumstances, and direct-to-consumer genetic testing firms might not be coated by the Well being Insurance coverage Portability and Accountability Act.

To ethically use genetic testing, it “have to be clinically indicated,” and well being care professionals should contemplate if the check outcomes will impression medical selections, based on ACP. The advantages of genetic testing are most vital when used to reply an actionable medical query, Lehmann and colleagues wrote.

The place paper outlined ACP’s stance on a number of different key points of genetic testing:

Like all medical testing, genetics have to be led by moral requirements, scientific proof and the very best curiosity of the affected person. Physicians should contemplate the advantages and dangers of any check in an effort to observe high-value care.

Physicians can and may interact with sufferers to assist them perceive all the advantages, dangers and uncertainty. They need to additionally focus on the moral challenges of precision medication and genetic testing, and “respect the nuanced distinctions between extremely predictive genetic variants that point out the presence of inherited situations and exams that provide probabilistic data,” Lehmann and colleagues wrote.

These with entry to affected person information should shield the privateness, safety and confidentiality of sufferers’ genomic data.

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