IF A genetic test could tell whether you are at increased risk of getting cancer or Alzheimer’s, would you take it? As such tests become more accessible, more and more people are saying “yes”. The insurance industry faces a few headaches as a result.
如果有一項基因測試可以告訴你是否身患癌症或阿爾茨海默氏病的風險在增大，你會做這樣的測試嗎?當這種檢測技術離我們越來越近的時候，更多的人會說“會”。隨之而來的是保險業對此感到頭疼。
Once used only for medical reasons, basic predictive genetic tests can now be ordered online for a few hundred dollars. One company, 23andMe, in California, has collected some 4,000 litres of sputum since 2007, enlightening 2m people on their ancestry, health risks and what they may pass on to offspring. In April it received regulatory approval to screen for risk factors connected to ten diseases and genetic conditions, including late-onset Alzheimer’s and Parkinson’s. The ruling could open the flood gates for others to sell direct to consumers.
基礎預測性基因檢測曾幾何時只用於醫療，但人們現在可以花幾百美元在網上購買。位於加利福尼亞的一家叫23andMe的公司，從2007年開始收集了4000多升的痰，200多萬人因此在祖先、健康風險及後代遺傳上深受啟發。該公司在四月得到了監管部門的批准，可以篩查十種疾病和與基因有關的風險因素，其中包括晚發性阿爾茨海默氏病和帕金森病。這項批准使得直接向顧客出售預測性基因檢測成為可能，從此便一發不可收拾。
“Information is power”, argue many who take such tests. But insurers fear that without equal access to such information, they will lose out to savvy customers. Consumer groups, on the other hand, fear that if underwriters did have access to such information, people with “bad” genes might find themselves unfairly excluded from cover. Either way, the scientific advances could well disrupt insurance significantly.
“資訊就是力量”，許多進行基因檢測的人們這樣說道。但是保險公司擔心如果獲取資訊的機會不 均衡，他們就會因為精明的客戶而吃大虧。另一方面，消費者擔心如果保險商獲得了資訊，那些有“壞”基因的人就會被不公平地排除在保險外。無論怎樣，科技的進步都明顯會給保險業帶來混亂。
Unlike diagnostic genetic tests, predictive ones are conducted on people without symptoms. The best-known example was provided by Angelina Jolie, an actress who discovered she had a gene mutation that markedly raised her risk of breast cancer. She underwent a double mastectomy.
與診斷性基因檢測不同，預測性基因檢測用於沒有病症的'人們身上。最著名的例子便是安吉麗娜•朱莉了，通過檢測，她發現自己患乳腺癌的風險因一個突變基因而顯著增加，於是她將兩個乳房切除。
Tests might influence financial as well as medical decisions. A person at increased risk of dying young may want to buy life insurance. Someone likely to contract cancer may buy cancer or critical-illness cover, which pays a lump sum upon diagnosis. Because predictive tests—unlike diagnostic ones—often need not be disclosed, the customer can secure an advantage over a future insurer.
基因檢測也會影響財政和醫療決策。一個人若得知自己英年早逝的風險增加的話，他或許會購買人壽保險。可能得癌症的人也許會購買癌症保險或重大疾病保險，這些保險會涵蓋診斷費用的大頭。因為預測性檢測不像診斷性檢測需要經常公開資訊，所以顧客相較於未來承保人會更有優勢。
So underwriters warn that predictive genetic testing could well lead to adverse selection. The New York Times recently reported on a woman who bought long-term care insurance after testing positive for ApoE4, a mutation of a gene related to increased risk of Alzheimer’s. The insurer had tested her memory three times before issuing the policy, but could not know about the genetic result. Robert Green, at Harvard University, found that people told they have the mutation were five times more likely to buy long-term care insurance than those without such information.
所以保險商警告稱預測性基因檢測可能產生不利的選擇。最新一期《紐約時報》報道了一位購買長期護理保險的女性，她是在檢測出ApoE4陽性後購買的。ApoE4是一種增大阿爾茨海默氏病風險的突變基因。保險公司在給她投保前對她做了三次記憶測試，但結果未知。來自哈佛大學的羅伯特•格林發現，被告知有突變基因的人購買長期護理保險的可能性是那些未知情況人的五倍。
Asymmetry of information—when the customer knows more than the insurer—is the industry’s nightmare. If predictive tests further improve and become more common while non-disclosure rules stay in place, some insurance products might eventually die out. Either insurers would go belly-up, or premiums would become prohibitively expensive. Hence, argue some insurers, if the customer knows something relevant about their health, so should the insurer.
當顧客比保險商知道更多的時候，資訊的不對稱性就成為了保險業的夢魘。當不曝光的規則仍佔主流時，如果預測性測試發展得更遠，變得更加普遍，那麼一些保險產品最後會消失。要麼是保險公司破產，要麼是保險費高得離譜。因此一些保險商認為如果顧客知道與他們健康有關的資訊，保險商也應知道這些資訊。
But tests might also help insurers. Christoph Nabholz, from Swiss Re, a reinsurance giant, is most excited about tests that spot early signs of cancer or cardiovascular disease. For life and health insurers, who want to keep people alive and well, such information could be invaluable. Discovery, a South African health insurer, plans to offer customers a test that maps part of their genome. The focus is on “actionable data”, where medical intervention or lifestyle change could mitigate risk, explains Jonathan Broomberg from Discovery.
但是基因檢測也有益於保險商。克里斯托夫·那不霍爾茨來自一家巨頭再保險公司——瑞士再保險。他對能夠發現癌症或者心血管疾病訊號的檢測技術頗感興奮。對想保持人身體健康的生命健康保險公司來說，這些資訊是極為寶貴的。Discovery是南非的一家健康保險公司，計劃給顧客們提供檢測，從而瞭解他們的部分基因組。該公司的喬納森·布魯姆博格說道，他們關注的焦點是“可操作資料”，緩和因醫療干預或生活方式改變引起的患病風險。
This might help people who are already insured. But it worries those seeking new policies, who fear that underwriters may use predictive information to discriminate. Some might lose access to insurance. This raises ethical questions about when, if ever, genetic discrimination is acceptable. Moreover, since the relative role that genes play in the development of diseases is still being studied, some people might be unfairly and wrongly penalised.
這可能會幫助到已參保人員。但那些尋求新保險的人卻有所顧慮了，他們擔心保險公司會因得到前瞻性資訊而區別對待投保人，一些人可能會失去保險。這產生了倫理問題——基因歧視能否接受?此外，因為基因在疾病中扮演的相關角色仍在研究中，一些人可能受到不公正，甚至是錯誤的判罰。
【本文作者：徐州七中彭向梅。(公眾號：草根英語行思教)】
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