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Open Access Research article

Genetic discrimination and life insurance: a systematic review of the evidence

Yann Joly1*, Ida Ngueng Feze1 and Jacques Simard2

Author affiliations

1 Department of Human Genetics, Faculty of Medicine, McGill University, 740 Dr Penfield Avenue, Suite 5200, Montreal, H3A 1A5 Canada

2 Department of Molecular Medicine, Faculty of Medicine, Laval University, 2705 Boulevard Laurier, Quebec City, G1V 4G2 Canada

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Citation and License

BMC Medicine 2013, 11:25  doi:10.1186/1741-7015-11-25

Published: 31 January 2013

Abstract

Background

Since the late 1980s, genetic discrimination has remained one of the major concerns associated with genetic research and clinical genetics. Europe has adopted a plethora of laws and policies, both at the regional and national levels, to prevent insurers from having access to genetic information for underwriting. Legislators from the United States and the United Kingdom have also felt compelled to adopt protective measures specifically addressing genetics and insurance. But does the available evidence really confirm the popular apprehension about genetic discrimination and the subsequent genetic exceptionalism?

Methods

This paper presents the results of a systematic, critical review of over 20 years of genetic discrimination studies in the context of life insurance.

Results

The available data clearly document the existence of individual cases of genetic discrimination. The significance of this initial finding is, however, greatly diminished by four observations. First, the methodology used in most of the studies is not sufficiently robust to clearly establish either the prevalence or the impact of discriminatory practices. Second, the current body of evidence was mostly developed around a small number of 'classic' genetic conditions. Third, the heterogeneity and small scope of most of the studies prevents formal statistical analysis of the aggregate results. Fourth, the small number of reported genetic discrimination cases in some studies could indicate that these incidents took place due to occasional errors, rather than the voluntary or planned choice, of the insurers.

Conclusion

Important methodological limitations and inconsistencies among the studies considered make it extremely difficult, at the moment, to justify policy action taken on the basis of evidence alone. Nonetheless, other empirical and theoretical factors have emerged (for example, the prevalence and impact of the fear of genetic discrimination among patients and research participants, the (un)importance of genetic information for the commercial viability of the private life insurance industry, and the need to develop more equitable schemes of access to life insurance) that should be considered along with the available evidence of genetic discrimination for a more holistic view of the debate.

Keywords:
Evidence; genetic discrimination; genetic exceptionalism; GINA; life insurance; personalized medicine; stigmatization; systematic review