Developments in the health technology arena continue to unfold at a robust pace. An aspect that may not attract as much attention as it deserves is how the health workforce will be affected. An example stems from 2007 when direct-to-consumer (DTC) genotyping for genomic risk assessment of common, genetically complex conditions began to become available. According to an article published in the May 2018 issue of the journal Health Affairs, among the marketplace options that are accessible, the firm 23andMe makes it possible to buy a kit and use the plastic tube contained in it to deposit two ml. of saliva and mail it to the company where a search will be conducted of the DNA for specific genetic variants known as single nucleotide polymorphisms (SNPs) associated with particular health conditions.
The purchaser later will receive a report containing some findings that may engender considerable stress because the test reveals the presence of the APOE4 variant, which is associated with the onset of Alzheimer’s disease. Association is not causation, yet a result of that kind can be highly worrisome for the individual who produced the saliva. Once a sense of panic is triggered, an expected response would be to seek professional advice regarding what to do next.
Primary care physicians represent a logical source of assistance, but current shortages of them exist and future projections indicate that the situation offers no signs of improvement. Even when they are available, it is likely that some of them may feel unprepared to work with patients at high risk for genetic conditions and also lack confidence in interpreting test results. Another professional group that may be in a favorable position to offer sound advice consists of genetic counselors.
As of May 2017 there were only 4,242 certified genetic counselors in North America. Becoming one typically involves completing a master’s program, obtaining clinical experience, and passing an exam from the American Board of Genetic Counseling. According to a 2018 report by a genetic counselors working group, that number is not projected to expand sufficiently even to meet traditional needs, such as genetic screening for a person who has a family history of cancer or who wants to become pregnant. ASAHP member institutions may be in a position to create new programs to add to the current supply. If so, they would need to determine: how much it will cost to do so, if there are enough faculty, and if enough students eventually will apply for admission.
CRISPR (clustered, regulatory, interspaced, short, palindromic repeats) is a gene editing tool that is being investigated for use in genetic modification of living organisms. If it reaches a stage where parents would be able to use it to engineer their offspring to be more intelligent, athletic, or imbued with other desirable attributes, genetic experts will be needed to provide sound advice. A challenge involving heritable genome interventions is to ensure that only the precise genome locations are the intended targets. Inappropriate, permanent gene modifying efforts may produce harmful results not only for the immediate offspring of a pair of parents, but also can influence successive generations.
More Articles from TRENDS July - August 2018
PRESIDENT’S CORNER—ASAHP MEMBER FOCUS
Barbara Jacobsmeyer, President of Inpatient Hospitals at Encompass Health, is featured in this issue of TRENDS. Read More
SOCIAL SECURITY AND PAYING FOR HEALTH CARE
If Social Security is the principal source of retirement income, it may not be enough to pay for health care. Read More
AFFORDABLE CARE ACT DEVELOPMENTS
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- Individual Insurance Performance In 2018
- Final Rule Issued On Short-Term, Limited-Duration Insurance Coverage Read More
DEVELOPMENTS IN HIGHER EDUCATION
- Democrats Introduce Plan In Congress To Reauthorize The Higher Education Act (HEA)
- U.S. Department Of Education Proposes New Set Of Higher Education Regulations
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AVAILABLE RESOURCES ACCESSIBLE ELECTRONICALLY
- Matching Patients And Their Records
- Reasonable Patient Care Under Uncertainty
- Patient-Centered Medical Homes And Accountable Care Organizations Read More
21ST CENTURY CURES ACT, CANCER MOONSHOT, AND PRECISION MEDICINE
Congressional testimony by NIH Director Francis S. Collins highlights advances that have been made in the implementation of this key piece of legislation. Read More
GENDER BIAS IN HOW PROFESSIONALS ARE SPOKEN ABOUT
A study reports evidence of gender bias and how it affects women in high-status fields, such as science, technology, engineering, and mathematics (STEM). Read More