DNA data could spawn 'genetic underclass.' (Paul R. Billings, chief of staff at the Clinic of the Veterans Admin. Palo Alto Health Care System, warns of discrimination in the collection and storage of genetic data) (Brief Article)

Public policy initiatives and increased physician awareness are needed to maintain a healthy balance between the promise of genetic engineering and the potential for genetic discrimination, maintains Paul R. Billings, deputy chief of staff for the San Jose (Calif.) Clinic of the Veterans Administration Palo Alto Health Care System and a clinical associate professor of medicine at Stanford University. Genetic discrimination already is occurring in insurance and employment settings and is reaching into the areas of adoption and military service, he points out.

"The storage of genetic information, in DNA banks like the one maintained by the Department of Defense, has already produced important problems. There have been several courts-martial of people who haven't agreed to contribute to the Department of Defense DNA bank." In addition, physicians, many of whom may be unaware of the dangers of genetic discrimination, are being asked to sanction the use of genetic tests as a "medical necessity," Billings indicates. "This important change may increase the incidence of genetic discrimination."

While key issues related to genetic discrimination are being played out in laboratories and in the courts, public policy responses are taking shape in both administrative and legislative spheres. For instance, the National Association of Insurance Commissioners has taken steps toward developing a position on the use of genetic tests in insurance matters. Such efforts have had limited effectiveness, however, Billings notes. "The first reason is that the insurance industry has an enormous amount of power to swing this argument away from public oversight and regulation. Second, through our own survey work and the work of others, we've found not only that consumers are generally unaware that the insurance commissioner's office might be of some help to them, but also that insurance commissioners themselves generally don't think this is an important issue and are not really paying attention to it."

Approximately 20 states have adopted legislation to protect consumers, primarily in the area of health insurance. Civil and criminal penalties can arise it genetic discrimination is shown to have resulted in unfair health insurance practices. Individuals often are afraid, however, that if they make a public complaint about some genetic issue, they might...