Myths and Fears in Relation to Life Insurance and Genetics

Several myths relate in one way or another to discussions about genetic information and life insurance. The first deals with the linkage between the terms "genetics" and "heredity." When people hear the phrases genetic disease or genetic test, most automatically think of inherited disease or tests for them. Whereas this would have been correct a few years back, scientists are learning that most if not all diseases have a molecular basis and that genetic disorders may be either inherited or acquired. Both genetically inherited and acquired conditions are likely to be significant to medical underwriting for a life insurance policy depending on their nature and the proposed insured's other medical characteristics.

Take cancer as an example. All cancers are genetic. They originate from a single cell that becomes malignant because the cellular DNA is transformed by a carcinogen or environmental factor. In addition, the tendency to develop some cancers is inherited. For example, 5% of breast cancers are caused by known, inherited genetic mutations; the other 95% are also genetic, but are overwhelmingly acquired somatic mutations.

Another disease that is not considered to be genetic is AIDS, although it is in a certain sense. When the AIDS virus enters human cells it inserts itself into the DNA or genome of those cells. This transforms or mutates, DNA and converts the cells into virus producers. Thus genetic changes induced by a virus are the cause of HIV disease.

The second myth deals with the widely held misperception that genetic test always concerned with future rather than present disease. DNA based genetic tests designed to diagnose cancers and other diseases by definition deal with conditions that are already present. They aid in early diagnosis of disease that already exists.

Genetic tests are being developed to define the genetic makeup of a tumor or disease-causing organism and to design therapies tailored to those genetic characteristics. For example, genetic tests are performed on the microorganism that causes tuberculosis to determine if a given Mycobacterium is resistant to conventional drug therapy.

Another prognostic genetic test involves polymerase chain reaction testing of blood to detect malignant cells that are in the process of metastasizing from a primary site to distant body locations. The results may signal an unexpected need for aggressive chemotherapy. Because results of both diagnostic and prognostic genetic tests provide information relevant to the likelihood of premature death, they are likely to be critical to medical underwriting.

A third myth underlies much of the debate over insurers' use of genetic information and relates to the proposition that it is unfair insurers to underwrite on the basis of conditions over which individuals have no control. Such a proposition reflects lack of understanding of risk classification. The function of risk classification is not to make value judgments with respect to certain behaviours but to evaluate levels of risk. Many, if not most, diseases are beyond an individual's control. Moreover, there is no single view regarding the meaning of factors that are within an individual's control. Finally, given the blurring of the distinction between genetic and other medical conditions, the issue of whether a disease or condition is within an applicant's control is likely to become moot.

A fourth myth derives from the view that it is unfair for insurers to underwrite on the basis of genetic tests that indicate that healthy persons will develop disease in the future. This proposition too reflects fundamental misunderstanding of risk classification. The process evaluates the possibility or probability, not the certainty, of a proposed insured contracting disease or dying prematurely. Life insurance underwriters use diagnostic tests, prognostic tests, and tests that measure predisposition to disease to assess the likelihood of the applicant's premature death. In fact, they are concerned only with existing disease to the extent that it does (or does not) indicate a risk of premature death.

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