A confluence of conflicts of interests in Down syndrome prenatal testing

MoneyYesterday, I shared Andrew Pollack’s excellent column headlined “Conflict Potential Seen in Genetic Counselors.” The report shared a confluence of conflicts of interests due to another recent development.

Pollack’s article concerns the potential conflict of genetic counselors being employed by testing laboratories. Who pays your paycheck may influence your actions. Employees typically try to serve their employers’ interests, since their livelihoods are tied to their employers’ success. Hence, genetic counselors employed by testing laboratories have a perceived interest in seeing their employers’ tests being accepted, which could potentially influence their counseling of patients.

I previously shared the remarks by Dr. Mary Norton suggesting that Non-Invasive Prenatal Screening (NIPS) be a secondary screen. This position is consistent with the majority of professional recommendations, namely those of the International Society for Prenatal Diagnosis (ISPD), the National Society of Genetic Counselors (NSGC), and the American Congress of Obstetricians & Gynecologists (ACOG). What was of further note about Dr. Norton’s remarks is that it is contrary to the position taken by Ariosa, which supports making its Harmony test available to all women–noteworthy because Norton had received research funding from Ariosa. Turns out, Norton isn’t the only doctor to resist this push by Ariosa.

Pollack’s column reports the following:

Dr. Richard Fischer, chairman of maternal fetal medicine at Cooper University Hospital in Camden, N.J., while saying he was pleased over all with the LabCorp counselors, said that he had to resist the company’s counselors to offer a test to all pregnant women that was not recommended by ACOG.

Given that these were counselors employed by LabCorp, whose division Integrated Genetics has partnered with Ariosa, it can be inferred that the test the genetic counselors wanted offer to all pregnant women was Ariosa’s Harmony test.

Of course, though, there are other doctors who may not have the same resistance as Dr. Fischer.

In a previous post, I addressed the advocacy by Dr. Adam Wolfberg for offering NIPS to all expectant women, contrary to the recommendations of ACOG, NSGC, and ISPD. Dr. Wolfberg admitted to doing just that in his clinical practice: offering NIPS as a primary screen, just as Ariosa has argued its test should be offered and Dr. Fischer encountered with LabCorp genetic counselors. This, despite Dr. Wolfberg’s own research corroborating with clinical experience what Dr. Norton’s theoretical models demonstrated: that NIPS is an effective secondary screen, but not as a primary screen.

A commenter to one of Dr. Wolfberg’s blog posts extolling the benefits of NIPS asked if Dr. Wolfberg had any conflicts of interest to declare, suspecting he may have some ties with NIPS laboratories. Dr. Wolfberg, though, assured his commenter that he had made a point of avoiding financial arrangements with any NIPS laboratory:Wolfberg comment reply conflict of interest denial

Until, that is, he did.

Last week, Ariosa announced a webinar on its Harmony test. In the announcement, who was featured as their new Associate Director for Medical Affairs? Dr. Adam Wolfberg.Wolfberg ariosa webinar

Ariosa’s announcement of Dr. Wolfberg came just a matter of weeks after his blog post for the Huffington Post where he criticized the “medical establishment” for recommending NIPS as only a secondary screen. Yep. No conflict at all there.

It is unknown whether Dr. Wolfberg was in discussions with Ariosa at the time of his post or Ariosa sought him out after his post. But, his hiring makes the headline for Pollack’s piece all the more worth keeping in mind when considering how prenatal testing for Down syndrome is being administered:Pollack NY Times Conflict Genetic Counselors

And, perhaps not just genetic counselors.

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