The cold, dumb logic of cost-effectiveness justification for prenatal genetic testing

DepressionDown syndrome has long been called the “canary in the genetics coalmine.” Here’s another example of why. 

Twitter’s 140 character limit requires some exposition of my tweeted question:

Scientists are finding genes associated with depression. They caution that such genes do not guarantee the condition, since there are environmental factors linked with depression manifesting, e.g. stress. The same is true for BRCA1/2 genes: the presence of those genes does not guarantee breast cancer, but women (Angeline Jolie most famously) are having prophylactic masectomies upon being diagnosed with BRCA1/2.

Linked in the article is a World Health Organization report that states:

  • Depression is the leading cause of disability worldwide, and is a major contributor to the overall global burden of disease.

As the science progresses, how long then before the logic that drives prenatal genetic testing funding as a public health measure is applied to other conditions that can be prenatally tested, such as the genes associated with depression?

Covering prenatal genetic testing as a public health measure is justified by cost-effectiveness studies showing that the amount expended in paying for prenatal genetic testing (the vast majority of which are for pregnancies not positive for the tested-for conditions) is less than the estimated costs of covering the healthcare of the lives of those with the tested-for condition (Down syndrome being the most common example).

If, as WHO states, “depression … is a major contributor to the overall global burden of disease” (emphasis mine), then the cost-effectiveness logic would support covering prenatal genetic testing and selective terminations when the “depression genes” are detected, if that cost would be less than the “burden” of caring for those with depression.

Some may say that reason demands that prenatal testing for depression genes should be covered. After all, it can result in an overall savings to an already strapped healthcare system. Others, particularly those who experience bouts of depression but otherwise are, on balance, glad to have been born and to experience life, might object that such logic unjustly stigmatizes their condition and inflates the disabling aspect of it.

And then others might note that if prenatal genetic testing is not subsidized for public health reasons to reduce the incidence of those born with depression, then the continued funding of prenatal genetic testing for Down syndrome is discriminatory, singling out one genetic condition for eradication, but not others.

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