HUM-MOLGEN archive: ETHI: Multiplex screening

Two responses to the question about markets for multiplex genetic screning tests: From: "E. ALLEN SMITH" <EALLENSMITH@MBCL.RUTGERS.EDU> In regard to Mr. Goerl's interesting questions on the multiplex gene detection system, I would like to propose two possible legitimate uses of such tests, beyond the other ones he mentioned. These services are sperm banks and diagnostic work. It is useful for sperm banks to screen their prospective donors for alleles that may cause disease in their descendents. This usage would be useful regarding both carrier status and alleles of which the phenotypic expression does not clearly appear at the donor's age (i.e., Alzheimer's). Given the probable commonness of carrier status, it may be most useful also to screen prospective clients to inform them whose sperm it would be inadvisable for them to use. This argument is strengthened by that it is better to know about possible carrier status due to a detectable allele than due to a currently undetectable one. The screening out of donors with alleles with incomplete or complete dominance and delayed negative effects is an obvious benefit. Admittedly, one conflict that may emerge in this regard is informing donors of detected carrier or probable later illness status. Such information should definitely be kept confidential, and should be handled by the ethical standards of genetic counseling. Since such counseling is not my field, I will defer on comments about it at this time. Some purposes of such tests may also be fulfilled by investigations of family history. However, such inquiries can be inaccurate and incomplete, especially regarding carrier status and diseases whose genetic basis was not understood until recently. A combination of such inquiry and genetic testing methods will probably be the best route for some time. This optimality is primarily because the alleles responsible for many genetic (especially partially genetic) diseases have not yet been identified. Some may raise the hoary specter of eugenics and recoil in horror at the idea of a prospective mother wishing to decrease the likelihood of her offspring having a disease. Unlike earlier eugenic efforts such as in Nazi Germany and (early in this century) the U.S., such means as I have mentioned are prima facie neither coercive nor inherently racist. I therefore do not see validity in such objections, which would otherwise be quite tenable. Of course, if a government chose to impose limits on sperm banks to require such screening, such would be, I believe, clearly unjustified. This governmental coercion would prevent a prospective mother who did not want to use such screening (for whatever reason) from using sperm banks. However, a requirement that sperm banks not claim to be using such technology when they were would be justified, since such a claim would be fraud. The other case in which, if properly designed, such tests could be useful, is in diagnostic work. By proper design, all of the negative allelic variations detected should, at least in their early stages, be difficult to distinguish on the phenotypic level. Not being a physician, I am uncertain what disease states would be appropriate candidates for this usage. Since the press release in question does not state what diseases (or potential diseases) are detected, it is difficult to tell if the initial kit would be useful for such an application. However, the (quite ingenious) techniques involved appear relatively easy to extend. Sincerely Yours, -E. Allen Smith ***************************************************************************** **** X-Sender: pmorris@ache.mad.adelaide.edu.au Your cynicism may be well founded, but to answer one of your questions, Yes, large numbers of people wish to have their children screened for genetic diseases. Every year 30 million neonates are screened for a number of different genetic diseases shortly after birth. This is potentially a large market for such technology. Regards, Phillip Morris. _______________________________