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Press releases Saturday 9 June 2007

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(1) Insurance companies should have access to genetic information

(2) New bill must end the unfair treatment of mentally ill patients in prison

(3) Millions of children denied drug that costs less than $3 a year

(1) Insurance companies should have access to genetic information
(Should genetic information be disclosed to insurers? Head to head)
http://www.bmj.com/cgi/content/short/334/7605/1196
http://www.bmj.com/cgi/content/short/334/7605/1197

There is no good reason to deny insurers access to genetic information, argues a Professor of Ethics in a debate published in this week±s BMJ.

Only if we refuse to give insurers access to all health information can we reasonably stop them seeking genetic test results, says Professor Søren Holm from Cardiff Law School.

If insurers were denied access to any health information they would only be able to differentiate premiums according to very general risk markers, for example, age, gender or occupation. This would mean in effect that the healthy subsidise the unhealthy - but there would be equality.

However, if we allow insurers to have some kinds of health information, such as a person±s BMI or cholesterol level we no longer have any principled reason for excluding genetic information:

"Genetic information is not special. It is not inherently more specific, predictive, sensitive or private than other kinds of health information."

Professor Holm concedes there are worries about sharing genetic information - allowing insurers to see genetic information could deter people from getting tested or insurers may use the information inappropriately. This may be the case, he says, but the same is true for other health information - for example whether someone is HIV positive.

He argues a better solution to this problem would be to make challengeable a decision to deny coverage for life or health insurance, thereby forcing insurers to make their reasoning transparent.

On the other side of the argument Professor Richard Ashcroft from the University of London says access to genetic information should not be allowed as it could lead to irrational discrimination. This arises, he says, from false beliefs about genetic information. It can be misunderstood or its significance over-estimated.

He says if insurers had access to complete health information, including genetic test results, it could lead to a situation which was "actuarially fair" but "socially unfair":

"If the point of insurance is to cover the costs of ill luck, the only sort of ill luck you could not insure against would be the misfortune to have a late onset serious genetic disorder. Arguably such people would need insurance more than most yet would be less able than most to get it."

In the face of uncertainty surrounding the interpretation of genetic information, occasional discriminatory practice by individual insurers and a lack of solutions to the problem of social justice, he says, it is preferable to maintain the status quo, at least in the medium term.

Contacts:
Søren Holm, Bioethics, Cardiff University Law School, Museum Avenue, Cardiff, CF10 3AX
Email: holms@cardiff.ac.uk
Richard Ashcroft, Biomedical Ethics, Queen Mary, University of London, Abernethy Building, 2 Newark Street, London, E1 2AT
Email: r.ashcroft@qmul.ac.uk

(2) New bill must end the unfair treatment of mentally ill patients in prison
(Human rights and the acutely mentally disordered offender
http://www.bmj.com/cgi/content/short/334/7605/12224

Mentally ill prisoners wait significantly longer to be transferred to hospital than their counterparts in the community and the new mental health bill must address this inequality, argue two doctors in this week±s BMJ.

Drs Becky Sales and Nigel McKenzie, who work at HMP Pentonville, say at the moment the system is failing a group of people who form a significant proportion of Britain±s overcrowded prison population.

People with a mental disorder are significantly overrepresented in UK prisons - by as much as 70-90%. Each year between 1300 and 2000 (5-8%) patients who have been sectioned in English psychiatric hospitals have come from either court or prison.

The authors want to see a time limit set for transfers to hospital from prison. At the moment they say mentally disordered prison patients are not treated in the same way as their counterparts in the community, which contravenes the Human Rights Act 1998.

Unlike patients in the community, those in prison will wait several months for a hospital bed. They invariably have fully developed psychosis and are left untreated. This is because, apart from the sections relating to transfers, the 1983 Mental Health Act does not apply in prison.

Drs Sales and McKenzie want to see statutory obligations in the bill to ensure that patients judged as needing hospital treatment while in police custody or while they are with the courts cannot be sent to prison.

It is ironic, they say, that at a time when Britain±s prisons are overcrowded there is a significant part of its population waiting for transfers to hospital.

They conclude their main argument is impossible to counter - acutely psychotic patients should not be in prison - and say:

"It is time for us as health professionals to act on behalf of one of the most forgotten, disempowered and disadvantaged patient groups."

Contact:
Becky Sales, Lead GP, HMP Pentonville, Caledonian Road, London, N7 8TT Email: becky.sales@hmps.gsi.gov.uk

(3) Millions of children denied drug that costs less than $3 a year
(A randomised controlled trial of phenobarbital and carbamazepine monotherapy in childhood epilepsy: a study of side effects in Bangladesh)
http://www.bmj.com/cgi/content/short/334/7605/1222

(Editorial: Treatment of epilepsy in developing countries)
http://www.bmj.com/cgi/content/short/334/7605/1175

Millions of children with epilepsy in developing countries are being denied an effective drug that costs less than $3 a year, according to an editorial in this week±s BMJ.

Professor Emilio Perucca urges governments and non-governmental organisations in developing countries to ensure that effective treatment is available for all.

Of the 35 million people with epilepsy who live in developing countries, around 85% receive no treatment at all. As a result, they experience seizures and the psychological consequences of stigma and discrimination.

Regrettably, most of these people, many of whom are children, could return to a normal life by taking a single daily dose of a drug (phenobarbital) that costs less than $3 (±1.5; Euro 2.2) each year.

The World Health Organisation recommends phenobarbital as the treatment of choice in resource restricted countries, but this policy has been questioned because of concerns about adverse behavioural effects, particularly in children.

Yet a study of children in Bangladesh also published in this week±s BMJ found no significant difference in behavioural problems between phenobarbital and another drug called carbamazepine. Despite some limitations, the study provides more evidence to support the use of phenobarbital in developing countries.

The burden of untreated epilepsy in terms of human suffering and social costs is enormous, says Professor Perucca.

An efficient epilepsy management programme will work only if fully integrated within a community healthcare delivery system, which should provide not only reliable supplies of drugs, with adequate facilities for storage and dispensing, but also educational programmes for health practitioners and the general population, he concludes.

Contact:
Emilio Perucca, Clinical Pharmacology Unit, Institute of Neurology, IRCCS Mondino Foundation, University of Pavia, Italy
Email: erucca@unipv.it

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