Em­ploy­ees jump at ge­netic test­ing. Is that a good thing?

The Peterborough Examiner - - Business - NATASHA SINGER The New York Times

Levi Strauss & Co. in­tro­duced a novel ben­e­fit for em­ploy­ees at its San Fran­cisco head­quar­ters last fall: free ge­netic screen­ing to as­sess their hered­i­tary risks for cer­tain can­cers and high choles­terol.

Chip Bergh, Levi’s chief ex­ec­u­tive, said he had hoped that the tests would spur em­ploy­ees to take pre­ven­tive health steps and in that way re­duce the com­pany’s health care costs. But even Bergh was sur­prised by the turnout. Of the 1,100 el­i­gi­ble Levi’s em­ploy­ees, more than half took the ge­netic tests. Now, he wants to ex­tend the ben­e­fit to em­ploy­ees in other cities.

“It re­ally is a dif­fer­en­tia­tor,” Bergh said. West Coast com­pa­nies vy­ing for tal­ent of­fer an un­usual ar­ray of ben­e­fits like col­lege loan re­pay­ment, egg freez­ing, sur­ro­gacy as­sis­tance and, for new moth­ers away on busi­ness trips, overnight breast milk ship­ping. Some com­pa­nies have added ge­netic screen­ing as well, and em­ploy­ees are lin­ing up for the tests. In­stacart, Nvidia, OpenTable, Sales­force, SAP, Slack, Stripe and Snap have of­fered the screen­ings as an em­ployee ben­e­fit.

So have some com­pa­nies based on the East Coast, like Gen­eral Elec­tric Ap­pli­ances and Visa. All of them, in­clud­ing Levi’s, work with Color Ge­nomics, a startup that has quickly be­come a leader in em­ployee ge­netic screen­ing and coun­selling. But the use of screen­ings as an em­ployee ben­e­fit is be­com­ing more com­mon­place just as fed­eral health agen­cies, re­searchers and physi­cians are wran­gling over whether the tests, orig­i­nally de­vel­oped to es­tab­lish pa­tients’ in­her­ited risks of de­vel­op­ing cer­tain dis­eases, are ready for wide­spread adop­tion.

The tests screen for in­her­ited gene mu­ta­tions that can greatly in­crease a per­son’s risk of de­vel­op­ing dis­eases like colon can­cer or breast can­cer. Doc­tors now reg­u­larly sug­gest them for high-risk pa­tients, such as peo­ple who have close fam­ily mem­bers with cer­tain can­cers. But for peo­ple of av­er­age risk in the gen­eral pub­lic, a screen­ing may not be all that use­ful — and could even cause harm, ex­perts said. A per­son with­out a fam­ily his­tory of can­cer may have the same prob­lem­atic mu­ta­tions as high-risk pa­tients, they said, but could have lower risk of de­vel­op­ing can­cer. A fed­eral ad­vi­sory panel on ev­i­dence-based pre­ven­tive medicine cur­rently rec­om­mends against rou­tine screen­ing for cer­tain harm­ful breast can­cer mu­ta­tions for women who do not have can­cer or a fam­ily his­tory of can­cer. The group con­cluded that the net ben­e­fit of rou­tine ge­netic screen­ing for these women could range from min­i­mal to po­ten­tially harm­ful.

“There is ex­actly no ev­i­dence that sys­tem­atic screen­ing of the gen­eral healthy pop­u­la­tion for rare ge­netic con­di­tions will have a net ben­e­fit in terms of health out­comes,” said Dr. Jonathan Berg, an as­so­ciate pro­fes­sor of ge­net­ics at the Univer­sity of North Carolina at Chapel Hill.

Most can­cers are not the re­sult of the hered­i­tary mu­ta­tions in sin­gle genes that these tests de­tect. Some ex­perts cau­tioned that ex­tend­ing use of the tests to the broader pop­u­la­tion may lead some peo­ple of av­er­age risk to forgo rec­om­mended screen­ing tests like colono­scopies. And they warned that it could also lead peo­ple to un­dergo un­nec­es­sary med­i­cal pro­ce­dures, in­clud­ing go­ing to the ex­treme of hav­ing surgery to re­move their breasts.

“You could scare the liv­ing day­lights out of peo­ple un­nec­es­sar­ily,” said Dr. Stephen Chanock, di­rec­tor of the divi­sion of can­cer epi­demi­ol­ogy and ge­net­ics at the Na­tional Can­cer In­sti­tute.

The Food and Drug Ad­min­is­tra­tion, how­ever, re­cently took the op­po­site stance. It au­tho­rized 23andMe, a con­sumer ge­net­ics com­pany that had al­ready re­ceived agency clear­ance to mar­ket sev­eral hered­i­tary dis­ease risk tests, to of­fer a test di­rectly to con­sumers for three breast can­cer gene mu­ta­tions com­mon in peo­ple of Eastern Euro­pean Jew­ish de­scent. While reg­u­la­tors called their de­ci­sion a step for­ward in the avail­abil­ity of di­rect-to­con­sumer ge­netic screen­ing, they ex­plic­itly warned that the test did not de­tect most mu­ta­tions that in­crease breast can­cer risk. They also warned con­sumers not to use the tests as a sub­sti­tute for qual­i­fied med­i­cal care and ge­netic coun­selling. Color, the ge­nomics com­pany, takes some­thing of a mid­dle road. It mar­kets com­pre­hen­sive med­i­cal di­ag­nos­tic tests that screen for all mu­ta­tions of cer­tain genes known to be linked to cer­tain kinds of hered­i­tary can­cers and heart risks. It has doc­tors avail­able to or­der its tests on­line for users and pro­vides ge­netic coun­selling to dis­cuss users’ re­sults.

“By us­ing ge­net­ics, you can help some peo­ple pre­vent or in­ter­rupt some­thing at an ear­lier stage where the costs are much lower,” said Othman Laraki, chief ex­ec­u­tive of Color Ge­nomics. The startup ad­vises users that they could de­velop ma­jor dis­eases even if their test re­sults show no harm­ful mu­ta­tions.

Ex­ec­u­tives at SAP and Nvidia said they hoped ge­netic screen­ing might ul­ti­mately help pre­vent at least a few late-stage can­cers, the kinds of life-threat­en­ing ill­nesses that can de­bil­i­tate em­ploy­ees and cost com­pa­nies with self-funded health plans more than $1 mil­lion in med­i­cal fees. Af­ter Nvidia be­gan of­fer­ing free screen­ing from Color last year, about 27 per cent of its 6,000 el­i­gi­ble em­ploy­ees in the United States took the test. Af­ter SAP started sub­si­diz­ing the ge­netic tests last year, about 17 per cent of the com­pany’s 30,000 el­i­gi­ble em­ploy­ees and fam­ily mem­bers par­tic­i­pated.

Color has raised $150 mil­lion from ven­ture cap­i­tal firms like Gen­eral Cat­a­lyst as well as Bay Area tech lu­mi­nar­ies in­clud­ing Max Levchin, a PayPal co-founder; Sun­dar Pichai, Google’s chief ex­ec­u­tive; and Lau­rene Pow­ell Jobs, a phi­lan­thropist-in­vestor and wi­dow of Steve Jobs.

JA­SON HENRY THE NEW YORK TIMES

Abdi Khalif works in the ge­nomic test­ing lab at Color Ge­nomics in Burlingame, Calif.

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