IF A genetic test could tell whether you are at increased risk of getting cancer or Alzheimer’s, would you take it? As such tests become more accessible, more and more people are saying “yes”. The insurance industry faces a few headaches as a result.

如果基因检测能查出你患癌症或阿尔茨海默症的风险有可能增加，你会去做吗？由于这种检测的门槛越来越低，越来越多的人会“愿意”做。不过，这却让保险行业会比较头疼。

Once used only for medical reasons, basic predictive genetic tests can now be ordered online for a few hundred dollars. One company, 23andMe, in California, has collected some 4,000 litres of sputum since 2007, enlightening 2m people on their ancestry, health risks and what they may pass on to offspring. In April it received regulatory approval to screen for risk factors connected to ten diseases and genetic conditions, including late-onset Alzheimer’s and Parkinson’s. The ruling could open the floodgates for others to sell direct to consumers.

基础的预测性基因检测曾经只用于医疗领域，但现在花几百美元就可以在网上预约了。从2007年起，美国加利福尼亚的23andMe公司收集4000升的唾液样本，帮助了200万人找到家族起源、健康风险以及会遗传给下一代人的基因。在四月，这家公司获准筛选与十种疾病和基因状况相关的风险因素，其中包括阿尔茨海默症和帕金森病。这项规定会为其他企业打开闸门，让它们直接向公众提供基因检测服务。

“Information is power”, argue many who take such tests. But insurers fear that without equal access to such information, they will lose out to savvy customers. Consumer groups, on the other hand, fear that if underwriters did have access to such information, people with “bad” genes might find themselves unfairly excluded from cover. Either way, the scientific advances could well disrupt insurance significantly.

很多接受过基因测试的人认为“信息就是力量”。但是，由于不能获得同样的基因信息，保险公司会丧失了解客户的机会。另一方面，客户群体也担心，如果保险公司知道自己基因“不好”，就会拒绝承保。但是，不管怎样，科学的进步确实严重影响了保险行业。

Unlike diagnostic genetic tests, predictive ones are conducted on people without symptoms. The best-known example was provided by Angelina Jolie, an actress who discovered she had a gene mutation that markedly raised her risk of breast cancer. She underwent a double mastectomy.

预测性基因测试与诊断性基因测试不同，前者可以在被测试人无任何症状的情况下进行。演员安吉丽娜·朱莉就是一个最好的例子：她（通过测试）发现自己的基因发生了变异，患乳腺癌的风险增加。于是她做了双乳房切除术。

Tests might influence financial as well as medical decisions. A person at increased risk of dying young may want to buy life insurance. Someone likely to contract cancer may buy cancer or critical-illness cover, which pays a lump sum upon diagnosis. Because predictive tests—unlike diagnostic ones—often need not be disclosed, the customer can secure an advantage over a future insurer.

这种基因测试不仅会影响在医疗时的决定，还会在费用支出方面产生影响。如果一个人知道自己英年早逝，他会去买人寿保险。如果一个人有可能患上癌症，他会去买癌症或重病保险，这样就能报销诊断费用。因为预测性测试——与诊断性测试不同——不需要公开，因此客户在买保险时会比保险公司更具优势。

So underwriters warn that predictive genetic testing could well lead to adverse selection. The New York Times recently reported on a woman who bought long-term care insurance after testing positive for ApoE4, a mutation of a gene related to increased risk of Alzheimer’s. The insurer had tested her memory three times before issuing the policy, but could not know about the genetic result. Robert Green, at Harvard University, found that people told they have the mutation were five times more likely to buy long-term care insurance than those without such information.

所以，保险公司警告称，预测性基因检测很有可能造成逆向选择。最近《纽约时报》报道称，一名女性在检测出载脂蛋白E4（ApoE4）（载脂蛋白的E4的变异会增加患阿尔茨海默症的风险）呈阳性之后，买了一份长期护理保险。保险公司在签发保险单证之前对她的记忆作了三次检测，但都无法得知检测结果。哈佛大学的罗伯特·格林（ Robert Green）发现，如果人们知道自己存在基因变异，那他们更有可能去购买长期护理保险，这种可能性要比那些不知道的人多四倍。

Asymmetry of information—when the customer knows more than the insurer—is the industry’s nightmare. If predictive tests further improve and become more common while non-disclosure rules stay in place, some insurance products might eventually die out. Either insurers would go belly-up, or premiums would become prohibitively expensive. Hence, argue some insurers, if the customer knows something relevant about their health, so should the insurer.

信息不对称性——即客户知道的信息比保险公司多——那将是保险行业的噩梦。如果预测性基因检测有更多地改进，变得越来越普遍，同时有保密法律的配合，一些保险业务最终有可能消失。最终，不是保险公司破产，就是保险费会变得极为高昂。因此，一些保险公司认为，如果客户了得知有关于他们身体的信息，保险公司也应该知道。

But tests might also help insurers. Christoph Nabholz, from Swiss Re, a reinsurance giant, is most excited about tests that spot early signs of cancer or cardiovascular disease. For life and health insurers, who want to keep people alive and well, such information could be invaluable. Discovery, a South African health insurer, plans to offer customers a test that maps part of their genome. The focus is on “actionable data”, where medical intervention or lifestyle change could mitigate risk, explains Jonathan Broomberg from Discovery.

但是，检测也有可能会对保险公司有帮助。对于能发现癌症或心血管疾病早期征兆的基因检测，保险巨头瑞士再保险公司的克里斯托弗·那布霍尔茨最为兴奋。对于人寿保险和医疗保险企业来说，他们希望受保人身体健康，因而这些信息是极为宝贵的。南非医疗保险公司Discovery的研究人员乔纳森·布伦伯格称，该公司计划对客户进行检测，以确定客户基因组的位置。检测以“可用数据”为重点，通过医疗干预和生活方式的改变，患病的风险可以降低。

This might help people who are already insured. But it worries those seeking new policies, who fear that underwriters may use predictive information to discriminate. Some might lose access to insurance. This raises ethical questions about when, if ever, genetic discrimination is acceptable. Moreover, since the relative role that genes play in the development of diseases is still being studied, some people might be unfairly and wrongly penalised.

这也许会对投保人会有帮助。但是，这也让那些想要投保的人感到担忧，担心保险公司会利用这些预测信息而歧视客户。有些人也许无法投保。这也会产生伦理问题：人们会认可基因歧视，如果曾经存在的话。此外，因为基因与疾病的相关性尚在研究当中，有些人也许会（因为错误的检测结果而）遭受不公平，甚至是错误的惩罚。

Unpredictability rules

不可预见性规定

So regulations today often protect consumers from the mandatory disclosure of predictive tests. But the rules are patchy. In Britain the industry has agreed to a blanket moratorium, renewable every three years, on using predictive genetic information. The sole exception is Huntington’s chorea, where a test of one gene is infallible and has to be disclosed to an insurer for life cover worth more than £500,000 ($662,000). In America the Genetic Information Nondiscrimination Act bans health insurers (and employers) from using such results, but is silent on other types of insurance. In several countries life insurers may already ask for disclosure of predictive genetic tests for policies over a certain value.

因此，如今一些监管规定通常是保护客户无须对外公开自己的预测性检测结果。但是，这些规定还存在一些纰漏。在英国，保险行业现在无限期地中止使用预测性基因信息，并每三年会评定一次。不过，亨廷顿舞蹈症是一个例外，因为这个对基因的检测是可靠的，在申请超过50万英镑（约合66.2万美元）的人寿保险时，必须提交给保险公司。美国有一项法案叫做《基因信息非歧视法案》，这项法案禁止医疗保险公司（以及工作单位）使用检测结果，但是在其他保险业务方面却没有规定。在一些国家，对于超过一定数额的保单，人寿保险企业会要求了解预测性基因检测结果。

But testing is rarely cut-and-dried. Ronnie Klein from the Geneva Association, an insurance-industry think-tank, says that, unlike Huntington’s, most illnesses stem from a number of factors, including lifestyle and environment, and a combination of genes. For example, although the ApoE4 allele increases the risk of Alzheimer’s, many without it still get the disease.

但是，基因检测不可能是事先准备好的。保险业智库日内瓦协会成员罗尼·克莱恩（Ronnie Klein）给示，与亨廷顿舞蹈症不同，大多数疾病都是在生活方式、环境以及基因组合等多种因素的作用下产生的。例如，虽然载脂蛋白E4等位基因会增加阿尔茨海默症的患病风险，但很多人即使基因中没有该等位基因，也会患上阿尔茨海默症。

Some regulators, such as Germany’s, have outlawed direct-to-consumer tests. But nothing stops Germans from ordering from abroad, and, just as it became normal for life insurers to ask for family history, so insurers will surely eventually have access to relevant genetic information. The question will be what they are allowed to do with it. When blood tests for AIDS first appeared, insurers also fretted about adverse selection. Many jurisdictions ruled they could not be used for calculating health premiums, as these were a basic good, but could be used for life policies. As genetic testing spreads, society and insurers may face many similar difficult assessments.

德国等国的监管机构认定直接面向消费者的基因检测为非法，但这并没能制止德国人在海外购买这种服务。因为人寿保险公司常常向投保人询问家族史，因此他们最终还是能得知相关基因信息。不过，由此会产生一个新问题，即保险公司能获准利用这些信息来做什么呢？当初艾滋病血液检测技术出现的时候，保险公司也为逆向选择而担忧。很多法院规定，检测结果不可以用来计算医疗保险费（这是基本道义），但是在人寿保险中，这可以作为一个条件。随着基因检测的推广，社会和保险企业可能会面临许多同样困难的评价。

编译：周少娴

审校：idGUETLCJ20

编辑：翻吧君

来源：经济学人