11 December 2017
For a long time, science was thought to follow a path of ever-increasing exactitude. This myth was blown away with early-20th century physics revelations such as wave-particle duality and Heisenberg’s uncertainty principle. Sometimes knowing the limits of your knowledge and understanding that the universe is all about probability is, if not quite Zen enlightenment, then certainly a big help in getting to grips with sciences like genomics and indeed, the finer points of the insurance business.
Predicting health and disease is more often rooted in probability than certainty, something that is well understood by public health practitioners. The insurance industry also understands this better than most, and has predictive expertise developed over decades of careful observation of macroscopic trends and data points gleaned from medical questionnaires and claim histories.
PHG Foundation is likewise very familiar with the concept of probability. Having spent 20 years looking at the individual and population health impacts of genomic technologies, among others, one of the most common misconceptions we encounter is genetic determinism – the belief that your DNA effectively seals your fate with respect to health. In the vast majority of cases (ie. with the general exception of rare, heritable forms of disease) the presence of a particular genetic variant provides only an indicator of your predisposition to disease, pertinent only when considered in the context of many other other genetic and non-genetic (environmental) factors, all of which affect risk.
Knowledge of your genetic predisposition can potentially influence your choices for more personalised disease prevention right now, given careful analysis.
Insights into the relationships between genomic variants and more common forms of disease are therefore relatively difficult to determine; researchers have to examine correlations between DNA and health outcomes from large numbers of people. Initiatives like the 100,000 Genomes Project and commercial players like 23andme aim to build biobanks of a size needed for research into diseases and potential therapeutics, but only when we see genomics routinely used in a clinical setting (and data shared freely) will we yield the really high volumes of genome profiles that will allow us to realise the full statistical potential to understand genomics and disease causation.
This might sound discouraging, both in terms of timescale and eventual outcome – surely the point of scientific investigation is to establish certainties and eliminate doubt? However, we should be clear that genomics can provide real answers today (in diagnostics and to guide the use of therapeutics); it’s just that we expect more for the future. Whilst significant hopes are invested in gene-editing technologies of tomorrow, knowledge of your genetic predisposition can potentially influence your choices for more personalised disease prevention right now, given careful analysis. In some individuals, this might mean a radical course of action –such as a prophylactic mastectomy for those with a high inherited risk of breast cancer – or more often a less radical one, such as eating a healthier diet and taking more exercise to reduce the risk associated with a moderately increased risk of cardiovascular disease or diabetes. Either way, the outcome could be to significantly reduce your risk of disease and lengthen your life.
Correctly predicting the impact of medical advances across a portfolio of policies (existing and potential) could have a significant impact on the viability of the business.
Insurance is an industry that looks forward as well as back – essential, since a policy signed today may be in place for many years to come. Therefore, correctly predicting the impact of medical advances across a portfolio of policies (existing and potential) could have a significant impact on the viability of the business. Whilst it is not currently possible in the UK to use genetic information to influence insurance decisions (see my previous blog), influencing strategies to improve health and wellbeing are already deployed by the innovative business model of Vitality Health. Whilst some in the industry see this as primarily a marketing angle that has proved successful in capturing an already health-conscious segment of the market, it is easy to envisage a future role for health technologies in influencing the life (and policy) outcomes of insurance clients.
The ability to deploy genomic testing is, for some, a golden opportunity to personalise advice and preventative care, but many other technologies also in development are offering improved routine monitoring and ever-earlier diagnoses of disease. Improved diagnostics and self-care apps are advancing particularly rapidly, and many could form a part of the sort of holistic health package that looks likely to form future insurance offerings.
In summary - medicine and insurance may in future take parallel roles in proactively managing personal risk – and of course, encourage the patient/policyholder to take personal responsibility for health choices.
PHG Foundation offers consultancy and advice on genomics and other emerging health technologies –please get in touch if we can help you understand the current state of the science and how it might affect your company.