Putting Health in the Marketplace. Ethical Issues about Providing Online Health Risk Information

In October 2015 the company 23andMe gained the Food and Drug Administration (FDA)’s approval to market genetic tests directly to consumers, without supervision of healthcare professionals. The FDA approved 36 carrier tests to provide health information on inherited disorders, including cystic fibrosis and Tay-Sachs. 23andMe is still prohibited in marketing genetic susceptibility testing (GST), but the company hopes to gain the FDA’s approval to provide health risk information. The idea is that informing customers of their genetic susceptibility may motivate them to change their health-related behavior, reducing the risk of the disease’s onset. “Direct-to-consumer healthcare is coming!”, said Anne Wojcicki, co-founder of 23andMe, after the FDA’s approval. Actually, besides other ways (such as mobile health, telemedicine, etc.) of getting access to health information and services through internet, direct-to-consumer genetic tests fosters a consumerist approach to healthcare. Nevertheless, is such an approach advantageous for medicine and consumers? Can we consider health as a mere consumer good whose promotion requires consumerist attitudes? To discuss these issues, the paper will firstly address problems with clinical validity and utility of GST as well as their implications for healthcare systems: although research is ongoing, GST have limited predictive power and therapeutic or preventive measures are not always available, leading to overmedicalization and fewer healthcare resources for others (consumers could require follow-up tests to confirm or deny obtained results). Secondly, ethical concerns regarding putting health in the marketplace will be analyzed by examining the progressive shift from healthcare professional-patient fiduciary relationship to provider-user consumerist relationship.