基因检测成为保险行业一大难题：保险公司担心它会导致“逆向选择”，而投保人则担心自己会因为自己的基因受到保险公司的歧视对待。
基因检测：你做了吗？
译者：
倪凌晖
校对：刘 蕊
策划：刘 璠
The gene is out of the bottle
基因检测：你做了吗？
本文选自 The Guardian
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Insurers worry about adverse selection; the insured worry about discrimination
基因检测成为保险行业一大难题：保险公司担心它会导致“逆向选择”，而投保人则担心自己会因为自己的基因受到保险公司的歧视对待。
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.
如果基因检测能显示，你是否比其他人有更高的患癌症和老年痴呆症的风险，那你是否会去做这样一项检测呢？随着基因检测变得越来越普及，越来越多的人选择去检测自己的基因。但是，这却让保险行业头痛万分。
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.
曾经预测性的基因检测是只有出于医学需要才能做的，而如今只要花上几百美金，你就能在网上订购到基本的基因检测。美国加利福尼亚州的23andMe就是这样一家基因检测公司。自2007年来，该公司已经采集了大约4千升的口水，为2百万人进行了基因检测。通过检测，客户们可以了解自己的祖源和健康风险，以及后代的遗传信息。今年六月，它获得了官方批准，可以针对包括迟发性老年痴呆症和帕金森病在内的十种疾病和基因特征，来进行遗传风险的排查。这扇大门一打开，未来将会有成群的基因检测公司涌入市场，向消费者直接提供检测服务。
“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.
许多进行了基因检测的人都感慨道：“信息就是力量啊。”但是，保险公司担心：由于自己没有办法获得这些基因信息，这就会使它们失去那些了解自己遗传风险的潜在客户。而另一方面，投保人则担心：如果保险公司获得了他们的基因信息，那些携带着“坏”基因的人就会遭到歧视，拿不到保险金。无论是上述哪种情况，基因检测技术都会对保险行业带来巨大的冲击。
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.
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.
不同于诊断性的基因检测，预测性检测的受众是那些还没有生病的人。最有名的例子莫过于安吉丽娜·朱莉（Angelina Jolie）为预防乳腺癌而进行了双侧乳腺切除术。朱莉当年通过基因检测确定自己携带会大大增加患乳腺癌几率的遗传缺陷基因。于是，她选择接受双侧乳腺切除术。基因检测不仅会影响人们在医疗上的决定，还会影响人们的财务选择。一个有较高可能性早死的人可能会选择购买人寿保险。那些有较高可能患癌症的人则可能会选择购买癌症险或重大疾病险。这样只要确诊患病，他们就可以一次性获得保险公司的给付。另外，不同于诊断性的基因检测，预测性检测是可以隐瞒的，这就使得受保人未来一定能占到保险公司的便宜。
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.
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.
因此，保险公司发出警告，预测性的基因检测极有可能使“保险市场”引发逆向选择。（译者注：“逆向选择”指：当市场交易的一方能够利用多于另一方的信息使自己受益而对方受损时，信息劣势的一方便难以顺利地做出买卖决策，导致市场效率的降低。）据《纽约时报》最近的一则报道，一位女性通过基因检测，确定自己携带老年痴呆症的主要遗传风险因子ApoE4。于是她购买了一份长期护理保险。但就算保险公司在签发保单之前，对她进行了三次记忆力测试，也不可能知道她携带有这样的遗传因子。哈佛大学的Robert Green发现，那些知道自己携带有ApoE4遗传因子的人购买长期护理保险的可能性是那些不知道的人的5倍。信息不对称，即投保人掌握的信息要多于保险公司，对于保险行业来说简直是一场噩梦。如果预测性测试变得更加先进和普及，而测试结果仍然不用告之保险公司，那么一些保险产品最终就会被淘汰。这种情况下，要么保险公司破产，要么保费变得惊人得高。于是，一些保险公司认为，如果投保人知道自己健康信息，那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.
但是这些信息对保险公司来说也是有用的。瑞士再保险公司（Swiss Re）的Christoph Nabholz对能够提前预测癌症和心血管疾病的基因测试极为感兴趣。人寿和健康保险公司最想看到的就是投保人健康长寿，因此基因信息对他们来说是极为有用的。南非的一家健康保险公司Discovery计划为投保人提供部分基因的测试。该公司的Jonathan Broomberg解释说，这项计划的重点是在那些“可人为操纵的数据”，即那些可以通过药物干涉或改变生活习惯就能改善的风险点。
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.
这或许可以帮助那些已经投保的人。但是，这对那些想要购买新保险的人来说可不是什么好事。他们担心，保险公司会利用这些预测性的基因数据来制定歧视性的销售战略。一些人可能因此就买不上保险了。这就引出了一个道德问题：如果基因歧视是被允许的话，那何时这种允许是可以接受的？另外，由于基因在疾病的发展过程中所起的作用仍然在研究当中，一些被检查出疾病基因的人可能会被不公平或错误对待。
Unpredictability rules
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，现在的法律常常规定投保人不一定要向保险公司告之自己的预测性基因检测。但是，这一规定并不十全十美。在英国，保险行业已经全面禁止使用预测性的基因信息了，而这一规定每三年就会重现拿出来决议一次。但有一个特例，那就是亨廷顿舞蹈病（Huntington’s chorea）。只要对一段基因进行检测，就能准确知道被检测者是否会得亨廷顿舞蹈病，而检测出该疾病的人需要找一家保险公司，告之检测结果并购买一份价值五十万英镑（约合662000美金）的人寿保险。在美国，《基因反歧视法案》规定：健康保险公司（以及雇主）不得使用这类基因检测结果。但对于其他类型的保险，该法案并没有做出任何规定。在一些国家，对于那些价值超过一定金额的保单，人寿保险公司可能已经向投保人要求出示预测性基因检测报告了。
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，基因测试并不能说明一切。日内瓦协会(Geneva Association全称“国际保险经济学研究会”)的Ronnie Klein表示，不同于完全由基因导致的亨廷顿舞蹈病，大部分疾病是由基因，以及许多其他因素引发的，包括生活习惯和环境。例如，ApoE4会增加得老年痴呆症的风险，但是许多没有携带有该基因的人仍然得病了。
