Saturday, March 1, 2014

Our Family History

TAG of the Week:


Read this piece by the American Cancer Society entitled “Genetic Testing for Cancer: What You Need to Know”.


Given the increased awareness of genetic components/factors that predispose or cause diseases and/or conditions, do you believe it is imperative to know your family’s genetic history? Also, should public (i.e. Medicaid and/or Medicare) or private insurers provide genetic testing and counseling to their customers? Finally, if you had the opportunity, free of charge, would you participate in genetic testing and subsequent counseling?

OR


1. You can share the new, 'surprising' information you learned
2. Ask a question that needs additional clarification,
3. Share a news link relevant to the discussion. 
4. Reply to another student's comment.

69 comments:

  1. Although there has been increased awareness of genetic predispositions for disease and other conditions, I do not think it is imperative to know your family’s genetic history. The only reason an individual should feel obligated to discover their genetic history is if there is a familial mutation and members within their close family have died or been afflicted by a conditions resulting from this specific mutation. In regards to public and private insurance covering the cost of genetic testing for everyone, I believe this service should only be offered to the few “high risk” cases. In other words, I do not think insurers should have to provide coverage for those who do not meet the criteria of being high risk due to the outrageous cost of genetic tests.

    I strongly believe there should be additional laws passed to shield genetic information from insurers when considering life, disability, and long-term care insurances. At current, GINA does not restrict the use of genetic information in these instances and I believe this is, in a sense, punishing those who underwent a genetic test because their situation desperately warranted one.

    If given the opportunity to take a genetic test free of charge, I would not do so because of the lack of regulation surrounding my results. If I was absolutely certain that my results would not be used against me in the future by insurance companies and that these results would remain confidential, I would seize the opportunity. However, right now I would not be open to participating because I would be too skeptical of how and if my results could impact my life (i.e. insurance costs and availability) in the future.

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  2. I do not believe that it is imperative to know your family’s genetic history. I think that more attention should be paid to things that you can control, such as lifestyle habits like diet and exercise. Just because someone is or is not more susceptible to a disease or condition does not put any less emphasis on the importance of healthy lifestyle habits.

    This is not to say that family history is not important. In fact, if you know that your family has a particular problem with something like breast cancer, then that is also useful information. Knowing the specific genetic history is not as imperative as knowing how to make healthy lifestyle choices. Therefore, I do not believe that insurers should have the obligation to provide genetic testing and counseling to their customers. I believe that resources would be better allocated for public health measures, and addressing important issues that have arisen such as obesity and type II diabetes.

    With that being said, if I had the opportunity of free genetic testing and subsequent counseling, I probably would not take advantage of it. It would be interesting to know my genetic makeup, and having professional counseling would make it more valid. However, I would not want to have a false sense of security or too much unnecessary anxiety. No matter what, I know I would have to keep up a healthy lifestyle, as I believe that is the fundamental feature of preventing diseases and/or conditions. I can stay aware of my family history without knowing my specific genetic makeup by keeping track of my relatives' conditions and such.

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  3. Although I do not think it is absolutely imperative for everyone to know your family's genetic history, I do feel that it is important for people to be aware of their families medical history. For example, if there have been many genetically linked mortalities/morbidities in a family, this might be a case where knowing your family's genetic history might be important to your health. But, if this is not an issue, as Kendra pointed out-- it is extremely important to put a focus on your own controllable health by practicing good lifestyle habits, rather than getting caught up with genetic family history. I do not believe that insurers should be obligated to provide genetic testing and counseling to all of their counselors, but it might be nice if they would provide it to people who meet certain qualifications like have a vast family history of genetic morbidity/mortality. I really can't say if I would take advantage of free genetic testing and counseling if it was offered to me, but as of now, I like to focus on the health that I have control over.

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  4. I also do not think it is of the utmost importance to know your family's genetic history. I think that even with increased awareness of genetic predispositions, there is still too much confusion and misunderstanding over genetic testing results. Even today, there would still be overestimation what someone's great-grandmother's risk for a disorder meant for them. I think that it is important, conversely, for individuals to get their own individual genetic testing and visit trained counselors if they see fit to further examine the genetic factors and/or risk they might have. Also, as discussed in this week's reading, I think family history obtained by a physician is always important because it shows what disorders actually manifest in a family. In addition, knowing that your family has an increased risk for some disorder may lead to an important case in which genetic testing is inherently necessary for an individual to find out exactly what her own risk is.

    With that being said, I think both public and private insurers should only provide genetic counseling and testing if the patient is proven to be at high risk for a disorder already, from family history and/or behavioral factors. That way, the genetic testing will be done only in addition in order to get a clearer picture of true, immediate risk. I do not think every patient should be able to get genetic testing and counseling free of charge, because in a large amount of cases, it is not necessary.

    I do not think I would take advantage of free genetic testing right now. Learning about all the genes that make up my genome would be interesting, and I know that GINA would protect me from being discriminated against in some ways. However, I don't think genetic tests are very necessary for me right now, and I do not want my risk for some disorder to be overcalculated, and stress my family and myself out.

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  5. I do not believe it is necessary to know your family genetic history. For some individuals this can lead to a feeling of helplessness and lack of control over their individual future or destiny. Knowing medical history is important in order to determine how you can lessen risk factors of genetic disease and stay healthy/lead an active lifestyle that prevents problems. I agree with Tessa that GINA needs to be amended to include long term care insurance etc to protect the long term consequences that can currently arise from getting genetic tests. Knowledge is power but knowledge can also be intimidating and stop people from living their every day lives due to a genetic factor their great grandmother had. It is important to not become debilitated over information but lead a lifestyle armed with knowledge to prevent disease

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  6. I do not believe that is crucial to have genetic testing done. I do believe that is may be important for certain people to do so because of increased risk, and I think it is necessary that people are educated on the benefits and the limitations of genetic testing so they can make an informed decision on whether or not they want to do genetic testing. I think that people do need to be aware of their familial disease history, but not necessarily do a genetic test.

    I think that private and public insurers should provide genetic testing only in the cases that can prove there is a family pattern (separate, multiple diagnoses for the same disease from different doctors for one family) for a disease that is treatable or even preventable at an early age. It should also provide for those deemed at high risk for certain diseases, backed up by clinical diagnosis. It should be an option that is taken on a case by case basis.

    If I had the opportunity to take a genetic test, then yes, I would. I would be extremely interested in the results. However, I know that genetic tests are not always predictive of what will happen in the future, and essentially take the results with a “grain of salt.” I also would not share the results with anyone, unless the counselor and I found something deeply unnerving, in which case I would consult my doctor.

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  7. Lauren TamburelloMarch 4, 2014 at 8:06 AM

    I do believe with Anika and my other classmates that genetic testing is not crucial and important for those with family history and a predisposition for a certain. The article provided above also suggests genetic testing for those you have had cancer previously or are exposed to certain risk factors. I definitely agree with this and like how this article seeks to inform individuals about genetic testing so they can decide it is something they are comfortable with. I think that is key. Genetic tests should be taken lightly. The information can be beneficial and express your risk for disease but there are often many, as the article discusses, drawbacks to the tests. One important drawback proves that the tests precise, they estimate your risk. Just because you test positively for the mutation does not mean you will get the disease. That being said I believe that education is key before receiving a genetic test. My last thought is will genetic testing lead to behavior change in people? or lead to intense worry and distress among test-takers? These two factors should be considered among patients before taking genetic tests. Patient's should ask themselves - if I test positive for a certain mutation am I prepared and ready to make changes in my life? For these reasons, right now I would not get a genetic test done as of now. I do not know if genetic test results would be enough for me, as a 20 year old, to make drastic changes to my lifestyle to prevent for a disease that would affect me years down the road.

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  8. I do not think that it is imperative to know your family’s genetic history. It is important to know your family medical history, and if there is a history of a certain disease that is genetically linked then it might be important to get genetic testing. However, I think that people should be focused on living a healthy lifestyle to mitigate their risks for many different diseases. I think that public and private insurers could provide genetic testing and counseling to their customers, but maybe only if there is sufficient evidence that the test is necessary. Otherwise, the tests would probably be overused, and would lead to a lot of unnecessary stress and procedures. I am not sure if I would want to participate in genetic testing and counseling. I would have to fully investigate my family history, talk with my family, and do more specific research on the conditions that I would be testing for.

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    Replies
    1. Rebecca, you don't think this approach to genetic testing coverage gives too much leeway to the individual? It would be extremely difficult, considering how unique a persons family histories could be and the sporadic inheritance patterns of disease due to mutations or scientific, to qualify people as 'sufficient' in needing testing covered or not. I think this gives the individual too much leeway; mandating that genetic tests be covered for everyone or at least those who request it would take some of the responsibility for keeping healthy off of insurance holders and help them make health provisions. Because most Americans are not genetic professionals, a person who is at high risk for great cancer could read the research and make the determination that they are safe when that is indeed not true. It could be preventative and potentially very protective if we try to slow the progression of disease transmission through generations by covering patients. And I don't know how you could turn down a free genetic test!! I would love to see if anything runs in my family so I could take the necessary steps now, at such a young age, to be healthy and living as long as possible.

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    2. Lindsay, I do agree with you on most points. Determining if a person is in need of genetic testing coverage based upon their family history would definitely not be easy for everyone. What if somebody is adopted, or even if one of their parents were adopted, and they have limited knowledge of their family history? How could it even be evaluated if genetic testing is "necessary", if it is based off of family history alone. And also sporadic inheritance patterns do raise another issue as far as basing genetic testing eligibility off of family history only, like you said. I do also agree that covering genetic testing could be a good preventative measure in health care (although at the moment US health care coverage isn't too concerned with preventative medicine, sadly).
      However, I can see why people would turn down a free genetic test. Besides privacy and confidentiality risks, which are important, there is a lot more to it than just knowing "if anything runs in your family". Everyone handles situations differently and holds different values. For example, to Joanna in "In the Family", it is devastating to her that if she takes the "necessary steps at a young age to live as long as possible" such as preventative surgery, she may never have children. However, to another woman this may not be as important to her.
      Everyone has varying levels of anxiety and fear. If two different people were to receive the same results, one may be emotionally fine and another may be debilitated by the news. Quality of life, not just length (or quantity) of life post-testing is an important consideration that needs to be kept in mind when deciding upon whether to receive a test.

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  9. Michelle TagermanMarch 4, 2014 at 11:58 AM

    The FDA is currently in hearings deciding whether “3-person embryo fertilization,” should be allowed. This technique combines DNA from two women and one man. Unfertilized eggs from the two women are combined to “weed out inherited genetic disorders contained in one woman’s DNA.” The safety of this technique has not been determined long-term but has been successfully performed on several monkeys. While the potential benefits may be huge, there are many ethical and social implications, most regarding fear of creating ‘designer babies.’

    In the video “In the Family,” that we watched today in class, one of the women says at one point that “there must be some other way to deal with breast cancer than to just remove body parts.” This got me to thinking about ways to prevent inheritance of the mutation, and thus, the possibility of women with the BRCA1/2 mutations using 3-person embryo fertilization to avoid doing so. While this technique is new and is not likely to be used on the public anytime soon (the FDA is currently discussing how to test it on humans in clinical trials), it is exciting to think the amount of cancer cases that could be prevented if such a procedure could be used.

    Sources:
    http://news.health.com/2014/02/25/fda-explores-3-person-embryo-fertilization/
    http://www.businessweek.com/ap/2014-02-25/fda-weighs-unknowns-of-3-person-embryo-technique

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  10. After seeing how much of an impact genetics can play in one's health, I think knowing family history is important to learn about one's health. It is beneficial because we can know what morbidities we may be predisposed to and that can aid in primary prevention. I think, however, that knowing one's own family history for disease and going through and getting genetic testing can have two different impacts. The former, is a good way to stay informed and aware of what the status of his/her own health is. I feel that the latter, although it can be very beneficial in terms of definitively knowing one's risk for a disease, can bring about more stress and anxiety. I think it's important for those who participate in genetic testing to remember that a positive screening is NOT a diagnosis. Users of genetic testing should be aware not only of the biological and health concerns of the testing, but also the potential psychological risks.

    I think first and foremost, one should be aware of his/her own family history. From there, he/she can decide whether or not the history warrants the need for genetic testing. For example, I know my father's side of the family has a history of diabetes; however, if I maintain a healthy lifestyle, it can help me avoid this risk. Aside from that, there are no histories of cancer or other diseases that I feel I would need a genetic test for.

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  11. Given the increased awareness of genetic components/factors that predispose or cause diseases and/or conditions, I do not believe it is imperative for everyone to know their families genetic history. I believe that exceptions could be made for families that have a certain mutation or disease that has been a recurring problem in their family. If a family member knows through genetic testing their risk of a certain disease, this could inspire them to take action to help prevent it and to change their behavior. In general though, I do not believe it is imperative for every family.

    In regards to insurers providing genetic testing and counseling to their customers, I am still not exactly sure how I feel. In families that have a history of a mutation, I feel like they should provide testing. If a test comes back positive, I then think that the insurer has the responsibility of covering genetic counseling. However, I do not believe insurers should offer testing free for all of their clients, only those who have already demonstrated risk. This will save money in the healthcare sector and save fears. If someone who does not have a clear family history wants to undergo genetic testing, I think that right now they should have to pay for that. Maybe in the future, when genetic tests are extremely mainstream, simplified and cheap they could be completely covered by insurers, but not right now.

    If I had the opportunity to participate in testing and counseling free of charge, I think I would. Firstly, this class has gotten me very interested and curious about my own genes. Second, I know that Alzheimers runs in my family, so I'd be curious to see my own risk.

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  12. I disagree with Kendra and Blair, as I think that knowing your family history is imperative. Obviously making good lifestyle choices is crucial for everyone to live a healthy life but knowing what has occurred in your family could be crucial to taking preventative measures for your own health. As genetic tests are still really expensive for many people family history is the next best thing. To see what others in your family with similar genetic make up have had issues from. You can then use this information to be wary of certain lifestyle choices and plan for treatment options in the future.

    Although I do think it is imperative to know I do not think disclosing family history should be mandatory. I mean, many people might not want to know what they are at risk for. I also think that Medicare, Medicaid and private insurance should offer genetic testing especially for those who have a family pattern of illness. This is what is recommended in the cancer article and i think it is fair to implement this into society as long as people have the right to choose. (Also, there are huge financial benefits in preventative care). Since GINA has been established the likelihood of people wanting genetic tests if they have family history of a disease I imagine will have increased. If i had the opportunity i think i would get a genetic test. As long as i knew how my genetic information would be stored. But, I don't think i would directly seek out a genetic test but if i was in the doctors and they said to you want a test then i think i would do it.

    Finally, I was surprised to learn throughout the last few classes and the last blog post, the lack of clarity and cohesion between all providers and NBS. Particularly how some states test for some diseases and other states for others. This seems to me like health lottery between states, where you just hope the state tests for the disease your child may have. Surely all states could agree to test for all the diseases they can. Also with the extraordinary benefits of NBS, more clarity over the use of genetic data after the test could eradicate any concerns and blockages to testing. In my opinion not knowing what happens to genetic information makes NBS a much harder decision than it should be. I think i would side towards getting NBS but I would be more skeptical to get the test with this uncertainty. Seeing how useful NBS is and how important it can be was new information to me and the problems that are attached to NBS are very surprising.

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  13. While I don't think that is is absolutely imperative to know your family genetic history, I think it would be smart to be aware of it. Like the movie we watched in class today, many women basically erase their chances of developing breast and ovarian cancer if they know they carry the BRCA1 mutation and have surgery to remove possibly affected organs. While this is certainly not the course of action every will want to take, we know that monitoring and constantly testing individuals with elevated risks can catch cancer early and improve the chances of ones survival.
    Like many of my classmates have already said, managing your environmental exposures is critical in reducing your risk of developing disease and just because you don't have a serious mutation doesn't mean you won't get that disease; likewise, just because you might have a mutation doesn't mean you will develop the disease. The movie described this well in terms of the BRCA1 gene in that the mutation affects one chromosome and that your other, healthy copy of the same chromosome can protect you. If the healthy chromosome is damaged, your risk of developing cancer increases greatly. In this case, knowing your family genetic history can be very useful because you know that you need to take certain precautions and avoid certain environmental exposures to protect your healthy chromosome.
    I believe that public and private insurers should allow their customers to have access to genetic testing and counselors, though I'm not entirely sure whose responsibility it is to pay for such testing and counseling; I think that probably lies with the customer.
    If I had the opportunity to participate in free screening and counseling, I'm not sure I would participate, at least not right now. Though being aware of possible risks is important, I don't think I would want to know if I had a mutation that could possible lead to cancer or another disease right now; I feel like that would be very stressful and worrisome, and that that knowledge that I could develop a disease would just mess with my head and make me stress out more than necessary.

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  14. Like Nick, I feel that it is imperative to know your family's medical history. Knowing such information can help you to plan your life accordingly, be it through healthy lifestyle changes, preventative screening tests, or any other prophylactic measures. For instance, if you know that your father, grandfather, and great grandfather all died of a heart attack around the same age, you can use that information to create a healthier and hopefully longer life for yourself. To ignore your family's medical history would be foolish, as that knowledge could help you and your doctor improve your quality of life.

    I feel that there should be some provisions for all types of insurance to cover genetic testing and counseling. My sister was recently tested to see if she had the gene for celiac disease, and although the test came back negative (luckily), my parents were still responsible for the almost $1000 price tag of the genetic test. We have private health insurance, but it does not cover any genetic testing whatsoever. In a case such as this, when a doctor has probable cause to suspect a genetic condition, I feel that private insurance, medicare, and medicaid should cover genetic testing. Learning of a condition or potential health problem early on can help the patient and doctor prevent it from ever happening, which would save insurance companies money in the long run.

    If a genetic test were offered to me for free and I knew for certain that only I would have future access to the information (meaning that it would never be used against me), I would absolutely take advantage of the offer. I am very much interested in learning about my own genome and how I can protect myself from health conditions in the future. I think genetic testing is very interesting, as it is the future of medicine. I would love to have the opportunity to get my genome tested!

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  15. I do not believe that it is imperative for everyone to know their families' genetic histories. Genetic testing should be an option for people who understand that they are genetically at risk for a hereditary mutation that can cause them harm. However, I believe that it is up to the individual to become informed and make that decision for themselves. In a family that is predisposed to a certain treatable disease, it may be a good idea to get tested so that you can combat the illness. But, for families that may have a predisposition to a non-treatable disease, it may not be worth knowing something that they won't be able to prevent.
    I believe that private insurance should cover genetic testing and counseling as preventative care if it is recommended by a primary care physician.
    If given the opportunity, I don't think I would receive genetic testing at this time. I am unaware of any serious preventative genetic disorders in my family that would warrant screening. I feel that at this time, genetic testing would only serve to scare me, and not actually be helpful in preventing disease. However, I am open to future genetic tests as I get older and if it becomes apparent that any certain types of disease or cancer are common in my family.

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  16. Although I do not believe it is imperative to know your family's genetic history, I think it is very valuable information, and there are immense benefits of that knowledge. If you know you have a family history of a certain disease, you can make lifestyle changes to decrease your risk of developing that disease. Genetic and medical history is also a huge factor in deciding whether or not to get genetic testing, which can be costly and unnecessary. For example, the woman in the film we watched knew that ovarian and breast cancer ran in her family, so she decided to get tested for BRCA1/BRCA2, and as a result she now knows she is positive for that gene and can have more frequent screening for breast and ovarian cancer.

    I think insurance companies should at least partially cover genetic testing as preventative care. Not only is it good for the subscriber, but it can also save them a lot of money. If someone found out they were positive for a gene that put them at a higher risk of developing a disease, they could make lifestyle changes to decrease their risk of developing that disease, and hopefully if they are effective they would never develop that disease, and the cost of the test would be much lower than the cost of treatment. Also, if say someone knew they were positive for BRCA1 they could get more frequent mammograms and ovarian cancer screenings, resulting in catching it earlier, so it could be treated earlier, which is more likely to be successful and shorter, which would save the insurance companies money. Catching the cancer earlier would also make it less likely to spread to other parts of the body that would require additional treatment. I think if the patient has a family medical history of a genetic disease than the genetic testing should be covered in full because it is more necessary and cost effective.

    I am torn between whether or not I would get a genetic test. Like I said earlier, I think it offers some very valuable information, but right now under GINA I don't feel safe having my genetic info available. If I could keep it completely confidential, I totally would take a genetic test, but GINA does nothing to prohibit discrimination in life insurance, disability insurance, long-term care insurance, or any of the other possible uses of genetic information besides employer and health insurance privacy.

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  17. Personally, i think it is important to know your family's history regarding cancers and diseases but not necessarily on the genetic level. For instance, I know that my mother and grandmother both had breast cancer, so i can safely assume that I have a higher risk of getting breast cancer. To me, this is enough information for me to know. I do not feel like i need to know the genetics behind it. However, I also feel like this is a very personal opinion. I have talked to some people that said that they think if there was a cancer or disease that seemed prevalent within their families that they would want to know the genetics and official mutation and whether or not they will be affected in the future.

    With my view on the idea that genetic family history is not imperative, I do not feel that is is necessary for private or public insurers to provide genetic testing and counseling to their customers. I think that if there are certain customers that present the information of a reoccurring disease or cancer in their family and they want the genetic testing, then i think it would be appropriate for them to receive it with some insurance. But i don't think that everyone needs to be tested for this.

    If i had the opportunity, free of charge to participate in the genetic testing and subsequent counseling i would not take it. I really related to the girl joey in the movie that we watched on tuesday. My grandmother had breast cancer 3 times and the third time it was a stage 4 and had crossed over the blood brain barrier and had spread to her brain. She died three weeks after finding out her results. My mother was diagnosed with breast cancer in 2001 and has been cancer free ever since. From this information, I know that I most probably have a higher risk of getting breast cancer but I do not want to get the genetic tests. For me, I would rather enjoy my life and find out if I had cancer when I had it and found it instead of always thinking about my mutation. In the documentary, Jo was so worried about her mutation and possibly thinking she had something wrong with her rather than living her life. I think that the information given to you if found positive can be more detrimental to your health than just finding cancer in the long run.

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  18. I agree with some of the above comments that knowing you were not more susceptible for diseases would might give a false sense of security and lead to discontinuation of healthy lifestyle habits. However, I disagree that this alone should prevent people from getting genetic testing and finding out their family's genetic history. With some genetic mutations (ie. breast and ovarian cancer from the movie in class), there are options if you find you are genetically more susceptible for a disease. Just knowing that you might have a mutation making you more susceptible might cause as much stress as finding out that you do have the mutation, so I don't think that being tested and getting positive results causes more anxiety in this case. I actually think it could cause less anxiety, because instead of fear of not knowing, you may have other options to explore to decrease your risk. The woman in the movie was so worried about her mutation, but at least she knows she has options that would lower her risk, and the decision is just whether she takes that chance or not.

    If I had the opportunity to have genetic testing, free of charge, I probably would not take it. If I had a family history of breast cancer, ovarian cancer, etc., my answer might have been different. If I was in that situation, I think I would want to know my risk so that, if necessary, I would have the option to take proactive steps in reducing my risk.

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  19. I agree with some people above in that I do not believe it is crucial for everyone to undergo genetic testing. However, I do think it would be beneficial if everyone was fully educated and informed about genetic testing and about the risks and benefits associated with genetic testing. After educating the public, I believe that it would be up to the individual when deciding whether or not they want to undergo a genetic test. Also, after being fully informed about genetic tests, I believe it should be up to the individual about whether or not they want to know about their families genetic history. Therefore, I do not think it would be imperative to undergo genetic testing, but I think it is crucial to educate and inform the public about the risks and benefits of genetic testing and let people make a decision for themselves.

    I also can see the point that the other classmates are making about the possibility that knowing you aren't more susceptible to a disease may make them feel like its okay if they make unhealthy choices. However, I also feel this would be the individuals choice. I think this would also be crucial for a doctor or a genetic counselor to stress that just because you are not genetically susceptible, doesn't rule out the fact that your lifestyle could influence your susceptibility to the disease. If the individual is fully aware of the consequences of their lifestyle and choices, then I feel it is their individual choice on whether or not to continue making these unhealthy choices.

    I think it would be nice if Public programs such as Medicare and Medicaid and private insurers covered genetic testing because maybe people who really want to do it but cannot afford it would then be provided the opportunity of doing so. However, I feel that there are many other crucial areas that both public programs and private insurers have trouble covering now that, in order to cover genetic testing, there would probably need to be some rationing of some health services already covered. It would be great if those programs did cover the genetic test, but our country has such conflicts over covering medications and basic health care services that I feel those would need to be addressed first before we cover genetic testing.

    If I had the opportunity to have genetic testing free of charge, I probably would take it just because I am curious and it could be beneficial to know. But if it was not free of charge, I wouldn't be as ready to try have it done at this time.

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  20. I do believe that it is important for one to know his/her family's genetic history. Knowing which diseases "run" in the family is important for lifestyle choices and can be crucial in making healthcare decisions. However such information may need to be discussed by families along with a genetic counselor, who can explain genetic testing and the benefits and possible drawbacks of undergoing genetic testing. While knowing about possible disease could increase the anxiety of family members, it is important for them to know that they could possibly have the disease and what they can do about it, instead of letting the disease run its course and being oblivious to the cause.
    Public and Private insurers should cover genetic testing if there is a strong indicator of a disease in a person's family genetic history. Unfortunately, current methods of genetic testing are costly, which could possibly eat up entire health programs' budgets if they could cover every single genetic test.
    If I had the opportunity to undergo genetic testing and counseling free of charge, I would probably do so. I am interested in seeing what mutated genes I possibly carry and would find the information useful in making lifestyle choices.

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  21. I don't think it is imperative to know your family's complete genetic history, although having a basic knowledge of what diseases have been in your family can be very useful. My father's side of the family has a very bad history of heart disease. This information is very valuable to me because now I am aware that I should exercise and take care of myself to reduce my chances of developing heart disease. Basic knowledge of family history seems useful. Genetic information may be going a little to far. Common knowledge of family history will provide one with enough information to protect themselves from a possible susceptibility. Genetic tests are very expensive, but also can be helpful. WIth that being said, I do believe that insurers should cover genetic testing when there is strong reason to believe a genetic mutation may be present. I do not see a reason for insurance companies to cover unnecessary genetic screenings. Perhaps a referral from a doctor would be necessary. I think genetic counseling should be covered under insurance plans. Many insurers cover counseling for other disorders like depression or obsessive compulsive disorder. These disorders cause high levels of discomfort, as does having a genetic mutation to a certain illness. I would have a genetic test done if it was free of charge. For me, I would not go out of my way to get a genetic test, but if it were accessible and free then I would definitely consider it.

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  22. Now that the scientific technology to find out who is genetically predisposed to this or that disease, it would be a waste of all those years of efforts to withhold that technology from the public. Anything we do should be thought about how it can be used by the general public. Especially for the purpose of science, it would be selfish to withhold new information form the public. Therefore, it would be years of waste if all the new genetic information is not applied on how it can be used to benefit the general public. Aside from that, it is also important for everyone to know what they are genetically predisposed to. However, this needs to be in conjunction with appointments with genetic counselors so people will understand what their results means.

    Similar to newborn screening, there needs to be a list of diseases that will benefit everyone. These diseases need to be easily prevented/ not easily provoked, treatable, and better to be dealt with earlier. These diseases should be provided for free to be screened, along with genetic counselors. However, for diseases that are less common among the population, there should be an affordable premium on those given the infrequency but it would still be available to the population, regardless of one's respective health insurance.

    If I had the opportunity to participate in genetic testing and counseling for free, I would absolutely do it as a prophylactic test. Similar to opening pandora's box, there will be unavoidable psychological side effects when one participates in genetic testing. I want to know what I am susceptible to, so I can change my habits accordingly. There will always be in the back of my head that I am, for example, susceptible to brain cancer. Therefore from then on I will be paranoid that every headache, regardless of how minor it is, I will be wary of a prospective brain tumor. However, I would rather be prepared for something than be blind-sighted.

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  23. I don’t think it is imperative to know your family’s genetic history. Personally, I am interested; however I don’t think it should be mandatory to know. Everyone should have the choice to learn their family’s genetic history for their own interest; whether it is curiosity on what they are at higher risk for, to learn more about their genes, to make healthier lifestyle choices, etc.

    I don’t believe public or private insurers should provide genetic counseling and testing to all of their patients, however I do believe there should be a guideline for those who they should provide it for, such as the high risk patients who have a previous family history.

    Given the opportunity, I would participate in free genetic testing and subsequent counseling. As I mentioned before, I am interested in knowing my family genetic history, although I would take the results with caution as we know it is not 100% conclusive on what will happen.

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  24. For me, I feel like my environment or family situation I am in would affect my decision to know my family's genetic history. Meaning, if my parents, aunts/uncles, and grandparents had all passed away at an early age due to the same or similar disease, I feel this would definitely affect my decision in knowing my family's genetic history and what I am at risk for. However, if a family member were to have had a disease but survived/overcame it, this would lessen my interest in knowing my family's genetic history. Not to say that one family member is not important in making my decision, but it would persuade me more and give me a bigger reason to know what diseases are running through my family and what disease I may be at risk for since more than one family member was affected. Because if it was more than one, there is an increased chance of what might have been passed down to me.

    Also, I do not believe that if one gets to know their genetic history and finds out that they are positive or at risk for a certain disease, that only then should they start making the right decisions. (i.e. eating right&exercise). I think that these should be steps we should take even before we find out our family's genetic history.

    In regards to the public/private insurers question, I am unsure whether they should provide their customers with genetic testing and counseling since my family would affect my decision in getting one. And if I had the opportunity of free genetic testing and counseling, as of now, I probably would not. First, I think the tests need to come out with more accurate results. In the video (In The Family Video), Joanna went to get results from different physicians on her chances of getting the cancer, and the fact all the numbers were all different somewhat shocked me and also scared me. Although they were all high numbers, I believe running from 80-95%, the fact that all these number were different, I wouldn't fully trust what the genetic test has to say. And back when we talked about the four big companies all resulting in different results, I'd say that if the tests were much more accurate, I would take the genetic test.

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  25. While knowing your family’s genetic history can be very beneficial, I don’t think it’s necessary imperative for everyone to know. People who have a family history of an inheritable disease that has testing available for it should consider testing, but for everyone else, genetic testing might not be useful. Genetic testing is expensive, and I think that insurance companies should cover or partially cover the costs for only people who are at risk for an inheritable disease.

    If I had the opportunity, I would participate in genetic testing. I don’t know much about my family’s history so I don’t know if I’m at risk for anything. The results of the genetic test, while not absolute, I think it still will be useful to know.

    This article looks at China’s large genetic testing market and how the government intervened to try cut back on the amount of testing performed. I thought it was interesting how big genetic testing is in China.
    http://www.forbes.com/sites/shuchingjeanchen/2014/03/03/china-cracks-down-on-dna-testing-2/

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  26. While I believe that knowing your family history is important, especially in determining if you may be a carrier for specific genes like BRCA1, I can't help wondering about the instances where your family history may not be determinable (say, if you were adopted). In those cases - especially in ones where you may not have access to the diseases that were common in your biological family - you can't exactly help not knowing, and I don't think those people should be "punished," for lack of a better word, because they lack that information. That said, family history has played a role in how I conduct myself, as all of my grandparents have diabetes - and so I know I have a much higher risk level for it than someone whose grandparents had normal insulin levels.

    In conjunction with family histories, genetic testing can tell you what diseases you may have inherited from your ancestors. Yet as some of my classmates have mentioned, the tests aren't exactly standardized yet, leaving levels of uncertainly that I'm not willing to risk with genetic testing and subsequent counseling. Right now, I'm not entirely sure that I would take a genetic test - not when I'm fairly certain of the diseases I could inherit from my parents and grandparents, but also I acknowledge a certain privilege in knowing my family history. For those who may not have detailed records of their past, genetic testing and counseling may provide an alternate route to determining the diseases they're most at risk for. When tests become more accurate, then they should be covered by public or private insurance. However, with their current levels of accuracy, I'd advise the tests to be covered only for certain patients - those with family histories and those who don't know their family history, for instance - at the provider's discretion. Even if the test were completely free, I don't think I'd take a genetic test and the subsequent counseling. There's bliss in ignorance, they say, and I don't mind taking my chances.

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  27. I think that it is important to know whether or not you are at risk for certain diseases or mutations. Genetic mutations are hereditary and provide a good indication of whether or not one should consider genetic testing. I believe that if someone knows they are high risk for a disease, it would be in their best interests to get tested in order to modify their lifestyle and reduce any risks. I think that individuals should take family history into consideration when deciding whether or not to have a genetic test. This being said, I think that genetic tests are not fully necessary for those who do not have reason to believe they are at risk for something.

    As the article mentions, for some who might know they are at risk, genetic testing could be a relief or provide direction on how to prolong a healthy life. I do not feel that insurance needs to be mandated to provide coverage for all patients. However, I do believe that those with strong family histories should have the option of knowing and modifying lifestyle/taking any preventative measures that may be beneficial. Therefore, insurance could cover partial to all of genetic tests for those who may benefit substantially from early diagnosis or treatment. I also feel that those who are not able to know their family histories should have free access to family records to find out if their genetic history includes any diseases or mutations.

    The article “Genetics and medicalization” (http://www.jstor.org/stable/pdfplus/25227979.pdf?&acceptTC=true&jpdConfirm=true) made a comment that stuck out to me, stating “Inflated perceptions of the value of specific genetic tests could drive a wave of inappropriate medicalization.” This makes me believe that before genetic testing is widely available, education on the true benefits of genetic testing and who would most benefit is something the general public should know before they are marketed as an easy test. People need to know exactly what these tests are for, and not rely on them as means of diagnosing themselves. This article brought up some thought-provoking ideas about genetic testing.

    I, personally, would not participate in genetic testing right now. My family has never had any cases of genetic diseases. I live a healthy and happy life, and feel that any testing would just cause anxiety and worry to myself. However, if I did have a family history of something, I probably would get it done so I could monitor my habits accordingly.

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  28. Although it is not imperative to know you family’s genetic history I think it is important to know about general genetic history of your family. Knowing your family’s history might be something that determines how you live your life. I would like to know to prevent it more but I feel if I eventually find out what exactly our genetic history is I will end up ruining my life and freaking out over every symptom.

    I think that public or private insurers should provide genetic testing and counseling to their customers just because its always nice to know that you have an option to get genetically tested and figure out your history. It also doesn’t hurt to understand the process and cost for genetic testing.

    If I personally had the opportunity to get genetic testing and subsequent counseling free of charge I would get genetically tested. I always found genetic testing interesting because it uncovers dormant genes and possible illness. Although I like to live without having a clear future in store because I personally like surprises but for some reason I would like to know about how genetic testing works more and the answers they give.

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  29. In my opinion, I don't think that any major conclusions regarding our family history should be made, I do think it is good to know what you may be predisposed to as a result of your genetic history. This can help shape the way we live our lives to help decrease any potential risks of disease that may be prevalent through our familial genetics. I also believe that physicians and health professionals should forewarn patients in telling them that they're not guaranteed developing the particular disease, to prevent paranoia and distress over what may be found in their family history. It should merely be used as a source to implement guidelines and measures towards prevention.

    I also definitely think that insurances should cover genetic testing and counseling because many people may be wary to get genetic tests because of the costs which can lead them to not knowing whether they're carriers of certain diseases or not. It would also potentially save a lot of money for both parties. If an individual becomes aware of their risk for a disease as a result of their genetic test, they may be more inclined to want to change the way they live, which could limit the medical procedures they would need to have down the road. It would be beneficial all around, in my perspective.

    If I were ever offered the opportunity to get genetic testing for free, I would definitely do so. If I knew that I had a higher chance of developing a certain disease because of my family history, I would definitely make the changes necessary to prevent that from happening. I do think the process and the results may make me a bit anxious at first, I believe it is better to know what you're at risk for rather than have it jump at you without knowing.

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  30. With the increased awareness and knowledge of genes and their associations with certain diseases, family history has become a key factor in determining risk factors of diseases. However, it is not imperative that you know your family's genetic history. With all the positive effects of knowing which diseases you may be likely to get, the negative effects of mistreating the information is more serious. Not a lot of doctors and patients are well armed to deal with increased genetic knowledge and this can lead to discrimination or improper diagnoses.

    Public and private insurers should absolutely provide coverage for genetic testing and genetic counseling. It should be up to the individual person to decide if they want to know their genetic information and family history. One of the major deterrents of people not undergoing a genetic test is the expensive cost of the test, as well as doctors explaining the results to them. Covering the test would certainly encourage more people to undergo the test, and hopefully seek out the proper counseling.

    If I were able to undergo genetic testing and counseling free of charge I would definitely do it. This is especially the case after being in this class and learning about the huge impact that family history has on my chances of developing a specific disease. One concern that people have brought up in privacy and confidentiality, so a major concern is making sure that my genetic results and information are kept private and only I can view them. Along with this goes preventing against discrimination from future employers and insurance companies. That being said, undergoing counseling to see what lifestyle changes need to be made to ensure that I lead a healthy, disease-free life is worth the genetic test.

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  31. I do not think it is imperative to know your family history even though many genetic factors predispose individuals to certain diseases and conditions. I think that if you know that a disease runs in your family, then you might want to do more research to find out just how many people had the disease but I don’t think that everyone needs to have a full genetic history done. Having mandatory family genetic history tests done would lead to a lot of worrying and unnecessary testing by people who feel they are at risk for certain conditions.

    Insurers could offer genetic testing and counseling to their customers but I feel that this would have to be on a case by case basis and customers would have to show a strong disposition and family history in order to receive the testing. The testing and counseling would be very costly to the insurance companies if they let every customer receive it, so I think there should be regulations on who receives the testing.

    If I had the opportunity, I’m not sure if I would participate in genetic testing and counseling. I know a little bit of my family history and know that some conditions run in the family but I’m not sure if I would want to know if I had a genetic mutation to cause the disorder. If I found out that I did, I would just worry all the time and wonder what I should do about it, like Joanna in the film we watched. But at the same time, as I become older I might change my mind because the threat of developing diseases or cancer becomes exponentially greater. It’s a difficult decision for anyone, but I think people would need to look into their history to figure out if it is necessary for them to get genetic testing or not before they go through with it.

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  32. I don't think knowing your family genetic history is imperative for everyone - it can be cicumstantial. If you know you and your family are at higher risk for a certain disorder based on your family medical history, it might become imperative for you to be tested. As the American Cancer Society article points out, you should see a genetic counselor before you actually get tested to actually discuss if the results will be useful for you and what kind of implications the results can have on you and your family.

    I do think that public and private insurance companies should prove free genetic testing to their customers if the customer wants it. Genetic information would not be very useful to insurance companies because of GINA, but I do think it should be offered for the peace of mind of the customer. If results look bad then customers can take preventive action against the disease - this preventive action may end up saving the insurance companies a lot of money if the treatment for the disease is expensive and treatment would take awhile.

    I can't say I would partake in genetic testing at my age right now, but perhaps in the future. After watching the first part of the movie "In the Family" during class I don't think I need to know my genetic history at this point in my life. There aren't too many prevalent genetic disorders in my family so it is not as concerning to me as it was to the filmmaker Joanna. But after watching the movie, I feel that the psychological implications of knowing are lessening Joanna's quality of life - the thought of ovarian or breast cancer is always on her mind now that she knows she has the BRCA 1 mutation. She is so young and always worrying about a disease that probably won't affect her for another 10 years. I don't think I would want to live like that. Perhaps when I am at the age at which I am at higher risk of developing a certain disease that is prevalent in my family I may re-consider having genetic testing.

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  33. I think that knowing one's family history is only imperative when trying to calculate one's risk of developing a disease. There are environmental risk factors and genetic risk factors that influence disease, but I don't think the true likelihood of developing a disease can be determined without considering family history.
    I also think more public and private insurers, especially Medicaid, should cover genetic testing. To avoid misuse of genetic testing, subscribers could maybe provide a letter from their primary care physician saying something like, "This individual seems likely to develop this condition based on these environmental risk factors and his family history, so genetic testing would be beneficial in determining his exact risk." Having something like this, proof that substantiates a subscriber's need for genetic testing, would allow insurers to ensure that they reimburse at-risk individuals for genetic testing.
    Lastly, I think I would participate in genetic testing and counseling if it was free because a lot of my mom's side of the family, both men and women, have been affected by various types of cancer. While I'm sure I would be overwhelmed by the information that would be revealed to me, I think I would appreciate knowing my genetic susceptibility to various cancers. I can make lifestyle choices to try to decrease my risk and having routine screening to closely monitor myself. I would rather know my risk and try to regain some control over my health than be surprised by my deteriorating health later in life.

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  34. I believe knowing your family history is important in determining your own health risks, regardless of the existence of genetic testing. First of all, scientists still do not know how to detect all different diseases or disorders in the genome, in fact very few are known for sure. This being so, it is important to know your family’s medical history because genetic markers for diseases you may be susceptible to may have not been identified yet. We cannot rely fully on genetics to determine what we are at risk for.

    I think that it is important for public or private insurers to provide genetic testing, but only to individuals who are at great risk for a specific disease that can be identified through genetic markers. As the article said, genetic testing is not needed for most people. If genetic testing is offered to specific people, I think that genetic counseling should not only be offered, but should be a mandatory part of genetic testing. Genetic counselors help to explain what results mean, help patients deal with what may happen, and give them suggestions of appropriate actions to take given the results.

    If I had the opportunity to participate in genetic testing, I would not, at least not for now. I would want to know more about my family’s medical history. None of my immediate family members have had any sort of major disease, so I don’t think it would be necessary now. Also, at my age I would rather not know of a potential disease than deal with the anxieties of knowing the possibility that something might happen. Given that I am not at risk for anything given my family history, I would rather live my life now and worry about it later.

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  35. It is imperative that we know our families' genetic histories. Regardless of whether or not the disease is serious, family history can help us track common links between generations and give us an idea of what genes are responsible for what. Moreover, this information can be used to plan for future generations. For example, if your family history shows that you are at risk of a serious disease, it might be important to take this into account before you start having children. Finally, earlier, we watched "The Ghost in Your Genes," where researchers believed that what previous generations were exposed to affects us today. This just goes to further show that family history is important to know because older generations still have a large effect on who we are today.

    I believe that public and private insurers should provide genetic testing and counseling to their customers ONLY if these customers are at high risk of getting a disease. For example, in the film we are watching in class, Joanne has an 80-90% chance of developing breast cancer because of a mutation that runs in her family. I believe that insurance should cover genetic testing for individuals like Joanne, who have examined their family histories and found that they are at a high risk of getting a serious disease. However, I don't believe that health insurance companies should be obligated to cover for individuals who aren't at risk based on their family histories and risk factors.

    If I had the opportunity, free of charge, to participate in genetic testing and subsequent counseling, I wouldn't participate in genetic testing and subsequent counseling. Based on my family history, I'm not at risk for any diseases. I feel like getting a genetic testing will give me anxiety, especially if results come back to suggest that I have mutations and am at risk for some diseases. These tests aren't conclusive and just because we have a mutation doesn't mean we'd get the disease so I think getting the test will only increase emotional stress for me.

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    1. Lena, I want to comment on your point about insurers providing genetic counseling and testing to customers. First, much of the American public is uninformed about the details of genenomics. A lack of understanding regarding gene mutations and relative risk based on familial genetic links is definitely present. Joan happened to look heavily into her family's genetic history, but I feel that most people who are either unaware of their ancestor's disease history or have been hidden from them do not do this. Whose responsibility would it be then , in your case-scenario, to determine what percentage of risk for inheritance of a disease is "high risk"? 80-90% is a very high risk but I don't think anyone can really know their exact risk UNTIL they get genetically tested. Also, is a person looking into their family history something that must be done before they are considered for coverage? I'm sure this could be a preliminary step in gauging risk, but even with researching this it is difficult to tell who falls into the high, low or moderate risk categories for insurance companies to then decide if they want to cover you. In my opinion, everyone should be covered equally: Either set the precedence as covering everyone or have no one be covered.

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  36. Although it would be a good advantage to know your family medical history, I don't think it is imperative. However, I think families should talk about and educate other family members of potential predispositions. For instance, I think a mother should let her daughter(s) know if their family has a significant history of breast cancer, ovarian cancer, etc. This would help make better life choices especially when it comes to behavioral decisions such as tobacco use, alcohol, and poor diet.

    I agree with Lena that insurance companies should only provide coverage if deemed necessary. Such situations include extensive family history, showing symptoms, or someone who would be considered at risk for developing a disease. If I had a free opportunity to participate in genetic testing I would not do it. Currently, I feel like I am pretty healthy and my family medical history is insignificant for any major diseases. At this moment, if my results came back positive for any mutation I will be completely paranoid about developing a disease. I might even become a hypercondriac. Once Joanna found out she was positive BRCA1&2, it consumed her life. It was all she could think about; I know I would go through the same thing if my results were positive. However, in Joanna's case she had a reason to be worried because her mother had ovarian cancer. Fortunately, we don't have a history of cancer in my family so I feel like I can relax my mind for now. Also, the tests can only provide estimated likelihood of developing a disease and they are not concrete results.

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  37. Knowing our family's genetic history was imperative both before and after the recent influx of genetic knowledge over the past few decades. If you know your family history in terms of health concerns, then you will have a better understanding of how to plan and live your life. Staying away from potential and known hazards while also being proactive in strengthening your body against known family diseases and/or conditions is paramount to living long and healthy lives.

    Because the field of genetics is still developing and evolving, I believe private insurers should be the ones to provide the genetic testing and counseling to their customers. In my mind, the risks of a false positive or a false negative for a disease are too great for this to be available in the public insurance realm. Over time, if prices for genetic testing come down or if the accuracy of the results are higher/more precise (such as specificity and sensitivity), then it may be possible to open up the public insurance sector for genetic testing.

    Personally, given the free opportunity for genetic testing, I would take it. I would agree to this because of the thousands of dollars in monetary savings along with the fact that somewhere down the road I may one day get this testing done anyways (such as before having kids). But, right now I would go into the testing with the mentality that this would not change my life. Being diagnosed with a disease or condition at such a young age would be horribly stressful and life-changing, but given my knowledge that these results could be false positives, I would not change my life drastically due to this new revelation. Moreover, false negatives may also be lingering in the results, which could give a person a certain leeway or freedom to indulge in things that may not be so beneficial to one's health. If I felt as if I could not maintain this mindset throughout the testing, I would not agree to it.

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  38. I believe that knowing your family's genetic history is imperative. It will allow you to know whether or not you are at a higher risk for developing a certain disease, which could save your life. My mom, who is a breast cancer survivor, decided to get tested for the BRCA1 and BRCA2 gene. Her main reason for doing so was to know whether or not she was a carrier and what that would mean for my two sisters and I, in regards to what our potential risk for having the gene could be. Thankfully the test results were negative, but I feel that it was important information to know, especially if other family members, like my sisters and I, could possibly be affected or at risk for a particular disease. I understand this is an opinion based on my personal experience.

    I also think that both public and private insurers should provide genetic testing and counseling to their customers. Genetic testing is very expensive, and I think it should be covered, especially for those who are at high risk of developing a disease. If these tests are covered, I think more people will be more likely to have these tests done, and that could lead to more lives being saved in the future. I also think its important that people take advantage of genetic counselors, so that they fully understand their results and avoid unreasonable stress.

    If I had the opportunity to participate in free screening or counseling I definitely would. I would want to know my risks for certain diseases and whether or not I would have to take preventative actions in the future. My health is very important to me, so I would definitely take advantage of this free testing.

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  39. As a health science student, I'm somewhat on the fence with the importance of genetic testing to determine one's cancer risk. I feel like the arguments for both sides have equally compelling and important factors. So, I will phrase my argument like this: while I believe that advancements in science and understanding of the human genome have allowed those seeking genetic information about themselves to get that information and act according to those results, it should in no way be "imperative" that we discover our own disease risk if we do not want to. I believe that this respects one's decision to live his or her life in a certain manner. Knowing your disease risk will almost undoubtedly change the way you live your life - for the better or the worse. As a pre health professional, I think having the knowledge with a bit of paranoia and being able to act accordingly is more important that living a life without the knowledge of potential diseases that are ahead. But, I do think it is entirely up to each individual person. There should not be any pressure to get genetically tested if one has no desire to do so.

    I do think that some form of genetic testing should be covered by insurance. More preventative care should be covered by insurance companies, and genetic screening is, in my opinion, one of the best preventative measures one can take to avoid diseases down the road. Realistically, I think that everyone should get one free genetic test for difference diseases. The information obtained during these tests could potentially save insurance companies millions of dollars down the road. It is in their best interest to pay for preventative care rather than treatment.

    Lastly, given the opportunity, I would most definitely get genetically tested. There are a few diseases that run in my family, and I would like to know my risk of getting these diseases, and what I can do now to prevent those diseases. I want to have as much knowledge as I can so I can adjust my lifestyle to the results.

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  40. I don’t think it is imperative for me to know my family genetic history. It is however a good idea to be aware of it and to understand my family genetic history. Knowing whether or not I have a higher chance for certain diseases can possibly be a motivation for me to take care of my health. Some would argue that knowing that they have a higher chance for certain diseases will make them paranoid but I believe it can also be the main reason for people to live a healthier lifestyle. Knowing that your family has a history of a certain disease can make you more aware of your own personal lifestyle.

    I believe that the insurance provider should not base his or her coverage by someone’s genetic history. That would be very unfair and unethical as well. It basically goes against GINA and discriminating people by their health. However, I do believe that insurance companies should help provide genetic testing upon patient’s request. This will actually help the insurance company as well because once the patients have more understanding of their health history; they will be able to take early actions to prevent certain disease. By doing this, it can possibly help to save the insurance company money in the long run.

    If the genetic testing was available for me, I would most likely be interested to find out about my family’s genetic history. I would take it so that I can be informed about which diseases my family has a higher chance of getting and take early prevention if it was necessary.

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  41. I find the film that we are currently watching. In the Family, to be very empowering. Since taking genomics, I’ve starting pondering what would happen to me if I got a genetic test and found out I was at high risk for developing a deadly illness. Before watching the film, I thought the decision was easy—to do everything possible to evade the disease, even if it includes sacrifices. However, from the film, I learn that the decision was not that easy. Also, talking to others who have gone through the disease you potentially can develop can really impact your decision-making. Joanna is a young-, carefree, adventurous woman who has her whole life ahead of her. Even after finding out she had the BRCA mutation, she didn’t seem bothered and refused the possibility of getting her breast and ovaries removed because she wanted to enjoy her life and have children one day.
    But after talking to a support group of several women with the BRCA and learning about several different views, Joanna got anxious about her condition and reconsidered her thoughts about the mutation. Before all this, she was somewhat in the “ignorance is bliss” state of mind. Just knowing she had the mutation was affecting not only her, but also everyone around her (Ie her boyfriend petrified of losing her). From what we watched so far, I learned how heavy the psychological gravity is from just learning that you have a high risk of developing a disease. In my opinion, Joanna is in a good condition since she is young, aware that she has the mutation, and gets screening frequently.

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  42. I don't think that knowing one's genetic family history is imperative but it could be helpful. If you already know that your family has high rates of certain diseases then getting a genetic test can tell you if you have a heightened risk due to genetics or if you do not have a genetic risk factor. However, as we saw from the first half of the movie, knowing more about your genetic risk for certain diseases may not actually be helpful. Joanna knew she had a heightened risk for breast/ovarian cancer because of her genes but it caused her a lot of worry and did not really seem to help her situation. Joanna already knew she had to be aware of breast/ovarian cancer because of her family history, all the genetic test did was reaffirm her that she had to be extra aware of the risk of breast cancer. Furthermore, someone people do not understand genetics even with the help of a genetic counselor and these tests which may only show a sightly higher risk may cause people without enough education a lot of unnecessary stress and worry. A gene may cause a person to have double the risk of developing a disease compared to the general public but if that only increases their risk from 5% to 10% that may sound high to some people but that is not a huge increase. I think that people should only know their genetic history if they already have suspicions that they may have a genetic risk factor for a certain disease but honestly, I think if the general public knew their genetic history that would cause too much worry and stress considering how frequently people misunderstand genetics and genetic information.

    While I don't see genetic testing as imperative, the US health insurance system has far too many gaps and I think it should cover genetic testing if a doctor recommends it to a patient rather than everyone who wants a genetic test just gets one. I think that their should be a requirement that if someone gets genetic test they must see a genetic counselor so they do not misinterpret it. I think both public and private insurance should cover testing and counseling because it can be very important and useful in certain situations.

    If I had the opportunity free of charge, I would not participate in genetic testing. While cancer does not run in my family I know other conditions do. I know I need to be aware of these conditions and make life style choices to reduce the risk of these conditions. I don't think genetic testing would change my attitude since I already know that I have to be conscious of these things. Knowing myself, even though I know I probably have an increased risk of these conditions having that confirmed by genetic test would cause me too much stress and anxiety and would not be helpful. Based on some people's personalities getting genetic tests may be the right choice, but I know that would not be the right choice for me.

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  43. I’m very interested in knowing my family’s genetic history. I’m not sure I’d say it’s “imperative” for me to know me specifically, or for most people. If genetic testing was completely stopped, we’d all continue to live our lives just as they are now. I am very strongly interested in knowing my own genetic history though. I am adopted and have recently begun searching for my biological parents. I have always wanted to know what they looked like and their characteristics. Though I’m not actually genetically testing my parents if I find them, just being able to see meet them will give me a small view into my own genes. I’m also very intrigued by the possibility of siblings.

    The cost of genetic testing should be shared among both public and private insurers. I feel that this system should be government run, as they control many aspects of our ability to do genetic testing. The insurers should have to pay the government part or all of the costs for individuals who decided to be tested. Patients should also be responsible for a certain amount . A group effort should also be made for educating individuals about the results , what they mean, and any action that should be taken after. The better educated we are, the better choices each person can make.

    I would love to participate in genetic testing and counseling. Knowing such an important part of your physical body is somewhat empowering. The power of knowing what possible problems you may have in the future, and exactly what you can do to lower the chances of these problems happening. It’s almost as if we are cheating death a little, extending our lives a little longer.

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  44. I think it is important to know your family genetic history in order to be aware of what could occur in your own body. Even though no one means to, ancestors can pass down harmful genetic mutations from one generation to the next. With cancer, for example, there are many types of mutated cells that are more prone to increasing the risk of being diagnosed with cancer. Knowing that your family has a history of cancer, or even has this one genetic mutation, would be helpful in knowing how at risk you are for developing the disease. Early knowledge of this information can lead to early prevention, which can in turn heighten one's chances of treating and surviving some of these life threatening disease.
    However, I do understand many people's hesitation with not wanting to know if they are a carrier of these mutated genes. In the film that we watched in class on Tuesday, the young women was extremely overwhelmed by the knowledge that she had this genetic mutation that could or could not develop into cancer later on. This emotional burden can be to much for some people to deal with, especially when the early treatment of these disease is something as dramatic as removing body parts. This is where I feel the use of genetic counseling would be most useful. The genetic counselor would be able to provide a more clear view in what someone in a difficult situation to do. This being said, I do think it would be a good idea for medicare/ medicaid to provide genetic testing and genetic counseling. However, they need to offer both and not one with out the other so that individuals are not confused and stressed about the results they receive from their genetic tests. Also, by offering these options to those on these public insurance companies, it will give all individuals a equal health opportunity and not just allow those who can afford them to be educated about their genetic health.
    I think I would get a free genetic test done. I think it is important to know about any genetic risks that I might have so that I am able to treat or prevent them earlier while I am still young and healthy and able to do something about it. As one interested in public health, I feel that the most effective way to take care of health risks is to prevent something before it happens. By knowing what my health risks are before the disease has developed, I would be able to seek early treatment or start monitoring early in order to increase my chances of avoiding/ surviving the disease.

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  45. I think that knowing your family's genetic history is great information to have, but not necessarily imperative. As we have learned in previous lectures, and by watching "The Ghost in Your Genes" video, things that our ancestors have done can be passed down to us. Additionally, there are diseases that are known to be genetic, such as cancer. In some cases, there are external factors that influence whether or not someone will have a certain disease, such as lifestyle choices. Knowing your genetic information does not allow you to change your genetics, but it might make people more aware of what they are at risk for, and therefore influence them to make positive lifestyle changes. As someone above me mentioned, it is more important to focus on the things that can be changed. While I do believe that is true, it is also important to listen to what your genes are telling you.

    I think that knowing this information is important, and I would definitely get a free genetic test done. Even though there is always a chance that I might learn some information I wish I hadn't, it would be better to know these things at an early age, while there is still time to make changes that could potentially stop or slow down the disease. Genetic counseling would also be useful, because a counselor can provide more in depth information about my specific risk, and advise me on what my next step should be.

    Finally, I think that private and public insurers should share this cost. Genetic tests could be seen as preventative measures, and should be made more available and accessible to the public. Cost sharing between insurance companies as well as the individual would be a great way to do so.

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  46. I think it is extremely important to know your families history. The U.S, along with many other countries, have enough technology to access and help fight cancer. Cancer is not always curable, but the earlier we can diagnose, the easier it is to kill. If cancer is not caught early enough, it may spread to the hole body and once that happens,chances of killing cancer are not as high in comparison to catching it in earlier stages. This week really hit home for me personally because my mom had breast cancer only two years ago. Through great doctors in the Sloan Kettering Cancer Center, they were able to diagnose her properly and go through proper steps to remove the cancer. I think if she had been diagnosed earlier, the cancer would not have spread as much as it did, but with proper technology she was cured. Knowing that my mom had cancer, I will go through all screenings and testings possible to educate myself and reduce chances of developing breast cancer. Having genetic testing is definitely worth going through if it can help catch cancer early.

    I think it would be a great idea for private and public insurers to provide genetic testing and counseling to their customers. Many people may not be able to interpret the testing or do not know how to approach cancer. I would participate in receiving genetic testing and would encourage everyone I know to receive testing. Cancer affects many lives and families and is only becoming more prevalent in women. If we can raise awareness and approach cancer in an orderly and organized manner, we can beat cancer.

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  47. Knowing your family’s genetic history is one of the smartest and easiest things you can do for your health and well-being. Our family history holds many important clues about our risk for diseases and those of us with genetic predispositions for certain types of cancers or disorders will benefit greatly from lifestyle changes (quitting smoking, reducing alcohol intake, increasing physical activity, improving poor eating habits). Early screening tests can also detect disease risk factors, such as high cholesterol or high blood pressure. Genetic testing is the future in preventative measures in healthcare; one can determine their level of risk for inherited diseases just by taking this small step in his or her health and assessing what lifestyle changes need to take place.

    It is imperative in this day and age that insurance companies, both private and public (Medicare and Medicaid) provide genetic testing and counseling to their customers. Learning about your genetic predisposition to certain diseases through this simple test is a preventative measure that can aid the patient in preventing that disease or disorder from being a problem in the future. Genetic testing as a preventative measure can potentially save insurance companies a lot of money in the long run; it is wise for them to be offered to consumers free of charge or at least at a reduced cost.

    If given the opportunity, I know I would certainly take advantage of genetic testing offered free of charge (as long as this information was for me only and no one else would have access to my genetic information without my permission) as I am interesting in taking control of my health and well-being. There are certain diseases that run in my family and getting tested for these mutations would help me prepare for the future. I believe that as long as there is a way to reduce risk and preventative measures are available for the disease, then one should be tested for it. If lifestyle changes will not change a future diagnosis (Alzheimer’s Disease), worry and anxiety is all that would come from testing; in these cases genetic testing is not the answer.

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  48. I believe it is important to know your family's genetic history. Knowing this information can greatly help someone make good behavioral choices regarding their health. For example, since my mother has had breast cancer, it would be very informative to know her genetic history. This way I could know if there was more of a genetic influence that cause her cancer or more of an environmental or behavioral influence over time. Also, if someone has knowledge of their family's genetic history, it can better motivate them to get genetic testing themselves or to make better, healthier choices if they are more at risk for a disease. I think that insurers should contribute to genetic testing. Relating back to my family, my mother wanted to get genetic testing for herself and her three children. However, genetic testing with no assistance from insurance is very expensive, and this information can help my family a lot. Perhaps one day insurers will be able to pay a component of the fee for the testing and patients can just make a copay. If I had access to genetic testing I would definitely decide to get it because I would like to know more about my family's disease history. My mother was also adopted, so knowing her genetic information would be especially helpful, especially since I do not know what diseases my grandparents had. I believe that receiving genetic testing and counseling can truly benefit a person and help them live their healthiest lives possible.

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  49. It is absolutely vital that you know your family history, especially in reference to your health. It is no coincidence that hospitals question you for your family history when you are trying to get treatment for any disease or illness. While we have inherited so many good traits from the genetics of our ancestors, we also inherit their genetic imperfections. This includes mutations that predispose us to various diseases such as Breast Cancer or Huntington’s. By not knowing our family history, we essentially disarm ourselves in our fight against various diseases. If you know you are predisposed to breast cancer, that can lead you to live a different lifestyle such as eating healthier, not smoking tobacco products and maybe abstaining from using birth control. Being ignorant of your family history will only hurt you in the end and may, indirectly, be the cause of your death should you develop a terminal illness you are predisposed to.

    I don’t think that Medicaid/Medicare should provide genetic testing to their insurers because I don’t like the idea of having access to that kind of information. Should security be compromised & that information went public, we would all be suffering from the consequences. While it is important to increase public awareness & knowledge regarding genetic testing predispositions, it is dangerous to enact something so dramatic without proper security or legislation in place to protect ourselves.

    Personally, if I had the opportunity I would definitely participate in genetic testing. Maybe it will push me to live a healthier lifestyle and be more proactive with my health. I am almost never sick and subsequently I almost never go to the doctor. It’s one of my worst nightmares to go to the doctor for some minor illness and then find out I have some form of cancer that I cannot treat because I waited too long to get diagnosed. Having a knowledge to what I am prone to will force me to be more proactive with my health and give me another tool to combat the diseases that I am likely to develop.

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  50. Although I think it is very important to know and understand you're family's history and understand your genetic predisposition to certain diseases, I don't think it's imperative because of the many factors other than genetic factors that effect your health and risk of disease. Somebody could be perfectly healthy, take care of themselves and have a genetic predisposition to a disease that never manifests as a result. Just the same, someone can have no genetic predisposition but live an unhealthy lifestyle and be exposed to environmental factor that cause the disease to manifest. Genetics only account for a small percent of risk. For example, a very small percentage of breast cancer cases can be accounted for by genetic factors.

    I think we should instead push people to focus on the factors they have control over such as their lifestyle, environment, and behaviors. If they lead a healthy life, they can control their risk no matter what their family history. I think the paranoia and mental stress that comes with genetic testing isn't always worth knowing your risk because there are so many other factors involved in assessing risk. The worst part about it, is the lack of control we have over it.

    After seeing the documentary in class and seeing the stress and how the results took over her life, I wonder if genetic testing would be helpful to everyone. I think whether or not someone gets genetic testing should be based on family history, the severity of the disease, and whether their is a guaranteed way to decrease risk. Some examples are breast cancer, ovarian cancer, or Alzheimer's disease. Or else, I don't know whether it is worth the stress that seems to take over your life.

    However, I do think genetic testing should be covered by insurance because those who do have a family history of severe diseases that have available treatments that reduce risk should be able to access their genetic information so they can take action as soon as possible. Some may argue that this may cause people to overuse the testing when it's not necessary. But there is a lot of evidence by studies on health insurance that show people do not abuse the facilities available to them just because it is covered by insurance.

    I don't think I would participate in genetic testing because I don't think it is worth the anxiety. I have a family history of diabetes and heart disease. I understand I am at risk but I live a healthy lifestyle and make an active effort to decrease my risk but being as healthy as possible. I have taken control of my health and that is all I can do. I don't see how genetic testing would benefit me when I am controlling the factors I am capable of controlling.

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  51. I personally think that knowing your family's genetic history should be a person's own choice. If they want to be informed about potential risks of disease or hereditary genetic markers, a person will follow and find their family's genetic history.Some people are afraid of what they will find, they believe what they don't know won't hurt them. Knowing your genetic information may cause people more anxiety and stress. It some cases it could a person to change their lifestyle habits, which actually may reduce their risk, but people are still afraid of finding out that they might develop a disease.
    I think that if people what genetic testing they should be able to obtain it, no matter what type of insurance they have. Yet, I don't think that insurer should be providing the testing. Getting genetic testing could possibly, in the long run, lower health expenses, as pre-symptomatic patients can be recognized and treat early, instead of going through intensive medical care later.
    Even if genetic testing was free, I'm not sure I would participate. I know most of my family's medical history, and while there are risks of disease that i might want to know about, I'm not sure what I would do with the information. Having genetic testing can significantly change you way of life, and the decision to participate should not be taken lightl

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  52. I think it is imperative to to be aware of your family history for diseases but I don't think it is imperative to know their genetic information. Not everyone is going to be okay to share their genetic information with family members. Knowing who has what disease should be enough information to know what you may be at risk for. If you know what you are at risk for, you can be sure to get tested for these disease at routine physicals. I also don't believe Medicare or Medicaid should offer up genetic counseling unless someone asks for it. It would be harmful to society to offer it to people who are unaware what they are signing up for.

    If I could get free genetic counseling I wouldn't do it. I know that it would change the way I would live my life in a negative manner. I don't want to sit around waiting until I get a disease I'd rather just catch it early and try to beat it and continue living my life as normally as possible. Finding out you have a mutation for a disease would just bring anxiety of when it will happen and that's just not how I want to live my life.

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  53. When it comes to family genetic history, I don’t believe it is imperative to know it, but I do believe it is important. Knowing your genetic history can help make lifestyle decisions to improve overall health, but on the other hand it can cause people to worry. In my opinion, genetic counseling should be sought by a person not only after genetic testing, but before. Receiving genetic counseling before seeking testing will be extremely helpful in preparing a patient for the results of the test. Similarly, the advantages and disadvantages of genetic testing would be discussed and the patient may decide against getting the test. If a patient does decide to go through with the genetic testing, then they should do so. Following genetic tests, the patient should be required to follow-up with the genetic counselor. Genetic testing and counseling are inextricably linked and have important implications for health and well-being.
    I believe public and private insurers should be responsible for some form of coverage. I believe the patient should also have some responsibility in terms of payment for the services they are seeking, like a co-pay for example. Given the opportunity to receive genetic counseling, I don’t think I would take it at this stage of my life. After I was born, I know that I was tested for a genetic blood disorder that runs on my father’s side of the family, luckily I tested negative. However, my parents were told that if they had another child, he or she would most likely inherit the disorder. Perhaps later on in life I might consider genetic testing it because of my family history of ovarian and breast cancer. As for right now, I do not see the need to undergo genetic testing and subsequent counseling.

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  54. As a patient, I would love to know about my family history and likelihood of cancer. I think most people would, so I won't touch on it too much. It is important to know and be aware so that one can take the necessary precautions through procedures or lifestyle changes. However, I am torn on whether or not health insurance companies should be obligated to pay for such a procedure. On one hand, it is likely in the patient's best interests, should they opt for it, but on the other hand, does this mean that the provider can charge more for this patient given their likelihood of increased medical expenses? My insurance (Kaiser), charges more if a person smokes (I believe) because it lends to lung cancer and unhealthy lifestyles. In that same vein, cancer does too. However, cancer is nonvoluntary. I think that patients need to either be willing to foot the bill for their genetic tests, given that it is non-urgent and more informational than medicinal in nature, or be willing for their insurance companies to charge more if the patient doesn't lead a healthy lifestyle.

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  55. Although it can be problematic to know your genetic mutation if the outlook for the diseased is dismal, it can also be beneficial in terms of planning for children and adjusting lifestyle habits to decrease chances of later developing diseases. This is definitely an individual choice, however, and because of the public's predicted mixed views on the subject I do not think it is necessary for insurance companies to provide genetic counseling. I think this would drive up the health care costs and have similar effects to mammogram screenings. In the case of mammograms, the cancer detected often has a better prognosis that typical slow-growing cancer. Most women, however, with the incentive to seek screening also have the incentive to seek treatment if they are identified as positive. This both creates unnecessary stress and increases unnecessary surgeries and health care expenditure. When Professor O'Keefe taught us about this last semester, she said she knew a women in public health who spoke out to lower the suggested age of mammograms for this reason, but later admitted that she gets routine mammograms herself. Due to all of this, I would not say it is imperative to know your family's genetic history. "Imperative" implies a certain necessity of genotypic knowledge, which I do not think is true because many people live healthy (and sometimes more stress-free) lives without knowing their family history. With that being said, I would definitely seek genetic counseling if I had the opportunity to free of charge. I am the type of person who would want to know my genotype in case I can make adjustments now to prevent disease later.

    As an aside, I recently wrote a paper for another class on a functional polymorphism (involving MAO A enzyme activity) that results in aggressive phenotypes when coupled with environmental risk factors such as childhood maltreatment and alcohol. This phenotype is often found in violent criminals. In deliberating treatment options, I could not decide on an appropriate method of intervention. If a treatment option is crated that would regulate MAO A activity in humans, when and in whom would it be appropriate to use? Should pregnant seek gene therapy for their fetuses if they are susceptible to the genotype even if they will not grow up in an environment with suspected risk factors? Is there an ethical way to treat prisoners with a history of violent crime such as homicide? Is it more ethical than the death penalty?

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  56. Given the increased awareness of genetic components/factors that predispose or cause diseases and/or conditions, it would be helpful to how one’s family’s genetic history. However, I can’t say it is quite imperative to know one’s family’s genetic history. Knowing would give many advantages in what to expect for the future, what to maybe be cautious of, and/or changes one might want to make ahead of time to better one’s chances of a healthy life. But, ultimately, I feel it is a personal decision for one to choose whether to live knowing or not knowing their family’s genetic history. Some can choose to live not knowing out of fear while others may not event have the option because of adoption or other situational conditions—not being able to contact their biological parents. I personally would like to know in order to have the option to better prepare myself in the case of.
    I do feel that public and private insurers should provide genetic testing and counseling to their customers. Given the increased awareness of genetic components that cause diseases, as mentioned above, it would only seem valid to have health care insurers provide such services. There is an obvious and clear reasoning behind getting genetic testing that is linked to one’s health, justifying the need for health care insurers to provide genetic testing and counseling. Such a service can even prove to be financially beneficial in some cases where the gained knowledge from genetic testing and counseling helped a customer discover their higher than normal risk level, causing lifestyle changes that possibly had positive effects in helping the customer avoid severe health problems thus saving the insurer money in medical fees. The same goes for cases where earlier disease-stage treatments are cheaper and when customers have time to find more cost-efficient treatments with the time they have gained from getting genetic testing and knowing earlier on.
    If I had the opportunity to get genetic testing and counseling free of charge I would. Despite the results, I feel that knowing and being better prepared is a better alternative to being caught off guard and thrown into confusion/chaos by a disease. With regard to sharing the results with family members, I would only inform them of my results if they themselves are prepared to hear information that may affect them. If there are family members that wish to not know, I would respect that and maybe not even mention that I have been genetically tested in the first place to remove the chance of curiosity getting the better of them and them regretting their decision to hear the results despite themselves later on. I also currently have little actual knowledge of my family’s genetic history and/or health due to the size and distance of my extended family’s residence (on the other side of the world). This level of ignorance may also be in part why I am so willing to get genetically tested and the subsequent counseling regardless of the results.

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  57. I believe that providing individuals the opportunity to receive genetic testing with
    the knowledge of their family health history is extremely important, and in many
    cases, life saving. If a person knows that a certain disease is prevalent amongst their
    family members, finding out if they are genetically predisposed to also developing
    the disease can help out in tremendous ways. Of course, this knowledge can also
    cause some anxiety and worry for family members if it turns out that a person does
    develop the disease in the future. This is why is it imperative that individuals are
    aware that a predictive test is not a diagnosis, and they should be given the proper
    information and facts from a genetic counselor on how they can make lifestyle
    changes to help further reduce their risk.

    Genetic testing and counseling should be provided by health insurers, but the
    results of these tests should in no way change the cost or amount of coverage
    offered to the individual being tested. I would personally participate in genetic
    testing and counseling in order to determine if I need to make any lifestyle changes
    and in order help reduce my risk of developing a certain disease. Genetic testing
    provides awareness in order that I can prepare and take the proper action steps in
    order to reduce and potentially eliminate this risk.

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    1. I completely agree with Brandi. I feel as though genetic testing can be very beneficial and is a great way of implementing more preventative care. I think people should have an "opt in" choice to get genetic testing if they would like to know their family history. If others do not want to cause unnecessary anxiety they should be allowed to pass on the genetic tests. However, I don't think the results of any tests should be used to alter health insurance price or coverage in any way. Genetic testing for family history is a good means for individuals to make necessary lifestyle changes that could potentially save lives.

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  58. I do think that it is imperative to know your family's genetic history. I think that knowing which diseases and conditions you may or may not be predisposed to could have enormous public health implications. This information could affect a person's decision whether or not to have children, for fear of passing on their genetic mutation. This could also cause people to seek treatment for their condition, raising awareness and the possibility of more available treatment options. In addition, knowing your family's genetic history could spur the decision to conceive children via IVF, and implanting only those embryos that do not carry the genes of interest. If this decision becomes a popular one for families, certain diseases even have the possibility of being completely eradicated.

    While I do think that insurers should provide genetic testing and counseling to their customers, I do not think that this should be a priority of insurers; I think that companies should work on expanding their coverage first, and on making basic insurance available to all people, before they focus on making currently unnecessary procedures available to their current customers.

    I would participate in genetic testing were I able, free of charge. If I found out I had the gene for a serious debilitating disease, such as Alzheimer's, it would very much affect my decision to have children, and how I would choose to live my life. I would also like to be given the opportunity to make appropriate steps in regards to treatment or settling affairs. Overall I think it is important to be informed.

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  60. I have always found the subject of genetic testing to be a very interesting one to say the least. I first learned about genetic testing last semester in my Epidemiology class where I was informed that through having a test preformed to check your “genes” or genetics, one could find out if you were predisposed to acquire certain diseases and or condition over their lifetime. Having said this I do not believe it is imperative to know your family’s history for a number of different reasons, meaning although most people find it very interesting to be able to know if they are predisposed to acquiring a diseases or not, through knowing there family’s history, some other people might not want to know that information because it could lead to minor or substantially significant changes in the lifestyle they chose to live. I continue with this point by saying that it is not only lifestyle changes that will effect the person that knows there family history, but if someone is predisposed to a very lethal disease or condition, the test results could have a very major negative psychological impact on there self.

    I believe that public and private insures should provide genetic testing free genetic testing and genetic counseling, leaving the decision to get tested or not up to each individual person. I believe this because if the insurance companies provide this for free, most people that could not afford it before due to its high costs are now able to, and this could save many peoples lives in the long run because if a person is found to be predisposed to a certain disease they can seek medical treatment to try and reduce this risk.

    If I had the opportunity to participate in genetic testing and subsequent counseling, I would choose not to participate. Although I find this subject of genetic counseling to be extremely interesting, I would not participate in testing because I would not want to know if I was predisposed to a certain disease so early in my life. I currently live a very healthy lifestyle and do not think that knowing my family’s history would provide me in making any lifestyle changes, rather it would just make my psychological outlook on life negative knowing I am predisposed to a disease.

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  61. I think everyone should know his or her family’s history so yes, it is definitely imperative. Most pediatricians and general practitioners ask the family’s history when the baby is born and also later in life, at least this is what I have experienced. In my yearly checkup, my general practitioner asks me if there has been a change in my family history. I’m not sure if this is something that every doctor asks, but the good ones should ask this because they understand the importance of the family history. Also, if we recall the first week of class, we saw in ‘The Ghost in your genes’ that family history and what our ancestors experienced throughout life can affect us and out genetics so many years later.
    I’m not really sure if I agree with insurance companies providing genetic testing and counseling for their patients. This is a tricky subject especially if the insurance companies find out that a patient is positive for a disease causing gene like the BRACA1/2 gene, they may be able to charge more for that. I’m sure every insurance company is different but my insurance company (Oxford) will charge extra is there is a smoker in my family and if we have a certain disease (I’m not sure exactly which ones). If the insurance company is offering the genetic testing and counseling without trying to charge extra for those who will test positive for a gene, I think it would be an excellent opportunity for these patients to get genetically tested. If I were given the opportunity to, I would get genetically tested because I understand the importance and the positive impact I can have on my life if I know I need to change my daily routine at an early stage of my life. But for some I understand it could make them upset and the counseling would really come in handy.

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  62. Alexander de GrootMarch 7, 2014 at 3:29 PM

    I view genetic testing as an option for disease treatment. Along with other information, such as family history, genetic testing can help people decide what treatment options are best for them, if they are necessary. Therefore, I think it is a personal decision whether or not to be tested for genetic anomalies, and so it is not imperative. However, I do believe it is imperative that people understand their family medical history, so that they have a better idea of how it could influence their health. As was discussed in "The Family History - More Important than Ever" article by Guttmacher et al., a family history is a good first look into a person's risk for genetic diseases, such as breast cancer, heart disease, or ovarian cancer. Often times, this information alone can be enough information for a person to make decisions regarding preventing their risk of disease. Thus, before obtaining a genetic test, people should understand their family history and then discuss it with a genetic counselor to see how the pros and cons of genetic testing balance out for their own individual circumstance.

    Because I view genetic testing as a tool for disease treatment, I do believe that public and private insurance companies should subsidize the costs for genetic tests and counseling. Depending on a person's discussions with a genetic counselor, testing could help a person decide if prophylactic measures need to be taken for disease prevention.

    All this being said, if genetic testing and counseling were free of charge, I would have a genetic test done, but only after thoroughly understanding my family history and discussing it with a genetic counselor. Genetic testing can be very distressing if the results come out negative, and taking the time to think about the pros and cons of having such powerful information is of the utmost importance.

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  63. I believe entirely that knowing one's family genetic history is important in the present as well as in the future. Knowing this information is advantageous as a person/family can sketch out an entire care plan and not be left in the dark when people are in a chaotic dilemma on what to do when required to assist a relative member in need. It doesn't hurt to have a plan in place when one's genes have somewhat predicted what disease the person may get in the future. Having knowledge of your family's genetic history is especially beneficial when planning to have a children. With today's technology, it's possible to modify some of the genes of a children so that they have less of a chance to develop a disease or mutation. I feel that if everyone can take advantage of modern technology and science, diseases that we fear now can be one day be rid of forever in the future.

    Insurers should provide genetic testing and counseling for their customers. However, these insurance companies should focus on other issues as I don't believe genetic testing/counseling is that high on the priority list. I'm taking HP353: Organization and Delivery of Health Care in the US at the moment, and after several weeks of taking the course, I realize how much the system needs to be fixed. We spend the most on health care, yet other countries' uniform health care is beating out system.

    If the opportunity would ever arise for a free genetic test, I would take it, but would make sure first that whoever is administering the test is doing so legally. Like I said above, knowing one's family genetic history is important to mapping out future plans for when I get sick or have a child with my spouse one day. However, I would have to make sure that if I do go through with the test that the company or whoever is providing the service will not use it for later use, give it to the government, or anything else that would require consent first.

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  64. Given the increased awareness of genetic components/factors that predispose or cause diseases and/or conditions, do you believe it is imperative to know your family’s genetic history? Also, should public (i.e. Medicaid and/or Medicare) or private insurers provide genetic testing and counseling to their customers? Finally, if you had the opportunity, free of charge, would you participate in genetic testing and subsequent counseling?

    I do not believe that it is imperative to know your family's genetic history because often times, you will have already known whether there are patterns for cardiovascular disease, diabetes, various cancers, and other diseases. General awareness (e.g. my mother had this disease, my grandmother had this, etc.) is not a surefire way of assessing one's risk of developing disease, but it has been fairly indicative to date. Likewise, I still consider genetic testing, the ability to understand one's entire biochemical makeup, a luxury so that is another reason why I do not believe it is essential.

    Following this pattern of thought, I have mixed opinions in regards to Medicaid and/or Medicare covering genetic testing. If there is a prevalent family history for some disease, then yes, genetic testing should be provided in the context of that disease. On the other hand, if the person has had a virtually healthy family history and continues to live a healthy lifestyle, then insurance companies should not feel obligated to cover genetic testing as in doing so would not be very cost-effective. Annual physicals could indicate a person's level of health, and based on this, the insurance company can or cannot provide coverage for genetic testing.

    Finally, if I had the opportunity to participate in a genetic test free of charge, I would choose not to do so. Had I found out I was some carrier or at great risk for a certain disease, I would have hated to live life in such a state of fear and uncertainty. Even if I found out I was at risk for a certain disease, most precautions are in line with the recommendations for a healthy lifestyle. Thus simply living life as healthy as possible is my preventive and curative solution.

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  65. I believe it is very important for all to know their family history, however, I do not think that it is vital for one to know their genetic history. Ones family history allows one to know the diseases that one is pre-disposed to. However, genetic testing should be an individual matter, and not something that family members need to share among one another, unless they want to. If you are at risk for certain diseases, you can be checked for those diseases at routine check ups. Although genetic testing would allow one to plan in case one gets the disease, one does not one to center ones life around a disease. Medicaid and Medicare, and other insurers, should offer genetic counseling if someone asks for it, however, this should be totally voluntary and not a priority. The health insurance and costs, however, should not be affected by the results of these tests.



    I would not take the opportunity to take a genetic test because my family does not have a history of cancer of any sort. Also, I do not want to live in fear of the inevitable. I want to live my life as healthy as possible and whatever the outcome, and whatever happens, I will plan for it then. I will prevent what I can, and battle what I cannot.

    (I fixed my browser and wanted to post it on here as well, refer to email)

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