One of the most controversial issues the insurance industry has had to tackle in recent years has been that of DNA genetic testing.
Medical science can determine someone's likelihood of developing a particular disease in their lifetime. Insurers want to use the information to calculate premiums for life, healthcare and other medical policies. Civil rights campaigners and consumer groups ask, will insurance companies be tempted to create an "underclass" of uninsurables or only insure some people under premiums that are unrealistic?
Putting it under the microscope
To give everyone involved a chance to scrutinse the topic thoroughly, the Association of British Insurers (ABI) last month introduced a five-year "moratorium" in agreement with the government on the use of genetic tests by insurers.
However, the move has prompted some in the industry to question whether the ABI should have bowed to pressure from the government, as the moratorium means the broad range of low-risk policyholders will be forced to shoulder the burden of the small number of high-risk policyholders.
Genetic tests, as approved by the Genetics and Insurance Committee (GAIC), can still be used in certain circumstances: when a person applies for life cover worth more than £500,000 or critical illness, long-term care and income protection cover worth more than £300,000 for each type of policy. These limits will be reviewed three years into the moratorium.
The ABI has operated a Code of Practice on the use of genetic tests since 1997 - the first of its kind in the world. The code was last revised in 1999 and will be revised again in the light of the latest changes.
The ABI has also promised to introduce an "independent and impartial" complaints mechanism to deal with non-compliance issues.
The five-year moratorium is in fact a minimum industry standard. Some insurers may decide to adopt a stricter genetics policy.
Public awareness
The government has recommended insurers publish their approach to the use of gene-tic tests so applicants can make an informed decision on where they place their business. For example, insurers are allowed to take into account a negative test when considering an application because then the insurer could apply standard premium levels, even if there is a family history of a particular condition.
The ABI plans to make sure the public is aware of the moratorium so people are not deterred from taking genetic tests for fear that a positive test will make it harder to get cover or increase premium costs.
The ABI's Malcolm Tarling says the point of the moratorium is to "take the heat out of the debate".
He says: "Genetic testing is very much in its infancy. For insurers, it is starting from the principle that relevant information should be disclosed to insurers.
"If the GAIC was to say a test isn't relevant, we'd stop using it. We are open to external scrutiny."
Debate the issues
Tarling says the moratorium allays criticism that insurers are creating an "underclass" or excluding people.
"Insurance is all about taking risk. Is the information you get accurate, reliable and relevant? If people think our stance is wrong, then let's debate it."
On whether insurance applicants will be subject to ever more detailed questioning about hereditary conditions, Tarling says: "There are always questions about family history."
But he accepts there is a lot unknown about DNA testing because it is still developing. "We're hitting a moving target - it's developing apace."
Tarling also says there is not currently a question of premiums being raised in the short term because the numbers are too small but, in the longer term, this could happen "if there's a strain on funds".
Chief actuary at health insurer BUPA, Geoff Brown, agrees: "Over five years, there may be a slight risk of higher premiums, but it is slight.
" If there are any upward moves, they will be not be in private medical insurance, but in critical illness, income protection and long term care. There would probably be a marginal increase of 2%-3%, but that would be if there's a lot more testing out there," he says. "Otherwise there's no major impact."
Brown backs the moratorium because "if there was a fear, it removes that fear". Like the ABI, he does not believe the issues will create exclusions or an "underclass".
He says: "The industry is moving to make it easier for people to get protection. I see no change to underwriting policy."
However, moratorium or not, those opposed to the principle of genetic testing remain steadfast. The pressure group Human Genetics Alert (HGA) has called for "an immediate permanent ban on the use of genetic test results by insurers."
The organisation attacks what it calls the "partial moratorium" as "an ongoing attempt by insurers to avoid external regulation.
Creating a stratified market
HGA co-ordinator Dr David King says: "Allowing the use of such tests by insurers is bound to lead to many people becoming uninsurable and to an increasingly stratified insurance market.
"It runs contrary to the social values most people in Britain hold dear, which is why the vast majority of people oppose it."
He adds: "Apart from the government's desire not to antagonise the insurance industry, there is no reason to hold back from a ban."
A middle view is expressed by consumer group the National Association of Bank and Insurance Customers. Spokesman Stuart Cliffe says: "It's obviously a very difficult area and raises a lot of emotion.
"On one hand, there is a risk for the insurers that, under a moratorium, people might rush out to get insurance who are known to be at risk from a hereditary disease. On the other hand, there's a risk
they might exclude anyone who gets a disease.
"As a former underwriter, I can see how insurers feel, but there's got to be an acceptable middle way," Cliffe says.
Cliffe also makes the point that DNA testing is not an exact science and mistakes could be made.
"It would be unfair for someone to be excluded from insurance because they happen to have the wrong genetic label."
What is genetic testing?
Genetic testing is still relatively new and the next five years are likely to see huge advances in the science.
Gene therapy is being used successfully to treat cystic fibrosis and an immune deficiency called ADA. Sickle cell anaemia and other blood disorders may the next targets for a genetic cure. Although genetic treatments for cancer may be a long way off there is still hope that many genetic cures may be found.
At one time, doctors could only diagnose genetic problems by a process called karyotyping - checking the number shape and dye stains in chromosomes. Now, genetic testing has developed far enough to allow doctors to pinpoint missing or defective genes.
Much of the newest information from genetic research has not been translated into useful screening tests. However, experts say this will soon change and they estimate that the number of genetic tests will increase tenfold over the next decade.
Although experts originally believed no more than 3% of all human diseases were caused by errors in a single gene, new research suggests this may be an underestimate. In the past few years, scientists have discovered genetic links to many diseases not thought of as "genetic", including several different types of cancer.
