Conflicts of Interest in Genetic Counseling?

Being on the payroll of a company that pays commissions (kickbacks—medicynical observation)  for more business sounds at least unethical in a medical practice.  If the service provided is more than a person needs and if the relationship with the company is not fully revealed,  it could be criminal.  Something out of a HBO crime  family show?  No it’s simply the way genetic testing is encouraged in the U.S.

Now, as the number of tests and the money to be made from them are exploding, another question is being asked by professionals in the field themselves. Is it ethical for genetic counselors, who advise patients on whether to undergo testing, to be paid by the companies that perform the tests?

While it might not always be immediately obvious to patients, some counselors offering them advice in hospitals and doctors’ offices work for the commercial genetic testing companies, not for the hospitals or doctors themselves.

The testing companies appear to have business arrangements with hospitals and practices that recommend the use of the company’s counselors and product.  They and/or the counselor often  pay for office space in the facilities, to facilitate access to patients.   The counselors get paid more for an increased volume of testing.  When the full details of the arrangement is known the conflict of interest is quite likely to be worse.

For example, are the counselors full employees with benefits from the testing company or are they contractors?  If they are contractors than the extra payments for increased volume have more the flavor of a kickback than a “bonus” to an employee for good service.  In either case, the arrangement borders, in my view, on being unethical particularly if the relationship between the counselor, testing company, doctor and hospital is unclear.

Medicynical Note:  A cleaner way of doing this would be to have a completely separate office/facility for the genetic counselor with the relationship between the facilities clearly and understandably spelled out.