Insurance Notes

The article “Federal Rule Limits Use of Genetic Testing” in the November 6, 2009, issue reports on the federal interim final rule implementing the Genetic Information and Nondiscrimination Act of 2008 (GINA, PL 110-233). The rule was issued on October 1, 2009, by the departments of Health and Human Services, Treasury, and Labor.

I would like to point out that the rule, GINA, covers the information in the standard family history interview—not just genetic information. And it forbids an employer from simply “possessing”—not just “using”—such information in an employment decision. Further, it rules that if employers do possess such information, they must “prove” that it was not only not used, but that is was obtained “by accident”!

I would also like to make a related point about the use of the term “disability” in regard to mental diagnoses. In several recent articles in our publications, having a mental diagnosis was equated with being disabled. Clinicians too do this when they list or report a diagnosis as though it were evidence that the individual is disabled. We need to be proactive about differentiating illness and disability. Many people with an illness have no disability; many have a disability but are not disabled. As the treatment of all chronic illness improves, and diagnosis is made earlier and earlier, most people will have a diagnosis and an active life. While this has always been true, it is becoming the rule. Conflating illness and disability can be detrimental to our patients and further stigmatizes mental disorders.