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November 3, 1989

Insurance and the Presymptomatic Diagnosis of Delayed-Onset Disease-Reply

Author Affiliations

The Johns Hopkins Medical Institutions Baltimore, Md

The Johns Hopkins Medical Institutions Baltimore, Md

JAMA. 1989;262(17):2385. doi:10.1001/jama.1989.03430170044018

In Reply. —  We thank Quarrell et al for highlighting some of the social issues raised by presymptomatic diagnosis of disease with molecular genetic tests. As clinicians and researchers testing for Huntington's disease, we are concerned that those found to be at increased risk for this illness not be subject to unreasonable discrimination. While Quarrell et al admonish us to be realistic about the needs of the insurance industry, our central concern will always be for the health and well-being of those who seek our counsel, technical expertise, and care.We are very aware that the insurance industry is based on the concept of differential risk. Those who have poor driving records pay higher premiums for automobile insurance, and tobacco smokers often pay higher life insurance premiums. This discrimination, most would agree, is fair and just. However, we as a society have decided that some risk variables should not be