Conflicts of interest in genetic counseling: persistent underlying questions.
Conflicts of interest in genetic counseling: persistent underlying questions.
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遗传咨询中的利益冲突：持续存在的潜在问题。
DOI：
10.1038/gim.2017.235
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
Michie,Marsha
中科院分区：
文献类型：
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作者：
Stoll,KatieA;Mackison,Amanda;Allyse,MeganA;Michie,Marsha
致编辑：我们感谢Iacoboni和同事们的一封信，这是我们希望促进的对话的一个值得欢迎的延续。Iacoboni等人还提到了国家遗传咨询师协会最近委托的利益冲突问题工作组（COI）的工作;这些资源在我们的评论提交后提供，是对这一急需的对话的另一个受欢迎的补充。Iacoboni等人，他们都受雇于Invitae公司，描述了他们的实验室的努力，以减轻他们的遗传咨询师（GC）之间的COI-包括多个点的披露和非委托的工资结构-我们衷心鼓掌。在我们看来，不幸的是，在缺乏行业监管或问责的情况下，患者无法确保所有实验室都做出了类似的努力。值得重申的是，我们不认为实验室雇用的GC无法提供优质的患者护理。正如我们在评论中强调的那样，“我们认识到，实验室雇用的遗传咨询师可能不会比其他遗传咨询师更专注于提供最好的、专业的护理。”[2]然而，这一观察结果并不能否定遗传咨询师的COI这一简单事实，因为他们同时受制于国家遗传咨询师协会的道德准则，该准则要求遗传咨询师在提供关于选择和替代方案的平衡信息的情况下使患者能够做出决策，并受制于商业雇主，其存在取决于维持或增加测试销售。
To the Editor: We appreciate Iacoboni and colleagues’1 letter as a welcome continuation of the conversation that we hoped to promote. Iacoboni et al. also mention the work of the Task Force on conflicts of interest (COI), recently commissioned by the National Society of Genetic Counselors; these resources, made available after our commentary was submitted, are another welcome addition to this much-needed conversation. Iacoboni et al., who are all employed by Invitae Corporation, describe their laboratory’s efforts to mitigate COI among their genetic counselors (GCs)—including multiple points of disclosure and a noncommissioned salary structure—which we wholeheartedly applaud. In our view, it is unfortunate that, in the absence of industry regulation or accountability on this issue, patients cannot be assured that all laboratories make similar efforts.It is worthwhile to reiterate that we do not believe that laboratory-employed GCs are unable to provide quality patient care. As we emphasized in our commentary,“We recognize that genetic counselors employed by laboratories are likely no less focused on providing the best, professionally responsive care than any other genetic counselor.” 2 This observation, however, does not negate the simple fact of COI for GCs who are simultaneously beholden to the National Society of Genetic Counselors’ Code of Ethics, which calls for GCs to enable patient decision making with balanced information about options and alternatives, and to a commercial employer whose existence depends on maintaining or increasing test sales.