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Examining Ethics Of Lung Cancer Test


That new medical test Joanne just reported on raises as many questions as it answers. And to take on a few of those questions, we turn to medical ethics expert Nancy Berlinger, who joins me now from New York.

Welcome to the show.

Dr. NANCY BERLINGER (Medical Ethicist; Deputy Director and Research Associate, The Hastings Center): Thank you.

LYDEN: So you had to think that some people are going to get tested and find that they're in a lower risk group and perhaps use these results as an excuse to keep smoking, don't you?

Dr. BERLINGER: Absolutely. I thought in the report, the idea, the Aunt Ethel syndrome, was really helpful because when we think about, you know, a person who we probably all know who had a lifelong smoking habit and didn't develop lung cancer, we probably are not thinking about the other chronic diseases that this person probably had.

If we just think about that disease in isolation, lung cancer, we may forget the whole story of what we know about what smoking can do to people.

LYDEN: Do tests like this, Nancy Berlinger, have an effect in terms of - we also heard maybe if it's highly scary to some people, that's a good thing.

Dr. BERLINGER: Definitely understanding cancer risk through the identification of biomarkers is hugely important. But one thing that really worries me is that - let's say you had a consumer version of this test, not something that you would use in a laboratory or in a doctor's office, but something you would market to people. Where would you market this test?

You would market it in the same low income neighborhoods where the cigarette billboards are. You would market it to smokers. You wouldn't market it to people who don't smoke and say, here, you can start smoking. You would direct it to people who already have an addiction that is already impairing their health, and that raises very severe ethical consequences not just for an individual, but for an entire community.

LYDEN: Beyond that, there are some big ethical questions. Take insurance companies. If this test passes muster, could we be seeing high risk smokers paying more for their policies?

Dr. BERLINGER: That's an interesting question. It's definitely something that we're concerned about every time a test comes online that there would be some sort of way or using a test to sort people out.

LYDEN: Uh-huh. You know, stepping back from this test for just a moment, we'll soon have tests, it seems, for just about everything. What challenges does that present for ethicists?

Dr. BERLINGER: Well, there's always the idea that a test equals certainty. Any clinician, any physician, any scientist, any ethicist who looks at a test knows that the test usually looks at a range of people, a range of samples - and this test is a good example.

People who had low levels of this metabolite had lower risk of developing lung cancer. And those with high levels had much higher risk of developing lung cancer.

However, there's this always, you know, the kind of muddy middle. There aren't that many tests that are absolutely predictive. And especially, there are not that many that I know of that will tell you categorically that you won't get something.

So putting all of our faith in a test and not in the totality of what we can do to prevent health problems rather than testing once they've already taken route is the big public health challenge.

LYDEN: Nancy Berlinger is the deputy director of The Hastings Center, a bioethics research institute.

Thank you very much.

Dr. BERLINGER: Thank you. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.