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Students of Health Resources and Policy Analysis need a solid understanding of the "stakeholders" involved in modern medicine and health care delivery. Prepare your list of the key stakeholders in U.S. health care as you see them. Describe your view of the primary role of each. Which stakeholder do you feel wields the greatest influence at this point in U.S. history, and why?

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Insha Fatima
Insha FatimaLv10
28 Sep 2019

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About 250 companies on the Internet now sell genetic tests directly to consumers. These companies include 23andMe, Navi- genics, GenePlanet, Gene by Gene, DNA Tribes, Genelex, Genova Diagnostics, Sure Genomics, Suracell, African Ances- try.50 The companies ask customers to collect a sample of their genetic DNA with a cheek swab and send it to them for testing. During testing, most companies put the customer’s gene sample on a small flat “DNA microarray chip” that already contains pieces of DNA matching known genes (or gene mutations). If one of the customer’s genes matches one of the pieces of DNA on the chip, it binds to the DNA fragment, which creates a tiny fluorescent glow showing that the gene indicated by the DNA fragment is in the sample. A computer then analyzes the pattern of glowing spots on the chip and prints out a list of the genes (or gene muta- tions) in the customer’s sample. Scientists have discovered a few genes that are associated with specific diseases or personal characteristics. Studies found, for example, genes or gene muta- tions that are linked to cystic fibrosis, Tay Sachs disease, and Lou Gehrig’s disease, genes that increase the risk of certain breast, colon, and thyroid cancers, and genes associated with sensation seeking, eye color, obesity, and lactose intolerance. They also found that some genes are more often found in people whose ancestors came from certain regions of the world. The gene- testing companies say that based on these studies and their own genetic research, they can give customers valuable personalized information (for a price, of course).

Critics say that some companies make claims that have little scientific validity. One company, Gene Planet, advertises on its website that it provides “an individually tailored diet and life-style plan based on a genetic analysis of each individ- ual . . . based on the fact that each individual possesses a
to bear all the costs of injury. Such a distribution of costs would seem to be more fair than imposing the costs on a few victims.
Underlying this third view of the duties of the manu- facturer are the standard utilitarian assumptions about the value of efficiency. This view assumes that an efficient use of resources is so important for society that social costs should be allocated in whatever way will lead to a more efficient use and care of our resources. On this basis, the social costs view argues that a manufacturer should bear the social costs for injuries caused by defects in a product even when no negligence was involved and no contractual relationship existed between the manufacturer and user.
specific genetic makeup and therefore each individual has spe- cific nutritional needs.” Another site promises: “Based upon . . . [genetic] analysis, Suracell recommends to each client a personalized regimen of nutraceuticals [vitamin supple- ments].” Thirty companies offer to identify people’s ancestry based on their genetic profiles. One company, for example, states: “DNA Tribes . . . uses genetic material . . . to measure your genetic connections to individual ethnic groups and major world regions.” Several companies offer paternity testing and “infidelity” tests, including a British company named “Who’z the Daddy?” Thirty-eight companies claim they test for genes related to athletic performance, such as DNA Fit, which adver- tises that “we test your DNA for 20 key genes to help you truly understand your body, and how best to train for your genetics.” For $1,500 Map My Gene offers to test for 46 distinct talents and character traits such as optimism and shyness.
A couple of companies offer to test for compatibility between lovers. Instant Chemistry, Inc., for example, claims on its web- site that “scientific research has shown that relationship markers—a combination of genetics and psychology—strongly affect who we are attracted to and how successful our relation- ships are. . . . Complementary genes result in a higher level of physical attraction and a higher likelihood of a long-term stable relationship.” Some companies, like Chemlaba, claim to do it all: “With a simple saliva sample we’ll help you gain insight into your traits, from baldness to muscle performance. Discover risk fac- tors for 95 diseases. Know your predicted response to drugs, from blood thinners to coffee. And uncover your ancestral ori- gins.” Critics claim, however, that with a few exceptions, most studies have shown only weak connections between genes and specific traits, disease risks, drug responses, nutritional or vita- min needs, talents, athletic performance, compatibility, or ancestral origins. Many studies that link specific genes to a dis- ease are only preliminary, and the full picture has not yet been worked out, while other studies conclude that many traits are the result of complex and unclear interactions among many genes and the environment.

Evaluate the ethics of selling gene tests directly to consumers like these companies are doing. What would each of the three theories of a business's duties to consumers say about what the companies are doing? Under what conditions do you think selling the tests would be ethically legitimate, and why?

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