Reader Response . . .

James P. Evans, Bryson Distinguished Professor of Genetics & Medicine and Editor-in-Chief of Genetics in Medicine, responds to my post on the FDC “warning letter” to 23andMe:

I liked your piece – with one exception. You say you are “libertarian” in the medical realm. This could make sense if you paid for all of your medical care. But you don’t – and I warrant even Bill Gates doesn’t. We’re all in some kind of insurance scheme, be it private or public. Thus, the libertarian argument (“It’s my body, I want this test/treatment/etc”.) doesn’t fly in my mind.

When medical tests are misused, we all pay – even if you pay for the initial test itself – because of downstream costs. If I give someone antibiotics inappropriately because they make the libertarian argument and even offer to pay for the prescription out of pocket, the problem is that the complications of antibiotic resistance may well cause downstream complications for them that their insurance (and thus I) have to pay for.

By the same token, if people use that argument to get inappropriate complex testing (e.g. a 23andMe profile or a whole-body MRI), we all end up paying for the (inevitable) downstream costs. Simply put, we all have a stake in seeing that complex medical tests are used appropriately. Thus, the FDA’s action was entirely reasonable and appropriate.

So, since your hand is in my pocket when it comes to medical care, I just don’t see the libertarian argument working, even putting aside my concerns about harm to people (which we all, I think, want to avoid) and my (admittedly paternalistic) view that we have to protect people from slick advertisements and themselves.