The Ethical Ramifications of Biomarker Use for Mood Disorders

Abstract

Over the past 20 years, researchers have made considerable progress in the search for diagnostic and prognostic biomarkers of psychiatric disorders, including major depressive disorder, bipolar disorder, and anxiety. Advocates of this research contend that identifying biomarkers will aid in the diagnosis and treatment of these disorders, as well as in the development of more effective psychiatric medications. However, the concept of biomarker testing generates significant ethical concerns, including the testing of non-symptomatic individuals, the potential for health insurance or employment discrimination, and the collection and use of genetic information. Genetic biomarkers are especially controversial since heredity information is uniquely personal it can reveal an individual's likely medical future; divulge personal information about one's parents, siblings and children; and has a history of being used to stigmatize and victimize individuals. Sonic legal protections are already in place; however, they are far from comprehensive. For example, the US Genetic Information Nondiscrimination Act of 2008 only encompasses tests that analyze DNA, RNA, or chromosomal changes. This means :hat tests for non-genetic biomarkers, like those based on protein expression or post-translational modifications, are exempt. In the rush toward developing etiological screening tools, it is pertinent to remember that patients are at the heart of the medical profession, not their DNA or protein profile. Any new diagnostic tools should confer a significant benefit to patients without promoting confusion, discrimination, or stigma.