Bioethical and clinical dilemmas of direct-to-consumer personal genomic testing: The problem of misattributed equivalence

A number of for-profit companies now provide personal genomic testing services to clients directly, without input from a physician or other health care provider, and the results of these tests include predictions about a broad spectrum of disease risks and traits. Validated clinical genetic testing and direct-to-consumer (DTC) genomic tests differ substantially in their reliability and usefulness, raising many clinical, ethical, and societal challenges, which are discussed in this Commentary. Of special concern is the problem of misattributed equivalence, which occurs when a patient or physician mistakenly views alternative methods of genetic evaluation as equivalent in their results and analytic rigor. Despite the many challenges raised by DTC genomic testing, we are reminded that commercial interests have sometimes acted as a disruptive force or technology that drives nonconventional approaches to difficult problems.