Licence: Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)
Credit: Counseling in medical genetics / Sheldon Reed. Source: Wellcome Collection.
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![14 / A Philosophy for Counseling Costs of Services Many counseling centers provide genetic counseling free of charge according to the philosophy that it is an educational and pubhc health activity. This should discourage charlatans and other clearly unqualified persons from hanging out their shingles and developing commercial enterprises. The diagnoses and laboratory tests must be paid for but these costs are often absorbed by research project funds. There is always a cost of the counseling, but this is usually borne by the taxpayer or by the counselee's health insurance rather than as a direct charge to the coun- selee. Where diagnoses, laboratory tests, and the counseling itself are done by the same group of professionals, the counselee may be charged for the whole proce¬ dure without itemization of the bill, a very annoying procedure for the counselee. A survey was carried out by Associate Professor Terry L. Myers, MD, of Creighton University, Omaha, Nebraska, some years ago as to charges for labora¬ tory services, clinical services, and counseling services. The average costs plus or minus the standard deviation for a few laboratory services were $230 ± $60 for karyotype preparation from an amniotic fluid and $140 ± $54 for Giemsa band¬ ing from a blood sample. Clinical consultations ran from $25 to $60. Units which charge for genetic counseling, including pedigree construction, asked from $25 to $50 for the service. The prices varied greatly and presumably were related to the amount of time involved. They all included written reports to the counselee and referring physician. It should be remembered that for each full-dress counseling case there are many phone calls and letters requesting information for which it would be economically unfeasible to attempt to collect a fee. On the whole, genetic counselors will be supported by their professional salaries, by hospitals, or from the public purse. Genetic counseling is not an industry. Risk and Burden The genetic counselor is a purveyor of genetic risk figures. His greatest problem is that of putting them in perspective and making them understandable. Murphy and Chase [1975] present a neat table (1-1 in their text), which shows that the risk of death per passenger per 1,000-mile U.S. scheduled airplane flight is only 1 in 625,000 — a risk any rational person would accept because it is lower per mile than that for automobile transportation. The risk per inhabitant per year of being bitten by a dog in New York City is 1 in 294, still a trivial problem. The risk of having a major defect at birth is in the neighborhood of 1 in 33, while the chance of an occurrence of cystic fibrosis in a family where it has occurred already is 1 in 4, and the risk of having a child affected with a simple dominant trait, when both parents have it, is 3 in 4. The last risk given is certainly high, though a rare event, while the risk of death from airplane travel per mile is extremely low but happens frequently, world wide.](https://iiif.wellcomecollection.org/image/b18037161_0028.JP2/full/800%2C/0/default.jpg)
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