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Guest Post: Reproductive Rights: When the Intent is Advocacy but the Impact is Exclusion / By Liann Jimmons

Author bioLiann Jimmons is a public health and pediatric genetic counselor whose work focuses on increasing access to genetic services for patients, and increasing access to the profession for future genetic counselors from historically excluded and exploited backgrounds. She is an active member and mentor in the Minority Genetic Professionals Network, Vice Chair of the NSGC Equity and Inclusion Implementation subcommittee, and a member of the NSGC Podcast subcommittee. Her work is driven by her personal experiences as a Black, Vietnamese, disabled, queer woman. 

More and more genetic counselors have taken to social media, especially Twitter, to share their thoughts on incidences of injustice. Most recently, the Roe v. Wade overturn sparked impassioned conversation surrounding reproductive rights. In their defense of abortion, some genetic counselors consciously or unconsciously reminded everyone of the problematic foundations of this profession which grew out of the ideals of cisgender, heterosexual, non-disabled, nuclear white families.

“It’s just social media, don’t take it so seriously.”

“It’s just social media, no one should take me seriously.”

Both statements most of us have either heard or said before and there was a time where they carried more truth. However, it is willfully ignorant and irresponsible to insist either are still accurate assessments of the impact of social media. Genetic counselors from historically excluded and exploited backgrounds have repeatedly explained how suppositional intentions are not enough to excuse impacts of tangible, enduring harm. Yet, the “unintentionally” ableist, racist, homophobic, transphobic, classist, etc. ideas prevail both on- and offline

After the overturn, #GeneChat was filled with immeasurable sadness and anger at this attack on bodily autonomy and privacy. However, too many were thoughtless when naming whose bodies deserved autonomy and privacy. Woman this, women that, sisters, mothers, aunties, girls, ladies, daughters, wives. Genetic counselors too loudly reminded everyone that this field was built for and by cishet women. Our trans, nonbinary, queer, and gender expansive colleagues, future colleagues, and patients deserved to feel seen, respected, cared for, and safe. But they were effectively excluded.

Shamefully abundant were posts by genetic counselors grieving over the potentially disabled children forced onto the world, reeking of the rotten roots of eugenics in this field. These posts implied disabled folks are inherently unwanted, unloved, and will be unable to live meaningful, fulfilling lives. Disabilities, visible and invisible, are all around us, your colleagues included. The grieving I’m doing is for the patients harmed by their own provider’s ableism. And I grieve for myself and other disabled genetic counselors being told we are less than.

In addition, there were many posts implying all pregnancies conceived from sexual violence should be terminated, from reducing them to reminders of their parents’ trauma to the hypothetical negative impact on society, with one post describing unwanted children as destined to become criminals because they are poor and abused. Pedestaling abortion as solution these greater societal disparities is an example of white feminism. These ideas are coded in racism and classism, and lead to poorer outcomes in already marginalized communities. This is what happens when advocacy is not intersectional.

My simple ask, please be mindful of language on public platforms to avoid unintentionally sending messages favoring eugenics.

Genetic counselors’ intent is not enough anymore and it hasn’t been for a long time. Excuses like, “It was a mistake because… we forgot, we weren’t thinking, it was in the heat of the moment, we’re still learning, we didn’t know, etc.,” send the message, “We forget about or don’t think of people not like us. Our instincts are to protect ourselves and those like us. We have not put in the effort to learn about people not like us.” To effectively address mistakes and prevent them from happening again, learn how to self-reflect and simply apologize without the if’s, and’s, but’s, because’s, or well actually’s.

The rhetoric used in this discussion of reproductive rights triggered a larger, much needed conversation about the language we use in public spaces. Some people may read this and feel overwhelmed, but consider the marginalized folks who can’t not think about these issues because these are our lived experiences. Lastly, a reminder: if there is too much to consider or you don’t feel informed enough, you always have the choice to simply not post.

Since such a small percentage of genetic counselors are even on social media, one might think that our words matter less. In reality, it’s the opposite. To outsiders, the small sliver of our community they’re able to find is interpreted as representative of the whole. If you choose to participate in these spaces identifiable as a genetic counselor, please be more responsible and inclusive in your statements for the sake of us within the profession, those who will enter, and those we serve.

Author’s Note: While I originally was moved to write this piece to advocate for patients, specifically inclusivity in conversations about reproductive rights, I could not speak about the harm exclusivity causes to patients without acknowledging how exclusive practices harm and weaken the genetic counseling community from within. We cannot bring about justice for those we serve or ourselves without fully surrendering the idea that GCs are the exception and completely embracing the painful self-reflection that shows, as a field, we may not always be as progressive as we think. Being thoughtful about our language and inclusivity is just as important for the safety of our patients as it is for each of us. 

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Breast Cancer Counseling: Personalizing Medicine Beyond BRCA Testing

This commentary is contributed as part of the guest blogger series Diverse GC Roles.

 

By Shannon Kieran

Shannon Kieran is a board-certified Genetic Counselor at Navigenics, a premier personal genome testing laboratory. Shannon’s clinical experience has encompassed a wide range of services from cancer genetics to family planning. As a Genetic Counselor at Navigenics, Shannon works with individuals and healthcare providers to educate them about genetic screening options, discuss test results, and facilitate the medical management of specific genetic predispositions. Additionally, she speaks regularly on the topics of personalized genomics, health privacy protections, and personal and clinical utility of genetic information. Her areas of research and publication have focused on cancer predisposition genetics and patient access to genetic test services.

After years of working as a traditional cancer counselor in the Bay Area, gaps in the practice of cancer genetic counseling were overwhelming me.

Patients were being declined cancer counseling unless they were deemed pre-eligible for BRCA testing, despite the fact that only 5-10% of breast cancer cases are BRCA-related.  Calls were constantly coming in from competent, caring health care providers seeking information for their patients beyond standard testing.  I knew there must be more to cancer genetics than the obvious genes and red tape.

That realization led me to take a step away from a traditional genetic counseling environment. In 2007, I took a position as one of two genetic counselors hired by the newly founded personalized genomics company, Navigenics.  Navigenics was in its infancy, but they firmly knew where they were headed —  into the realm of genetic risk assessment for common diseases including breast, colon, and prostate cancer.  Bringing genetic counselors in from the ground up was a new concept for the laboratory industry.  But this world of personalized medicine promised to help me understand the 90% of breast cancers that are NOT related to BRCA, and indeed, it has.

From 2007 to 2008, I worked with an integrated team of top-notch research and clinical scientists developing a SNP-based test panel that would illuminate individuals’ predisposition genetic markers to mutifactorial diseases.  It was the height of the genome-wide association era, and data regarding common condition genetic susceptibility was pouring out of the peer-reviewed literature weekly.  After months of reading, research, lab assay development and content creation, we launched our first service in late 2008.

Today, my colleagues and I offer SNP-based predisposition testing for a handful of cancers, including breast cancer.  Every day, I am able to counsel patients by phone about their family history, available and appropriate testing, and often, integrate their Navigenics results.  Most of the patients I talk to do not have family history consistent with a BRCA mutation, but are still deeply concerned about their cancer risk.  As recent studies have demonstrated, integrating SNP information, along with traditional breast cancer risk models such as GAIL, can improve our ability to discriminate between high and low risk women.

Perhaps even more clinically interesting is the research that has demonstrated disease sub-type SNP based risk assessment (such as estrogen receptor status.)  Finally, we are now learning that SNP assessment can inform on risk stratification for BRCA positive women, allowing the clinical team to further delineate each individual risk. Moving beyond traditional breast cancer gene testing has enabled my colleagues and I to provide all women, those with and without BRCA mutations, with risk assessment information beyond the scope of the family tree.  This is the personalized counseling I only hoped for just 4 years ago.  As a genetic counselor, being able to utilize all of the available tools and information to help my patients get a full picture of their disease risk is truly fulfilling.  Genetic counselors are poised to be the clinical leaders in the integration of these new technologies.  And thanks to my position at Navigenics, not only have I learned a great deal about building a successful business, but I have also found career fulfillment and true excitement for the future of personalized genomic medicine.

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Wherever You Go, There You Are

This commentary is contributed as part of the guest blogger series Diverse GC Roles.

 

By Amelia Chappelle, MA, MS

Amelia Chappelle graduated from Sarah Lawrence College in 2007 with a dual masters degrees in Human Genetics and Health Advocacy. Upon graduation, she joined Genetic Alliance, a nonprofit health advocacy organization, and oversaw the Access to Credible Resources Network project and Genetic Alliance resources and services. In November 2010, Amelia moved from Washington, DC to her hometown of Seattle, WA to manage research projects at the University of Washington in the areas of preventing and disclosing medical errors. Amelia continues to work part-time with Genetic Alliance and is enjoying splitting her professional time between both organizations.

Even during graduate school, I supposed I was what the field of genetic counseling calls “nontraditional.” Although at the time, I wasn’t necessarily thinking of what position I would hold in the field as much as following what naturally interested me. During the first semester of human genetics classes at Sarah Lawrence, I kept hearing about the courses the Health Advocacy program students were taking. They seemed so complementary to my current courses, and in my second semester in the human genetics program, I added some health advocacy classes. Yes, “busy” doesn’t begin to describe it. As both were two-year programs, I smooshed them into three years and completed two summer internships (that combined requirements for both programs). Looking back, what I was yearning for was an understanding of the larger system in which genetic counselors practice. I wanted to better understand health economics, health politics, illness narratives- a single genetic counseling session doesn’t happen in a vacuum, and I wanted a better grasp on that messy, complicated bigger picture.

During graduate school, I heard about a nonprofit called Genetic Alliance, and upon learning more, I knew I found a place for me. Genetic Alliance so closely mirrored my interests (and degrees)- an organization that is the voice of advocacy in genetics. I was drawn to the scope of the mission, addressing health and genetics from the perspective of individuals and families but also from a larger systemic view. I applied for a position that I was in no way qualified for (five years of experience in project management? Ummm…), and somehow got an interview. While I was being a bit ambitious, it turns out Genetic Alliance was as well. They hired me and another employee, without having a direct line of funding for my position. Just goes to show- if you’re passionate about an organization, a cause, a position, a project, take a chance! You just never know. I worked full-time for Genetic Alliance for three and a half years, grew as a person, and gained an extremely wide range of skills and experience.

Although I enjoyed my 11-year stint on the East Coast, I felt a pull back to my Pacific Northwest home grow stronger and stronger with every passing season. In November 2010, I took a position at the University of Washington as a research coordinator. It was a full-time position, but I negotiated a 32 hour/week position in order to maintain an 8 hour/week stint working remotely for Genetic Alliance.

At first I thought it was a bit strange that I was taking a job that doesn’t directly have anything to do with genetics, but when I actually got down to the work, it doesn’t feel odd at all. My research team’s work all revolves around medical errors and adverse events- how to reduce them and how to handle them appropriately when they happen. While I’m not talking about genetics every day, the topics I do encounter every day are extremely familiar: empathy, truth-telling, sincerity, accurate and situational appropriate communication skills, an understanding of both the individual and the system’s role, the list goes on. The job skills are also familiar, thanks to my training and years at Genetic Alliance: project management, time management, relational skills, communication skills, supervisory skills, organizational skills, business savvy, flexibility, creativity, and patience.

I think two unique aspects that make genetic counselors poised to excel in any number of positions are the abilities to make complex topics easy to understand and to empathize with others. Those two skills are applicable to so many professions- and situations throughout life. If I’ve learned anything throughout my (humbly short) career, it’s to take a chance, go after what you want, and it just might happen!

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