Palmer K T, Poole J, Rawbone R G, Coggon D
MRC Environmental Epidemiology Unit, Community Clinical Sciences, University of Southampton, Southampton SO16 6YD, UK.
Occup Environ Med. 2004 May;61(5):448-53. doi: 10.1136/oem.2002.005611.
Tests of genotype may enable workers at unusual risk of future ill-health to be identified. Using them to select for employment, however, entails gains and losses to employers and employees. Ensuring a fair balance between the rights and obligations of each group requires a value judgement, but the advantages and disadvantages to interested parties must first be quantified in a meaningful way.
The purposes of pre-employment screening are reviewed, and several simple measures relevant to the separate interests of employers and job applicants proposed-number screened to prevent a single adverse outcome; number excluded to prevent a case; expected incidence of the adverse outcome in those excluded; and preventable fraction. The derivation of these measures is illustrated, and the factors that influence them (the prevalence of the prognostic trait, the relative risk that it carries for an adverse outcome, and the overall incidence of disease) are related algebraically and graphically, to aid judgement on the utility of screening under different circumstances.
In sensitive areas such as genetic testing the onus should be on the employer to justify plans for pre-placement screening. Several quantitative measures can be used to inform the ethical and economic debate about screening and to evaluate alternative strategies for prevention.
基因检测或许能够识别出未来健康状况面临异常风险的劳动者。然而，利用基因检测结果进行招聘筛选，对雇主和雇员而言都各有利弊。要确保各方的权利与义务实现公平平衡，就需要进行价值判断，但首先必须以有意义的方式对相关各方的利弊进行量化。
本文回顾了入职前筛查的目的，并提出了几项分别关乎雇主和求职者利益的简单衡量指标——为预防单一不良后果而筛查的人数；为预防病例而排除的人数；被排除者中不良后果的预期发生率；以及可预防比例。文中阐述了这些指标的推导过程，并以代数和图表形式展示了影响这些指标的因素（预后特征的患病率、其导致不良后果的相对风险以及疾病的总体发病率），以辅助判断不同情况下筛查的效用。
在基因检测等敏感领域，雇主有责任为入职前筛查计划提供正当理由。可以采用几种量化措施，为有关筛查的伦理和经济辩论提供参考，并评估预防的替代策略。
