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Clin Obstet Gynecol. 1993 Sep;36(3):532-40.

The cost of choice: a price too high in the triple screen for Down syndrome.

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Department of Obstetrics and Gynecology, Louisiana State University, School of Medicine, New Orleans 70112.



At US national medical society meetings in 1992, researchers from a major university presented their data on a triple screen of maternal serum tests for the detection of trisomy 21 or fetal Down syndrome. Low maternal serum levels of estriol and alpha-fetoprotein, along with a high level of human chorionic gonadotropin can predict pregnancies at risk. The authors claimed that a person with Down syndrome costs approximately $196,000 including health, education, and residential costs. Simple economic costs about persons with Down syndrome in the cost analysis seem unbalanced. Some recent studies show no increase in divorce rates for families including persons with Down syndrome. In a 1971 review of 104 brothers and sisters of persons with Down syndrome, no specific behavioral disturbances were noted. Among complex costs triple screening threatens the integrity of the medical profession. Genetics counselors promoting nondirective informed consent, but the cost analysis description of Down syndrome are in the mild-to-moderate mental retardation range consistent with a 3rd-9th grade reading level. Less than 1% have leukemia, and less than 3% have in operable cardiac disease. Another cost that is difficult to measure includes the value placed on the maternal, paternal, and familial anxiety caused by genetic screening tests. Triple screening for Down syndrome is about societal concerns and social character. Many methods of health care rationing await the American medical system. A large number of factors must be considered before any system of limiting costs and choices is selected in a pluralistic society. Accepting the fact that limitations to choice must occur is the first step toward future rationality in genetic counseling.

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