Are We Equipped To Care About Risks To Our Health?

Key Takeaways

  • Integrated polygenic risk assessments can identify 2-5x more at-risk adults than traditional risk assessments alone.
  • It’s not enough to perform risk assessments without also offering solutions and treatment plans.
  • Many patients are reluctant to pursue risk-related information, making these conversations difficult, although still all the more important.

Recently, I helped host the inaugural “Know Your Risk” Forum, a global event series discussing the importance of genetic testing and risk assessments for women. In partnership with the global patient advocacy agency We Humanise Health and Genetype (Genetic Technologies LTD), we welcomed policymakers, CEOs, and renowned physicians to discuss this hot topic in women’s health.

While planning the forum, I found many parallels between the theme of “Know Your Risk” and my work building at Ethos. Ethos is a tech-enabled platform helping individuals, and their care teams manage alcohol across its spectrum of risk. A lot of our work focuses on developing early detection and intervention pathways to address substance misuse before addiction.

In this line of work, I have become well familiar with finding ways to have conversations about people’s health that they seemingly want to avoid- as a patient, advocate, and startup operator.

What Are Risk Assessments?

The purpose of risk assessments is to identify individuals at elevated risk of disease who may benefit from genetic testing, additional screening, or preventive interventions.

What surprised me was learning that not all risk assessments are the same, which is crucial to know if you discuss risk assessments with your doctor or if they recommend one.

For example, Genetype’s risk assessments focus on polygenic risk scores (PRS), which consider the combined effect of many genes, each contributing a small amount to the overall risk of developing a condition. Their integrated risk model combines polygenic risk with other factors, such as demographics and clinical measurements. To put this into context, BRCA1 and BRCA2 genetic testing is considered monogenic because it only looks at mutations in those specific genes. However, integrated polygenic risk assessments can identify 2-5x more at-risk adults than traditional risk assessments alone.

Risk assessments can also be conducted for other conditions, such as coronary artery disease, type 2 diabetes, and even mental and behavioral health issues like substance/alcohol use disorder. For example, at Ethos, we are focused on developing preventive risk assessments for alcohol misuse, a healthcare category that, despite its $24 billion in direct spending, lacks a clinically robust framework for screening and intervention.

Simply put, risk assessments help you identify health risks so you can modify your behavior early on and invest in preventive treatments.

Kavita Rai

As payers in the healthcare system, employers play a crucial role in adopting and implementing risk assessments. For example, the Biden Administration just launched a partnership with large employers such as United Airlines, Gilead, and Amazon, through the Biden Cancer Moonshot initiative to expand employee programs for cancer prevention and early screenings. Other payers and providers also benefit from risk assessments because the data allows them to categorize risk and allocate resources most effectively, targeting populations that require the most attention.

You Received Your Risk Score. Now What?

Let’s say after learning about all the evidence and policies and completing testing, how many of us would actually change our behavior and lifestyle after knowing our risk?

One of my favorite panels at the Know Your Risk forum was called “Patient Voice at the Center,” particularly because of Matthew Zachary’s (Co-Founder of Stupid Cancer and Brain Cancer survivor) commentary. When asked why health systems are not doing more to adopt preventative solutions like risk assessments, I assumed panelists would begin to talk about the mixed financial incentives that burden health systems. Instead, Matthew’s response stunned me:

“Risk aversion is embedded in our DNA. Only those who’ve been pre-shaken to their core and grounded by a relatable life-altering experience does that congenital fear wane. Are society and culture ready to embrace the idea of “pre-cancer” or a different way to think about prevention and risk reduction? This is a consumer issue more than it is a clinical one. Science will not solve for this. An understanding of cultural anthropology might.”

While I do not think people should adopt restrictive behaviors or live in fear after knowing more information about their health, I do agree with Matthew. Western culture devalues our health until we are deemed “sick.” Do not let fad brands fool you into thinking they care about Ayurveda and Eastern Medicine. In the U.S., improving our health is synonymous with enhancing our (economic) performance. It quite literally is the business model of many health and wellness companies that sell to employers under the premise of improving employee “productivity.”

With all that said, I am not a pessimist! I would not be building in healthcare, let alone behavioral health, if I was one. One of the earliest insights we gained while launching the direct-to-consumer (DTC) “mindful drinking” version of Ethos was the importance of meeting people where they were. For example, our decision to market our app as a social app instead of a habit-tracking one allowed people to answer truthfully when it came to screening for the Alcohol Use Disorder Identification Test (AUDIT-C). In fact, our average user had an AUDIT-C Score of 6.8, which means they could be already showing early signs of liver damage.

As a healthcare company, it was not enough to provide individuals with information about their risks; we also had to link them to necessary care.

In the B2B SaaS version of Ethos, assisting physicians in addressing patient behavioral change has underscored the importance of establishing clear next steps. Risk Assessments are created for us to take action based on information; it is not enough to just know our risks. We need to feel supported and have the guidance to take action afterward as well.

Having Conversations No One Wants To Have

This is easier said than done. In my health journey, I still remember my own reluctance to push for more testing. I wanted to desperately believe everyone around me was right and that I really was fine. However, ignoring the situation does not change the circumstances. 

As Matthew said, only those “pre-shaken” understand their risk. Otherwise, no one really cares about what their middle school health class taught them or, for that matter, what AlcoholEdu had to say. Health education is often boring and uninspired, which is why it is imperative to find new, innovative ways to engage people.

Original post by author found here, and republished with permission.

Kavita Rai

Kavita is a cancer survivor and startup operator focused on fighting for health equity and solving public health challenges through various avenues: tech-enabled healthcare, policy and law, and patient-led solutions. Her views are her own.

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