What Happens When Your Employer Knows the Diseases You Might Get?

The rapid advancement of predictive medicine, particularly polygenic risk scoring, is exposing gaps in U.S. employment laws designed to prevent genetic discrimination. While the Genetic Information Nondiscrimination Act (GINA) of 2008 prohibits employers from firing workers based on genetic test results, it does not require accommodations for mitigating future health risks—such as a high likelihood of heart disease—identified through DNA analysis. Similarly, the Americans With Disabilities Act only protects those with current disabilities, leaving a legal void for individuals with elevated genetic risk factors but no active conditions. The technology in question, polygenic risk scoring, assesses a person’s likelihood of developing diseases like diabetes or cancer by analyzing multiple genetic variants across the genome. Unlike monogenic tests, which detect specific gene mutations causing disorders like Huntington’s disease, polygenic scores synthesize complex genetic data to estimate risk probabilities. Harvard Law School professor I. Glenn Cohen, who studies bioethics and law, warns that these scores will increasingly influence personal and professional decisions, raising urgent questions about legal protections. Current laws, he notes, were written for an era when genome mapping was expensive and limited, failing to account for the nuanced, predictive capabilities of modern genetic tools. Legal and public health scholars argue that GINA’s protections are insufficient for the challenges posed by polygenic risk scores. Princeton University sociologist Sam Trejo emphasizes the need for stronger safeguards, treating genetic information akin to a protected class to prevent discrimination. The opacity of these scores—often tied to lifestyle factors like diet, exercise habits, or personality traits—adds complexity, as the root causes of high-risk scores remain unclear. Employers might deny accommodations, such as reduced-stress roles, based on genetic predictions, even if the individual feels healthy and functional. Critics highlight that GINA’s framework was designed for a different technological landscape, where genetic testing was limited to identifying clear, monogenic disorders. Polygenic risk scores, however, operate on probabilistic data, creating ethical and legal dilemmas. For example, a high-risk score for heart disease might reflect genetic predispositions influenced by taste preferences, exercise tendencies, or stress-related traits—factors that could indirectly impact job performance or workplace accommodations. Without clearer legal guidelines, workers risk facing discrimination or denial of preventive measures, despite no immediate health impairment. The debate underscores the need for updated legal frameworks to address the intersection of genetics, employment, and privacy. Experts like Cohen and Trejo advocate for reopening policy discussions to ensure protections align with advancements in personalized medicine. As polygenic risk scoring becomes more integrated into healthcare, the potential for employer misuse of genetic data grows, necessitating stronger safeguards to balance innovation with individual rights.