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To the Editor: In attempting to define who should be protected by the Americans With Disabilities Act (ADA), Mr Gostin and colleagues¹ failed to mention the critical distinction between risk factors (eg, carriage of a BRCA1 mutation for breast cancer) and presymptomatic disease (eg, human immunodeficiency virus carriage or cervical dysplasia). The former is not a disease and may never manifest with illness and disability. To paraphrase Judge Ginsberg, no rational legislature would require nondiscrimination because of risk for a disease that may never become manifest. If we wish to allow "disability" to continue to have real meaning, we must be careful to distinguish between disability that is inevitable, as in the case of presymptomatic disease, and disability that is potential, as in the presence of risk factors.

Thomas D. Wendel, MD
Beth Israel Medical Center
New York, NY

1. Gostin LO, Feldblum C, Webber DW. Disability discrimination in America: HIV/AIDS and other health conditions. JAMA. 1999;281:745-752. FREE FULL TEXT

To the Editor: The article by Mr Gostin and colleagues¹ makes . . . [Full Text of this Article]

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RELATED ARTICLE

Disability Discrimination in America: HIV/AIDS and Other Health Conditions
Lawrence O. Gostin, Chai Feldblum, and David W. Webber
JAMA. 1999;281(8):745-752.
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