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Dashboards, Detroit, and DNA.

Most physicians, unless they have been stranded in the Amazon jungle for the last few years, have probably noticed the increasing attention given by popular culture to genetics and biotechnology.

From the New York Times to Newsweek magazine to CNN, CSI, or author Michael Crichton, topics such as stem cells, cloning, forensic genetics, paternity testing, and the relationship between evolution and religion have captured people's interest to an astonishing degree.

The public's attention to these topics has been paralleled by political attention to them; last year saw a flurry of national legislative activity pertaining to genetics in health care.

Perhaps the most important is the Genetic Information Nondiscrimination Act, which offers the possibility of national protections from insurance and workplace discrimination based on heredity.

The Genetic Information Nondiscrimination Bill was passed by the House of Representatives in April 2007, but has stalled and has not yet been passed by the Senate.

Why this sudden surge in the focus on genetics and biotechnology? Many factors have contributed to it, but several core advances in biomedicine have served as its driving force.

First, the Human Genome Project has contributed to an exponential increase in the number of genes identified as causing less-common disorders, bringing renewed hope to patients worldwide.

In addition, the project has led to a nearly 400-fold decrease in the cost of sequencing DNA in the last decade, allowing the power of genetic analysis to be more fully applied to an array of other species that serve as useful models for studying disease in humans.

Second, the field of pharmacogenomics has seen a rising number of prominent therapeutic success stories including imatinib (Gleevec) for treatment of chronic myeloid leukemia; bevacizumab (Avastin) for macular degeneration; and trastuzumab (Herceptin) for breast cancers.

And third, the completion of the HapMap project has provided scientists with tools that are facilitating gene discovery in some of the common disorders, including diabetes, macular degeneration, inflammatory bowel disease, and prostate cancer.

A hard-bitten primary care colleague of mine has said in the past, "Genetics is the future of medicine and always will be." But this is no longer the case.

At a genetics meeting I attended, discussions about the need to educate primary care providers were rife with car analogies. It became evident that gene-based technologies (the cars) are guiding prevention, diagnosis, and therapies for increasingly larger segments of the population.

The general feeling among the attendees was that past education efforts directed at primary care providers had failed because there was too much emphasis on teaching the provider (the driver) about how basic genetics (the engine) was put together and not enough emphasis on how to apply and interpret genetic tests (understanding the workings of the dashboard).

As a primary care clinician, I agree. However, the genetics community (Detroit) has failed to realize that a decade ago the technologies they were producing were expensive, not widely applicable, and difficult to understand (quirky), and that their evidence base for its application (roads) was scant. Primary care had little reason to buy a "car" in such an environment.

But today, that environment is different; the cars are more user-friendly, there are many more models to choose from, and the roads are much improved--though we don't have a fully developed interstate system yet. Our patients (passengers) will expect us to help them understand and take full advantage of gene-based technologies.

A new set of opportunities awaits those informed primary care clinicians positioned where the rubber meets the road.

DR. FEERO is a family physician with a doctorate in human genetics from the University of Pittsburgh. He serves as senior adviser for genomic medicine in the Office of the Director at the National Human Genome Research Institute.

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Title Annotation:GUEST EDITORIAL
Author:Feero, Greg
Publication:OB GYN News
Date:Jan 1, 2008
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