Implications for clinical services in Britain and the United States

This is the third of four articles discussing the broader implications of advances in genetics

Meeting the rising demand for genetic information and advice will require a major reorganisation of genetic services. In the United States, demand has led to the growth of private genetics services that are marketed directly to the public. In the United Kingdom, specialist genetic services are struggling to cope with increased workloads and it is acknowledged that some genetics services will have to be incorporated into mainstream clinical medicine, particularly at primary care level. A range of pilot schemes has been set up to establish how to do this, but few schemes have been fully evaluated. A broad educational effort is needed to increase awareness of the scope and potential of genetic information among health professionals and the public. This article reviews current developments and argues that contrasting approaches in Britain and the United States each offer special opportunities in innovation and evaluation.