Intended for healthcare professionals

Education And Debate The new genetics

Implications for clinical services in Britain and the United States

BMJ 1998; 316 doi: (Published 07 March 1998) Cite this as: BMJ 1998;316:767
  1. Ann Louise Kinmonth (, professor of general practicea,
  2. John Reinhard, associate clinical professor of medicineb,
  3. Martin Bobrow, professor of medical geneticsc,
  4. Susan Pauker, assistant professord
  1. a General Practice and Primary Care Research Unit, Institute of Public Health, University of Cambridge, Cambridge CB2 2SR
  2. b State University of New York at Buffalo, Buffalo, NY, USA
  3. c University of Cambridge, Department of Medical Genetics, Addenbrooke's Hospital, Cambridge CB2 2QQ
  4. d Genetics Department, Harvard Pilgrim Health Care, Boston, MA 02116-3502, USA
  1. Correspondence to: Dr Kinmonth

    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.

    Summary points

    Advances in genetics underpin the need to equip primary care teams with skills to assess genetic risk of disease, discuss the implications of gene testing, and control access to specialist services

    Involvement of primary care teams will vary with public awareness and uptake of tests, type and prevalence of disorder, precision of genetic tests, and therapeutic choices available

    Despite increasing availability of genetic tests, it is premature to offer population screening for genetic predisposition (such as to breast cancer), and even the case for screening carriers for cystic fibrosis through primary care is uncertain

    Different cultures of American and British health care may lead to faster innovation in United States but greater opportunity for development within a research framework in Britain

    Current service configuration

    The organisation of genetic services in the United Kingdom is currently based on regional centres. These mainly deal with relatively uncommon …

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