Intended for healthcare professionals

Education And Debate

Rational or rationed medicine? The promise of genetics for improved clinical practice

BMJ 2000; 320 doi: (Published 01 April 2000) Cite this as: BMJ 2000;320:933
  1. Robin Fears, director, science policy (,
  2. Derek Roberts, senior research policy fellowb,
  3. George Poste, chief executive officer, health technology networksa
  1. a SmithKline Beecham, Harlow CM19 5AW
  2. b School of Public Policy, University College London, London WC1H 9EZ
  1. Correspondence to: R Fears
  • Accepted 29 November 1999

A recent BMJ editorial highlighted the challenges and the opportunities for improving the quality of health care that are afforded by advances in genomics and molecular medicine.1 It also emphasised that the NHS must develop a coherent strategy to realise the substantial benefits that new technologies can deliver. We applaud this recommendation and the concluding sentiment that “at a time of uncertainty about future potential, the NHS must anticipate innovation, not block it.” A BMJ editorial published a year earlier had also drawn attention to the urgency in meeting the challenge of defining future service needs by orchestrating optimum relations between laboratory, clinic, and society.2 Much has been written since then about the likely future impact of genetics on clinical care, the potential models for service provision,3 and the broader ethical, legal, and social issues relating to the use of genetic information for non-medical purposes. However, there seems to be little tangible progress in the capacity of the NHS to anticipate and respond to the accelerating momentum of technological change.

We believe that a pluralistic approach, with commitment to a new public-private partnership in strategic thinking and policy development might help to inform NHS priorities and preparedness. The BMJ editorial described the United Kingdom's aspiration to become the “Genome Valley” of Europe by building on a strong bioscience base for generating health and wealth,1 and it is understandable that the Silicon Valley experience in the United States should be chosen as a model in developing this. However, we need to understand and analyse the factors contributing to the success of Silicon Valley in order to determine whether they can be generalised to medical research and development and the NHS. Foremost in the evolution of the microelectronic and computer industries in California was the large public procurement …

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