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Limits of the Genetic Revolution
Angela Scheuerle, MD, PA
Arch Pediatr Adolesc Med. 2001;155:1204-1209.
The genetic revolution will touch all disciplines of medicine, much
like the antibiotic discoveries in the last century did. However, genetic
medicine is not an immediate "magic bullet" for all noninfectious conditions.
Despite the sometimes melodramatic announcements by the lay media, there are
hurdles to overcome before genetic treatments become as ubiquitous as antibiotics.
These barriers fall into 3 categories: molecular, economic, and behavioral.
First, the molecular difficulties include the biochemical complexity of genes
and genetic disease, variation in pathogenesis among races, and gene-environment
interaction. Second, economic disincentive to develop orphan drugs, and the
expense of such medications, may hinder production of treatments for truly
rare genetic diseases. Third, patients are unlikely to be any more compliant
with new medications or recommendations than they are with the current ones.
The "magic bullet" of folic acid is not used by the majority of women who
are aware of its usefulness in preventing birth defects. While the genetic
revolution has much potential, the complexity of genetics itself is difficult
and the current barriers to useful treatment will not change. As with oncological
and transplantation technology, great strides are likely to be made, but only
at a measured pace.
From Genetics, Teratology, and Ethics Consulting, Dallas Tex.
Corresponding author: Angela Scheuerle, MD, PA, Genetics, Teratology,
and Ethics Consulting, 9702 Vinewood Dr, Dallas, TX 75228-3772 (e-mail: angela.scheuerle{at}tdh.state.tx.us).
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