The new genetics: Implications for clinical services in Britain and the United States

Abstract

Current service configuration The organisation of genetic services in the United Kingdom is currently based on regional centres. These mainly deal with relatively uncommon inherited and congenital disorders such as familial cancer and learning disorder syndromes. They provide information, advice, genetic testing, and counselling about opportunities for disease prevention to individuals and their families. Their ethos (stemming from historical ethical concerns about forced eugenics) has traditionally been based on non-directiveness and non-paternalism.1 Until recently clinical genetics was dominated by reproductive issues, but this may change rapidly as gene loci defining susceptibility to hereditary cancers (particularly breast cancer) and other common disorders are discovered. In the United Kingdom the general practitioner's role in the diagnosis of genetic disorders has often involved indirect referral on clinical grounds. For example, cases of recurrent chest infection in infancy or recurrent miscarriage may be referred first to a local paediatrician or gynaecologist. Direct referral to geneticists arising from awareness of the implications of the family history are now increasing, and in the United States many patients refer themselves to geneticists.