Limits of the genetic revolution

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.