Tuesday, July 15, 2008

Resistance is Futile

I was reading some peer review comments of an article I am submitting and it got me thinking.....How can we combat certain resistant to change mindsets? For example from the anonymized reviewer:

I strongly disagree that because there aren't currently sufficient numbers of genetics providers (even if you add up clinical geneticists and genetic counselors, as suggested above) that this means that the only solution is to move genetics into primary care. ...........

Ok, you can disagree.....but.....when you say this......

First of all, the demand for genetics services has not yet led to long waiting periods or other crises.

Ever tried to get into a cancer genetics or clinical genetics office in less than 1 month? More likely less than 3 months. That being said...even this reviewer acknowledged that there is not a massive amount of referrals.......

What number of trained genetics providers are needed and what are the barriers to educating, producing and hiring more and supporting their work?

Ahh....trade secrets that I will be publishing soon......

Can the authors imagine another group of specialists (for example, brain surgeons) deciding that there aren't enough knowledgeable brain surgeons, so primary care providers need to be trained (via a short course, perhaps) to do brain surgery?

The term is Neurosurgeon....and this argument is a fallacy..... They trained for 7 years and brain surgeons don't operate on Alzhemier's

I think statements about moving genetics into the primary care arena need to be much more carefully thought through and evaluated -- what are the outcomes likely to be associated with the suggested interventions??

Other than earlier pick ups in cancer predisposition, MI predisposition, adverse drug reactions, improved medication dosing, more cost effective utilization of care, less "loss of chance" malpractice....I could go on and on.....but I won't

The Sherpa Says:

This is the resistance we face ladies and gentlemen. Why do I have to learn something, just because there aren't enough specialists???? There is something called continuing medical education.......just because they didn't discover DNA when you were in medical school, doesn't mean you don't have to learn about it........Resistance is Futile....


Fredric Abramson said...

The situation is far more dire. A rough calculation would show that the current pool of 2000 genetic counselors would need 50 years to deliver one hour of counseling to each of 200,000,000 American adults.

Additionally, even though the genomics era is over a decade old, there is no evidence that the medical profession is ramping up to learn sufficient genetics to actually deliver meaningful and correct information. Indeed, I think it is a prescription for massive malpractice issues.

So, there are two main solution paths. One is to open genetics to the public, much like 23andMe, Navigenics and others are doing. The other is to keep genetic information available only through physicians. Seems to me that creates a 21st Century version of the Dark Ages.

Steve Murphy MD said...

Why do people view their genomes as the holy grail???? This information is gobledey gook. It is a load of crap and we have no clue what it means yet....I am always amazed how people really want something that they "can't" have.

I say that because, there is nothing to not have....Do you understand what I mean?

When will it be something?......Someday. When we know more, then I am certain we will open it up.