By Lisa Seachrist

Washington Editor

WASHINGTON — In the midst of the genetic medicine revolution, patients expect their family physician to be on the front line in helping them use and understand the results of a host of genetic tests.

At least that is what the results of a new survey by the American Medical Association (AMA) indicate. The problem, however, lies in the fact that the vast majority of family physicians feel ill-prepared to employ and explain these new tests.

That very concern has led to a collaboration between the AMA and the Biotechnology Industry Organization (BIO) to help educate primary care physicians about the science and ethics involved in testing patients for genetic diseases.

"I think it is fair to say that the genetic revolution has in some ways ambushed primary care physicians," said Carl Feldbaum, president of BIO. "Many, like my own brother, feel like they have to go back to medical school with a whole new curriculum if they are going to serve their patients in the next decade. As a result, we have this cooperation between BIO and the AMA."

The collaboration between the two organizations, which began more than a year ago, has produced a continuing medical education conference, "Genetic Medicine and the Practicing Physician," to be held this weekend in New Orleans. The purpose of the meeting is to begin educating front-line physicians on interpreting the results of tests, counseling patients about genetic tests and delving into the ethical dilemmas that come with the territory.

A survey by the AMA indicates that patients already are counting on their physicians to have a firm grasp on the use of genetic tests. Fifty-nine percent of those surveyed said they would be somewhat or very likely to take advantage of genetic testing. Eighty-one percent said they're confident that their primary care physicians could tell them if they are at risk for developing an inherited disease, and 72 percent believe their family practitioner could interpret the results of genetic tests.

"In order to ensure that patients benefit from the remarkable advances of genetic research, it will be critical that in the near future physicians become as conversant with genetics as they currently are with physiology and pharmacology," said a statement by Francis Collins, director of the National Human Genome Research Institute.

In addition to becoming conversant with genetics, physicians also will need to become sensitive to the privacy and ethical issues associated with genetic testing, the survey indicated. Sixty-eight percent of those surveyed said they're somewhat or very concerned that their employers and/or health insurance carriers would use the results of genetic tests against them. Seventy-seven percent said the physician should not share the information without the patient's expressed consent.

Feldbaum noted that physicians already are beginning to deal with such sensitive issues in the form of state mandated blood tests for newborns. The tests were originally designed to catch newborns who had defects in their PKU gene so that their parents could alter the child's diet and prevent mental retardation. The advent of genetic tests has resulted in requirements for more tests, results from which could have implications on the insurability of the child's parents and siblings.

"The advances in genetic testing have hit us hard and fast and we need to deal with them harder and faster," Feldbaum said.

BIO supports congressional action to create a national privacy standard for all medical information in order to alleviate fears about discrimination and allow patients to take advantage of genetic information that may lead to earlier intervention for many diseases, he added.

Feldbaum intends to convey the importance of bioethics and the commitment the biotechnology industry has to ethical uses of the emerging technology during his address to the conference on Friday.

"I know the primary care physicians have no idea how deeply the biotech industry is into the ethical issues," Feldbaum said. "This is just the beginning of our association with the AMA. We really need to work with physicians and the AMA to ensure that patients will reap the benefits of genetic medicine." *

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