Tensions in implementing the new genetics

Women with a family history of breast cancer and those in the general population consistently overestimate their risk of breast cancer before genetic risk assessment and counselling, a process which improves knowledge without causing negative impact on mental health. 4 Failure to identify clinically significant family histories denies patients access to a specialist service which addresses the needs of people who are at risk or affected. Donnai et al dismiss evidence of general practitioners' legitimate ethical concern. 1 Informed general practitioners were neither prejudging nor dismissing patients' anxieties by raising ethical concerns; those who were knowledgeable about genetic advances were discriminating in implementing new technologies that do not yet fully fulfil Junger and Wilson's criteria. 2 Donnai et al do not address the issue of general practitioners as mediators between biological and holistic models of illness 3 and the importance of this role in view of concerns about biological determinism and geneticisation. 4 Patients' genetic risks need to be managed with an understanding of the broader social and psychological context, to which-as we argue in the paper-generalists bring the key skills.