Functional genomics: clinical effect and the evolving role of the surgeon

The genetic and molecular revolution that has occurred over the last 2 decades has dramatically increased our understanding of basic disease processes and will undoubtedly lead to improved detection methods and treatment. This will occur at an even more rapid rate after the completion of the Human Genome Project in the next 2 to 3 years. While these remarkable technological advances offer great hopes for novel therapeutic modalities, complicated medical, ethical, and legal issues will need to be addressed. This article briefly describes the advances that have occurred and their future ramifications for the field of surgery. Most assuredly, we will all be affected by these changes. Surgeons have the opportunity to be active participants and real leaders in the research and complex decisions regarding the optimal treatment of patients. However, formal training in these techniques and their potential applications will be required. Surgeons, as well as all physicians, must rise to the occasion or, otherwise, we will be relegated to a bystander status with clinical and moral decisions being made by nonclinicians.