The long view: how genetic discoveries will aid healthcare reform

This article addresses social and ethical priorities on the agenda for women's health research in the next century. Specifically, the relevance of genetic discoveries for healthcare reform and why both topics ought to be among these priorities are discussed. If the present gap between diagnosis and treatment of genetic diseases could be bridged, especially in such common diseases as cancer and heart disease, arguments for universal access to healthcare would be vastly strengthened. Important scientific and ethical problems are involved in bridging the gap, including volatile issues of research with human embryos and fetuses. Other issues deserve high priority on the women's health research agenda: adequate funding for biomedical research, maintaining an equitable number of women in clinical trials, and creating a knowledge base in gender-based biology. Progress in genetic research is clearly relevant to women's health for understanding and treating common diseases, as well as for reproductive decisions. Until recently, genetic services have been aimed exclusively at reproductive choices, including counseling, prenatal diagnosis, and carrier screening. However, the meaning of the term needs to be vastly broadened to include the uses of genetic information in mainstream medicine. Through genetic testing and DNA technology, it will be increasingly possible for physicians to have access to family history and a reliable profile of each patient's genetic health risks. Drugs will be designed that will be responsive to individual genetic variability and risks for disease. If scientific and ethical obstacles are overcome, there may also be effective human gene therapy to correct mutations and prevent lifelong harm. In my view, linking the agenda for women's health research with the unfinished social task of ensuring access to adequate primary and preventive care, which foreseeably will include genetic services and human gene therapy, strengthens the agenda and promotes solidarity with the needs of the majority of Americans. This link will help to prevent political and moral isolation of women's health research.