Courtesy of U.S. Dept. of Energy Human Genome Program	More NurseWeek Features   Smoke-Free Zone   Nurses and patients tackle nicotine addiction   Bloodless Survival     Surgical techniques to use when transfusion drops out of the equation
Advances in genetics are transforming the medical framework. Now, in addition to the physiological, practitioners will look at health issues in terms of cells, chromosomes and DNA.

Imagine a day in the not-so-distant future when, in addition to taking temperatures, checking blood pressures and noting oxygen saturation levels, you scan your patients' genetic information from a computer microchip.

This information, interpreted by a superfast computer, tells you if your new cancer patient metabolizes certain medicines quickly, normally or slowly. It tells what medication works best for her high blood pressure. It indicates whether her breast cancer will best respond to standard treatment or to a new drug on the market, and whether she is in a high-risk category for other cancers triggered by certain environmental factors like cigarette smoke or air pollution.

You work with a pharmacist and physicians to administer doses of medication based on genetic information that shows how your patient responds to them. Your cancer patient slowly metabolizes the cancer drug shown to work best for her. She will start off with low doses to reduce the side effects of toxic drugs lingering in her system. But she metabolizes pain medications quickly and may need more frequent doses of painkillers to stay comfortable.

You explain to her children why their mother is receiving a lower dose of the cancer drug than an aunt on the same medication. You explain why this therapy has a better chance of working, based on their mother's individual genetic profile, than a different drug they read about on the Internet.

You work with the patient and her family to draw up a health plan based on certain environmental indicators shown by her genetic information. For instance, she seems to be susceptible to stress and should take care to avoid situations that might exacerbate her illness or increase chances of a recurrence. You recommend testing for family members to see whether they also have indicators that should be watched-or even blocked with early intervention medications based on their own genetic information.

The children wonder if they should share this information with other relatives. They also are concerned about how this might affect their own health insurance-would it be considered a pre-existing condition? You explain the privacy laws that cover genetic information and discuss ways they could alert other family members without unduly alarming them.

Thanks to your explanations, the patient and her family feel much more relieved about the new therapy.

Some details of this marvelous medical scenario-the microchip containing detailed genetic information, for instance-are still at least 10 years and perhaps many more years away, those who work in genetics say. Others, such as genetic information that helps determine what blood pressure medicine to take, may arrive within a few years. Some are happening as you read this: Patients across the country are receiving medicines targeted to their illnesses and genetic makeup.

In the world of medical therapies, one size no longer necessarily fits all.

What does this mean for nurses? Nurses already are involved as researchers for genetically targeted tests, drugs and procedures, and the demand probably will rise as the need for more research and clinical trials increases, those who work with pharmaceutical companies say. Nurses already may be dealing with patients' questions about genetically targeted therapies and tests in clinical trials or already on the market.

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