Dr. Butterworth questions whether the use of genetic information from clinical studies to examine the impact of genetic variability on disease characterization and outcome, or functional genomics , is ready for “prime time.” However, before replying to that question, a brief review of the history of genetics may be in order. On April 14, 2003, the Human Genome Project announced the complete sequencing of the human genome †just 11 days shy of the fiftieth anniversary of Watson’s and Crick’s seminal description of the DNA double helix. During this brief timespan, we have witnessed the use of genomics for the rapid identification of newly discovered pathogens, such as that involved in the severe acute respiratory syndrome (SARS); the use of gene-expression profiling to assess cancer prognosis and guide therapy; the use of genotyping to stratify patients according to the risk of a disease, such as prolonged QT interval syndrome or myocardial infarction; the use of genotyping to increase our understanding of drug pharmacokinetics and pharmocodynamics; and the use of genetics for tissue engineering and the cloning of several different species. 1–4Recently, the National Human Genome Research Institute announced the formation of the International HapMap project, which will attempt to improve the ease and accuracy of human genetic risk profiling by creating a haplotype map consisting of approximately 500,000 tag single nucleotide polymorphisms from the more than 10 million that exist within the human genome. Even in diseases such as Huntington chorea, in which identification of the specific causative mutation has yet to lead to improved treatment, patients and their families have benefited from genetic counseling. 5 All of these mind-boggling accomplishments have occurred within a single generation.
Is perioperative functional genomics ready for prime time? Maybe not quite yet. But one thing is assured: If genetic advances continue to occur at the current rate and the discipline of anesthesiology remains on the sidelines, we may very well find ourselves in the scientific “reruns” instead of at the forefront of novel, cutting-edge research.