Potential for Genetics to Promote Public HealthGenetics Research on Smoking Suggests Caution About Expectations

The number of DNA-based tests available for use in clinical care has rapidly increased over the past decade, and this trend has implications for public health and preventive medicine. In the 1990s, Coughlin¹ described an “emerging paradigm of disease prevention—the identification and modification of environmental risk factors among persons susceptible to disease due to genotype.” This optimistic vision of genetically based prevention was applied to lung cancer when Collins introduced “John,” who joins a support group of persons at genetically high risk of complications of smoking and thereby kicks the habit.² Yet a closer look raises questions about public health and research priorities.³