The Genome Is Mapped. Now What?

It will be decades before scientists identify and understand all of our genes. But that hasn't stopped them from making dramatic discoveries

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In any case, pinpointing the genetic basis for disease and an individual's genetic response to medication is only a small part of what genomics is about. Further along the biochemical cascade of cause and effect are the proteins, the ultimate products of genetic information. Understanding the nature of proteins and their complex interactions will give scientists an entirely different and perhaps even more valuable insight into disease--and again, nobody's waiting for the genome sequence to be done to start finding out. (See accompanying story.)

The actions of individual genes, moreover, make a lot more sense in the context of other genes. "Right now," says Stanford biochemist Patrick Brown, "it's like watching a movie on TV a few pixels at a time and trying to figure out the overall story. Having the complete genome sequence is something categorically different, like going from 100 scattered pixels on your screen to having the whole image. There will be a substantial increase in the rate at which discoveries are made."

Maybe too much of an increase, argues Tom Delbanco, chair of general medicine at Harvard Medical School. "Discovery is intoxicating," he says. "But the consequences of discovery are often complex, and instead of progress, it can lead to disaster." Delbanco is worried that the revolution in genetic medicine may further drain the limited amount of time that physicians have to spend with patients and add even more costs to the already expensive health-care system.

Yet while Delbanco's fears may be justified--and while the genetic revolution has raised plenty of other troubling issues (see "What We Should Worry About")--its promise is so huge that putting on the brakes may be impossible. The age of genomic medicine is here; the sequencing of the human genome just marks the ceremonial start.

And that's perhaps the most significant difference between the genome project and the first moon landing. The latter was a clean, well-defined achievement. But more than 30 years after Neil Armstrong's dusty first step, space travel has gone pretty much nowhere. Thirty years from now, our understanding of the human organism and its various ills is likely to be transformed beyond recognition.

--Reported by Dan Cray/Los Angeles, Alice Park and Sora Song/New York and Dick Thompson/Washington

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