Review

Breeding discontent

BRAVE NEW NHS? The impact of the new genetics on the health service
Jo Lenaghan
IPPR, 1998, £7.50

Despite the title, Brave New NHS? does not delve into a futuristic dystopia, but investigates the present day, and the apparent lack of clear direction that the NHS holds regarding the ‘new genetics’.

This book is clearly set out, with a couple of highly detailed contents pages at the beginning, though sadly lacking a proper index, an omission that I feel warrants a complaint. The book starts off with a useful introduction to the ‘new genetics’ and the genetic services that may become available within the health service. It looks at issues for purchasers and providers, and discusses the future role of the public and private sectors. Before concluding, a few ethical points are raised, the right to privacy for individuals who undergo genetic testing and security of access for the information collected. It specifically considers the potential risk of misuse of information that may lead to discrimination in the provision of insurance and in one’s employment.

The book does not, though, provide a detailed account of ethical and scientific aspects, but concentrates on the impact of developments on the NHS itself. Neither does it deal with social aspects adequately, though it briefly deals with subjects such as variations in the provision of services in different regions of the country. I feel that this is wrong, as such a view becomes essentially economic and managerial. This encourages the reader to believe that the status quo is accepted by the author, which would be a shame if true.

Another area that it inadequately covers is the relationship to inequality in health and access to health care, which is likely also to structure the development of the ‘new genetics’.

What Brave New NHS? does discuss is the obvious lack of direction at present, suggesting that this short report can only help to start the debate, and it does offer some suggestions for the future. It shows a concern over the patenting of genes, but, because this area is developing quickly, it cannot analyse more recent political developments; eg the recent Anglo-American attempt to ensure that research on human genes should be shared information, and that genetic information should not become yet another commodity in the market.

Jo Lenaghan’s book is an affordable read and it should help to stimulate the necessary debate.