Physicians recognize that they have a role in explaining medical genetics to patients and discussing the impact that genetics has on health outcomes.₇, ₁₆,₂₃, ₂₆ Despite this awareness, many physicians are uncomfortable acting as genetic medical providers.₇, ₁₇,₁₈, ₂₈ Although physicians are willing to make referrals, when the results come back, many are unwilling to provide basic genetic counseling.₆,₉,₂₀, ₂₂ This unwillingness has been attributed often to knowledge gaps. Up to 75 percent of physicians lack basic knowledge of genetics, and will thus misunderstand the role of genetics in health.₆,₇, ₁₅,₁₇, ₂₂,₂₃,₂₄,₂₅,₂₆ Specialized training appears to influence practitioner understanding of medical genetics; obstetricians/ gynecologists, neurologists, oncologists, and gastroenterologists each report great comfort with genetic technologies than do general practitioners.₁₅,₁₆,₂₀,₂₉ Collectively and individually, these studies indicate that, as a physician is exposed to more information, her technical knowledge increases.

A physician's greater comfort with genetic medicine does not guarantee that patient treatment will improve. There has been considerable discussion over whether genetic medicine in educational curricula benefits or harms the patient. Education in medical genetics may change the assumptions and tools that a physician brings to the clinical encounter.₃₀,₃₁ Although the tools may lead to more effective treatment, some researchers worry medical genetics education will encourage deterministic and discriminatory assumptions that will harm the patient and society.₃₂,₃₃,₃₄,₃₅ Other researchers suggest that these concerns are overstated, holding that physicians will consider genetics alongside environmental and behavioral variables.₃₄,₃₅,₃₆,₃₇ In addition to disputes over the impact of geneticization, it is unclear as to whether geneticization is a growing phenomenon or not.₃₈,₃₉ Both sides in the discussion agree that medical education must not promote geneticization or its corollaries, genetic determinism and genetic discrimination.₄₀,₄₁

Geneticized medicine has the potential to make many of us already diseased. With more than 2000 known loci associated with Mendelian disorders and more than 4 million identified single nucleotide polymorphisms, Francis Collins's claim that “all of us carry dozens of glitches in our DNA” does not seem hyperbolic.₄₂ If physicians are trained to read the genetic code in a deterministic and discriminatory manner, all patients could be viewed through a geneticized lens.

Technical concerns about genetics in medicine are more likely to be addressed if a physician has graduated more recently from medical school, has taken coursework specific to genetics, or considers herself highly qualified in genetics. Social implications of genetics may articulated alongside technical information. As a physician obtains more information about genetic medicine, she may be trained to view genetics as a deterministic factor in health and adopt more discriminatory attitudes about genetics in social policy. As such, the central hypothesis in this study was:

H1: Physicians who have received more education about genetics will express more socially problematic attitudes in regard to genetics than will physicians who have received less education about genetics.

Two direct measures of education in genetics and three indirect measures were employed. Formal education, i.e. enrolling in a genetics course, may provide training that addresses both technical and the social concerns related to genetic medicine. Therefore, this study hypothesized:

H1a: Physicians who have taken a formal course in genetics in college will express more socially problematic attitudes in regard to genetics than will physicians who have not taken a college course in genetics.

H1b: Physicians who have taken a formal course in genetics in medical school will express more socially problematic attitudes in regard to genetics than will physicians who have not taken a medical school course in genetics.

In addition to specialized courses in genetics, genetics has been incorporated throughout medical curricula. Thus, those physicians who have graduated more recently are more likely to have technical competence in genetic medicine. Likewise, social issues related to genetics may be addressed in current curricula more often for more recent graduates. Therefore, this study hypothesized:

H1c: Younger physicians who will express more socially problematic attitudes in regard to genetics than will older physicians.

H1d: Physicians who have graduated more recently from medical school will express more socially problematic attitudes in regard to genetics than will physicians who have graduated less recently.

Finally, one's self-evaluation in medical genetics may influence their social comfort with genetic medicine and genetic technology. Thus, this study hypothesized:

H1a: Physicians who rate themselves as highly qualified in medical genetics will express more socially problematic attitudes in regard to genetics than will physicians who do not consider themselves highly qualified.

Physicians were identified through lists obtained from the Ohio Medical Board representing all licensed physicians in Ohio. Six hundred physicians practicing in Ohio were identified and surveyed. Respondents were assured of the anonymity of their responses.

The survey consisted of two sections. The first section consisted of three reliable and validated scales designed to evaluate social attitudes about genetics. ₄₃ These were the Genetic Determinism Instrument, the Genetic Relativism Scale, and the Genetic Discrimination Scale, The Genetic Determinism Instrument is a seven-item instrument that measures how strongly a participant agrees that health outcomes are controlled directly by a person's genetics. The Genetic Relativism Scale is an 11-item instrument that measures how strongly a participant agrees that a person's health outcomes are moderated by a variety of external factors. This Scale consists of three sub-measures: personal behaviors (i.e. that personal choice moderates genetic influences, 3 items), social support (i.e. that family and friendship networks moderate genetic influences, 3 items), and faith (i.e. that a Higher Power moderates genetic influence, 5 items). The Genetic Discrimination Scale is a 16-item instrument that measures how accepting a participant is of treating people differentially based on genetics. This Scale consists of five sub-measures: organizational discrimination (i.e. that a person's genetic make-up should be considered in employment decisions, 3 items), criminal discrimination (i.e. that persons convicted of crimes should have their genetic information recorded, 2 items), insurance discrimination (i.e. that a person's genetic make-up should be considered when assessing insurability, 4 items), physician discrimination (i.e. that physicians should be able to advise persons with genetic conditions against having children, 3 items), and individual/reproductive discrimination (i.e. that the participant would not want to have a spouse, partner, or child with a genetic condition, 4 items). The second section of the survey consisted of demographic items. Appropriate Institutional Review Boards approved the study.

Calculations were performed using SPSS version 11.5. Comparisons between groups were made using independent samples t-tests. As appropriate, nominal dichotomous variable were used for assignment. For continuous variables, participants were assigned to groups based on the midpoint for the question. Differences between groups were considered statistically significant at the .05 level.

Six hundred surveys were mailed. Fifteen surveys were undeliverable because of death or closure of practice. Of the 585 remaining surveys, 66 were returned. Although this return rate is only 11.3%, it is consistent with other surveys of physician attitudes toward genetics that did not offer continuing medical education credit or financial reimbursement.₆, ₂₂, ₄₄ Table 1 displays a full demographic breakdown.

Figure 1

Table 1: Demographics

The survey materials were generally reliable. In the present sample, the Genetic Determinism Instrument had the lowest reliability, with a Cronbach's alpha of .52. Although this reliability is low, because the counterpart scale, the Genetic Relativism Scale was sufficiently reliabe the results were retained. The Genetic Relativism Scale, and all components, was reliable (faith factors, a=.89; social support factors, a=.85; personal behavior, a=.82). Likewise, the Genetic Discrimination Scale was reliable, with all components emerging as reliable (organizational discrimination, a=.75; criminal discrimination a=.76; insurance discrimination, a=.82; physician discrimination, a=.78; individual/reproductive discrimination, a=.93).

Because information about medical genetics has the potential to geneticize medicine, this study hypothesized that physicians who have received more education about genetics would express more socially problematic attitudes than would physicians who have received less education. The hypothesis was not confirmed. Additional education about genetics is not associated with more socially problematic attitudes. Additionally, the converse proposition – that additional education about genetics would lead to fewer socially problematic attitudes – gains no support from the present study.

Two direct measures of education in genetics were employed. Information with the potential to geneticize medicine may be presented in either the college or medical school genetics course. As indicated in Table 2, physicians who took a college course in genetics did not express more socially problematic attitudes than did physicians who did not. No differences in genetic determinism, genetic relativism, or genetic discrimination were found between the two populations, with the exception that physicians who did not take a college genetics course assign a higher role to personal behaviors in health outcomes than did physicians who took a course. Table 3 shows that there were no differences in socially problematic attitudes between physicians who took a medical school genetics course and those who did not, including the role of personal behaviors. These findings suggest that courses devoted to genetics are unlikely to promote geneticized attitudes.

Figure 2

Table 2: Comparison of means between attitudes of physicians who completed a genetics course in college to attitudes of physicians who did not

In addition to direct measures of education, three indirect measures were employed. Genetics is increasingly included across the medical school curriculum. If medical education is geneticized throughout this curriculum, then physicians who graduated more recently may have received a more geneticized education than those who graduated less recently. This projected difference did not materialize. As indicated in Table 4, younger physicians did not express more socially problematic attitudes than did older physicians. Additioanlly, as shown in Table 5, physicians who have practiced for a shorter period of time did not express more socially problematic attitudes than did physicians who have been in practice longer. Finally, physicians who self-evaluated themselves a highly qualified in medical genetics did not express more socially problematic attitudes than physicians who did not consider themselves highly qualified. Table 6 indicates that the physicians who should be most geneticized – i.e. the experts – did not display higher levels of genetic discrimination or genetic determinism than did “non-expert” physicians. Moreover, the “experts” did not display lower levels of genetic relativism.

Figure 3

Table 3: Comparison of means between attitudes of physicians who completed a genetics course in medical school to attitudes of physicians who did not

Figure 4

Table 4: Comparison of means between older physician attitudes and younger physician attitudes

Figure 5

Table 5: Comparison of means between attitudes of physicians who have practiced longer to attitudes of physicians who have practiced for a shorter period

Figure 6

Table 6: Comparison of means between attitudes of physicians who consider themselves highly qualified to attitudes of physicians who do not