Friday, June 30, 2023
Michelle Fox, MS, CGC, is a giant in genetic counseling. She began her career when the genetic counseling field was young and has since led the way for numerous advancements in helping patients and cementing genetic counseling’s role in medicine. These successes were honored in 2022, when she received the National Society of Genetic Counselor’s Natalie Weissberger Paul National Achievement Award, a well-earned title.
We spoke with Michelle about her career journey and where she sees the field heading next.
What initially drew you to the field of genetic counseling and how did you become a certified genetic counselor?
I started off loving science, and my mom insisted I get certified to teach school. I was a disastrous middle school science teacher. I heard about the genetic counseling program at Sarah Lawrence, and it sounded perfect for me. With luck, I got in. For people who love to talk, this is the perfect field! I spent 35 years at UCLA in clinical research and teaching. Now, I work remotely as a genetic counseling consultant for a company. If you had told me years ago I’d ever work for a lab, I’d say you’re crazy. I spent my years calling the labs to complain about the test report, and now I see how difficult it is!
How has the field of genetic counseling evolved during your career, and what changes have you seen in the way genetic information is communicated to patients and families?
When I started, we had very few patients. On the first certification exam, there was no molecular genetics. Now, we are sequencing thousands of genes. Without the supreme court case regarding BRCA1 and BRCA2, none of this lab work would’ve gone on.
The internet opened up everything for us. We used to have to go to the library and look up a gene. We sometimes knew the syndrome, because of the signs and symptoms of our patients, but then we looked it up in “Index Medicus” to find additional information. We would find an author of a paper and try to call them. There wasn’t another way to do it. Now, there’s nothing we can’t Google in a few seconds.
I spent my career lowering the barriers to genetic counseling and genetic testing. Genetic counselors are the best-kept secret in medicine. Right now, we’ve had a sea change. There was a bit of a bubble starting with the industry hiring a lot of genetic counselors and raising salaries. With steady advancements in technology, genetic counselors will always be in demand. We are working for universal screening in the area of cancer. That will create a huge market for genetic counselors. We’re going to start doing gene sequencing for newborns. If that happens, the best people to explain all genetic testing results are genetic counselors. We talk all the time about how we can explain this difficult information to anyone at any level. A lot of physicians did not have a lot of genetics in medical school. We are the subject matter experts in genetics.
You have extensive experience in the ethical issues surrounding the provision of genetic services. Could you speak to some of the challenges that arise in the decision-making process for genetic testing?
In the beginning, we had so many issues about how this genetic testing was going to work. Were people going to accept it or not? I think we made a little too much out of it. Ethics are part of every medical practice; it’s part of everyone’s lives. I think there were a lot of ethical dilemmas when we started thinking about who should take the test and why they should take the test. Is it okay to test children for late onset disease? Is it okay to do a diagnosis during pregnancy for a disease that manifests in your 20s or 30s? Everyone is bound by their ethics and the way they approach that and what the issues are.
In general, education is power and knowledge is power, but people come to you thinking they know what to do. 23&Me is not the same as the testing we do, but it led the way to put genetic testing in everyone’s face, and it became common for people to get kits and swab the inside of their cheeks. It’s our job to explain what the difference is and what the limitations are. There are limitations for diagnostic genetic testing, too. You must be a knowledgeable consumer.
Could you speak to the importance of mentorship in the field of genetic counseling, and how you have helped to guide and support students in their careers?
We are the best network of healthcare professionals around. You send an email to a genetic counselor or a phone call and within a day you get a response. Networking is everything and mentoring is everything, too. In my career, I had amazing mentors. Dr. Steve Cederbaum led the way for me to get a faculty position at UCLA, even though I only had a master’s degree.
I worked for years to start a genetic counseling program at UCLA, and we graduated our first class about a year ago. It’s very rewarding to see that growth. We recently accepted our third cohort of students. Students are learning up-to-the-minute stuff all the time. All the genetic counselor supervisors are learning, too.
We haven’t been able to diversify our profession in general, but we are doing our bit in California. We’re reaching out to community colleges on a regular basis to talk about genetic counseling, and we’re helping prospective students get their prerequisites by the time they graduate with a four-year degree.
You are currently providing consultation services. Could you discuss some of the unique challenges and opportunities in working in this setting?
It’s wonderful. It’s the best way I can keep abreast of what is happening in the field. I consult with the regional managers, who are the salespeople for Invitae. I help them with the training, which is very interesting. They are not scientists — they are in sales. It’s so exciting because I’m helping them break down all this very difficult information, so they can explain to the clinicians what the test means and why they would use our laboratory and all the benefits of taking the genetic test.
What has it meant to you to receive the 2022 Natalie Weissberger Paul National Achievement Award?
It meant so much to me to be recognized by my peers and to receive the award and be able to thank all the people who have been my mentors and my dear friends in genetics. When you graduate with a cohort, those genetic counselors are your friends for life. It was so great to be involved over the years with different projects and to be recognized for that work. To have the opportunity at this point in my career to still be in it, I just don’t want to stop. I am too passionate about it. There is something new every day.
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