Legacy of the American eugenics movement: implications for primary care.

One hundred years ago the first "genetic revolution" promised a boon to society through the rational application of scientific knowledge about heredity. Leading American physicians, psychologists,social workers, scientists, educators, and philanthropists advocated a eugenics agenda that called for the elimination of the "unfit." This legacy has affected profoundly the current nondirective model of genetic counseling. As primary care now prepares for the age of genomic medicine, the history of eugenics provides a perspective for the application of patient-centered care and shared decision-making models to the process of genetic testing.