Post by Rekha S Namachivayam PhD

Let’s Stop Trying to Retrofit Ethics Into a Revenue Model After my recent post on why Tamil Nadu hasn’t emerged as a leader in genetic counseling despite its medical legacy, professionals across India voiced out. Healthcare in India, particularly in high-volume states like Tamil Nadu, is built on speed, scale, and specialization. Every consultation is expected to be quick, efficient, and revenue-generating. Within that model, genetic counseling doesn’t fit. And it’s not supposed to. Genetic counseling demands time. It requires trust. It centers around uncertainty, identity, long-term risk, and family dynamics. Sometimes, after a full session, the most ethical and informed decision is to not take a test. That is good healthcare. But to the current system, it looks like lost income. As Suruthi Abirami put it, “Genetic counselors are underpaid, underused, or made invisible.” Nadir Aman , who works across South India, noted that while the region is full of talent, “many trained professionals move away due to lack of structure and support.” Vaishnavi Suresh (MSc, CGC) added, “Somewhere, the conversation around genomics and counseling got siloed.” And Parichay S.R captured the spirit of this moment when he said, “The top-down structure won’t change easily, but we can lead from the bottom. We need community warriors. This is not just about genetic counseling. It is a reflection of a larger structural problem. Any healthcare professional whose work involves time, listening, empathy, or education, but does not directly generate revenue faces the same invisibility. #Clinicalpsychologists, #socialworkers, #Nutritionists, #speechtherapists, and #rehabilitationspecialists often find themselves undervalued in the same way. Their work is critical to healing, but hard to measure in margins. When care is evaluated only by what it earns, not what it offers, we end up with a system that rewards speed over depth, transactions over trust, and procedures over people. We cannot expect ethical, patient-centered care to thrive in an environment that doesn’t allow space for reflection or uncertainty. We cannot expect trust to grow in a model that was never designed to hold it. If we are serious about advancing genomics and precision medicine in India, we must redesign the system that holds it. That means creating care models where counseling comes before testing. That means building billing systems that recognize the value of time, of consent, of human conversation. It means seeing “no test today” as a clinical success, not a missed opportunity. Tamil Nadu is known as the medical tourism capital of India. That title brings responsibility not just to lead in infrastructure and volume, but to lead in values and integrity. This conversation isn’t only about genetic counseling. It is about the kind of system we are choosing to shape and the kind of care we believe in. Let’s build a system where ethics are not retrofitted, but designed from the start.