Medical and lay publications give increasing, and sometimes overwhelming, coverage of genetic discoveries. Concrete progress in therapy, however, has been and will likely continue to be slow. Dr Scheuerle discusses the molecular, economic, and behavioral barriers to the development of genetic treatments. The economic disincentives to develop orphan drugs may hinder therapy for truly rare diseases. The lack of uniform compliance with existing effective therapies will limit the adoption of new treatments. While the genetic revolution had much potential, the complexity of genetics itself is great. Advancements will be made, but they are likely to occur only at a measured pace.