New technologies emerging from the Human Genome Project and the rapidly expanding direct-to-consumer DNA testing have provided a challenging environment for the entry of pharmacogenomics into clinical practice. The traditional pathology laboratory, which is centered around a referring clinician and the patient, is also being reshaped by these developments. These changes are occurring as the shrinking health dollar imposes a greater focus on preventative medicine. For the latter to benefit from genomics requires the community to be engaged, and the development of the disease process identified earlier than otherwise possible. These two prerequisites are now being sought through the concept of 'personalized medicine'. Much has been occurring in a relatively short time frame, and as a consequence, education becomes a major rate-limiting step to change.