Genetic engineering holds the promise of totally changing the individual’s risk for immediate or long-term diseases. By discovering the susceptibility of a disease, insertion of corrective genetic information will be able to prevent that occurrence. For those where there is not a cure, early knowledge of the disease predilection can permit an aggressive behavior modification program to lessen the ravages of the disease. There are also wondrous and frightening futures from the genetic genie that has been let out of the bottle. Initial understanding of the aging process through discoveries of apoptosis and the role of telomeres and telomerase point to the potential for extending life beyond the current maximum limits of 120-130 years. The implications of these genetic manipulations, especially for preventive medicine to provide a high quality of life in the extended years, should become a major focus for preventive medicine. It will not be possible to afford a hundred or more years of chronic medications and treatments for those who live long but are chronically ill. And access to the information and treatments to insure healthy longevity will necessarily be distributed through tele- preventive health.