The next stage: molecular epidemiology.
The traditional approach in epidemiology of relating exposure to an environmental agent such as a drug or infective agent has been to measure an overall risk (i.e., average and then "adjust risk for demographic variables and other confounders"). An attempt is sometimes made to define a "susceptible" subgroup. The analyses are usually based on good statistical methodology rather than an understanding of the interaction of body of host and agent. A twofold risk for 1000 exposed versus nonexposed people could be an average twofold risk for all 1000 exposed or a 20-fold risk for 100 exposed individuals (i.e., a drug-host interaction). Clearly, finding the 100 individuals with a 20-fold risk has much greater clinical importance than a twofold risk for 1000 people. The world of epidemiology may be changing-we may soon be able to define risk based on genetic susceptibility, at least sometimes.
Shpilberg
O
O
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania 15261, USA.
Dorman
J S
JS
Ferrell
R E
RE
Trucco
M
M
Shahar
A
A
Kuller
L H
LH
D001057:Apolipoproteins E / Q000235:genetics; D001161:Arteriosclerosis / Q000453:epidemiology / Q000235:genetics; D002273:Carcinogens / Q000009:adverse effects; D002908:Chronic Disease; D003276:Contraceptives, Oral / Q000009:adverse effects; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology / Q000235:genetics; D004812:Epidemiologic Methods; D015914:Estrogen Replacement Therapy / Q000009:adverse effects; D020022:Genetic Predisposition to Disease; D005838:Genotype; D006801:Humans; D011322:Primary Prevention / Q000379:methods; D012306:Risk; D013923:Thromboembolism / Q000453:epidemiology / Q000235:genetics
D001057:Apolipoproteins E; D002273:Carcinogens; D003276:Contraceptives, Oral