How big is big enough for epidemiology?
How big is big enough for epidemiology?
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对于流行病学来说多大才算足够大？
DOI：
10.1097/01.ede.0000249507.52550.90
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发表时间：
2007
期刊：
影响因子：
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通讯作者：
Kaplan,GeorgeA
中科院分区：
文献类型：
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作者：
Kaplan,GeorgeA
当编辑找我写这篇评论时，我百感交集。一方面，由于开展流行病学“大型”和“超大型”研究（B/VBE）的国家和国际倡议（无论是正在进行的还是提出的）的数量，解决围绕此类研究的许多复杂问题变得越来越重要。另一方面，关于这些问题的争论引发了令人不安的画面，让人想起汤姆汉克斯的电影《大人物》和乔纳森斯威夫特的《格列佛游记》。你可能还记得电影《大人物》中的主人公乔希，一个13岁的男孩，被一个名叫佐尔塔的投币算命先生变成了一个成年人。尽管乔希天真无邪，缺乏经验，但他发现，尽管成年的经历确实有一些好处，但他渴望回到孩子的状态。从斯威夫特身上，我们回忆起在小人国太大而在布罗布丁纳格太小的危险和回报，并希望我们不会成为流行病学上的“耶胡”。没有Zoltar的帮助，算命先生，我们无法预测流行病学变得“大”的后果，但斯威夫特的讽刺性洞察力确实警告我们，一种尺寸绝对不适合所有人，这种尺寸可能会影响我们的视野。在过去的几年里，我参加或参加了许多关于“大流行病学”主题的会议和研讨会，他与许多同事讨论了这类研究的前景和局限性，参与了一项“大型”前瞻性国家研究的一些规划，并遵循了秘书的遗传学、健康和社会咨询委员会及其大型人口研究工作组等团体的考虑。虽然我不想断言我是这方面的专家，但我对故事的各个方面都有相当的欣赏，并且越来越怀疑这种研究的必要性，可行性和可取性。我还担心，目前非常大规模的流行病学研究可能会产生严重的意外后果。我不会试图在这篇评论中解决所有这些问题，我从一开始就承认，对复杂问题的简单答案总是有些可疑。当前的问题是我们所说的“大”或“非常大”流行病学是什么意思。在我的评论中，我将重点关注有10万多名参与者的研究。然而，即使这样也没有足够的缩小范围，正如我们可以想象的那样，已经有病例对照研究，队列研究，基于人群的登记，生物样本的大规模收集，如在BIOBANK和deCode中，以及其他“大”设计的例子。因此，如果不清楚我们讨论的是什么样的研究，就不能真正评估与“大”流行病学相关的前景和问题。在接下来的大部分时间里，我主要关注“大”和“非常大”的纵向研究，因为它们可能是最大的挑战。
When I was approached by the Editor to write this commentary, I had mixed feelings. On the one hand, grappling with the many complex issues that surround the role of “big” and “very big” studies in epidemiology (B/VBE) has increasingly become important given the number of national and international initiatives, both underway and proposed, to conduct such studies. On the other hand, the debate on these issues raises disquieting images reminiscent of both Tom Hanks’ movie Big and Jonathan Swift’s Gulliver’s Travels. As you may recall from the movie Big, the protagonist—Josh, a 13-year-old boy—is transformed by a coin-operated fortune teller named Zoltar into a grown man. Innocent and inexperienced as he is, Josh finds that, although the experience of being grown-up does have some advantages, he longs to return to being a kid. From Swift we recall the perils and rewards of being too big in Lilliput and too small in Brobdingnag and hope that we will not become epidemiologic “Yahoos.” Without the aid of Zoltar, the fortune teller, we have no way of predicting the consequences of epidemiology becoming “big,” but Swift’s satirical insight does forewarn us that one size definitely does not fit all and that size may impact our vision.Over the last few years, I have attended or participated in numerous conferences and symposia on the topic of “big epidemiology,” have discussed the prospects and limitations of such studies with many colleagues, have participated in some of the planning for a “big” prospective national study, and have followed the considerations of groups such as the Secretary’s Advisory Committee on Genetics, Health, and Society and its Task Force on Large Population Studies. Although I do not want to assert that I am an expert on the subject, I have developed considerable appreciation for all sides of the story and have become more and more skeptical about the need, feasibility, and desirability of such studies. I am also concerned that there may be potential for serious unintended consequences of very large epidemiologic studies at this time. I will not try to address all of these issues in this commentary and I admit from the outset that simple answers to complex issues are always somewhat suspect. Of immediate concern is what we mean by “big” or “very big” epidemiology. For the purposes of my comments, I am going to focus on studies with 100,000 plus participants. However, even that does not narrow the field enough, as we can imagine—and there already are—examples of case–control studies, cohort studies, population-based registries, collections of biologic samples on a grand scale as in BIOBANK and deCode, and other “big” designs. Thus, one cannot really assess the promises and problems associated with “big” epidemiology without being very clear about what kinds of studies we are discussing. For much of what follows I mostly focus on “big” and “very big” longitudinal studies, because they present perhaps the biggest challenges.