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LETTER |
Correspondence: Requests for reprints should be sent to Gio Batta Gori, ScD, MPH, The Health Policy Center, 6704 Barr Rd, Bethesda, MD 20816-1016 (e-mail: gorigb{at}msn.com).
With regard to the "Risky Concepts" focus in the March issue of the Journal,1–3 are we to believe that there is a polarization of population vs individual approaches to prevention, when the two are intuitively complementary?1–3 Or is the allegation a pretext to extol command-performance population interventions while obscuring the obvious perception that any form of intervention eventually touches individuals?
Colditz believes we know all there is to know about risk factors and asserts that "readily modifiable risks can be readily translated into ways to reduce the population burden of cancer."1 Yet he should pause to consider the current prevalence of smoking and obesity in America. Talk of coercive measures that promise "little individual gain"1 uncovers the Achilles heel of mass interventions. Mainly, they engender little individual motivation because, as Rockhill notes, most risk factors "are neither necessarily nor sufficiently causal at the individual level."3 Colditz may lament a current ethos that favors individual freedom to choose, but he dares not offer alternatives.1
Begg, on the other hand, asserts that "the primary purpose of epidemiology is to determine individual risks,"2 but he spends most of his article documenting the seemingly hopeless complexity of exogenous and endogenous interactions that determine individual risks. New proteogenomic devices may unearth ever more of the possible factors involved, but—probably with few exceptions—more factors are apt to further complicate the assessment of adverse and beneficial combinations that make up personal and population risks.
Pace Colditz, epidemiology is not at the end of its road, but it could not avoid facing what appears to be an increasingly complex biological reality. Reductionism may still come in handy for theoretical disputes or to advocate mass interventions, but truly defensible public health injunctions may not be possible without unraveling generic and individual complexity in some meaningful way. In this sense, the epidemiology of multifactorial diseases is still in its infancy and in need of much patience and humility.
Accepted for publication April 11, 2001.
References
1.
Colditz GA. Cancer culture: epidemics, human behavior, and the dubious search for risk factors. Am J Public Health.2001;91:357–359.
2.
Begg CB. The search for cancer risk factors: when can we stop looking? Am J Public Health.2001;91:360–364.
3.
Rockhill B. The privatization of risk. Am J Public Health.2001;91:365–368.
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