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C: What Are the Results and Will They Help Me in Caring for My Patients?

John Attia, MD, PhD; John P. A. Ioannidis, MD, PhD; Ammarin Thakkinstian, PhD; Mark McEvoy, MMedSc; Rodney J. Scott, PhD; Cosetta Minelli, PhD; John Thompson, PhD; Claire Infante-Rivard, MD, PhD; Gordon Guyatt, MD, MSc

JAMA. 2009;301(3):304-308.

In the first 2 articles of this series, we reviewed the basic genetics concepts necessary to understand genetic association studies, and we enumerated the major issues in judging the validity of these studies. In this third article, we review the issues relating to the applicability of the results in the clinical situation. How large and precise are the associations? Many genetic effects are expected to be smaller in magnitude than traditional risk factors. Does the genetic association improve predictive power beyond easily measured clinical variables? In some cases, the additional genetic information adds only a small increment in the predictive ability of a diagnostic or prognostic test. What are the absolute vs relative effects? Even if the genetic risk is high in relative terms, the baseline risk may be very low in absolute terms. Is the risk-associated allele likely to be present in my patient? A risk allele may have a strong effect but be rare in a particular ethnic group. Is the patient likely better off knowing the genetic information? Given that genes cannot be modified, one must weigh whether the genetic information is likely to be helpful in planning other health interventions or initiating behavior change.

Author Affiliations: Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Hunter Medical Research Institute, and Department of General Medicine, John Hunter Hospital, Newcastle, Australia (Dr Attia); Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece, and Center for Genetic Epidemiology and Modeling, Tufts Medical Center, Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts (Dr Ioannidis); Clinical Epidemiology Unit, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (Dr Thakkinstian); Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, Australia (Mr McEvoy); Division of Genetics, Hunter Area Pathology Service, John Hunter Hospital, New Lambton, Australia, and Centre for Information Based Medicine, Faculty of Health, University of Newcastle, Hunter Medical Research Institute, Newcastle, Australia (Dr Scott); Respiratory Epidemiology and Public Health, National Heart and Lung Institute, Imperial College, London, England (Dr Minelli); Department of Health Sciences, University of Leicester, Leicester, England (Dr Thompson); Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Canada (Dr Infante-Rivard); and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada (Dr Guyatt).

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