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Too Early, Too Late, or Just Too Complicated?

Mark Atkinson, PhD; Edwin A. M. Gale, MD

JAMA. 2003;290:1771-1772.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Important questions about type 1 diabetes mellitus (DM) remain unanswered, but few have been more perplexing, more exhausting, and perhaps even more unproductive than the issue of what causes the disease.^1-4 While geneticists and immunologists have made measurable progress, the work of epidemiologists at times recalls Veblen's comment that "the outcome of any serious research can only be to make two questions grow where only one question grew before."⁵ Despite this confusion, the notion that environmental influences, or the loss of such influences, may in some way promote the development of type 1 DM appears well-founded, and the changing incidence of the disease is indeed difficult to explain on any other basis.⁶

Earlier explorations of disease causation looked for simple one-to-one correlations between the environment and disease, an approach that worked well for infectious agents, nutritional deficiency, and toxins. The quest for . . . [Full Text of this Article]

Author Affiliations: Department of Pathology, Center for Immunology and Transplantation, University of Florida, Gainesville (Dr Atkinson); and Diabetes and Metabolism, Division of Medicine, University of Bristol, Bristol, England (Dr Gale).

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