Integration of molecular pathology, epidemiology and social science for global precision medicine

Abstract

The precision medicine concept and the unique disease principle imply that each patient has unique pathogenic processes resulting from heterogeneous cellular genetic and epigenetic alterations and interactions between cells (including immune cells) and exposures, including dietary, environmental, microbial and lifestyle factors. As a core method field in population health science and medicine, epidemiology is a growing scientific discipline that can analyze disease risk factors and develop statistical methodologies to maximize utilization of big data on populations and disease pathology. The evolving transdisciplinary field of molecular pathological epidemiology (MPE) can advance biomedical and health research by linking exposures to molecular pathologic signatures, enhancing causal inference and identifying potential biomarkers for clinical impact. The MPE approach can be applied to any diseases, although it has been most commonly used in neoplastic diseases (including breast, lung and colorectal cancers) because of availability of various molecular diagnostic tests. However, use of state-of-the-art genomic, epigenomic and other omic technologies and expensive drugs in modern healthcare systems increases racial, ethnic and socioeconomic disparities. To address this, we propose to integrate molecular pathology, epidemiology and social science. Social epidemiology integrates the latter two fields. The integrative social MPE model can embrace sociology, economics and precision medicine, address global health disparities and inequalities, and elucidate biological effects of social environments, behaviors and networks. We foresee advancements of molecular medicine, including molecular diagnostics, biomedical imaging and targeted therapeutics, which should benefit individuals in a global population, by means of an interdisciplinary approach of integrative MPE and social health science.

Keywords: clinical outcome; disparity; epigenetics; interdisciplinary; molecular pathologic epidemiology; network analysis; personalized medicine; social medicine.

Figure 1

Trans-multidisciplinary integrations of molecular pathology, epidemiology and social science. The integration of molecular pathology and epidemiology has given risen to molecular pathological epidemiology (MPE), while the integration of social science and epidemiology has given risen to social epidemiology. We propose that the integration of MPE and social epidemiology gives rise to social MPE. Note that epidemiology plays a pivotal role as a core field of population health science in these transdisciplinary integrations.

Figure 2

Collaborative relationship between social epidemiology and molecular pathological epidemiology (MPE). Both fields are method-based subspecialty disciplines in epidemiology, and cover the entire spectrum of human diseases. The methodologic strengths of each field can complement those of the other field. Both fields can be synergized to create an integrative field of social MPE, which can further enhance research and education in both fields.