Scientific Discovery, Contextual Factors, and Cardiometabolic Health Research: Back to the Future.

Abstract

Precision medicine typically addresses questions related to person, and population health commonly addresses questions related to place; however, neither approach emphasizes the role of time, such as the environmental context during critical time windows and associated biological mechanisms that have the potential to impact cardiometabolic health across the life cycle and generations. We use the epidemic of overweight and obesity to illustrate the case for needing to attend to contextual factors during critical time windows in discovery science, and we conclude that we need to look back to early in life and across generations if we want to impact the future. Scientific discovery has long accelerated the generation and translation of knowledge, and recent efforts to promote precision medicine and population health research seek to shorten the pipeline to interventions that reduce the burden of cardiometabolic diseases.1,2 It has been suggested that progress in addressing the health needs of patients and populations requires an increased focus on precision in both medicine and public health.3 Although there is an on-going debate about whether precision medicine will improve population health, with compelling arguments on both sides of the issue, it has also been suggested that precision medicine and population health researchers combine their knowledge and efforts to improve population health.4 Although these issues are important, they do not address a frequently overlooked characteristic that limits discovery science and merits increased attention. Specifically, precision medicine typically addresses questions related to person, and population health commonly addresses questions related to place; however, neither approach emphasizes the role of time, such as the environmental context during critical time windows and associated biological mechanisms that have the potential to impact cardiometabolic health across the life cycle and generations. In this viewpoint, we suggest that reimagining the focus of precision medicine and …