Ethics, epidemiology and the thrifty gene: Biological determinism as a health hazard

This paper briefly describes the rise of the thrifty genotype hypothesis as an explanation for the late twentieth century epidemic of diabetes, particularly in post-colonial indigenous societies. It looks at some of the ethical consequences of the biological deterministic paradigm, particularly the popular confusion of "genes" with "race" and how this paradigm served to exclude consideration of social determinants of disease in epidemiological thinking. Some alternative hypotheses to the thrifty gene theory are explored, together with the consequences of acceptance of these other theories in terms of public health action. Finally, there is a need for epidemiology to be continually conscious, critical and transparent with respect to the general disease (and wellness) theory under which it operates if it is to be truly a science rather than a collection of methodologies. (C) 1998 Elsevier Science Ltd. All rights reserved.