With respect to both the effects of the environment and the human genome project, the "Gloomy Prospect" (as described by Turkheimer, 2000) suggests

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-A component in the differences between individuals in the risk of disease can be explained by events that are not epidemiologically manageable, including events that extend through the subcellular and cellular level, to casual events.

-At the population level, a large proportion of cases of disease is attributable to influences that only represent a small proportion of inter-individual variation in risk.

-Epidemiology is a discipline at the group level, often related to the incidence rather than to particular incidents. Some ecological studies address the causes of population disease, but are subject to many well-known biases and objective evidence tests in different study designs.

-Genetic variants are supported by individuals but must be analyzed at the group level.

-The important stochastic element in the cause of illness and the response to the specific treatment that medicine should be personalized. In fact, the transition from personalized to stratified medicine reflects the fact that, in most situations, data at the group level instead of individual data provide decisions for treatment, and affect the basis for evidence based medicine.