To the Editor:—

In their recent review, Ziegeler et al.  1present their view of the future of medicine in which assessment of perioperative risk and prediction of perioperative outcome soon will be enhanced through genotyping of patients. However, the quick jump from increased genetic knowledge to improved health is not assured, as was recently pointed out by Floyd Bloom, President of the American Association for the Advancement of Science. 2For example, knowledge of the specific mutation responsible for Huntington disease has not led to prevention, better treatment, or even an animal model for this condition. The authors also state, “Increasing evidence suggests an association between APO ε4 genotype and neurocognitive dysfunction after CPB.”1I should regard the supporting evidence for this conclusion to be, at best, uncertain given that the association between genotype and neurocognitive dysfunction could be demonstrated in only the first of three publications on the subject. 3–5 

References

1.
Ziegeler S, Tsusaki BE, Collard CD: Influence of genotype on perioperative risk and outcome. A nesthesiology 2003; 99: 212–9
2.
Bloom FE: Science as a way of life: Perplexities of a physician-scientist (presidential address). Science 2003; 300: 1680–5
3.
Tardiff BE, Newman MF, Saunders AM, Strittmatter WJ, Blumenthal JA, White WD, Croughwell ND, Davis RD Jr, Roses AD, Reves JG: Preliminary report of a genetic basis for cognitive decline after cardiac operations. The Neurologic Outcome Research Group of the Duke Heart Center. Ann Thorac Surg 1997; 64: 715–20
4.
Steed L, Kong R, Stygall J, Acharya J, Bolla M, Harrison MJG, Humphries SE, Newman SP: The role of apolipoprotein in E in cognitive decline after cardiac operation. Ann Thorac Surg 2001; 71: 823–6
5.
Robson MJA: Apolipoprotein E and neurocognitive outcome from coronary artery surgery. J Neurol Neurosurg Psychiatry 2002; 72: 675–6