The identification of many hundreds of genetic variants associated with complex diseases and their potential for interactions with environmental factors have increased the need for prospective cohort studies involving several hundred thousand participants.1,2 Costs of such studies under conventional funding models are high because typically they are conducted by a consortia of academic centers, each responsible for recruitment, examination, and follow-up of a subcohort of participants in its geographic area.3,4 The costs and inefficiencies in 100-fold expansion of these standard models can be prohibitive; large studies should not be viewed simply as small studies made large. Rather, they require fundamentally different approaches in which minimizing cost is a primary consideration, and process proficiency to maximize efficiency is as important as scientific expertise.
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