Genome-Wide Association Statistics

In 2005, researchers scanning the genomes of patients with age-related macular degeneration found something striking. A single DNA letter change on chromosome 1 was dramatically more common in people who had lost their central vision. It was far less common in people who had not. That single-nucleotide difference sat inside a gene called complement factor H. It pointed biologists toward an entire immune pathway. They had not previously connected that pathway to blindness. This was one of the first great successes of the genome-wide association study, or GWAS. GWAS is a method that tests hundreds of thousands to millions of genetic variants. It checks each variant for statistical association with a trait, all at once. It requires no prior hypothesis about which gene should matter. GWAS matters because most common human diseases and traits are not caused by single genes acting alone. This includes height, blood pressure, schizophrenia risk, and type 2 diabetes. They are polygenic: shaped by thousands of variants of small effect. These variants are scattered across the genome. Each one nudges risk up or down by a tiny amount. Before GWAS, human genetics was dominated by candidate-gene studies. These tested one gene at a time based on a guess about biology. Linkage studies were also common, tracing disease within families using a handful of markers. Both approaches missed most of the genetic architecture of common disease. GWAS instead asks an agnostic question at enormous scale. Of every variant we can measure, which ones show a statistical signal? Can we trust that signal once we account for the sheer number of tests performed? Can we trust it despite the hidden ancestry structure lurking in any human sample? The intellectual core of this chapter is a marriage of straightforward statistics. This means a regression or contingency-table test repeated per variant. It combines with two hard problems that are anything but straightforward. These are multiple testing on a scale of a million or more tests. The other is confounding by population structure. Here, ancestry differences between cases and controls create spurious associations. These associations have nothing to do with disease biology. Solving the first problem gives us the famous genome-wide significance threshold. Solving the second gives us principal-component correction and mixed models. Together they turn a Manhattan plot's skyline of spikes into a set of scientifically defensible discoveries. This article builds the method from the ground up. It covers the per-SNP test itself, and the Manhattan plot as its visual signature. It explains the arithmetic behind the 5×10⁻⁸ threshold. It also covers the machinery used to keep population structure from masquerading as biology. This machinery includes genomic control, principal components, and linear mixed models. It closes with the classic studies that established the field. It also covers the ways GWAS results are now used in medicine and beyond.

Key takeaways
  • A GWAS tests millions of SNPs one at a time for statistical association with a trait, typically via regression of phenotype on genotype dosage (0, 1, or 2 copies of an allele).
  • Testing so many SNPs demands a stringent threshold; the standard genome-wide significance level is p < 5×10⁻⁸, derived from a Bonferroni-style correction for roughly one million independent common variants.
  • Results are visualized in a Manhattan plot: −log₁₀(p) on the y-axis against genomic position on the x-axis, producing "skyscraper" peaks at associated loci.
  • Population stratification — ancestry differences correlated with both allele frequency and the trait — can generate thousands of false-positive associations if uncorrected.
  • Principal component analysis on genome-wide genotypes captures ancestry structure; including top PCs as covariates (or using linear mixed models) removes this confound.
  • GWAS hits are typically small-effect and non-causal by default — they mark a genomic region in linkage disequilibrium with a causal variant, motivating downstream fine-mapping and, eventually, cross-study meta-analysis.
The core insight

A GWAS is a million-fold-repeated statistical test whose two central dangers — false positives from multiple testing and false positives from ancestry confounding — are controlled respectively by a stringent p-value threshold and by modeling genetic ancestry as a covariate.

The core idea

A genome-wide association study asks, independently for each of typically 500,000 to several million single-nucleotide polymorphisms (SNPs), whether genotype at that site is statistically associated with a phenotype. Each SNP is a position in the genome with two common alleles; an individual's genotype there is one of three classes — homozygous for the major allele, heterozygous, or homozygous for the minor allele — usually recoded as a numeric allele dosage (0, 1, or 2 copies of the minor allele). For a continuous trait such as height or LDL cholesterol, the standard test is a linear regression of the trait on dosage: Trait = β₀ + β₁·(dosage) + β₂·(covariates) + ε The coefficient β₁ estimates the average change in trait per additional copy of the minor allele — the SNP's effect size. For a binary trait such as disease status, the analogous model is logistic regression, giving an odds ratio per allele copy. Each of the hundreds of thousands to millions of SNPs gets its own regression, its own β₁, its own standard error, and its own p-value, entirely independently of every other SNP. This "one-SNP-at-a-time" design is what makes GWAS both computationally tractable at biobank scale and statistically treacherous: repeating a test a million times guarantees a large number of nominally significant results by chance alone, which is precisely the multiple-testing problem addressed by The Bonferroni Correction and The False Discovery Rate in other contexts. A second, distinct hazard is population stratification: if allele frequencies differ across subpopulations within the sample, and those subpopulations also differ in disease risk or trait level for reasons unrelated to that allele (diet, environment, other genetic background), a SNP that merely tags ancestry will show a spurious association with the trait. The classic illustration is chopsticks and lactase: an allele frequency that differs between Chinese and European ancestry groups will "associate" with chopstick use if the sample mixes ancestries carelessly, even though no chopstick gene exists. Controlling for this confound is where Principal Component Analysis: An Introduction enters GWAS methodology directly — the top principal components of genome-wide genotype data serve as continuous proxies for ancestry, entered as covariates in every SNP's regression.

Mechanism

Step 1 — Genotyping or sequencing. Modern GWAS use SNP microarrays (genotyping several hundred thousand to a million tag SNPs directly) followed by imputation, a statistical procedure that uses a reference panel of fully sequenced genomes (e.g., the 1000 Genomes Project or TOPMed) to infer genotypes at millions of untyped SNPs based on local correlation structure, or linkage disequilibrium (LD), with the typed SNPs. This inflates the effective number of tested variants from ~1 million to 5–10 million or more.

Step 2 — Quality control. SNPs and samples are filtered for genotyping call rate, minor allele frequency (commonly requiring MAF > 1%), deviation from Hardy–Weinberg equilibrium in controls (a sign of genotyping error), and sample relatedness or duplication. This step is unglamorous but determines whether downstream p-values mean anything at all.

Step 3 — Population structure correction. Genome-wide genotype data are reduced via principal component analysis; the first 5–20 PCs typically capture the dominant axes of ancestry (e.g., PC1 separating African from non-African ancestry, PC2 separating European from East Asian, and so on within more homogeneous samples, PCs can still capture fine-scale sub-structure such as North vs. South European ancestry). These PCs are included as covariates in every SNP regression. An alternative and increasingly standard approach is the linear mixed model (LMM), which models a random effect capturing genome-wide relatedness (the genetic relationship matrix, GRM) between every pair of individuals, correcting simultaneously for ancestry and for cryptic relatedness (undisclosed cousins, siblings) in the sample. Tools such as BOLT-LMM and SAIGE implement this at biobank scale (n > 400,000).

Step 4 — Per-SNP association testing. For each QC-passed SNP, the trait is regressed on dosage plus covariates (age, sex, genotyping batch, top PCs), yielding a β, standard error, test statistic, and p-value. This is repeated independently for every SNP — millions of essentially identical regressions, run in parallel.

Step 5 — Genomic control and diagnostics. Before trusting any single p-value, analysts inspect the genomic inflation factor, λ_GC — the ratio of the observed median chi-squared test statistic to the expected median under the null (0.4549 for 1 df). Values of λ_GC noticeably above 1.0 (e.g., 1.05–1.10 in a large, unstratified, polygenic study is often tolerable; values above ~1.10 in smaller studies are a red flag) suggest residual stratification or cryptic relatedness that PCs failed to fully absorb. A complementary and now more informative diagnostic is LD Score regression, which distinguishes true polygenic signal (many small real effects, which inflate the mean but not necessarily the intercept) from stratification/confounding (which inflates the regression intercept even after accounting for LD).

Step 6 — Multiple-testing correction and the genome-wide threshold. Because adjacent SNPs are correlated (in linkage disequilibrium), the ~1 million typed-and-imputed common SNPs behave like roughly 1 million independent tests in the human genome — an empirically derived number, not a guess. Applying a Bonferroni correction for α = 0.05 across ~1,000,000 independent tests gives: p_threshold = 0.05 / 1,000,000 = 5 × 10⁻⁸ This is the celebrated genome-wide significance threshold, first formalized by Risch and Merikangas (1996) and empirically validated by permutation studies (notably Pe'er et al., 2008, simulating the LD structure of the HapMap panel), which is why the field converged on 5×10�sup>−8 rather than a naive 0.05/(number of SNPs on the array).

Step 7 — Visualization: the Manhattan plot. Every SNP's −log₁₀(p-value) is plotted against its chromosomal position. Because nearby SNPs in LD share correlated (though not identical) p-values, true signals appear as clusters of elevated points — "skyscrapers" — rather than isolated spikes, while noise scatters near the baseline. A horizontal line at −log₁₀(5×10⁻⁸) ≈ 7.3 marks genome-wide significance.

Step 8 — Follow-up. A genome-wide-significant SNP is rarely itself the causal variant; it is usually a marker in LD with the true functional variant somewhere in the same haploblock. Fine-mapping, functional genomics (e.g., chromatin accessibility, expression quantitative trait loci or eQTLs), and replication in independent cohorts (foreshadowing formal Meta-Analysis in Biology across GWAS from multiple studies) are needed to move from statistical association to causal, mechanistic understanding.

Figure
Manhattan plot: −log₁₀(p) by chromosomal position, with genome-wide (5×10⁻⁸) and suggestive lines
−log₁₀(p) Chromosomal position (chr 1 → 22) genome-wide significance, p = 5×10⁻⁸ suggestive, p = 1×10⁻⁵ locus A (chr 3) locus B (chr 11)
Figure
Ancestry confound: two subpopulations differing in both allele frequency and trait mean generate spurious association
Without ancestry correction SNP dosage (0,1,2) Trait value apparent slope: strong "association" ancestry A (low dosage, high trait) ancestry B (high dosage, low trait) Within each ancestry group (PC-adjusted) SNP dosage (0,1,2) flat: no real effect flat: no real effect

The evidence

Establishing that agnostic genome scans could find real, replicable biology. The pivotal early proof-of-concept was the study by Robert J. Klein and colleagues (Science, 2005), which scanned roughly 116,000 SNPs in 96 cases of age-related macular degeneration (AMD) and 50 controls — a tiny sample by today's standards. One SNP, rs380390, near the complement factor H (CFH) gene, reached striking significance and was replicated in an independent cohort. The odds ratio for the risk-associated haplotype was large (homozygotes for the risk allele had roughly 7-fold increased odds of AMD compared to non-carriers), and the finding immediately reoriented AMD research toward complement-pathway inflammation, a mechanism not previously suspected for this common cause of blindness. It showed, for the first time in a common complex disease, that an unbiased genome scan — rather than a hypothesis-driven candidate-gene study — could discover a major, previously unknown biological pathway.

Establishing the field at scale: the Wellcome Trust Case Control Consortium (WTCCC). Published in Nature in 2007, the WTCCC study genotyped roughly 500,000 SNPs in 14,000 cases across seven common diseases (bipolar disorder, coronary artery disease, Crohn's disease, hypertension, rheumatoid arthritis, type 1 diabetes, type 2 diabetes) and 3,000 shared controls — at the time, the largest GWAS ever performed. It confirmed known loci (e.g., the TCF7L2 association with type 2 diabetes, the HLA region with type 1 diabetes and rheumatoid arthritis) and discovered many previously unknown ones, while also rigorously demonstrating, through its careful QC pipeline (SNP clustering diagnostics, exclusion of plate and batch effects, exclusion of related and stratified samples), how much of a naive GWAS signal can be technical or ancestry-driven artifact rather than biology. The WTCCC paper essentially wrote the field's methodological playbook: standardized QC filters, genomic control, and the now-universal 5×10⁻⁸ threshold.

Establishing the danger of stratification, quantitatively. Before WTCCC, the chopsticks/lactase intuition was formalized by simulation and real-data studies (notably work summarized by Cardon and Palmer, Lancet, 2003), which showed that even modest, undetected ancestry differences between cases and controls — differences far too subtle to see by eye — could generate hundreds of genome-wide-significant false positives in association studies. This motivated the adoption of genomic control (Devlin and Roeder, 1999) as an early correction and later the switch to PCA-based correction, formalized by Alkes Price and colleagues (EigenStrat, Nature Genetics, 2006), who showed on real human genotype data that the top principal components of genome-wide SNP data closely track known geographic and self-reported ancestry, and that including them as covariates removed most residual inflation (λ_GC) in structured samples. This was the direct methodological bridge that brought Principal Component Analysis: An Introduction into standard GWAS practice, and later work (Yang et al. 2011; Loh et al. 2015, BOLT-LMM) extended the same logic into linear mixed models that correct for structure and relatedness simultaneously using a genome-wide genetic relationship matrix.

Worked examples

Example 1 — Setting and interpreting the genome-wide threshold, with an asymmetric discovery. Suppose a GWAS of type 2 diabetes tests 6,900,000 imputed SNPs (after imputation against a modern reference panel) in 40,000 cases and 60,000 controls. The LD structure of the genome means these are not 6.9 million independent tests; empirical estimates place the number of independent common-variant tests in a European-ancestry sample near 1,000,000. Applying Bonferroni at family-wise α = 0.05: p_threshold = 0.05 / 1,000,000 = 5 × 10⁻⁸ Two SNPs turn up:

SNPNearest geneMAFOdds ratio (per risk allele)p-value
rs001TCF7L2-region0.301.372×10⁻⁴²
rs002novel locus, chr 90.021.96×10⁻⁸

rs001 sails past the threshold with enormous significance — expected, since TCF7L2 is among the strongest and most replicated type 2 diabetes loci known, first identified in earlier candidate and GWAS work. rs002 barely clears 5×10⁻⁸, has a much larger point-estimate odds ratio (1.9 vs. 1.37), but is a rare variant (MAF = 0.02). Because rare variants are measured with less precision (fewer minor-allele carriers contribute information), a large point-estimate odds ratio at a rare variant is more likely to be an inflated or unstable estimate, and this SNP is exactly the kind of hit that must be prioritized for independent replication before publication — a single p-value just over threshold, especially for a rare variant with a large effect, is the classic signature of a result that regresses toward a smaller effect (or vanishes) upon replication, an instance of the winner's curse in GWAS effect-size estimation.

Example 2 — Detecting and correcting stratification with λ_GC and PCs. A case-control study of hypertension recruits 5,000 cases and 5,000 controls from a single national biobank. Unknown to the analyst, cases were recruited disproportionately from an urban region with a distinct ancestry composition compared to the largely rural control recruitment sites — a classic recruitment-driven stratification. The initial GWAS, run without ancestry covariates, yields:

  • Genomic inflation factor λ_GC = 1.38 (expected under the null: 1.0)
  • 214 SNPs exceed 5×10⁻⁸, scattered across nearly every chromosome, with no clear clustering into LD-correlated peaks — a red flag, since true polygenic signal tends to cluster in LD blocks, while broad genome-wide inflation without clustering is the signature of stratification.

The analyst performs PCA on ~200,000 LD-pruned genome-wide SNPs. PC1 correlates strongly (r = 0.71) with self-reported region of recruitment; PC2 correlates with a finer sub-ancestry gradient. Re-running the GWAS with PC1–PC10 as covariates:

  • λ_GC falls to 1.03 (within the range considered acceptable for a well-corrected polygenic trait)
  • The number of genome-wide-significant SNPs falls from 214 to 6, all of them clustering into two clean LD blocks on chromosomes 12 and 17 — the pattern expected of true signal.

This before/after contrast is the standard diagnostic workflow: a large drop in λ_GC and a shift from scattered singleton hits to LD-clustered peaks after PC correction is strong evidence that most of the original "signal" was ancestry confounding, not disease biology, and it demonstrates concretely why every modern GWAS pipeline reports λ_GC and a PCA-based (or mixed-model) correction as standard due diligence.

Common misconceptions & traps

MisconceptionWhy it's wrong
"A genome-wide-significant SNP causes the disease."It usually only marks a genomic region via linkage disequilibrium; the actual causal variant may be a different SNP nearby, requiring fine-mapping and functional follow-up.
"A bigger odds ratio means a more important gene for public health."Common GWAS hits typically have small effects (OR often 1.05–1.3); large effects at genome-wide-significant SNPs are frequently overestimates at rare variants (winner's curse), and population-level impact depends on effect size and allele frequency together.
"5×10⁻⁸ is an arbitrary, overly conservative number."It is a Bonferroni-style correction calibrated empirically to the actual number of independent common-variant tests (~1 million) in the human genome, not a round-number convention.
"Principal components fully solve confounding, always."PCs capture broad ancestry but can miss fine-scale structure, family relatedness, or environmental confounds correlated with ancestry; mixed models and careful study design remain necessary.
"A non-significant SNP has no effect on the trait."Many true effects fall below the genome-wide threshold, especially for highly polygenic traits; failure to reach significance reflects limited power, not proof of zero effect.
"Replication in the same population confirms causality."Replication in an independent sample rules out chance and study-specific artifacts, but confirms association, not causal mechanism — that requires functional or experimental follow-up.

The scientist behind it

Modern human statistical genetics owes much of its methodological backbone to David Reich, Nick Patterson, and Alkes Price, whose 2006 development of EigenStrat brought rigorous, computationally efficient principal-component correction for population stratification into standard GWAS practice, directly answering the stratification crisis that threatened the credibility of early association studies. Equally foundational is the Wellcome Trust Case Control Consortium, a multi-institution UK collaboration whose 2007 seven-disease study established the field's methodological conventions — QC pipelines, genomic control diagnostics, and the 5×10⁻⁸ threshold — that essentially every subsequent GWAS has followed.

Origins · 1 minAlkes L. Price and how this was discovered
AL
Alkes L. Price
b. 1978, active in statistical/population genetics · Harvard T.H. Chan School of Public Health; co-developer of EigenStrat and later methods for heritability partitioning (LD Score regression) and mixed-model association

Price's work sits at the intersection of population genetics theory and applied statistics: rather than treating ancestry as a nuisance to be crudely matched by recruitment design, his methods extract ancestry directly and quantitatively from the genotype data itself, turning a confound into a measurable, correctable covariate.

History
1996
— Neil Risch and Kathleen Merikangas formally argue that genome-wide association designs, despite needing stringent significance thresholds, are statistically better powered than linkage studies for detecting common variants of modest effect in complex disease.
1999
— Bernie Devlin and Kathryn Roeder introduce genomic control, the first widely used correction for population stratification in association statistics.
2005
— Robert Klein and colleagues report the CFH association with age-related macular degeneration, an early landmark proof-of-concept for hypothesis-free genome scanning.
2006
— Alkes Price, Nick Patterson, and colleagues publish EigenStrat, establishing PCA-based ancestry correction as a GWAS standard.
2007
— The Wellcome Trust Case Control Consortium publishes its seven-disease, 500,000-SNP study, codifying QC standards and the 5×10⁻⁸ genome-wide significance threshold.
2015
— Po-Ru Loh and colleagues release BOLT-LMM, enabling linear mixed-model association testing at biobank scale (hundreds of thousands of samples).

Where this matters today

Polygenic risk scores in medicine. GWAS summary statistics across thousands to millions of SNPs are combined into polygenic risk scores (PRS) that estimate an individual's genetic liability for diseases such as coronary artery disease, breast cancer, and type 2 diabetes, increasingly explored as adjuncts to traditional clinical risk factors — though current PRS accuracy and portability across ancestries remains limited, a direct consequence of most GWAS to date being conducted predominantly in European-ancestry cohorts.

Drug target discovery and validation. GWAS hits that replicate and colocalize with expression data (eQTLs) provide genetically validated drug targets; the PCSK9 pathway, connected to LDL cholesterol genetics, is a celebrated case where GWAS-adjacent human genetics research supported a drug mechanism (PCSK9 inhibitors) now used clinically to lower cardiovascular risk.

Agriculture and livestock breeding. The same per-marker association logic underlies genomic selection in crops and livestock, where breeders use dense marker panels to predict trait values (yield, disease resistance, milk production) and select breeding stock without waiting for full phenotypic maturation.

Conservation and wildlife genetics. Association and structure-correction methods developed for human GWAS are applied to wild populations to map trait and disease-resistance loci while properly accounting for population subdivision, which is often far more pronounced in wild or fragmented populations than in human cohorts.

Public health and biobank science. Large national biobanks (UK Biobank, All of Us, FinnGen, Biobank Japan) now run GWAS across thousands of phenotypes simultaneously, generating publicly available summary statistics that fuel exactly the kind of downstream synthesis — combining effect estimates across many independent studies — that motivates formal Meta-Analysis in Biology.

Ask the tutor: How do genome-wide association results from multiple independent studies get statistically combined, and what extra pitfalls does that meta-analysis introduce?

What exactly does a Manhattan plot show, and why do true signals look like clusters rather than single spikes?

A Manhattan plot places each tested SNP's genomic position on the x-axis and its −log₁₀(p-value) on the y-axis, so lower p-values (stronger evidence) plot higher. Because nearby SNPs are correlated through linkage disequilibrium, a true association typically elevates a whole neighborhood of correlated SNPs together, producing a "skyscraper" cluster of points rising toward and above the genome-wide threshold line. An isolated single SNP spiking far above its neighbors, with no elevation in adjacent SNPs, is often a red flag for genotyping error rather than genuine biology, since real LD structure predicts correlated neighbors should move together.

Why is 5×10⁻⁸ used instead of simply dividing 0.05 by the number of SNPs on the genotyping array?

Dividing 0.05 by the raw number of SNPs assayed (which can range from 500,000 to many millions depending on imputation) would give an inconsistent, array-dependent threshold. Because neighboring SNPs are correlated through linkage disequilibrium, they are not truly independent tests. Empirical studies of the LD structure across diverse human populations (notably permutation-based work using HapMap and 1000 Genomes data) estimated the effective number of independent common-variant tests in the genome at roughly one million, giving 0.05/1,000,000 = 5×10⁻⁸. This threshold is therefore empirically calibrated, not an arbitrary round number.

How is population stratification different from confounding by a known covariate like age or smoking?

Confounding by age or smoking is usually measurable and directly adjustable, since the variable is recorded. Population stratification is subtler: it arises from differences in genetic ancestry between cases and controls that are rarely fully captured by self-reported race or ethnicity, since ancestry varies continuously and can differ at fine geographic scales even within self-identified groups. Because ancestry simultaneously affects allele frequencies at every SNP and can correlate with the trait through environmental or cultural pathways, it acts as a pervasive, genome-wide confound rather than a single adjustable nuisance variable, which is why it requires genome-wide tools like PCA or mixed models rather than a simple covariate adjustment.

Do linear mixed models replace principal component correction entirely?

Not entirely — they extend it. PCA-based correction adds a fixed number of ancestry covariates (e.g., top 10 PCs) to each regression, which captures broad ancestry structure well but can under-correct for fine-scale relatedness (distant cousins, subtle sub-population structure). Linear mixed models instead include a random effect based on the full genome-wide genetic relationship matrix between all pairs of samples, simultaneously modeling ancestry and cryptic relatedness more comprehensively. In practice, many large modern studies (biobank scale) use LMMs, often still including several top PCs as fixed-effect covariates as well, combining both approaches.

Why do most GWAS-identified variants have small effect sizes, and does that mean they are unimportant?

Common diseases and quantitative traits are shaped by natural selection, which tends to keep variants with very large effects on fitness-relevant traits at low frequency or removes them from the population over time. As a result, most SNPs common enough to be captured by standard GWAS (MAF typically > 1%) have historically been under weaker selective constraint, consistent with small individual effects. This does not make them unimportant: small per-SNP effects, when summed across thousands of loci via a polygenic risk score, can meaningfully stratify disease risk across a population even though no single variant is individually decisive for any one person.

What is the "winner's curse" in GWAS, and why does it matter for interpreting a newly discovered hit?

The winner's curse describes the tendency for the estimated effect size of a newly discovered, statistically significant association to be inflated compared to its true value, especially near the significance threshold. This happens because, among all SNPs tested, the ones that cross a strict threshold by chance are disproportionately those whose sampling noise happened to push the estimate upward as well as the truth. Consequently, first-reported GWAS effect sizes—particularly for rare variants near the p = 5×10⁻⁸ boundary—typically shrink somewhat in independent replication cohorts, which is why replication, not just crossing a threshold, is considered essential before a finding is treated as established.

How does a GWAS hit lead eventually to a specific causal gene or drug target?

A genome-wide-significant SNP marks a genomic region, not necessarily a gene. Researchers narrow this down through fine-mapping (statistical methods that use LD patterns across many SNPs in the region to identify the most likely causal variant or variants), functional genomic annotation (checking whether the variant overlaps a regulatory element, alters transcription factor binding, or is an expression quantitative trait locus, or eQTL, changing a nearby gene's expression), and colocalization analysis (testing whether the same causal variant explains both the GWAS signal and an eQTL signal in the relevant tissue). Only after this multi-step process does a statistical association typically become a candidate causal gene worth pursuing experimentally or as a drug target.

Before this

Where this leads