Challenge of Evidence in Individualized Medicine

Kathleen Kraft; Wolfgang Hoffmann

Disclosures

Personalized Medicine. 2012;9(1):65-71. 

In This Article

Conclusion & Future Perspective

Even though many medical practitioners still look at the concept of EBM with considerable skepticism, over several recent decades it has already greatly contributed to major advances in medicine. However, while evidence-based guidelines can inform rational treatment decisions, they cannot replace individual clinical judgment. For a long time physicians will have to decide whether any body of evidence rightfully applies to this individual patient and how established evidence and clinical judgment can be integrated in a good clinical decision. Considering state-of-the-art scientific evidence in each medical decision will improve medical care.[45,46] Individualized medicine offers promising approaches to consider even more evidence. The example of tumor treatment exemplifies that individualized medicine has found its way in the guidelines. Nevertheless, both acceptance and implementation of these guidelines need to be improved in the future. Transparent and reliable rules for reimbursement will be a focus of further discussions and will be pivotal to improve acceptance. Yet clinical medicine is only just at the beginning of tailoring its therapies. By dividing patient groups into subgroups, clinical trials are becoming more complex in the context of individualized medicine. A better standardization of methods, more accurately characterized patients and much larger sample sizes will be necessary for the clinical validation of research results. Therefore, in the future, clinical trials will increasingly require a network of large research projects involving industry and experts from various areas beyond clinical medicine such as molecular biology, genetics, analytical chemistry, engineering, epidemiology and statistics.[47] The goal of evidence-based individualized medicine is not new – condensing the best available scientific evidence to inform clinical decisions. This applies identically to any rational concept of individualized medicine. However, with their different emphasis EBM and individualized medicine will complement each other and will stimulate better hypotheses, more precise research questions, more integrative, comprehensive diagnostic and therapeutic concepts and detailed clinical algorithms that allow to more adequately address the diversity of each of our individual patients.

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