From Evidence Based Medicine to Medicine Based Evidence

Evidence based medicine, using randomized controlled trials and metaanalyses as the major tools and sources ofevidence about average results for heterogeneous groups of patients, developed as a reaction against poorly designed observational treatment research and physician reliance on personal experience with other patients as a guideto decision-making about a patient at hand. However, these tools do not answer the clinician’s question: “Will agiven therapeutic regimen help my patient at a given point in her/his clinical course?” We introduce fine-grainedprofiling of the patient at hand, accompanied by comparative evidence of responses from approximate matches tothis patient on whom a contemplated treatment has/has not been administered. This represents medicine based ev-idence that is tuned to decision-making for the particular patient.

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