Evidence against precision medicine?

What is it about?

It is well known that individual patients have different outcomes. The point is: are those differences in the evolution due to special patient characteristics that imply a different response to the treatment? Or those idiosyncrasies just imply a different prognosis, independently of the treatment? i.e., may the treatment have a different effect in each patient or just a similar effect with differences in the outcome explained by the previous prognosis factors?

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Why is it important?

In the former situation, clinical trials only may estimate the “averaged” treatment effect; but on the later, they estimate the “common” or constant effect size. The standard clinical trial is designed under the assumption of a constant effect that only can be assessed according to some important and well measured baseline factors (subgroup analysis). We know that a constant effect implies the same outcome variability among the different groups at the end of the study. We compare those variances in a series of 208 parallel clinical trials from 2004 to 2013. Our results does not support a higher variability in the experimental arm, making individualized medicine useless in most cases.

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