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.
Perspectives
We do not want to eradicate precision medicine. We only advise against blind faith in it. For each situation, researchers must provide evidence (similar to our proposal) about the need or not to further sophisticate the treatment to patients.
Mr Jordi Cortés
Universitat Politecnica de Catalunya
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This page is a summary of: Does evidence support the high expectations placed in precision medicine? A bibliographic review, F1000Research, January 2018, Faculty of 1000, Ltd.,
DOI: 10.12688/f1000research.13490.1.
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