Combining Evidence-based Medicine and Personalized Medicine for personalized microbiome treatments

What is it about?

Health care professionals want to give each patient the best possible care. But figuring out what "the best" care is can be complicated. Two common approaches are Evidence-Based Medicine (EBM) and Personalized Medicine (PM). Each has its own pros and cons, and both aim to help doctors choose the right treatment. This article looks at EBM and PM from both the patient's and the health care professionals' point of view. It explores how to decide on the best treatment for a specific person, discussing both scientific methods and broader ways of thinking about knowledge. EBM relies on research and data from large groups, while PM focuses on the unique characteristics of each individual. By using a practical way of thinking called pragmatism, it's possible to combine the strengths of both approaches into an new approach called Evidence-Based Personalized Medicine (EBPM). To show how EBPM works, the article uses the example of treatments that target the microbiome. The EBPM approach involves four steps: 1. The health care professionals gathers detailed information about the patient—such as their diagnosis, symptoms, personal needs, and lab results. 2. A online tool is filled with the quality of the scientific evidence behind different treatment options. 3. The tool matches the patient’s information and preferences with the best available evidence to suggest a personalized treatment. 4. This approach tracks how well the treatment works, using that information to improve care for future patients.

Featured Image

Why is it important?

This importance of this work lies in several aspects: First, it addresses the strength and weaknesses of the Evidence-Based Medicine (EBM) and Personalized Medicine (PM) paradigms through their epistemological foundations. To the best of our knowledge this has not been done elsewhere. Our findings show that both EBM and PM are rooted in a realist worldview. This worldview assumes that there is a single reality that just has to be discovered, which ignores the fact that any interpretation of reality is inherently colored by one’s experiences, expectations, and preferences. This means that e.g. the choice which scientific insights one uses for clinical decision-making cannot be made based on evidence only but also involves one’s presuppositions. This is often overlooked in discussions about the pros and cons of EBM of PM and is important because presupposition by definitions cannot be proven or disproven. In other words, disputes cannot be settled with more evidence. This insight is valuable in discussions around evidence and evidence-based ways of working. Second, we introduce a pragmatist worldview, that accepts things to be true if they work. Using this pragmatist worldview enables combining the strengths of EBM and PM into an new approach called Evidence-Based Personalized Medicine (EBPM). This unlocks a new way of using evidence for clinical decision-making. Third, the pragmatic solution that we propose aligns very well with the daily practice of clinical decision-making. It provides a way to take into account all available scientific evidence, rather than a strictly defined subset. This can help to empower patients and HCPs in their clinical decision-making. Fourth, the review uses treatments that target the microbiome as an example. We show that it makes sense to involve a personalized way of working in these kinds of treatments, because each person's microbiome is as unique as a fingerprint. Moreover, microbiome-targeting treatments typically involve patients with chronic diseases, and in turn chronic diseases are typically multimorbid (i.e. involving multiple health problems simultaneously). The combination of health problems in chronically ill patients is often also unique per person, which is another reason to employ a personalized approach. It is not easy to work evidence-based in personalized treatments, and the novel EBPM approach is an enabler for using personalized treatment approaches with an evidence-based basis.

Perspectives