Seeking the best treatment for each patient
Every practitioner strives to provide the best treatment for each patient. However, determining what is “the best” treatment can be challenging – particularly in patients with multimorbidity, which is the most common condition today (1). In many modern approaches to medical decision-making, scientific evidence plays a central role. Various frameworks exist to guide practitioners in using evidence to select the most appropriate treatment. Two of the best-known are Evidence-Based Medicine (EBM) and Personalized Medicine (PM).
Both EBM and PM have their own strengths, but also limitations. For example, EBM uses randomized-controlled trials (RCTs) as the golden standard study method, because it is the best method to eliminate most sources of bias (2). On the other hand, RCTs do not translate easily to real-world patients and provide only the average effect, which does not predict the effect on the individual patient (3,4).
The various limitations make it difficult to apply the EBM or PM method in the real-world clinical practice. Because chronic patients each have a unique profile, and because the gut microbiome is both highly individual and involved in many chronic diseases, Microbiome Center recognized a large need for a new approach.
The microbiome in QFS and other Post-Acute Infectious Syndromes (PAIS)
Several forms of Post-Acute Infectious Syndromes (PAIS) are known, including for example ME/CFS, Long-covid, post-treatment Lyme disease syndrome (PTLDS), post-Pfeiffer fatigue syndrome (post-EBV), post-infection IBS, and Q-fever fatigue syndrome (QFS). These forms of PAIS are all characterized by chronic fatigue, post exertional malaise, neurocognitive problems like brain-fog, flu-like symptoms, joint pain, IBS, and a variety of other symptoms (1).
Interestingly, scientific studies have found gut microbiome dysbiosis in all these different forms of PAIS (1), and it is speculated that dysbiosis may be the underlying factor in all PAIS forms. Mechanisms that are thought to play a role are persistent infection (with the gut as a reservoir of the pathogen), systemic and brain inflammation, co-infections (i.e. pathogen overgrowth in the gut), and disturbed microbiome functions such as reduced butyrate and neurotransmitter production (1).
The Microbiome Center method: now peer-reviewed and published
In 2019, Microbiome Center together with a collaboration of experts from the field of immunology, pharmacology, computational sciences, citizen science, and clinicians developed the methodology to combine the strengths of EBM and PM. Since then, we have implemented, fine-tuned, improved, and expanded this method. As practitioner, you encounter this when you use our advice aid. This is not just a set of questionnaires and buttons; it is much more than that: it is a concrete manifestation of a comprehensive and carefully developed philosophy and scientific approach.
Recently, the philosophy and scientific method behind our approach have been peer reviewed and published in a scientific article. The article was written together with several coauthors from different universities and institutes and is published in the scientific journal Beneficial Microbes (5). In the article, the various strengths and pitfalls from the EBM and PM method are discussed, and the authors zoom out to philosophy of science to integrate these two paradigms. The new approach, called Evidence-Based Personalized Medicine (EBPM) is based on the philosophical world view called pragmatism.
With this publication, the fundamental approach that Microbiome Center uses is now peer-reviewed and considered a sound and innovative method to treat patients.
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