Looking for the best treatment for a patient
Every healthcare provider strives to provide the best treatment for each patient. However, determining what is "the best" treatment can be tricky – especially in patients with multimorbidity, which is the most common situation today (1). In many modern approaches to medical decision-making, scientific evidence plays a central role. There are various frameworks that help healthcare providers to use evidence when choosing 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 gold standard for research, as this is the best method to eliminate most forms of bias (2). At the same time, RCTs are not easily translated to patients in daily practice and only describe the average effect, which does not predict the effect in the individual patient (3,4).
These various limitations make it difficult to fully apply the EBM or PM approach in clinical practice. Because chronic patients each have a unique profile, and because the gut microbiome is both highly individual and involved in many chronic conditions, Microbiome Center saw a great need for a new approach.
The Microbiome Center method: now peer-reviewed and published
In 2019, Microbiome Center, together with a collaboration of experts from immunology, pharmacology, computational sciences, citizen science and clinical practice, developed a methodology to combine the strengths of EBM and PM. Since then, we have implemented, refined, improved and further expanded this method. As a practitioner, you will encounter this when you use our advice tool. This is not just a set of questionnaires and buttons, it is much more than that: it is a concrete elaboration of an extensive 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 various universities and institutes and has been published in the scientific journal Beneficial Microbes (5). The article discusses the different strengths and pitfalls of the EBM and PM methods, and places them in a broader perspective from the philosophy of science to integrate both paradigms. The new approach, called Evidence-Based Personalized Medicine (EBPM), is based on the philosophical worldview known as pragmatism.
With this publication, the fundamental approach that Microbiome Center uses is now peer-reviewed and recognized as a solid and innovative method of treating patients.
References:
1. https://doi.org/10.1001/jama.2012.5265
2. https://doi.org/10.1016/j.cmet.2018.02.017
https://doi.org/10.1093/ije/dyp174
https://miguelhernan.org/whatifbook
https://doi.org/10.1163/18762891-bja00110