Which came first the chicken or the egg?

Scientific developments in high-resolution, high-throughput data-collecting technologies enable the analysis of huge multi-dimensional datasets on individual health. These advancements have triggered many initiatives in PM. Proper and effective application of PM with evidence-based approach poses countless challenges and opportunities. Foremost, PM needs to be contrasted with the powerful and widely used practice of EBM. EBM is informed by meta-analyses or wider group-centred studies from which mean recommendations are based on data analytics and strong evidence. However, in common sense, EBM sits on a “one size fits all” approach and it has limits that it does not provide adequate solutions for borderline. In contrast to EBM, one of the strengths of PM lies in individualized management, and this includes borderliners.

To achieve desired objectives, it will be necessary to bridge between EBM and PM. Clinical implementation of precision medicine will require worldwide and responsible data sharing, as well as regularly updated training programs. Through the collection, analyses and sharing of standardized data globally, evidence-based precision medicine will shift progressively from treatment to prevention, thus will lead eventually to improved, patient-practitioner communication, citizen-centred healthcare and sustained healthy living.

In broad terms, it is not possible to see the two headings separately. While PM has to be evidence-based, EBM has to be focused on the individual.

"Chicken or egg situation" doesn't matter. You can make an omelette with two eggs or you can make barbeque with chicken wings.

Bon appetite

Here is some recommendation;

https://academic.oup.com/pcm/article/1/2/60/5075444

http://old.iss.it/publ/anna/2011/1/47131.pdf

Article Precision Medicine: From Science To Value

As a physician:

The answer would depend on whether you look at the question from a philosophical view point or from the background of current mainstream scientific literature.

In the case of the former, all medicine is evidence-based.

From a professional and moral perspective, a physician cannot diagnose and prescribe future treatment without:

- knowledge (from medical education & practice) of the impact of various diseases, AND

- the presence of concrete past and present evidence (specific to each patient) for the need to do so.

As such, all medicine (whether termed EBM or PM) is both retrospective and prospective.

Simply, PM takes recent bio-chemical, genetic, and machine-based advances in medicine and applies them to observing disease impact and treatment on an individual patient, bearing in mind his/her medical history and other diseases.

In other words, PM brings forward the notion that effective healthcare means person-targeted treatment, rather than group-based best practice.

It is unknown however how much of this idea is driven by a genuine desire to assist individual patients versus simply to make money off of personalized medication and service due to an ever growing potential client base; the middle and upper class of which are primarily the ones that can afford more personalized healthcare.

My fear, as a physician, is that the current push for personalized medicine, without correspondent changes in medical education or state healthcare/ insurance systems, may lead to a multi-tier medicine - based on the financial means of each patient.

If, however, you chose the two opposing camps view, and are looking strictly at definitions in scientific literature, the answer to your question gets more complicated.

Then, it turns out that EBM and PM have different ideological origins, and, therefore, different raison d'être. It is no surprise that the support groups and the funding of each school of thought, are also different.

For more on the subject, please, read this editorial:

https://pdfs.semanticscholar.org/737c/a940f17ec23ceb8e1e9a1ae311d62cecad5e.pdf

One thing is certain. As PM is the younger movement of the two (and is, to a large degree, still lacking in useful/ consistently confirmed evidence), when met with a medical uncertainty, even PM proponents recourse to EBM.

I hope this brings some clarity. :)

A note that the concepts of precision medicine and personalized medicine are related. The former leads to the latter.