The ultimate personalised medicine

For the best clinical care in every area of medicine, the therapeutic goals of an intervention must be defined before that therapy is initiated. In the setting of chronic disease, this will also inform whether to continue the therapy in the longer term. This includes understanding the time-frame within which benefit is expected to be achieved, and a clear understanding of the intervention’s potential harms and the individual time courses of these adverse effects (immediate, short-term, intermediate and long term). Conveying this information to patients in a meaningful way is crucial before therapy is initiated, not simply when harm is caused or the desired therapeutic benefit is not realised. Phrases such as ‘You will need to take this for the rest of your life’ fail to recognise the changes that every person experiences with ageing, increasing numbers of co-morbidities and, at times, changing goals of care. Evidence-based practice is so often associated in our minds with new and emerging evidence. Likewise, the current emphasis on personalised medicine enabled through genomics and other precision sciences fails to recognise that we do not use the data we have to inform practice, and even currently available data are poorly applied when taking care of individual patients. How are we, as clinicians, going to deal with all this new information if we have not put in place systematic processes to deal with the currently available information? People frequently experience multiple illnesses simultaneously; care of patients with multiple chronic potentially life-threatening diseases makes up approximately 80% of the United States Medicare budget (1). Clinical care can be improved right now without the further addition of any new therapies by systematically expanding the development and application of three data sources: