A pragmatic approach to integrate evidence-based medicine and personalized medicine: the example of personalized microbiome-targeting interventions.

Health care practitioners (HCPs) strive to provide the best medical care for each individual patient. The question as to what constitutes 'the best' does, however, not have a single straightforward answer. Evidence-based Medicine (EBM) and Personalized Medicine (PM) are two paradigms that have emerged as means to improve intervention selection. Both paradigms have their own strengths and weaknesses that affect their use in clinical decision-making. In this review we discuss the strengths and weaknesses from the patient's and HCP perspective: how to find the best intervention for a particular patient. We review methodological and practical aspects, and zoom out from the scientific level to the epistemological level to integrate EBM and PM. Both EBM and PM are based on a realist worldview and by adopting a pragmatist worldview the strengths of both paradigms can be combined. We apply this pragmatic approach, called Evidence-based Personalized Medicine (EBPM), to microbiome-targeting interventions. The example EBPM implementation uses four steps. First, it allows HCPs to provide information (clinical diagnosis, complaints, patient needs, laboratory measures) about an individual patient. Second, it uses a GRADE-based system to grade evidence of specific intervention components. Next, it combines the patient profile data and preferences with the graded evidence, to come to a suggestion for a personalized intervention. Finally, this method enables gathering of treatment effects providing feedback into the system and further improve suggestions for future patients.