We need a new paradigm for doing medicine. I make the case by first speaking about the problems of our current paradigm of evidence-based medicine.

The status quo of evidence-based medicine

While biology moves forward and the cost of genetic-sequencing dropped a lot faster than Moore's law the opposite is true for the development of new drugs. In the current status quo the development of new drugs rises exponentially with Eroom's law. While average lifespan increased greatly about the last century in Canada the average life span at age 90 increased only 1.9 years over the last century. In 2008 the Centers for Disease Control and Prevention reported that life expectancy in the US declined from 77.9 to 77.8 years. After Worldbank data Germany increased average lifespan by two years over the last decade which is not enough for the dream of radical lifespan increases in our lifetime.

When it costs 80 million to test whether an intervention works and most attempts show that the intervention doesn't work we have a problem. We end up paying billions for every new intervention.

Eric Ries wrote "The Lean Startup". In it he argues that it's the job of a startup to produce validated learning. He proposes that companies that work with small batch sizes can produce more innovation because they can learn faster how to build good products. The existing process in medicine doesn't allow for small batch innovation because the measuring stick for whether an intervention works is too expensive.

In addition the evidence-based approach rests on the assumption that we don't build bespoke interventions for every client. As long as a treatment doesn’t generalize about multiple different patients, it’s not possible to test it with a trial. In principle a double-blind trial can't give you evidence that a bespoke intervention that targets the specific DNA profile of a patient and his co-morbidity works.

The ideal of prediction-based medicine

The evidence-based approach also assumes that practitioners are exchangeable. It doesn't model the fact that different physical therapist or psychologists have different skill levels. It doesn't provide a mechanism to reward highly skilled practitioners but it treats every practitioner that uses the same treatment intervention the same way.

Its strong focus on asking whether a treatment beats a placebo in double-blind studie...

Medical Paradigms