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    Is the end of evidence-based guidelines near?

    The technologies advancing our world are changing it so rapidly that it is almost frightening! Computer technology; tracking systems; apps that can locate personal items; codes that permit online retailers to know our personal shopping preferences; artificial intelligence that has the ability to understand our voice commands and to care for our personal needs by sending online orders for purchases; calling us an Uber; and playing songs for us to fall asleep, and wake us up—all are the reality in which we now live.  One can only imagine, what is next?

    Treatment beyond ‘big data’

    Dr. Bass’ recent article in Contemporary Pediatrics, “Personalized medicine, right drug, right patient, right time,” provides a miniature but profound view of what may be the future of pediatric healthcare: focusing on healthcare that is truly individualized through precision science in the areas of diagnosis and treatment, rather than generalized, population-based treatment guidelines.

    Dr. Bass gives us with a glimpse of what may be next…personalized, precision genomic medicine for each individual—especially for those with the potential for or who have chronic illnesses that affect every aspect of one’s life. Its impact may bring significant changes just around the corner. Will precision medicine create new provider roles or, as Dr. Bass suggests, compel pediatric providers to learn new ways for diagnosis and treatment and present them to the parent and the cognitively-ready child for collaborative input into personalized healthcare?

    Care in a post-guidelines world

    Think about it. Our current evidence-based guidelines are based on big data sets that may be obsolete in the very near future. For example, the attention-deficit/hyperactive disorder (ADHD) guideline, currently considered the gold standard of care for children with a diagnosis of ADHD, are evidence-based, but generalized standards of care place all children and adolescents into one of several categories for diagnosis and treatment of presenting symptoms.

    Dr. Bass discusses the latest evidence obtained through electroencephalograph studies that have shown a subgroup of children with ADHD and impaired vigilance may respond to stimulant therapy. However, if the child also has depression, a common co-morbidity, the child needs a precision medicine personalized treatment plan.  These children may need a larger dose of stimulant medication to obtain the desired effect, not the dosing recommendation in the current practice guideline.

    So, what is the future of precision medicine for the pediatric population?  Dr. Bass provides an insightful prognostication of the possibilities through a new lens in which pediatric medicine, scientifically-based evidence, genetics, and epigenetics are sculpted into a plan so specific that the treatment plan is designed just for that one unique individual, with the goal of achieving optimal health through precision healthcare.

    The training imperative

    The changes are happening so quickly that we have not had the time to consider how practicing healthcare providers would be trained to achieve these precise outcomes, or specifically how the care can be delivered and evaluated for each individual. While all healthcare providers must be committed to be life-long learners, precision medicine will clearly place demands on the continuous learning processes.

    It is hard to imagine incorporating such changes within our current healthcare system. Perhaps a personalized mind-body interspatial genomic journey—one as unique as each child is—is worth traveling for those of us who seek each patient’s optimal health. 


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