Precision Medicine: The Promise and the Paradox

Precision Medicine: Benefits and Barriers

Abstract

The practice of Clinical Medicine is a dynamically evolving paradigm. In its earliest era, medicine was intuitive – doctors relied on “experience” and heuristic assessment of signs and symptoms rather than scientific evidence.¹ Since the late 20th century, this has rightly been replaced by evidence-based medicine (EBM), with clinical trials and meta-analyses considered the height of empirical evidence. EBM has undoubtedly transformed population-level patient outcomes by fostering “best medical practices” supported by systematic medical research. Nonetheless, this system has an inherent limitation evidence-based guidelines are formulated from mean results from a relatively homogeneous trial population, with the deliberate exclusion of heterogeneous characteristics.² Consequently, at the individual level in real-world settings, this often leads to heterogeneous outcomes such as poor responses or adverse events. This is due to inter-individual variation in genetics, lifestyle, environmental exposures, comorbidities or drug interactions.³ It has become increasingly evident that treatment should be personalized, i.e.,it should target the patient with the disease, rather than the disease in the patient.

Bangladesh Medical Res Counc Bull 2026;52(1): 1-3