From evidence-based medicine to genomic medicine

Abstract

The concept of 'evidence-based medicine' dates back to mid-19th century or even earlier. It remains pivotal in planning, funding and in delivering the health care. Clinicians, public health practitioners, health commissioners/purchasers, health planners, politicians and public seek formal 'evidence' in approving any form of health care provision. Essentially 'evidence-based medicine' aims at the conscientious, explicit and judicious use of the current best evidence in making decisions about the care of individual patients. It is in fact the 'personalised medicine' in practice. Since the completion of the human genome project and the rapid accumulation of huge amount of data, scientists and physicians alike are excited on the prospect of 'personalised health care' based on individual's genotype and phenotype. The first decade of the new millennium now witnesses the transition from 'evidence-based medicine' to the 'genomic medicine'. The practice of medicine, including health promotion and prevention of disease, stands now at a wide-open road as the scientific and medical community embraces itself with the rapidly expanding and revolutionising field of genomic medicine. This article reviews the rapid transformation of modern medicine from the 'evidence-based medicine' to 'genomic medicine'.

Fig. 1

Steps in ‘evidence-based practice’ (modified from Donaldson and Donaldson 2003)

Fig. 2

Evolution of traditional clinical practice to genomic medicine (modified from Go et al. 2004)

Fig. 3

The application of genomic science in clinical nutrition (Go et al. ; reproduced with permission from The Journal of Nutrition)

Fig. 4

Progression of pharmacogenomics to clinical practice (Johnson 2003)