Personalizing and Integrating Medicine

Recommendation. Reorganize medicine around preemptive health, built on N-of-1 reach, continuous monitoring, and long-horizon stewardship. Support clinical research that can narrow the N-of-1 gap: EHR data mining and complex system decoding of pathophysiologic mechanism. Design explicitly for the interpretive and communicative work only a human can do. Ask each patient directly for what they want a physician to remain answerable, rather than inferring it from the category into which they fall. Commission the research to better understand what patients will want once machines match physician performance in selected areas, because preferences take longer to decipher than systems take to accommodate them. Hold preemptive health interventions to a strict standard: outcomes rather than surrogates; net benefit balanced against the harms wrought by patient labeling; and expected rate of overdiagnosis. Settle by consortium the workflow, provenance, and liability rules for clinical digital twins, on the principle that prediction is an input, but the decision belongs to the physician. Create a clearing in the forest for holistic-integrative medicine, with an evidentiary basis, and reorient systems towards lifetime health trajectories.