Médecine de précision et Evidence-Based Medicine : quelle articulation ?
DOI :
https://doi.org/10.20416/lsrsps.v4i2.683Mots-clés :
médecine personnalisée, médecine systémique des 4P, médecine de précision, cancérologie, mécanisme, statistique, Evidence-based Medicine, personalised medicine, P4 systems medicine, precision medicine, oncology, mechanism, statisticRésumé
L’Evidence-Based Medicine (EBM) et la médecine personnalisée (MP) ont une ambition commune : réduire l’écart entre les résultats de la recherche biomédicale et leur application en clinique. Toutefois la MP est souvent présentée comme un « nouveau paradigme » pour la médecine, comme l’avait d’ailleurs été l’EBM dans les années 1990. Elle recouvre beaucoup de projets différents mais au cœur de la plupart d’entre eux, on retrouve la prétention d’une meilleure prise en compte des spécificités individuelles que ne le permettrait l’EBM avec son approche populationnelle et statistique. Dans cet article, nous concentrons notre attention sur la MP en cancérologie : elle concerne essentiellement un ciblage des traitements à partir de caractéristiques moléculaires des patients. Ce ciblage est rendu notamment possible par la meilleure connaissance des mécanismes moléculaires des cancers. Il conduit à une stratification en sous-groupes plus restreints de patients et met en difficulté l’évaluation classique des thérapeutiques promue par l’EBM, en particulier, les essais cliniques randomisés qui reposent sur des cohortes de grande taille. Mais la meilleure connaissance des mécanismes et la plus grande précision des thérapies pourraient rendre ces essais moins nécessaires. Assistons-nous avec la MP à une revanche de la culture physiopathologique et mécaniste sur celle statistique et empiriste au sein de la recherche clinique ? Notre objectif est de mettre en évidence ce qui, pour cette MP déjà effective, conduit à des changements épistémologiques dans la manière de considérer ce qui compte comme type d’information et de preuve en médecine, en particulier dans le champ de l’évaluation thérapeutique. Nous défendons l’idée que la MP, loin de pouvoir se passer des approches statistiques et place en réalité l’EBM face à de nouveaux défis. Elle la conduit à renforcer l’articulation et l’intégration des données statistiques et mécanistes pour une meilleure prise en charge de chaque patient.
Références
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CATENACCI, Daniel V. T. 2015. Next-generation clinical trials: Novel strategies to address the challenge of tumor molecular heterogeneity. Molecular Oncology, 9, Clinical Trials for Development of Personalized Cancer Medicine, 967–996.
CLARKE, Brendan, GILLIES Donald, ILLARI Phyllis, RUSSO Federica, and WILLIAMSON Jon. 2013. The evidence that evidence-based medicine omits. Preventive Medicine, 57, 745–747.
CLARKE, Brendan, GILLIES Donald, ILLARI Phyllis, RUSSO Federica, and WILLIAMSON Jon. 2014. Mechanisms and the evidence hierarchy. Topoi, 33, 339–360.
DALY, Jeanne. 2005. Evidence-based medicine and the search for a science of clinical care. Vol. 12. Univ of California Press.
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DION-LABRIE, Marianne, FORTIN M. C., HEBERT M. J., and DOUCET H. 2008. Réflexions éthiques sur la médecine personnalisée: l’alliance de la science et de la médecine enfin réalisée? Revista Colombiana de Bioética, 3, 33–56.
DUAN, Naihua, KRAVITZ Richard L., and SCHMID Christopher H. 2013. Single-patient (n-of-1) trials: a pragmatic clinical decision methodology for patient-centered comparative effectiveness re-search. Journal of clinical epidemiology, 66, S21–S28.
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GIROUX, Élodie. 2012. De l’épidémiologie de santé publique à l’épidémiologie clinique. Bulletin d’Histoire et d’épistémologie des sciences de la vie, 19, 21–43.
GIROUX, Élodie. 2013. The Framingham study and the constitution of a restrictive concept of risk factor. Social history of medicine, 26, 94–112.
GROENENDIJK, Floris H., and René Bernards. 2014. Drug resistance to targeted therapies: déjà vu all over again. Molecular Oncology, 8, 1067–1083.
GUCHET, Xavier. 2016. La médecine personnalisée: un essai philosophique. Paris : Les Belles Lettres.
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HOOD, Leroy, and FRIEND, Stephen. 2011. Predictive, personalized, preventive, participatory (P4) cancer medicine. Nature Reviews Clinical Oncology, 8, 184–187.
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HOWICK, Jeremy, GLASZIOU, Paul, and ARONSON, Jeffrey K.. 2013. Problems with using mechanisms to solve the problem of extrapolation. Theoretical medicine and bioethics, 34, 275–291.
IOANNIDIS, John P. A. 2008. Why most discovered true associations are inflated. Epidemiology, 19, 640–648.
IOANNIDIS, John PA. 2009. Limits to forecasting in personalized medicine: an overview. International Journal of Forecasting, 25, 773–783.
IOANNIDIS, John PA, and KHOURY, Muin J. 2013. Are randomized trials obsolete or more important than ever in the genomic era? Genome Medicine 5, 32.
ITHIMAKIN, Suthinee, DAY, Kathleen C., MALIK, Fayaz, ZEN, Qin, DAWSEY, Scott J., BERSANOBEGEY Tom F., QURAISHI Ahmed A., et al. 2013. HER2 Drives Luminal Breast Cancer Stem Cells in the Absence of HER2 Amplification: Implications for Efficacy of Adjuvant Trastuzumab. Cancer Research, 73, 1635–1646.
JOFFE, Michael. 2011. The gap between evidence discovery and actual causal relationships. Preventive Medicine, 53, Special Section: Epidemiology, Risk, and Causation, 246–249.
KEATING, Peter, and CAMBROSIO, Alberto. 2011. Cancer on trial: oncology as a new style of practice. University of Chicago Press.
La CAZE, Adam. 2011. The role of basic science in evidence-based medicine. Biology & Philosophy, 26, 81–98.
LE TOURNEAU, Christophe, BELIN, Lisa, PAOLETTI, Xavier, BIECHE, Ivan, and KAMAL, Maud. 2015. Precision medicine: lessons learned from the SHIVA trial – Authors’ reply. The Lancet Oncology, 16, e581–e582.
LE TOURNEAU, Christophe, KAMAL, Maud, TREDAN, Olivier, DELORD, Jean-Pierre, CAMPONE, Mario, GONCALVES, Anthony, ISAMBERT, Nicolas, et al. 2012. Designs and challenges for personalized medicine studies in oncology: focus on the SHIVA trial. Targeted oncology, 7, 253–265.
DE LEON, Jose. 2012. Evidence-based medicine versus personalized medicine: are they enemies? Journal of clinical psychopharmacology, 32, 153–164.
LILLIE Elizabeth O, PATAY Bradley, DIAMANT Joel, ISSELL Brian, TOPOL Eric J. et SCHORK Nicholas J. 2011. The n-of-1 clinical trial: the ultimate strategy for individualizing medicine? Personalized medicine, 8, 161–173.
MARTIN, Thierry. 2011. Chapitre 2. De la diversité des probabilités. In KUPIEC Jean-Jacques, GANDRILLON Olivier, MORANGE Michel et SILBERSTEIN Marc (dir.), Le hasard au cœur de la cellule. Editions Matériologiques. 60.
MENDELSOHN, John, RINGBORG, Ulrik, and SCHILSKY, Richard. 2015. Innovative clinical trials for development of personalized cancer medicine. Molecular Oncology, 9, Clinical Trials for Development of Personalized Cancer Medicine, 933–934.
NARDINI, Cecilia, ANNONI, Marco, and SCHIAVONE, Giuseppe. 2012. Mechanistic understanding in clinical practice: complementing evidence-based medicine with personalized medicine. Journal of evaluation in clinical practice, 18, 1000–1005.
NELSON, Nicole C., KEATING, Peter, CAMBROSIO, Alberto, AGUILAR-MAHECHA, Adriana, and BASIK, Mark. 2014. Testing devices or experimental systems? Cancer clinical trials take the ge-nomic turn. Social Science & Medicine, 111, 74–83.
OCANA Alberto, AMIR Eitan, VERABADILLO Francisco, SERUGA Bostjan et TANNOCK Ian F.. 2013. Phase III trials of targeted anticancer therapies: redesigning the concept. Clinical Cancer Research: An Official Journal of the American Association for Cancer Research, 19, 4931–4940.
PACI, Angelo, BLETON, Benjamin, HAGGIAG MAZEAU, Dominique, and D’USSEL, Aude. 2013. Médecine personnalisée et cancer. Paris : IGR Press.
PEREIRA, Tiago V., HORWITZ, Ralph I., and IOANNIDIS, John P. A. 2012. Empirical evaluation of very large treatment effects of medical interventions. JAMA, 308, 1676–1684.
PIGNATTI Francesco, JONSSON Bertil, BLUMENTHAL Gideon et JUSTICE Robert. 2015. Assessment of benefits and risks in development of targeted therapies for cancer–the view of regulatory authorities. Molecular oncology, 9, 1034–1041.
PLUTYNSKI, Anya. 2013. Cancer and the Goals of Integration. Studies in History and Philosophy of Science Part C, 466–476.
POKORSKA-BOCCI, Anna, STEWART, Alison, SAGOO, Gurdeep S., HALL, Alison, KROESE, Mark, and BURTON, Hilary. 2014. “Personalized medicine”: what’s in a name? Personalized Medi-cine, 11, 197–210.
ROSE, Geoffrey. 1992. The strategy of preventive medicine. Oxford: Oxford University Press.
RUSSO, Federica, and WILLIAMSON Jon. 2007. Interpreting causality in the health sciences. International studies in the philosophy of science, 21, 157–170.
SACKETT, D L, ROSENBERG, W M, GRAY, J A, HAYNES, R B, and RICHARDSON, W.S. 1996. Evidence based medicine: what it is and what it isn’t. BMJ (Clinical research ed.), 312, 71–72.
SCHWARTZ, Daniel. 1999. Le jeu de la science et du hasard. La statistique et le vivant. Paris : Flammarion.
SHARMA, Manish R., and SCHILSKY, Richard L.. 2011. Role of randomized phase III trials in an era of effective targeted therapies. Nature reviews Clinical oncology, 9, 208–214.
TEIRA, David. 2011. Frequentist versus Bayesian clinical trials. In GIFFORD Fred (ed.), Philosophy of Medicine. Elsevier. 255–297.
TEIRA, David. 2016. Testing oncological treatments in the era of personalized medicine. In Philosophy of molecular Medicine. Foundational Issues in Research and Practice. London; New York: Routledge. 236–250.
TONELLI, M. R. 1998. The philosophical limits of evidence-based medicine. Academic Medicine: Journal of the Association of American Medical Colleges, 73, 1234–1240.
TRÖLHER, Ulrich. 2012. Chapitre 1. Surmonter l’ignorance thérapeutique : un voyage à travers trois siècles. Sciences & philosophie, 31–53.
TSIMBERIDOU, Apostolia-Maria, BRAITEH, Fadi, STEWART, David J., and KURZROCK Razelle. 2009. Ultimate fate of oncology drugs approved by the us food and drug administration without a randomized Trial. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 27, 6243–6250.
TURSZ Thomas et BERNARDS Rene. 2015. Hurdles on the road to personalized medicine. Molecular Oncology, 9, Clinical Trials for Development of Personalized Cancer Medicine, 935–939.
VAIDYANATHAN, Gayathri. 2012. Redefining clinical trials: the age of personalized medicine. Cell, 148, 1079–1080.
VANDENBROUCKE, J P. 1988. Is “the causes of cancer” a miasma theory for the end of the twentieth century? International journal of epidemiology, 17, 708–709.
WEISS, Glen J. 2015. Precision medicine: lessons learned from the SHIVA trial. The Lancet Oncology, 16, e580. .
WORRALL, John. 2002. What Evidence in Evidence-Based Medicine? Proceedings of the Philosophy of Science Association 2002, 316–330.
WORRALL, John. 2007. Evidence in Medicine and Evidence-Based Medicine. Philosophy Compass, 2, 981–8211.
BADCOTT, David. 2006. Some causal limitations of pharmacogenetic concepts. Medicine, Health Care and Philosophy 9, 307.
BERRY, Donald A. 2011. Adaptive Clinical Trials: The Promise and the Caution. Journal of Clinical Oncology, 29, 606–609.
BERRY, Donald A. 2015. The Brave New World of clinical cancer research: Adaptive biomarker-driven trials integrating clinical practice with clinical research. Molecular Oncology 9. Clinical Trials for Development of Personalized Cancer Medicine: 951–959.
BERTOLASO, Maria. 2016. Philosophy of Cancer - A Dynamic and Relational View. Springer.
BILLAUD, Marc. 2012. L’hétérogénéité intratumorale. M/S-Medecine Sciences 28, 1116.
BLUHM, Robyn, and BORGERSON, Kirstin. 2011. Evidence-Based Medicine. In GIFFORD, Fred (dir.), Philosophy of Medicine. Elsevier, 203-238.
CARTWRIGHT, Nancy. 2012. Presidential address: Will this policy work for you? Predicting effectiveness better: How philosophy helps. Philosophy of Science, 79, 973–989.
CARTWRIGHT, Nancy, and MUNRO Eileen. 2010. The limitations of randomized controlled trials in predicting effectiveness. Journal of evaluation in clinical practice, 16, 260–266.
CATENACCI, Daniel V. T. 2015. Next-generation clinical trials: Novel strategies to address the challenge of tumor molecular heterogeneity. Molecular Oncology, 9, Clinical Trials for Development of Personalized Cancer Medicine, 967–996.
CLARKE, Brendan, GILLIES Donald, ILLARI Phyllis, RUSSO Federica, and WILLIAMSON Jon. 2013. The evidence that evidence-based medicine omits. Preventive Medicine, 57, 745–747.
CLARKE, Brendan, GILLIES Donald, ILLARI Phyllis, RUSSO Federica, and WILLIAMSON Jon. 2014. Mechanisms and the evidence hierarchy. Topoi, 33, 339–360.
DALY, Jeanne. 2005. Evidence-based medicine and the search for a science of clinical care. Vol. 12. Univ of California Press.
DE GRANDIS, Giovanni, and HALGUNSET Vidar. 2016. Conceptual and terminological confusion around personalised medicine: a coping strategy. BMC Medical Ethics, 17, 43.
DION-LABRIE, Marianne, FORTIN M. C., HEBERT M. J., and DOUCET H. 2008. Réflexions éthiques sur la médecine personnalisée: l’alliance de la science et de la médecine enfin réalisée? Revista Colombiana de Bioética, 3, 33–56.
DUAN, Naihua, KRAVITZ Richard L., and SCHMID Christopher H. 2013. Single-patient (n-of-1) trials: a pragmatic clinical decision methodology for patient-centered comparative effectiveness re-search. Journal of clinical epidemiology, 66, S21–S28.
EVIDENCE-BASED MEDICINE WORKING GROUP. 1992. Evidence-based medicine. A new approach to teaching the practice of medicine. JAMA: the journal of the American Medical Association, 268, 2420.
FLETCHER, Robert H., FLETCHER Suzanne W., and FLETCHER Grant S. 2012. Clinical epidemiology: the essentials. Lippincott Williams & Wilkins.
GIROUX, Élodie. 2008. L’épidémiologie entre population et individu : quelques clarifications à partir de la notion de la pensée populationnelle’. Bulletin d’Histoire et d’épistémologie des sciences de la vie, 1, 37–52.
GIROUX, Élodie. 2012. De l’épidémiologie de santé publique à l’épidémiologie clinique. Bulletin d’Histoire et d’épistémologie des sciences de la vie, 19, 21–43.
GIROUX, Élodie. 2013. The Framingham study and the constitution of a restrictive concept of risk factor. Social history of medicine, 26, 94–112.
GROENENDIJK, Floris H., and René Bernards. 2014. Drug resistance to targeted therapies: déjà vu all over again. Molecular Oncology, 8, 1067–1083.
GUCHET, Xavier. 2016. La médecine personnalisée: un essai philosophique. Paris : Les Belles Lettres.
GUYATT, G. H., KELLER J. L., JAESCHKE R., ROSENBLOOM, D., ADACHI J.D., and NEWHOUSE, M.T. 1990. The n-of-1 randomized controlled trial: clinical usefulness. Our three-year experience. Annals of internal medicine, 112, 293–299.
GUYATT, G, SACKETT, D., TAYLOR, D. W., CHONG, J., ROBERTS, R., and PUGSLEY, S. 1986. Determining optimal therapy-randomized trials in individual patients. The New England journal of medicine, 314, 889–892.
HOOD, Leroy. 2013. Systems biology and p4 medicine: past, present, and future. Rambam Maimonides medical journal, 4.
HOOD, Leroy, BALLING, Rudi, and AUFFRAY, Charles. 2012. Revolutionizing medicine in the 21st century through systems approaches. Biotechnology Journal, 7, 992–1001.
HOOD, Leroy, and FLORES, Mauricio. 2012. A personal view on systems medicine and the emergence of proactive P4 medicine: predictive, preventive, personalized and participatory. New Biotechnology, 29, Molecular Diagnostics & Personalised Medicine, 613–624.
HOOD, Leroy, and FRIEND, Stephen. 2011. Predictive, personalized, preventive, participatory (P4) cancer medicine. Nature Reviews Clinical Oncology, 8, 184–187.
HOWICK, Jeremy H. 2011. The Philosophy of Evidence-based Medicine. John Wiley & Sons.
HOWICK, Jeremy, GLASZIOU, Paul, and ARONSON, Jeffrey K.. 2013. Problems with using mechanisms to solve the problem of extrapolation. Theoretical medicine and bioethics, 34, 275–291.
IOANNIDIS, John P. A. 2008. Why most discovered true associations are inflated. Epidemiology, 19, 640–648.
IOANNIDIS, John PA. 2009. Limits to forecasting in personalized medicine: an overview. International Journal of Forecasting, 25, 773–783.
IOANNIDIS, John PA, and KHOURY, Muin J. 2013. Are randomized trials obsolete or more important than ever in the genomic era? Genome Medicine 5, 32.
ITHIMAKIN, Suthinee, DAY, Kathleen C., MALIK, Fayaz, ZEN, Qin, DAWSEY, Scott J., BERSANOBEGEY Tom F., QURAISHI Ahmed A., et al. 2013. HER2 Drives Luminal Breast Cancer Stem Cells in the Absence of HER2 Amplification: Implications for Efficacy of Adjuvant Trastuzumab. Cancer Research, 73, 1635–1646.
JOFFE, Michael. 2011. The gap between evidence discovery and actual causal relationships. Preventive Medicine, 53, Special Section: Epidemiology, Risk, and Causation, 246–249.
KEATING, Peter, and CAMBROSIO, Alberto. 2011. Cancer on trial: oncology as a new style of practice. University of Chicago Press.
La CAZE, Adam. 2011. The role of basic science in evidence-based medicine. Biology & Philosophy, 26, 81–98.
LE TOURNEAU, Christophe, BELIN, Lisa, PAOLETTI, Xavier, BIECHE, Ivan, and KAMAL, Maud. 2015. Precision medicine: lessons learned from the SHIVA trial – Authors’ reply. The Lancet Oncology, 16, e581–e582.
LE TOURNEAU, Christophe, KAMAL, Maud, TREDAN, Olivier, DELORD, Jean-Pierre, CAMPONE, Mario, GONCALVES, Anthony, ISAMBERT, Nicolas, et al. 2012. Designs and challenges for personalized medicine studies in oncology: focus on the SHIVA trial. Targeted oncology, 7, 253–265.
DE LEON, Jose. 2012. Evidence-based medicine versus personalized medicine: are they enemies? Journal of clinical psychopharmacology, 32, 153–164.
LILLIE Elizabeth O, PATAY Bradley, DIAMANT Joel, ISSELL Brian, TOPOL Eric J. et SCHORK Nicholas J. 2011. The n-of-1 clinical trial: the ultimate strategy for individualizing medicine? Personalized medicine, 8, 161–173.
MARTIN, Thierry. 2011. Chapitre 2. De la diversité des probabilités. In KUPIEC Jean-Jacques, GANDRILLON Olivier, MORANGE Michel et SILBERSTEIN Marc (dir.), Le hasard au cœur de la cellule. Editions Matériologiques. 60.
MENDELSOHN, John, RINGBORG, Ulrik, and SCHILSKY, Richard. 2015. Innovative clinical trials for development of personalized cancer medicine. Molecular Oncology, 9, Clinical Trials for Development of Personalized Cancer Medicine, 933–934.
NARDINI, Cecilia, ANNONI, Marco, and SCHIAVONE, Giuseppe. 2012. Mechanistic understanding in clinical practice: complementing evidence-based medicine with personalized medicine. Journal of evaluation in clinical practice, 18, 1000–1005.
NELSON, Nicole C., KEATING, Peter, CAMBROSIO, Alberto, AGUILAR-MAHECHA, Adriana, and BASIK, Mark. 2014. Testing devices or experimental systems? Cancer clinical trials take the ge-nomic turn. Social Science & Medicine, 111, 74–83.
OCANA Alberto, AMIR Eitan, VERABADILLO Francisco, SERUGA Bostjan et TANNOCK Ian F.. 2013. Phase III trials of targeted anticancer therapies: redesigning the concept. Clinical Cancer Research: An Official Journal of the American Association for Cancer Research, 19, 4931–4940.
PACI, Angelo, BLETON, Benjamin, HAGGIAG MAZEAU, Dominique, and D’USSEL, Aude. 2013. Médecine personnalisée et cancer. Paris : IGR Press.
PEREIRA, Tiago V., HORWITZ, Ralph I., and IOANNIDIS, John P. A. 2012. Empirical evaluation of very large treatment effects of medical interventions. JAMA, 308, 1676–1684.
PIGNATTI Francesco, JONSSON Bertil, BLUMENTHAL Gideon et JUSTICE Robert. 2015. Assessment of benefits and risks in development of targeted therapies for cancer–the view of regulatory authorities. Molecular oncology, 9, 1034–1041.
PLUTYNSKI, Anya. 2013. Cancer and the Goals of Integration. Studies in History and Philosophy of Science Part C, 466–476.
POKORSKA-BOCCI, Anna, STEWART, Alison, SAGOO, Gurdeep S., HALL, Alison, KROESE, Mark, and BURTON, Hilary. 2014. “Personalized medicine”: what’s in a name? Personalized Medi-cine, 11, 197–210.
ROSE, Geoffrey. 1992. The strategy of preventive medicine. Oxford: Oxford University Press.
RUSSO, Federica, and WILLIAMSON Jon. 2007. Interpreting causality in the health sciences. International studies in the philosophy of science, 21, 157–170.
SACKETT, D L, ROSENBERG, W M, GRAY, J A, HAYNES, R B, and RICHARDSON, W.S. 1996. Evidence based medicine: what it is and what it isn’t. BMJ (Clinical research ed.), 312, 71–72.
SCHWARTZ, Daniel. 1999. Le jeu de la science et du hasard. La statistique et le vivant. Paris : Flammarion.
SHARMA, Manish R., and SCHILSKY, Richard L.. 2011. Role of randomized phase III trials in an era of effective targeted therapies. Nature reviews Clinical oncology, 9, 208–214.
TEIRA, David. 2011. Frequentist versus Bayesian clinical trials. In GIFFORD Fred (ed.), Philosophy of Medicine. Elsevier. 255–297.
TEIRA, David. 2016. Testing oncological treatments in the era of personalized medicine. In Philosophy of molecular Medicine. Foundational Issues in Research and Practice. London; New York: Routledge. 236–250.
TONELLI, M. R. 1998. The philosophical limits of evidence-based medicine. Academic Medicine: Journal of the Association of American Medical Colleges, 73, 1234–1240.
TRÖLHER, Ulrich. 2012. Chapitre 1. Surmonter l’ignorance thérapeutique : un voyage à travers trois siècles. Sciences & philosophie, 31–53.
TSIMBERIDOU, Apostolia-Maria, BRAITEH, Fadi, STEWART, David J., and KURZROCK Razelle. 2009. Ultimate fate of oncology drugs approved by the us food and drug administration without a randomized Trial. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 27, 6243–6250.
TURSZ Thomas et BERNARDS Rene. 2015. Hurdles on the road to personalized medicine. Molecular Oncology, 9, Clinical Trials for Development of Personalized Cancer Medicine, 935–939.
VAIDYANATHAN, Gayathri. 2012. Redefining clinical trials: the age of personalized medicine. Cell, 148, 1079–1080.
VANDENBROUCKE, J P. 1988. Is “the causes of cancer” a miasma theory for the end of the twentieth century? International journal of epidemiology, 17, 708–709.
WEISS, Glen J. 2015. Precision medicine: lessons learned from the SHIVA trial. The Lancet Oncology, 16, e580. .
WORRALL, John. 2002. What Evidence in Evidence-Based Medicine? Proceedings of the Philosophy of Science Association 2002, 316–330.
WORRALL, John. 2007. Evidence in Medicine and Evidence-Based Medicine. Philosophy Compass, 2, 981–8211.
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2018-03-27
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Giroux, Élodie. 2018. « Médecine De précision Et Evidence-Based Medicine : Quelle Articulation ? ». Lato Sensu: Revue De La Société De Philosophie Des Sciences 4 (2). https://doi.org/10.20416/lsrsps.v4i2.683.
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Les enjeux contemporains de la médecine personnalisée
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