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Gurvaneet Randhawa is the senior advisor on clinical genomics and personalized medicine at the Agency for Healthcare Research and Quality, a unit within the US Department of Health and Human Services. GT's Jeanene Swanson caught up with him to discuss the use of evidence-based medicine in the clinic, and how far along systems biology tools have come in affecting patient care.

Genome Technology: What is evidence-based medicine?

Gurvaneet Randhawa: Evidence-based medicine typically implies three different elements that need to be considered together, the first being the best and current scientific evidence, the second being the clinical expertise, and the third being the patients' values — combining all of these in making decisions jointly between the clinician and the patient in terms of what is the best course of action to take.

GT: How do you apply that in clinical practice?

GR: That is a very challenging aspect, primarily because given the workload, there really isn't enough time for the busy primary care physician to look up all the latest studies that are being published, let alone try and synthesize them in a fashion that is digestible and useable in the clinic. To do all of those steps — specifying what questions you want to answer, collecting all of the research evidence in a systematic fashion, and integrating that knowledge with expertise and patient values — requires a multidisciplinary team of people working on these reports for several months.

The challenge we are struggling with is how to do it more consistently and uniformly, and one of the options is to have available different credible sources of information that can guide the clinicians. An example of that are the recent recommendations released by the US Preventive Services Task Force on prostate cancer screening.

GT: How does large-scale biological research play a role here?

GR: The task force hasn't ventured too much in that area because it deals mostly with clinical prevention.

AHRQ's mission is to improve the effectiveness, safety, quality, and efficiency of healthcare. So our focus is on things that are already being used in clinical practice, or that are new to clinical practice and still haven't gained widespread use. All of the 'omics studies tend to be more exploratory analyses.

GT: What are some of the challenges facing evidence-based medicine?

GR: Getting good, validated information is the first challenge. It's important to have large-scale studies, but ... there are many other factors beyond genetics and beyond markers that influence the causation of disease.

The second challenge is, even if we know what genes or what biological factors are predictive of what diseases, what do we do with that information? There is no drug that is without adverse events. We have to assess the balance of benefits and harms.

The third challenge is trying to implement the best possible research evidence into practice, and again, there's a huge information overload that is occurring. The information needs to be reliable and credible, and you have to make sure that it is interoperable across different systems.

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