I agree completely. Individualized patient care is key, and it’s messy, as you say. I am looking though at medicine and biomedical science more generally, with considerations to, for instance, treatment guideline development and the origins of assumptions that lead ultimately to reversal of erroneous standards of care. This is a topic I’ve focused on for the last decade or so, and asking critical questions about medicine and biomedical science has been a major part of career as a medical writer and manuscript editor. I don’t mean to imply that patient-level care is completely broken, obviously not, but there are undeniably some very shaky foundations underlying much of what is considered standard of care in some areas of medicine. There was an editorial in JAMA this week summarizing the current thinking on moving from a P <0.05 to a P <0.005 threshold for statistical significance to eliminate many spurious assumptions in biomedicine. The American Statistical Association estimated that doing so would eliminate the significance from about a third of biomedical findings, yet the idea has some real merit (ie., to focus research going forward on identifying interventions with more robust treatment effects as opposed statistical relative differences that aren’t meaningful to patients).