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  • Perspective
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The next generation of evidence-based medicine

Nature Medicine volume 29, pages 49–58 (2023)Cite this article

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Abstract

Recently, advances in wearable technologies, data science and machine learning have begun to transform evidence-based medicine, offering a tantalizing glimpse into a future of next-generation ‘deep’ medicine. Despite stunning advances in basic science and technology, clinical translations in major areas of medicine are lagging. While the COVID-19 pandemic exposed inherent systemic limitations of the clinical trial landscape, it also spurred some positive changes, including new trial designs and a shift toward a more patient-centric and intuitive evidence-generation system. In this Perspective, I share my heuristic vision of the future of clinical trials and evidence-based medicine.

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Fig. 1: Timeline of drug development from the present to the future.
Fig. 2: Classes of master protocols.
Fig. 3: The patient as the center of the clinical trial universe in the clinical research enterprise.
Fig. 4: Evidence-based deep medicine iceberg.

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Acknowledgements

V.S. is an Andrew Sabin Family Foundation fellow at the University of Texas MD Anderson Cancer Center. V.S. acknowledges the support of the Jacquelyn A. Brady Fund. V.S. thanks the team at Draw Impacts for figures. V.S. is supported by the US National Institutes of Health (NIH) (grants R01CA242845 and R01CA273168); the MD Anderson Cancer Center Department of Investigational Cancer Therapeutics is supported by the Cancer Prevention and Research Institute of Texas (grant RP1100584), the Sheikh Khalifa Bin Zayed Al Nahyan Institute for Personalized Cancer Therapy (grant 1U01CA180964), NCATS (Center for Clinical and Translational Sciences) (grant UL1TR000371) and the MD Anderson Cancer Center Support (grant P30CA016672).

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  1. Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Vivek Subbiah

  2. Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Vivek Subbiah

  3. MD Anderson Cancer Network, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Vivek Subbiah

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Correspondence to Vivek Subbiah.

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None relevant to the manuscript. V.S. reports research funding/grant support for clinical trials from AbbVie, Agensys, Alfasigma, Altum, Amgen, Bayer, BERG Health, Blueprint Medicines, Boston Biomedical, Boston Pharmaceuticals, Celgene, D3 Bio, Dragonfly Therapeutics, Exelixis, Fujifilm, GlaxoSmithKline, Idera Pharmaceuticals, Incyte, Inhibrx, Loxo Oncology, MedImmune, MultiVir, NanoCarrier, National Comprehensive Cancer Network, NCI-CTEP, Northwest Biotherapeutics, Novartis, PharmaMar, Pfizer, Relay Therapeutics, Roche/Genentech, Takeda, Turning Point Therapeutics, UT MD Anderson Cancer Center and Vegenics; travel support from ASCO, ESMO, Helsinn Healthcare, Incyte, Novartis and PharmaMar; consultancy/advisory board participation for Helsinn Healthcare, Jazz Pharmaceuticals, Incyte, Loxo Oncology/Eli Lilly, MedImmune, Novartis, QED Therapeutics, Relay Therapeutics, Daiichi-Sankyo and R-Pharm US; and a relationship with Medscape.

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Subbiah, V. The next generation of evidence-based medicine. Nat Med 29, 49–58 (2023). https://doi.org/10.1038/s41591-022-02160-z

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