The paradox of precision medicine

According to the paradigm of precision medicine, the administration of agents targeting the molecular alteration detected in a particular patient’s tumour reduces uncertainty in the clinical management of that patient. We describe how approaches to precision medicine can lead, paradoxically, to increased levels of uncertainty. We offer recommendations for how physicians can better navigate new uncertainties in precision medicine.

  • Subscribe to Nature Reviews Clinical Oncology for full access:



Additional access options:

Already a subscriber?  Log in  now or  Register  for online access.


  1. 1.

    Harris, M. H. et al. Multicenter feasibility study of tumor molecular profiling to inform therapeutic decisions in advanced pediatric solid tumors: the individualized cancer therapy (iCat) study. JAMA Oncol. 2, 608–615 (2016).

  2. 2.

    Hayes, D. F. et al. Breaking a vicious cycle. Sci. Transl. Med. 31, 196cm6 (2013).

  3. 3.

    Poonacha, T. K. & Go, R. S. Level of scientific evidence underlying recommendations arising from the National Comprehensive Cancer Network clinical practice guidelines. J. Clin. Oncol. 10, 186–191 (2011).

  4. 4.

    Fleck, L. M. Personalized medicine’s ragged edge. Hastings Cent. Rep. 40, 16–18 (2010).

  5. 5.

    Fehrenbacher, L. et al. in 2017 San Antonio Breast Cancer Symposium Day 2 GS1-02 (San Antonio, TX, USA, 2017).

  6. 6.

    Camidge, D. R. et al. Activity and safety of crizotinib in patients with ALK-positive non-small-cell lung cancer: updated results from a phase 1 study. Lancet Oncol. 13, 1011–1019 (2012).

  7. 7.

    Le Tourneau, C., Kamal, M. & Bièche, I. The SHIVA01 trial: what have we learned? Pharmacogenomics 18, 831–834 (2017).

  8. 8.

    Bar-Hillel, M. & Fischhoff, B. When do base rates affect predictions? J. Pers. Soc. Psychol. 41, 671–680 (1981).

  9. 9.

    Kahneman, D. Thinking, Fast and Slow (Farrar, Straus and Giroux, New York, 2011).

Download references


J.K. is funded by Genome Canada/Genome Quebec (PACEOMICS).

Author information


  1. Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada

    • Jonathan Kimmelman
  2. Department of Social Studies of Medicine, McGill University, Montreal, Quebec, Canada

    • Jonathan Kimmelman
  3. Division of Medical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada

    • Ian Tannock


  1. Search for Jonathan Kimmelman in:

  2. Search for Ian Tannock in:

The authors declare no competing interests.

Corresponding author

Correspondence to Jonathan Kimmelman.