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That clinical medicine has contributed enormously to our ability to treat and cure sick people is beyond contention. But whether and to what extent medical care has transformed morbidity and mortality patterns at a population level and what contribution, if any, it has made to the well-being and life expectancy of the least-advantaged people have been matters of contention for more than a century. This debate has taken on renewed importance as the scientific leadership at the National Institutes of Health (NIH), National Academy of Medicine, and U.S. universities have taken up the challenge of personalized or precision medicine. It is a challenge given all the more salience by President Barack Obama's announcement in his State of the Union address that his administration would seek to fund a major new initiative. Responding to the President's words, Harold Varmus, director of the National Cancer Institute, and Francis Collins, director of the NIH, have written that “What is needed now is a broad research program to build the evidence base needed to guide clinical practice.”1

The enthusiasm for this...

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