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Medicine Grand Rounds - Precision Medicine Beyond the -omics: Emerging Tools for Personalized Data Science

Dr. Kravitz discusses the importance of recognizing to doctors and patients in differentiating between medical treatment options that work “on average” and those that “work on me”. The Average Treatment Effect (ATE) is highly influenced by a multitude of factors and may not be relevant to patients who are more interested in the individual treatment effect (ITE). There are emerging tools and strategies for identifying ITE. Risk stratification is commonly used in controlled trials but requires large sample sizes and subgroup analysis that can generate false positive results. The self-tracking industry can provide copious amounts of information on individuals informing “small data” but is not particularly scientific and has privacy concerns. N-of-1 trials are promising as they offer information based on experimental treatments in individual subjects over time. They work well with conditions that are stable and treatments that are fast acting and have measurable outcomes. Challenges to N-of-1 trials are that they are non-traditional and require electronic infrastructure. Strengths include patient enthusiasm and engagement in the process. Dr. Kravitz is hopeful that we can move from treatments that do not work for most patients, to finding treatments for most patients that work.

Activity Details

Start Date: October 28, 2018
End Date: October 28, 2020

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  • Richard L. Kravitz, MD, MSPH
    Professor of Internal Medicine
    University of California Davis
    Director: University of California Center Sacramento

    Richard Kravitz, MD, MSPH is a general internist and health services researcher, whose scholarship focuses on health communication and individualization of care.  He recently completed an eight year term as co-editor-in-chief of the Journal of General Internal Medicine.  He is the author or co-author of some 280 academic articles, two of which have been recognized with the Academy Health Article of the Year Award. A graduate of Stanford University, University of California San Francisco School of Medicine, and UCLA School of Public Health, Dr. Kravitz was the 2014 recipient of the George Engel Award for Outstanding Research Contributing to the Theory, Practice and Teaching of Effective Health Care Communication and Related Skills.
Learning Outcome

At the conclusion of this activity, participants will be able to discuss the problem of heterogeneity of treatment effects and be able to identify the strengths and weaknesses of three approaches for estimating individual treatment effects (ITE) including risk stratification, “small data” and N-of-1 trials.


Dartmouth-Hitchcock is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Dartmouth-Hitchcock designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Requirements for Successful Completion

In order to receive credit for this Continuing Medical Education (CME) activity, you must:

  • View the entire presentation
  • Complete the online Attestation of Attendance & Evaluation Form (you must register to access).

In accordance with the disclosure policy of Dartmouth-Hitchcock/Geisel School of Medicine at Dartmouth as well as standards set forth by the Accreditation Council on Continuing Medical Education and the Nursing Continuing Education Council standards set forth by the American Nurses Credentialing Center Commission on Accreditation, continuing medical education and nursing education activity director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content have been asked to disclose any financial relationship* they have to a commercial interest (any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on patients). Such disclosure is not intended to suggest or condone bias in any presentation, but is elicited to provide participants with information that might be of potential importance to their evaluation of a given activity.

The following Activity Physician Director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content for Precision Medicine Beyond the -omics: Emerging Tools for Personalized Data Science (Medicine Grand Rounds) have reported the following financial interest or relationship* with various companies/organizations. The Activity Director and Planning Committee member roles were resolved by altering the individual’s control over content about the products or services of the commercial interest by the Associate Dean for CME and the Department of Medicine Chair. The speaker role has been resolved by validating the activity content through independent peer review by the Activity Director. All potential conflict(s) were resolved.

* Kelly Kieffer, MD ~ her spouse is a consultant for OcculoBio. 

* Richard I. Rothstein, MD ~ has research support from Baranova (research grant to Dartmouth-Hitchcock Medical Center) and has other financial interest from Takeda. 

* Richard L.Kravitz, MD ~ is a consultant for Platform Q Health Education.

Other planning committee member(s), speaker(s), activity director(s), author(s) or anyone in a position to control the content for this program report no financial interest or relationship* with any company(ies) or organizations whose product may be germane to the content of their presentations.

*A “financial interest or relationship" refers to an equity position, receipt of royalties, consultantship, funding by a research grant, receiving honoraria for educational services elsewhere, or to any other relationship to a company that provides sufficient reason for disclosure, in keeping with the spirit of the stated policy.

Provider Contact Information

Provider contact information for questions regarding accreditation of the activity:

Center for Learning and Professional Development
Dartmouth-Hitchcock Medical Center

Type:     Internet Activity (Enduring Material)
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