{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T18:47:49Z","timestamp":1791830869365,"version":"4.3.4"},"reference-count":73,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Evidence\u2010based medicine (EBM) replaced authority with appraisal and has reduced harm. Its own methodologists have documented a persistent gap between what its methods conclude and what its practice does: average effects that are marginal for most treated patients, guidelines that misfit the individual, widespread difficulty converting relative into absolute effects, and no built\u2010in trigger for stopping a treatment that is not helping.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims and Objectives<\/jats:title>\n                    <jats:p>To identify a common source of these problems in the application of population\u2010level estimates to individuals, and to propose a framework that corrects it without abandoning controlled evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Conceptual and critical analysis drawing on the methodological critique of EBM published by its founders and leading epidemiologists; the theory of ergodicity in dynamical systems and its empirical tests; the reference class problem; and existing clinical existence proofs of individual\u2010level measurement and closed\u2010loop intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The assumption that a population estimate applies to an individual is the ergodic assumption, which holds when a process is homogeneous across persons and stationary over time. Homogeneity fails whenever treatment response differs between people, which is common; where an individual's responses are reproducible, individual\u2010level inference is both necessary and feasible. Large within\u2010person variability weakens every inference and must be measured rather than assumed away. The N\u2010of\u20101 randomised trial, which estimates an effect in the individual, was published by Guyatt and Sackett in 1986 and ranks at Level 1 of the Oxford 2011 Levels of Evidence, yet a systematic review found 108 published trials in twenty\u2010five\u00a0years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>I propose Individual\u2010Dynamic Medicine, a biocybernetic framework of six principles, each with an existence proof in mainstream medicine, specifying how population evidence and within\u2010person trials divide the work of an individual decision, and state its assumptions, limitations, and the predictions on which it could fail.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jep.70657","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T18:23:22Z","timestamp":1791829402000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond the Average Patient: The Ergodicity Problem in Evidence\u2010Based Medicine and a Proposal for Individual\u2010Dynamic Medicine"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-8263-2156","authenticated-orcid":false,"given":"Utah","family":"Hans","sequence":"first","affiliation":[{"name":"Independent Researcher Richmond Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1992.03490170092032"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.312.7023.71"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMms1604593"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31592-6"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39489.470347.AD"},{"key":"e_1_2_11_7_1","unstructured":"OCEBM Levels of Evidence Working Group. 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