Yes, @irenekwshiu, I am totally convinced that NGS and other...

Yes, @irenekwshiu, I am totally convinced that NGS and other techniques for matching patients to treatments with the aim of greatly increasing the chance of a beneficial result is a wide-open and welcoming avenue for medicine. It will immensely benefit the economics by eliminating that proportion of patients who would have little or no chance of improvement. It will save clinician and patient time and spare some patients the risks of therapy. There may be other benefits that evade my attention because this is a relatively new field for me. But it is already being employed, with demonstrated benefit.

”The goal of precision medicine is to target the right treatments to the right patients at the right time.” appeals very much to me. But IMO the selection of patients for stem cell treatment of intervertebral disc lesions is, to me, more related to the treating clinicians' assessment based on physical examination and radiological evidence and as far as I know there is no reason to think that NGS would have a role. If there is a genetic tendency to disc lesions I am not aware of it (nor would I be, as I suspect this would be still in the hands of researchers). A history of injury could influence decisions, even though disc patients often report no significant injury. The other factors that would enter the treat-or-not-to treat equation appear, on the basis of MSB trial results, duration of symptoms and age of patient.

So, in summary, precision medicine has a definite role in selecting patients who would more likely benefit from stem cell treatment but in the case of CLBP the pre-operative assessment by the clinician, using all available technology, is the only guide to precision

A huge benefit of stem cell treatment here is the almost total absence of adverse effects. Not so with surgery.

As an aside, I add that very extensive experience of compensable back injuries inclines me to a belief that these respond quite poorly to surgery or steroid injections compared to non-compensable. This is NOT a comment about motivation to be compensated. I rather think it is due to the additional emotional influence of the precipitating event. In most cases, anyway. Just a personal observation and not an invitation to argument.