From Population-Level Evidence to Individual-Level Strategy: Logical Gaps, Structural Limitations, and Corrigible Pathways in Evidence-Based Medicine

This deposit contains an archival draft of a conceptual manuscript addressing a structural issue in evidence-based medicine: the gap between population-level average effects and individual-level clinical decision-making. The manuscript proposes that the common translation from “better on average” to “better for this patient” constitutes an implicit inferential step, grounded in the unobservability of individual counterfactual outcomes. It introduces the concept of a projective decision pathway, defined as a framework that integrates trial evidence, mechanistic reasoning, and clinical experience to support anticipatory and corrigible decision-making at the individual level. This version is deposited for timestamping purposes to establish precedence of the conceptual framework and its associated terminology.