Evidence-First, Not Test-First: A Smarter On-Ramp to Precision

Andres Jimenez MD MSED MBA MS

“Advanced diagnostics should never be a reflex—they’re a destination reached after rigorous risk stratification. Start with the fundamentals, then let local environment, lifestyle, and occupational context move risk up or down. Genomics and pharmacogenomics add precision when they intersect with real therapeutic choices—especially where FDA labeling ties variants to safety and dosing. Evidence-first means fewer false alarms, cleaner decisions, and patients who understand why a test is—or isn’t—right for them.” Dr. Andres Jimenez, Board-Certified in Public Health & Prevention, and Clinical Informatics. Founder & CEO of HealthPrevent360

Advanced diagnostics are powerful, but they’re not a starting line—they’re an output of disciplined risk stratification. “Evidence-first” means we begin with what is known and defensible, expand with what is emerging and plausible, and only then consider precision tools where the pre-test probability justifies them.

Start with clinical fundamentals: age, sex, family history, comorbidities, vitals, longitudinal labs, imaging history, medications, and adherence. Then layer context that meaningfully moves risk:

• Environmental hazards: In the West, sustained exposure to wildfire smoke elevates cardiopulmonary risk; in certain regions, radon measurably increases lung cancer risk even in never-smokers. Local water and soil contaminants can alter endocrine or metabolic profiles over time.

• Lifestyle and behavioral factors: sleep restriction, weight cycling, high-risk alcohol patterns, and inactivity shift cardio-metabolic and cognitive trajectories.

• Occupational exposure: shift workers, first responders, industrial settings, and frequent flyers (radiation exposure) each bend risk in different directions.

Next, consider genomics where actionability exists—e.g., hereditary cancer syndromes, familial hypercholesterolemia, cardiomyopathies. For medications, pharmacogenomics matters: hundreds of FDA labeling statements tie specific variants to dosing or drug selection to improve safety and efficacy. PGx is not an indiscriminate screen; it’s a safety amplifier when a patient’s current or likely drug regimen intersects with known gene–drug pairs.

The US FDA maintains a public table of therapeutic products whose drug labeling contains pharmacogenomic biomarker information; for some drugs, labels specify clinical actions based on the biomarker. U.S. Food and Drug

Only after this scaffolding do we evaluate precision diagnostics (e.g., MCED blood tests, cfRNA panels, coronary CT angiography, targeted MRI protocols). The question isn’t “Can we test?” It’s “Will the result change what we do next—and with what net benefit?” That calculus includes downstream workups, false-positive rates, psychological impact, and the patient’s values.

Evidence-first respects concierge time and patient trust. It channels curiosity into clear thresholds and timing, ensuring advanced tools are used when they meaningfully shift risk management—not merely because they exist.

How HP360 can support your concierge practice

Operationalizing Precision—Only When It Changes CareWe help you apply clear thresholds so precision tools are used where pre-test probability and patient values justify them.

• Structured risk tiers that blend clinical + environmental + lifestyle data

• Region-aware hazard inputs (e.g., wildfire smoke, radon, water/soil)

• PGx mapping against the active medication list for safety/efficacy

• Pre-test probability and “change-in-management” checkpoints

• Written stop rules to reduce downstream noise and patient anxiety

Learn About our Concierge Clinic Programs

About Dr. Jimenez

Board-certified physician, triple Ivy League–trained innovator leading the nation’s first prevention-only clinic. Dr. Jimenez has built physician-led technology adopted by 3,000+ hospitals and clinics, guided companies through acquisition and IPO, and serves as Assistant Clinical Professor (Environmental & Public Health) at Mount Sinai School of Medicine in NY. At HealthPrevent360, he applies clinical informatics and prevention science to help individuals anticipate risk, prevent and early-detect disease. The clinic’s prevention engine has analyzed hundreds of thousands of clinical pages and supports thousands of patients.