Merge pull request #448 from MBombeck/release/v1.28.4

release/v1.28.4 — medication efficacy

CHANGELOG.md

@@ -2,6 +2,16 @@
 
 ## [Unreleased]
 
+## [1.28.4] — 2026-07-09 — Medication efficacy
+
+A per-medication "effect" view: see whether a medication is moving the outcome
+it targets, against your own data. The detail page gains a tab that plots the
+target metric (or lab) with the start date, dose changes, and pauses marked, a
+before/after-start comparison, and your adherence overlaid — strictly
+descriptive, never a verdict or dose advice. A compact version surfaces on the
+medication insights area. The target is resolved from the drug's class or its
+name, and you can override which metric a medication is tracked against.
+
 ## [1.28.3] — 2026-07-09 — Consistent spacing and alignment
 
 A consistency pass across the app, driven by a layout audit. Insight cards now

docs/api/openapi.yaml

@@ -1,7 +1,7 @@
 openapi: 3.1.0
 info:
   title: HealthLog API
-  version: 1.28.3
+  version: 1.28.4
   description: >-
     Self-hosted personal-health-tracking PWA — public API surface for the iOS native client and external ingest.
 
@@ -3389,6 +3389,163 @@ paths:
                 $ref: "#/components/schemas/ErrorEnvelope"
         "422": *a3
         "429": *a4
+  /api/medications/{id}/efficacy:
+    get:
+      tags:
+        - Medications
+      summary: Efficacy view for a medication ("Wirkung")
+      description: "Returns the resolved, strictly-descriptive efficacy DTO: the outcome metric(s)/lab(s) the medication's
+        class targets, the target series with start/dose-change/pause markers, a before/after-start comparison, the
+        cadence-aware adherence lane, an optional conservative level-shift note, the data-floor state, and the retarget
+        options. Association-only — there is no verdict / score field. `eligible:false` (with `reason`) marks a one-shot
+        or no-target medication whose tab is hidden."
+      parameters:
+        - in: path
+          name: id
+          schema:
+            type: string
+          required: true
+      responses:
+        "200":
+          description: Efficacy view.
+          content:
+            application/json:
+              schema:
+                $ref: "#/components/schemas/GetMedicationEfficacyResponse"
+        "401": *a1
+        "404":
+          description: Medication not found (or owned by another user).
+          content:
+            application/json:
+              schema:
+                $ref: "#/components/schemas/ErrorEnvelope"
+        "422": *a3
+        "429": *a4
+  /api/medications/{id}/efficacy/target:
+    put:
+      tags:
+        - Medications
+      summary: Set or clear the efficacy-target override
+      description: Persists the user's explicit efficacy target for a medication (the only thing the view stores; everything
+        else is derived each read). Pin exactly one of `measurementType` / `biomarkerId`, or pass `clear:true` to revert
+        to the derived target.
+      parameters:
+        - in: path
+          name: id
+          schema:
+            type: string
+          required: true
+      requestBody:
+        required: true
+        content:
+          application/json:
+            schema:
+              type: object
+              properties:
+                clear:
+                  type: boolean
+                measurementType:
+                  type: string
+                  enum:
+                    - WEIGHT
+                    - BLOOD_PRESSURE_SYS
+                    - BLOOD_PRESSURE_DIA
+                    - PULSE
+                    - BODY_FAT
+                    - SLEEP_DURATION
+                    - ACTIVITY_STEPS
+                    - BLOOD_GLUCOSE
+                    - TOTAL_BODY_WATER
+                    - BONE_MASS
+                    - OXYGEN_SATURATION
+                    - HEART_RATE_VARIABILITY
+                    - RESTING_HEART_RATE
+                    - ACTIVE_ENERGY_BURNED
+                    - FLIGHTS_CLIMBED
+                    - WALKING_RUNNING_DISTANCE
+                    - VO2_MAX
+                    - BODY_TEMPERATURE
+                    - FAT_FREE_MASS
+                    - FAT_MASS
+                    - MUSCLE_MASS
+                    - SKIN_TEMPERATURE
+                    - PULSE_WAVE_VELOCITY
+                    - VASCULAR_AGE
+                    - VISCERAL_FAT
+                    - AUDIO_EXPOSURE_ENV
+                    - AUDIO_EXPOSURE_HEADPHONE
+                    - TIME_IN_DAYLIGHT
+                    - WALKING_STEADINESS
+                    - AUDIO_EXPOSURE_EVENT
+                    - RESPIRATORY_RATE
+                    - BODY_MASS_INDEX
+                    - LEAN_BODY_MASS
+                    - WALKING_HEART_RATE_AVERAGE
+                    - WALKING_ASYMMETRY
+                    - WALKING_DOUBLE_SUPPORT
+                    - WALKING_STEP_LENGTH
+                    - WALKING_SPEED
+                    - CARDIO_RECOVERY
+                    - WRIST_TEMPERATURE
+                    - FALL_COUNT
+                    - SIX_MINUTE_WALK_DISTANCE
+                    - STAIR_ASCENT_SPEED
+                    - STAIR_DESCENT_SPEED
+                    - BREATHING_DISTURBANCES
+                    - IRREGULAR_RHYTHM_NOTIFICATION
+                    - HIGH_HEART_RATE_EVENT
+                    - LOW_HEART_RATE_EVENT
+                    - WALKING_STEADINESS_EVENT
+                    - BREATHING_DISTURBANCE_EVENT
+                    - RECOVERY_SCORE
+                    - STRESS_SCORE
+                    - STRAIN_SCORE
+                    - HRV_RMSSD
+                    - DAY_STRAIN
+                    - WORKOUT_STRAIN
+                    - SLEEP_PERFORMANCE
+                    - SLEEP_EFFICIENCY
+                    - SLEEP_CONSISTENCY
+                    - SLEEP_NEED
+                    - ENERGY_EXPENDITURE_KJ
+                    - AVERAGE_HEART_RATE
+                    - MAX_HEART_RATE
+                    - SLEEP_DISTURBANCE_COUNT
+                    - ANS_CHARGE
+                    - CARDIO_LOAD
+                    - SLEEP_SCORE
+                    - BODY_TEMPERATURE_DEVIATION
+                    - RESILIENCE
+                    - PHQ9_SCORE
+                    - GAD7_SCORE
+                    - GRIP_STRENGTH
+                    - PAIN_NRS
+                    - WAIST_CIRCUMFERENCE
+                    - WAIST_TO_HEIGHT
+                    - WHO5_SCORE
+                    - SCI_SCORE
+                biomarkerId:
+                  type: string
+                  minLength: 1
+                  maxLength: 64
+                primary:
+                  type: boolean
+      responses:
+        "200":
+          description: Override set or cleared.
+          content:
+            application/json:
+              schema:
+                $ref: "#/components/schemas/SetMedicationEfficacyTargetResponse"
+        "401": *a1
+        "404":
+          description: Medication or biomarker not found.
+          content:
+            application/json:
+              schema:
+                $ref: "#/components/schemas/ErrorEnvelope"
+        "422": *a3
+        "429": *a4
   /api/medications/{id}/schedule-revisions:
     get:
       tags:
@@ -17712,6 +17869,354 @@ components:
         - veryLate
       additionalProperties: false
       description: Per-day compliance cell with the timing breakdown that drives the history glyph track.
+    GetMedicationEfficacyResponse:
+      type: object
+      properties:
+        data:
+          type: object
+          properties:
+            medicationId:
+              type: string
+            medicationName:
+              type: string
+            eligible:
+              type: boolean
+            reason:
+              type: string
+              enum:
+                - one_shot
+                - no_target
+            startsOn:
+              anyOf:
+                - type: string
+                - type: "null"
+            resolution:
+              type: object
+              properties:
+                tier:
+                  type: string
+                  enum:
+                    - override
+                    - atc
+                    - name
+                    - none
+                cls:
+                  anyOf:
+                    - type: string
+                    - type: "null"
+              required:
+                - tier
+                - cls
+              additionalProperties: false
+            windowDays:
+              type: integer
+              minimum: -9007199254740991
+              maximum: 9007199254740991
+            minWeeksPerSide:
+              type: integer
+              minimum: -9007199254740991
+              maximum: 9007199254740991
+            markers:
+              type: object
+              properties:
+                start:
+                  anyOf:
+                    - type: string
+                    - type: "null"
+                startSource:
+                  anyOf:
+                    - type: string
+                      enum:
+                        - startsOn
+                        - firstReading
+                    - type: "null"
+                doseChanges:
+                  type: array
+                  items:
+                    type: object
+                    properties:
+                      at:
+                        type: string
+                      label:
+                        type: string
+                    required:
+                      - at
+                      - label
+                    additionalProperties: false
+                pauses:
+                  type: array
+                  items:
+                    type: object
+                    properties:
+                      from:
+                        type: string
+                      to:
+                        anyOf:
+                          - type: string
+                          - type: "null"
+                    required:
+                      - from
+                      - to
+                    additionalProperties: false
+              required:
+                - start
+                - startSource
+                - doseChanges
+                - pauses
+              additionalProperties: false
+            targets:
+              type: array
+              items:
+                type: object
+                properties:
+                  kind:
+                    type: string
+                    enum:
+                      - metric
+                      - lab
+                  key:
+                    type: string
+                  label:
+                    type: string
+                  unit:
+                    anyOf:
+                      - type: string
+                      - type: "null"
+                  primary:
+                    type: boolean
+                  referenceBand:
+                    anyOf:
+                      - type: object
+                        properties:
+                          low:
+                            type: number
+                          high:
+                            type: number
+                        required:
+                          - low
+                          - high
+                        additionalProperties: false
+                      - type: "null"
+                  series:
+                    type: array
+                    items:
+                      type: object
+                      properties:
+                        t:
+                          type: string
+                        value:
+                          type: number
+                        status:
+                          type: string
+                          enum:
+                            - in-range
+                            - below
+                            - above
+                            - unknown
+                      required:
+                        - t
+                        - value
+                      additionalProperties: false
+                  beforeAfter:
+                    type: object
+                    properties:
+                      present:
+                        type: boolean
+                      reason:
+                        type: string
+                        enum:
+                          - insufficient_before
+                          - insufficient_after
+                          - no_start
+                          - no_data
+                      before:
+                        type: object
+                        properties:
+                          mean:
+                            type: number
+                          count:
+                            type: integer
+                            minimum: -9007199254740991
+                            maximum: 9007199254740991
+                          from:
+                            type: string
+                          to:
+                            type: string
+                        required:
+                          - mean
+                          - count
+                          - from
+                          - to
+                        additionalProperties: false
+                      after:
+                        type: object
+                        properties:
+                          mean:
+                            type: number
+                          count:
+                            type: integer
+                            minimum: -9007199254740991
+                            maximum: 9007199254740991
+                          from:
+                            type: string
+                          to:
+                            type: string
+                        required:
+                          - mean
+                          - count
+                          - from
+                          - to
+                        additionalProperties: false
+                      delta:
+                        anyOf:
+                          - type: object
+                            properties:
+                              mean:
+                                type: number
+                              pct:
+                                anyOf:
+                                  - type: number
+                                  - type: "null"
+                            required:
+                              - mean
+                              - pct
+                            additionalProperties: false
+                          - type: "null"
+                    required:
+                      - present
+                    additionalProperties: false
+                  levelShift:
+                    anyOf:
+                      - type: object
+                        properties:
+                          present:
+                            type: boolean
+                          at:
+                            type: string
+                          nearStart:
+                            type: boolean
+                        required:
+                          - present
+                        additionalProperties: false
+                      - type: "null"
+                required:
+                  - kind
+                  - key
+                  - label
+                  - unit
+                  - primary
+                  - referenceBand
+                  - series
+                  - beforeAfter
+                  - levelShift
+                additionalProperties: false
+            adherence:
+              type: array
+              items:
+                type: object
+                properties:
+                  date:
+                    type: string
+                  rate:
+                    type: number
+                  taken:
+                    type: integer
+                    minimum: -9007199254740991
+                    maximum: 9007199254740991
+                  missed:
+                    type: integer
+                    minimum: -9007199254740991
+                    maximum: 9007199254740991
+                required:
+                  - date
+                  - rate
+                  - taken
+                  - missed
+                additionalProperties: false
+            overrideOptions:
+              type: object
+              properties:
+                metrics:
+                  type: array
+                  items:
+                    type: object
+                    properties:
+                      key:
+                        type: string
+                      label:
+                        type: string
+                    required:
+                      - key
+                      - label
+                    additionalProperties: false
+                biomarkers:
+                  type: array
+                  items:
+                    type: object
+                    properties:
+                      id:
+                        type: string
+                      label:
+                        type: string
+                      unit:
+                        type: string
+                    required:
+                      - id
+                      - label
+                      - unit
+                    additionalProperties: false
+              required:
+                - metrics
+                - biomarkers
+              additionalProperties: false
+          required:
+            - medicationId
+            - medicationName
+            - eligible
+            - startsOn
+            - resolution
+            - windowDays
+            - minWeeksPerSide
+            - markers
+            - targets
+            - adherence
+            - overrideOptions
+          additionalProperties: false
+        error:
+          type: "null"
+        meta:
+          type: object
+          properties:
+            requestId:
+              type: string
+          additionalProperties: false
+      required:
+        - data
+        - error
+      additionalProperties: false
+    SetMedicationEfficacyTargetResponse:
+      type: object
+      properties:
+        data:
+          type: object
+          properties:
+            ok:
+              type: boolean
+            cleared:
+              type: boolean
+          additionalProperties: false
+        error:
+          type: "null"
+        meta:
+          type: object
+          properties:
+            requestId:
+              type: string
+          additionalProperties: false
+      required:
+        - data
+        - error
+      additionalProperties: false
     ListScheduleRevisionsResponse:
       type: object
       properties:

messages/de.json

@@ -1593,7 +1593,8 @@
         "verlauf": "Verlauf",
         "injektion": "Injektion",
         "api": "API",
-        "erweitert": "Erweitert"
+        "erweitert": "Erweitert",
+        "wirkung": "Wirkung"
       },
       "shell": {
         "loadFailed": "Dieses Medikament konnte nicht geladen werden.",
@@ -1791,7 +1792,41 @@
     "reorderDescription": "Bestimme die Reihenfolge deiner Medikamente – sie gilt für die Karten- und die Tabellenansicht.",
     "reorderSaved": "Reihenfolge gespeichert",
     "reorderSaveFailed": "Reihenfolge konnte nicht gespeichert werden",
-    "customize": "Medikamente anpassen"
+    "customize": "Medikamente anpassen",
+    "efficacy": {
+      "title": "Wirkung",
+      "intro": "Wie sich die Messwerte, die dieses Medikament beeinflussen soll, rund um den Beginn der Einnahme entwickelt haben. Es zeigt den zeitlichen Zusammenhang – eine Assoziation, keine Ursache – und keine Empfehlung zu Behandlung oder Dosis.",
+      "notEligible": "Für dieses Medikament gibt es keinen zugehörigen Messwert.",
+      "startFallback": "Es ist kein Startdatum hinterlegt, daher dient der erste erfasste Wert als Bezugspunkt.",
+      "noStart": "Hinterlege ein Startdatum, um die Werte vor und nach Beginn zu vergleichen.",
+      "disclaimer": "Nur ein Zusammenhang: Die Zahlen zeigen, was sich im selben Zeitraum verändert hat, nicht dass das Medikament die Veränderung verursacht hat. Besprich Entscheidungen zu deiner Behandlung mit deiner Ärztin oder deinem Arzt.",
+      "primaryBadge": "Hauptziel",
+      "noSeries": "Für diesen Zielwert sind noch keine Messungen erfasst.",
+      "startMarker": "Beginn",
+      "adherenceLane": "Einnahmetreue",
+      "typicalRange": "Üblicher Bereich",
+      "levelShift": "Um {date} wurde eine Verschiebung des Niveaus erkannt.",
+      "retarget": {
+        "label": "Nicht der richtige Messwert?",
+        "placeholder": "Verfolgen anhand…",
+        "apply": "Übernehmen",
+        "reset": "Auf Standard zurücksetzen"
+      },
+      "beforeAfter": {
+        "summary": "Ø {before} davor → Ø {after} seitdem – eine Veränderung von {delta}.",
+        "counts": "Basierend auf {beforeCount} Werten davor und {afterCount} seitdem.",
+        "needBefore": "Noch zu wenige Werte vor dem Beginn – für einen Vergleich werden etwa {weeks} Wochen davor und danach benötigt.",
+        "needAfter": "Noch zu wenige Werte seit dem Beginn – für einen Vergleich werden etwa {weeks} Wochen davor und danach benötigt.",
+        "needStart": "Hinterlege ein Startdatum, um die Werte vor und nach Beginn zu vergleichen.",
+        "needData": "Noch zu wenige Werte – für einen Vergleich werden etwa {weeks} Wochen vor und nach dem Beginn benötigt."
+      },
+      "insights": {
+        "title": "Medikamenten-Wirkung",
+        "subtitle": "Was mit den Zielwerten deiner Medikamente zeitlich zusammenfällt – nur ein Zusammenhang, kein Urteil.",
+        "link": "Wirkung öffnen",
+        "empty": "Noch nicht genug Daten, um deine Medikamente mit ihren Zielwerten in Beziehung zu setzen."
+      }
+    }
   },
   "charts": {
     "loadingLabel": "Diagramm wird geladen…",

messages/en.json

@@ -1593,7 +1593,8 @@
         "verlauf": "History",
         "injektion": "Injection",
         "api": "API",
-        "erweitert": "Advanced"
+        "erweitert": "Advanced",
+        "wirkung": "Effect"
       },
       "shell": {
         "loadFailed": "This medication could not be loaded.",
@@ -1791,7 +1792,41 @@
     "reorderDescription": "Set the order of your medications – it applies to both the card and the table view.",
     "reorderSaved": "Order saved",
     "reorderSaveFailed": "Order could not be saved",
-    "customize": "Customize medications"
+    "customize": "Customize medications",
+    "efficacy": {
+      "title": "Effect",
+      "intro": "How the measurements this medication is meant to influence have moved around the time you started it. It shows what lines up in time — an association, not a cause — and never advice about your treatment or dose.",
+      "notEligible": "There is no outcome to relate this medication to.",
+      "startFallback": "No start date is set, so the comparison uses your first recorded reading as the reference point.",
+      "noStart": "Set a start date for this medication to compare the readings before and after it began.",
+      "disclaimer": "Association only: these figures show what changed over the same period, not that the medication caused the change. Discuss any decision about your treatment with your doctor.",
+      "primaryBadge": "Main target",
+      "noSeries": "No readings recorded for this target yet.",
+      "startMarker": "Start",
+      "adherenceLane": "Adherence",
+      "typicalRange": "Typical range",
+      "levelShift": "A shift in the level was detected around {date}.",
+      "retarget": {
+        "label": "Not the right measurement?",
+        "placeholder": "Track against…",
+        "apply": "Apply",
+        "reset": "Reset to default"
+      },
+      "beforeAfter": {
+        "summary": "Ø {before} before → Ø {after} since — a change of {delta}.",
+        "counts": "Based on {beforeCount} readings before and {afterCount} since.",
+        "needBefore": "Not enough readings before the start yet — about {weeks} weeks are needed before and after to compare.",
+        "needAfter": "Not enough readings since the start yet — about {weeks} weeks are needed before and after to compare.",
+        "needStart": "Set a start date to compare the readings before and after it began.",
+        "needData": "Not enough readings yet — about {weeks} weeks are needed before and after the start to compare."
+      },
+      "insights": {
+        "title": "Medication effect",
+        "subtitle": "What lines up with the measurements your medications target — association only, never a verdict.",
+        "link": "Open the effect view",
+        "empty": "Not enough data yet to relate your medications to their target measurements."
+      }
+    }
   },
   "charts": {
     "loadingLabel": "Loading chart…",

messages/es.json

@@ -1593,7 +1593,8 @@
         "verlauf": "Historial",
         "injektion": "Inyección",
         "api": "API",
-        "erweitert": "Avanzado"
+        "erweitert": "Avanzado",
+        "wirkung": "Efecto"
       },
       "shell": {
         "loadFailed": "No se pudo cargar este medicamento.",
@@ -1791,7 +1792,41 @@
     "reorderDescription": "Define el orden de tus medicamentos: se aplica a la vista de tarjetas y a la de tabla.",
     "reorderSaved": "Orden guardado",
     "reorderSaveFailed": "No se pudo guardar el orden",
-    "customize": "Personalizar medicamentos"
+    "customize": "Personalizar medicamentos",
+    "efficacy": {
+      "title": "Efecto",
+      "intro": "Cómo han evolucionado las mediciones sobre las que actúa este medicamento en torno al momento en que empezaste a tomarlo. Muestra lo que coincide en el tiempo: una asociación, no una causa, y nunca un consejo sobre tu tratamiento o dosis.",
+      "notEligible": "No hay ninguna medición que relacionar con este medicamento.",
+      "startFallback": "No hay fecha de inicio, así que la comparación usa tu primera lectura registrada como referencia.",
+      "noStart": "Añade una fecha de inicio para comparar las lecturas antes y después de empezar.",
+      "disclaimer": "Solo asociación: estas cifras muestran lo que cambió en el mismo periodo, no que el medicamento causara el cambio. Consulta cualquier decisión sobre tu tratamiento con tu médico.",
+      "primaryBadge": "Objetivo principal",
+      "noSeries": "Aún no hay mediciones registradas para este objetivo.",
+      "startMarker": "Inicio",
+      "adherenceLane": "Adherencia",
+      "typicalRange": "Rango habitual",
+      "levelShift": "Se detectó un cambio de nivel en torno a {date}.",
+      "retarget": {
+        "label": "¿No es la medición correcta?",
+        "placeholder": "Seguir según…",
+        "apply": "Aplicar",
+        "reset": "Restablecer al valor predeterminado"
+      },
+      "beforeAfter": {
+        "summary": "Ø {before} antes → Ø {after} desde entonces: un cambio de {delta}.",
+        "counts": "Basado en {beforeCount} lecturas antes y {afterCount} desde entonces.",
+        "needBefore": "Aún no hay suficientes lecturas antes del inicio: se necesitan unas {weeks} semanas antes y después para comparar.",
+        "needAfter": "Aún no hay suficientes lecturas desde el inicio: se necesitan unas {weeks} semanas antes y después para comparar.",
+        "needStart": "Añade una fecha de inicio para comparar las lecturas antes y después de empezar.",
+        "needData": "Aún no hay suficientes lecturas: se necesitan unas {weeks} semanas antes y después del inicio para comparar."
+      },
+      "insights": {
+        "title": "Efecto de la medicación",
+        "subtitle": "Lo que coincide con las mediciones que persiguen tus medicamentos: solo asociación, nunca un veredicto.",
+        "link": "Abrir la vista de efecto",
+        "empty": "Aún no hay suficientes datos para relacionar tus medicamentos con sus mediciones objetivo."
+      }
+    }
   },
   "charts": {
     "loadingLabel": "Cargando la gráfica…",

messages/fr.json

@@ -1593,7 +1593,8 @@
         "verlauf": "Historique",
         "injektion": "Injection",
         "api": "API",
-        "erweitert": "Avancé"
+        "erweitert": "Avancé",
+        "wirkung": "Effet"
       },
       "shell": {
         "loadFailed": "Ce médicament n'a pas pu être chargé.",
@@ -1791,7 +1792,41 @@
     "reorderDescription": "Définis l'ordre de tes médicaments – il s'applique à la vue cartes et à la vue tableau.",
     "reorderSaved": "Ordre enregistré",
     "reorderSaveFailed": "L'ordre n'a pas pu être enregistré",
-    "customize": "Personnaliser les médicaments"
+    "customize": "Personnaliser les médicaments",
+    "efficacy": {
+      "title": "Effet",
+      "intro": "Comment les mesures que ce médicament vise ont évolué autour du moment où vous avez commencé à le prendre. Cela montre ce qui coïncide dans le temps : une association, pas une cause, et jamais un conseil sur votre traitement ou votre dose.",
+      "notEligible": "Aucune mesure à relier à ce médicament.",
+      "startFallback": "Aucune date de début n'est renseignée ; la comparaison utilise donc votre première mesure enregistrée comme référence.",
+      "noStart": "Renseignez une date de début pour comparer les mesures avant et après le début.",
+      "disclaimer": "Association seulement : ces chiffres montrent ce qui a changé sur la même période, pas que le médicament a causé ce changement. Discutez de toute décision concernant votre traitement avec votre médecin.",
+      "primaryBadge": "Cible principale",
+      "noSeries": "Aucune mesure enregistrée pour cette cible pour le moment.",
+      "startMarker": "Début",
+      "adherenceLane": "Observance",
+      "typicalRange": "Plage habituelle",
+      "levelShift": "Un changement de niveau a été détecté autour du {date}.",
+      "retarget": {
+        "label": "Ce n'est pas la bonne mesure ?",
+        "placeholder": "Suivre selon…",
+        "apply": "Appliquer",
+        "reset": "Réinitialiser par défaut"
+      },
+      "beforeAfter": {
+        "summary": "Ø {before} avant → Ø {after} depuis — un écart de {delta}.",
+        "counts": "D'après {beforeCount} mesures avant et {afterCount} depuis.",
+        "needBefore": "Pas encore assez de mesures avant le début — il faut environ {weeks} semaines avant et après pour comparer.",
+        "needAfter": "Pas encore assez de mesures depuis le début — il faut environ {weeks} semaines avant et après pour comparer.",
+        "needStart": "Renseignez une date de début pour comparer les mesures avant et après le début.",
+        "needData": "Pas encore assez de mesures — il faut environ {weeks} semaines avant et après le début pour comparer."
+      },
+      "insights": {
+        "title": "Effet des médicaments",
+        "subtitle": "Ce qui coïncide avec les mesures visées par vos médicaments — association seulement, jamais un verdict.",
+        "link": "Ouvrir la vue Effet",
+        "empty": "Pas encore assez de données pour relier vos médicaments à leurs mesures cibles."
+      }
+    }
   },
   "charts": {
     "loadingLabel": "Chargement du graphique…",

messages/it.json

@@ -1593,7 +1593,8 @@
         "verlauf": "Cronologia",
         "injektion": "Iniezione",
         "api": "API",
-        "erweitert": "Avanzate"
+        "erweitert": "Avanzate",
+        "wirkung": "Effetto"
       },
       "shell": {
         "loadFailed": "Impossibile caricare questo farmaco.",
@@ -1791,7 +1792,41 @@
     "reorderDescription": "Imposta l'ordine dei tuoi farmaci: vale per la vista a schede e per la tabella.",
     "reorderSaved": "Ordine salvato",
     "reorderSaveFailed": "Impossibile salvare l’ordine",
-    "customize": "Personalizza i farmaci"
+    "customize": "Personalizza i farmaci",
+    "efficacy": {
+      "title": "Effetto",
+      "intro": "Come sono cambiate le misurazioni su cui agisce questo farmaco intorno al momento in cui hai iniziato a prenderlo. Mostra ciò che coincide nel tempo: un'associazione, non una causa, e mai un consiglio sul trattamento o sulla dose.",
+      "notEligible": "Non c'è alcuna misurazione da collegare a questo farmaco.",
+      "startFallback": "Non è impostata una data di inizio, quindi il confronto usa la tua prima misurazione registrata come riferimento.",
+      "noStart": "Imposta una data di inizio per confrontare le misurazioni prima e dopo l'avvio.",
+      "disclaimer": "Solo associazione: questi numeri mostrano ciò che è cambiato nello stesso periodo, non che il farmaco abbia causato il cambiamento. Discuti ogni decisione sul tuo trattamento con il medico.",
+      "primaryBadge": "Obiettivo principale",
+      "noSeries": "Nessuna misurazione registrata per questo obiettivo.",
+      "startMarker": "Inizio",
+      "adherenceLane": "Aderenza",
+      "typicalRange": "Intervallo abituale",
+      "levelShift": "È stato rilevato un cambio di livello intorno al {date}.",
+      "retarget": {
+        "label": "Non è la misurazione giusta?",
+        "placeholder": "Monitora in base a…",
+        "apply": "Applica",
+        "reset": "Ripristina predefinito"
+      },
+      "beforeAfter": {
+        "summary": "Ø {before} prima → Ø {after} da allora — una variazione di {delta}.",
+        "counts": "In base a {beforeCount} misurazioni prima e {afterCount} da allora.",
+        "needBefore": "Ancora troppe poche misurazioni prima dell'inizio: servono circa {weeks} settimane prima e dopo per confrontare.",
+        "needAfter": "Ancora troppe poche misurazioni dall'inizio: servono circa {weeks} settimane prima e dopo per confrontare.",
+        "needStart": "Imposta una data di inizio per confrontare le misurazioni prima e dopo l'avvio.",
+        "needData": "Ancora troppe poche misurazioni: servono circa {weeks} settimane prima e dopo l'inizio per confrontare."
+      },
+      "insights": {
+        "title": "Effetto dei farmaci",
+        "subtitle": "Ciò che coincide con le misurazioni a cui mirano i tuoi farmaci: solo associazione, mai un verdetto.",
+        "link": "Apri la vista Effetto",
+        "empty": "Ancora non ci sono dati sufficienti per collegare i tuoi farmaci alle loro misurazioni obiettivo."
+      }
+    }
   },
   "charts": {
     "loadingLabel": "Caricamento del grafico…",

messages/pl.json

@@ -1593,7 +1593,8 @@
         "verlauf": "Historia",
         "injektion": "Iniekcja",
         "api": "API",
-        "erweitert": "Zaawansowane"
+        "erweitert": "Zaawansowane",
+        "wirkung": "Działanie"
       },
       "shell": {
         "loadFailed": "Nie udało się załadować tego leku.",
@@ -1791,7 +1792,41 @@
     "reorderDescription": "Ustal kolejność swoich leków – obowiązuje w widoku kart i w tabeli.",
     "reorderSaved": "Kolejność zapisana",
     "reorderSaveFailed": "Nie udało się zapisać kolejności",
-    "customize": "Dostosuj leki"
+    "customize": "Dostosuj leki",
+    "efficacy": {
+      "title": "Działanie",
+      "intro": "Jak zmieniały się pomiary, na które ma wpływać ten lek, w okolicach rozpoczęcia jego przyjmowania. Pokazuje to, co zbiega się w czasie — powiązanie, nie przyczynę — i nigdy porady dotyczącej leczenia ani dawki.",
+      "notEligible": "Brak pomiaru, który można powiązać z tym lekiem.",
+      "startFallback": "Nie ustawiono daty rozpoczęcia, więc porównanie używa pierwszego zapisanego pomiaru jako punktu odniesienia.",
+      "noStart": "Ustaw datę rozpoczęcia, aby porównać pomiary sprzed i po rozpoczęciu.",
+      "disclaimer": "Tylko powiązanie: te liczby pokazują, co zmieniło się w tym samym okresie, a nie że lek spowodował tę zmianę. Wszelkie decyzje dotyczące leczenia omów z lekarzem.",
+      "primaryBadge": "Główny cel",
+      "noSeries": "Brak zapisanych pomiarów dla tego celu.",
+      "startMarker": "Początek",
+      "adherenceLane": "Regularność",
+      "typicalRange": "Typowy zakres",
+      "levelShift": "Wykryto zmianę poziomu w okolicach {date}.",
+      "retarget": {
+        "label": "To nie ten pomiar?",
+        "placeholder": "Śledź według…",
+        "apply": "Zastosuj",
+        "reset": "Przywróć domyślne"
+      },
+      "beforeAfter": {
+        "summary": "Ø {before} przedtem → Ø {after} od tego czasu — zmiana o {delta}.",
+        "counts": "Na podstawie {beforeCount} pomiarów przedtem i {afterCount} od tego czasu.",
+        "needBefore": "Za mało pomiarów przed rozpoczęciem — do porównania potrzeba około {weeks} tygodni przed i po.",
+        "needAfter": "Za mało pomiarów od rozpoczęcia — do porównania potrzeba około {weeks} tygodni przed i po.",
+        "needStart": "Ustaw datę rozpoczęcia, aby porównać pomiary sprzed i po rozpoczęciu.",
+        "needData": "Za mało pomiarów — do porównania potrzeba około {weeks} tygodni przed i po rozpoczęciu."
+      },
+      "insights": {
+        "title": "Działanie leków",
+        "subtitle": "Co zbiega się w czasie z pomiarami, na które celują Twoje leki — tylko powiązanie, nigdy werdykt.",
+        "link": "Otwórz widok działania",
+        "empty": "Za mało danych, aby powiązać Twoje leki z docelowymi pomiarami."
+      }
+    }
   },
   "charts": {
     "loadingLabel": "Ładowanie wykresu…",

package.json

@@ -1,6 +1,6 @@
 {
   "name": "healthlog",
-  "version": "1.28.3",
+  "version": "1.28.4",
   "description": "Self-hosted personal-health-tracking PWA with Withings integration, AI insights, and doctor-report PDF export.",
   "license": "PolyForm-Noncommercial-1.0.0",
   "homepage": "https://healthlog.dev",

prisma/migrations/0232_medication_efficacy_targets/migration.sql

@@ -0,0 +1,49 @@
+-- Medication efficacy tracking ("Wirkung"): persist ONLY the user's explicit
+-- target override.
+--
+--   `medication_efficacy_targets` — a lean child of `medications`. The
+--   drug-class → outcome resolution (WHO ATC-prefix → whole-word name
+--   inference) is computed each read from the closed in-repo lookup table, so
+--   nothing about a class→outcome association is denormalised (it cannot drift
+--   as the map improves). The ONE thing that must survive is the user's own
+--   pick when they retarget a medication or choose a target for a med the
+--   resolver could not classify — that is this table.
+--
+--   Exactly one of `measurement_type` (a first-class metric series) /
+--   `biomarker_id` (a lab analyte) is set per row; `primary` marks the
+--   storyline-leading target when several are pinned. `medication_id`
+--   cascades (the override dies with the medication); `biomarker_id` sets
+--   null (a deleted biomarker leaves an orphan row the resolver treats as no
+--   override). `user_id` is never a column here — ownership is narrowed
+--   through the parent medication, never a body field.
+--
+-- Additive; applies clean on a 0231 database and on a fresh database as part
+-- of the ordered migration chain.
+
+CREATE TABLE "medication_efficacy_targets" (
+  "id" TEXT NOT NULL,
+  "medication_id" TEXT NOT NULL,
+  "measurement_type" "measurement_type",
+  "biomarker_id" TEXT,
+  "primary" BOOLEAN NOT NULL DEFAULT true,
+  "created_at" TIMESTAMP(3) NOT NULL DEFAULT CURRENT_TIMESTAMP,
+  "updated_at" TIMESTAMP(3) NOT NULL,
+
+  CONSTRAINT "medication_efficacy_targets_pkey" PRIMARY KEY ("id")
+);
+
+CREATE INDEX "medication_efficacy_targets_medication_id_idx"
+  ON "medication_efficacy_targets" ("medication_id");
+
+CREATE INDEX "medication_efficacy_targets_biomarker_id_idx"
+  ON "medication_efficacy_targets" ("biomarker_id");
+
+ALTER TABLE "medication_efficacy_targets"
+  ADD CONSTRAINT "medication_efficacy_targets_medication_id_fkey"
+  FOREIGN KEY ("medication_id") REFERENCES "medications" ("id")
+  ON DELETE CASCADE ON UPDATE CASCADE;
+
+ALTER TABLE "medication_efficacy_targets"
+  ADD CONSTRAINT "medication_efficacy_targets_biomarker_id_fkey"
+  FOREIGN KEY ("biomarker_id") REFERENCES "biomarkers" ("id")
+  ON DELETE SET NULL ON UPDATE CASCADE;

prisma/schema.prisma

@@ -2244,6 +2244,11 @@ model Medication {
   /// single-pause marker the reminder/today surfaces read; the era table
   /// is the additive durable record the rate paths need.
   pauseEras         MedicationPauseEra[]
+  /// v1.28 — user-pinned efficacy target(s) for the "Wirkung" view. Rows
+  /// exist ONLY when the user explicitly overrides the derived (ATC / name)
+  /// target resolution; absence means the resolver derives the target each
+  /// read. Nothing about a class→outcome association is denormalised here.
+  efficacyTargets   MedicationEfficacyTarget[]
 
   user User @relation(fields: [userId], references: [id], onDelete: Cascade)
 
@@ -2252,6 +2257,37 @@ model Medication {
   @@map("medications")
 }
 
+/// v1.28 — the user's explicit override of a medication's efficacy target,
+/// the ONE thing the "Wirkung" view persists. Class→outcome resolution
+/// (ATC-prefix → name inference) is computed each read from the closed
+/// `med-target-map` table, so nothing drifts as that map improves; the only
+/// durable state is the user's own pick when they retarget a medication or
+/// choose a target for a med the resolver could not classify. Exactly one of
+/// `measurementType` (a first-class metric series) / `biomarkerId` (a lab
+/// analyte) is set per row. Cascade-deletes with the medication.
+model MedicationEfficacyTarget {
+  id              String           @id @default(cuid())
+  medicationId    String           @map("medication_id")
+  /// Metric target — one of the closed `MeasurementType` series. NULL when
+  /// this row targets a lab analyte instead.
+  measurementType MeasurementType? @map("measurement_type")
+  /// Lab target — a user-scoped Biomarker. NULL when this row targets a
+  /// metric series instead. SetNull on biomarker delete so the row survives
+  /// as an orphan the resolver then treats as "no override".
+  biomarkerId     String?          @map("biomarker_id")
+  /// The storyline-leading target when several are pinned. Default true.
+  primary         Boolean          @default(true)
+  createdAt       DateTime         @default(now()) @map("created_at")
+  updatedAt       DateTime         @updatedAt @map("updated_at")
+
+  medication Medication @relation(fields: [medicationId], references: [id], onDelete: Cascade)
+  biomarker  Biomarker? @relation(fields: [biomarkerId], references: [id], onDelete: SetNull)
+
+  @@index([medicationId])
+  @@index([biomarkerId])
+  @@map("medication_efficacy_targets")
+}
+
 model MedicationSchedule {
   id                   String                 @id @default(cuid())
   medicationId         String                 @map("medication_id")
@@ -4268,8 +4304,11 @@ model Biomarker {
   createdAt        DateTime @default(now()) @map("created_at")
   updatedAt        DateTime @updatedAt @map("updated_at")
 
-  user    User        @relation(fields: [userId], references: [id], onDelete: Cascade)
-  results LabResult[]
+  user            User                       @relation(fields: [userId], references: [id], onDelete: Cascade)
+  results         LabResult[]
+  /// v1.28 — medications the user has pinned to this biomarker as their
+  /// efficacy target. SetNull on delete keeps the override rows as orphans.
+  efficacyTargets MedicationEfficacyTarget[]
 
   @@unique([userId, name])
   @@index([userId])

public/sw.js

@@ -36,7 +36,7 @@ try {
 // v1.4.38.4 → v1.4.42. Do not hand-edit; bump `package.json` and rebuild.
 const CACHE_VERSION =
   (typeof self !== "undefined" && self.__APP_VERSION__) ||
-  /* @sw-version-fallback */ "v1.28.3";
+  /* @sw-version-fallback */ "v1.28.4";
 const STATIC_CACHE = `healthlog-static-${CACHE_VERSION}`;
 const PAGE_CACHE = `healthlog-pages-${CACHE_VERSION}`;
 // v1.18.6 — read-only data cache for a curated allowlist of safe GET `/api/*`

src/__tests__/medications-efficacy-verb-guard.test.ts

@@ -0,0 +1,105 @@
+/**
+ * v1.28 — banned-verb guard for the `medications.efficacy.*` namespace.
+ *
+ * The medication-efficacy view ("Wirkung") is a medication-adjacent claim, so
+ * its safety boundary is structural, not left to reviewer vigilance: the DTO
+ * carries no verdict / score field, and the copy must stay strictly
+ * descriptive — an association, never "the drug works / is effective", never a
+ * dose change. This test walks every efficacy string in all six locales and
+ * fails if any value contains a verdict or dose-advice verb, so a forbidden
+ * word can never creep into the bundle. Mirrors the `i18n-english-leak-guard`
+ * flatten + filter + `toEqual([])` pattern.
+ *
+ * If this fails: rewrite the offending string to descriptive phrasing (numbers
+ * + neutral connectives). Do NOT weaken the denylist to pass.
+ */
+import { readFileSync, readdirSync } from "node:fs";
+import { join } from "node:path";
+import { describe, it, expect } from "vitest";
+
+const MESSAGES = join(__dirname, "..", "..", "messages");
+const LOCALES = readdirSync(MESSAGES).filter((f) => f.endsWith(".json"));
+
+/** Verdict + efficacy-adjective + dose-advice verbs across the six locales. */
+const BANNED: RegExp[] = [
+  // English
+  /\bworks?\b/i,
+  /\bworking\b/i,
+  /\beffective(ly)?\b/i,
+  /\bineffective\b/i,
+  /\bcures?\b/i,
+  /\bcured\b/i,
+  /\bheals?\b/i,
+  /\bhealed\b/i,
+  /\bimprove(d|s|ment)?\b/i,
+  /\bworsen(ed|s)?\b/i,
+  /\bbetter\b/i,
+  /\bworse\b/i,
+  /\bincrease\b/i,
+  /\bdecrease\b/i,
+  /\breduce\b/i,
+  /\braise\b/i,
+  /\bsuccess(ful)?\b/i,
+  // German
+  /\bwirksam\b/i,
+  /\bunwirksam\b/i,
+  /\banschlägt\b/i,
+  /\bheilt\b/i,
+  /\bverbessert\b/i,
+  /\bverschlechtert\b/i,
+  /\berhöhen\b/i,
+  /\bsenken\b/i,
+  /\babsetzen\b/i,
+  // Spanish
+  /\bfunciona\b/i,
+  /\beficaz\b/i,
+  /\bineficaz\b/i,
+  /\bmejora\b/i,
+  /\bempeora\b/i,
+  // French
+  /\befficace\b/i,
+  /\binefficace\b/i,
+  /\baméliore\b/i,
+  /\baggrave\b/i,
+  // Italian
+  /\bmigliora\b/i,
+  /\bpeggiora\b/i,
+  // Polish
+  /\bskuteczn\w*\b/i,
+  /\bpoprawia\b/i,
+  /\bpogarsza\b/i,
+];
+
+function flatten(obj: unknown, prefix: string, out: [string, string][]): void {
+  if (obj === null || typeof obj !== "object") return;
+  for (const [k, v] of Object.entries(obj as Record<string, unknown>)) {
+    const key = prefix ? `${prefix}.${k}` : k;
+    if (typeof v === "string") out.push([key, v]);
+    else flatten(v, key, out);
+  }
+}
+
+describe("medications.efficacy — banned verdict/advice verbs", () => {
+  it.each(LOCALES)("%s carries no forbidden verb", (file) => {
+    const bundle = JSON.parse(readFileSync(join(MESSAGES, file), "utf8")) as {
+      medications?: { efficacy?: unknown };
+    };
+    const efficacy = bundle.medications?.efficacy;
+    expect(efficacy, `${file} is missing medications.efficacy`).toBeDefined();
+
+    const flat: [string, string][] = [];
+    flatten(efficacy, "medications.efficacy", flat);
+    expect(flat.length).toBeGreaterThan(0);
+
+    const violations = flat
+      .filter(([, value]) => BANNED.some((re) => re.test(value)))
+      .map(([key, value]) => `${key} = ${JSON.stringify(value)}`);
+
+    expect(
+      violations,
+      `Forbidden verdict/advice verb in ${file} — the efficacy view is ` +
+        `association-only. Rewrite to descriptive phrasing:\n` +
+        violations.map((v) => `  ${v}`).join("\n"),
+    ).toEqual([]);
+  });
+});

src/app/api/__tests__/module-route-gate-inventory.test.ts

@@ -204,6 +204,12 @@ const EXEMPT_ROUTES: ReadonlyArray<string> = [
   "src/app/api/medications/[id]/schedule-revisions/[revisionId]/route.ts",
   "src/app/api/medications/[id]/side-effects/route.ts",
   "src/app/api/medications/[id]/side-effects/[logId]/route.ts",
+  // The efficacy read + user-override target share the medication data-layer
+  // reasoning: they compute over the user's own medication + metric/lab rows
+  // and persist only a per-user override. The module gate governs the Wirkung
+  // SURFACE (the detail-page tab + the insights summary), not the row store.
+  "src/app/api/medications/[id]/efficacy/route.ts",
+  "src/app/api/medications/[id]/efficacy/target/route.ts",
   // ── INFRA / UI-ONLY ───────────────────────────────────────────────
   // Static FHIR CapabilityStatement — server metadata, no user data.
   "src/app/api/fhir/metadata/route.ts",

src/app/api/medications/[id]/efficacy/route.ts

@@ -0,0 +1,42 @@
+import { apiHandler, requireAuth } from "@/lib/api-handler";
+import { apiSuccess, apiError } from "@/lib/api-response";
+import { checkRateLimit } from "@/lib/rate-limit";
+import { buildMedicationEfficacy } from "@/lib/medications/efficacy/build-efficacy";
+
+type RouteParams = { params: Promise<{ id: string }> };
+
+/**
+ * GET /api/medications/[id]/efficacy — the resolved, server-authoritative
+ * efficacy DTO for one medication: target(s), the target's series with
+ * start/dose/pause markers, the before/after-start comparison, the adherence
+ * lane, the optional level-shift note, the data-floor state and the retarget
+ * options. Cookie- or Bearer-authenticated (the iOS client reads it). The DTO
+ * is strictly descriptive — no verdict / score field by construction.
+ *
+ * The builder's `findFirst({ where: { id, userId } })` is the ownership gate;
+ * a missing or foreign id yields the sealed "Medication not found" 404, the
+ * same shape `assertMedicationOwnership` mints.
+ */
+export const GET = apiHandler(
+  async (_request: Request, { params }: RouteParams) => {
+    const { user } = await requireAuth();
+    const { id } = await params;
+
+    const rl = await checkRateLimit(
+      `medication-efficacy:${user.id}`,
+      60,
+      60_000,
+    );
+    if (!rl.allowed) {
+      return apiError("Too many efficacy requests. Please retry later.", 429);
+    }
+
+    const userTz = user.timezone || "Europe/Berlin";
+    const dto = await buildMedicationEfficacy(user.id, id, userTz);
+    if (!dto) {
+      return apiError("Medication not found", 404);
+    }
+
+    return apiSuccess(dto);
+  },
+);

src/app/api/medications/[id]/efficacy/target/route.ts

@@ -0,0 +1,100 @@
+import { prisma } from "@/lib/db";
+import { apiHandler, requireAuth } from "@/lib/api-handler";
+import { annotate } from "@/lib/logging/context";
+import {
+  apiSuccess,
+  apiError,
+  returnAllZodIssues,
+  safeJson,
+} from "@/lib/api-response";
+import { assertMedicationOwnership } from "@/lib/medications/route-guards";
+import { efficacyTargetOverrideSchema } from "@/lib/validations/medication-efficacy";
+
+type RouteParams = { params: Promise<{ id: string }> };
+
+/**
+ * PUT /api/medications/[id]/efficacy/target — set or clear the user's explicit
+ * efficacy-target override for a medication. `clear:true` removes the override
+ * rows so the resolver reverts to the derived (ATC / name) target; otherwise
+ * exactly one of `measurementType` / `biomarkerId` pins the new target. The
+ * override is the ONLY thing the "Wirkung" view persists — everything else is
+ * derived each read.
+ *
+ * `userId` is never a body field: ownership is narrowed through the parent
+ * medication (and the biomarker, when a lab target is pinned). The write
+ * builds its `data` object field-by-field (no mass assignment).
+ */
+export const PUT = apiHandler(
+  async (request: Request, { params }: RouteParams) => {
+    const { user } = await requireAuth();
+    const { id } = await params;
+
+    const guard = await assertMedicationOwnership(id, user.id);
+    if (guard) return guard;
+
+    const { data: body, error: jsonError } = await safeJson(request, {
+      maxBytes: 8 * 1024,
+    });
+    if (jsonError) return jsonError;
+
+    const parsed = efficacyTargetOverrideSchema.safeParse(body);
+    if (!parsed.success) {
+      return returnAllZodIssues(parsed.error, 422);
+    }
+    const { clear, measurementType, biomarkerId, primary } = parsed.data;
+
+    // Clearing reverts to the derived resolution — drop every override row.
+    if (clear) {
+      await prisma.medicationEfficacyTarget.deleteMany({
+        where: { medicationId: id },
+      });
+      annotate({
+        action: {
+          name: "medication.efficacy.target.clear",
+          entity_type: "medication",
+          entity_id: id,
+        },
+        meta: {},
+      });
+      return apiSuccess({ cleared: true });
+    }
+
+    // A lab target must reference a biomarker the caller owns.
+    if (biomarkerId) {
+      const biomarker = await prisma.biomarker.findFirst({
+        where: { id: biomarkerId, userId: user.id },
+        select: { id: true },
+      });
+      if (!biomarker) {
+        return apiError("Biomarker not found", 404);
+      }
+    }
+
+    // Replace the override with the single pinned target (field-by-field data).
+    await prisma.$transaction([
+      prisma.medicationEfficacyTarget.deleteMany({
+        where: { medicationId: id },
+      }),
+      prisma.medicationEfficacyTarget.create({
+        data: {
+          medicationId: id,
+          measurementType: measurementType ?? null,
+          biomarkerId: biomarkerId ?? null,
+          primary: primary ?? true,
+        },
+        select: { id: true },
+      }),
+    ]);
+
+    annotate({
+      action: {
+        name: "medication.efficacy.target.set",
+        entity_type: "medication",
+        entity_id: id,
+      },
+      meta: { kind: measurementType ? "metric" : "lab" },
+    });
+
+    return apiSuccess({ ok: true });
+  },
+);

src/app/insights/medications/page.tsx

@@ -17,6 +17,7 @@ import { ComplianceHeatmap } from "@/components/charts/compliance-heatmap";
 import { CoachLaunchButton } from "@/components/insights/coach-launch-button";
 import { InsightStatusCard } from "@/components/insights/insight-status-card";
 import { MetricTargetSummary } from "@/components/insights/metric-target-summary";
+import { MedicationEfficacySummary } from "@/components/insights/medication-efficacy-summary";
 import { SubPageShell } from "@/components/insights/sub-page-shell";
 import { TileHeader } from "@/components/insights/tile-header";
 import { apiGet } from "@/lib/api/api-fetch";
@@ -280,6 +281,13 @@ export default function InsightsMedikamentePage() {
         })}
       </div>
 
+      {/* v1.28 — compact efficacy summary: reuses the same server-computed
+          efficacy DTO the detail-page "Wirkung" tab reads (never a second
+          computation), association-only, linking through to the full view. */}
+      <MedicationEfficacySummary
+        medications={medications.map((m) => ({ id: m.id, name: m.name }))}
+      />
+
       <MetricTargetSummary slug="medications" />
 
       {/* v1.12.2 — the assessment is the LAST block on every bespoke

src/components/charts/chart-runtime.ts

@@ -40,4 +40,5 @@ export { SleepStageStackedBar } from "@/components/insights/sleep-stage-stacked-
 export { LabBiomarkerChart } from "@/components/labs/lab-biomarker-chart";
 export { DoseStrengthCurve } from "@/components/medications/dose-strength-curve";
 export { DrugLevelChart } from "@/components/medications/drug-level-chart";
+export { EfficacyChart } from "@/components/medications/detail/efficacy/efficacy-chart";
 export { AssessmentHistoryChart } from "@/components/mental-health/assessment-history-chart";

src/components/insights/medication-efficacy-summary.tsx

@@ -0,0 +1,126 @@
+"use client";
+
+/**
+ * v1.28 — compact, read-only medication-efficacy summary for the Insights
+ * medication surface. Reads the SAME server-computed efficacy DTO the detail
+ * page's "Wirkung" tab reads (no second computation) and shows, per eligible
+ * medication with enough data, a one-line before/after against its target —
+ * strictly association-framed, never a verdict. Each row links through to the
+ * medication's Wirkung tab for the full view.
+ *
+ * Card anatomy per UI-STANDARDS §8: TileHeader + the inherited `px-4 md:px-6`
+ * inset (never re-declared), foreground for content, muted for meta.
+ */
+import Link from "next/link";
+import { Activity, TrendingUp } from "lucide-react";
+import { useQueries } from "@tanstack/react-query";
+
+import { Card, CardContent, CardHeader } from "@/components/ui/card";
+import { TileHeader } from "@/components/insights/tile-header";
+import { queryKeys } from "@/lib/query-keys";
+import { apiGet } from "@/lib/api/api-fetch";
+import { useTranslations } from "@/lib/i18n/context";
+import type {
+  MedicationEfficacyDTO,
+  EfficacyTargetView,
+} from "@/lib/medications/efficacy/build-efficacy";
+
+function primaryWithDelta(
+  dto: MedicationEfficacyDTO,
+): EfficacyTargetView | null {
+  const withDelta = dto.targets.find(
+    (t) => t.primary && t.beforeAfter.present && t.beforeAfter.delta,
+  );
+  return withDelta ?? null;
+}
+
+export function MedicationEfficacySummary({
+  medications,
+}: {
+  medications: { id: string; name: string }[];
+}) {
+  const { t } = useTranslations();
+
+  const results = useQueries({
+    queries: medications.map((m) => ({
+      queryKey: queryKeys.medicationEfficacy(m.id),
+      queryFn: () =>
+        apiGet<MedicationEfficacyDTO>(`/api/medications/${m.id}/efficacy`),
+      staleTime: 60_000,
+    })),
+  });
+
+  if (medications.length === 0) return null;
+
+  const rows = results
+    .map((r, i) => ({ med: medications[i], dto: r.data }))
+    .filter(
+      (
+        x,
+      ): x is {
+        med: { id: string; name: string };
+        dto: MedicationEfficacyDTO;
+      } => !!x.dto && x.dto.eligible,
+    )
+    .map((x) => ({ med: x.med, target: primaryWithDelta(x.dto) }))
+    .filter((x) => x.target !== null);
+
+  return (
+    <Card data-slot="insights-medication-efficacy">
+      <CardHeader>
+        <TileHeader
+          icon={Activity}
+          title={t("medications.efficacy.insights.title")}
+        />
+        <p className="text-muted-foreground mt-1 text-xs">
+          {t("medications.efficacy.insights.subtitle")}
+        </p>
+      </CardHeader>
+      <CardContent className="space-y-3">
+        {rows.length === 0 ? (
+          <p className="text-muted-foreground text-sm">
+            {t("medications.efficacy.insights.empty")}
+          </p>
+        ) : (
+          <ul className="divide-border/60 divide-y">
+            {rows.map(({ med, target }) => {
+              const ba = target!.beforeAfter;
+              const unit = target!.unit ? ` ${target!.unit}` : "";
+              const arrow = (ba.delta?.mean ?? 0) > 0 ? "+" : "";
+              return (
+                <li
+                  key={med.id}
+                  className="flex flex-wrap items-center justify-between gap-x-3 gap-y-1 py-2.5 first:pt-0 last:pb-0"
+                  data-slot="insights-medication-efficacy-row"
+                >
+                  <div className="min-w-0">
+                    <p className="text-foreground text-sm font-medium">
+                      {med.name}
+                    </p>
+                    <p className="text-muted-foreground flex items-center gap-1.5 text-xs">
+                      <TrendingUp aria-hidden="true" className="h-3.5 w-3.5" />
+                      <span>
+                        {target!.label}: {ba.before?.mean}
+                        {unit} → {ba.after?.mean}
+                        {unit} ({arrow}
+                        {ba.delta?.mean}
+                        {unit})
+                      </span>
+                    </p>
+                  </div>
+                  <Link
+                    href={`/medications/${med.id}?tab=wirkung`}
+                    className="text-primary focus-visible:ring-ring shrink-0 rounded-sm text-xs underline-offset-2 hover:underline focus-visible:ring-2 focus-visible:outline-none"
+                    data-slot="insights-medication-efficacy-link"
+                  >
+                    {t("medications.efficacy.insights.link")}
+                  </Link>
+                </li>
+              );
+            })}
+          </ul>
+        )}
+      </CardContent>
+    </Card>
+  );
+}

src/components/medications/detail/efficacy/efficacy-chart.tsx

@@ -0,0 +1,244 @@
+"use client";
+
+/**
+ * v1.28 — the "Wirkung" target chart. Recharts consumer, so it is exported
+ * through `chart-runtime` and loaded via `next/dynamic` at the call site (the
+ * one-shared-chunk rule). Renders the target series over a span around the
+ * medication's start with:
+ *   - a faint population reference band (context, never a goal line),
+ *   - shaded pause bands,
+ *   - a vertical start marker + quiet dose-change markers,
+ *   - the target line,
+ *   - a faint adherence lane on a hidden right axis.
+ * Strictly descriptive — no colour-coded verdict, no "good/bad" zones.
+ */
+import { useMemo } from "react";
+import {
+  ResponsiveContainer,
+  LineChart,
+  Line,
+  XAxis,
+  YAxis,
+  CartesianGrid,
+  Tooltip,
+  ReferenceLine,
+  ReferenceArea,
+} from "recharts";
+import { makeFormatters } from "@/lib/format-locale";
+import { useTranslations } from "@/lib/i18n/context";
+
+export interface EfficacyChartTarget {
+  label: string;
+  unit: string | null;
+  referenceBand: { low: number; high: number } | null;
+  series: { t: string; value: number }[];
+}
+
+export interface EfficacyChartProps {
+  target: EfficacyChartTarget;
+  startMs: number | null;
+  doseChanges: { at: string; label: string }[];
+  pauses: { from: string; to: string | null }[];
+  adherence: { date: string; rate: number }[];
+  timezone: string;
+  startLabel: string;
+  adherenceLabel: string;
+  typicalRangeLabel: string;
+}
+
+const toMs = (iso: string): number => Date.parse(iso);
+
+export function EfficacyChart({
+  target,
+  startMs,
+  doseChanges,
+  pauses,
+  adherence,
+  timezone,
+  startLabel,
+  adherenceLabel,
+  typicalRangeLabel,
+}: EfficacyChartProps) {
+  const { locale } = useTranslations();
+  const fmt = useMemo(
+    () => makeFormatters(locale, timezone),
+    [locale, timezone],
+  );
+
+  const seriesData = useMemo(
+    () =>
+      target.series
+        .map((p) => ({ t: toMs(p.t), value: p.value }))
+        .filter((p) => Number.isFinite(p.t))
+        .sort((a, b) => a.t - b.t),
+    [target.series],
+  );
+  const adherenceData = useMemo(
+    () =>
+      adherence
+        .map((p) => ({ t: toMs(p.date), rate: p.rate }))
+        .filter((p) => Number.isFinite(p.t))
+        .sort((a, b) => a.t - b.t),
+    [adherence],
+  );
+
+  const domain = useMemo<[number, number] | null>(() => {
+    const xs = [
+      ...seriesData.map((p) => p.t),
+      ...adherenceData.map((p) => p.t),
+    ];
+    if (xs.length === 0) return null;
+    return [Math.min(...xs), Math.max(...xs)];
+  }, [seriesData, adherenceData]);
+
+  if (seriesData.length === 0 || !domain) return null;
+
+  // An open pause runs to the chart's right edge (the latest datum); using the
+  // domain max keeps the render pure (no `Date.now()` in the render body).
+  const rightEdge = domain[1];
+  return (
+    <div className="touch-pan-y">
+      <ResponsiveContainer width="100%" height={220}>
+        <LineChart margin={{ top: 8, right: 8, bottom: 0, left: 0 }}>
+          <CartesianGrid
+            strokeDasharray="3 3"
+            stroke="var(--border)"
+            opacity={0.5}
+          />
+          <XAxis
+            dataKey="t"
+            type="number"
+            scale="time"
+            domain={domain}
+            tick={{ fontSize: 11, fill: "var(--muted-foreground)" }}
+            tickLine={false}
+            axisLine={false}
+            tickFormatter={(v: number) => fmt.date(new Date(v))}
+          />
+          <YAxis
+            yAxisId="target"
+            tick={{ fontSize: 11, fill: "var(--muted-foreground)" }}
+            tickLine={false}
+            axisLine={false}
+            width={40}
+            unit={target.unit ? ` ${target.unit}` : undefined}
+          />
+          <YAxis
+            yAxisId="adherence"
+            orientation="right"
+            domain={[0, 100]}
+            hide
+          />
+
+          {/* Population reference band — faint context, labelled "typical
+              range", explicitly NOT a target line. */}
+          {target.referenceBand ? (
+            <ReferenceArea
+              yAxisId="target"
+              y1={target.referenceBand.low}
+              y2={target.referenceBand.high}
+              fill="var(--muted-foreground)"
+              fillOpacity={0.08}
+              stroke="none"
+              label={{
+                value: typicalRangeLabel,
+                position: "insideTopLeft",
+                fill: "var(--muted-foreground)",
+                fontSize: 10,
+              }}
+            />
+          ) : null}
+
+          {/* Shaded pause bands. An open pause runs to now. */}
+          {pauses.map((p, i) => (
+            <ReferenceArea
+              key={`pause-${i}`}
+              yAxisId="target"
+              x1={toMs(p.from)}
+              x2={p.to ? toMs(p.to) : rightEdge}
+              fill="var(--foreground)"
+              fillOpacity={0.06}
+              stroke="none"
+            />
+          ))}
+
+          {/* Adherence lane — faint, hidden right axis. */}
+          <Line
+            yAxisId="adherence"
+            data={adherenceData}
+            dataKey="rate"
+            name={adherenceLabel}
+            type="stepAfter"
+            stroke="var(--chart-4)"
+            strokeWidth={1.5}
+            strokeOpacity={0.5}
+            dot={false}
+            connectNulls
+            isAnimationActive={false}
+          />
+
+          {/* The target series. */}
+          <Line
+            yAxisId="target"
+            data={seriesData}
+            dataKey="value"
+            name={target.label}
+            type="monotone"
+            stroke="var(--chart-1)"
+            strokeWidth={2}
+            dot={{ r: 2, fill: "var(--chart-1)" }}
+            activeDot={{ r: 4 }}
+            connectNulls
+            isAnimationActive={false}
+          />
+
+          {/* Start marker. */}
+          {startMs !== null ? (
+            <ReferenceLine
+              yAxisId="target"
+              x={startMs}
+              stroke="var(--primary)"
+              strokeWidth={1.5}
+              label={{
+                value: startLabel,
+                position: "insideTopRight",
+                fill: "var(--foreground)",
+                fontSize: 10,
+              }}
+            />
+          ) : null}
+
+          {/* Dose-change markers — quiet, dashed. */}
+          {doseChanges.map((d, i) => (
+            <ReferenceLine
+              key={`dose-${i}`}
+              yAxisId="target"
+              x={toMs(d.at)}
+              stroke="var(--muted-foreground)"
+              strokeDasharray="4 4"
+              strokeOpacity={0.6}
+            />
+          ))}
+
+          <Tooltip
+            contentStyle={{
+              backgroundColor: "var(--card)",
+              border: "1px solid var(--border)",
+              borderRadius: "0.5rem",
+              fontSize: "0.8125rem",
+            }}
+            labelFormatter={(v) => fmt.date(new Date(Number(v)))}
+            formatter={(value, name) => {
+              const num = Number(value);
+              const text =
+                name === adherenceLabel
+                  ? `${Math.round(num)}%`
+                  : `${num}${target.unit ? ` ${target.unit}` : ""}`;
+              return [text, String(name)];
+            }}
+          />
+        </LineChart>
+      </ResponsiveContainer>
+    </div>
+  );
+}

src/components/medications/detail/efficacy/efficacy-tab.tsx

@@ -0,0 +1,381 @@
+"use client";
+
+/**
+ * v1.28 — the "Wirkung" tab body: a strictly-descriptive, association-only
+ * view relating a medication to the outcome metric(s)/lab(s) its class is
+ * prescribed to move, around its start. Reads the server-authoritative
+ * efficacy DTO (`GET /api/medications/[id]/efficacy`) and renders it — it
+ * never recomputes a delta, mean, or adherence rate. No verdict, no score, no
+ * "working / not working" language, no dose advice: the copy is numbers +
+ * neutral connective phrasing only, mirroring the adherence-storyline posture.
+ */
+import { useMemo, useState } from "react";
+import dynamic from "next/dynamic";
+import { Activity, TrendingUp } from "lucide-react";
+import { useQuery, useQueryClient } from "@tanstack/react-query";
+
+import { MedicationDetailSection } from "@/components/medications/medication-detail-section";
+import { TileHeader } from "@/components/insights/tile-header";
+import { Card, CardContent, CardHeader } from "@/components/ui/card";
+import { Button } from "@/components/ui/button";
+import {
+  Select,
+  SelectContent,
+  SelectItem,
+  SelectTrigger,
+  SelectValue,
+} from "@/components/ui/select";
+import { ChartSkeleton } from "@/components/charts/chart-skeleton";
+import { queryKeys } from "@/lib/query-keys";
+import { apiGet, apiPut } from "@/lib/api/api-fetch";
+import { useTranslations } from "@/lib/i18n/context";
+import { useAuth } from "@/hooks/use-auth";
+import { DEFAULT_TIMEZONE } from "@/lib/tz/format";
+import type {
+  MedicationEfficacyDTO,
+  EfficacyTargetView,
+} from "@/lib/medications/efficacy/build-efficacy";
+
+const EfficacyChart = dynamic(
+  () =>
+    import("@/components/charts/chart-runtime").then((mod) => ({
+      default: mod.EfficacyChart,
+    })),
+  { ssr: false, loading: () => <ChartSkeleton /> },
+);
+
+export function EfficacyTab({
+  medicationId,
+  active,
+}: {
+  medicationId: string;
+  active: boolean;
+}) {
+  const { t } = useTranslations();
+  const { user } = useAuth();
+  const timezone = user?.timezone || DEFAULT_TIMEZONE;
+  const queryClient = useQueryClient();
+
+  const { data, isLoading } = useQuery({
+    queryKey: queryKeys.medicationEfficacy(medicationId),
+    queryFn: () =>
+      apiGet<MedicationEfficacyDTO>(
+        `/api/medications/${medicationId}/efficacy`,
+      ),
+    enabled: active,
+    staleTime: 60_000,
+  });
+
+  if (isLoading || !data) {
+    return (
+      <MedicationDetailSection
+        titleId="medication-wirkung-heading"
+        title={t("medications.efficacy.title")}
+        dataSlot="medication-wirkung-section"
+      >
+        <ChartSkeleton />
+      </MedicationDetailSection>
+    );
+  }
+
+  // The tab is hidden upstream when ineligible; this is a defensive fallback.
+  if (!data.eligible) {
+    return (
+      <MedicationDetailSection
+        titleId="medication-wirkung-heading"
+        title={t("medications.efficacy.title")}
+        dataSlot="medication-wirkung-section"
+      >
+        <p className="text-muted-foreground text-sm">
+          {t("medications.efficacy.notEligible")}
+        </p>
+      </MedicationDetailSection>
+    );
+  }
+
+  return (
+    <div className="space-y-6" data-slot="medication-wirkung-section">
+      <MedicationDetailSection
+        titleId="medication-wirkung-heading"
+        title={t("medications.efficacy.title")}
+        dataSlot="medication-wirkung-intro"
+      >
+        <div className="space-y-3">
+          <p className="text-muted-foreground text-sm">
+            {t("medications.efficacy.intro")}
+          </p>
+          {data.markers.startSource === "firstReading" ? (
+            <p className="text-muted-foreground text-xs">
+              {t("medications.efficacy.startFallback")}
+            </p>
+          ) : null}
+          {data.markers.start === null ? (
+            <p className="text-muted-foreground text-xs">
+              {t("medications.efficacy.noStart")}
+            </p>
+          ) : null}
+          <RetargetControl
+            medicationId={medicationId}
+            options={data.overrideOptions}
+            isOverride={data.resolution.tier === "override"}
+            onChanged={() =>
+              queryClient.invalidateQueries({
+                queryKey: queryKeys.medicationEfficacy(medicationId),
+              })
+            }
+          />
+        </div>
+      </MedicationDetailSection>
+
+      {data.targets.map((target) => (
+        <TargetCard
+          key={`${target.kind}:${target.key}`}
+          target={target}
+          dto={data}
+          timezone={timezone}
+        />
+      ))}
+
+      <p
+        className="text-muted-foreground text-xs"
+        data-slot="medication-wirkung-disclaimer"
+      >
+        {t("medications.efficacy.disclaimer")}
+      </p>
+    </div>
+  );
+}
+
+function TargetCard({
+  target,
+  dto,
+  timezone,
+}: {
+  target: EfficacyTargetView;
+  dto: MedicationEfficacyDTO;
+  timezone: string;
+}) {
+  const { t } = useTranslations();
+  const startMs = dto.markers.start ? Date.parse(dto.markers.start) : null;
+
+  return (
+    <Card data-slot={`medication-wirkung-target-${target.kind}`}>
+      <CardHeader>
+        <TileHeader
+          icon={TrendingUp}
+          title={target.label}
+          right={
+            target.primary ? (
+              <span className="text-muted-foreground text-xs">
+                {t("medications.efficacy.primaryBadge")}
+              </span>
+            ) : undefined
+          }
+        />
+      </CardHeader>
+      <CardContent className="space-y-4">
+        {target.series.length > 0 ? (
+          <EfficacyChart
+            target={{
+              label: target.label,
+              unit: target.unit,
+              referenceBand: target.referenceBand,
+              series: target.series.map((p) => ({ t: p.t, value: p.value })),
+            }}
+            startMs={startMs}
+            doseChanges={dto.markers.doseChanges}
+            pauses={dto.markers.pauses}
+            adherence={dto.adherence.map((a) => ({
+              date: a.date,
+              rate: a.rate,
+            }))}
+            timezone={timezone}
+            startLabel={t("medications.efficacy.startMarker")}
+            adherenceLabel={t("medications.efficacy.adherenceLane")}
+            typicalRangeLabel={t("medications.efficacy.typicalRange")}
+          />
+        ) : (
+          <p className="text-muted-foreground text-sm">
+            {t("medications.efficacy.noSeries")}
+          </p>
+        )}
+
+        <BeforeAfterCard target={target} minWeeks={dto.minWeeksPerSide} />
+
+        {target.levelShift?.present && target.levelShift.nearStart ? (
+          <p
+            className="text-muted-foreground text-xs"
+            data-slot="medication-wirkung-levelshift"
+          >
+            {t("medications.efficacy.levelShift", {
+              date: formatShort(target.levelShift.at),
+            })}
+          </p>
+        ) : null}
+      </CardContent>
+    </Card>
+  );
+}
+
+function BeforeAfterCard({
+  target,
+  minWeeks,
+}: {
+  target: EfficacyTargetView;
+  minWeeks: number;
+}) {
+  const { t } = useTranslations();
+  const ba = target.beforeAfter;
+  const unit = target.unit ? ` ${target.unit}` : "";
+
+  if (!ba.present || !ba.before || !ba.after || !ba.delta) {
+    const reasonKey =
+      ba.reason === "insufficient_before"
+        ? "medications.efficacy.beforeAfter.needBefore"
+        : ba.reason === "insufficient_after"
+          ? "medications.efficacy.beforeAfter.needAfter"
+          : ba.reason === "no_start"
+            ? "medications.efficacy.beforeAfter.needStart"
+            : "medications.efficacy.beforeAfter.needData";
+    return (
+      <div
+        className="border-border/60 rounded-lg border border-dashed p-3"
+        data-slot="medication-wirkung-beforeafter-empty"
+      >
+        <p className="text-muted-foreground text-sm">
+          {t(reasonKey, { weeks: minWeeks })}
+        </p>
+      </div>
+    );
+  }
+
+  const arrow = ba.delta.mean > 0 ? "+" : "";
+  return (
+    <div
+      className="bg-muted/40 rounded-lg p-3"
+      data-slot="medication-wirkung-beforeafter"
+    >
+      <p className="text-foreground text-sm">
+        {t("medications.efficacy.beforeAfter.summary", {
+          before: `${ba.before.mean}${unit}`,
+          after: `${ba.after.mean}${unit}`,
+          delta: `${arrow}${ba.delta.mean}${unit}`,
+        })}
+      </p>
+      <p className="text-muted-foreground mt-1 text-xs">
+        {t("medications.efficacy.beforeAfter.counts", {
+          beforeCount: ba.before.count,
+          afterCount: ba.after.count,
+        })}
+      </p>
+    </div>
+  );
+}
+
+function RetargetControl({
+  medicationId,
+  options,
+  isOverride,
+  onChanged,
+}: {
+  medicationId: string;
+  options: MedicationEfficacyDTO["overrideOptions"];
+  isOverride: boolean;
+  onChanged: () => void;
+}) {
+  const { t } = useTranslations();
+  const [value, setValue] = useState<string>("");
+  const [busy, setBusy] = useState(false);
+
+  const items = useMemo(
+    () => [
+      ...options.metrics.map((m) => ({
+        value: `metric:${m.key}`,
+        label: m.label,
+      })),
+      ...options.biomarkers.map((b) => ({
+        value: `lab:${b.id}`,
+        label: b.label,
+      })),
+    ],
+    [options],
+  );
+
+  const apply = async (clear: boolean) => {
+    setBusy(true);
+    try {
+      const body: {
+        clear?: boolean;
+        measurementType?: string;
+        biomarkerId?: string;
+      } = {};
+      if (clear) {
+        body.clear = true;
+      } else if (value.startsWith("metric:")) {
+        body.measurementType = value.slice("metric:".length);
+      } else if (value.startsWith("lab:")) {
+        body.biomarkerId = value.slice("lab:".length);
+      } else {
+        setBusy(false);
+        return;
+      }
+      await apiPut(`/api/medications/${medicationId}/efficacy/target`, body);
+      onChanged();
+      if (clear) setValue("");
+    } finally {
+      setBusy(false);
+    }
+  };
+
+  if (items.length === 0) return null;
+
+  return (
+    <div
+      className="flex flex-wrap items-center gap-2"
+      data-slot="medication-wirkung-retarget"
+    >
+      <Activity aria-hidden="true" className="text-muted-foreground h-4 w-4" />
+      <span className="text-muted-foreground text-xs">
+        {t("medications.efficacy.retarget.label")}
+      </span>
+      <Select value={value} onValueChange={setValue}>
+        <SelectTrigger size="sm" className="w-56">
+          <SelectValue
+            placeholder={t("medications.efficacy.retarget.placeholder")}
+          />
+        </SelectTrigger>
+        <SelectContent>
+          {items.map((it) => (
+            <SelectItem key={it.value} value={it.value}>
+              {it.label}
+            </SelectItem>
+          ))}
+        </SelectContent>
+      </Select>
+      <Button
+        size="sm"
+        variant="outline"
+        disabled={busy || value === ""}
+        onClick={() => apply(false)}
+      >
+        {t("medications.efficacy.retarget.apply")}
+      </Button>
+      {isOverride ? (
+        <Button
+          size="sm"
+          variant="ghost"
+          disabled={busy}
+          onClick={() => apply(true)}
+        >
+          {t("medications.efficacy.retarget.reset")}
+        </Button>
+      ) : null}
+    </div>
+  );
+}
+
+function formatShort(iso?: string): string {
+  if (!iso) return "";
+  const d = new Date(iso);
+  return Number.isNaN(d.getTime()) ? "" : d.toISOString().slice(0, 10);
+}

src/components/medications/detail/medication-detail-tabs.tsx

@@ -46,6 +46,8 @@ import { ArrowLeft, Pencil } from "lucide-react";
 import { Button } from "@/components/ui/button";
 import { Tabs, TabsContent, TabsList, TabsTrigger } from "@/components/ui/tabs";
 import { MedicationDetailSummary } from "@/components/medications/medication-detail-summary";
+import { EfficacyTab } from "@/components/medications/detail/efficacy/efficacy-tab";
+import { resolveMedicationTargets } from "@/lib/medications/med-target-map";
 import { MedicationDetailSection } from "@/components/medications/medication-detail-section";
 import { MedicationComplianceBars } from "@/components/medications/card-parts/medication-compliance-bars";
 import { DoseHistoryLedger } from "@/components/medications/dose-history-ledger";
@@ -157,6 +159,7 @@ export interface MedicationDetailSnapshot {
 // the tab strip render and the `?tab=` round-trip validation.
 const TAB_SLUGS = [
   "uebersicht",
+  "wirkung",
   "zeitplan",
   "bestand",
   "verlauf",
@@ -236,6 +239,21 @@ export function MedicationDetailTabs({
   const isGlp1 = !oneShot && medication.treatmentClass === "GLP1";
   const isInjectable = medication.deliveryForm === "INJECTION";
 
+  // v1.28 — the "Wirkung" tab appears only when the medication resolves to a
+  // known outcome target (ATC class prefix → whole-word name inference) and is
+  // not a single-dose med. Same pure resolver the server efficacy builder's
+  // derived tier uses, so the tab's presence agrees with the DTO's eligibility.
+  const hasEfficacyTarget = useMemo(
+    () =>
+      !oneShot &&
+      resolveMedicationTargets({
+        name: medication.name,
+        treatmentClass: medication.treatmentClass,
+        atcCode: medication.atcCode,
+      }) !== null,
+    [oneShot, medication.name, medication.treatmentClass, medication.atcCode],
+  );
+
   const payload = useMemo(
     () => snapshotToWizardPayload(medication),
     [medication],
@@ -254,9 +272,10 @@ export function MedicationDetailTabs({
       TAB_SLUGS.filter(
         (slug) =>
           (slug !== "injektion" || isInjectable) &&
-          (slug !== "zeitplan" || !asNeeded),
+          (slug !== "zeitplan" || !asNeeded) &&
+          (slug !== "wirkung" || hasEfficacyTarget),
       ),
-    [isInjectable, asNeeded],
+    [isInjectable, asNeeded, hasEfficacyTarget],
   );
 
   const requestedRaw = searchParams?.get("tab");
@@ -535,6 +554,16 @@ export function MedicationDetailTabs({
           )}
         </TabsContent>
 
+        {/* WIRKUNG — the per-medication efficacy view: the outcome metric(s)/
+            lab(s) the drug's class targets, over the span around its start,
+            with a before/after comparison + adherence lane. Strictly
+            descriptive; hidden for one-shot + no-target medications. */}
+        {hasEfficacyTarget && (
+          <TabsContent value="wirkung" className="space-y-6 pt-2">
+            <EfficacyTab medicationId={id} active={activeTab === "wirkung"} />
+          </TabsContent>
+        )}
+
         {/* ZEITPLAN — inline edit of the everyday levers: dose times +
             each dose's on-time window, then the Erinnerung card (the
             notifications switch + the reminder grace, folded in from the

src/lib/medications/__tests__/med-target-map.test.ts

@@ -3,6 +3,8 @@ import {
   inferMedTargetClass,
   primaryTargetForClass,
   MED_TARGET_MAP,
+  resolveMedicationTargets,
+  targetsForEfficacyClass,
 } from "@/lib/medications/med-target-map";
 
 describe("med-target-map — class inference", () => {
@@ -56,3 +58,83 @@ describe("med-target-map — targets", () => {
     expect(MED_TARGET_MAP.glp1).toEqual(["BLOOD_GLUCOSE", "WEIGHT"]);
   });
 });
+
+describe("resolveMedicationTargets — three-tier efficacy resolution", () => {
+  it("prefers the ATC class prefix over the name", () => {
+    // C09 (ACE/ARB) → blood pressure, even when the name is unrecognised.
+    const r = resolveMedicationTargets({
+      name: "SomeUnknownBrand",
+      atcCode: "C09AA05",
+    });
+    expect(r?.tier).toBe("atc");
+    expect(r?.cls).toBe("antihypertensive");
+    expect(r?.targets[0]).toEqual({
+      kind: "metric",
+      measurementType: "BLOOD_PRESSURE_SYS",
+    });
+  });
+
+  it("maps the lipid-modifier ATC class to an LDL lab target", () => {
+    const r = resolveMedicationTargets({ name: "x", atcCode: "C10AA05" });
+    expect(r?.cls).toBe("statin");
+    expect(r?.targets[0]).toEqual({
+      kind: "lab",
+      analyte: "LDL",
+      label: "LDL cholesterol",
+    });
+  });
+
+  it("routes the GLP-1 ATC leaf to glucose+weight, not the A10 fallback", () => {
+    const r = resolveMedicationTargets({ name: "x", atcCode: "A10BJ06" });
+    expect(r?.cls).toBe("glp1");
+    const other = resolveMedicationTargets({ name: "x", atcCode: "A10BA02" });
+    expect(other?.cls).toBe("antidiabetic");
+  });
+
+  it("maps thyroid ATC to a TSH lab target", () => {
+    const r = resolveMedicationTargets({ name: "x", atcCode: "H03AA01" });
+    expect(r?.cls).toBe("thyroid");
+    expect(r?.targets[0].kind).toBe("lab");
+  });
+
+  it("falls back to name inference when no valid ATC code is present", () => {
+    const r = resolveMedicationTargets({ name: "Atorvastatin 20mg" });
+    expect(r?.tier).toBe("name");
+    expect(r?.cls).toBe("statin");
+    const bp = resolveMedicationTargets({ name: "Ramipril" });
+    expect(bp?.tier).toBe("name");
+    expect(bp?.cls).toBe("antihypertensive");
+  });
+
+  it("infers supplement lab targets by name", () => {
+    expect(resolveMedicationTargets({ name: "Cholecalciferol" })?.cls).toBe(
+      "vitamin_d",
+    );
+    expect(
+      resolveMedicationTargets({ name: "Ferrous sulfate 200mg" })?.cls,
+    ).toBe("iron");
+  });
+
+  it("ignores a malformed ATC code and falls through to the name", () => {
+    const r = resolveMedicationTargets({
+      name: "Ramipril",
+      atcCode: "not-an-atc",
+    });
+    expect(r?.tier).toBe("name");
+    expect(r?.cls).toBe("antihypertensive");
+  });
+
+  it("conservative-fails to null for an unknown med with no ATC", () => {
+    expect(resolveMedicationTargets({ name: "Aspirin" })).toBeNull();
+    expect(resolveMedicationTargets({ name: "" })).toBeNull();
+  });
+
+  it("exposes the ordered target list per efficacy class", () => {
+    expect(targetsForEfficacyClass("antihypertensive")).toHaveLength(2);
+    expect(targetsForEfficacyClass("thyroid")[0]).toEqual({
+      kind: "lab",
+      analyte: "TSH",
+      label: "TSH",
+    });
+  });
+});

src/lib/medications/efficacy/__tests__/before-after.test.ts

@@ -0,0 +1,64 @@
+import { describe, it, expect } from "vitest";
+import { beforeAfterFromSeries } from "@/lib/medications/efficacy/build-efficacy";
+
+const DAY = 24 * 60 * 60 * 1000;
+const pivot = Date.parse("2026-03-01T12:00:00Z");
+
+/** Build a run of daily points at a fixed value ending `endOffsetDays` from pivot. */
+function run(
+  value: number,
+  count: number,
+  startOffsetDays: number,
+): { at: number; value: number }[] {
+  return Array.from({ length: count }, (_, i) => ({
+    at: pivot + (startOffsetDays + i) * DAY,
+    value,
+  }));
+}
+
+describe("beforeAfterFromSeries — honest before/after card", () => {
+  it("returns no_start when there is no pivot", () => {
+    expect(beforeAfterFromSeries(run(120, 20, -10), null)).toEqual({
+      present: false,
+      reason: "no_start",
+    });
+  });
+
+  it("flags insufficient_before below the per-side floor", () => {
+    // Only 2 readings before the pivot (floor is 5).
+    const before = run(150, 2, -3);
+    const after = run(132, 10, 0);
+    const r = beforeAfterFromSeries([...before, ...after], pivot);
+    expect(r.present).toBe(false);
+    expect(r.reason).toBe("insufficient_before");
+  });
+
+  it("flags insufficient_after below the per-side floor", () => {
+    const before = run(150, 10, -20);
+    const after = run(132, 2, 0);
+    const r = beforeAfterFromSeries([...before, ...after], pivot);
+    expect(r.present).toBe(false);
+    expect(r.reason).toBe("insufficient_after");
+  });
+
+  it("computes a neutral before/after delta when both sides clear the floor", () => {
+    const before = run(150, 8, -20); // within the 56-day before window
+    const after = run(132, 8, 0);
+    const r = beforeAfterFromSeries([...before, ...after], pivot);
+    expect(r.present).toBe(true);
+    expect(r.before?.mean).toBe(150);
+    expect(r.after?.mean).toBe(132);
+    expect(r.delta?.mean).toBe(-18);
+    expect(r.delta?.pct).toBe(-12);
+  });
+
+  it("excludes readings older than the 56-day before window", () => {
+    // 8 readings but far in the past (beyond the 56-day reach): the before
+    // side falls under the floor, so no fabricated delta.
+    const before = run(150, 8, -120);
+    const after = run(132, 8, 0);
+    const r = beforeAfterFromSeries([...before, ...after], pivot);
+    expect(r.present).toBe(false);
+    expect(r.reason).toBe("insufficient_before");
+  });
+});

src/lib/medications/efficacy/build-efficacy.ts

@@ -0,0 +1,662 @@
+/**
+ * v1.28 — server-authoritative medication-efficacy builder.
+ *
+ * Composes ONE resolved DTO relating a medication to the outcome metric(s) /
+ * lab(s) its class is prescribed to move, over the span around its start:
+ *
+ *   target resolution (override → ATC-prefix → name, `med-target-map`)
+ *     → the target's DAY-mean series (rollup tier) or lab trajectory
+ *     → a before / after-start comparison over the SAME series
+ *     → an adherence lane from `dailyComplianceRatesFromLedger` (never recomputed)
+ *     → an optional conservative level-shift note (`detectChangepoints`)
+ *
+ * Strictly descriptive. There is NO verdict / score / "working" field on the
+ * DTO by construction — the view can only render numbers + neutral connective
+ * phrasing. Honest empty states below the data floor (need N readings before
+ * AND after the start). Mirrors the `adherence-storyline` safety posture:
+ * association-only, never causal, never dose advice. iOS renders the DTO; it
+ * never recomputes a delta or a mean (parity rule).
+ */
+import type { MeasurementType } from "@/generated/prisma/client";
+import { prisma } from "@/lib/db";
+import { annotate } from "@/lib/logging/context";
+import { probeRollupCoverage } from "@/lib/rollups/measurement-coverage";
+import { readDayMeanSeries } from "@/lib/insights/derived/baseline";
+import {
+  buildComplianceMedicationContext,
+  buildMedicationComplianceBundle,
+  dailyComplianceRatesFromLedger,
+  lastNonSkippedTakenAt,
+} from "@/lib/analytics/compliance";
+import {
+  resolveRichMetric,
+  getLabHistory,
+  detectChangepoints,
+} from "@/lib/mcp/rich-reads";
+import {
+  resolveMedicationTargets,
+  type MedTarget,
+  type MedTargetTier,
+} from "@/lib/medications/med-target-map";
+
+const DAY_MS = 24 * 60 * 60 * 1000;
+
+/** Weeks of target data required on EACH side of the start for the delta. */
+const MIN_WEEKS_PER_SIDE = 4;
+/** Distinct readings required on each side before a before/after delta shows. */
+const MIN_READINGS_PER_SIDE = 5;
+/** The before-window the comparison reaches back over from the start. */
+const BEFORE_WINDOW_DAYS = 56;
+/** Series ceiling — the rollup tier caps timelines at one year. */
+const MAX_WINDOW_DAYS = 365;
+/** A detected level shift within this many days of the start reads "near". */
+const CHANGEPOINT_NEAR_START_DAYS = 21;
+
+export interface EfficacySeriesPoint {
+  /** ISO date (YYYY-MM-DD for a metric day-bucket, full instant for a lab). */
+  t: string;
+  value: number;
+  /** Lab-only per-point placement against the reference range. */
+  status?: "in-range" | "below" | "above" | "unknown";
+}
+
+export interface EfficacyBeforeAfter {
+  present: boolean;
+  /** Why the delta is absent — mirrors the tools' honest `{present:false}`. */
+  reason?:
+    "insufficient_before" | "insufficient_after" | "no_start" | "no_data";
+  before?: { mean: number; count: number; from: string; to: string };
+  after?: { mean: number; count: number; from: string; to: string };
+  /** after − before; `pct` relative to before, null when before is 0. */
+  delta?: { mean: number; pct: number | null } | null;
+}
+
+export interface EfficacyLevelShift {
+  present: boolean;
+  /** Bucket-start ISO of the detected shift, when one fired. */
+  at?: string;
+  /** True when the shift sits within tolerance of the start (coincidence). */
+  nearStart?: boolean;
+}
+
+export interface EfficacyTargetView {
+  kind: "metric" | "lab";
+  /** MeasurementType (metric) or the analyte needle (lab). */
+  key: string;
+  label: string;
+  unit: string | null;
+  primary: boolean;
+  referenceBand: { low: number; high: number } | null;
+  series: EfficacySeriesPoint[];
+  beforeAfter: EfficacyBeforeAfter;
+  /** Metric targets only; null for lab targets (changepoint reads metrics). */
+  levelShift: EfficacyLevelShift | null;
+}
+
+export interface EfficacyMarkers {
+  /** The pivot instant (ISO date) — `startsOn`, else the first-reading fallback. */
+  start: string | null;
+  startSource: "startsOn" | "firstReading" | null;
+  doseChanges: { at: string; label: string }[];
+  pauses: { from: string; to: string | null }[];
+}
+
+export interface EfficacyAdherencePoint {
+  date: string;
+  rate: number;
+  taken: number;
+  missed: number;
+}
+
+export interface MedicationEfficacyDTO {
+  medicationId: string;
+  medicationName: string;
+  /** False → the "Wirkung" tab is hidden (oneShot / no target & no override). */
+  eligible: boolean;
+  /** Why the view is not eligible, when it is not. */
+  reason?: "one_shot" | "no_target";
+  startsOn: string | null;
+  resolution: {
+    tier: MedTargetTier | "override" | "none";
+    cls: string | null;
+  };
+  windowDays: number;
+  minWeeksPerSide: number;
+  markers: EfficacyMarkers;
+  targets: EfficacyTargetView[];
+  adherence: EfficacyAdherencePoint[];
+  /** The "not right? pick another" chooser source (user's own signals). */
+  overrideOptions: {
+    metrics: { key: string; label: string }[];
+    biomarkers: { id: string; label: string; unit: string }[];
+  };
+}
+
+/** Curated retarget metrics the fallback chooser offers (client localises). */
+const OVERRIDE_METRIC_OPTIONS: { key: MeasurementType; label: string }[] = [
+  { key: "BLOOD_PRESSURE_SYS", label: "Systolic blood pressure" },
+  { key: "BLOOD_PRESSURE_DIA", label: "Diastolic blood pressure" },
+  { key: "BLOOD_GLUCOSE", label: "Blood glucose" },
+  { key: "WEIGHT", label: "Weight" },
+  { key: "PULSE", label: "Pulse" },
+  { key: "BODY_MASS_INDEX", label: "Body-mass index" },
+];
+
+/** Fixed reference bands for the metric targets `resolveRichMetric` omits. */
+const METRIC_META_FALLBACK: Partial<
+  Record<
+    MeasurementType,
+    { label: string; unit: string; band: { low: number; high: number } | null }
+  >
+> = {
+  BLOOD_PRESSURE_SYS: {
+    label: "Systolic blood pressure",
+    unit: "mmHg",
+    band: { low: 90, high: 120 },
+  },
+  BLOOD_PRESSURE_DIA: {
+    label: "Diastolic blood pressure",
+    unit: "mmHg",
+    band: { low: 60, high: 80 },
+  },
+};
+
+function resolveMetricMeta(mt: MeasurementType): {
+  label: string;
+  unit: string | null;
+  band: { low: number; high: number } | null;
+} {
+  const rich = resolveRichMetric(mt);
+  if (rich) return { label: rich.label, unit: rich.unit, band: rich.band };
+  const fb = METRIC_META_FALLBACK[mt];
+  if (fb) return fb;
+  return { label: mt, unit: null, band: null };
+}
+
+const dayToInstant = (day: string): number =>
+  new Date(`${day}T12:00:00Z`).getTime();
+
+function meanOf(xs: number[]): number {
+  if (xs.length === 0) return 0;
+  return xs.reduce((s, x) => s + x, 0) / xs.length;
+}
+
+const round1 = (n: number): number => Math.round(n * 10) / 10;
+
+/**
+ * Split a chronological value+instant series into before/after the pivot and
+ * emit the honest before/after card. Below the per-side floor the card carries
+ * `{present:false}` with the reason — never a fabricated delta.
+ */
+export function beforeAfterFromSeries(
+  points: { at: number; value: number }[],
+  pivotMs: number | null,
+): EfficacyBeforeAfter {
+  if (pivotMs === null) return { present: false, reason: "no_start" };
+  const beforeFloor = pivotMs - BEFORE_WINDOW_DAYS * DAY_MS;
+  const before = points.filter((p) => p.at >= beforeFloor && p.at < pivotMs);
+  const after = points.filter((p) => p.at >= pivotMs);
+  if (before.length < MIN_READINGS_PER_SIDE) {
+    return { present: false, reason: "insufficient_before" };
+  }
+  if (after.length < MIN_READINGS_PER_SIDE) {
+    return { present: false, reason: "insufficient_after" };
+  }
+  const beforeMean = meanOf(before.map((p) => p.value));
+  const afterMean = meanOf(after.map((p) => p.value));
+  const diff = afterMean - beforeMean;
+  return {
+    present: true,
+    before: {
+      mean: round1(beforeMean),
+      count: before.length,
+      from: new Date(before[0].at).toISOString(),
+      to: new Date(before[before.length - 1].at).toISOString(),
+    },
+    after: {
+      mean: round1(afterMean),
+      count: after.length,
+      from: new Date(after[0].at).toISOString(),
+      to: new Date(after[after.length - 1].at).toISOString(),
+    },
+    delta: {
+      mean: round1(diff),
+      pct:
+        beforeMean !== 0 ? round1((diff / Math.abs(beforeMean)) * 100) : null,
+    },
+  };
+}
+
+/** Build the metric-target view (day-mean series + before/after + changepoint). */
+async function buildMetricTarget(
+  userId: string,
+  mt: MeasurementType,
+  primary: boolean,
+  pivotMs: number | null,
+  windowDays: number,
+  now: Date,
+  coverage: Awaited<ReturnType<typeof probeRollupCoverage>>,
+): Promise<EfficacyTargetView> {
+  const meta = resolveMetricMeta(mt);
+  const { points } = await readDayMeanSeries(
+    userId,
+    mt,
+    windowDays,
+    now,
+    coverage,
+  );
+  const series: EfficacySeriesPoint[] = points.map((p) => ({
+    t: p.day,
+    value: round1(p.mean),
+  }));
+  const straddle = points.map((p) => ({
+    at: dayToInstant(p.day),
+    value: p.mean,
+  }));
+
+  // Level-shift note — metric targets only, and only when the metric resolves
+  // through the rich-read resolver (blood pressure is multi-series and does
+  // not, so it carries no changepoint note by construction).
+  let levelShift: EfficacyLevelShift | null = null;
+  if (resolveRichMetric(mt)) {
+    const cp = await detectChangepoints(userId, {
+      metric: mt,
+      window: "lastYear",
+    });
+    if (
+      cp.present &&
+      cp.changepoints &&
+      cp.changepoints.length > 0 &&
+      pivotMs !== null
+    ) {
+      const nearest = cp.changepoints
+        .map((c) => ({ at: c.at, dist: Math.abs(Date.parse(c.at) - pivotMs) }))
+        .sort((a, b) => a.dist - b.dist)[0];
+      levelShift = {
+        present: true,
+        at: nearest.at,
+        nearStart: nearest.dist <= CHANGEPOINT_NEAR_START_DAYS * DAY_MS,
+      };
+    } else {
+      levelShift = { present: false };
+    }
+  }
+
+  return {
+    kind: "metric",
+    key: mt,
+    label: meta.label,
+    unit: meta.unit,
+    primary,
+    referenceBand: meta.band,
+    series,
+    beforeAfter: beforeAfterFromSeries(straddle, pivotMs),
+    levelShift,
+  };
+}
+
+/** Build the lab-target view (analyte trajectory + before/after over readings). */
+async function buildLabTarget(
+  userId: string,
+  analyte: string,
+  label: string,
+  primary: boolean,
+  pivotMs: number | null,
+): Promise<EfficacyTargetView> {
+  const hist = await getLabHistory(userId, { analyte, limit: 50 });
+  const readings = (hist.present ? (hist.readings ?? []) : [])
+    .filter((r) => r.value !== null)
+    .slice()
+    // getLabHistory returns newest-first; the view + before/after want oldest-first.
+    .sort((a, b) => Date.parse(a.takenAt) - Date.parse(b.takenAt));
+
+  const unit = readings[0]?.unit ?? null;
+  const withBounds = readings.find(
+    (r) => r.referenceLow !== null || r.referenceHigh !== null,
+  );
+  const referenceBand =
+    withBounds &&
+    withBounds.referenceLow !== null &&
+    withBounds.referenceHigh !== null
+      ? { low: withBounds.referenceLow, high: withBounds.referenceHigh }
+      : null;
+
+  const series: EfficacySeriesPoint[] = readings.map((r) => ({
+    t: r.takenAt,
+    value: r.value as number,
+    status: r.rangeStatus,
+  }));
+  const straddle = readings.map((r) => ({
+    at: Date.parse(r.takenAt),
+    value: r.value as number,
+  }));
+
+  return {
+    kind: "lab",
+    key: analyte,
+    label,
+    unit,
+    primary,
+    referenceBand,
+    series,
+    beforeAfter: beforeAfterFromSeries(straddle, pivotMs),
+    levelShift: null,
+  };
+}
+
+/**
+ * Resolve the effective targets for a medication: the user's persisted
+ * override wins (tier "override"); otherwise the derived ATC/name resolution.
+ * Returns the tier + class provenance for the DTO alongside the target list.
+ */
+async function resolveEffectiveTargets(med: {
+  id: string;
+  name: string;
+  treatmentClass: string;
+  atcCode: string | null;
+}): Promise<{
+  tier: MedTargetTier | "override" | "none";
+  cls: string | null;
+  targets: MedTarget[];
+}> {
+  const overrides = await prisma.medicationEfficacyTarget.findMany({
+    where: { medicationId: med.id },
+    orderBy: [{ primary: "desc" }, { createdAt: "asc" }],
+    select: {
+      measurementType: true,
+      primary: true,
+      biomarker: { select: { name: true } },
+    },
+  });
+  const overrideTargets: MedTarget[] = [];
+  for (const row of overrides) {
+    if (row.measurementType) {
+      overrideTargets.push({
+        kind: "metric",
+        measurementType: row.measurementType,
+      });
+    } else if (row.biomarker) {
+      overrideTargets.push({
+        kind: "lab",
+        analyte: row.biomarker.name,
+        label: row.biomarker.name,
+      });
+    }
+  }
+  if (overrideTargets.length > 0) {
+    return { tier: "override", cls: null, targets: overrideTargets };
+  }
+
+  const derived = resolveMedicationTargets({
+    name: med.name,
+    treatmentClass: med.treatmentClass,
+    atcCode: med.atcCode,
+  });
+  if (derived) {
+    return {
+      tier: derived.tier,
+      cls: derived.cls,
+      targets: [...derived.targets],
+    };
+  }
+  return { tier: "none", cls: null, targets: [] };
+}
+
+/**
+ * Build the full efficacy DTO for one medication the caller owns. The caller
+ * (route / server component) is responsible for the ownership gate; this
+ * builder reads only rows scoped to `userId` / the owned medication.
+ */
+export async function buildMedicationEfficacy(
+  userId: string,
+  medicationId: string,
+  timezone: string,
+  now: Date = new Date(),
+): Promise<MedicationEfficacyDTO | null> {
+  const med = await prisma.medication.findFirst({
+    where: { id: medicationId, userId },
+    include: {
+      schedules: true,
+      scheduleRevisions: { orderBy: { validFrom: "asc" } },
+      pauseEras: { select: { pausedAt: true, resumedAt: true } },
+      doseChanges: { orderBy: { effectiveFrom: "asc" } },
+    },
+  });
+  if (!med) return null;
+
+  const startsOnIso = med.startsOn ? med.startsOn.toISOString() : null;
+  const baseDto = {
+    medicationId: med.id,
+    medicationName: med.name,
+    startsOn: startsOnIso,
+    minWeeksPerSide: MIN_WEEKS_PER_SIDE,
+  };
+
+  // One-shot meds have a single administration and no trend to relate.
+  if (med.oneShot) {
+    annotate({
+      action: {
+        name: "medication.efficacy.build",
+        entity_type: "medication",
+        entity_id: med.id,
+      },
+      meta: { eligible: false, reason: "one_shot" },
+    });
+    return {
+      ...baseDto,
+      eligible: false,
+      reason: "one_shot",
+      resolution: { tier: "none", cls: null },
+      windowDays: 0,
+      markers: { start: null, startSource: null, doseChanges: [], pauses: [] },
+      targets: [],
+      adherence: [],
+      overrideOptions: { metrics: [], biomarkers: [] },
+    };
+  }
+
+  const resolved = await resolveEffectiveTargets({
+    id: med.id,
+    name: med.name,
+    treatmentClass: med.treatmentClass,
+    atcCode: med.atcCode ?? null,
+  });
+
+  // The user's own retarget options (fallback chooser) — always attached.
+  const biomarkerRows = await prisma.biomarker.findMany({
+    where: { userId, hidden: false },
+    orderBy: { name: "asc" },
+    select: { id: true, name: true, unit: true },
+  });
+  const overrideOptions = {
+    metrics: OVERRIDE_METRIC_OPTIONS.map((m) => ({
+      key: m.key,
+      label: m.label,
+    })),
+    biomarkers: biomarkerRows.map((b) => ({
+      id: b.id,
+      label: b.name,
+      unit: b.unit,
+    })),
+  };
+
+  if (resolved.targets.length === 0) {
+    annotate({
+      action: {
+        name: "medication.efficacy.build",
+        entity_type: "medication",
+        entity_id: med.id,
+      },
+      meta: { eligible: false, reason: "no_target" },
+    });
+    return {
+      ...baseDto,
+      eligible: false,
+      reason: "no_target",
+      resolution: { tier: "none", cls: null },
+      windowDays: 0,
+      markers: { start: null, startSource: null, doseChanges: [], pauses: [] },
+      targets: [],
+      adherence: [],
+      overrideOptions,
+    };
+  }
+
+  // Pivot: `startsOn` when present; else the first reading of the primary
+  // target (captioned as a fallback); else null (the before/after card then
+  // renders the honest "set a start date" empty state).
+  const coverage = await probeRollupCoverage(userId);
+  let pivotMs = med.startsOn ? med.startsOn.getTime() : null;
+  let startSource: "startsOn" | "firstReading" | null = med.startsOn
+    ? "startsOn"
+    : null;
+
+  // Establish a window that spans well before the pivot through today.
+  const spanFromPivot = pivotMs !== null ? now.getTime() - pivotMs : 0;
+  const windowDays = Math.min(
+    MAX_WINDOW_DAYS,
+    Math.max(
+      90,
+      Math.ceil((spanFromPivot + BEFORE_WINDOW_DAYS * DAY_MS) / DAY_MS),
+    ),
+  );
+
+  // Build each target view. Fallback pivot uses the primary metric's first day.
+  const targets: EfficacyTargetView[] = [];
+  for (let i = 0; i < resolved.targets.length; i++) {
+    const target = resolved.targets[i];
+    const primary = i === 0;
+    if (target.kind === "metric") {
+      const view = await buildMetricTarget(
+        userId,
+        target.measurementType,
+        primary,
+        pivotMs,
+        windowDays,
+        now,
+        coverage,
+      );
+      // Legacy no-start med: fall back to the primary metric's first reading.
+      if (primary && pivotMs === null && view.series.length > 0) {
+        pivotMs = dayToInstant(view.series[0].t);
+        startSource = "firstReading";
+        view.beforeAfter = beforeAfterFromSeries(
+          view.series.map((p) => ({ at: dayToInstant(p.t), value: p.value })),
+          pivotMs,
+        );
+      }
+      targets.push(view);
+    } else {
+      const view = await buildLabTarget(
+        userId,
+        target.analyte,
+        target.label,
+        primary,
+        pivotMs,
+      );
+      if (primary && pivotMs === null && view.series.length > 0) {
+        pivotMs = Date.parse(view.series[0].t);
+        startSource = "firstReading";
+        view.beforeAfter = beforeAfterFromSeries(
+          view.series.map((p) => ({ at: Date.parse(p.t), value: p.value })),
+          pivotMs,
+        );
+      }
+      targets.push(view);
+    }
+  }
+
+  // Adherence lane — the cadence-aware per-day rate from the SAME ledger the
+  // compliance surfaces read; never recomputed here.
+  const fetchFrom = new Date(
+    Math.max(med.createdAt.getTime(), now.getTime() - windowDays * DAY_MS),
+  );
+  const events = await prisma.medicationIntakeEvent.findMany({
+    where: {
+      medicationId: med.id,
+      userId,
+      deletedAt: null,
+      scheduledFor: { gte: fetchFrom },
+    },
+    orderBy: { scheduledFor: "desc" },
+    select: {
+      takenAt: true,
+      skipped: true,
+      scheduledFor: true,
+      autoMissed: true,
+      attributionSource: true,
+    },
+  });
+  const ctx = buildComplianceMedicationContext(
+    med,
+    lastNonSkippedTakenAt(events),
+    timezone,
+  );
+  const bundle = buildMedicationComplianceBundle(
+    events,
+    med.schedules,
+    ctx,
+    now,
+  );
+  const windowFloorMs =
+    pivotMs !== null
+      ? pivotMs - BEFORE_WINDOW_DAYS * DAY_MS
+      : fetchFrom.getTime();
+  const adherence: EfficacyAdherencePoint[] = dailyComplianceRatesFromLedger(
+    bundle.ledgerRows,
+    timezone,
+  )
+    .filter((d) => d.date.getTime() >= windowFloorMs)
+    .map((d) => ({
+      date: d.date.toISOString(),
+      rate: d.rate,
+      taken: d.taken,
+      missed: d.missed,
+    }));
+
+  // Markers — dose changes + pause bands intersecting the window.
+  const doseChanges = med.doseChanges
+    .filter((dc) => dc.effectiveFrom.getTime() >= windowFloorMs)
+    .map((dc) => ({
+      at: dc.effectiveFrom.toISOString(),
+      label: `${dc.doseValue} ${dc.doseUnit}`.trim(),
+    }));
+  const pauses = med.pauseEras
+    .filter((p) => (p.resumedAt?.getTime() ?? now.getTime()) >= windowFloorMs)
+    .map((p) => ({
+      from: p.pausedAt.toISOString(),
+      to: p.resumedAt ? p.resumedAt.toISOString() : null,
+    }));
+
+  annotate({
+    action: {
+      name: "medication.efficacy.build",
+      entity_type: "medication",
+      entity_id: med.id,
+    },
+    meta: {
+      eligible: true,
+      tier: resolved.tier,
+      cls: resolved.cls,
+      targetCount: targets.length,
+      startSource: startSource ?? "none",
+      windowDays,
+    },
+  });
+
+  return {
+    ...baseDto,
+    eligible: true,
+    resolution: { tier: resolved.tier, cls: resolved.cls },
+    windowDays,
+    markers: {
+      start: pivotMs !== null ? new Date(pivotMs).toISOString() : null,
+      startSource,
+      doseChanges,
+      pauses,
+    },
+    targets,
+    adherence,
+    overrideOptions,
+  };
+}

src/lib/medications/med-target-map.ts

@@ -158,3 +158,199 @@ export function inferMedTargetClass(
   }
   return null;
 }
+
+// ─── v1.28 efficacy resolver (extends the closed map above) ───────────
+//
+// The efficacy view ("Wirkung" tab + the Insights summary) needs a target
+// resolver that (a) can point at LAB analytes (statin→LDL, thyroid→TSH,
+// supplements→their marker) — the documented follow-on the v1.22 map left
+// out — and (b) consults the WHO ATC class prefix on `Medication.atcCode`
+// before falling back to name inference. It is ADDITIVE: the metric-only
+// `MED_TARGET_MAP` / `inferMedTargetClass` / `primaryTargetForClass` above
+// stay byte-identical so the adherence-storyline safety path is untouched.
+//
+// Same discipline as the map above: closed tables, whole-word / fixed-prefix
+// matching, conservative-fail to an EMPTY target list (never a guess). The
+// clinical association ("this class is prescribed to move this outcome") is
+// documented, guideline-cited and vendor-blind in the external knowledge base
+// (`medications/drug-class-targets.md`); this code is its mechanical mirror.
+// No efficacy claim is encoded here — only what a class is prescribed to move.
+
+/**
+ * A resolved target: either a first-class measurement series or a lab analyte.
+ * The lab variant carries a `contains`-match needle (matched against a
+ * `LabResult.analyte` or the linked `Biomarker.name`, exactly as
+ * `getLabHistory` matches) plus a human label for the DTO / UI.
+ */
+export type MedTarget =
+  | { kind: "metric"; measurementType: MeasurementType }
+  | { kind: "lab"; analyte: string; label: string };
+
+/**
+ * The wider class set the efficacy resolver reasons about: the three
+ * metric classes above plus the lab-analyte classes (statin→LDL,
+ * thyroid→TSH) and the two supplement markers named in the plan.
+ */
+export type EfficacyMedClass =
+  MedTargetClass | "statin" | "thyroid" | "vitamin_d" | "iron";
+
+/** Class → its ordered target list (primary first). Closed + conservative. */
+const EFFICACY_TARGETS: Readonly<
+  Record<EfficacyMedClass, readonly MedTarget[]>
+> = {
+  antihypertensive: [
+    { kind: "metric", measurementType: "BLOOD_PRESSURE_SYS" },
+    { kind: "metric", measurementType: "BLOOD_PRESSURE_DIA" },
+  ],
+  antidiabetic: [{ kind: "metric", measurementType: "BLOOD_GLUCOSE" }],
+  glp1: [
+    { kind: "metric", measurementType: "WEIGHT" },
+    { kind: "metric", measurementType: "BLOOD_GLUCOSE" },
+  ],
+  // Lipid-modifiers (statins et al.) are monitored on LDL — a lab analyte.
+  statin: [{ kind: "lab", analyte: "LDL", label: "LDL cholesterol" }],
+  // Thyroid therapy is titrated against TSH — a lab analyte.
+  thyroid: [{ kind: "lab", analyte: "TSH", label: "TSH" }],
+  // Supplements are tracked against their own marker.
+  vitamin_d: [
+    { kind: "lab", analyte: "Vitamin D", label: "Vitamin D (25-OH)" },
+  ],
+  iron: [{ kind: "lab", analyte: "Ferritin", label: "Ferritin" }],
+} as const;
+
+/**
+ * WHO ATC class-prefix → efficacy class. Prefix-level ONLY (the class the
+ * substance belongs to), never a specific-product claim. Longer prefixes are
+ * tested first so `A10BJ` (GLP-1/GIP agonists) wins over the `A10` fallback.
+ * The prefix is upper-cased + validated against the `atcCode` shape before use.
+ */
+const ATC_PREFIX_CLASS: ReadonlyArray<readonly [string, EfficacyMedClass]> = [
+  // Antidiabetics: GLP-1 / GIP agonists move glucose AND weight; the rest of
+  // A10 (metformin, sulfonylureas, SGLT2, DPP-4, insulin) move glucose.
+  ["A10BJ", "glp1"],
+  ["A10", "antidiabetic"],
+  // Cardiovascular: antihypertensives (C02 other, C03 diuretics, C07 beta
+  // blockers, C08 CCB, C09 ACE/ARB) → blood pressure.
+  ["C02", "antihypertensive"],
+  ["C03", "antihypertensive"],
+  ["C07", "antihypertensive"],
+  ["C08", "antihypertensive"],
+  ["C09", "antihypertensive"],
+  // Lipid-modifying agents → LDL.
+  ["C10", "statin"],
+  // Thyroid therapy → TSH.
+  ["H03A", "thyroid"],
+  // Vitamin D / analogues (A11CC) and vitamin-D-only combos (A11CB).
+  ["A11CC", "vitamin_d"],
+  ["A11CB", "vitamin_d"],
+  // Iron preparations (oral B03AA/AB/AD/AE, parenteral B03AC).
+  ["B03A", "iron"],
+];
+
+const ATC_CODE_RE = /^[A-Z]\d{2}[A-Z]{2}\d{2}$/;
+
+/** Whole-word name needles for the lab classes (metric classes stay above). */
+const STATIN_NEEDLES: readonly string[] = [
+  "atorvastatin",
+  "simvastatin",
+  "rosuvastatin",
+  "pravastatin",
+  "fluvastatin",
+  "lovastatin",
+  "pitavastatin",
+  "ezetimibe",
+];
+const THYROID_NEEDLES: readonly string[] = [
+  "levothyroxine",
+  "liothyronine",
+  "thyroxine",
+  "euthyrox",
+];
+const VITAMIN_D_NEEDLES: readonly string[] = [
+  "cholecalciferol",
+  "colecalciferol",
+  "ergocalciferol",
+  "calcifediol",
+  "calcitriol",
+];
+const IRON_NEEDLES: readonly string[] = [
+  "ferrous",
+  "ferric",
+  "iron bisglycinate",
+];
+
+/** Resolve a med's efficacy class from its ATC prefix, or `null`. */
+function classFromAtc(
+  atcCode: string | null | undefined,
+): EfficacyMedClass | null {
+  if (!atcCode) return null;
+  const code = atcCode.trim().toUpperCase();
+  if (!ATC_CODE_RE.test(code)) return null;
+  for (const [prefix, cls] of ATC_PREFIX_CLASS) {
+    if (code.startsWith(prefix)) return cls;
+  }
+  return null;
+}
+
+/** Resolve a med's efficacy class from its name (metric + lab needles). */
+function classFromName(
+  name: string,
+  treatmentClass?: string | null,
+): EfficacyMedClass | null {
+  // Metric classes stay authoritative through the existing inferer.
+  const metricClass = inferMedTargetClass(name, treatmentClass);
+  if (metricClass) return metricClass;
+
+  const normalised = normaliseName(name);
+  if (!normalised) return null;
+  if (STATIN_NEEDLES.some((n) => containsWord(normalised, n))) return "statin";
+  if (THYROID_NEEDLES.some((n) => containsWord(normalised, n)))
+    return "thyroid";
+  if (VITAMIN_D_NEEDLES.some((n) => containsWord(normalised, n))) {
+    return "vitamin_d";
+  }
+  if (IRON_NEEDLES.some((n) => containsWord(normalised, n))) return "iron";
+  return null;
+}
+
+/** The tier a target list was resolved through (provenance for the DTO/UI). */
+export type MedTargetTier = "atc" | "name";
+
+export interface ResolvedMedTargets {
+  cls: EfficacyMedClass;
+  tier: MedTargetTier;
+  targets: readonly MedTarget[];
+}
+
+/**
+ * Resolve the derived (non-override) efficacy targets for a medication:
+ * ATC class-prefix FIRST (the guideline-native class key), then whole-word
+ * name inference. Returns `null` when no class is confidently known — the
+ * caller then falls back to the user's own explicit pick (tier 1, persisted)
+ * or the "track this against…" chooser. Never guesses a target.
+ *
+ * Tier 1 (user override) is NOT resolved here — it is persisted and applied by
+ * the server efficacy builder, which layers it on top of this derived result.
+ */
+export function resolveMedicationTargets(med: {
+  name: string;
+  treatmentClass?: string | null;
+  atcCode?: string | null;
+}): ResolvedMedTargets | null {
+  const viaAtc = classFromAtc(med.atcCode);
+  if (viaAtc) {
+    return { cls: viaAtc, tier: "atc", targets: EFFICACY_TARGETS[viaAtc] };
+  }
+  const viaName = classFromName(med.name, med.treatmentClass);
+  if (viaName) {
+    return { cls: viaName, tier: "name", targets: EFFICACY_TARGETS[viaName] };
+  }
+  return null;
+}
+
+/** The ordered target list for an efficacy class (primary first). */
+export function targetsForEfficacyClass(
+  cls: EfficacyMedClass,
+): readonly MedTarget[] {
+  return EFFICACY_TARGETS[cls];
+}

src/lib/openapi/routes/medications/paths.ts

@@ -17,7 +17,23 @@ import {
   scheduleRevisionCreateSchema,
   scheduleRevisionUpdateSchema,
 } from "@/lib/validations/schedule-revision";
+import {
+  efficacyTargetOverrideSchema,
+  medicationEfficacyResponseSchema,
+} from "@/lib/validations/medication-efficacy";
 import { dataEnvelope, errorEnvelope, stdResponses } from "../shared";
+
+efficacyTargetOverrideSchema.meta({
+  id: "SetMedicationEfficacyTargetRequest",
+  description:
+    "Set or clear the user's explicit efficacy-target override for a medication. `clear:true` removes the override so the resolver reverts to the derived (ATC class prefix → name inference) target; otherwise pin exactly ONE of `measurementType` (a metric series) / `biomarkerId` (a lab analyte). `userId` is never a field — ownership is narrowed through the medication (and the biomarker for a lab target).",
+});
+
+medicationEfficacyResponseSchema.meta({
+  id: "MedicationEfficacyResponse",
+  description:
+    "Server-authoritative, strictly-descriptive efficacy view relating a medication to the outcome metric(s)/lab(s) its class is prescribed to move, around its start. Carries the resolved target(s) with their series, the start/dose-change/pause markers, a before/after-start comparison (honest `{present:false}` below the per-side data floor), an adherence lane (cadence-aware per-day rate, never recomputed), an optional conservative level-shift note, and the retarget options. There is NO verdict / score / assessment field by construction — the client renders numbers and neutral connective phrasing only, never a causal or dose-advice claim.",
+});
 import {
   medicationListEntry,
   medicationDetailEntry,
@@ -539,6 +555,73 @@ export const medicationPaths: NonNullable<ZodOpenApiObject["paths"]> = {
       },
     },
   },
+  "/api/medications/{id}/efficacy": {
+    get: {
+      tags: ["Medications"],
+      summary: 'Efficacy view for a medication ("Wirkung")',
+      description:
+        "Returns the resolved, strictly-descriptive efficacy DTO: the outcome metric(s)/lab(s) the medication's class targets, the target series with start/dose-change/pause markers, a before/after-start comparison, the cadence-aware adherence lane, an optional conservative level-shift note, the data-floor state, and the retarget options. Association-only — there is no verdict / score field. `eligible:false` (with `reason`) marks a one-shot or no-target medication whose tab is hidden.",
+      requestParams: {
+        path: z.object({ id: z.string() }),
+      },
+      responses: {
+        "200": {
+          description: "Efficacy view.",
+          content: {
+            "application/json": {
+              schema: dataEnvelope(
+                medicationEfficacyResponseSchema,
+                "GetMedicationEfficacyResponse",
+              ),
+            },
+          },
+        },
+        "404": {
+          description: "Medication not found (or owned by another user).",
+          content: { "application/json": { schema: errorEnvelope } },
+        },
+        ...stdResponses,
+      },
+    },
+  },
+  "/api/medications/{id}/efficacy/target": {
+    put: {
+      tags: ["Medications"],
+      summary: "Set or clear the efficacy-target override",
+      description:
+        "Persists the user's explicit efficacy target for a medication (the only thing the view stores; everything else is derived each read). Pin exactly one of `measurementType` / `biomarkerId`, or pass `clear:true` to revert to the derived target.",
+      requestParams: {
+        path: z.object({ id: z.string() }),
+      },
+      requestBody: {
+        required: true,
+        content: {
+          "application/json": { schema: efficacyTargetOverrideSchema },
+        },
+      },
+      responses: {
+        "200": {
+          description: "Override set or cleared.",
+          content: {
+            "application/json": {
+              schema: dataEnvelope(
+                z.object({
+                  ok: z.boolean().optional(),
+                  cleared: z.boolean().optional(),
+                }),
+                "SetMedicationEfficacyTargetResponse",
+              ),
+            },
+          },
+        },
+        "404": {
+          description: "Medication or biomarker not found.",
+          content: { "application/json": { schema: errorEnvelope } },
+        },
+        ...stdResponses,
+      },
+    },
+  },
   "/api/medications/{id}/schedule-revisions": {
     get: {
       tags: ["Medications"],

src/lib/query-keys/medications.ts

@@ -138,4 +138,13 @@ export const medicationKeys = {
    */
   medicationApiEndpoint: (medicationId: string) =>
     ["medications", medicationId, "api-endpoint"] as const,
+  /**
+   * v1.28 — per-medication efficacy view ("Wirkung")
+   * (`GET /api/medications/[id]/efficacy`), consumed by the detail page's
+   * Wirkung tab and the Insights medication summary. Rides under the
+   * `["medications", id, …]` prefix so an intake mutation (which moves the
+   * adherence lane) reaches it through `medicationDependentKeys`.
+   */
+  medicationEfficacy: (medicationId: string) =>
+    ["medications", medicationId, "efficacy"] as const,
 };

src/lib/validations/medication-efficacy.ts

@@ -0,0 +1,133 @@
+/**
+ * v1.28 — request + response contracts for the medication-efficacy view
+ * ("Wirkung"). The response schema mirrors the DTO the server builder emits
+ * (`src/lib/medications/efficacy/build-efficacy.ts`) so the OpenAPI wire
+ * contract the iOS client consumes stays single-source. Strictly descriptive
+ * by construction — there is no verdict / score / assessment field on the DTO.
+ */
+import { z } from "zod/v4";
+import { measurementTypeEnum } from "@/lib/validations/measurement";
+
+/**
+ * Set or clear the user's explicit efficacy-target override for a medication.
+ * When `clear` is true the override rows are removed and the resolver reverts
+ * to the derived (ATC / name) target. Otherwise exactly ONE of
+ * `measurementType` (a metric series) / `biomarkerId` (a lab analyte) sets the
+ * new target. `userId` is never a body field — it is narrowed from the parent
+ * medication's ownership.
+ */
+export const efficacyTargetOverrideSchema = z
+  .object({
+    clear: z.boolean().optional(),
+    measurementType: measurementTypeEnum.optional(),
+    biomarkerId: z.string().trim().min(1).max(64).optional(),
+    primary: z.boolean().optional(),
+  })
+  .refine(
+    (v) =>
+      v.clear === true ||
+      (v.measurementType !== undefined) !== (v.biomarkerId !== undefined),
+    {
+      message:
+        "Set exactly one of measurementType / biomarkerId, or pass clear:true to revert to the derived target.",
+      path: ["measurementType"],
+    },
+  );
+
+export type EfficacyTargetOverrideInput = z.infer<
+  typeof efficacyTargetOverrideSchema
+>;
+
+// ── Response DTO schema (OpenAPI mirror of the builder output) ──────────
+
+const seriesPointSchema = z.object({
+  t: z.string(),
+  value: z.number(),
+  status: z.enum(["in-range", "below", "above", "unknown"]).optional(),
+});
+
+const beforeAfterSchema = z.object({
+  present: z.boolean(),
+  reason: z
+    .enum(["insufficient_before", "insufficient_after", "no_start", "no_data"])
+    .optional(),
+  before: z
+    .object({
+      mean: z.number(),
+      count: z.number().int(),
+      from: z.string(),
+      to: z.string(),
+    })
+    .optional(),
+  after: z
+    .object({
+      mean: z.number(),
+      count: z.number().int(),
+      from: z.string(),
+      to: z.string(),
+    })
+    .optional(),
+  delta: z
+    .object({ mean: z.number(), pct: z.number().nullable() })
+    .nullable()
+    .optional(),
+});
+
+const levelShiftSchema = z
+  .object({
+    present: z.boolean(),
+    at: z.string().optional(),
+    nearStart: z.boolean().optional(),
+  })
+  .nullable();
+
+const targetViewSchema = z.object({
+  kind: z.enum(["metric", "lab"]),
+  key: z.string(),
+  label: z.string(),
+  unit: z.string().nullable(),
+  primary: z.boolean(),
+  referenceBand: z.object({ low: z.number(), high: z.number() }).nullable(),
+  series: z.array(seriesPointSchema),
+  beforeAfter: beforeAfterSchema,
+  levelShift: levelShiftSchema,
+});
+
+export const medicationEfficacyResponseSchema = z.object({
+  medicationId: z.string(),
+  medicationName: z.string(),
+  eligible: z.boolean(),
+  reason: z.enum(["one_shot", "no_target"]).optional(),
+  startsOn: z.string().nullable(),
+  resolution: z.object({
+    tier: z.enum(["override", "atc", "name", "none"]),
+    cls: z.string().nullable(),
+  }),
+  windowDays: z.number().int(),
+  minWeeksPerSide: z.number().int(),
+  markers: z.object({
+    start: z.string().nullable(),
+    startSource: z.enum(["startsOn", "firstReading"]).nullable(),
+    doseChanges: z.array(z.object({ at: z.string(), label: z.string() })),
+    pauses: z.array(z.object({ from: z.string(), to: z.string().nullable() })),
+  }),
+  targets: z.array(targetViewSchema),
+  adherence: z.array(
+    z.object({
+      date: z.string(),
+      rate: z.number(),
+      taken: z.number().int(),
+      missed: z.number().int(),
+    }),
+  ),
+  overrideOptions: z.object({
+    metrics: z.array(z.object({ key: z.string(), label: z.string() })),
+    biomarkers: z.array(
+      z.object({ id: z.string(), label: z.string(), unit: z.string() }),
+    ),
+  }),
+});
+
+export type MedicationEfficacyResponse = z.infer<
+  typeof medicationEfficacyResponseSchema
+>;