For disclosure: I am a basic biomedical scientist
Currently, biomedical research is categorized as either basic or translational. Basic research, in the biomedical world, is that which is focused on understanding some system or process related to human health. This could be trying to elucidate how a pathogen grows and carries out its nefarious plan of attack on the human host, learning how distinct types of human cells arise and what their function within the body is, learning how a drug affects a given target cell in an attempt to predict the ramifications of said affects. In short, basic research in biomedicine is focused on increasing our basic knowledge of something related to human health.
Translational research, often referred to as bench to bedside research, is that which is focused on solving a specific problem essentially from scratch. This could be developing a new antibiotic against some pathogen or curing some non-infectious disease. In general, this type of research is superficially important and warrants significant funding. However in practice, this type of research is in general a failed approach to problem solving and results in large expenditures of research dollars without necessarily providing new information.
The problem with translational research is that it is immediately goal driven, we need to prevent autoimmune disease XYZ (I made this name up for the sake of example in case you thought it was a real disease). Obviously, preventing autoimmune disease XYZ is a worthy goal, but that does not mean a soluton is readily apparent.
A basic biomedical research program would focus on determining the cause of disease XYZ and establishing the specific difference(s) that distinguish a healthy individual from a patient with XYZ. Once these differences are identified approaches can be taken to prevent, correct, or otherwise intercede with the onset of XYZ. In short, basic biomedical science is goal driven but is more imbedded in the biology and idea of generating new information. For example, determining the cause of autoimmune disease XYZ will almost certainly provide new information about the immune system and how it functions. Identifying differences between healthy individual and patients can provide molecular, biochemical, cell biological, and genetic insights into human biology. Going to get a cure using this approach, I do not know. But I can essentailly guarantee we will know a lot more than we do now. "Well so what?" you say. Remember this information does not exist in a vacuum, other researchers doing fundamentally different research on cancer ABC may greatly benefit from the studies done on autoimmune disease XYZ and develop a new therapy.
A translational researcher program needs to focus on getting to the beside, in other words a treatment. So how do we go about developing treatments? Well if much is known about the disease (in other words much basic research has already been done) then there are likely approaches to be found in the literature. So a translational researcher could develop projects from the available body of literature. However, if these approaches were tried and failed to work, they may not have been published so our would be translational researcher may be wasting their time and your money. Hell, an approach may actually be suggested in the literature but not followed up on for any number of reasons, the researchers were pursuing other approaches they thought were more viable, it was not an area the researchers were trained in, etc. This would represent a reasonable use of translational research. Its also possible that the translational researcher would make an educated guess and essentially take a shot in the dark at an approach. The problem here is that if the approach does not work, we often have not learned any meaningful biological information in the process. Remember what I discussing now is based on a disease we know a lot about. What if we know squat? Well, now we are left with the shot in the dark approach and we generally learn nothing about the disease in the process.
Another shot against "translational" research. In previous interations it was termed "applied research" to contrast with basic research. It was flawed as a major thrust then as it is now, the name change did not alleviate the problems.
Now with all that I have just said, I do not have an inherent problem with translational research. It is an important, nay essential, part of biomedical research. The entire field of diagnostics is translational. My problem lies in the funding priorities that are swinging tremendous amounts of money towards translational research and by definition away from basic research. This may result in more therapies in the short term (although I extremely doubt it), it will certainly slow down progress on improving human health in the long run as these resources are often lost without at least the gain of basic biological understanding.
Why are these funding priorities changing? Easy. Translational research is sexy to the average Joe. Congressman JP Assclown can understand needing a cure for cancer, so lets throw more money at it and stop wasting time studying the cell cycle in some irrelevant fungus (see Noble prizes for 2001) However, the honorable Assclown doesnt realize that this is not a viable approach. Its like saying we need cars that get 150 miles per gallon, knowing what your goal is does not tell you how to get there. Research is not like a maze where you can start at the end and work your way back.
An eminent scientist I was talking to over this issue made the point that in any good basic science program the applications should be clear. I think that sums up my feelings on the subject well.
The goal of Transitional research should not be the "prevent" a disease, rather to treat a disease. To a basic biomedical scientist this is a semantic, treating vs preventing. To a basic clinician grappling daily with the toll that the disease exacts on the lives of patients and left with inadequate products or just a library of vastly enlarged knowledge about the disease is woefully inadequate. There must be a group of clinical scientist acting like contact lenses to focus "select sections" of that vast information on to the symptomatic problems experienced in the disease. This effort is not "sexy" it is at the bottom of must every substantial therapeutic breakthrough. For each therapeutic breakthrough there was some clinician or clinician-surrogate practicing translational research.ReplyDelete
Sir the goal can not be so obtuse and broad as "preventing" disease. This is a myopic opinion on the true work of translational research. Treatment of disease is the goal and the more acute and humble approach to the issue and for the patient suffering from the disease, this it the most meaningful approach. If along the way of focusing freshly generated bench-knowledge on the alleviation of disease symptoms, the Translational clinical-scientist discovers a means of preventing disease then great. But the goal is not prevention of disease, the goal of my translational research is to alleviate symptomatic suffering of the disease, by reversing the pathophysiology of the disease's symptomatic expression.
Ricky W. McCullough MD (BSc Biol, BA Chem, MSc Biol) and discoverer of the cure for IBS, irritable bowel syndrome via translational research; Mueller Medical LLC, 401-397-6203.