Monday, April 22, 2013

Translational Research--What Does It Mean?

The occasion for these musings is Dr. Barney Carroll's post over at our friends, Health Care Renewal:

Dr. Carroll once again focuses our attention on Dr. Charles Nemeroff and his checkered career at Emory University, in this case getting a big grant that ended up producing nothing of note, in the name of "translational research." This allows Dr. Carroll to make some trenchent comments about the current state of research in psychiatry, such as: "Lost in the wailing [over academics' loss of research funding by drug companies] is a clear understanding that the defecting corporations are acting out of their own enlightened self interest. For 50 years, no fundamentally incisive innovations have occurred, so the defectors are telling the academics to get their act together in respect of better understanding disease mechanisms. Trouble is, too many academic clinical investigators have devolved into key opinion leaders promoting corporate marketing messages at the expense of generating original clinical science. Now they are squawking about being caught with their pants down."

A word, now, about the notion of "translational research," in the name of which this big grant to Emory from the National Institute for Mental Health was awarded, and then renewed, despite lack of scientific productivity (and with some concerns for conflicts of interest). Translational research, when the Feds began trumpeting this new paradigm several years ago, seemed to have two alternative meanings. The meaning that I respect and favor is that investigators in academe must be more concerned and informed about the entire process of research that takes new discoveries from the lab to the patient's bedside and eventually to widespread community applications. Translational research requires interdisciplinary teams of scientists and clinicians. From my vantage point at the outer reaches of a translational research effort, this has proven harder to do than most guessed. Scientists educated the old way are simply not trained to talk with other scientists outside their field, let alone clinicans seeing patients and people who work in community programs. Indeed, the major contributions a translational research center might make in the long run is creating a way to better train the next generation of scientists and research-clinicians.

But some of us worried all along that to some, at least, "translational" had a more sinister meaning--"get academic scientists in bed with industry early and often." What Dr. Carroll's post seems to me to illustrate most forcefully is that the idea that one could get a big grant, include both academic scientists and a big drug company in the project, add water and stir, and magically wonderful new drugs would appear out the other end to cure all our ills, is simply insane, and could have been known to be insane from the get-go.

As I explained in HOOKED, my own nonexpert opinion is that major new discoveries in drug treatment are for the most part some years away and cannot be produced according to anyone's industrial or marketing timeline. This is not because really smart people aren't busting their buns to try to discover new drugs. It is simply a reflection that we have probably picked all the low hanging fruit from past discoveries of basic disease mechanisms, and that before we can come up with generations of new, useful, and safe drugs, we need to make more basic discoveries about disease mechanisms. That sort of research is notoriously unpredictable. A solid translational research effort will focus appropriate resources on basic research into mechanisms, and then try to tie that research in a useful way to what we know about clinical and community applications. It won't shortchange basic research in the name of having a product to bring to market next week.

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