Translational research: what does it mean?

T HE National Institutes of Health has just announced the creation of the National Center for Advancing Translational Sciences. Translational research has become the buzzword in medical research. Research institutes, universities, and even journals are increasingly eager to develop their translational research credentials. So how does ANESTHESIOLOGY fare when it comes to translational research? To answer this question requires some idea of what is meant by translational research. It seems all agree that translational research is worthy, and some would say desperately needed; however, there is still some confusion over what it actually is. The term was first used in the late 1990s. Through the last decades of the 20th century, spending and discovery in the basic medical sciences increased dramatically while improvement in health outcomes remained stubbornly slow. One perceived problem was the lag between basic discovery and the appearance of new drugs and treatments. The time from discovery in basic science to drug approval ranged from 10–20 yr and, after adjusting for the costs of all the failed drugs, the cost for developing a successful drug was heading toward $1 billion. There was no shortage of basic science discovery; advances in genomics and other “omics” have paved the way for even greater capacity in basic science discovery. The challenge was how to use that knowledge efficiently and effectively to develop new effective treatments. There was a call for more research that could bridge the gap from bench to bed: a call for translational research. One purported reason for the gap between discovery and clinical application was the decline in the number of clinician-scientists. In the early 20 century medical scientists were often clinicians. The basic science was driven by problems the clinician-scientists encountered in their clinical work, and in turn the clinician-scientists were quick to use laboratory breakthroughs in their patient management. The number of true clinician-scientists diminished as basic science became more complex and as clinicians were increasingly drawn, or pushed, toward purely clinical work. In response there has been a drive for more clinician-scientists. This should help close the gap, but as science becomes increasingly complex it is more important that clinicians and scientists in hospitals, universities, and research institutes work together in truly collaborative environments. This is one of the aims of the National Institutes of Healthsupported Clinical and Translational Science Centers. Although going from bench to bed was perhaps the original meaning of translational research, the term was soon also used to encompass the problem of translating research into practice; the gap between the development of the new treatment and the uptake and everyday clinical use of the treatment, the development of policy, and determining that treatments are indeed improving the health of the population. A drug may have proven efficacy in a tightly controlled trial in a well-circumscribed subpopulation but lack effectiveness in the broader population. The real-life effectiveness may be reduced by comorbidities, other medication, or failure in delivery. Even if a drug is proven to be effective, there are difficulties disseminating that knowledge to clinicians and problems getting clinicians to actually change prescribing practice. There is a lack of evidencebased practice. There are three approaches to increasing this aspect of translation. The information-based approach is to condense and summarize information with meta-analyses and sysIllustration: A. Johnson.