Voices From The Community
Translating research
Story by Connie Bryson/Photo by iStockPhoto
The difficult business of translating medical research into patient care
You don’t have to look any further than the pages of this magazine to see the fruits of biomedical research. Our understanding of a multitude of diseases and the molecular processes behind them has increased exponentially. Yet the impact of this research on patients up to now has been surprisingly small.
This issue has been on Dr. Alan Winter’s mind for years. He has dedicated his career to the application of research and advanced technology to real-world problems. As President and CEO of Genome British Columbia since 2001, he spearheads efforts to translate valuable academic discoveries in genomics (the science that aims to decipher and understand the entire genetic information of an organism) into changes in the health system.
“It’s extraordinarily difficult to do this, and it’s not because researchers don’t want to have an impact on health,” says Dr. Winter. “Ask any scientist why they are investigating a particular mechanism, and they’ll answer that this will help people. Even someone out on the farthest limb of discovery research will talk about patients. But what we don’t often discuss, when we talk to the media and even to each other, is the time it takes to do this and the disciplined process that’s required.”
The process is known as translational research. It involves taking a discovery and transforming it into something—a therapy, diagnostic procedure, or device—that actually changes the standard of care for patients. There are numerous challenges in translational research, not the least of which is the lack of funding. Health authorities focus funding on operations in healthcare, whereas government granting councils tend to focus their research dollars on discovery research. As a result, the bulk of research done in Canada and around the world is discovery research. For example, a study from the U.S. Centers for Disease Control and Prevention estimated that, in 2007, only 17% of 1,000 representative biomedical papers studied a specific application for a discovery, and only 2% addressed further translation.
Funding isn’t the only issue, says Dr. Winter. “There’s a mindset that must change. We can’t look at discovery as an end in itself. We have to think about how we’re going to complete that discovery by undertaking the development of an application for it.”
Another key aspect is the personnel needed to do translational research. They are most often clinician-scientists—physicians who have opened part of their careers to science. “Most physicians are not trained as scientists,” explains Dr. Winter. “Clinician-scientists are unique because they can do both. They can straddle both worlds and be the champions who take a discovery out of the lab and develop it as an application that will benefit their patients.”
Combining a laboratory research career with a clinical career is extremely difficult. One of the challenges for a clinician is finding the time to write a significant research proposal. “Translational research projects are often equivalent to starting a small biotech company,” says Dr. Winter. “Without funding, you’re essentially asking a clinician-scientist to volunteer to do this up front. That is a huge cost for an individual to bear.” Funding agencies in Europe and the United States are beginning to recognize this and offer support to clinician-scientists for preliminary work in developing proposals.
Another reason to focus on translational research now is that the science of genomics has advanced to a point where there is great potential to contribute to human health. One example is a project on acute myeloid leukemia (AML) funded by Genome British Columbia’s Personalized Medicine Program. AML is presently treated with stem-cell transplantation or chemotherapy. Researchers plan to use genetic information to identify different AML subtypes found in patients, leading to targeted and more personalized treatment and, hopefully, to improved outcomes.
Other potential applications of genomics to personalized medicine include reducing adverse drug reactions, combating infectious diseases, treating cancer, and minimizing organ rejection in transplantation. The idea is to improve therapy by tailoring treatment using an individual’s genome. Farther down the road, it could be possible to use genomic knowledge in disease prevention.
“Current healthcare spending is unsustainable,” notes Dr. Winter. “There will come a time when health authorities will have to look beyond simply reducing cost increases and do things differently. I believe that genomics is the kind of enabling technology that can allow the health system to shift its focus from chronic care to prevention of disease. We are standing on the threshold of using the results of research to truly benefit a large number of people.”
Genomics research
The study of genomics has the potential to affect not only human health, but areas such as agriculture, environment, fisheries, forestry, bioenergy, and new technology development. For example, genomics could be applied to these areas to improve fish breeding programs, ensure stronger and more sustainable forests, and develop disease-resistant crops.