A New Model for Translational Research
From Visions, Spring 2006
By William B. Applegate, MD, MPH
The new catch phrase in medicine is “translational research.” The National Institutes of Health (NIH) is touting translational research for the development of new scientific knowledge into quality treatments for patients. Once upon a time that process was called “from bench to bedside.” The new translational research emphasizes this process as bi-directional, bedside to bench also. I believe the Wake Forest School of Medicine (WFSM) is poised to take advantage of this trend.
A key difference between “bench-to-bedside” and translational research is speed. Basic science has accumulated an astonishing body of knowledge in just the last half-century. A lot of that has led to new and more efficient treatments for human disease and trauma. But one thing we have learned in academic medicine over the same period is that we need more clinical research (research based on human patients).
The steady growth of NIH dollars available for research can be credited with stimulating much of the progress in modern medicine since World War II. However, through much of the second half of the 20th century the majority of that money was directed to basic science (the bench part of the equation). Now the balance is tipping toward the clinical application of new knowledge.
Wake Forest has a proud tradition of training excellent clinicians for the delivery of the highest quality care. We also have become a significant participant in NIH funding and, thus, a major contributor to science and innovations for the national health system.
An important step toward a greater interest in and commitment to clinical research came with the creation by NIH of the General Clinical Research Center (GCRC) program. Wake Forest’s GCRC is currently under a five-year renewal with nearly $24 million in funding. This resource will be pivotal in obtaining an NIH Clinical and Translation Science Award, a new initiative that expands and transforms the GCRC model.
Another important element for Wake Forest in the move to a translational research model is the elevation of the Department of Public Health Sciences to the Division of Public Health Sciences and Health Policy, comprised of three departments (epidemiology, biometry, and social sciences and health policy). Public Health Sciences at WFSM is the national leader among its peers in research funding from NIH. Its size and stature are important to translational research because of its national reach in the design and implementation of clinical research trials and because of the scope of its work in the health arena — from HIV/AIDS to diabetes and obesity to cancer and cardiovascular disease.
Sally Shumaker, PhD, associate dean of research, and Charles E. “Cash” McCall, MD, deputy associate dean for research, are organizing Wake Forest’s Clinical and Translation Science Award (CTSA) planning grant application. They are assisted by Vicky Zickmund, executive director for research development, planning and operation; Richard F. Loeser Jr., MD, chairman of the Department of Molecular Medicine; David Goff, MD, PhD, professor of public health sciences/epidemiology; David Herrington, MD, professor of internal medicine/cardiology; and Karen Klein, assistant director, grant and publication development.
The CTSA concept is a multi-dimensional program. Major components will include clinical research through the GCRC and other units; graduate education and faculty development; integration of translational research technologies (e.g., biomolecular imaging, genomics, proteomics, biomedical engineering, nanotechnology, bioinformatics, etc.); partnerships with industry; community outreach; and a translational research incubator.
Despite the resources we already have for this initiative, making translational research successful is fraught with challenges. For example, educating and training a new generation of clinician researchers must be a priority. Medical graduates may expect an additional 6–9 years of training to adequately prepare for the task of linking the clinic back to the laboratory to complete the cycle that constitutes translational research (linking the complexities of biomedical science with clinical medicine).
There are many ways that private philanthropy can and does advance our mission. But for the immediate future, one of the most important dimensions of our work that private donors can boost is this realm of translational research with its focus on intensified clinical applications of potentially life-saving knowledge.