Translational medicine

Translational medicine is a medical practice based on interventional epidemiology. It is regarded by its proponents as a natural progression from Evidence-Based Medicine. It integrates research from the basic sciences, social sciences and political sciences with the aim of optimising patient care and preventive measures which may extend beyond healthcare services.^{[citation needed]} In short, it is the process of turning appropriate biological discoveries into drugs and medical devices that can be used in the treatment of patients.

Translational research

Translational Research is the basis for Translational Medicine. It is the process which leads from evidence based medicine to sustainable solutions for public health problems. It aims to improve the health and longevity of the world's populations and depends on developing broad-based teams of scientists and scholars who are able to focus their efforts to link basic scientific discoveries with the arena of clinical investigation, and translating the results of clinical trials into changes in clinical practice, informed by evidence from the social and political sciences.* It has three phases:

Phase one research

Phase 1 Translational Research is the research process that investigates and translates non-clinical research results into clinical applications and tests their safety and efficacy in a Phase 1 clinical trial. The concept arose from research into pharmacotherapy and formed the initial basis for evidence-based practice and clinical guidelines, now incorporated into Translational Medicine. In the case of drug discovery and development, translational research typically refers to the translation of non-human research finding, from the laboratory and from animal studies, into therapies for patients. This is often called "bench to bedside". pharmaceutical companies and contract research organisations have a translational medicine division to facilitate the interaction between basic research and clinical medicine to design and conduct clinical trials.

Phase two research

Phase 2 Translational Research examines how findings from clinical science, shown to be efficacious and safe treatments established in phase 1 translational research, function when they are applied in routine practice, as first described by Hiss RG. It thus addresses development and application of new technologies in a patient driven environment - where the emphasis is on real patients in real-life situations, where demographic factors and competing priorities modify clinical decisions, and treatment responses. Phase 2 Translational Research thus informs guidelines about needs, acceptability, effectiveness, and cost efficiency in ecological settings and policies to promote uptake for optimal management and resource use. As examples, consumer research explores patients’ behavioural responses to interventions and provides important insights into compliance; health economics adds the evaluation of cost effectiveness and cost avoidance. These needs challenge hierarchical views of "research quality" and funding allocation, traditionally dominated by randomised controlled trials, and point to the need for non-hierarchical typological approaches.

Phase three research

Phase 3 Translational Research adds the necessary information to convert treatments and prevention strategies, shown to be effective and cost-effective in Phase 2 Translational Research, into sustainable solutions. Thus governments can generate enduring evidence-based policies. These require different types of research processes to evaluate the complex interacting environmental and policy measures that affect susceptibility to disease and the sustainability of clinical and public health management and prevention strategies. Achieving sustainability depends on evidence from two fronts. Firstly, closed-loop audit approaches are needed within Continuous Improvement Methodology to refine the intervention. Lessons can be learned from successful commercial and product developments, which use multidisciplinary non-experimental research to inform incremental improvements. Continuous improvement methodology is known as "kaizen" in Japanese, where it originated. Secondly, research is needed to obtain evidence for making changes to multiple environmental and policy factors which will reduce the need for funding to sustain the intervention.

An example - Obesity

Controlling the mounting prevalence of obesity and its secondary diseases will require new multicomponent methods for effective treatments, based on randomized clinical trials and continuous improvements of community-based approaches, and also effective and sustainable approaches for prevention. This needs an integrated view of educational and environmental actions to facilitate greater physical activity, together with fiscal and regulatory changes to promote production, promotion, and delivery of healthier meals and total food supply. Practitioners, policy makers, and the public need sound evidence from different and new research methods, involving both experimental and non-experimental methodologies, that are sensitive to cultural and ethnic priorities.

Postgraduate degree courses

The University of Edinburgh has been running an MSc in Translational Medicine program since 2007. It is a 3-year online distance learning programme, which is ideal for the working professional.

Andy Grove has pledged $1.5 million so that the University of California campuses in San Francisco and Berkeley can start a joint master’s degree program aimed at translational medicine.

A master's degree programme in translational medicine was started at the University of Helsinki in 2010.

Implications of translational medicine

Reliance on actions within health services will be insufficient to control rising obesity, diabetes, and associated diseases. Clinical science and ecological support from effective policies cannot continue to be regarded as independent disciplines. Integrated training in translational research methods is needed for clinicians, guideline writers, grant awarding bodies, and policy makers, in order to redress current biases in funding and research publications, in order to reflect better the balance of research efforts which are necessary for better assessment of complex evidence-bases, to integrate effective and culturally sensitive interventions with supporting environmental changes, and to encourage continuous improvement of evidence based public policies.

See also

• Interdisciplinary work
• Clinical and Translational Science
• Science Translational Medicine
• American Journal of Translational Research

References

• Letter Philip Pizzo, MD - Dean, Stanford School of Medicine
• Geraghty J. Adenomatous polyposis coli and translational medicine. Lancet. 1996 Aug 17;348(9025):422.
• Marincola FM, Translational Medicine: A two-way road. J Transl Med. 2003 Jul 24;1(1):1.
• Stacey P Mankoff, Christian Brander, Soldano Ferrone, and Francesco M Marincola. Lost in Translation: Obstacles to Translational Medicine, J Transl Med. 2004; 2: 14.
• Woolf, SH. The Meaning of Translational Research and Why It Matters. JAMA 2008;299;211-213.
• Feldman, A. Does Academic Culture Support Translational Research? CTS: Clinical and Translational Science 2008;volume 1, issue 2;87-88

External links

• Translational Medicine Research Collaboration
• American Journal of Translational Research
• Institute for Translational Medicine and Therapeutics
• TRANSMED
• The University of Edinburgh, MSc in Translational Medicine
• OSCAT2012: 2nd International conference on open source for computer-aided Translational medicine.