The Best Of Times, The Worst Of Times

March 27, 2018

Current State of Translational Medicine

"It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of light, it was the season of darkness, it was the spring of hope, it was the winter of despair.”  

- Charles Dickens, A Tale of Two Cities

There is no doubt that the promise of what translational research can contribute towards the care and treatment of patients is huge. It is the foundation upon which the practice of precision medicine grows and thrives. Instead of simply treating the disease, the advances in these fields provide the opportunity to treat the patient as an individual with a very specific blueprint, who responds to very specific therapies and may not respond to other therapies at all, or in fact can be adversely impacted by treatments that may be very effective for another individual. The difference can very well be a matter of life and death.

The past few decades have seen tremendous activity in these areas. We have a much better understanding of many diseases and how they can be treated or prevented. We also have a much better understanding of what an individual’s blueprint is composed of and are able to sequence the entire genome in a fraction of the time and at a fraction of the cost of the initial 15 year, 3 billion dollar project to sequence the first whole human genome. Multiple breakthrough advancements in the ‘omic’ sciences and rapid improvements in data processing and analytics have further helped us learn from our research activities.

However this promise doesn’t come without its share of challenges. There is still a large gap – aptly named “Valley of Death” -- between our basic discoveries, and the translation of these into actual products that can be utilized for patient care in a clinical setting. Numerous discoveries start and finish in the lab, and even more projects never take off the ground due to lack of funding or inability to find the resources needed for research. Whether it is finding peers with a similar interest to share knowledge with; identifying funding sources for discovery waiting to happen; or finding resources such as biospecimens or patients that meet the very complex eligibility criteria that are an increasing norm for translational research projects – the inability of researchers to get the support that would help them succeed often becomes a restricting factor that deters innovation.

In addition, with the evolving scientific landscape, there is a shift in how research is conducted. The complexity of the protocols themselves and the way that they are conducted, has grown massively. There is the need for more specificity in selection of sites and patients, which begs the need for a larger pool to search from. An increasing number of trial procedures and endpoints, and more comprehensive data collection needs further adds complications to the management of these trials. Compliance, security and privacy issues are under the spotlight increasing the demand for trained and experienced staff who can conduct trials effectively and efficiently. And while the use of data management systems has grown and many innovative systems have come in the market, the number of disparate data silos – silos holding valuable information not accessible to the broader research community – is at an all-time high.

So while on the one hand, we are eager to usher in an era of exciting transformation in the way we treat and care for our patients, we should also recognize the challenges that are currently preventing us from getting to that point. Empowering sponsors, sites and researchers in their common quest for new innovations through efficient communication, collaboration and knowledge sharing, will be critical to the continued advancement in this field. Precision medicine is poised for amazing growth and each one of us has a part to play in this. Collectively we can be faster, stronger, better. Collectively we are an unstoppable force.

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