Diabetes: Translating Research into Practice PDF

Preface

Galen, Maimonides, Jenner, and Osler tour the modern academic medical center, agape at the application of medicine in 2008. Their wonderment at the pandemonium confronting them on the wards turns to complete incomprehension as they eavesdrop on a seminar titled, "Translational Medicine." A white-haired, casually dressed lecturer explains to a room full of distracted and tired looking, multihued men and women that scientific discoveries must be "translated" to medical care to improve the health of individuals. When a member of the audience interjects, "This won't get my grant funded," there is a murmur of agreement from a fidgety audience looking for an excuse to leave. How is it possible, these wise men wonder, that people speak of the need to reconnect science and health—how did the disconnect happen in the first place?

The answer (though not the solution) is simple. Even these giants of medicine's past could not possibly grasp the enormity of new scientific information and the complexities of social, cultural, and economic factors impacting on the delivery of medical care and the health of the community—the reality of modern medicine. Information requires analysis and conversion to knowledge, and knowledge requires reduction to practice. A casual PubMed search with "diabetes" as a keyword reveals more than 17,000 articles during the past year alone! Even the most vigilant, sleep-deprived doctor could not keep up.

The need for translational medicine is another way of saying that we must cross boundaries, talk with one another despite differences in training and outlook, and periodically lift our heads to look broadly at the question of health. Conceptually, it means that what is learned in basic science must challenge extant paradigms, lead to new insights into the bases of ill-health, and deliver potentially new approaches to diagnosis, prevention, and treatment to be tested clinically. What is learned through clinical testing must be efficaciously translated to patients and the community. The loop then must be both closed and perpetuated so that clinical observations inform basic science questions.

A small part in making this a reality is literally in translating because, like a fledgling foreign language student, the clinician has only a rudimentary understanding of the language of the basic scientist, and the basic scientist working in "omics" often does not understand the language of clinical care. The language barrier is not the only, or even the most important, block to translational medicine. There are significant institutional barriers including historical specialty-based divisions of academia and academic centers, as well as mechanisms of funding, career planning, regulatory requirements, and intellectual property issues. In the United States, the NIH RoadMap initiative is trying to change this environment, by promoting collaborative efforts to bring medical science and health together again, and similar efforts are underway elsewhere.

These ruminations on translational medicine are the genesis of this book. It is aimed both at the scientist, who wants to better understand the big picture, and the clinician, who wants to understand where new diagnostics and therapeutics come from. Authors were asked to try to bridge the language gap—not write the standard "review," which would be rapidly outdated, but provide a succinct overview and rationale of their subject and its relevance to human health.We hope this experiment works to broaden the reader's perspective and encourage creative, collaborative thinking and the work needed to translate research to practice.

Perhaps, if our august predecessors visit again in decades hence, their incredulity will be at how translational medicine has changed the lives of people with diabetes.