Materializing research promises: opportunities, priorities and conflicts in translational medicine

Abstract

There is considerable evidence that the translation rate of major basic science promises to clinical applications has been inefficient and disappointing. The deficiencies of translational science have often been proposed as an explanation for this failure. An alternative explanation is that until recently basic science advances have made oversimplified assumptions that have not matched the true etiological complexity of most common diseases; while clinical science has suffered from poor research practices, overt biases and conflicts of interest. The advent of molecular medicine and the recasting of clinical science along the principles of evidence-based medicine provide a better environment where translational research may now materialize its goals. At the same time, priority issues need to be addressed in order to exploit the new opportunities. Translational research should focus on diseases with global impact, if true progress is to be made against human suffering. The health outcomes of interest for translational efforts need to be carefully defined and a balance must be struck between the subjective needs of healthcare consumers and objective health outcomes. Development of more simple, practical and safer interventions may be as important a target for translational research as the development of cures for diseases where no effective interventions are available at all. Moreover, while the role of the industry is catalytic in translating research advances to licensed interventions, academic independence needs to be sustained and strengthened at a global level. Conflicts of interest may stifle translational research efforts internationally. The profit motive is unlikely to be sufficient alone to advance biomedical research towards genuine progress.

Figure 1

Translation of basic science promises after two decades: number of promises resulting or not in at least one randomized controlled trial (RCT) according to whether an industry author was involved in the original basic science publication, the industry was involved in some other way (offering acknowledged financial support or providing the technology under testing), or there was no acknowledged industry involvement at all. Data are from ref [8].

Figure 2

Research players at large-scale: research budget of the European Commission (6^th Framework Programme [FP]) and the NIH as compared with the revenue of large pharmaceutical companies.