Because I decided life wasn’t busy enough (!) and I have this irritating obsession with learning things, I’ve just started a course in translational medicine. What, I hear you cry? This has been the general reaction from my colleagues and chums. So I thought I’d take a break from my first assignment to give you my take on what I’m increasingly seeing as ‘Common Sense Science’.
I think to describe translational medicine; it’s probably easier to think of what one might expect medical research to achieve. I’d probably kick off with understanding how disease functions on a molecular level, how it starts and progresses, what cells and proteins are involved. I’d then move on to working out what parts of this mechanism we could target – what are the most important drivers of the disease process? Next – how can we manipulate these? Do we have to go back to the original genes that programme the components of the mechanism? Can we block, change or remove certain cogs in the machine using drugs, chemicals or radiation? And finally, how do we take all of that into something that you or I could walk into a hospital and benefit from, to either reduce our risk of, or treat, a certain disease?
Sounds pretty common sense, huh? Essentially, I think Translational Medicine is taking our understanding of how disease works and using that to make effective treatments for patients. Sznol has described this better elsewhere as a four- or five-point process, but that’s my take on Common Sense Science.
But it can also work the other way around. For example, a commonly cited case of pharmacology-gone-(slightly)-wrong is that of Imatinib, a drug designed to target an important disease-progressing protein in a form of leukaemia (Chronic Myeloid Leukaemia). Cited as a wonder-drug and potential cure, they then realised that actually some patients didn’t benefit from it at all, or alternatively, stopped responding to it after an initially positive response. Rather than abandon ship, research groups have sought to understand why certain patients are resistant, or develop, resistance to imatinib. As a result of reversing the bench-to-bedside process, hopefully patients will benefit from imatinib, or drugs like it, in years to come.
My initial delve into the translational world has raised some interesting quandaries for me. First, the idea of human beings as a test model. In the surgical world, it is now well recognised that with new techniques such as laparoscopic (key-hole) surgery increasingly used, and challenges to training opportunities ever-more prevalent, we must create an environment where patients are not practice models. Innovations in virtual reality and simulators, as well as robotic surgery, are gathering a-pace. But can the same really happen in the medical (i.e. not surgical) world? Human beings are so complicated that no other animal, petri dish or fancy chemical model could ever hope to recreate us in our entirety. But are we ready to accept that we must be willing to be the trial run for drugs?
Second, the idea of physician scientists. Many authors talk of scientific progress progressing faster than clinical science – i.e. scientists are getting there faster than people like me (remembering though that I am a very junior physician. In fact I don’t know if I even feel comfortable calling myself that!). I am an academic trainee, which means that over the next two years, I have some protected research time. But I have certainly been in situations where people have questioned whether it is wise, or even safe, for me to do this. Shouldn’t I be training to be a safe physician first and foremost? Is it appropriate for me to be taking time out of this early stage in my career to do research? I find this astonishing, and even more so now that I’ve read a bit more about translational medicine. How are we ever to bridge the gap between scientific innovation and clinical outcomes if there aren’t the people there to bridge the gap? Stepping into a lab as a physician is a bit like stepping into a parallel universe, and frankly, I’d rather get on board now so I can learn from the start how to combine my life as a physician and a researcher rather than later. You don’t need to tell me twice about patient safety – it’s what keeps me up at night, me and every other junior doctor.
Me, Everything Everything and a cup of tea are getting on nicely in our quest to get this assignment done. And yes, I have received a suitable amount of heckling from my friends that this is how I choose to spend a small chunk of my week of annual leave.