Creating a Worldview and Permissive Microenvironment for Translational Sciences

engaged in fundamental biological discoveries that lead to practical applications into human health as its fi nal goal. Over the last decades much has been written about the rapid transformation of basic sciences, yet the progression and implementation of these new ideas into the marketplace continues to occur at a glacial pace. To overcome this “translational” gap, there have been calls for new methodologies, new mechanisms of funding research, and the need to create multidisciplinary research teams with expertise in “translational sciences.” Th is has resulted in the establishment the National Center for Advancing Translational Sciences (NCATS) within the National Institutes of Health, and funding of 61 Clinical and Translational Science Awards (CTSAs) to establish “integrated homes” across academic medical centers for translational research. Partly due to increasing societal and consumer demands and tightening funding constraints, there is now clear emphasis on translational research in all areas of biomedical research. Such a paradigm change has forced academic research establishments into rethinking about institutional resources, effi ciency of processes, and wholesale transformation of institutional environments to foster translational research. However, this is not a simple or linear process that can be easily accomplished within academic environments. For example, the series of translational steps that take a small molecule to market are quite distinct from similar steps required to take a device to patients, which is yet diff erent from the steps that make eff ective implementation of a practice innovation into the broader community possible. Also, since translating fundamental discoveries into practice involves a series of complex scientifi c, regulatory, commercial, and fi nancial steps, and a coordinated activity of a wide range of experts working in teams, it has created a need for establishing a systematic fi eld of knowledge. Despite this increased emphasis on translation, the formal field of “translational sciences” is still relatively recent and evolving. Also, the term translational sciences is a fi eld that has started to take on somewhat diff ering meanings to groups engaged in moving diff erent types of discoveries into practice, and has created signifi cant confusion in its practitioners, leading to fragmentation of eff orts to advance its mission. Th is problem is particularly acute when it comes to training young investigators and students, i.e., the translational research workforce of the future. Th us, a clear and immediate task from the point of view of the Association of Clinical Translational Sciences (ACTS) is to clearly defi ne a comprehensive “worldview” of translational sciences and catalogue its diverse practitioners and stakeholders for inclusion into its broad tent. Such an eff ort would not only help develop unique programs within ACTS and other biomedical research societies, provide career development resources for future practitioners, streamline advocacy for translational research through multiple stakeholders, and also increase the readership and contributor base for the CTS and similar journals. Th erefore, the leadership of ACTS is rolling out a series of strategic planning sessions, focus group meetings, and broad surveys to better defi ne the fi eld “translational sciences” and its “membership” over the next few months. While there is general acceptance of the need to transform our research processes and training of future researchers, there are still many challenges to making these transformations at the level of individual academic medical centers. Th e majority of the research faculty at academic medical centers, although very interested in and willing to embrace translational research, are housed in environments where they are recognized for being experts in very focused areas of discovery and supported by traditional R01 grant mechanisms which put a premium on deep expertise. Th e institutional success metrics (publications, recognition by societies, invitations to panels, etc.) further keep them discouraged from deviating from the current model. Academic researchers need a “permissive” local habitat for translational research, and much of this responsibility falls on university and academic center leadership where there is a paucity of best practices to guide the leadership. Local transformation will need an institutional “microenvironment” that will not kill such eff orts with disincentives based on rigid systems of reward, promotion, and tenure processes. One approach that is being explored by some institutions is populating increasing numbers of “clinician-scientists” who could create a fulcrum of change within clinical departments, and begin to bridge collaborations with basic science departments . Increasing such “cross-cutting” faculty group will naturally create a tipping point when rapid cultural transformation can occur. I am familiar with one great example of such an eff ort with the Physician-Scientist Initiative (PSI) being implemented at Indiana University. Th e PSI program was funded by a $60 million grant from the Lilly Endowment under the leadership of the dean of the school of medicine, and managed by committee of translational research leaders that is chaired by the executive associate dean for research. Th e initiative provides start-up and recruitment dollars to any clinical department that is interested in bringing in clinician-scientists, defi ned broadly as those with clinical training who devote substantive eff ort to research anywhere along the entire spectrum of biomedical inquiry, ranging from basic sciences to patient outcomes and policy. Th e requirements are that such faculty need to be dually recruited with a basic science department, and are incentivized upon arrival to create new cross-disciplinary research programs and grants. Th e program has been extremely popular with clinical department chairs and has so far recruited nearly 20 such researchers. It has created new programs ranging from bone biology, cancer therapeutics,