EDITORIAL Support for translational research: exhausting all the possibilities Winston Churchill believed that Americans will always do the right thing, but only after they have ‘‘exhausted all other possibilities.’’ This is not a bad description of how our government is funding medical science right now because resources for medical research always seem to be in some sort of crisis lately. Although its aims are too extraordinary for it not to be, the gap between what can be achieved and the resources to achieve is widening. This should be viewed as a banner year for medical research. Taking a cue from the 3-dimensional printers employed in model building for industry, and now even by hobbyists at home, bioresorbable splints have been used to construct an airway in a newborn with tracheobronchomalasia1; printed, tissue-engineered intervertebral discs and tricalcium phosphate scaffolds have restored biomechanical function and enhanced osteogenesis and angiogenesis in rodents2,3; and similar technology has been a boon to regenerative medicine in fields as diverse as urology, otology, cardiology, and wound healing.4 For example, in an attempt to address the critical shortage of donor livers for transplantation— over 20% of individuals awaiting such transplants die prior to receiving a suitable organ5—a group from Yokohama, Japan created a vascularized and functional liver by directed differentiation of human induced pluripotent stem cells.6 The organ formed by transplanting liver buds created from these cells into mice rescued them from ganciclovir-induced hepatic failure.6 Transformative treatments in cancer and acquired immune deficiency syndrome (AIDS) have also been developed, their impact recorded over this past year. For example, nondrug-abusing human immunodeficiency virus (HIV)-infected individuals maintaining high CD41 T cell counts and low viral loads with new antiretroviral therapies—often a single pill a day—now have life expectancies identical to the general population.7 Furthermore, major academic medical centers,
Translational Research 2014;163:1–2. 1931-5244/$ - see front matter Ó 2014 Mosby, Inc. All rights reserved. http://dx.doi.org/10.1016/j.trsl.2013.09.012
including my own at Weill Cornell,8 are creating centers for the eventual routine sequencing and analysis of every patients genome, in the quest for a ‘‘precision medicine.’’ But despite these exciting times, and the fact that an academic faculty research career is the path most often considered ‘‘extremely attractive’’ and ‘‘most desirable’’ by US-trained life scientists and physicists, the majority of these PhD graduates instead enter industry, government, or alternative careers.9 At tier 1 universities, the attractiveness of an academic career decreases steadily and significantly over the course of their training.9 And this pessimism is not restricted to PhD-based translational researchers. Dr Ferric Fang, editor-in-chief of Infection and Immunity, observed that ‘‘All the scientists I know are so anxious about their funding that they don’t make inspiring role models.’’10 With constraints from the economy and, more recently, the sequestration budget imposed on all federal agencies, government sources have not been of much help. National Institutes of Health funding percentiles remain in the single digits at many of the institutes. In a brief supporting National Institutes of Health Director Dr Francis Collins’s hope for a new translational medicine and therapeutics development center, the need to identify solutions and models to bridge what was deemed a ‘‘Valley of Death’’—the everwidening gap in funding and support for the kind of research that moves basic science down the path toward treatments—was highlighted.11 In this context, industry and academia are cooperating in new ways, and novel revenue streams are one anticipated outcome of these collaborations. As noted in a recent New York Times article, academic medical centers are investing in the infrastructure to collect and sequence patient DNA, identifying patients who could benefit from a particular drug, and aggressively recruiting patients for trials in the hope of playing ‘‘a bigger role in the development of new drugs, which could lead to lucrative patent royalties.’’8 In addition, the Minerva Project, named after the Roman goddess of wisdom, was recently established by private venture funds to provide an annual $500,000 award for ‘‘extraordinary, innovative teaching,’’ along with construction of a new research university to support such training.12 1
2
Translational Research January 2014
Laurence
Readers of Translational Research will not be surprised by any of these medical advances nor the challenges confronting continued progress. Recent ‘‘Special Issues,’’ ‘‘In-Depth Reviews,’’ and ‘‘Editorials’’ have or will soon be published reviewing these topics in the science and the politics of science.13-15 And, it clearly has been an important year for our journal. Our science citation index rose to 3.490 in figures released in 2013, after a 2.986 in 2012 and a 2.903 in 2011. Editorial initiatives to promote medical research, including our ‘‘Featured New Investigator’’ papers and travel awards to present such work at the annual meeting of the Central Society for Clinical and Translational Research, have been developed.16 The book division of Elsevier, publisher of our journal, has agreed to begin a series of volumes, targeted to the clinical researcher and PhD scientist involved in translational research, called Advances in Translational Medicine. Volumes will be based upon expanded versions of our special issues and invited reviews, with 5 currently in the works: Translating Gene Therapy to the Clinic Regenerative Medicine Translational Epigenetics Translating microRNAs to the Clinic Biomarkers and Human Disease. I will serve as Academic Editor, and Michael Franklin, MS, as Technical Editor. We look forward to bringing these to you. Finally, what is our call to action to ensure that these extraordinary advances keep coming? Persistent, reenergized advocacy, establishing the importance of research, and supporting new funding streams for that research, as part of the solution to rising health care costs. The newly instituted Affordable Care Act will need to demonstrate value added for any interventions. Implementation science, helping to formulate the actionable items that should improve health outcomes, will become an increasingly important part of translational research. Our journal will highlight such studies. The importance of science to policy cannot be overstated.
As the prince in di Lampedusas novel The Leopard cogently observed, ‘‘Everything needs to change, so everything can stay the same.’’ Jeffrey Laurence Editor in Chief REFERENCES
1. Zopf DA, Hollister SJ, Nelson ME, Ohye RG, Green GE. Bioresorbable airway splint created with a three-dimensional printer. N Engl J Med 2013;368:2043–5. 2. Bowles RD, Gebhard HH, Hartl IR, Bonasser LJ. Tissueengineered intervertebral discs produce new matrix, maintain disc height, and restore biomechanical function to the rodent spine. Proc Natl Acad Sci USA 2011;108:13106–11. 3. Fielding G, Bose S. SiO2 and ZnO dopants in three-dimensional printed tricalcium phosphate scaffolds enhance osteogenesis and angiogenesis in vivo. Acta Biomater 2013. in press. 4. Yandell K. Organs on demand. The Scientist 2013;27:38–45. 5. Goldberg D, French B, Trotter J, et al. Underreporting of liver transplant waitlist removals due to death or clinical deterioration: results at four major centers. Transplantation 2013;96:211–6. 6. Takebe T, Sekine K, Enomura M, et al. Vascularized and functional human liver from an iPSC-derived organ bud transplant. Nature 2013;499:481–4. 7. Rodger JA, Lodwick R, Mauro S, et al. Mortality in well controlled HIV in the continuous antiretroviral therapy arms of the SMART and ESPRIT trials compared with the general population. AIDS 2013;27:973–9. 8. Hartocollis A. Cancer centers racing to map patients genes. NY Times 2013. 9. Sauermann H, Roach M. Science PhD career preferences: levels, changes, and advisor encouragement. PloS One 2012;7:e36307. 10. Zimmer C. A sharp rise in retractions prompts calls for reform. NY Times 2012. 11. Lewin T. Yearly prize of $500,000 is created for faculty. NY Times 2013. 12. Anderson M. Medical research: when scientific ‘‘breakthroughs’’ get lost in translation. Huffington Post 2010. 13. Tolar J. Translating genome engineering to better clinical outcomes. Transl Res 2013;161:199–204. 14. Laurence J. Stem cell ping-pong: the politics of science. Transl Res 2010;156:315–6. 15. Laurence J. Getting personal: the promises and pitfalls of personalized medicine. Transl Res 2009;154:269–71. 16. Franklin MJ. Recognizing the research achievements of new investigators. Transl Res 2013;162:130–1.
Translational Research 2014;163:1–2. 1931-5244/$ - see front matter Ó 2014 Mosby, Inc. All rights reserved. http://dx.doi.org/10.1016/j.trsl.2013.09.012
including my own at Weill Cornell,8 are creating centers for the eventual routine sequencing and analysis of every patients genome, in the quest for a ‘‘precision medicine.’’ But despite these exciting times, and the fact that an academic faculty research career is the path most often considered ‘‘extremely attractive’’ and ‘‘most desirable’’ by US-trained life scientists and physicists, the majority of these PhD graduates instead enter industry, government, or alternative careers.9 At tier 1 universities, the attractiveness of an academic career decreases steadily and significantly over the course of their training.9 And this pessimism is not restricted to PhD-based translational researchers. Dr Ferric Fang, editor-in-chief of Infection and Immunity, observed that ‘‘All the scientists I know are so anxious about their funding that they don’t make inspiring role models.’’10 With constraints from the economy and, more recently, the sequestration budget imposed on all federal agencies, government sources have not been of much help. National Institutes of Health funding percentiles remain in the single digits at many of the institutes. In a brief supporting National Institutes of Health Director Dr Francis Collins’s hope for a new translational medicine and therapeutics development center, the need to identify solutions and models to bridge what was deemed a ‘‘Valley of Death’’—the everwidening gap in funding and support for the kind of research that moves basic science down the path toward treatments—was highlighted.11 In this context, industry and academia are cooperating in new ways, and novel revenue streams are one anticipated outcome of these collaborations. As noted in a recent New York Times article, academic medical centers are investing in the infrastructure to collect and sequence patient DNA, identifying patients who could benefit from a particular drug, and aggressively recruiting patients for trials in the hope of playing ‘‘a bigger role in the development of new drugs, which could lead to lucrative patent royalties.’’8 In addition, the Minerva Project, named after the Roman goddess of wisdom, was recently established by private venture funds to provide an annual $500,000 award for ‘‘extraordinary, innovative teaching,’’ along with construction of a new research university to support such training.12 1
2
Translational Research January 2014
Laurence
Readers of Translational Research will not be surprised by any of these medical advances nor the challenges confronting continued progress. Recent ‘‘Special Issues,’’ ‘‘In-Depth Reviews,’’ and ‘‘Editorials’’ have or will soon be published reviewing these topics in the science and the politics of science.13-15 And, it clearly has been an important year for our journal. Our science citation index rose to 3.490 in figures released in 2013, after a 2.986 in 2012 and a 2.903 in 2011. Editorial initiatives to promote medical research, including our ‘‘Featured New Investigator’’ papers and travel awards to present such work at the annual meeting of the Central Society for Clinical and Translational Research, have been developed.16 The book division of Elsevier, publisher of our journal, has agreed to begin a series of volumes, targeted to the clinical researcher and PhD scientist involved in translational research, called Advances in Translational Medicine. Volumes will be based upon expanded versions of our special issues and invited reviews, with 5 currently in the works: Translating Gene Therapy to the Clinic Regenerative Medicine Translational Epigenetics Translating microRNAs to the Clinic Biomarkers and Human Disease. I will serve as Academic Editor, and Michael Franklin, MS, as Technical Editor. We look forward to bringing these to you. Finally, what is our call to action to ensure that these extraordinary advances keep coming? Persistent, reenergized advocacy, establishing the importance of research, and supporting new funding streams for that research, as part of the solution to rising health care costs. The newly instituted Affordable Care Act will need to demonstrate value added for any interventions. Implementation science, helping to formulate the actionable items that should improve health outcomes, will become an increasingly important part of translational research. Our journal will highlight such studies. The importance of science to policy cannot be overstated.
As the prince in di Lampedusas novel The Leopard cogently observed, ‘‘Everything needs to change, so everything can stay the same.’’ Jeffrey Laurence Editor in Chief REFERENCES
1. Zopf DA, Hollister SJ, Nelson ME, Ohye RG, Green GE. Bioresorbable airway splint created with a three-dimensional printer. N Engl J Med 2013;368:2043–5. 2. Bowles RD, Gebhard HH, Hartl IR, Bonasser LJ. Tissueengineered intervertebral discs produce new matrix, maintain disc height, and restore biomechanical function to the rodent spine. Proc Natl Acad Sci USA 2011;108:13106–11. 3. Fielding G, Bose S. SiO2 and ZnO dopants in three-dimensional printed tricalcium phosphate scaffolds enhance osteogenesis and angiogenesis in vivo. Acta Biomater 2013. in press. 4. Yandell K. Organs on demand. The Scientist 2013;27:38–45. 5. Goldberg D, French B, Trotter J, et al. Underreporting of liver transplant waitlist removals due to death or clinical deterioration: results at four major centers. Transplantation 2013;96:211–6. 6. Takebe T, Sekine K, Enomura M, et al. Vascularized and functional human liver from an iPSC-derived organ bud transplant. Nature 2013;499:481–4. 7. Rodger JA, Lodwick R, Mauro S, et al. Mortality in well controlled HIV in the continuous antiretroviral therapy arms of the SMART and ESPRIT trials compared with the general population. AIDS 2013;27:973–9. 8. Hartocollis A. Cancer centers racing to map patients genes. NY Times 2013. 9. Sauermann H, Roach M. Science PhD career preferences: levels, changes, and advisor encouragement. PloS One 2012;7:e36307. 10. Zimmer C. A sharp rise in retractions prompts calls for reform. NY Times 2012. 11. Lewin T. Yearly prize of $500,000 is created for faculty. NY Times 2013. 12. Anderson M. Medical research: when scientific ‘‘breakthroughs’’ get lost in translation. Huffington Post 2010. 13. Tolar J. Translating genome engineering to better clinical outcomes. Transl Res 2013;161:199–204. 14. Laurence J. Stem cell ping-pong: the politics of science. Transl Res 2010;156:315–6. 15. Laurence J. Getting personal: the promises and pitfalls of personalized medicine. Transl Res 2009;154:269–71. 16. Franklin MJ. Recognizing the research achievements of new investigators. Transl Res 2013;162:130–1.
