|
 
 |
| LETTER TO EDITOR |
|
| Year : 2015 | Volume
: 1
| Issue : 1 | Page : 64-65 |
|
Narrowing the gap between bench and bedside
Aneesh Basheer
Department of Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| Date of Web Publication | 9-Nov-2015 |
Correspondence Address:
Aneesh Basheer
Department of Medicine, Pondicherry Institute of Medical Sciences, Puducherry
India
 Source of Support: None, Conflict of Interest: None  | Check |
How to cite this article:
Basheer A. Narrowing the gap between bench and bedside. J Curr Res Sci Med 2015;1:64-5 |
Dear Sir,
Very often prolific research at basic sciences level does not translate to measurable clinically relevant outcomes. This gap has increasingly been recognized since the beginning of this century, boosting the popularity of translational research.[1] While research at molecular level has provided significant insights into the pathophysiology and different manifestations of diseases, it takes several years to be applied to patients, the ultimate beneficiary of all scientific medical research. Experts have identified two types of the gap, T1 and T2. The former refers to roadblocks in translating information gained in basic science laboratories into innovations that improve diagnosis or management and their testing in humans. T2 indicates a roadblock in converting results of clinical studies into practice changes.[2] In general, translational gap could result from several factors including lack of funds to escalate basic research to large-scale clinical trials, inadequate communication between the basic science researcher and clinicians, ethical issues involved in translating the basic research to human studies, rules and regulations regarding human studies and constraints in recruitment of study participants.[3] Although uncommon in developed nations, limited access to published literature on basic research also contributes to a translational gap in developing countries.[4] Some characteristics inherent to medical research also result in this gap. For example, animal models or cell line studies cannot be directly translated to human studies as results in humans are also influenced by a large number of factors, including behavior, judgment patterns, and environmental influences. Conversely, randomized control trials do not always reflect real-life conditions despite offering statistical validity to research.[5]
A recently proposed approach to deal with this translational gap is to characterize it by three domains.[3] First it must be determined whether the gap is broad or narrow. A broad gap exists when the results of the basic research could have multiple endpoints such as transforming the understanding of the disease, revolutionizing diagnostic methods or improving patient outcomes. A narrow gap is much easier to address as it often signifies a defect in the translation of preclinical work into a specific clinical outcome. Second, we need to ascertain whether the gap is the result of external or internal factors. Third, we must determine whether the translation can take place linearly or bi-directionally.[6] A linear model is one where the flow of translational research starts with basic sciences, progresses through its translation into increased knowledge of human system, development of newer methods or technology and finally culminates in improved care of the individual and thereby of the society. The bi-directional or "backward" model in simple terms refers to use of interim or final results of clinical studies as a hypothesis for future basic science research. This model seems to offer the advantage of enabling basic scientists to make their research more relevant and useful to its end users.[3]
Whatever be the cause or type of gap, its impact on progress in healthcare is undeniable. Policymakers, health care providers, and basic researchers should join hands to identify areas of translational gaps and their reasons to achieve the common goal of universal health affordable to all. Amalgamating bench with bedside across all stages of planning and execution of medical research can be achieved through conferences, by providing more space to basic research in general medical journals, and increasing journals devoted to translational research. These initiatives are likely to bridge this gap and ensure better utilization of resources and thus higher quality of care.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Zerhouni EA. The NIH roadmap. Science 2003;302:72.  |
| 2. | Woolf SH. The meaning of translational research and why it matters. JAMA 2008;299:211-3. |
| 3. | van der Laan AL, Boenink M. Beyond bench and bedside: Disentangling the concept of translational research. Health Care Anal 2015;23:32-49. |
| 4. | Albani S, Colomb J, Prakken B. Translational medicine 2.0: From clinical diagnosis-based to molecular-targeted therapies in the era of globalization. Clin Pharmacol Ther 2010;87:642-5. |
| 5. | Weinberg GA, Szilagyi PG. Vaccine epidemiology: Efficacy, effectiveness, and the translational research roadmap. J Infect Dis 2010;201:1607-10. [ PUBMED] |
| 6. | Grady PA. Translational research and nursing science. Nurs Outlook 2010;58:164-6. [ PUBMED] |
|
Search Pubmed for