The Antidote

Counterspin for Health Care and Health News

Wednesday, October 04, 2006

Unblocking translational research

The U.S. National Institutes of Health has just announced $100 million in startup funding for a consortium of 12 academic health centers to work collaboratively within and between institutions to accelerate clinical research and to bring new research to practice. This money will go towards developing research informatics tools, training the next generation of researchers, expanding outreach to minority and medically underserved communities, and promoting interdisciplinary research among biology, clinical medicine, dentistry, nursing, biomedical engineering, genomics, and population sciences.

I'm wondering to what extent this effort really reflects what it takes to bring research into practice ("bench to bedside" is almost a cliché at this point, and usually originates at the basic sciences end of research, rather than from the perspective of practicing clinicians, not to mention that quality health care should not stop at the bedside).

Lauran Neergaard, writing for the Associated Press dug a little deeper into what exactly is meant by translation science, and she got some interesting answers. According to Neergaard, NIH Director Elias Zerhouni said that it took a 10-year study (i.e., the Women's Health Initiative, a randomized trial) to overturn the existing belief that estrogen was, on the whole, good for women's health, implying that the current effort towards improved collaborations and networking would do away with such delays. But wait... is he saying that the rapid aggregation of networked information on case subjects would obviate a randomized trial? For example, universities can pool patients to spot drug side effects. But in the absence of an RCT, or even controls, what do these side effects mean? As I've said before, big numbers aren't everything.

Or in other words, as many others have said, the plural of anecdote is not data.

RCTs already function in a centralized and highly networked fashion; perhaps these awards could add functionality to interinstitutional collaborations, but I doubt it would eliminate the 10 years required to accumulate meaningful health outcomes such as the ones we needed to see in the Women's Health Initiative. Or am I missing something here?

Next, where is the health systems aspect? Neergaard also interviewed Robert Califf of Duke University (one of the institutional award recipients), who pointed out that some of the money will be used to study why practitioners don't always follow proven strategies. Now we're talking. But it's not just the practitioners - and since we know that simply handing practitioners new information doesn't get them to change their practice, we need to look at the larger systems within which practitioners operate, and what the various helps and hindrances are to providing quality care.

The interdisciplinary efforts described don't mention systems science, behavioral sciences, or economics. And much of what's needed in closing the quality gap involves increasing the use of established research. I'd advocate for big-picture oversight to make sure that gaps are being systematically identified and filled, and that the taxpayers' money funding this stuff is being put to the best use.


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