Is there a role for communication studies in translational research?

ABSTRACT

As a concept and as a form of practice in the biomedical sciences, “translational research” is both everywhere and yet nowhere, and the challenges to translational success are significant. This essay introduces the notion of translational research in its contemporary sociopolitical context and proceeds to identify problems of communication at the core of translational research. Widely discussed and yet poorly understood, even by those who conduct it, translational research would benefit from the sustained attention of scholars working at the intersection of medical/health humanities and health communication studies.

KEYWORDS:

• Translational research
• biomedicine
• biomedical research
• health humanities
• medical humanities
• science communication

Notes

1. Steven H. Woolf, “The Meaning of Translational Research and Why It Matters,” Journal of the American Medical Association 299, no. 2 (2008): 211.

2. Jane Maienschein et al., “The Ethos and Ethics of Translational Research,” The American Journal of Bioethics 8, no. 3 (2008): 43–51; Miriam Solomon, Making Medical Knowledge (Oxford: Oxford University Press, 2015).

3. Carol R. Horowitz et al., “Community-based Participatory Research from the Margin to the Mainstream: Are Researchers Prepared?” Circulation 119, no. 19 (2009): 2364.

4. John M. Westfall, James Mold, and Lyle Fagnan, “Practice-based Research—‘Blue highways’ on the NIH Roadmap,” Journal of the American Medical Association 297, no. 4 (2007): 403–6.

5. Maienschein et al., “The Ethos and Ethics of Translational Research.”

6. Joseph V. Kennedy, “The Sources and Uses of US Science Funding,” The New Atlantis Summer (2012): 3–22.

7. Note that calls for genuinely translational research tend to emphasize the importance of public–private (or academic–corporate) research alliances. See Dale Yu, “Translational Research: Current Status, Challenges and Future Strategies,” American Journal of Translational Research 3, no. 5 (2011): 422–33. It is critical to bear in mind that such ventures can also be sites of ethical turmoil. See Sheldon M. Krimsky, Science in the Private Interest (Lanham, MD: Rowman & Littlefield, 2004).

8. See Despina G. Contopoulos-Ioannidis, Evangelia E. Ntzani, and John P. A. Ioannidis, “Translation of Highly Promising Basic Science Research into Clinical Applications,” The American Journal of Medicine 114, no. 6 (2003): 477–84; John P. A. Ioannidis, “Materializing Research Promises: Opportunities, Priorities and Conflicts in Translational Medicine,” Journal of Translational Medicine 2, no. 5 (2004), doi:10.1186/1479-5876-2-5 (accessed April 29, 2016); Heidi Hörig, Elizabeth Marincola, and Francesco M. Marincola, “Obstacles and Opportunities in Translational Research,” Nature Medicine 11 (2005): 705–8; Despina G. Contopoulos-Ioannidis et al., “Life Cycle of Translational Research for Medical Interventions,” Science 321, no. 5894 (2008): 1298–9; Mary Carmichael, “Why Don’t More Medical Discoveries Become Cures?” Newsweek, May 14, 2010, http://www.newsweek.com/why-dont-more-medical-discoveries-become-cures-72475; Malcolm R. Macleod et al., “Biomedical Research: Increasing Value, Reducing Waste,” The Lancet 383, no. 9912 (2014): 101–4.

9. Failures of translation are legion, and some researchers have begun to explore how such failures could illuminate the pathway to more successful ventures in future. This important insight harkens back to philosophical work on false models as a means to better theories. But a lot depends on whether the failures of translation are systematic and predictable rather than idiosyncratic. See John P. A. Ioannidis, “Translational Research May Be Most Successful When It Fails,” Hastings Center Report 45, no. 2 (2015): 39–40; Alex John London and Jonathan Kimmelman, “Why Clinical Translation Cannot Succeed Without Failure,” eLife 4 (2015), doi:10.7554/eLife.12844 (accessed April 29, 2016); William C. Wimsatt, “False Models as Means to Truer Theories,” in Neutral Models in Biology, ed. Antoni Hoffman (Oxford: Oxford University Press, 1987), 23–55.

10. William Proxmire, “Turning Points in Wisconsin History: Sen. William Proxmire Uncovers Wasteful Government Spending, 1975–1987,” Wisconsin Historical Society, http://www.wisconsinhistory.org/turningpoints/search.asp?id=1742.

11. “Government Performance and Results Act of 2003,” https://www.gpo.gov/fdsys/pkg/STATUTE-107/pdf/STATUTE-107-Pg285.pdf; “GPRA Modernization Act of 2010,” https://www.gpo.gov/fdsys/pkg/PLAW-111publ352/pdf/PLAW-111publ352.pdf.

12. Brandon Keim, “Republican Congressmen Crowdsource Attack on Science,” Wired.com, December 7, 2010, http://www.wired.com/2010/12/nsf-youcut-review/.

13. See J. M. Ladd et al., “The ‘How’ and ‘Whys’ of Research: Life Scientists’ Views of Accountability,” Journal of Medical Ethics 35, no. 12 (2009): 762–7. At the US National Science Foundation (NSF), the emphasis has been on “transformative research,” as the scope of the NSF’s fields falls well beyond the usual domains in which “translation” might happen (http://www.nsf.gov/about/transformative_research/). Of course, “transformative research” is a notion as ripe for analysis as “translational research.”

14. Business Wire, “Organization Will Still Use BIO Name,” Business Wire, January 4, 2016, http://www.businesswire.com/news/home/20160104006245/en/Biotechnology-Industry-Organization-Biotechnology-Innovation-Organization.

15. See Woolf, “The Meaning of Translational Research”; Maienschein et al., “Ethos and Ethics”; Nancy S. Sung et al., “Central Challenges Facing the National Clinical Research Enterprise,” Journal of the American Medical Association 289, no. 10 (2003): 1278–87; Elias A. Zerhouni, “Translational and Clinical Science—Time for a New Vision,” New England Journal of Medicine 353 (2005): 1621–3.

16. Carmichael, “Why Don’t More Medical Discoveries Become Cures?”

17. Declan Butler, “Translational Research: Crossing the Valley of Death,” Nature 453 (2008): 840–2; see also Carmichael, “Why Don’t More Medical Discoveries Become Cures?”

18. See Steven P. Wainwright et al., “From Bench to Bedside? Biomedical Scientists’ Expectations of Stem Cell Science as a Future Therapy for Diabetes,” Social Science & Medicine 63, no. 8 (2006): 2052–64; Caren Heller and Inmaculada de Melo-Martín, “Clinical and Translational Science Awards: Can They Increase the Efficiency and the Speed of Clinical and Translational Research?” Academic Medicine 84, no. 4 (2009): 424–32; Bryn Lander and Janet Atkinson-Grosjean, “Translational Science and the Hidden Research System in Universities and Academic Hospitals: A Case Study,” Social Science & Medicine 72, no. 4 (2011): 537–44; Myfanwy Morgan, et al., “Implementing ‘Translational’ Biomedical Research: Convergence and Divergence Among Clinical and Basic Scientists,” Social Science & Medicine 73, no. 7 (2011): 945–52. Of especial interest is the need to unpack the cognitive, linguistic, and praxis aspects of the clinician–investigator: the MD/PhD who inhabits both worlds (bedside and bench), speaks both languages (clinical and biological-biomedical-preclinical), and for whom translation is a mode of being—putatively.

19. Heller and de Melo-Martín, “Clinical and Translational Science Awards,” 425.

20. Whether these Centers work is a difficult and complex question to address, not least because the metrics of success are unclear.

21. In addition to many of the hundreds of images revealed by a Google image search on “translational research,” see also the Figure in Westfall, Mold, and Fagnan, “Practice-based Research,” 405; and Table 1 in Carl Kieburtz and C. Warren Olanow, “Translational Experimental Therapeutics: The Translation of Laboratory-Based Discovery into Disease-Related Therapy,” Mount Sinai Journal of Medicine 74, no. 1 (2007): 7–14. Other metaphors have been proposed, such as a translational web emphasizing the dynamic interconnectedness of key elements, but these alternatives have not caught on. See Dwayne D. Kirk and Jason Scott Robert, “Assessing Commercial Feasibility: A Practical and Ethical Prerequisite for Human Clinical Testing,” Accountability in Research 12, no. 4 (2005): 281–97.

22. Kieburtz and Olanow, “Translational Experimental Therapeutics.”

23. See Jonathan Lomas, “Connecting Research and Policy,” Isuma: Canadian Journal of Policy Research 1 (2000): 140–4; “The In-between World of Knowledge Brokering,” British Medical Journal 334, no. 7585 (2007): 129–32; John N. Lavis et al., “How Can Research Organizations More Effectively Transfer Research Knowledge to Decision Makers?” The Milbank Quarterly 81, no. 2 (2003): 221–48; Jon F. Kerner, “Knowledge Translation Versus Knowledge Integration: A ‘Funder’s’ Perspective,” Journal of Continuing Education in the Health Professions 26, no. 1 (2006): 72–80.

24. McDonnell Social Norms Group, “Enhancing the Use of Clinical Guidelines: A Social Norms Perspective,” Journal of the American College of Surgeons 202, no. 5 (2006): 826–36.

25. Of course, health communication scholars should not ignore T2 and T3 translation, ripe as these domains are for conceptual and empirical analysis. See the next section for discussion.

26. For instance, see Jason Scott Robert, “Model Systems in Stem Cell Biology,” BioEssays 26, no. 9 (2004): 1005–12; “The Comparative Biology of Human Nature,” Philosophical Psychology 21, no. 3 (2008): 425–36; John P. A. Ioannidis, “Extrapolating from Animals to Humans,” Science Translational Medicine 4, no. 151 (2012): 1–4; Jessica Bolker, “Model Organisms: There’s More to Life than Rats and Flies,” Nature 491 (2012): 31–3; Todd M. Preuss and Jason S. Robert, “Animal Models of the Human Brain: Repairing the Paradigm,” in The Cognitive Neurosciences, 5th ed., ed. Michael S. Gazzaniga and George S. Mangun (Cambridge, MA: MIT Press, 2014), 59–66; Susan Bridgwood Green, “Can Animal Data Translate to Innovations Necessary for a New Era of Patient-Centred and Individualised Healthcare? Bias in Preclinical Animal Research,” BMC Medical Ethics 16, no. 53 (2015), doi:10.1186/s12910-015-0043-7 (accessed April 29, 2016).

27. Consider Charles Grant III, Kenneth Cissna, and Lawrence Rosenfeld, “Patients’ Perceptions of Physicians Communication and Outcomes of the Accrual to Trial Process,” Health Communication 12, no. 1 (2000): 23–39; Pamela Sankar, “Communication and Miscommunication in Informed Consent to Research,” Medical Anthropology Quarterly 18, no. 4 (2004): 429–46; Steven Joffe and Franklin G. Miller, “Bench to Bedside: Mapping the Moral Terrain of Clinical Research,” Hastings Center Report 38, no. 2 (2008): 30–42; Katherine A. McComas et al., “Individuals’ Willingness to Talk to Their Doctors About Clinical Trial Enrollment,” Journal of Health Communication 15, no. 2 (2010): 189–204.

28. For important disambiguation of the concept “therapeutic misconception,” see Jonathan Kimmelman, “The Therapeutic Misconception at 25: Treatment, Research, and Confusion,” Hastings Center Report 37, no. 6 (2007): 36–42.

29. See Laurie T. Martin et al., “Patient Activation and Advocacy: Which Literacy Skills Matter Most?” Journal of Health Communication 16, no. 3 (2011): 177–90; Rebecca Kukla, “How Do Patients Know?” Hastings Center Report 37, no. 5 (2007): 27–35; Susannah L. Rose, “Patient Advocacy Organizations: Institutional Conflicts of Interest, Trust, and Trustworthiness,” Journal of Law, Medicine, and Ethics 41, no. 3 (2013): 680–7.

30. Bolker, “Model Organisms”; Preuss and Robert, “Animal Models of the Human Brain”; “Editorial: Let’s Think About Cognitive Bias,” Nature 526 (2015): 163 (much of this issue of Nature is devoted to unpacking the biases that infuse human cognition, including the thinking and practices of scientists); Monya Baker, “1,500 Scientists Lift the Lid on Reproducibility,” Nature 533 (2016): 453–5; C. Glenn Begley and Lee M. Ellis, “Drug Development: Raise Standards for Preclinical Cancer Research,” Nature 483 (2012): 531–3.

31. Richard Harris, Rigor Mortis: How Sloppy Science Creates Worthless Cures, Crushes Hope, and Wastes Billions (New York: Basic), 2017.

32. Robert, “The Comparative Biology of Human Nature”; Preuss and Robert, “Animal Models of the Human Brain.”

33. See Paul E. Griffiths and Eva M. Neumann-Held, “The Many Faces of the Gene,” BioScience 49, no. 8 (1999): 656–62; Paul Griffiths and Karola Stotz, Genetics and Philosophy: An Introduction (Cambridge: Cambridge University Press, 2013); Celeste M. Condit, “Public Understandings of Genetics and Health,” Clinical Genetics 77, no. 1 (2010): 1–9. Griffiths is a philosopher of science; he and his colleagues have unpacked numerous senses of “gene” at work in contemporary biology. Condit is a very accomplished communication scholar who has made a significant contribution to public beliefs and attitudes about genes and genetics.

34. As reported by Richard Van Noorden, “Global Scientific Output Doubles Every Nine Years,” Nature.com newsblog, May 7, 2014, http://blogs.nature.com/news/2014/05/global-scientific-output-doubles-every-nine-years.html.

35. Geoffrey Kabat, “The Crisis in Peer Review,” Forbes.com, November 23, 2015, http://www.forbes.com/sites/geoffreykabat/2015/11/23/the-crisis-of-peer-review/#3ef7540612c6.

36. See Linn Getz, Anna Luise Kirkengen, and Irene Hetlevik, “Too Much Doing and Too Little Thinking in Medical Science!” Scandinavian Journal of Primary Health Care 26, no. 2 (2008): 65–6; “Incentive Malus,” The Economist, September 24, 2016, http://www.economist.com/news/science-and-technology/21707513-poor-scientific-methods-may-be-hereditary-incentive-malus.

37. Rose Eveleth, “Academics Write Papers Arguing over How Many People Read (and Cite) Their Papers,” Smithsonian.com, March 25, 2014, http://www.smithsonianmag.com/smart-news/half-academic-studies-are-never-read-more-three-people-180950222/.