Translational medicine: what's the importance to rheumatologic practice?

LETTER TO THE EDITORS

Translational medicine: what's the importance to rheumatologic practice?

Valderilio Feijó Azevedo

^{Correspondence to}

The clinical sciences and the environmental support for effective healthcare policies cannot continue as independent disciplines! The emerging view of medical practice which presents itself as a sustainable solutions process is called Translational Medicine and has strong roots in the evolution of interventionist actions allowed by general epidemiology throughout the last century. It is contextual to consider it as an evolution of Evidence-Based Medicine. But what is interesting in this approach of human health? It seems that its attractiveness is in fact that it supplies a view based in the integration of basic sciences, social sciences and political sciences with the objective of optimizing patient care and developing preventive measures which should extend beyond the provision of Healthcare Services.¹ Translational Medicine is a science because it's based in research originated production. According to Lean et al.,² it is "a process which leads from evidence based medicine to sustainable solutions for public health problems".

Logically, to reach its political objectives in health and for the term not to be considered just another cliché like the one designated by the terminology "holistic medicine", translational research needs to involve a broad team of scientists and scholars. These human pillars should concentrate their effort in fulfilling the promise that translational research should improve the health and longevity of the world's population. For that, translational researchers should be prepared to unite the discoveries of basic sciences with the wide territory of clinical investigation and translate these results in changes in clinical practice. In this tortuous process three distinct phases are described by Lean. Normally, the investigation processes of the first phase explore the necessities in health, develop potential treatments from basic laboratorial research and test the safety and effectiveness of medicines, mainly in clinical trials. The concepts involved in this phase form the base for the practice, based on evidences and in the creation of clinical directives. In relation to the development of medicines, the term "bench to bedside" is adequately used. Diverse pharmaceutical companies have created translational medicine teams to facilitate the interaction between basic and clinical research, particularly in trials. This is already occurring in the development of immunobiologicals specially aimed towards autoimmune diseases. In this context, the evaluation of therapies, as we see today, is obtained from disciplines as diverse as psychology, nutritional and physical therapy. The studies of the second phase examine which interventions of clinical sciences show to be effective and safe. Generally, studies of the first phase are confronted with practical applications in real environments and in everyday life situations, in which demographic factors and varied priorities can modify clinical decisions and treatment responses. The researches of this phase perform a very informative role, feeding the directives about necessities, acceptability, effectiveness and cost efficiency and also health policies to promote optimum management and resources use. Particularly in the modern world, in ways of a great economical recession, these needs should challenge the environment created by the restrict view perspectives allowed by the exclusive environment of clinical trials.^3,4 The translational researches of phase 3 add necessary information to convert treatments and prevention strategies, which already demonstrated its effectiveness and cost efficiency in phase 2, in bases for more rigid and at the same time wide governmental policies, based in evidences. These policies require different types of research processes to evaluate more complex interaction environments. They involve a sustainability process which depends on approaches that need a continuous refinement and methodological improvement.

Medical practice has benefited from translational medicine. Today, for example, we have learned, in psoriatic arthritis, that the relations of pathogenicity between cutaneous and muscle-skeletal disease are much closer than one decade ago.⁵ Therefore, is very probable that in a very near future the directives and public healthcare policies are directed towards the psoriatic disease in its different presentations and not only for spondylarthropathies and psoriasis. As another example, the epidemic control of osteoporosis and its sequels will require novel methods with multiple components directed towards more effective treatments, based not just in randomized trials, but in a continuous improvement of community-based approaches. The concept of sustainable promotional and preventive measures is notorious for this success and the natural unfolding of this is an educational and environmental integration which will facilitate actions for the increase of physical activity of populations and regulatory alterations for promotion, production and access to more healthy diets. The question that won't silence is: "Are our academic environments and cultures capable of standing translational research?" The new generation of physicians will certainly face this challenge, and we hope that there isn't other way than to grow within this dialectic perspective.

REFERENCES

The author declares to have no conflict of interest for the publication of this article.

• ¹
  Feldman A. Does Academic Culture Support Translational Research? CTS: Clinical and Translational Science 2008;1(2):87-8
• ²
  Lean MEJ, Mann JI, Hoek JA, Elliot RM and Schofield G. Translational Research: from evidence-based medicine to sustainable solutions for public health problems. BMJ 2008;337:a863.
• ³
  Berwick DM. Broadening the view of evidence-based medicine. Int J Qual Saf Health Care 2005;14:315-6.
• ⁴
  Woolf SH. The Meaning of Translational Research and Why It Matters. JAMA 2008;299:211-3.
• ⁵
  Ritchlin C. From Skin to Bone: Translational Perspectives on Psoriatic Disease. J Rheumatol 2008; 35(7):1434-7

Publication Dates

• Publication in this collection
  03 Mar 2009
• Date of issue
  Feb 2009