Path Talk
Commentary by
David B. Roth, Irene Diamond Professor of Immunology and Chair of the Department of Pathology
Breaking the Barriers between Basic Science and Medicine
February 29, 2008
In the last Pathtalk column, I mentioned the challenge of increasing specialization. Although specialization is useful and necessary, the compartmentalization between disciplines can hinder efforts to look at problems in new ways. The consequences can be particularly obvious (and problematic) in biomedicine, where the ability to effectively translate our increasingly detailed knowledge of molecular biology, genetics, genomics, etc. into practical therapeutics requires a broad knowledge of human biology and the pathophysiology of disease.
The solution seems transparent enough: encourage physician-scientists, clinicians, and teams of basic scientists and clinicians to do "translational research." But how? In a 2005 interview that appeared in Science, Elias Zerhouni, MD, the Director of the NIH, made some observations about translational research:
"This topic [translational research] has been talked about for the last 20 years...If you look at the past 10 years, we've spent almost $6 billion on translational training, if you combine GCRCs [General Clinical Research Centers], the K12 [training grants], and all of the awards, and they haven't transformed anything...
"We want to challenge the community to put together real academic homes for translational science and for clinical science. Where, A, you can have a joint appointment, [and] B, you can really train in what you need to train in translational science. ... And it needs degree-granting programs, it needs graduate programs, it needs postdocs..."
Clearly, one impediment to translational research has been the lack of real academic homes in which faculty and students can collaborate fruitfully on translational problems. What steps can we take to reduce barriers, to provide individuals with training that allows them to make discoveries that bring basic science to bear on the disease processes that cause human suffering? At NYU Medical Center we are fortunate to be able to provide several approaches, two of which I will discuss here.
One is our recently developed graduate program in Pathobiology, which is designed to provide PhD students a highly edited but cohesive body of medical knowledge to support their basic research pursuits. Faculty, students, and postgraduate trainees work together to tackle questions that inhabit the interstitial spaces between bench and bedside, and, for that matter, between one bench and the next. So far, this program has stimulated great interest and enthusiasm among students and faculty alike, within and outside our Department. I have high hopes for our first class of trainees and the research they will catalyze.
The second approach is through the Medical Scientist Training Program. MSTPs (also known as MD/PhD programs) were begun in the 1960s, in part, to provide training that would enable scientists and doctors to 1) speak the same language, and 2) translate basic discoveries into practical measures that would improve the quality of people's lives. I doubt that many realized at the time how difficult this task would be as biological and medical knowledge grew and split into ever more cloistered subspecialties over the next few decades.
I recently took on the directorship of this program, and my vision for it is to solidify the program as a center for education not just in the separate practices of science and medicine, but also with a key role in bridging the two. I feel that MD/PhD's need special training in bringing basic science and medicine together, particularly at a time when each field is being swept along by powerful new currents (which will be the subject of future Pathtalk columns). To accomplish these goals, I hope to draw on the lessons we have begun to learn from our Pathobiology Graduate Program, and to implement several new integrative activities. The young physician-scientists and the medically knowledgeable basic scientists we train through our MSTP and Pathobiology programs will lead us into a golden age for translational research.
A note on the image: The depiction above of a pilgrim's cosmological discovery is known as the Flammarion woodcut. It is often reproduced to illustrate a break-through in scientific knowledge or as a paradigmatic visualization of the medieval imaginary. Its earliest documented appearance, however, dates to the late 19th century in a book by the French astronomer Camille Flammarion. (Colorized version by Hugo Heikenwaelder, reproduced by permission.)
