Christopher P. Austin, Nature
Misconceptions about translation — defined as the process of turning observations in the laboratory, clinic and community into interventions that improve the health of individuals — hinder efforts to close gaps and address challenges related to the translational process. This article highlights some misconceptions with the aim of improving understanding and advancing solutions.
“What gets us into trouble is not what we don’t know. It’s what we know for sure that just ain’t so.” Mark Twain
I am sometimes asked what my biggest surprise has been as director of the National Center for Advancing Translational Sciences (NCATS), the component of the US NIH focused on the science of translation. Without hesitation, I answer “apperception” — meaning ‘to comprehend a new idea by assimilation with the sum of one’s previous knowledge and experience’. Translational science is a new idea1 and turns out to be challenging to assimilate with what is believed to be true by many stakeholders based on their previous experience. This difficulty with apperception is surprisingly resistant to data and substantially impedes progress in translational science that would otherwise be accelerating the development of new treatments for disease — a goal all stakeholders share.
I offer here several of the most prevalent and robust misconceptions I have experienced in speaking to diverse audiences about translation, along with some ideas on causation and amelioration. I present these as one trained in, and unflinchingly supportive of, basic scientific investigation. And with apologies, I present each misconception in its purest form without subtlety or qualifications, for the purposes of exposition.
Common misconceptions about translation
Translation does not exist. This is a surprisingly widely and firmly held belief, with multiple variants, including the ‘basic discovery ≡ intervention ≡ health improvement’ false equivalency. This seems to derive in part from well-placed respect for the wonders of fundamental science, along with widespread lack of knowledge of how interventions (drugs, devices, behavioural interventions and medical procedures) are developed, separation of the stages of translation into dozens of ‘silos’ and a paucity of individuals who have first-hand experience in more than a few of these silos.
The result is that a fundamental discovery is commonly believed to be tantamount to a marketed intervention. Furthermore, the widely used term ‘technology transfer’ encourages this notion, as it implies that a basic technology can be transferred to a commercial organization and immediately marketed without substantial further investment or risk of failure. To those with this simplistic world view, the concept of translation as a discrete stage between fundamental discovery and health improvement is confusing at best and a fiction at worst.
Translation is a ‘thermodynamically favoured’ process. The concept here is that translation does exist, but it occurs naturally and automatically. This is also known as the ‘snowpack in the mountains’ model, in which fundamental science is the metaphorical winter snow that, in the spring, naturally melts and runs downhill and provides the needed product, an intervention that improves human health.
One source of this misconception appears to be the common statements at the end of scientific and lay publications about fundamental discoveries that note the potential for the discovery to lead to a drug or other therapeutic intervention in a few years. This must be a misconception given that the remarkable success of basic science in delivering fundamental insights in the past several decades has not led to the number of drugs or other interventions being approved increasing to a corresponding extent.