Constructing an environment that fosters success in translational research was the subject of UCSF School of Medicine's annual retreat held in Napa on Jan. 19 and 20.
More than 150 members of UCSF's leadership grappled to understand the barriers that keep researchers from conducting the kind of research that translates basic and clinical scientific findings into discoveries that can be applied to advance human health.
"Enabling clinical and translational research at UCSF means that we have to work across the campus and make it easier for faculty to pursue translational research," said David Kessler, MD, dean of the UCSF School of Medicine and vice chancellor for medical affairs. "What we heard clearly at the retreat is that our current promotion system does not adequately recognize faculty who want to do clinical and translational research, and we have a lot to do to facilitate the development of infrastructure so that the research can move forward more efficiently."
The retreat comes on the heels of a $100 million-plus, five-year National Institutes of Health (NIH) grant to UCSF to fund clinical and translational science. UCSF was one of only 11 institutions nationwide to receive NIH funding for full clinical and translational science institutes, and the University received the largest award in the first round of funding.
Creating an environment in which translational research can flourish is a daunting task, requiring major changes in the way that the University is organized.
The School of Medicine's annual retreat has been a nucleus for such major changes for more than a decade. The reorganization that resulted in the nation's most innovative and integrative medical school curriculum, which was introduced in 2001, crystallized during a School of Medicine retreat years ago. Last year's retreat gave birth to the Pathways to Discovery program, which will create new opportunities to incorporate scientific inquiry into both undergraduate and graduate medical education at UCSF.
Retreat participants noted that in many ways, UCSF is ahead of other medical research centers. "We have already been doing a lot of translational research through the Cardiovascular Research Institute, the Institute for Health Policy Studies and the Comprehensive Cancer Center, among others," Kessler said.
Overcoming Barriers
Nonetheless, there are significant barriers to making translational research an integral part of the University culture, participants noted. One of the barriers is that current funding mechanisms don't support translational research. Regis Kelly, PhD, director of the California Institute for Quantitative Biomedical Research (QB3), described "the Valley of Death," a funding gap between research grants and industry support. "You take an idea to a certain level, and then the NIH won't support it because it's too applied, and industry tells you to come back when you are farther along," Kelly says.
Another significant barrier that participants noted is that the current structure of the University is not organized to recognize and reward researchers who engage in translational research. "It's very hard to get noticed for applied research," said Jeffrey Bluestone, PhD, director of the UCSF Diabetes Center and Immune Tolerance Network. "We have investigators who can't get promoted because they don't have first- and last-author papers, even though the research couldn't have been done without them."
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Asthma researcher John Fahy, MD, was one of several faculty members who said they disagreed with colleagues who believe that academic researchers should shun industry interactions. Fahy said a clinical trial for an investigational new drug that he did early in his career turned out to be one of his most important scientific accomplishments because it helped produce a new drug now in wide use. To Fahy, barriers to clinical research at UCSF include a lack of full-time faculty positions for clinical research and the school's perennial space limitations.
Young investigators find it even harder to get noticed and promoted, others noted, if they are part of a large team of researchers. Large teams of researchers have become common in other scientific areas such as particle physics, and many feel that translational breakthroughs in medicine will require a similar approach.
"In my mind, we can't do it without teams," says Joseph "Mike" McCune, MD, PhD, senior associate dean for clinical and translational research and program director of the Clinical and Translational Science Institute. "The question is how to do this in a university, which often values individualism."
Retreat participants also agreed that the availability of good infrastructure and administrative support is also crucial to an effective translational research program. One recently initiated program is the Strategic Opportunities Support Center to provide pilot grants to those who are interested in clinical and translational research.
Patient records have to be constructed so that they provide useful research information and are tied to tissue banks, DNA banks and other repositories of information, some said. "There is a lot of work to be done to make sure that the marriage between research data and clinical data is useful," said Ronald Arenson, MD, chair of the Department of Radiology.
In addition, such records have to be secured centrally to ensure patient privacy, not merely kept in desktop computer files in the laboratory. "One of the challenges is that we need to provide research subjects the same protections that we do other patients," said Mark Laret, chief executive officer of UCSF Medical Center.
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Yet many of the resources that researchers want already exist at UCSF, although they tend to be available to individual units. "People are saying we need infrastructure, but we already have a lot of that infrastructure," said Geoffrey Manley, MD, PhD, associate professor of neurological surgery, who has constructed a secure, detailed system for patient records at San Francisco General Hospital.
Manley is collaborating with computer scientists from Intel to develop a critical care data warehouse to support multi-institutional clinical data management, which will facilitate knowledge discovery. A second goal of the project is to test the hypothesis that data-driven informatics methods can identify patterns in multivariate clinical data that define patient physiology and predict outcome.
By the end of the retreat, researchers agreed that measures in infrastructure, training and faculty advancement were key first steps for creating an environment conducive to translational research at UCSF. In particular, the leadership agreed that the scientific cores required for translational research need to be bolstered, and that regulatory barriers need to be addressed. Many of those attending the retreat felt that the University needs a knowledge management system to share information about resources and regulations that affect translational research.
Retreat participants also agreed that there should be additional training in translational research for students and young investigators, and that graduate programs and medical programs should coordinate with each other more. In addition, the groups strongly felt that faculty interested in translational research need more support, and should have a clear path to advancement through such research.
Although the challenges fostering translational research are great, the feeling among most of the group is that a supportive environment for translational research would provide large rewards. Addressing the retreat participants, Kessler noted the mood by saying, "I feel a palpable enthusiasm among you to make this work."
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