Cardiology and Translational Research
Like the rubric that has made the rounds for years "evidence based" medicine this term has become popular in medical schools and in the press. The former term, "evidence based" medicine, was meant to demand proof that each treatment worked on the basis of experimental protocols. Actually medicine was always based on some form of evidence, but the scientific method was not as well supported by new ways to look at things. Before 1900, information disseminated from one doctor, or country to another slowly, with a few journals, but more by word of mouth. If a doctor found something that worked for a disease better than prior therapies, he or she would tell as many other doctors as possible, or write an article in a journal. The therapy would be "picked up" slowly, and "tested" by others who could confirm (or deny) that the therapy worked.
The first large scale trials using the relatively new field of statistics did not occur until the mid twentieth century, and the field is still young, with new methods for analyzing data being developed as I write. Indeed, time honored treatments are now subjected to analysis by this new method and even today as I write, the Archives of Internal Medicine (www.archintermed.com) has an article demonstrating that people with kidney disease and diabetes benefit from who regular visits to specialists in kidney disease. Thus we continue to ask for scientific evidence that the things that doctors do benefit patients. To say that something is "evidence based" means that we actually have some scientific reason to believe that the therapy is the best that we have to offer. Once we have that, we must make an effort to be consistent in its use, and we develop guidelines and standards. Some things however will never be "evidence based" for very obvious reasons (Want to try testing the theory that falling out of an airplane without a parachute is good for your health?).
One of the newest terms in use is "translational research". What does this mean? A recent article in the Journal of the American Medical Association (www.jama.com) tries to define this concept in a meaningful way and break it down into parts. The purpose for the term is clear. It refers to translating the knowledge that we achieve in the basic science research laboratory into use on a clinical basis. We study DNA to find out why certain individuals are born with certain defects, or why diseases affect a family. The next step is to use that knowledge to benefit people. Unfortunately it takes a long time, and a lot of work to translate our scientific discoveries into treatments that can be used for people who are sick, or information that can be used to prevent disease. For certain diseases we are at the very beginning of breakthroughs. But for most genetic problems we are decades away. Three years ago I was concerned about the likelihood of a patient and his wife having a baby with a genetic defect, so I requested a genetic consultation from a major teaching center for them. All sorts of measurements and tests were taken and the risks of having a sick baby were assessed. Yet with all our scientific knowledge we were unable to deliver a healthy child. We are as yet unable to translate much of our science to better outcomes. For this reason, many medical schools are now forming translational science departments.
You may have read about the ENHANCE trial designed to determine if a cholesterol lowering drug (ezetemibe) decreases the amount of cholesterol plaque formation in the arteries. The results demonstrated that although the cholesterol was lowered, the amount of plaque formed on the interior of vessel was not. Thus far, the scientific research suggesting that this drug, and another (torcetrapib) that raises the good cholesterol would be of benefit did not translate into a major breakthrough for patient care. Yet other scientific breakthroughs that have gone from the laboratory to clinical care have truly benefited from cooperation between basic scientists and clinicians. Hopefully there will be even more of these efforts that will benefit patient care.