Monday, August 20, 2012

The translational pipeline

Over the weekend I read yet another excellent article by Atul Gawande in the most recent issue of the New Yorker. There are many interesting things in this article and I highly recommend it, but there was one minor comment that really resonated with my own experience. Dr. Gawande mentioned that it's hard to get health care providers (doctors, nurses, clinicians of all types) to accept changes. This resistance to change is one of the obstacles in the translational research pipeline identified by my colleague John Whyte (e.g., Whyte & Barrett, 2012). The other major obstacle is using a theoretical understanding of some process, mechanism, or impairment to develop a potential treatment. 

I deeply value basic science (after all, it is most of what I do) and I recognize the importance of specialization -- the skills required for good basic science are not the same as the skills required for developing and testing treatments. Nevertheless, sometimes I worry that we basic scientists don't even speak the same language as the researchers trying to develop and test interventions. The clinical fields that border cognitive science (education, rehabilitation medicine, etc.) certainly stand to benefit from rigorous development of cognitive and neuroscience theory and this is the standard motivation given by basic scientists when applying for funding to the National Institutes of Health. 

Over the last few years I've come to realize that the benefits also run in the other direction: interventions can provide unique tests of theories. Making new, testable predictions is one of the hallmarks of a good a theory, but if the new predictions are limited to much-used, highly constrained laboratory paradigms then it can feel like we're just spinning our wheels. Making predictions for interventions, or even just for individual differences, is one way to test a theory and to simultaneously expand its scope. As NIH puts more emphasis on its health mission, I hope cognitive and neural scientists will see this as an opportunity to expand the scope of our theories rather than as an inconvenient constraint. Whyte J, & Barrett AM (2012). Advancing the evidence base of rehabilitation treatments: A developmental approach. Archives of Physical Medicine and Rehabilitation, 93 (8 Suppl 2) PMID: 22683206

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