Translational Medicine

Translational Medicine is the strategy of focusing on new medical research that can be rapidly translated into useful clinical tools, lower costs and improved patient care.

A Tsunami of new bio-medical knowledge promises to change nearly everything about the way we diagnose and treat disease.

The White Elephant in the room is the insurance companies. Others: drug companies and administrative entities including many hospitals feed deeply from the trough of the over bloated health care economy.

Reforming the system will be a near impossible uphill battle against entities with enormous market power, perhaps more market power than the government. The widely quoted mantra is that we have the best medical care in the world. This claim is only true for the congressmen who claim it, and others fortunate enough to have comprehensive insurance and proximity to the very top echelon of medical providers. Public health statistics undeniably ranks our overall health care well behind most of the Western World. Mal-distribution of service, access difficulties and outrageous cost cause most of the problems. Many with known chronic disease hide the fact for fear of loosing what insurance they have. Any major event involving diabetes, cancer, heart disease or major surgery results in almost certain bankruptcy for all but the wealthy uninsured elderly. If the insurance company gets wind of one of these high-risk conditions, the patient will most certainly be uninsured.

The reform legislation pending – you can argue all you want – remains a near necessity. We cannot sustain the current costs. A large segment of our population receives substandard care or no care at all. The proposals may provide insurance for the uninsured and stem some of the insurance abuses. The costs and quality of care may remain another matter. One might expect the reform to be gamed and gutted by subsequent administrations.

In my view, only an academic and educational approach moving away from pay for service can contain cost and bring us back to scientific medicine. Furthermore, our regional differences and unique problems will respond poorly to central administrative guidelines.

State sponsored university medical schools already amount to a public option. Strengthening this option with federally funded subsidy as an administrative fiat would avoid the wrangling and gridlock that blocks our present struggle for a complete solution. This incremental approach and the state sponsored nature of medical schools should be acceptable to conservative elements from both sides, and it has the advantage of being an accomplished fact.

If asked, how American medicine is the best in the world, one would have to reply, its teaching centers. Only these medical schools and teaching hospitals can direct a scientific solution to local problems and facilitate translation of new bio-medical research onto the front lines of clinical medicine. A great deal of postgraduate education will need to accompany new clinical approaches.

A scientific academic approach to the health care problem may compete with the private sector improving performance and reducing cost as a competitive necessity. Such diverse state-by-state planning is in keeping with the scientific method. Competing research and development with open source will float the best solutions to the top. Such a research based academic solution should return our profession to its past humanity, a better distribution of care, an alternative to the unaffordable and a translation of new science to the front lines of clinical care.