Fiscella and Yousefi Nooraie Envision a Community-Focused Complementary Pathway for Translational Research
Faced with numerous challenges to population health, including declining life expectancies, the COVID-19 pandemic, and increasing psychological distress, the biomedical translational research field would benefit from a novel, complementary pathway for translational research that centers community priorities, argues Kevin Fiscella, MD, MPH, and Reza Yousefi Nooraie, MSc, PhD, in a paper published in the Journal of Clinical and Translational Science.
In “Health first, for all: Envisioning a novel complementary pathway for translational research,” Fiscella and Yousefi Nooraie envision a second complementary translational research pathway that works in tandem with the current biomedical-based pathway. They outline three principles: an end goal of promoting health for all—rather than an emphasis on basic scientific discovery—that targets health determinants instead of mechanisms; a community-partnered and driven focus on research to address these determinants, especially material and psychological needs; and development based on long-term partnerships with communities and healthcare providers based on team science principles.
“Being part of the UR CTSI and co-leaders for the Equity-Focused Dissemination and Implementation team prompted us to think a lot about what it would take to accelerate evidence-based interventions into practice to advance health equity,” Fiscella said. “We realized that despite bidirectional translational pathways, the dominant one starts with basic research. We thought starting with community priorities instead might not only accelerate translation but better align translational research with community priorities.”
“Focusing on the last translational stage—dissemination and implementation of research findings in clinics and communities—we see lots of opportunities for how the real-world evidence of uptake and use could inform future technology development and pre-clinical research,” Yousefi Nooraie said. “These reverse translational pathways are quite underexplored.”
The researchers understand how health research can sometimes seem too slow, and how the focus and outcomes may appear to be out of step with the on-the-ground realities of community population health needs. With a complementary, community-driven pathway, popular criticisms of health research and even partisan distrust of medical research could be mitigated as communities themselves help drive the focus and outcomes of translational research.
“Bridging across the disciplinary, professional, and socio-ecological silos is the essence of translational research,” Yousefi Nooraie said. “We practice in a field where researchers are already used to communication with colleagues in other fields and with very diverse skill sets.”
Processes to gather community input into the operation of research institutions already exist. Fiscella cited the example of hospitals, which engage with local governments and community organizations to satisfy their tax-exempt status and community-focused priorities.
“What is needed is improved democratization of these processes—and significant funding to support them,” Fiscella said.
Fiscella and Yousefi Nooraie argue that the current state of US health care is in crisis, but that the possibility exists to better facilitate a community-driven complementary translational pathway.
“There are two factors that come to mind,” Fiscella said. “The first is that the mechanistic biomedical model that yields remarkable discoveries predominates. The idea of discovering a silver bullet to cure cancer, for example, is irresistible. Second, discovery and marketing of drugs and devices represents a jackpot for the powerful biomedical industry.”
But without checks and balances, Fiscella pointed out, the profit motive distorts health research outcomes.
“Similar to many other aspects of our societies, the suboptimal systems are in a balance and remain sustainable,” Yousefi Nooraie said. “That is why inequities exist, and may remain forever, unless we break the status quo and get out of our comfort zones.”
The authors intend to follow up this proposal with small-scale pilot projects.
Michael Hazard | 10/31/2023
