Translational research: Getting the word and the meaning right

I’m a little embarrassed but proud to accept the American College of Rheumatology’s Award of Distinction for Clinical Research on behalf of my colleagues in the Robert B. Brigham Arthritis and Musculoskeletal Diseases Clinical Research Center, and in memory of three of our fellows who died just as they were starting their careers in clinical research, Katherine Ginsburg, Charles Rivest, and Oliver Sangha. I thank the teachers who shaped my thinking and those who provided support over the years: Halsted Holman, Jim Fries, Eugene Braunwald, the late Dick Nesson, Frank Austen, Mike Brenner, Peter Schur, John Esdaile, Cheryl Koehn, Lawren Daltroy, Mary Scamman, and Irmhild Liang. I could not have done it without them. I take for my topic, translational research. The term seemed to appear out of nowhere one day and a definition is not easy find. In his attempt to define the term, Daniel Federman noted that, “as in the translation of a language, getting the word right is relatively easy but getting the meaning of a word is much more difficult (1).” I was recruited to the old Robert Breck Brigham Hospital, the first teaching hospital in America devoted to the care of people with arthritis and musculoskeletal disorders, teaching, and research and was told that I would become rich and famous. I became notorious, instead. It was an exciting place. I was surrounded by the most demanding of basic scientists to whom I had to explain my science, and by great physicians, Ron Anderson, John Coblyn, Arthur Hall, Mike Weinblatt, Jean Jackson, Marshall Wolf, Tom Lansdale, Beverly Woo, and Phyllis Jen, on whom I could always depend on to ask about the relevance of our work. In the course of things I made many mistakes, some I still regret, but as a consequence, learned a lot—the biggest insights were often unpublished—and all of it made me a better doctor and person. Our local sage, Ronald J. Anderson, says, “If everything goes right, you’ll never learn anything!” As we look back, we had become a group, which shared the characteristics of the best research environments as reviewed in detail by Bland and Ruffin (Table 1) (2). Being funded by the NIH, research was our raison d’etre. The “clear, common goals” were to solve patient and societal problems while advancing basic knowledge or developing novel methodologies. Our culture, irrespective of funding, was people first, solving the most important problems in that order. Taking risks and learning frommistakes was valued positively. Governance was shared, decentralized, and fluid. A biometry core was at the heart of every project and was accessible by all. The group eventually grew such that we were surrounded by people of varied academic rank, experience, and discipline who looked and thought differently. Bland and Ruffin’s review of the literature suggests the most appropriate (effective) reward is, surprisingly perhaps, praise more than money . . . and we have supported that view, by necessity, for 25 years (2). The best research environments must constantly strive for originality and renewal; this is operationalized by continued recruitment of the best and brightest, irrespective of discipline. Finally, a vital research environment must be led by excellent scientists with high expectations and management skills. In July of 2002, Diane Garthwaite introduced me to Botany of Desire, Michael Pollan’s tour de force (3). In it, co-evolution, defined as the reciprocal changes in 2 or more non-interbreeding populations with ecologic relationship act as agents of natural selection for each other, is discussed from the perspective of 4 plants–the apple, tulip, cannabis, and potato. Pollan shows how each of these plants evolved in a special way that satisfied man’s desire for sweetness in the case of the apple; for beauty in the tulip; intoxication in the case of cannabis, and control of nature in the case of the potato. Presented in part at the 66th Annual Scientific Meeting of the American College of Rheumatology, New Orleans, Louisana, October 26, 2002. Supported by NIH grant P60-AR47782, and a Kirkland Scholar Award. Matthew H. Liang, MD, MPH: Brigham and Women’s Hospital, Robert B. Brigham Arthritis and Musculoskeletal Diseases Clinical Research Center, Harvard Medical School, Boston, Massachusetts. Address correspondence to Matthew H. Liang, MD, MPH, Brigham and Women’s Hospital, 75 Francis Street, PBB3, Boston, MA 02115. E-mail: mliang@partners.org. Arthritis & Rheumatism (Arthritis Care & Research) Vol. 49, No. 5, October 15, 2003, pp 720–721 DOI 10.1002/art.11370 © 2003, American College of Rheumatology