New Vision, New Goals for Clinical and Translational Gastroenterology

As busy physicians and scientists, we must prioritize our time and energy between responsibilities, opportunities, and passions. I am an academic gastroenterologist and scientist because of a lifelong passion: facilitating translation of great science and new tools into innovative clinical practice that impacts patient well-being. My appointment as Editor-in-Chief of Clinical and Translational Gastroenterology (CTG) provides new responsibilities and opportunities to facilitate this process. My specific passion is the prevention of complex chronic diseases through the paradigm of precision medicine.1 This paradigm differs from the framework of medicine in the twentieth century, which focused on infectious diseases, symptom- or histology-based syndromes, and global statistics with the goals of finding the single causative agent for a disease and eliminating it (the germ theory of disease). Although this approach revolutionized the treatment of simple disorders and remains applicable in modern medicine, it fails to provide a framework for effectively managing more complicated processes, such as inflammatory bowel disease, liver cirrhosis, chronic pancreatitis, all complex ‘functional' disorders, and other digestive diseases. The new paradigm of precision medicine focuses on how combinations of factors, including genetic variants and environmental exposures, come together in an individual to result in progressive pathology. It also focuses on variability within a disease in terms of susceptibility, severity, trajectory, complications and responses to therapy. The goal is to determine the underlying mechanism of an individual's disease, improve diagnostic testing, and to develop an individualized therapeutic strategy based on pharmacogenomic principles and targeted therapies to alter the natural history of disease early in its course, thereby preventing adverse outcomes and improving health. Amazingly, a shift to this paradigm is already happening, led by forward-thinking physicians, scientists, and health-care providers. The results of new studies go beyond a ‘statistically significant association' to clarify the underlying disease mechanisms and define principles that can be applied in predictive ways to improve patients' lives. How can CTG be a leader in emerging health care and especially personalized medicine? First, CTG is open access so that anyone can read and interact with new advances immediately. Second, CTG offers rapid publication of high-quality papers, without waiting for openings in monthly journal volumes. Third, the complexity of the questions we face in translational science and precision medicine requires international collaborations to solve. Many of the brightest minds in the world remain in countries with limited resources and where English is not the native language. Thus, researcher investment into the publication cost of a high-quality, open-access journal that publishes studies written in simple, clear English remains the best way to make important work accessible, impactful, and more frequently cited. It also addresses the issue of when publicly funded research should become publicly available. Fourth, CTG is committed to publishing expert perspectives on the field, either as “Translational Medicine: Bench to Bedside,” “Gut Instincts,” or as more lengthy narrative reviews, in order to continually update physicians about important advances. Through this approach, we hope CTG will address the 10 well-defined hurdles impeding implementation of precision medicine2 for complex disorders in general, and digestive diseases in particular. CTG, as a society journal, belongs to the American College of Gastroenterology, and it serves broader goals in publishing than the focused area that I intend to champion. Indeed, CTG should also serve as a venue for early-phase clinical trials, qualitative and quantitative epidemiologic research, hypothesis-generating research, studies of novel mechanisms and methodologies including public health interventions, and integration of approaches across organs and disciplines. Thus, as an open-access sister journal to the American Journal of Gastroenterology, CTG should serve a complementary role in disseminating new knowledge and ideas to an educated and proactive community of specialty physicians. This balance of design, goals, and vision will be maintained by the appointment of two outstanding Associate Editors, Ashwin Ananthakrishnan, MD, MPH, and Amit Singal, MD, MS, with special expertise in luminal disorders and IBD, and in liver disorders and hepatocellular carcinoma, respectively. Yogi Berra noted, “It's tough to make predictions, especially about the future.” One can easily predict that health-care delivery will change drastically in the near future, especially in the United States. We trust that the nature and quality of works published in CTG will provide insight and guidance for practicing medicine in smarter ways, so that everyone will benefit. Our commitment is to provide outstanding service to the field of gastroenterology and hepatology and forge the way into the future.