Academic Health Science Centres combine teaching, research and healthcare service delivery. They are complex organisations bringing together hospitals with academic institutions, and embrace socially important missions. They employ people who work on wards, caring for very ill people, as well as researchers working at the limits of our knowledge. Reconciling these twin challenges in particular is important because many front-line staff are users of research results through medical devices and medicines, yet have little direct involvement, and perhaps interest in, research. At the other end are researchers, particularly those involved in basic research. The translation challenge is to figure out how these basic researchers and their work can link, if at all, to the issues confronting patients. Much research goes nowhere, but even failures are important research learning.
This is why research translation, the bench to bedside agenda, has become so very important. But it is fraught with conflicting interests, as basic researchers are skeptical, for understandable reasons, that mission directed research should replace the basic research priorities. My reason is that we, as humans, are simply not smart enough to pick the winners, as serendipity and luck are research colleagues. Those faced daily with the problems and challenges of disease and treatment may not fully understand this, as they demand better tools and methods. They don’t understand why a good idea can’t be made easier for them to use (taking sensible account of risk of course). For them the issue is adoption and diffusion, not invention.
Somewhere in this mess lie people who can bring products to markets, meaning in effect that they link ideas to markets, frequently a commercial activity involving money but also a bit like a dating agency, of bringing people with ideas together with people wishing to solve problems in a practical manner. Sometimes governments have to take on this role, and sometimes they are so enthusiastic that they drive the risk takers away and all the funding and commercial responsibility falls on the public sector. There are risks here, as for every dollar/pound/euro that the governments put into a risky development pot, the private sector takes out the same amount. This creates the impression of market failure in commercialisation, but is really more an example of the government crowding out investors. Unless governments have become particularly good at commercialisation, something commentators are broadly agreed they are not very good at, this defeats the whole research process, and leads to a public welfare-like system of research and development.