Translational health covers the innovation journey from concept to reality, Healthcare World Editor Sarah Cartledge learns.
The new buzzword in healthcare is translational health, but what is it and how does it work? This was the main thrust of the session at the Healthcare World Festival and was clearly explained by the panellists who have been working in this field for several years.
Jane Kinghorn, Director of the Translational Health Research Office at University College London, previously worked in drug discovery for a multinational pharma company. She has seen translational health from both sides, and describes it as putting into action the steps and support for researchers to move their ideas into action and address unmet needs.
Joseph Ferenbok, Director of the Translational Health Program at the University of Toronto, built on her definition by saying that many people think their Eureka idea will instantly change the world, but the reality is much more banal. “Just because it works in one context and in one hospital or in one community centre, it doesn’t magically work everywhere in the globe. Each application of research or knowledge has contextual differences that make it important to be able to work out some of these ideas beforehand to ensure better implementation and success that is more effective, less costly and with benefits to people.”
Behind all of this research and application lies the funding, an area in which Heather-Anne Hubble of Phundex is situated. For her, it’s a question of whether the innovation is a solution to a need, and then how it’s effectively commercialised. The realisation that funding can be a slow and painful process for innovators has led her to create Phundex, a platform to simplify the necessary steps for everyone involved.
The importance of co-operation
So it’s quite clearly not enough to have a brilliant idea that can change the world. That’s just the first step. Bringing it to market is a long and complicated process that is made all the more convoluted by the lack of structure to follow through in a formal and regulated manner.
The panel emphasised the many silos that exist traditionally within academia and funding, leading to people following their own paths – from researchers moving to the next idea to get the next grant, to the lack of patient involvement to determine whether an innovation does indeed have a practical and beneficial application.
As a result, many universities have found themselves in a situation where they are handling the development of ideas created by their researchers. At UCL they have embedded the scientists with knowledge from industry and support to show them how to move forward. As a result of the close association with University College Hospital they are actively trying to address the patients’ needs, so the clinicians are active researchers, particularly in gene and cell therapy. “Ten years ago there was no commercialisation of the market so the medical council decided to address this and now we have spun out 10 companies in 10 years,” says Jane.
In Joseph Ferenbok’s Health Innovation Hub, some of the 450 companies have gone on to outstanding success. “The key is to fail fast and to fail early,” he says. “Identify a legitimate need that actually exists and is not in your head. Step out of the research environment and speak to the patients, users, clients and see what they want. Then frame the need in the jurisdictional, legal and regulatory context within which you’re going to have to build out.”
It was a point picked up by Dr Austin Gibbs, Director at The Allan Lab in Jersey, a former emergency doctor who worked across the globe. “In healthcare, the moment you put something in the hands of a patient or a doctor, things happen to it that you could not possibly have predicted, either beneficial or negative,” he said. “There needs to be a much closer link between the front line and research so there’s a rapidly exchange of ideas and needs.” For him, commercialisation of innovations is a powerful Darwinian selection mechanism – those who survive in a commercial world have probably worked closely with their end users.
Cultural change is needed to figure out how to bridge the gap, but in many respects it’s being driven by the patients themselves who don’t understand why, if they can manage their own affairs online, healthcare is so behind in this regard.
The commercialisation of ideas and data
In fact, patients themselves are comfortable with the idea of citizen scientists. In today’s world anyone can come up with a concept and the successful ones secure funding. But healthcare has specific issues mostly around patient data, which is vital for research and validation of ideas, and the absence of effective communication between the different silos in the early stages of development.
The lack of incentives for academics, healthcare workers and healthcare organisations to participate was identified by the panel, while the drivers for clinicians to make an impact for their patients was recognised.
Austin referred to the commercialisation of healthcare data and the terabytes of data that are lost every day, also citing conversations taking place in Jersey at the moment around recognising that data belongs to the patient. By making this data available to researchers who would reward the patient for allowing its use, the patient is actively involved in research which will enable better treatment and potential outcomes. This patient feedback makes life easier for the clinicians with outcome base measures of time and money, which will drive innovation further.
“We moving away from doctor knows best in healthcare generally, so we should move away from the doctor being the data owner as it’s actually all the patient’s personal information,” he said. “The patient should truly be at the centre of everything and not squeezed into a box each time.”
Access to data has traditionally met ethical, practical, cultural and traditional barriers. Joseph acknowledged that some of the most valuable insights can take place just by observation on a ward, which are of immense value to engineers and scientists who are often working from a theoretical standpoint. But ethical review boards often relate to publications and output rather than innovation, and they limit patient input at the beginning of the commercial cycle. In his opinion, each patient should have the right to decide whether they want their data to help themselves or other sufferers.
The question of fair value for the data was discussed, with the agreement that it needs careful consideration and debate around what data can be ringfenced for academia and what can be used commercially.
“It’s about interesting ideas being accessible and available to the public, “ said Heather-Anne Hubble. “The key is regulation and to build a sustainable process that every party gets to have a place in that process and is rewarded for the aspect they bring to the table.”
Need for a systemic approach
The panel agreed that translating an idea from a business concept to getting funding requires a tried and trusted process to validate it. Currently it’s a messy and complicated space that can kill good ideas, so it’s about changing the language to allow an entrepreneur to translate their idea into a commercially viable proposition.
Within each phase there can be multiple teams taking unstructured step so the need for a systemic approach, along with guidelines about vetting and selecting concepts, then putting them forward to each step in the process, will enable good ideas to progress. But currently there is a lack of funding to translate ideas as most funding goes into development. “This is the bigger problem and is crucial to the future of innovation. We need better relationships with industry and more focussed governments,” said Joseph.
Heather-Anne emphasised the need for giving potential funders an understanding of the necessary steps via a collaborative hub where everyone can work together and share successes and failures. The panel agreed that getting investors in earlier gives a much better approach as they can de-risk their investment, while good investors will have a sector roadmap of 20-30 years to filter ideas.
Conclusion
The development of the Covid vaccine was singled out as a the perfect example of translational health in action. Vaccines used to take 10-15 years to roll out, but now several have been rolled out in the past 18 months for this novel virus. The fundamental research has been in train for decades but the expedited collaboration between multiple labs and researchers, between governments and industry to cut down pathways and barriers to a fraction, has been unprecedented.
Talking early and sharing was identified as the key, along with the superhuman effort round the clock by everyone working on a singular goal with clear aims and objectives with one coherent incentive. This shared knowledge base, along with implementing a feedback loop, is vital in evaluating how best to mobilise knowledge in particular contexts.
But for translational healthcare, most important of all is a collaborative approach between stakeholders to develop a set of practices and adapt them when needed to better innovate in the future, making sure it’s sustainable. This set of guidelines will give each participant in the process a clear understanding of their place in the roadmap, the reward for their involvement and a shared vision of the ideal outcome – a solution to an identified need that will improve patient experience and clinical outcomes.