Is Translational Science and Medicine new? Its dramatic expansion has spelled a dizzying array of new disciplines, departments, buildings, and terminology. Yet, without novel theories or concepts, Translational Science and Medicine may appear to be nothing more than an old concept with a new brand. Yet, is this view true? As is illustrated herein, histories of TSM which treat it as merely an old product under a new name misunderstand its essential architecture. As an expressly economic (...) transformation, modern translational approaches are differentiated precisely by a set of semi-permanent architectures which render it an altogether different kind of object when compared to previous attempts by institutions to turn science into medicine. Powered by new software, embedded within campuses that now house companies, and with legal agreements that outline agreed-upon scientific activity, TSM is now powered by a set of robust and durable structures that differentiate it from previous approaches. Based on ethnographic research about translational neuroscience in North America, this paper suggests that the sense of TSM as not being new is a consequence of analytic modes that tend to see scientific enterprises in epistemic terms alone. Analyzing TSM as primarily a scientific object misses the fact that it is a principally a financial one. (shrink)

The above-mentioned article has been published online on 7 November 2019 as part of topical collection ‘_Before Translational Medicine: Laboratory Clinic Relations_’.

The reigning paradigm of rational drug discovery in translational medicine attempts to exploit biological theories and pathophysiological explanations to identify novel drug targets and therapeutic strategies. Given that there are limited human and material resources available for testing experimental therapeutics, this theory- and explanation-driven strategy of drug development seems to make good sense: it narrows the number of plausible drug candidates to be put through rigorous and expensive testing; it potentially improves the success rate of clinical translation; and (...) it provides some epistemological basis to extrapolate evidence from one domain to another and potentially minimize risks to patient-subjects.Yet... (shrink)

Cortisone, initially known as ‘compound E’ was the medical sensation of the late 1940s and early 1950s. As early as April 1949, only a week after Philip Hench and colleagues first described the potential of ‘compound E’ at a Mayo Clinic seminar, the New York Times reported the drug’s promise as a ‘modern miracle’ in the treatment of rheumatoid arthritis. Given its high profile, it is unsurprising that historians of medicine have been attracted to study the innovation of cortisone. (...) It arrived at the end of a decade of ‘therapeutic revolutions’, kicked off by penicillin transforming the treatment of bacterial infections and ending with hopes of a revolution in the treatment of non-infectious, chronic inflammatory diseases. Despite these studies of cortisone’s introduction, few historians have taken the story forward and considered how cortisone was adopted and adapted into clinical practice. This article tells the longer of how the drug and its derivatives were taken from research laboratories and integrated into clinical practice; what has in recent decades become known as translational medicine. In exploring cortisone’s first decade in Britain, we focus specifically on its role in the treatment of RA. Our approach is always to consider cortisone’s use in the context of other treatments available to clinicians, and at local and national institutional settings. We do not discuss the many other therapeutic uses of cortisone, which ranged for topical applications for skin diseases to the management of cancers, especially childhood leukaemia, nor do we discuss its close analogue ACTH—AdenoCorticoTropic Hormone. We think there are lessons in our study for TM policies today. (shrink)

This article explores the development of a novel biomedical research organism, and its potential to remake the species and spaces of translational medicine. The humanized mouse is a complex experimental object in which mice, rendered immunodeficient through genetic alteration, are engrafted with human stem cells in the hope of reconstituting a human immune system for biomedical research and drug testing. These chimeric organisms have yet to garner the same commentary from social scientists as other human–animal hybrid forms. Yet, (...) they are rapidly being positioned as central to translational medicine in immunological research and pharmaceutical development. This article explores the complex relations between species and spaces they seek to enact. Humanizing mice simultaneously moves these animal forms towards the intimate geographies of corporeal equivalence with humans and the expansive geographies of translational research. These multiple trajectories are achieved by the way humanized mice function as both uncertain ‘epistemic things’ and as expansive ‘collaborative things’, articulating mouse genetics with other research, notably stem cell science. In the context of post-genomics, their indeterminacy is critical to their collaborative value; their expansive potential follows as much from their biological openness as from specific expectations. Yet, these new research organisms have both accumulative and disruptive capacities, for there are patterns of interference between these trajectories, remaking boundaries between experimental practices and clinical contexts. (shrink)

This article discusses some aspects of the practice of complementary and traditional medicine in urban Mexico through a transcultural paradigm, hence it focuses on how medical knowledge(s) are commodified as well as how a `travelling' medical knowledge acquires agency in a transculturation process. This study, while analysing different practices of Chinese and Japanese medicine, argues that oriental medicine is translated in at least two ways - a popular and a cosmopolitan form - that shape particular expressions of (...) citizenship. The popular form is carried out in low-income neighbourhoods and it focuses around a `Mexicanization' of oriental medicine and the reaffirmation of the popular as part of the national. Cosmopolitan medicine, on the other hand, is particularly practised in exclusive health spas and seeks to purge the popular out of the national and to incorporate `traditional' medicine as one of the multiple components of cosmopolitan consumption. The article argues that both popular and cosmopolitan expressions are important to understanding how complementary and oriental medicine have become not only part of a global market, but also part of a particular history of national and popular medical systems. (shrink)

The concept of “translational bioethics” has received considerable attention in recent years. Most publications draw an analogy to translational medicine and describe bioethical research that aims at implementing and evaluating ethical interventions. However, current accounts of translational bioethics are often rather vague and seem to differ with regard to conceptual and methodological assumptions. It is not clear and scarcely analyzed what exactly “translation” in the field of bioethics means, in particular regarding goals and processes so that (...) it is justified to appeal to translational medicine. In this article, we thus explore possible analogies and disanalogies between translational medicine and translational bioethics to establish whether the often occurring reference to concepts of translational medicine in the field of bioethics can be justified by substantial analogies. We will first provide an account of different models of translational medicine. In a second step, we will propose an analytic definition that explicitly articulates the essential characteristics of “translational research” irrespective of the research field (i.e., biomedicine, bioethics). Subsequently, we will explore whether and in how far general characteristics and phases of translational research in medicine can be applied to translational research in bioethics. Based on our analyses, we will come to the skeptical conclusion that at present there are considerable conceptual disanalogies and unsolved conceptual problems that disallow using “translational bioethics” in a meaningful analogy to respective accounts in biomedicine. Nevertheless, we will demonstrate that some insights gained by the conceptual accounts of translational medicine can contribute to advance current research activities in bioethics. (shrink)

Next SectionIn a series of previous articles, we have considered how we might reconceptualise central themes in medicine and medical education through ‘thinking with Homer’. This has involved using textual approaches, scenes and characters from the Iliad and Odyssey for rethinking what is a ‘communication skill’, and what do we mean by ‘empathy’ in medical practice; in what sense is medical practice formulaic, like a Homeric ‘song’; and what is lyrical about medical practice. Our approach is not to historicise (...) medicine and medical education, but to use thinking with Homer as a medium and metaphor for questioning the habitual and the taken-for-granted in contemporary practice. In this article, we tackle the complex theme of ‘translation’. We use the lens of translation studies to examine the process of turning the patient's story into medical language. We address the questions: what makes a ‘good’ translation? What are the consequences of mistranslation and poor translation? And, while things are inevitably lost in translation, does this matter? (shrink)

Despite considerable scientific progress and the evolution of regulatory pathways to ensure safety and efficacy, US healthcare continues to see increasing health disparities. This suggests that clinical translation in of itself cannot be the only measure of its own success, especially when the most marginalized patients, are neglected in the development and implementation of medical innovations. This raises the question of whether a system that is narrowly focused on technical achievement can meet the moral obligations of medicine and public (...) health. We argue that traditional technocratic standards are failing to integrate normative considerations into biomedical translation. What is needed is a translational domain that moves beyond safety and efficacy toward anticipating how proposed technologies will be effective in society as it exists. We propose an additional metric of success: translational justice. (shrink)

Herophilus, a contemporary of Euclid, practiced medicine in Alexandria in the third century B.C., and seems to have been the first Western scientist to dissect the human body. He made especially impressive contributions to many branches of anatomy and also developed influential views on many other aspects of medicine. Von Staden assembles the fragmentary evidence concerning one of the more important scientists of ancient Greece. Part 1 of the book presents the Greek and Latin texts accompanied by English (...) translation and interpretative commentary. Significant background information is given in the introductory essay preceding each chapter. Part 2 briefly sketches the major developments within the Herophilean school after Herophilus, and discusses the individual members within it. Anyone interested in the history of science, the history of medicine, or intellectual history will find this book a rich source of information about an unusual and important aspect of Greek culture. (shrink)

Genomic medicine has the potential to contribute to the development of an array of novel technologies within the clinical armoury, making possible early detection and management of high-risk conditions such as cancer. While significant impact has already been felt in the context of rare inherited single gene disorders, much of the advancement in patient care through genomic medicine more broadly is going to be made possible by research involving large data sets that enable analyses of multiple genetic variants (...) that contribute to risk of common diseases. 1 As well as informing diagnosis and treatment of these diseases, these advances will support prediction and prevention. Considering risk prediction, combining data from multiple variants can produce a polygenic (or integrated) score (PGS/IGS). This will provide more accurate prediction than simply relying on environmental risk factors. While still in their early stages of development and implementation, it is clear that translation... (shrink)

Evidence-Based Medicine (EBM) developed from the work of clinical epidemiologists at McMaster University and Oxford University in the 1970s and 1980s and self-consciously presented itself as a "new paradigm" called "evidence-based medicine" in the early 1990s. The techniques of the randomized controlled trial, systematic review and meta-analysis have produced an extensive and powerful body of research. They have also generated a critical literature that raises general concerns about its methods. This paper is a systematic review of the critical (...) literature. It finds the description of EBM as a Kuhnian paradigm helpful and worth taking further. Three kinds of criticism are evaluated in detail: criticisms of procedural aspects of EBM (especially from Cartwright, Worrall and Howick), data showing the greater than expected fallibility of EBM (Ioaanidis and others), and concerns that EBM is incomplete as a philosophy of science (Ashcroft and others). The paper recommends a more instrumental or pragmatic approach to EBM, in which any ranking of evidence is done by reference to the actual, rather than the theoretically expected, reliability of results. Emphasis on EBM has eclipsed other necessary research methods in medicine. With the recent emphasis on translational medicine, we are seeing a restoration of the recognition that clinical research requires an engagement with basic theory (e.g. physiological, genetic, biochemical) and a range of empirical techniques such as bedside observation, laboratory and animal studies. EBM works best when used in this context. (shrink)

Translational research in medicine requires researchers to identify the steps to transfer basic scientific discoveries from laboratory benches to bedside decision-making, and eventually into clinical practice. On a parallel track, philosophical work in ethics has not been obliged to identify the steps to translate theoretical conclusions into adequate practice. The medical ethicist A. Cribb suggested some years ago that it is now time to debate ‘the business of translational’ in medical ethics. Despite the very interesting and useful (...) perspective on the field of medical ethics launched by Cribb, the debate is still missing. In this paper, I take up Cribb’s invitation and discuss further analytic distinctions needed to base an ethics aiming to translate between theory and practice. (shrink)

RésuméTechnê iatrikêde Galien a été traduit en hébreu trois fois. Deux fois dans le midi, autour de l'an 1199: d'abord, à partir de la version latine de Constantine l'Africain, par un médecin anonyme qui utilisait le pseudonyme “Doeg l’Édomite”; et une seconde fois de l'arabe, par Samuel Ibn Tibbon à Béziers, laVorlageétant maintenant la version arabe de Ḥunayn Ibn Isḥāq (al-Ṣināʿa al-ṣaġīra), accompagnée par le commentaire de ʿAlī Ibn Riḍwān. (La paternité de Samuel Ibn Tibbon de cette traduction a été (...) contestée, mais elle est établie dans l'article de Gad Freudenthal dans ce numéro d’ASP.) Une troisième traduction, encore une fois du latin et comprenant le commentaire d'Ibn Riḍwān, a été réalisée par Hillel ben Samuel à Rome à la fin du XIIIesiècle, mais elle n'entre pas dans notre sujet.Nous présentons leTegniet décrivons son histoire. Puis nous posons la question pourquoi cet ouvrage a été traduit en hébreu deux fois exactement au même moment et dans la même région. Nous montrons que les deux traducteurs ont répondu à un besoin des médecins juifs lisant seulement l'hébreu. Doeg réalise sa traduction dans le cadre de son vaste projet de mise à disposition en traduction hébraïque de la plus grande partie du corpus de l’école de Salerne. Samuel Ibn Tibbon, pour sa part, a traduit leTegniavec le commentaire d'Ibn Riḍwān parce que, après avoir été médecin, il évoluait graduellement vers la vocation d'un traducteur de l'arabe en hébreu d’œuvres philosophiques et ce texte médico-philosophique était en adéquation avec cette évolution d'un médecin avec des intérêts philosophiques vers un scientifique-philosophe. (shrink)

While many "benchtop-to-bedside" research pathways have been developed in "Type I" translational medicine, vehicles to facilitate "Type II" and "Type III" translation that convert scientific data into clinical and community interventions designed to improve the health of human populations remain elusive. Further, while a high percentage of physicians endorse the principle of citizen leadership, many have difficulty practicing it. This discrepancy has been attributed, in part, to lack of training and preparation for public advocacy, time limitation, and institutional (...) resistance. As translational medicine and physician-citizenship implicate social, political, economic and cultural factors, both enterprises require "integrative" research strategies that blend insights from multiple fields of study, as well as rhetorical acumen in adapting messages to reach multiple audiences. This article considers how argumentation theory's epistemological flexibility, audience attentiveness, and heuristic qualities, combined with concepts from classical rhetoric, such as rhetorical invention, the synecdoche, and ethos, yield tools to facilitate translational medicine and enable physician-citizenship. (shrink)

Evaluation of a volume of English renderings of Akkadian-language texts con- cerning treatment of illness in ancient Assyria and Babylonia.

Evidence-based medicine’s (EBM) quantitative methodologies reflect medical science’s long-standing mistrust of the imprecision and subjectivity of ordinary descriptive language. However, EBM’s attempts to replace subjectivity with precise empirical methods are problematic when clinicians must negotiate between scientific medicine and patients’ experience. This problem is evident in the case of bibliotherapy (patient reading as treatment modality), a practice widespread despite its reliance on anecdotal evidence. While EBM purports to replace such flawed practice with reliable evidence-based methods, this essay argues (...) that its aversion to subjective language prevents EBM from effectively evaluating bibliotherapy or making it amenable to clinical and research governance. (shrink)

The article presents the advantages and limitations of adaptive clinical trials for assessing the effectiveness of medical interventions and specifies the conditions that contributed to their development and implementation in clinical practice. I advance two arguments by discussing different cases of adaptive trials. The normative argument is that responsible adaptation should be taken seriously as a new way of doing clinical research insofar as a valid justification, sufficient understanding, and adequate operational conditions are provided. The second argument is historical. The (...) development of adaptive trials can be related to lessons learned from research in cases of urgency and to the decades-long efforts to end the productivity crisis of pharmaceutical research, which led to the emergence of translational, personalized, and, recently, precision medicine movements. (shrink)

In 2018-2019, at the Keck School of Medicine of the University of Southern California, we developed and piloted a narrative-based health systems science intervention for patients living with HIV and medical students in which medical students co-wrote patients’ life narratives for inclusion in the electronic health record. The pilot study aimed to assess the acceptability of the “life narrative protocol” from multiple stakeholder positions and characterize participants’ experiences of the clinical and pedagogical implications of the LNP. Students were recruited (...) from KSOM. Patients and staff were recruited from the Maternal, Child, and Adolescent/Adult Center for Infectious Disease and Virology at Los Angeles County+USC Medical Center. Ten patients, seventeen students, and ten MCA staff participated in the pilot study. Qualitative methods were used to gather data from students’, patients’, and staff’s perspectives. Three themes emerged from the thematic analysis: patients’ life narratives conveyed their unique life experiences and voices; the protocol could result in wide-ranging effects on HIV care; the LNP enabled students to contribute value to patients’ healthcare. Across groups, participants considered the LNP an acceptable intervention. The LNP, its limitations, and implications for HIV care, narrative medicine, and health information technology are presented. (shrink)

Translational research is now a critically important current in academic medicine. Researchers in all health-related fields are being encouraged not only to demonstrate the potential benefits of their research but also to help identify the steps through which their research might be ‘made practical’. This paper considers the prospects of a corresponding movement of ‘translational ethics’. Some of the advantages and disadvantages of focusing upon the translation of ethical scholarship are reviewed. While emphasising the difficulties of crossing (...) the gap between scholarship and practice, the paper concludes that a debate about the business of translation would be useful for medical ethics. (shrink)

Innovation is fundamental to the pharmaceutical industry and a key to improvements in healthcare. Its effectiveness depends on huge, constant investments in research. This innovative industry directly affects the course of studies in healthcare and medicine. Its efforts translate directly into the length and quality of our lives. For several years now, the progress underway in pharmaceutical industry has produced measurable benefits. Doctors have new pharmaceuticals at their disposal, including many types of antibiotics and anti-viral drugs, vaccines and a (...) wide range of drugs which save lives or make them more comfortable. In the near future, ever more efficient cures for neoplastic, rheumatic, neurological, psychic, metabolic, circulatory or respiratory diseases can be expected. (shrink)

We suggest that in the particular context of medical education, ethics can be considered in a similar way to other kinds of knowledge that are categorised and shaped by academics in the context of wider society. Moreover, the study of medical ethics education is translational in a manner loosely analogous to the study of medical education as adjunct to translational medicine. Some have suggested there is merit in the idea that much as translational research attempts to (...) connect the laboratory scientist's work to its implications for patient care, translational ethics focuses on bringing ethics scholarship into the sphere of personal and public action. We distinguish the term ‘translational ethics’ (the study of ethics being translated between academy, classroom and clinic) from other prominent definitions in the bioethics literature. To do this, we build off a notion of knowledge translation that focuses on the nonlinear movement of information that comes to professionals through multiple competing sources. We suggest that this knowledge, and particularly knowledge about ethics, becomes embodied by the individual. It is through a reflective practice that internally embedded ethics knowledge might be modified, and this work might be best carried out with a moral community that maintains a sense of practical wisdom. Applying this translational approach to the study of medical ethics education can be both academically relevant and practically useful. This view of translation can help bridge the evident, multidirectional relationships between research, education and performance. It might also create further opportunities to develop medical ethics education theory. (shrink)

Disproportional morbidity and mortality experienced by ethnic minorities in the UK have been highlighted by the COVID-19 pandemic. The ‘Black Lives Matter’ movement has exposed structural racism’s contribution to these health inequities. ‘Cultural Safety’, an antiracist, decolonising and educational innovation originating in New Zealand, has been adopted in Australia. Cultural Safety aims to dismantle barriers faced by colonised Indigenous peoples in mainstream healthcare by addressing systemic racism.This paper explores what it means to be ‘culturally safe’. The ways in which New (...) Zealand and Australia are incorporating Cultural Safety into educating healthcare professionals and in day-to-day practice in medicine are highlighted. We consider the ‘nuts and bolts’ of translating Cultural Safety into the UK to reduce racism within healthcare. Listening to the voices of black, Asian and minority ethnic National Health Service (NHS) consumers, education in reflexivity, both personal and organisational within the NHS are key. By listening to Indigenous colonised peoples, the ex-Empire may find solutions to health inequity. A decolonising feedback loop is required; however, we should take care not to culturally appropriate this valuable reverse innovation. (shrink)

Translational research is a main focus of current health policy (Albani and Prakken 2009; PLoS Medicine 2008). Translation of biomedical research knowledge to effective clinical treatment is essential to the public good (Lavis et al. 2003). Only 5% of basic science studies showing significant therapeutic promise are successfully translated into clinical application (Contopoulos-Ioannidis, Ntzani, and Ionannidis 2003; FDA 2004). As Hall (2001) observes, this is a problem: "When too many important discoveries lie dormant, the public good suffers" (p. (...) G1127). Recent health policy initiatives intended to foster the translation of basic science into clinical advances must consider the unique bioethical issues raised by .. (shrink)

In this paper, we describe the spiritual and kinship alliances between heads of an urban Santo Daime church from Rio de Janeiro and some leaders of the Yawanawá people from the Amazonian region. We suggest that these alliances involve exchanges and dialogical relationships that hold different meanings for the diverse social actors that take part in them. Further, we argue that equivocation and functional misunderstandings have an important role in these multidirectional dialogues. Based on this case study, we approach the (...) Yawanawá strategies for capturing otherness, and the insertion of the daimistas in the indigenous sociality networks. We focus especially on the Yawanawá mode of producing kin by capturing non-indigenous people and their participation in exchange networks that encompass multiple regimes of value. From the daimista point of view, we describe these relationships using the native category of “eclecticism.” We suggest that the daimistas attempt to translate the Yawanawá shamanic knowledge and the consumption of the “forest medicines,” experiencing the performance of “becoming indigenous.”. (shrink)

In this paper, we describe the spiritual and kinship alliances between heads of an urban Santo Daime church from Rio de Janeiro and some leaders of the Yawanawá people from the Amazonian region. We suggest that these alliances involve exchanges and dialogical relationships that hold different meanings for the diverse social actors that take part in them. Further, we argue that equivocation and functional misunderstandings have an important role in these multidirectional dialogues. Based on this case study, we approach the (...) Yawanawá strategies for capturing otherness, and the insertion of the daimistas in the indigenous sociality networks. We focus especially on the Yawanawá mode of producing kin by capturing non‐indigenous people and their participation in exchange networks that encompass multiple regimes of value. From the daimista point of view, we describe these relationships using the native category of “eclecticism.” We suggest that the daimistas attempt to translate the Yawanawá shamanic knowledge and the consumption of the “forest medicines,” experiencing the performance of “becoming indigenous.”. (shrink)

The label ‘Translational Research’ (TR) has become ever more popular in the biomedical domain in recent years. It is usually presented as an attempt to bridge a supposed gap between knowledge produced at the lab bench and its use at the clinical bedside. This is claimed to help society harvest the benefits of its investments in scientific research. The rhetorical as well as moral force of the label TR obscure, however, that it is actually used in very different ways. (...) In this paper, we analyse the scientific discourse on TR, with the aim to disentangle and critically evaluate the different meanings of the label. We start with a brief reconstruction of the history of the concept. Subsequently, we unravel how the label is actually used in a sample of scientific publications on TR and examine the presuppositions implied by different views of TR. We argue that it is useful to distinguish different views of TR on the basis of three dimensions, related to (1) the construction of the ‘translational gap’; (2) the model of the translational process; and (3) the cause of the perceived translational gap. We conclude that the motive to make society benefit from its investments in biomedical science may be laudable, but that it is doubtful whether the dominant views of TR will contribute to this end. (shrink)

A Literary History of Medicine: The ʿUyūn al-anbāʾ fī ṭabaqāt al-aṭibbāʾ of Ibn Abī Uṣaybiʿah. Edited and translated by Emilie Savage-Smith, Simon Swain, and Geert Jan van Gelder. Handbuch für Orientalistik, 1: The Near and Middle East, vol. 134. 5 vols. Leiden: Brill, 2020. $865. Open access: https://scholarlyeditions.brill.com/lhom/.

Berichte zur Wissenschaftsgeschichte, Volume 45, Issue 3, Page 487-498, September 2022.

BackgroundLiterature on issues relating to comprehension during the process of obtaining informed consent (IC) has largely focused on the challenges potential participants can face in understanding the IC documents, and the strategies used to enhance comprehension of those documents. In this review, we set out to describe the factors that have an impact on comprehension and the strategies used to enhance the IC process in sub-Saharan African countries.MethodsFrom November 2021 to January 2022, we conducted a literature search using a PRISMA (...) tool. We searched electronic databases (PubMed, EMBASE, EBSCOHOST) to identify relevant peer reviewed studies. We then reviewed the references of these articles to find additional literature that might have been missed through the initial search. We were particularly interested in full text articles in English that focused on the IC process in SSA published between 2006 and 2020. We included systematic reviews, and studies from Western and Asian countries that included data about SSA. We excluded articles that focused on medical interventions and studies that did not require IC.ResultsOut of the 50 studies included most were multi-country (n = 13) followed by single country studies in South Africa (n = 12); Kenya, Tanzania, Uganda (n = 5) each; Gambia, Ghana and Nigeria (n = 2)each ; and one each for Botswana, Malawi, Mali, Mozambique. We identified three areas of focus: (1) socio-cultural factors affecting IC; (2) gaps in the ethical and legal frameworks guiding the IC process; and (3) strategies used to improve participants’ understanding of IC.ConclusionOur review showed wide recognition that the process of achieving IC in SSA is inherently challenging, and there are limitations in the strategies aimed at improving comprehension in IC. We suggest that there is a need for greater flexibility and negotiation with communities to ensure that the approach to IC is suited to the diverse socio-cultural contexts. We propose moving beyond the literal translations and technical language to understanding IC comprehension from the participants’ perspectives and the researchers’ views, while examining contextual factors that impact the IC process. (shrink)

It is widely accepted that translational research practitioners need to acquire special skills and knowledge that will enable them to anticipate, analyze, and manage a range of ethical issues. While there is a small but growing literature that addresses the ethics of translational research, there is a dearth of scholarship regarding how this might apply to engineers. In this paper we examine engineers as key translators and argue that they are well positioned to ask transformative ethical questions. Asking (...) engineers to both broaden and deepen their consideration of ethics in their work, however, requires a shift in the way ethics is often portrayed and perceived in science and engineering communities. Rather than interpreting ethics as a roadblock to the success of translational research, we suggest that engineers should be encouraged to ask questions about the socio-ethical dimensions of their work. This requires expanding the conceptual framework of engineering beyond its traditional focus on “how” and “what” questions to also include “why” and “who” questions to facilitate the gathering of normative, socially-situated information. Empowering engineers to ask “why” and “who” questions should spur the development of technologies and practices that contribute to improving health outcomes. (shrink)

Since the arrival of Translational Medicine, as both a term and movement in the late 1990s, it has been associated almost exclusively with attempts to accelerate the “translation” of research-laboratory findings to improve efficacy and outcomes in clinical practice. This framing privileges one source of change in medicine, that from bench-to-bedside. In this article we dig into the history of translation research to identify and discuss three other types of translational work in medicine that can (...) also reshape ideas, practices, institutions, behaviours, or all of these, to produce transformations in clinical effectiveness. These are: making accessible state-of-the-art knowledge and best practice across the medical profession; remodelling and creating institutions to better develop and make available specialist knowledge and practice; and improving public and patient understandings of disease prevention, symptoms and treatments. We do so by examining the work of William S. C. Copeman, a dominant figure in British rheumatology from the 1930 through the late 1960s. Throughout his long career, Copeman blended approaches to “translation” in order to produce transformative change in clinical medicine, making his work an exemplar of our expanded notion of TM. (shrink)

Chaplains often describe their work in health care as “translation” between the world of the patient and the world of hospital medicine. Translators usually work with texts, interpreters with words. However, when chaplains use this metaphor, it describes something other than a discrete task associated with the meaning of words. While medical professionals focus on patients' medical conditions, chaplains seek to read the whole person, asking questions about what people's lives are like outside of the hospital, what they care (...) about most, and where they find joy and support in the world. Chaplains offer a supportive presence that serves to remind patients and caregivers that people are more than just their medical conditions or their current collection of concerns. Some chaplains are skilled at translating patients' experiences and sources of meaning in real time, allowing medical teams to better understand the person they are treating. “Translation” is also defined as metamorphosis. Chaplains provide this sort of translation when they are alone with patients, listening to their deepest concerns, helping them redefine their lives. (shrink)

Trust relations in the health services have changed from asymmetrical paternalism to symmetrical autonomy-based participation, according to a common account. The promises of personalized medicine emphasizing empowerment of the individual through active participation in managing her health, disease and well-being, is characteristic of symmetrical trust. In the influential Kantian account of autonomy, active participation in management of own health is not only an opportunity, but an obligation. Personalized medicine is made possible by the digitalization of medicine with (...) an ensuing increased tailoring of diagnostics, treatment and prevention to the individual. The ideal is to increase wellness by minimizing the layer of interpretation and translation between relevant health information and the patient or user. Arguably, this opens for a new level of autonomy through increased participation in treatment and prevention, and by that, increased empowerment of the individual. However, the empirical realities reveal a more complicated landscape disturbed by information ‘noise’ and involving a number of complementary areas of expertise and technologies, hiding the source and logic of data interpretation. This has lead to calls for a return to a mild form of paternalism, allowing expertise coaching of patients and even withholding information, with patients escaping responsibility through blind or lazy trust. This is morally unacceptable, according to Kant’s ideal of enlightenment, as we have a duty to take responsibility by trusting others reflexively, even as patients. Realizing the promises of personalized medicine requires a system of institutional controls of information and diagnostics, accessible for non-specialists, supported by medical expertise that can function as the accountable gate-keeper taking moral responsibility required for an active, reflexive trust. (shrink)