by Paul Cassar, Stem Cell Network Scientist-in-Residence
You’ve heard this already, I’m sure. Stem cell research is a multidisciplinary endeavour that requires an assemblage of scientists, engineers, clinicians, lawyers and ethicists. And I know I don’t have to tell you that to bring a new therapy to the clinic requires decades of basic, pre-clinical and clinical research, and hundreds of millions of dollars. Let’s be honest, for most of us stem cell researchers, the thought of advancing the questions asked at the bench to the bedside is a bit of a stretch, and translating our discoveries to the clinic is something we’ll strive for during our post-doc, or second post-doc.
Why not call a spade a spade? The reason you are where you are is because you were funded to answer a basic research question with basic research funding that never intended to ask the questions, “Who is the consumer? Who is the receptor? Who will benefit? Who will pay?” On top of this, nobody really thought to question whether the typical receptors (i.e. journals) were adding to the noise in the knowledge sphere by prioritizing the publication of invalidated “fresh ideas” rather than rewarding good basic science that could support more costly pre-clinical and clinical studies. Apologies, after writing the last sentence, I suddenly realize that as long as the name of the game is “chasing impact”, it is the consumer who will continue to pay.
Perhaps I sound a bit too cynical, or for some, maybe all-the-way jaded, but after attending the “Approaches to Clinical & Translational Research (ACTR) Workshop” at the Sprott Centre for Stem Cell Research in Ottawa last week, I got a real shot in the arm – a dose of reality if you will. The workshop faculty and attendees scrutinized the scientific, clinical, ethical and economic merit of new and emerging therapies, such as oncolytic virus as a therapeutic for certain types of cancer and mesenchymal stromal cell (MSC) therapy for septic shock. The verdict? We can do translational and clinical research without a huge injection of industry funding, provided that we operate with economic tact (as defined by Dr. Chris McCabe’s presentation, “But I still haven’t found what they’re looking for! Economic insights for translational scientists“); scientific integrity (as outlined by Dr. Jonathan Kimmelman’s talk, “Ethics and clinical development of novel treatments“); and scientific and clinical organization (as exemplified by Dr. Harold Atkins’ talk “Connecting the dots between treatments and clinical outcome”).
As was highlighted by Dr. Duncan Stewart, Canada has the actors and the infrastructure in place to develop “displacement” technologies, such as the oncolytic virus and MSC therapies noted above, as the next generation of standard care for patients. These sentiments were echoed by Dr. Peter Ganz, Director at Government of Canada-Health Canada, who stated that Canada “will no doubt see a growth in therapeutics” provided “we get the science right”.
So where does this leave us? In my opinion, we’re caught in the middle. We need groundbreaking, revolutionary science, but more importantly we need real science, the kind of translational science that keeps planes flying at 30,000 feet in the air. What we don’t need is more published data that doesn’t satisfy the technical requirements to support expensive pre-clinical and clinical studies. We need a concerted research effort into diseases where there is currently little to no standard of care; where new cell-based therapies are most likely to be adopted into the Canadian private, not-for-profit health care system. Perhaps we need a little bit of Robert Frost:
I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I—
I took the one less traveled by,
And that has made all the difference.
This is a call to all basic, translational and clinical stem cell scientists: Let us unite towards the road less traveled; let us redefine what impactful science is; let us in our fortunate position in this socio-economic landscape, be the difference!