From Bench to Bedside…

… is an evocative phrase that almost has one believe that busy scientists in their immaculate white lab coats, bustling about a clean high-tech lab filled with glass flasks containing brilliantly blue and luminescent yellow solutions, are delivering “magic bullet” drugs directly to their colleagues in the clinic. In my, admittedly limited, experience nothing could be further from the truth. When I tell people that I “did cancer research” this summer, investigating the differences between primary and metastatic prostate cancer (PC) in a lab at Cold Spring Harbor Laboratory, it sounds a lot more glamorous than it is.

There are probably two major factors that contribute to this somewhat idealised notion of how translational science works. Firstly, I would wager that the majority of the general public is not aware of what a long-winded process scientific discovery is. In the cancer research field, for example, basic cellular processes are usually probed and tested in cell culture models to begin with. If these experiments yield interesting results then the next step will involve using an animal model (often mice) to test whether the previously formed hypotheses hold true in vivo. If, either by sheer luck or rational thought, a drug is identified that can interfere with the process under scrutiny then it can be tested pre-clinically. If this is successful – and the definition of “successful” in this case is complex because of the guidelines from the Food & Drug Administration, for example – then maybe the drug can be used in Phase I (out of III) clinical trials. The clinical trials are expensive and can take several years to carry out and evaluate. So in total it usually takes at least a decade (and this is most likely a very optimistic estimate) for some basic discovery to gain clinical relevance. Of course there are exceptions to this, and despite the length of the process it is still certainly worth doing.

Secondly, I think that a lot of researchers investigating some disease or other are often unaware of the clinical/medical/social/personal implications that a disease has. A few days ago a close friend of my mother’s, who was diagnosed with PC earlier this year, asked me whether I could tell him more about the research I had done and more about PC in general. I didn’t know what to say. Presumably he didn’t really want to hear about the molecular pathways (e.g. PTEN/Akt pathway) involved. Nor is it particularly interesting to an Austrian individual what the current incidence and mortality rate statistics are in the USA. Reading about novel therapeutic agents that are just starting to be tested and won’t be ready for widespread use anytime soon isn’t going to be helpful either. I ended up sending him some review papers that focus on the clinical aspects of PC (e.g. Heidenreich et al. (2013)), but essentially I was helpless. Working with and experimenting on a cell line that, once upon a time, came from a bone metastasis of a patient with PC just isn’t the same as being confronted with a whole human being suffering from the disease.

In summary, therefore, I think more communication between both sides, and education on both sides, are needed. Patients lying on the bed or people standing by the bedside (doctors and relatives alike) often don’t know about how research at the bench works, and understandably, knowledge about basic research isn’t necessarily a priority for them at such a difficult time. Conversely, people standing at the bench usually aren’t doctors and don’t know about the disease, except in a defined experimental setting. Even MD/PhD researchers need to go through the laborious process outlined above.

Are there any ways of improving the situation? As a layperson: ask more questions. As a scientist: learn better ways of communicating, and maybe to enrol in a “Bench to Bedside” PhD programme such as the one offered by UCL.

Reference:

Heidenreich A, Pfister D, Merseburger A, Bartsch G (2013) Castration-resistant prostate cancer: where we stand in 2013 and what urologists should know. European urology 64: 260-265

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2 thoughts on “From Bench to Bedside…

  1. In a recent Toronto Diabetes Summit, Dr Flather of Norwich Med School in the UK presented a talk on “evaluating new drugs”. He told the audience that the average cost for enrolling a patient in all 5 phases of a clinical trial is about $ 48000, therefore to have any meaningful interpretation of any new drug efficacy and safety from the test data, one needs upward from 500 million to a billion dollars to do a clinical trial (10000 or more patients) !! even then, one has to get over the hurdle of governmental approval. Hence new drugs are not coming out fast (10 years or more as this blog writer so correctly indicated). And we see a lot of new drugs approved for release (based on trials done on much fewer subjects) and then subsequently withdrawn due to safety or efficacy concerns.

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  2. Pingback: Organoids. | Gotta Love Cells

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