In Reply to Abelson, Rysavy et al, and Eley and Wilkinson:
We are grateful for the enthusiastic support and additional perspectives on our article.1 There is a troublesome gap between laboratory discoveries and new medical advances. This separation has been labeled the “valley of death”2 and requires innovative approaches to translate promising discoveries to patients. In our article, we discuss the impact of the declining presence of clinician–scientists in research on this recent gap and review the institutional and national responses to support clinician–scientists in the demanding medical and scientific environments of the 21st century.
While attenuating the decline of the clinician–scientist represents one potential solution to bridge the valley of death, we fully agree with the perspectives presented in the three preceding letters and thank the authors for their compelling considerations. Abelson makes an excellent point regarding the admission process and the criteria for selecting the next generation of medical students. While we mention that the numbers of individuals eager to explore a clinical research career are increasing, examining the current medical student admission processes to select the highest-caliber students supports the training of intelligent, compassionate, and inquisitive clinician–scientists. Similarly, the importance of dual-degree training, as presented by Rysavy et al, emphasizes the importance of population health knowledge among clinicians in the quest to bridge the valley of death. We fully support the need for translational research teams that encompass the vast skill sets required for translational success, and dual-degree programs in epidemiology and other public-health-related disciplines will foster individuals capable of supporting population-based translational research and practices. Finally, we agree with Eley and Wilkinson that incorporating a component for research processes into the training of today’s clinicians could encourage some students to become clinician–scientists. While clinician–scientists represent a unique opportunity to foster communication between the clinic and lab, training clinicians about the importance of communicating with the research community, even if those clinicians do not become researchers, may also support the successful translation of research advances to and from the clinic.
Overall, there are many approaches that may drive the successful translation of scientific discoveries into advances in the clinic. By acknowledging the problem of the valley of death and supporting programs that aim to bridge it, we can continue to support translational research and advance our ability to diagnose, treat, and prevent human diseases.
Stacey A. Sakowski, PhD
Deputy managing director, A. Alfred Taubman Medical Research Institute, University of Michigan, Ann Arbor, Michigan.
Eva L. Feldman, MD, PhD
Russell N. DeJong Professor of Neurology, University of Michigan, Ann Arbor, Michigan; email@example.com.
1. Roberts SF, Fischhoff MA, Sakowski SA, Feldman EL. Perspective: Transforming science into medicine: How clinician–scientists can build bridges across research’s “valley of death.” Acad Med. 2012;87:266–270
2. Butler D. Translational research: Crossing the valley of death. Nature. 2008;453:840–842