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Improving health care, adjusting policies, and allowing research to make an impact is vital for advancing our technologies to meet our new needs. As communities grow larger, and new problems arise, technology must adapt to be effective. People that work on tackling integration of new technology into society are known as Translational Scientists. Dr. Keith Brunt, a Translational Scientist with IMPART labs, and a faculty member in Medicine and Business at Dalhousie Medicine New Brunswick and UNBSJ has first-hand experience in the area of translational medicine and understands its importance for the future. Dr. Brunt began as a student keen on becoming a chiropractor, starting his first research experience through an NSERC grant examining the effects of the enzyme, neuronal nitric oxide synthase, on body temperature. It turned out that the enzyme didn’t have the effect on body temperature as expected.
I realized I wasn’t just learning from the textbook, but adding to it and even correcting errors in how knowledge is created. - Dr. Keith Brunt
Over his time as a student, Dr. Brunt worked in a variety of fields, including pulmonary and cardiovascular physiology, stem cell and gene therapy. After completing his PhD in experimental medicine at Queen’s University, he received a clinical fellowship in cardiovascular surgery and regenerative medicine at the MaRS Institute of UHN in Toronto.
Translational medicine is an interdisciplinary field of science, which facilitates communication and integration between fundamental science, clinical research & practice, and public policy. It is a process of turning scientific studies into new tools or treatments, comparing new treatments to current practices, and coordinating with governments to implement them. Translational medicine plays a vital role in our healthcare system, and paves the way for innovation to make its way in medicine. By effectively using translational science in Canada’s health system, there is the potential for health costs to be reduced. It involves not just being a consumer of health services, but producing medical products or technologies and adopting innovative practices and policies. Translational science has the ability to reduce dependencies and create a more sustainable healthcare system.
People often misunderstand innovation, what they don’t recognize is that in order for innovation to exist, something gets displaced or destroyed. Which means either the old way of doing things is changed (and replaced by something better) or a new way of doing things fails (and we learn valuable lessons). However, people generally don’t like change or failure – so translational scientists are trained to be fearless of both. - Dr. Keith Brunt
The IMPART lab team at Dalhousie Medicine New Brunswick
One way to represent translational science is through baking. Say you just discovered a new type of cricket flour that is considered to be gluten free. You know that there are a lot of people that are gluten sensitive or intolerant, and they could benefit highly from being able to enjoy a delicious cookie again. Upon further research, you discover that there has yet to be a cookie made of gluten-free cricket flour that also tastes good, and decide to take matters into your own hands and try to create such a recipe. Through trial and error, you are then are able to create a recipe that incorporates both the gluten-free flower, and the satisfying taste of a regular cookie. You share your recipe with others with similar interests in the baking field to see if they are able to replicate your newfound gluten-free cookie, and perhaps even improve the recipe further. Once you have confirmed the recipe for the best tasting cookie made with gluten-free cricket flower, you then work to ensure that such cookies are always available at all university events where cookies are given out for free, so everyone can be a cookie monster.
We are too often in a trade deficit when it comes to Health Care, we too often import and consume solutions and too rarely create, develop and export them. - Dr. Keith Brunt
Breaking down Translational Science
Image Submitted by Dr. Keith Brunt
There are 3 levels of translational science; T1, T2 and T3. The first level, T1, is referred to as “bedside to bench and back”. Its purpose is to take scientific findings from laboratory conditions, bring the results to clinical trials, and finally work to implement the findings into clinical practice. T1 allows researchers to determine if a new treatment being studied can be used in order to treat human illnesses effectively. Likewise, it is important to know just how effective a new treatment is compared to what is currently available (new isn’t always better or different). This research also explores issues weighing down our healthcare system so that we may direct research to focus on how to solve problems, like wait times. The coalescence of health and research plays an important role in advancing a sustainable healthcare system. Referring back to our gluten-free cricket flour example, T1 would be most similar to the process of incorporating the gluten-free cricket flour into cookies to see if they retain their taste to satisfy the need for gluten-free cookies. It is the first-step to making gluten-free cookies available on campus!
The second level of translational science, T2, concentrates on management and organization, as well as ensuring the best clinical practices possible are being used. T2 is the process of discovering if new clinical treatments shown to be more effective or efficient than traditional methods of treatment are being adopted and valued by everyone (not just the scientists). An example of this would be conducting a cost-benefit analyses on new drugs compared to commonly prescribed drugs. Perhaps new drugs are more expensive, but if they are more potent and allow patients to be discharged much sooner, the extra cost may be worthwhile. Thus, the cost of keeping the patient in the hospital with an old drug would be more than when using the newer drug. As it is more efficient, and more cost-effective, it is beneficial to implement the change into healthcare system. Again, back to the cookie example, T2 would be similar to the process of sharing your recipe with fellow bakers to insure your batch was not just a fluke, and to see if there are any other ways to improve your recipe. By sharing the recipe with other bakers, you are able to optimize your gluten free cookies and learn whether they could afford to sell those cookies in their bakery.
The third and final level of translational science is called T3. T3 is concerned with implementing policies based on the results from previous translational levels to assure they are used in clinical practice making healthcare more effective. There may be a new and improved method to treat a specific illness, but without permission from government (or other health care payers, like insurance companies), new methods cannot be applied. Thus, by advocating for advanced medical care, T3 works to improve the current healthcare system. In our example, T3 would be most similar to having the University make it a policy that gluten-free cookies must be made available at all university events.
New Brunswick Researchers from the Institute of Biomedical Engineering at UNB, the Stan Cassidy Centre for rehabilitation, New Brunswick Innovation Foundation & Dalhousie Medicine New Brunswick meeting with the Honourable Julie Payette, Governor General of Canada - Submitted by Dr. Keith Brunt
An example of translational science in medicine in action is the development and implementation of a new imaging technology. Perhaps a medical imaging expert discovers a new technology that allows for more accurate diagnostics. The imaging expert files a patent and proves it works in the real world to benefit a few patients - T1. Next, the imaging expert partners with industry to build the new technology, and optimize it to benefit many patients - T2. Lastly, the expert works with hospitals and governments to use the technology, make it available, and improve medical imaging to benefit all patients - T3.
Looking Towards the Future: Building an app to understand vulnerability
Translational science trainees, Jinan Rousselle and Juliana Prestes have had the opportunity to work with Dr. Keith Brunt on a number of different projects. Most notably, the team is working on the development of an app that can estimate vulnerability in individuals and populations. Prestes is leading the app development team, linking local humanitarian organizations, research groups, funding agencies and health care providers together in an effort to make this app a viable tool for the future. Rouselle is working with Prestes, as well as completing her own research with Dr. Brunt on similar topics.
In New Brunswick, 1 in 5 patients are considered to be vulnerable. These people cumulatively account for 80% of the healthcare costs. Vulnerability is characterized by populations most likely to have health conditions that can be worsened due to certain life factors. These factors include socioeconomic status, housing, and current health status. Understanding why people are vulnerable has the potential to reduce health care costs tremendously since they have the most to gain; impacting health care far beyond New Brunswick. Canada’s health care system was developed to treat acute conditions - infections, wounds, trauma etc. It was not developed to treat chronic diseases, like heart failure, diabetes, and arthritis. As such, modern healthcare has encountered a comorbidity crisis, causing rising levels of chronic disease that are not easily treated.
We are seeing an increase in patient vulnerability from social determinants of health, for example aging, poverty, and isolation. The presence of more than one chronic disease, particularly in vulnerable patients, is making it difficult to develop effective treatment strategies. We need to act quickly to contain the comorbidity crisis before 2030 or it could become a catastrophe. - Keith Brunt
Envision a tool that can highlight the difficulties that one is having - without the individual even being aware that they are facing these difficulties. Imagine this tool not only helping this individual, but showing what difficulties entire communities face - from food security, to housing, to environmental factors. Better yet, imagine if this tool can be modified for use around the world, to objectively identify potential problems being faced in any area. What if, as all this happens, people like you can help to collect data and make decisions?
Prestes, Rouselle, Dr. Brunt and others at Dalhousie Medicine New Brunswick, and IMPART labs are working on just that. The team is working to create an application that collects data from the community to build a vulnerability index, which can estimate the overall vulnerability a person, community, province, country, and even a continent is facing.The app will assess the individuals around a variety of criteria including social support, health habits, family history, housing, income, food security, education, and employment. By collecting data on this information, impacts of community health programs can be quantified, and potential areas of focus come into view for where to concentrate new or different support programs in communities.
There is wide-scale potential impact by deploying an app like this. Conceivably, more people can lead healthier lives, stay out of the hospital, and in some instances, return to work. All of these effects can reduce the burden on healthcare, and work to boost productivity. With large potential impacts, one simple app has the opportunity to change the landscape and better direct not only scientists and physicians, but policymakers and social scientists to make better and more cost effective decisions for communities.
If this research interests you, you can contact IMPART labs by visiting their website to learn more about these projects and many others.
Authors
References:
1. IMPART app can help save billions in health care: Telegraph Journal. IMPART. March 2018. https://impart.team/impart-app-can-help-save-billions-health-care-telegraphjournal/. Accessed March 25, 2018.
2. Caring for Vulnerable Canadians: Canada’s Registered Nurses Speak out for Palliative and Compassionate Care. Canadian Nurses Association; 2010. https://www.cna-aiic.ca/-/media/cna/page-content/pdf-en/parliamentary_brief_palliative_care_e.pdf?la=en&hash=BA32CB027A9666EBB01A8D3E08956C0F1B16EFEF. Accessed April 2, 2018.
3. Steketee G, Ross AM, Wachman MK. Health Outcomes and Costs of Social Work Services: A Systematic Review. Am J Public Health. 2017;107(Suppl 3):S256-S266. doi:10.2105/AJPH.2017.304004
4. Whose Care will Cause Payor Costs to Rise Next Year? CVS Health Payor Solutions. https://payorsolutions.cvshealth.com/insights/whose-care-will-cause-costs-to-rise. Accessed April 2, 2018.
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