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Genomics was great but it’s time for a new medical revolution

Francis Crick (right) and James Watson (far left) started a revolution in medicine. AAP

Medical science has changed the human health and lifespan in the last century and now another revolution is coming in health.

This revolution will entail closing the chasm between what medical evidence tells us we should be doing and what we actually do in practice.

An earlier revolution

When Watson and Crick first described the structure of DNA, they started a half-century of fundamental discovery of the genome.

This discovery has had a breathtaking impact on our knowledge of these fundamental components of life.

Genomic research in biomedical and life sciences is providing us with not just the essential biology of DNA but also how its messages are translated into the physiology and biology of every cell in the body.

One of the recent surprises in our growing understanding of the genome is how DNA’s messages can be affected - profoundly and over a lifetime - by environmental factors during fetal development and early childhood.

But there is another translation that is an even bigger challenge: the translation of this basic knowledge into clinical practice and into preventative strategies.

Research translation is needed so the health care system can take advantage of new knowledge and cope with emerging issues: challenges such as the ageing population; providing equitable access to medical care; managing the social and medical impact of mental health issues; and reducing the obesity epidemic.

Ever since science was used to improve patient care, there has been concern about the speed at which new knowledge passes from the research arena to patient benefit.

Seventy-five years ago, the Lyons government identified this with the establishment of the National Health and Medical Research Council (NHMRC).

The health minister at the time, Billy Hughes, said at the opening session of the NHMRC, “Research must be actively pursued and developed and as fast as new knowledge is acquired, it must be applied.”

This call to action still reflects the challenges the health system faces over the next decade and beyond. We need to learn how best to ensure patients benefit from the vast insights engendered by genomics.

Of course, this is just one of many, many gaps that need to be filled.

Discoveries that improve preventative policies, that result in better services for patients and more efficient practices in the health system, all need to overcome the research-to-implementation gap.

The need to address this gap is recognised internationally and locally, through such mechanisms as the Cochrane Collaboration, the Canadian Health Services Research Foundation, the National Institute of Clinical Excellence in the United Kingdom, and in a number of bodies in particular areas of the health system, such as the Australian Primary Health Care Research Institute (APHRCI) and the Sax Institute.

At the NHMRC, we recognise our responsibility to contribute to and bring all parts of the health system together. This is why we are especially pleased that the role of providing funding support, on behalf of the Australia Government, to the Cochrane Centre, and the Dementia Collaborative Research Centres will shortly be transferred to us.

We currently fund translational research activities through schemes such as Fellowships for Practitioners, which is for researchers employed in the health system to provide patient care; Centres of Clinical Research Excellence; Centres in Health Services Research; large clinical Program Grants; and Partnership for Better Health research projects, which links organisations with specific research needs to leading researchers.

The way forward

We are now working on two new ideas to promote national leadership in research translation and to encourage collaboration across research and clinical care.

The first is a plan to establish a network of NHMRC-funded groups in translational research. These groups will be used as a powerful voice in the NHMRC’s Health Care Committee and Council, and as leaders in implementation of evidence from research into clinical practice.

The National Institute of Clinical Studies, bringing the expertise and experience in evidence implementation it has garnered since its establishment in 2000, will support this national network.

The second is our concept of Advanced Health Research Centres, which will integrate leadership in research and translation, education and evidence-based medicine of our leading campuses, clinical university departments, medical research institutes, and hospitals involved in patient care.

We have seen technology rapidly transform our social and information management structures. Advances in computing have crossed into our language, social structures and all aspects of our work.

The speed of its translation has been incredible: we need to replicate this in our health system.

The NHMRC is uniquely placed to build the networks and capacity across the Australian health system to ensure that the broader public benefits from the outcomes of health and medical research. We intend to do so by having those outcomes translated into better policies and practices.

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