Amanda Lucas always thought she wanted to be a doctor. But in college, basic science drew her attention. She tried to marry her interests in health and science by heading for a career in epidemiology, working at the Austin/Travis County Health and Human Services Department in Texas and helping to investigate a pertussis, or whopping cough, outbreak. Thinking she'd found her calling, Lucas entered an epidemiology Ph.D. program at the University of Rochester Medical Center in New York state.
But after a semester, Lucas felt "something was missing." She began researching other options and stumbled across a Web site for Rochester's new Ph.D. program in translational biomedical science. "I was completely excited when I heard about it," Lucas says. "It was a path that incorporated clinical science, public health, and basic biomedical research." So Lucas transferred this fall, becoming Rochester's first Ph.D. student in the new program.
As that program ramps up--more students will join Lucas in coming semesters--Rochester joins a growing cohort of universities offering Ph.D. programs in translational medicine. Nearly two dozen U.S. universities now offer such programs under rubrics such as "molecular medicine" and "translational biology." All are similarly structured and share a common goal: to train a new generation of researchers in applying the latest biological breakthroughs to human health.
Translational Ph.D. student Donald Shaffer assumed that such was the aim of most Ph.D. programs in the biomedical sciences. But as he began interviewing at various schools, he found a chasm between the lab and the clinic. "I always assumed when you do biomedical research that there was a close collaboration between clinical medicine and research scientists," Shaffer says. "But I realized this wasn't necessarily the case. At a lot of schools, the Ph.D.s stayed in one tower and the clinical doctors stayed in another tower."
Shaffer ended up joining the first class of students in the Translational Biology and Molecular Medicine Ph.D. program at Baylor College of Medicine in Houston, Texas. Now in his 4th year, Shaffer is debating whether to pursue an academic career or head to a biotech company after graduation. "This program prepares you well for doing either," he says. "The skills you acquire here are going to be sought after."
Those skills include learning the jargon of physicians, knowing how to design and run clinical trials, and understanding the regulatory hurdles of drug development. Specially designed courses introduce students to the ins and outs of modern medicine--and sometimes to patients, too.
At the University of Alabama, Birmingham (UAB), Carolyn Durham became interested in lung diseases after hearing from two lung transplant patients in one of her courses. The course--in which the students got to choose which diseases to learn about--featured a lung researcher, who discussed his work, and a clinician, who delved into the practical hurdles of lung transplants. Then the patients described their experiences and what improvements in the procedure and their outcomes they'd like to see.
The patient perspective is unique, says Durham, who is pursuing a Ph.D. in pathology with an added certificate in translational medicine--an approach some of the new programs are taking. "I can read about a disease and think, 'This is the most important thing,' but in reality, the patient doesn't give a lick about it." Durham picked an asthma project for her dissertation.
At Baylor, Rochester, and UAB, as at most of the other programs, students choose a basic science mentor and a clinical mentor, usually an M.D. Students are encouraged to choose mentors whose work overlaps and to find research projects that land squarely between the lab and the clinic. For instance, Shaffer chose a pediatric hematologist/oncologist as his clinical mentor, and in the lab, he's developing a new immunotherapy for blood cancers. Shaffer spends much of his time honing the therapy with animals, but he also has access to blood from patients. "I'm fortunate here that I'm able to get quite a few patient samples," Shaffer says. "We're laying the groundwork for the initiation of a phase I trial."
Clinical experiences, including going on rounds with physicians, attending tumor board meetings, and working in clinical settings, feature heavily in the first few years of most of the Ph.D. programs, which require a certain amount of clinical experience to graduate. Tiffany Williams, a 4th year student in the Baylor program, spends half a day each week at an HIV clinic in Houston, where she sees patients under the tutelage of an infectious-disease specialist.
Williams spent 2 years in medical school before entering the Baylor program and plans to finish her M.D. after her Ph.D. The clinical experience "allows me to get a realistic perspective on how it will be to be a physician-scientist, to have a research career, and also try to stay involved in the medical aspects," Williams says. Colleagues in the program who don't intend to become physicians also benefit, she says. "It gives a human side to the work you read about. I know all of my [non-M.D.] Ph.D. friends in the program really value the time they get to spend with patients. It motivates them, and it gives them a frame of reference for how they work. It informs how they design their experiments and the questions they ask."
Students at UAB also spend time watching drug development up close. They take one course on the campus of Southern Research Institute, a drug-discovery company. "When we did a survey of where [biomedical] Ph.D. students ended up, probably as many as 15% to 20% ended up at least doing some time in biotech or big pharma," says Thomas Clemens, a professor of pathology and the program director of the UAB Hughes Med-Grad Fellowship Program. "And they had no experience at all in terms of what goes on there. So we thought, just as they ought to be aware of what goes on in the clinic and be aware of how research can be translated to the bedside, they ought to know what goes on in developing drugs."
In its Roadmap for Medical Research, the National Institutes of Health (NIH) places a heavy emphasis on translational research. The agency is spending as much as $500 million funding new centers for translational medicine. Educators, though, felt that student training was not emphasized enough in the plan, says Peter Bruns, vice president for grants and special programs at the Howard Hughes Medical Institute (HHMI) in Chevy Chase, Maryland. In 2006, HHMI decided to fund new Ph.D. programs in translational medicine, dubbed the Med into Grad Initiative. Thirteen institutions received 4-year grants totaling $10 million. Perceiving an ongoing need, the institute is offering another round of grants for the program, to be awarded next year.
Bruns says the program, which counts 193 students in the 13 programs, has three goals: to foster collaboration between basic science and clinical faculty; to launch translational research projects for students to work on; and, of course, to build a new generation of translational researchers. "It's too soon to know if that's going to happen," Bruns says. "But I'm assuming, in speaking with NIH and the faculty involved in this program, that people who go out and do this will be competitive for future [research] funding."
Martha Cathcart, a cell biologist and director of the Molecular Medicine Ph.D. Program at the Cleveland Clinic Lerner Research Institute in Ohio, a joint venture with Case Western Reserve University, says that her program, like the others, is taking a chance. "We don't know whether the M.D.-Ph.D. approach of integrating research into medical school or the Ph.D. approach that we're doing is going to work better."
But the faculty has high hopes. "We want the Ph.D. students to understand the whole vocabulary of clinical medicine, pathology, and drug discovery," Clemens says, "so when they eventually go out on the job market, they're really understanding where their discoveries are going to end up."
As for Lucas, she's just happy she discovered Rochester's program. "I thought, 'Why hasn't anyone told me about this? It's perfect for me.' "
Translational Ph.D. Programs and Related Training
HHMI Med into Grad Initiatives:
- University of Alabama, Birmingham (Ph.D. in Translational Research and Drug Discovery)
- Baylor College of Medicine (Translational Biology and Molecular Medicine Ph.D.)
- Cleveland Clinic Lerner College of Medicine/Case Western Reserve University (Molecular Medicine Ph.D.)
- Harvard Medical School (Leder Human Biology and Translational Medicine Program)
- Massachusetts Institute of Technology (Graduate Education in Medical Sciences)
- Rice University (Ph.D. training in Translational Bioengineering for Cancer Diagnostics and Therapeutics)
- Stanford University School of Medicine (Master of Science in Medicine)
- University of California, Davis (Integrating Medicine Into Basic Science)
- University of California, San Diego, School of Medicine (Integrating Medical Knowledge Into Graduate Training)
- University of North Carolina, Chapel Hill (Program in Translational Medicine)
- University of Pennsylvania School of Medicine (Graduate Training in Medical Sciences Certificate Program)
- University of Washington (Molecular Medicine Training Program)
- Yale University (Medical Research Scholars Program)
- Johns Hopkins School of Medicine (Graduate Program in Cellular and Molecular Medicine)
- Wake Forest University School of Medicine (Molecular Medicine and Translational Science Graduate Degree Programs)
- Mayo Clinic College of Medicine (Clinical and Translational Science)
- University of Rochester (Translational Biomedical Science Ph.D.)
Photos. Top: Comstock. Middle:Courtesy, Amanda Lucas. Bottom: Paul Fetters for HHMI.
Brian Vastag is a freelance science journalist based in Washington, D.C.