ABSTRACT
In the opening years of the 21st century the term “translation”
emerged rapidly and seemingly out of nowhere as the new
“buzzword” in biomedicine (Fig. 2.1). The “translational turn,”
evidenced in the prefixing of “translational” to-medicine, research,
and science, emphasized the place of these different spheres in
biomedical innovation. Embedded within the “translational turn”
was the notion that all was not well with biomedical innovation
and here the relationship between laboratory and clinic came in
for particular criticism. The relationship between these sites has,
historically, been uneasy, reflecting long-standing and deeply rooted
differences between them. Constantly negotiated and renegotiated
throughout the 20th century, this encounter became increasingly
troubled from the 1970s onward as scientific and technical advances
within molecular biology began to take practical effect in both
laboratory and clinical settings. If there was agreement that
problems existed, there was little agreement between practitioners
in these settings about the cause(s) of these problems, or howbest to
solve them. In the United States, repeated warnings and misgivings
from the late 1970s to the early 1990s about the relationship
between the lab and the clinic, and also about the impoverished
condition of clinical research, especially the patient-centred kind,
went largely unheeded in policy-making circles. This was not,
however, an impediment to increasing investment in biomedical
research evidenced most strikingly perhaps in the rising budget of
the National Institutes of Health (NIH), and the commitment in 1990
of $3bn to “biology’s moonshot,” the Human Genome Project (HGP).
The inertia towards the lab/clinic problem created something of a
policy vacuum around what many felt to be a serious and systemic
problem within the biomedical enterprise — even as this continued
to expand and diversify.
