Sir

Your News Feature 'The Full Cycle' (Nature 453, 843–845; 2008), about taking research from bedside to bench, focused on unexpected results from clinical trials that stimulated a basic scientific investigation into what went wrong in those trials. Although this is a fascinating application of 'reverse translation', I fear it misses the much bigger opportunities and challenges that arise from researchers trying to understand clinical problems that are nowhere near the clinical-trial stage. By listening to the problems experienced by our clinical colleagues, and having the resources to address those problems in novel and creative ways, researchers can not only contribute to patient benefit, but can also introduce new ways of thinking or whole new paradigms to basic research.

But there is a sting in the tail to this approach, mentioned in your News Feature 'Crossing the Valley of Death' (Nature 453, 840–842; 2008). Attempting to resolve apparently intractable clinical problems can be a valley of death for researchers who currently need to produce high-impact papers, reviewed mostly by basic scientists. The time taken to get to grips with a new problem, sometimes even a completely new approach, together with the necessarily less clear-cut experimental design inherent in clinical research, can become a 'do or die' endeavour for a biomedical scientist.

I believe the solution to this dilemma is procedural and cultural. Grant-review committees need to give a clear steer on the trade-off between many forms of clinical problem-solving and conventional criteria for scientific excellence. To this end, leaders of funding bodies must pay more than lip service to ensuring that both forward and reverse translation are placed at the centre of their funding strategy. Longer-term funding schemes, such as the intramural support provided by many public and private funding bodies on both sides of the Atlantic, can play a specific role in promoting risky but potentially fruitful translational research. In the end, though, all parties must somehow be persuaded to sign up to both health and research.