Sir

The belated push to accelerate clinical discovery through translational research is an uncertain undertaking, as you remark in your Editorial 'To thwart disease, apply now' (Nature 453, 823; 2008).

In addition to the conversion of laboratory knowledge into new products and the adoption of such products by providers into routine clinical practice, clinical translational research must encompass behavioural and communications science in order to study population uptake of new medical and scientific advances. This is crucial in a world of increasingly empowered, but not necessarily discerning, consumer patients suffering from information overload.

Community-based participatory research aims to engage the public, with a view to facilitating clinical-trial accrual and mobilizing the local expertise of community leaders. This can help to shape the investigations themselves, so that new science is both medically efficacious and effective in the real world of diverse people and patients.

The US National Institutes of Health (NIH) attempts to steer institutional culture and organizational ethics in this direction. It is supporting assessment of the effects of clinical translational science on social processes and infrastructure in academic medical centres, as well as the design of the research studies themselves.

Translational research should demonstrate a return on investment for basic science that is supported by the tax payer, and be a game-changing commitment by the NIH. The effort will need to transcend disciplinary silos to create a genuine delivery continuum for health science, from bench to bedside to trench and back again.