that show us when particular enzymes or receptors and “various other players within a pathway come together through activity or feedback action.” Part of the reason for both of these gaps, he said, is the isolation of specialists in “professional silos” that impede collaboration. A result of this reductionism, he said, is that we know little about basic disease questions: What is the normal natural course of a disease? How does that normal natural course change under certain situations and environmental conditions? “We do not know in a real sense what the progress of disease is.” Nor, he said, do we have biomarkers that indicate treatment failures—for example, in a particular patient sub-population—and we do not have good predictive models of diseases or how to halt them. A familiar case is when a healing agent works well in a mouse model but not in a human patient, or in one patient but not another.

Filling Biomedical ‘Gaps’ Through Interdisciplinary Platforms

Many of these gaps, Dr. Douglas said, could be corrected by using a more integrative approach. For example, wider use of chemical and biological “platforms,” studied in interdisciplinary fashion, would raise the chances of identifying disease targets, understanding the targets, and finding drugs to use against them. Such platforms have been introduced in basic research, he said, and “I think the time has come to do something similar within the transformational medicine space, to develop transformational medicine platforms.”

Since he left the pharmaceutical industry, he said, where he managed the R&D program of Aventis, he has thought hard about how to bring the industry into closer engagement with personalized medicine. He concluded that every large pharmaceutical company, instead of supporting its own massive research enterprise, would benefit by reaching out to clusters of academic and bio-tech company researchers in approaching large research questions. These might resemble the clusters northeast Ohio was forming in flexible electronics, photovoltaics, and other technologies. A pharmaceutical company could investigate much broader phenomena, such as the pathways of disease, by enlisting a diversity points of view and expertise.

Moving Closer to Personalized Medicine

Dr. Douglas suggested that other fundamental changes in biomedical research and health care could make the field more predictive and move it closer to personalized medicine. These included shifting budgets away from sales and marketing toward R&D, not granting intellectual property rights until later in the clinical trial process, and more emphasis on partnerships for pre-competitive research problems that no one institution can resolve.” If these changes were to happen,” he said, “then pharma would look more like integrators of many small specialty players. The VC companies would become true translators, and more



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