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To the Editor: Dr Nathan¹ described barriers to the career pathways of physicians who seek to perform translational clinical research, and he proposed some ways to encourage their development. However, there is widespread agreement that in the number of translational researchers continues to decrease. More effective ways for supporting and rewarding careers in clinical investigation are needed. Thus, Nathan's suggestion for a new approach by "establishing appropriate core resources and a new collaborative working environment for translational clinical researchers" is welcome indeed. Although we strongly agree with his proposal for stimulating clinical research, we suggest that it does not go nearly far enough in changing the fundamental premises of the current medical research program.

It generally has been assumed that advances in basic research propel applied or clinical accomplishments through the intermediate stage of translational research. This conceptual model implicitly assumes a unidirectional flow of innovation and is used to . . . [Full Text of this Article]

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