Building Better Medicine: Translational Justice and the Quest for Equity in US Healthcare

This paper was co-authored by PaSAGE Team Members: Megan A. Allyse, Preya Agam, Yvonne Bombard, McKenna Horstmann, Assata Kokayi, Rosario Isasi, Karen M. Meagher, Marsha Michie, Kiran Musunuru, Kelly E. Ormond, Kirsten A. Riggan, and Jane Q. Yap

Despite impressive scientific progress and enhanced regulatory pathways ensuring the safety and efficacy of medical innovations, health disparities continue to grow. This has led us to conclude that clinical translation—bringing scientific discoveries into practical use—cannot be deemed successful based solely on technical milestones. In this manuscript, we highlight how marginalized populations are frequently excluded from the benefits of these advancements, prompting us to question whether a system focused on technological success can meet the ethical demands of medicine and public health.

Our manuscript challenges the traditional technocratic approach that governs biomedical translation, arguing that its narrow focus on safety and efficacy overlooks critical normative issues like equity and societal impact. To address this, we introduce a new metric we call "translational justice." We discuss how this concept pushes the translational framework beyond lab and trial outcomes, urging consideration of how innovations will function in today’s society. Our goal, as laid out in the manuscript, is to ensure that medical advancements don’t just excel technically but also actively bridge inequities, delivering benefits to all—especially the most disadvantaged.