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The following is a general summary of the NIH retreat for behavioral and social sciences.
Detailed summaries of the events and sessions are available for viewing to NIH staff only at:
http://obssr-intranet.od.nih.gov/Ret_Sum/default.aspx (in “Shared Documents”).
Please note that the detailed summaries are limited to internal NIH review. Those with an NIH e-mail account should select the above URL; if required to login, please enter your current username and password (your username should be entered as “nih\username”).
Behavioral and Social Sciences at NIH: Advancing the Science Together
Wednesday, November 12, 2008
NIH Main Campus, Natcher Conference Center
Christine A. Bachrach, Ph.D., Acting Director,
Office of Behavioral and Social Sciences Research (OBSSR)
Dr. Bachrach opened the inaugural retreat by inviting the NIH behavioral and social science research community to interact and communicate freely and candidly about advancing the OBSSR mission. Toward this goal, the retreat aims to strengthen existent connections and to build new ones, extending the reach and potential of behavioral and social science research toward improving the nation’s health.
Panelists:
Nora Volkow, M.D., Director,
National Institute on Drug Abuse (NIDA)
Thomas Insel, M.D., Director,
National Institute of Mental Health (NIMH)
Robert Croyle, Ph.D., Director,
Division of Cancer Control and Population Sciences, National Cancer Institute (NCI)
Moderator: Richard Suzman, Ph.D., Director,
Division of Behavioral and Social Research, National Institute on Aging (NIA)
Nora Volkow, M.D., Director,
National Institute on Drug Abuse (NIDA)
The nation’s investment in medical research has led to significant health gains: Cancer and cardiovascular deaths have both decreased. But the main driver for both of these trends is the reduction in the number of people who smoke, and this has resulted from a behavioral intervention.
Currently, four main factors put the most strain on our health system: smoking, obesity, aging, and health care costs, and behavioral and social science research can contribute to each. Smoking cessation remains the single most important public health intervention we have. In the 1950s, about 50 percent of men smoked. Now, about 20 percent do, but that rate has remained stubbornly constant in recent years, suggesting that those who continue to smoke are more severely addicted. Meanwhile, we have not influenced the incidence of obesity in this country--especially in our youth--and the incidence of diabetes continues to rise, largely because many people do not appreciate the consequences of unhealthy behaviors. At the same time, our population is aging, and older people have more health problems. The cost of health care is also going up precipitously, and the amount of money we put into the health care system does not translate to better outcomes.
Some questions do not need more science, but rather workable implementation approaches: We will not solve the obesity problem by simply telling people to eat well, because many things affect dietary choice: economic, social, and other factors. Similarly, looking at genes by themselves is not sufficient to help researchers understand diseases like obesity. Instead, we must focus on gene-environment interactions. We need to learn how to quantify environmental influences: “phenotyping the social environment.” Ongoing investigations of the microbiome and epigenomics will advance this research.
Technological advances in imaging let us see areas of the brain involved in social thinking. We can use these tools to understand how brain regions are affected by learning, and how messaging affects individual responses. The advertising industry has incorporated this understanding into using messages to influence behavior. The use of web-based technologies has dramatically changed our social systems and we should embrace this powerful communication tool for prevention.
Social stressors play an important role in many diseases and neuropsychiatric disorders by affecting gene expression and the biochemistry of the brain. For example, adverse events in childhood relate to the likelihood of addiction in adulthood, and drug abuse and addiction permeate many disruptive behaviors. These remain a main challenge within our health care system.
Thomas Insel, M.D., Director,
National Institute of Mental Health (NIMH)
NIMH’s overall concern is improving the lives of people with serious mental illnesses. How do we prioritize our scientific investment to achieve the most significant health gains?
Some of our perceptions have changed over the past 15 to 30 years as we reframe mental disorders in terms of brain function that is manifested by behavioral, social, and mental changes. However, the physiology of the brain underlies all these disorders. For example, a longitudinal study of children with attention deficit hyperactivity disorder (ADHD) revealed a three-year delay in brain development. These results suggest that although ADHD has been defined as a cognitive dissonance disorder, it may be more of a problem with cortical maturation.
We need to measure success in public health parameters, such as: “How does our research investment impact morbidity and mortality?” For example, does increasing the rate of employment among schizophrenics reduce their suicide rate? We need more research on emotion and mood disorders, and how social systems and behavior are tied to the brain. We also need to use behavioral approaches to understand cognitive deficits impervious to medical treatment. Continued investment in behavioral and social science research is necessary to target these and many other areas.
Integration is key and provides profound opportunity for discovery. We cannot continue to study behavioral and social science without reference to biology, genes, cells, and circuits--and the converse is also true. As a reference tool, the Diagnostic and Statistical Manual of Mental Disorders works well for reimbursement purposes, but not so well for research. This poses challenges for integrating clinical and basic findings.
To begin to address these issues, NIMH has reorganized its extramural research program, consolidating basic and applied behavioral and psychological research into a new division of Mental Disorders, Behavioral Research, and AIDS. Behavioral research is also represented, but to a lesser degree, in two other new divisions: the Division of Basic and Clinical Neuroscience Research and the Division of Services and Intervention Research.
Robert Croyle, Ph.D., Director,
Division of Cancer Control and Population Sciences, National Cancer Institute (NCI)
Behavioral risk factors are relevant across all NIH disease domains. How can we encourage integration? A big challenge is that the NIH resembles a university without a college of arts and sciences. We have the opportunity now to integrate more fully with biological and medical research in order to broaden the NIH definition of translational research. The main challenge in achieving this goal is to define the proper infrastructure for collaboration.
We need research on dissemination and implementation, and on methodology and measurement. Congress is frustrated by the NIH’s inability to provide data that would facilitate policy making, but behavioral and social scientists can provide a bridge between basic research and public health. Expertise in psychometrics can further research on major health problems such as diabetes and obesity.
Certain “boundary” issues are those science domains that “fall though the cracks” between federal agencies. These include service delivery (between the NIH and the Centers for Disease Control and Prevention) and health care quality and improvement (between the NIH and the Agency for Healthcare Research and Quality). The NIH should also strengthen collaborations with the National Science Foundation whenever possible.
Panel Discussion
Discussion themes from the town hall meeting are presented below in context.
Theme: Better collaboration is needed between behavioral/social scientists and biomedical scientists at the NIH.
Above all, good science drives effective and productive collaboration: Common interest in a scientific problem will generate effort and results from varied angles. Achieving coordination entails challenges, since the NIH does not have a formal infrastructure for collaboration. Web technology, along with the development and adoption of a common language, can facilitate interactions between fields. In particular need are scientists who can straddle informatics and the behavioral and social sciences. This expertise is especially useful for surveillance, mining health information, answering methodological questions, and helping to develop and implement consumer health informatics. The behavioral and social science community also needs to adopt and use better tools for research, communication, and implementation. For example, assessing dynamic social environments is more like filming a movie than taking a snapshot.
Theme: The behavioral and social science research community can contribute to health policy decision making.
In this climate of rocketing health care costs, the issue of cost-effectiveness has taken on a new urgency within the Congress and the new Administration. Although the NIH is only part of the solution, medical research is an important component. Guided by the behavioral and social science community, the NIH can be an active participant in cost-effectiveness policy-making by generating clear, objective data and computing cost savings from tested interventions. The NIH should also be sure to be part of policy discussions from the outset, to assure that trial designs answer appropriate questions.
Ten groups of 20 to 40 meeting participants met to discuss the interface between behavioral/social and biomedical science. The groups were tasked with considering common challenges and successful models to overcome them, in particular focusing on the following questions:
- How do we thrive as behavioral and social scientists in an institution that is predominantly biomedical in orientation?
- What lessons have we learned about how to advance and integrate our sciences and their contributions to the NIH mission?
Read individual session summaries and a compiled summary of the groups’ discussions of this topic at:
http://obssr-intranet.od.nih.gov/Ret_Sum/default.aspx
(in “Shared Documents”).
Participants had the option to each lunch on their own or to join senior NIH behavioral/social science staff from across the institutes for informal lunch conversations. Photos can be viewed at: http://conferences.thehillgroup.com/obssr/NIHretreat/photos.html.
Ten concurrent breakout sessions of 20 to 40 meeting participants convened to discuss each of the following topics:
- Health Disparities
- Community-Based Participatory Research (CBPR) and Community Engagement
- Brain and Behavior
- Health Promotion/Prevention and Adherence
- Theories of Behavior Change
- Technology and Health
- Genes and Environment
- Measures, Methods and Data
- Health Policy and Quality of Care
- Social, Environmental and Psychological Factors Related to Health
Read summaries of each group’s discussion of these topics at:
http://obssr-intranet.od.nih.gov/Ret_Sum/default.aspx
(in “Shared Documents”).
Raynard S. Kington, M.D., Ph.D., Acting Director,
National Institutes of Health (NIH)
Dr. Kington encouraged the NIH behavioral and social science community to define a strategic agenda for understanding gene-environment interactions and to forge connections grounded in rigorous science with the biomedical research community. The behavioral and social science community can play a unique, dual role in advancing the NIH mission by developing near-term interventions while also continuing to grow the knowledge base. The behavioral and social science community can also contribute in important ways toward guiding science and health policy.
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