On the front page...
In a celebration of its research, action and partnerships,
the Office of Behavioral and Social Sciences Research on June 21-22
marked its first 10 years with a call for a new perspective on
Every health innovation that improves societal health and well-being
ultimately requires some form of behavior change, "a daunting challenge
and a great responsibility," said OBSSR director Dr. David Abrams.
The behavioral and social sciences face "the grandest challenge
of them all — understanding human behavior in all its complexity" — from
genes, neuroscience, motivation, cognition and emotion to individual
lifestyles to the collective "behavior" of families, communities,
providers and health care delivery systems to global economics
"There is a need for the field to change the way we envision
the future," said NIH director Dr. Elias Zerhouni in opening remarks. "Science
must reduce problems to their constituent elements and use valid
measures, but this is not always possible. We do not know how all
systems work. Yet a systems approach on what will make change is
the core challenge of this office. Behavior is an emerging property
from subsystems of which we do not have a deep understanding."
As part of the Office of the Director, OBSSR is charged with increasing
the scope of and support for behavioral and social sciences research
across all of NIH. Officially opened on July 1, 1995, it was established
by Congress in recognition of the key role that behavioral and social
factors often play in illness and health.
|OBSSR’s Dr. David Abrams
"Health care has to change," Zerhouni stressed. "Health care is
not sustainable. No single discipline has the answers. We need
to change our philosophical and conceptual model of what health
care is. The 5,000-year-old relationship between patient and doctor
is changing before our eyes."
New solutions are needed, he declared. "When you look at the next
25 years and you look at every prediction, clearly we are on a
path to a collision. Health care as we know it is not sustainable."
A systems approach is required. The key, Zerhouni said, "is we
need a new vision of how medicine and health will evolve — predictive,
personalized, pre-emptive and participatory medicine." He added, "It's
hard to see how the NIH will succeed without participation from
patients, their communities, their political environment, their
behavioral change factors and their social environment. If we do
not understand that [medicine] needs a comprehensive, interdisciplinary
solution, we will fail."
When we study the roots of disease and disability, Zerhouni observed,
we often find them in personal behavior or socioeconomic and human-created
environmental influences. Both domains are addressed by behavioral
and social sciences research, which he lauded for its clear impact
on public health. He offered two examples: the recent drop in cancer
rates, largely due to decreased tobacco use in males, and the benefits
of diet and exercise — more effective than drug therapy — in
preventing the onset of type 2 diabetes. Ten percent of the NIH
budget is invested in social and behavioral science, he noted.
Dr. Norman Anderson, founding OBSSR director, and Dr. Raynard
Kington, NIH deputy director and former OBSSR director, offered
background history and beginnings of the office and outlined its
role at NIH.
Kington pointed out one challenge related to the rigor
of measurement of behavioral and social causal factors and outcomes.
He said there is "even bias in the language of how these challenges
are described by those outside of the fields." The same types of
problems in measurement in the biomedical sciences are referred
to "as challenging and complex" but when they occur in the behavioral
and social sciences, they are often referred to as "fuzzy and poorly
In spite of his criticism of both the biomedical community and
its continued pockets of resistance to acceptance of behavioral
and social sciences as essential to the NIH mission, and the social
and behavioral sciences for their pockets of resistance to self-criticism
and self-correction, Kington sees great opportunities for OBSSR
in helping NIH achieve the four Ps described by Zerhouni.
Kington also sees the need for more scientists adequately cross-trained
to bridge the behavioral, social and biomedical sciences. "There
is no area with greater need than the area of gene-environment
interaction where there are enormous possibilities for new areas
of research," he said.
Anderson recalled that he was often asked "why is such an office
(OBSSR) here?" He reminded listeners that, when he headed the office,
he was fond of paraphrasing the late President John F. Kennedy:
Ask not what NIH can do for behavioral and social sciences research;
ask what social and behavioral sciences research can do for NIH.
"Scientific advances could be accelerated by greater attention to behavioral and social sciences
factors and their interactions with biomedical variables — many of the same things Dr.
Zerhouni spoke about," Anderson explained. He offered three justifications for increased attention:
behavioral and social factors are major contributors to health and illness; behavioral and
social factors represent important avenues for diagnosis, treatment and prevention; and by
focusing more on behavioral and social factors, NIH would be more effective in fulfilling its
|As special assistant to the OBSSR director,
Dr. Ronald Abeles fosters behavioral and social research across
Abrams proposed a new conceptual synthesis for understanding patterns
of population health and disease, a model that is "interactive
and dynamic. The key conceptual integration for the future of our
science," he suggested, is that "the dominant and successful biomedical
models on the one hand and the strong socio-ecological models of
public health on the other hand are really two sides of the same
coin." A full conceptual integration of these two powerful 20th
century paradigms is now emerging, he said. "This represents an
extraordinary opportunity.Behavior is the bridge between biology
and society. You have to see behavior as a bridge. You can't get
under it or around it. You have to cross it."
Abrams noted that research has saved millions of lives and billions
of dollars through preventing, reducing or treating tobacco use
behavior, HIV/AIDS, cardiovascular disease, cancers, addictions
and mental illness, and giving us the tools to tackle the rising
epidemic of obesity and diabetes. "NIH used prevention and reduction
of risky behavior to improve the nation's health and well-being.
But there is still much work to be done."
Over the anniversary's 2 days in Bldg. 45, there were nearly 500
attendees, including 30 speakers, one of whom was 2002 Nobel laureate
Dr. Daniel Kahneman. He said NIH "is primarily a bench science
institution. How can we change the institutes and centers and the
study sections? How can we influence the agency? Our job is not
done until solutions are disseminated and health improves."
"This is a conference that is bringing in seminal work from researchers
in diverse groups," said NCI's Audie Atienza, "and promoting partnerships
The focus of the final plenary session was a town-hall style meeting
on OBSSR's strategic prospectus to guide future priorities for
research funding. The moderator, Dr. Allan Best, called for and
received dozens of suggestions from the audience, from the creation
of a primary health care prevention system, to a call for strong
basic science, to more partnerships with business, the community
and the public.
Abrams concluded by saying the vision of OBSSR is to mobilize
the biomedical, behavioral, social science and population science
research communities as partners to solve the most pressing health
challenges faced by our society.