Abrams on NIH: “BSSR is a key player.”

David Abrams, PhD, former Director of the NIH Office of Behavioral and Social Sciences Research (OBSSR) reflects on his three years in the position. Read on to learn his view of how the behavioral and social sciences are doing at NIH and why this office is so important for population health and the mission of NIH.

David Abrams, PhD, former Director of the NIH Office of Behavioral and Social Sciences Research (OBSSR) reflects on his three years in the position. Read on to learn his view of how the behavioral and social sciences are doing at NIH and why this office is so important for population health and the mission of NIH. You saw part of the interview in the June edition of Psychological Science Agenda: the complete interview follows.

SPIN: To what extent was your job as Director of OBSSR different than what you initially supposed?

Abrams: The position is more intellectually stimulating, has potentially more influence on overarching NIH-wide priorities, and is also more challenging than I had anticipated. The extraordinary intellectual climate and commitment to strong science is a basis for strategic influence. The climate demands demonstrating excellence through strong science, rather than simply asserting the value of BSSR. Being exposed to the latest cutting edge research and participating in deliberations with scientific luminaries across the entire biomedical, behavioral, social and population sciences spectrum was stimulating. Strong science is the currency at NIH. The potential for influencing NIH-wide priorities is greater than I had expected. But you must be well prepared, patient and persistent to justify your core thesis against the best and brightest and against many other equally deserving ideas. OBSSR has a place at the table to make the case. NIH Director Dr. Zerhouni’s crosscutting transdisciplinary and translational roadmap initiatives provide a new vehicle to make that case (now embodied in the Common Fund and the Office of Portfolio Analysis and Strategic Planning - OPASI). The case can also be made through OBSSR’s congressional mandate and convening power. One can bring together two or more of the 27 Institutes or Centers (IC’s) who may share interests. One can approach an individual IC Director. The other hidden gold I discovered at NIH is those special staff and leaders of the BSSR programs within IC’s who champion BSSR with extraordinary zeal. These are unsung heroes. Dedicated “heavy lifters” who relentlessly strive to support BSSR for the research community and the nation.

As far as unexpected challenges go, I served on the National Cancer Institute’s (NCI) Board of Scientific Advisors (BSA) for five years, so I thought I knew about how strategic policy and funding priorities were set. The NCI experience was excellent preparation, but the trans-NIH issues and the very different leadership styles and organizational structures within each of the 27 IC’s is a whole new ballgame. The biggest unanticipated challenge, as I came to see it, was the need to examine the implicit culture of the NIH, in contrast to the explicit “surface structure”. The culture is context that frames how the NIH leaders make decisions. Understanding the “deep structure” of the NIH culture is key to OBSSR being effective. This understanding is essential for learning how to influence strategic planning, priority setting and funding allocations. The learning curve to become effective at influencing NIH-wide strategic priorities took about 18 months, much longer than I had expected (especially for the “deep structure” of how NIH really works on the inside). The way NIH as a whole and the IC directors “behave”, in organizational terms, has a long tradition and also changes as external demands and internal politics emerge. Tensions of cooperation and competition exist, and it is not obvious how to harness these forces for the greater good of the overall health and well- being of the nation. Fortunately I could draw on the knowledge we have amassed in the behavioral and social sciences about group and organizational behavior. The NIH as a whole is a fascinating “case study” in complex behavior and emergent system dynamics.

SPIN: Which accomplishments in your position are you proudest of?

Abrams: I hope I made a strong case for investing more research resources in understanding “brain and behavior in its social and physical context” as an integrated “system within systems.” This is the last major frontier to be conquered. We now have unprecedented tools and technology to study behavior in context in real time (e.g., using the growing global cyber-infrastructure, powerful computers to run system dynamic and agent based modeling, spatial analysis, powerful imaging and other measurement tools, changing social networks and social contagion based on the internet, personal digital devices and other emerging informatics and communications technologies. As Thomas Friedman states, “The World is Flat”. If we do not obtain new insights into the nexus of “brain-behavior-social-context” and obtain them soon, the consequences for our species’ long-term quality of life and survival could be dire. If we do invest in the BSSR arena and then conquer this last frontier, then there is hope for creating a new global model for a sustainable, just, optimally healthy, peaceful and stable world).

I hope that in a small way my staff at OBSSR and I helped create a new vision for the future and a set of key messages for making BSSR stronger, more credible, visible and valuable in the eyes of the scientific and public constituencies we serve. This vision galvanized energy and interest in appreciating the extraordinarily significant contributions already made by BSSR in the last decades. It also demonstrated the strong science base (basic and applied) and spelled out the critical role played by BSSR within the outside of the NIH in improving the nation’s health and wellbeing. An immediate challenge for the upcoming election is to show clearly how our science can contribute substantially to solving the growing health care crisis and address the urgent needs for health care reform.

Some concrete examples of how we at OBSSR demonstrated the value and potential for BSSR to improve our nation’s physical and mental health and longevity include: (a) the 10th anniversary celebration of Dr. Norman Anderson’s establishment of OBSSR and Dr. Raynard Kington’s continuation of that mandate. The celebration was a visible and credible event. It showcased the amazing accomplishments, substantial returns on investment, health care cost savings and other advances in basic science that BSSR achieved in the last decades (for details, see the new OBSSR strategic prospectus; (b) The development, production and dissemination of the new and strongly collaborative strategic prospectus. The prospectus is intentionally a work in progress. A prospectus can and must be updated as the landscape of new discovery and technology is changing so rapidly and transforming what we know and what we will need to know that will make a difference in improving our national health status (also see Mabry, Olster, Morgan & Abrams, 2008 for details); (c) OBSSR was strengthened by redefining its staff responsibilities and by hiring several new staff and establishing a new NIH-wide steering committee composed of the leaders of the BSSR programs within those ICs that have strong BSSR portfolios; (d) Creating a new position for a full-time communications officer dedicated to BSSR at NIH. Developing and implementing a communications plan to send information and to make key target audiences more aware of the discoveries, value, achievements and future potential of investing in basic and applied BSSR. I also proactively reached out to communicate with many key audiences within and outside of government (e.g. NSF, CDC, AHRQ, RWJF, Medical Schools, Public Health and Professional Schools like nursing and social work researchers, the Biomedical and the many BSSR societies) to educate, build transdisciplinary bridges, represent the diverse BSSR scientific community as a unified whole (a big tent coalition), and outline partnership opportunities at the many annual meetings of the biomedical and BSSR research societies; and (e) OBSSR has funded several new initiatives in critical areas including: genes behavior and the social environment, systems thinking, complexity and systems sciences, integrative transdisciplinary approaches to eliminating health disparities and making the conceptual case for more vertical “systems science” integration of biology, behavior, social, and population sciences (see Mabry, Olster, Morgan & Abrams, 2008) and in advancing new methods measures and technologies to examine the role of stress in gene-environment interactions.

BSSR is an essential partner. Behavior is the only bridge between biology and society (the natural and human-built social and physical environment in which we live). You can’t get around behavior, crawl under it or try to jump over it. You can’t avoid dealing with behavior because behavior and behavior change is the ultimate final common pathway to improved health and quality of life at individual, proximal group, community, societal, policy and global levels of structural complexity. You must embrace the need for understanding human behavior and the brain in its social context. This is the grandest challenge of all the challenges we have left at this critical moment in time for humanity.

SPIN: Was there anything about your job that you found difficult or discouraging?

Abrams: During tough financial times people tend to focus even more on the core values of the basic biomedical research culture at NIH. Thus the NIH culture that I referred to in question 1 above comes into play as the decision makers at NIH and in the IC’s gravitate to areas that are predominantly basic biological science domains. This is despite the strong emergence of transdisciplinary science and the need to address the most pressing public health challenges facing our nation that are largely of a BSSR nature. Many of the NIH leaders are trained in basic biological sciences and have intramural labs that provide an implicit culture, context and core “value system” that serves as their normative context for their decision-making. Thus the implicit culture at NIH leans towards basic and clinical biological science, and towards linear molecular causality (reductionism) within the individual organism as the unit of analysis. For behavioral and especially for social, environmental, population and economic sciences, this implicit biological “cultural value bias” makes things very difficult. The reality of this “cultural chasm” between micro biomedical models and macro ecological or public health models of health and disease must be taken into consideration and can also be very discouraging. At the risk of oversimplifying and creating false dichotomies I believe whole organism physiology and behavior is indeed the bridge (the intermediate phenotypes) between the different concepts and languages spoken by biomedicine and public constituencies. Bridging the chasm requires taking additional steps in explaining, educating and influencing those biomedical leaders at NIH whose training is not within the domains of what I call a broader ecological / public health view of the world. A world where there is multiple and dynamic, interacting (non linear) higher levels of causal influence (e.g. between individual and group level causes, organizational, community and societal level macro-economic causes). For example macro economic forces that cascade down and are then expressed in massive health disparities and much shorter longevity among low socioeconomic groups).

Thus the best BSSR ideas compete directly against other biomedical ideas, domains where the NIH leadership and key decision makers are more familiar or comfortable with. So the bar is perhaps higher to get a scientifically strong behavioral, social or population science initiative understood and fully funded as a major long-term NIH priority. For example, investing in the human behav- or popul “-omics” at the same level as the investment made in gene- or prote “-omics”. This is frustrating because the decisions are then made without a deep understanding or appreciation of the value of some of the most exciting BSSR proposals.

Most frustrating of all is that there is even (thankfully among a minority of the NIH decision makers) a lingering stereotypic, perhaps even stigmatized and certainly an antiquated view of what BSSR was fifty years ago but is not so today. That stereotypic view includes misperceptions that I have heard from time to time such as: BSSR is still a “soft” science; is based on weak, fuzzy or unreliable self report measures; is common sense that your grandmother knew already and therefore BSSR does not need NIH research dollars to prove the obvious; is all applied research that should be funded by CDC; any basic behavioral research should be supported by NSF as its not relevant to the NIH mission of health and illness; that behavior is hard or impossible to change and that change cannot be maintained or sustained. For every myth there are many counter examples to dispel that myths. Our BSSR communities do not realize that we must constantly work at providing counter examples of strong science and evidence-based practice that show BSSR is every bit as strong, as much hard science and has had many major successes at changing population trends on a massive scale (e.g. smoking and HIVAIDS incidence in the US in the last 40 years) and thus BSSR is at least as relevant as the so called “natural and biological” sciences in address in the nations pressing public health needs. We must demonstrate this not simply assert it.

One thing is clear, the best and strongest science gets heard and considered, whereas “whining and complaining” that your particular field / discipline is getting “short changed” does not. Such whining may in fact set one back as an unintended consequence. However effective identification of gaps or reduced funding for BSSR programs and effective educating and lobbying efforts on the Hill and elsewhere are important too. Those within the NIH such as at OBSSR have limitations and cannot effectively change the systems from within. By the way, many of the biological sub-disciplines and especially the clinical scientists whine as much as the BSSR scientists. Whiners are especially vocal during lean times at NIH where funding is losing ground in real Dollars. So why should one discipline or professions loud “whining” be taken more seriously than another’s? The NIH view is that no one group deserves special attention on the basis of “whining”. It’s the best, strongest science ideas and the identification of legitimate gaps in the service of addressing the nation’s pressing public health needs that ought to win at the end of the day. Clinical medical researchers don’t get as much respect as basic biomedical scientists do. Here the NIH is doing something about that complaint by creating exciting new Clinical Translational Science programs (CTSA’s) in about 60 of the major medical schools in the US. One can hope that similar considerations will be given to worthy BSSR needs and gaps.

SPIN: What sort of trajectory for the behavioral and social sciences do you see at NIH? Are opportunities getting better, worse, staying the same?

Abrams: This is a difficult question to answer. The statistics that code for BSSR at NIH, that are admittedly rather global and have a significant degree of subjectivity to them, suggest that BSSR is at about the same level of funding as it was five years ago and that BSSR did quite well in the doubling of the NIH budget prior to that. However within specific Institutes, and perhaps especially within NIMH, where the largest amount of basic and applied BSSR is supported, there have been some troubling trends and changes in program priority that seem to have diminished some areas of BSSR. These are indeed troubling trends. There is substantial concern that things could get worse across the board as other ICs fall back to their “core biomedical” values during lean times and see BSSR as expendable and not a part of these core values.

However many fields are changing rapidly in Biomedicine and in BSSR domains. One has to determine if a previously productive program of research is now obsolete or unlikely to yield more insights and thus should be phased out in favor of a new area of extraordinary opportunity. As we see more integrative transdisciplinary research, especially of the sort that embraces the vertical integration of biology with behavior, social, physical, population public health and economic environmental disciplines, it may get harder to make the determination of what is “pure BSSR” whether it is basic or applied (e.g. in the fields of cognitive and social neurosciences, behavioral and developmental epigenetics or behavioral economics). In general I think BSSR is substantially underfunded, but that here are enormous emerging opportunities for partnerships between BSSR, Biomedical and Public Health sciences, fueled by the amazing developments in computer sciences, mathematical modeling, imaging, engineering, cybernetics and systems theory, spatial and geographic positioning (GPS) analysis, micro-sensor and real time tracking systems, and the informatics and communications technologies within a growing global cyber-infrastructure (see Mabry, Olster, Morgan and Abrams, 2008). BSSR must position itself to take full advantage of these opportunities if it is to survive and be a force for the future. This will require transformations in BSSR training programs and in producing the next generation of BSSR scientists who are more strongly versed in these new scientific domains and extraordinary areas of opportunity. As we steer the BSSR community “automobile” into the future, we must look forward through the windshield at the road ahead in the 21st century, rather than keep looking backwards in the rear view mirror of what used to be, hoping to resurrect “the good old days” of BSSR research in the mid 20th century.

SPIN: No doubt people considering applying for the directorship are going to contact you to see what it is REALLY like at NIH. What will you tell them?

Abrams: This is one of the most critical, visible and important positions in the world for supporting BSSR. It has enormous influence, power and extraordinary opportunity to make a real difference in the improving the lives of our entire nation especially at this critical moment in time and especially to eliminate health disparities and to promote prevention and support chronic disease management. Despite the frustrations and enormous challenges of working in the NIH culture, take the job and put all your energy into it. BSSR can do it and BSSR has matured and is coming of age in the 21st century. BSSR is a key player. With the most pressing problems facing not only our nation but the world being as much in the domain of the behavioral social and public health sciences as they are in the biomedical sciences, strong and articulate leadership, backed up by strong science and new technology, can and will make a difference. This job is well worth the commitment to service. At OBSSR there is a wonderful team of dedicated staff and there are many leaders and supporters of BSSR within the IC’s and in the Office of the Director as well as an amazing outside community of societies and groups (like the APA and the Consortium of Social Science Associations) that will support your efforts. The positive opportunities far outweigh the negatives.

SPIN: What sort of work will you do at the Legacy Foundation?

Abrams: I will be directing a new research institute, The Steven A. Schroeder Institute for Tobacco Research and Policy Studies at the American Legacy Foundation in Washington DC. The vision of the institute is to find new ways to further reduce the nations single most preventable cause of premature death, disability, disease burden and excess expense, the continuing scourge of tobacco use behavior. I have had a lifelong interest in understanding and intervening to treat addictive behavior in general and tobacco use behavior in particular, taking an integrative systems view of addiction, from cells to society across the lifespan and across generations.

REFERENCE

Mabry PL, Olster DH, Morgan GD, Abrams DB. “Interdisciplinarity and Systems Science to Improve Population Health: A View from the NIH Offce of Behavioral and Social Sciences Research,” American Journal of Preventive Medicine, (2008) in press.