|T H E N I H C A T A L Y S T||J U L Y A U G U S T 2006|
with David Abrams
|by Fran Pollner|
David Abrams: "As we learn more about our genes and the biological vulnerabilities we all have to certain kinds of lifestyles and exposures to pathogens, we see how critically important it is to ensure that we create less toxic lifestyles, neighborhoods, communities, and societies."
David Abrams founded the Transdisciplinary Center for Behavioral and Preventive Medicine at Brown University in Providence, R.I., and was its director for the last 17 of his 25 years at Brown, as well as professor of psychiatry and human behavior and of community health.
He was a continuously funded NIH grantee from 1982 until he left Brown in 2005 to become the third director of the NIH Office of Behavioral and Social Science Research.
Abrams' research has focused on the interactions of risk factors of chronic diseases, addictions, and stress and has covered the bases from bench to bedside to public health and policy. The NIH Catalyst interviewed Abrams the week after the OBSSR's 10th-anniversary symposium, June 2122.
Q: How do you define basic research in the behavioral and social sciences?
ABRAMS: The same as you would in any other science: the study of basic mechanisms without necessarily a defined endpoint or disease in mind. Examples would be cognitive mechanisms in motivation related to behavior change and fundamental mechanisms that explain the formation of social attitudes and beliefs that are the basis of stigma, stereotyping, and discrimination.
I think there's a misperception that the study of behavior and society must by definition be applied research. That's not true. How we interact with others and how that relates to the society we construct is basic research.
We can work forward from basic biologic and sociobehavioral mechanisms through neuroscience, cognition, and emotion to understand the basic behavior patterns of groups, families, and nations. At that point, there may be implications for intervention and policythe applied science of behavior change goes to prevention, treatment, and more global policymaking.
The starting point could also be a complicated problem with multiple causal pathwaysresearch involving tobacco and health disparities are probably two of the best examplesfrom which you work backwards through different disciplines, different basic sciences, to the basic mechanisms, which lead to a fuller understanding and better interventions.
Q: Are your reasons for coming here materializing?
ABRAMS: Yes. Right now, we are at the crossroads of unprecedented discoveries and urgent demands for solutions. I am talking about the fact that the costs of maintaining quality health care will be unsustainable as aging baby boomers create a huge bolus of chronic diseases that threaten to overwhelm our acute-care medical services.
Behavioral and social sciences have a lot to contribute to potential solutions. We have very good principles and measures and evidence-based findingsand we will have more opportunity to share that knowledge. This is an exciting time for me to be here, to spur on the most pressing research questions and, perhaps even more important, the fuller use of what we know already. We need more integrative approaches and systems thinking.
For instance, there are 40 million people who still smoke. That's still the single leading cause of preventable death and costs more than $160 billion a year in unnecessary health care and lost productivity. So while in the past 40 years we've had resounding success in cutting smoking in half and dramatically reducing associated death and disability, there are still 40 million smokers who need to be motivated to quit. Behavior therapy doubles the rate of quitting; add nicotine replacement therapy, and the rate is quadrupled. If we could get only 5 percent more smokers to quit each year, we could halve the number of smokers in the next 10 years. That might not sound as dramatic as the impact of a heart transplant on an individual, but it would make a huge societal difference in the burden of some of the biggest preventable killers in our countrycancer, heart disease, and pulmonary diseases.
The behavioral and social sciences can also be brought to bear on the obesity epidemic and the emergence of type 2 diabetes.
Q: In his talk [at the 10th- anniversary symposium], Dr. Kington referred to pockets of resistance to behavioral science in the biomedical community. Is that at NIH or the biomedical community at large?
ABRAMS: I think both. It's also a two-way street. There is resistance among both the biomedical and the behavioral sciences. Each tends to protect its own guild-like interests.
There are still disciplinary silos, many people who are comfortable doing only what they were trained to do in graduate school, a persisting belief that the big discoveries are made by an individual who has become an absolute expert on a very narrow mechanism and wins a Nobel prize. There's a misplaced fear that transdisciplinary science will not solve the biggest problems.
Although there is an emerging openness to team science with the realization that no one discipline or causal model is adequate to address complicated problemswe are seeing this particularly in the area of systems biologythat openness is more within the broad disciplines of the biomedical sciences or within the broad disciplines of the behavioral, social, and population sciences. Each of these tends to resist learning from the other, resists crossing from one to the other to understand all the causal roles sociocultural, psychosocial, biologic, genetic. Systems thinking can be expanded from biology to behavior to society, from genomics to "populomics."
For instance, some in the populationpublic health science community have a causes-of-the-causes model: The real cause of preventable diseases and health disparities ultimately resides in the macrosocio-economic environmentpoverty, lack of opportunity, pockets of prevalence of multiple risk factors, lack of access to health care and to fresh fruits and vegetables, reliance on fast foods, unsafe environments that prevent outdoor activity.
I do believe that we have developed an industrial society that unintentionally has created an environment toxic to our genes, which are not capable of changing as fast. For instance, we have developed processed foods that tend to taste good and reward certain brain pathways but are unhealthy. We used to live in a world where pleasure was hard to come bywhere we had to run many miles to catch a deer, which might have happened only every three weeks; but now if your brain craves fat and sugar, you can get it most any day and cheaply. So there is a lot to say for changing the environment and our behavior.
But you can't have disease unless those environmental exposures get under the skin and interact with genes that are vulnerable. There's still the questions of why do some of us get fat and others not, why some have heart attacks and others not, why some kids get addicted to tobacco and others not. Genes and biology are as important as environment. It's not one or the other but both. The action is in the interactionit's really two sides of the same coin.
I see my job as helping to form partnerships, accelerate the sense of excitement among biomedical, psychosocial, and population scientists who are starting to embrace a paradigm shift based on the growing recognition that the 20th-century model of genetic determinism is incomplete. I see my job as challenging the resistant members of all the disciplines to roll up their sleeves and learn from and talk to one another.
Q: In that capacity, are you dealing mostly extramurally or intramurallyand how?
ABRAMS: At the moment, our office has been largely positioned and focused on enhancing extramural research, working with our 27 IC partners, some of whom were early enthusiastic supporters of our programsuch as NCI, NIMH, NIA, NHLBI, NIDA, NIAAA, NCCAM, NIDDK, NIDCR, NINR, ORWH, and NCMHD, to name a few.
We build consensus for new initiatives to bridge behavioral and biologic areas; we identify high priorities, see where things may be falling through the cracks, and use traditional program mechanisms, such as RFAs, to address issues that given ICs might not necessarily see as their domainsay, the issue of depression and cardiac disease.
I think this whole process will be facilitated by OPASI (Office of Portfolio Analysis and Strategic Initiatives), which is designed to look at trans-IC opportunities. My hope is that because OBSSR exists, there will be quicker, better, stronger trans-IC research initiatives.
Now for the intramural sideI also think we should play more of a role in looking at behavioral and social science in the intramural program. At this point, I would start simply by doing an inventory of what is going on intramurally and what needs strengthening. We need to go through that process.
Q: Do you fear the tightening budget will negatively affect your office?
ABRAMS: No. I think there is even more awareness of how valuable behavioral and social science research is. As Dr. Zerhouni said [at the anniversary meeting], this is a critical time in which so much of preventable disease clearly has changeable behavioral causes. If anything, that situation should enhance appreciation of the need for partnershipsworking together to solve problems more efficiently.
Q: Did you find the OBSSR meeting exciting?
ABRAMS: It exceeded my wildest expectations. We don't often put together in one place all the amazing researchthe discoveries, the applied research contributionsacross the 27 ICs over 10 or more years. It's also great for behavioral and social scientists to see how far we've come, how much our science has matured, to see the evidence-based interventions that have been proven to work in randomized trials and other rigorous research designsand that do work in the real world. We are a hard science that is actually improving the public health and the quality of care and reducing costs.
As the chairman of the British Medical Research Council recently said, the challenge now is to move from genomics to populomics to look at the patterns of disease in whole populations, which should facilitate understanding the gene-environment interaction for the major chronic diseases and most common diseases.
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