Leadership Needed

Neuroscientist Ira B. Black: "So many of the diseases facing us involve behavioral patterns." A search committee will stop accepting applications for the directorship of the newly chartered Office of Behavioral and Social Sciences Research (OBSSR) at the National Institutes of Health this week. The deadline's passing sets the stage for the appointment, by year's end, of a leader whose task will be to effective- ly integrate behavioral and social sciences research into the traditional biomedical investigations for which NIH is better known. Advocates who have long struggled to raise the stature of these disciplines at NIH succeeded through pressure and persuasion in getting Congress to write the new office into the health agency's fiscal 1994 authorization. Now, they say that if a strong first director is named, OBSSR should be able to promote in-novative, interdisciplinary re- search that will significantly extend understandings of basic processes in disease and health. Some of these observers voice concerns, however, that OBSSR may not be easily incorporated into the laboratory sciences culture that prevails at NIH. The office's most important potential ally, NIH director Harold Varmus, has expressed, at best, lukewarm support for the behavioral and social sciences, they say. Although the new OBSSR director will have a high profile-- the position will carry the additional title of associate director of NIH and will reside within the NIH director's office--how the office fares will depend, in part, on the welcome it receives from Varmus. The search committee is expected to forward a short list of candidates to Varmus by late November or early December; the NIH chief will then make the final selection, pending approval of Public Health Service head Philip Lee. Once installed, the new office's chief will begin the challenging task of coordinating with various NIH institutes to promote research linking behavioral and social factors to health and disease. Scientists believe that the office's initial funding of about $2.5 million will probably not be enough to grant research awards directly. They expect, however, that the amount should be adequate to sponsor conferences, workshops, and other projects to catalyze important new scientific investigations, both within and outside NIH. "So many of the diseases facing us involve behavioral patterns participating in their pathogenesis or perpetuation," says Ira B. Black, chairman of the department of neuroscience and cell biology at the University of Medicine and Dentistry of New Jersey at the Robert Wood Johnson Medical School in Piscataway. Black, a past president of the Society for Neuroscience, Washington, D.C., was also a member of the Institute of Medicine committee that produced the report AIDS and Behavior: An Integrated Approach (Washington, National Academy Press, 1994). "There's an extraordinary need for the behavioral sciences to crosstalk more effectively with what we might call the biological sciences--even though those very distinctions that I'm drawing are artificial. If this office can contribute to that kind of interaction, it will be successful." Although generally optimistic that, with a sufficiently articulate and scientifically qualified director, OBSSR can accomplish its goals, some behavioral and social scientists worry about past statements made by Varmus that they characterize as disparaging of their disciplines. The new position is being constructed as, potentially, quite a visible post," declares Felice J. Levine, executive officer of the American Sociological Association in Washington, D.C. "We are concerned that Dr. Varmus has not seemed to appreciate the real value added of looking at the social and behavioral dynamics of health and disease. But we're hoping that this office can be part of the solution, and that he will be open to the scientific counsel of an effective director." Others note what they feel has been an excessively long wait between congressional authorization for the new office in June 1993 and action taken to create it, indicating resistance to OBSSR. Department of Health and Human Services Secretary Donna Shalala signed the necessary paperwork to establish the office on July 13 of this year. The delay has been ascribed by NIH, however, to normal bureaucratic procedure. NIH officials say that, whatever tensions may exist, OBSSR will likely join other congressionally ordered units that have been productively integrated into the office of the director--the offices for research on minority health and research on women's health, for example. "It's difficult when there are legislative mandates," observes Delores Parron, associate director for special populations in the office of the director of the National Institute of Mental Health (NIMH)--a job also created by act of Congress, in 1980--and cochairwoman of the search committee for the OBSSR director. "But with minority health and women's health, we've learned how to really make good use of these offices to do the kind of things that we need to do, to take the leadership to move us into areas where we've needed to move for a long time." Because the office will not have a large budget and, hence, will have limited direct powers, the new director's leadership capabilities--both scientific and for coalition- building with other offices in NIH--will be crucial to OBSSR's effectiveness. A demonstrable understanding of the scientific methodologies used in the laboratory-focused biomedical disciplines will also be needed, researchers agree. The [OBSSR director] will have to work very closely with all the institutes at NIH, so there should be a very strong appreciation for systematic pursuit of knowledge," says Cora Marrett, an assistant director of the National Science Foundation in Washington. Marrett, the first head of NSF's directorate for the social, behavioral, and economic sciences--an office comparable to OBSSR, established at the science foundation in 1992--is a member of the search committee for the OBSSR director. "The person clearly will have to have a strong ability to communicate ideas and to bring others together, because the position will not have a lot of staff or resources initially. OBSSR, for example, "won't have the budget authority of the Office of AIDS Research [OAR]," according to Susan Persons, associate director for government affairs of the Consortium of Social Science Associations (COSSA) in Washington. OAR consolidates AIDS research budgets and planning at NIH. "That's one of the reasons that it's important that the new director be someone who's respected in the larger community as well as at NIH. Hopefully, if there's a good, strong director, that person will be able to get the institutes to collaborate more." Persons adds that a director interacting well with all parts of NIH should help ensure that duplicative research is minimized. One difficult, early objective of the new director will be establishing consensus about just what constitutes behavioral and social science. Different definitions are used throughout the health agency. "One of the first tasks for the new person coming in will be to define precisely how much [behavioral and social science] there is at NIH right now," Marrett says. According to Marrett, this will be difficult because of the breadth and diversity of what has been called behavioral or social science. For her office to coordinate well with its NIH counterpart, she says, inter- and intradisciplinary distinctions will be important. "There are some areas where most of the support would be at NSF," Marrett notes. "There is more support for anthropology at NSF than NIH, for example. But for a number of parts of psychology--physiological neuropsychology and, to some extent, cognitive psychology--there is substantially more support at NIH than at NSF currently." In many ways, links between biomedical laboratory sciences and behavioral and social sciences research are only just emerging. Perhaps for this reason, defining just what types of studies will lie within the purview of OBSSR may be difficult. Will, for example, psychosomatic medicine be included in the category? What about the search for behavior genes? "With behavior genes, you're really talking about straightforward molecular biology," says Louis Sibal, director of the office of laboratory animal research in the NIH director's office. Sibal is the official managing the process of establishing OBSSR and will be asked to help the office's new leader navigate the bureaucracy at NIH, an especially important job if the incoming person is from outside the agency. "Those kinds of [investigations] would come in the genome program, where people would be mapping the genes and finding out what their functions are." NIMH's Parron, however, suggests that work with behavior genes and psychosomatic medicine probably will both fall within OBSSR's mandate. "But coming up with an agreed-upon definition of what's encompassed is one of the main tasks the new director will be undertaking, because there has been controversy in various sectors of NIH about what the appropriate definition of behavioral science research should be," Parron points out, noting that the social sciences are more easily defined. "There are some people who say that much of the research in the neurosciences should be excluded, for example, and then others who make the argument as to why it should be included." Areas of investigation that most scientists agree will be addressed by the new office include so-called preventive research--studies on the persistence of high-risk behaviors among populations with the potential to be exposed to the HIV virus, for example, or why young people aware of the fact that smoking can lead to cancer are still attracted to cigarettes. NIH director Varmus, a Nobel-Prize-winning molecular biologist, has been accused by behavioral and social scientists of being unsympathetic to their disciplines, and their concerns based on this impression extend to their expectations for OBSSR. The feeling that the NIH director is less than favorably disposed to behavioral and social science stems, in part, from a statement that appeared in The New York Times (N. Angier, Nov. 23, 1993, page C1). "I begin with the premise that behavior is an incredibly important element in medicine," Varmus told the newspaper. "People's habits, their willingness to take steps to avoid transmission of HIV, are all behavioral questions. But what I'm looking for are new ideas, real discoveries. When I read about genetics, I see breakthroughs every day. And while I'm trying to learn more about behavioral science, I must say that I don't feel I get tremendous intellectual stimulation from most of the things I read." Varmus's defenders insist that his comments have been misinterpreted and that he was merely expressing his personal affinity for the methodologies of molecular biology. Through spokespersons, Varmus declines to respond directly. "Dr. Varmus is a molecular biologist at heart," says Sibal. "And, obviously, he's a brilliant man who has very high standards. He's a stickler for high-quality research. That's what was intended by that remark." Behavioral and social scientists acknowledge that an ability to challenge the impression--relatively common among traditional biomedical researchers--that the behavioral and social sciences lack a rigor comparable to that of their own disciplines, will be key to the new director's success. "The scientific depth and acumen [of the new director] will be core," says Levine, "not just in interaction with Dr. Varmus but also in being able to play a leadership role across the agency." In the view of Denis J. Prager, former director of the health program at the John D. and Catherine T. MacArthur Foundation in Chicago and now head of a consulting firm for foundation planning, "there's room for some strengthening of the behavioral and social sciences." For most of the past decade, the MacArthur Foundation supported a research network for health and behavior headed by psychologist Judith Rodin, the new president of the University of Pennsylvania. Says Prager: "Certainly, there's some room for strengthening the degree to which they're integrated into the biomedical sciences. On the other hand, it doesn't take a lot of reading of the literature to become convinced that some of the most powerful determinants of health in our society are behavioral and social." Varmus is also said to be broadening his knowledge of the behavioral and social sciences as his time in office lengthens. "He's on a learning curve and open to hearing," says Anne Thomas, associate director for communications in Varmus's office. "And I've heard him express his understanding that behavioral science is important." "We've been told that he's educable, that this just isn't his area of interest, and I can understand that," counters COSSA's Susan Persons. After Congress authorized OBSSR in June 1993, she formed the Coalition for the Advancement of Health Through Behavioral and Social Science Research, consisting of 12 member societies and organizations, to monitor NIH progress toward establishing the office. Persons reports that Varmus failed to mention the behavioral and social sciences at his confirmation hearings and in other testimony before Congress. He has also refused to meet with representatives of her group, while meeting often with other biomedical researchers, raising fears that the new OBSSR will be coolly received in his office, she says. "I'm not inclined to give him the benefit of the doubt any further," Persons says. "There have been opportunities. As the NIH director, truly, he represents all of the research that is done there." She adds, however: "In spite of the slow progress in getting this done, I'm really hopeful that, once it is in place and we have a good [OBSSR] director, things will improve. I don't think we're going to be able to tackle most of the health challenges that we have without behavioral and social science. It's just impossible." Persons's views--a mix of optimism and cynicism--are shared by other scientists. "Behavioral and social scientists are enthusiastic about the fact that such an office will exist, but skeptical that it will, in fact, be well integrated into the NIH system and have much impact," Prager says. Whatever the start-up problems with OBSSR, most behavioral and social scientists agree that the questions to be addressed by the office will be critical ones for biomedical research and public health in the future. "The most interesting and most powerful science down the road is going to be that science which is capable of integrating the inputs of social, behavioral, and biological [sciences] in such a way that we get a really detailed view of how the organism operates in the real world and how it is affected by the environment within which it lives," Prager says. "If the NIH people, including Varmus, can be brought to understand that, then we're going to make much more progress, much more quickly, in promoting health and preventing disease." "I very much hope this office will be a spur for ever- increasing multidisciplinary efforts," neuroscientist Ira Black says. "We're in a position now for that to become a reality, for us to regard the biology of behavior, the behavioral output, and the behavior of interacting individuals as different facets of the same pursuit." Black adds: "Medicine of the 21st century, in large measure, may well be psychosomatic and somatopsychic medicine."

Leadership Needed

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