Strategic Directions for the Office of Behavioral and Social
Sciences Research
Robert M. Kaplan2012 Summer Institute on Social and Behavioral Intervention
ResearchColumbia University
July 9, 2012
• What is the name of the government agency that funds most of the medical research paid for by taxpayers in this country?
• Less than 10% can identify NIH.
• About as many people identify Harvard.
• More people identify CDC– about 1/3rd of NIH budget
• Drug Companies commonly cited
Poll Question
• We are all NIH• Never forget to mention
your grant in publications and discussions with the press
• Look for clearer branding in the future
Where are we going?
“Science in pursuit of fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to extend healthy life and reduce the burdens of illness and disability.”
NIH: Steward of Medical and Behavioral Research for the Nation
Office of the DirectorOffice of the Director
National Instituteon Alcohol Abuseand Alcoholism
National InstituteNational Instituteon Alcohol Abuseon Alcohol Abuseand Alcoholismand Alcoholism
National Instituteof Arthritis andMusculoskeletal
and Skin Diseases
National Instituteof Arthritis andMusculoskeletal
and Skin Diseases
National CancerInstitute
National CancerInstitute
National Instituteof Diabetes andDigestive and
Kidney Diseases
National Instituteof Diabetes andDigestive and
Kidney Diseases
National Instituteof Dental andCraniofacial
Research
National Instituteof Dental andCraniofacial
Research
National Instituteon Drug Abuse
National InstituteNational Instituteon Drug Abuseon Drug Abuse
National Instituteof Environmental Health Sciences
National Instituteof Environmental Health Sciences
National Instituteon Aging
National InstituteNational Instituteon Agingon Aging
National Instituteof Child Health
and HumanDevelopment
National InstituteNational Instituteof Child Healthof Child Health
and Humanand HumanDevelopmentDevelopment
National Institute onDeafness and Other
CommunicationDisorders
National Institute onDeafness and Other
CommunicationDisorders
National EyeInstitute
National EyeInstitute
National HumanGenome Research
Institute
National HumanGenome Research
Institute
National Heart,Lung, and Blood
Institute
National Heart,Lung, and Blood
Institute
National Instituteof Mental Health
National InstituteNational Instituteof Mental Healthof Mental Health
National Instituteof NeurologicalDisorders and
Stroke
National Instituteof NeurologicalDisorders and
Stroke
National Instituteof General
Medical Sciences
National Instituteof General
Medical Sciences
National Instituteof Nursing Research
National Instituteof Nursing Research
National Libraryof Medicine
National Libraryof Medicine
Center for InformationTechnology
Center for InformationTechnology
Center for Scientific Review
Center for Scientific Review
National Centerfor Complementary
and AlternativeMedicine
National Centerfor Complementary
and AlternativeMedicine
National Instituteof Allergy and
Infectious Diseases
National Instituteof Allergy and
Infectious Diseases
National Centerfor ResearchResources
National Centerfor ResearchResources
Clinical CenterClinical Center
National Center on Minority Health andHealth Disparities
National Center on Minority Health andHealth Disparities
National Institute of Biomedical Imagingand Bioengineering
National Institute of Biomedical Imagingand Bioengineering
FogartyInternational
Center
FogartyFogartyInternationalInternational
CenterCenter
National Institutes of Health
DPCPSI –OBSSR, ORWHODP, OAR
We Cover a lot of Turf
Academic Disciplines• Anthropology• Child Development• Cognitive Science• Communication• Criminology• Cultural Studies• Economics• Education• Geography• History• Linguistics• Neuroscience• Law• Philosophy• Political Science• Psychology• Sociology
Professional Schools• Clinical Psychology• Gerontology• Medicine
– Pediatrics– Family Medicine– General Internal
Medicine• Nursing• Social Work• Pubic Health• Public Policy
Together these make up the majority of students and faculty at most research intensive universities.
Tobacco 435K18%
Poor diet and physical inactiv-
ity 365K15%
Alcohol con-sumption 85K
4%
Microbial agents 75K
3%Toxic agents
55K2%
Motor vehicle 43K2%
Firearms 29K1%Sexual behavior 20K
1%
Illicit drug use 17K1%
Other 1.3M53%
Mokdad, JAMA 2004 *corrected
A few behaviors explain almost half of all deaths 9
Theme 1: The Next Generation of Data and Analysis Methods
– mHealth– Electronic Health Records– Systems science– Masses of data– Data Visualization– New methods for analysis
“At it’s most complete, the exposome encompasses life-course environmental exposures (including lifestyle factors), from the prenatal period onwards…” -- Christopher Paul Wild
Exposomics (from Kevin Patrick, UCSD)
Genome Exposome
Together these lead to whether disease occurs or health is promoted…
(from Kevin Patrick, UCSD)
Billions of mobile devices
+ Billions of sensors Unprecedented opportunities for population-level sensing + Billions using social networks
=
The game is changing!
Improving Dietary Assessment Methods Using the Cell Phone and Digital Imaging
• Uses a mobile phone as a food record
• Image processing to identify food in real time- Supplement with search
list - Calculates volume to
estimate portion size • Calculates nutrient and
food intake
PI: Carol Boushey, Purdue University
LUCAS images of CD4+ and CD8+ T cells compared to a regular microscope image..
LUCASmicroscope
Photos from Karin Nielsen and Aydogan Ozcan
Computer softwareautomaticallyinterprets images at remote siteCell phone transmits image
Karin Nielsen, UCLA, FIC, R24TW008811
A. OZCAN, 1R21EB009222-01
LUCAS- Mobile MicroscopeProblem: Create a low-cost quality microscope to use in low resources settings.Solution: A specially-developed lens fits to a cell phone to create a microscope Field testing: Malawi, Mozambique and Brazil
High-resolution fiber-optic microendoscope
• Problem: Methods to detect cancer from traditional biopsies are invasive for patients and require lab facilities.
• Solution: A scientific charge-coupled device camera and a laptop computer for under $4,000 (clinical trials in China, Botswana, Guatemala)
Rebecca Richards-Kortum, Rice Univ. NIBIB RO1 EB007594
Adherence Monitoring (Uganda)
Jessica Haberer, Partners Healthcare NIMH K23MH087228
Problem: Adherence to chronic disease medications is poor. In resource-poor settings, getting people medication is only part of the solution Solution: Wireless medication canisters that signal medication timing, transmit adherence data and allow resources to target the non-compliant
Noika Files New Patent (March 2012)
• Haptic tattoos for mobile sensing– Tattoos with ferromagnetic
inks, that will vibrate based on commands from your phone
– Can receive signals, like vibrations and Morris code like instructions
The Evolving Health Care SystemThe First Era(Yesterday)
The Second Era(Today) The Third Era
(Tomorrow) Focused on acute
and infectious disease
Germ Theory Short time frames Medical Care Insurance-based
financing Industrial Model Reducing Deaths
Increasing focus on chronic disease
Multiple Risk Factors Longer time frames Chronic Disease Mgmt
& Prevention Pre-paid benefits Corporate Model Prolonging Disability
free Life
Increasing focus on achieving optimal health
Complex Systems - Life Course Pathways
Lifespan/ generational Investing in population-
based prevention Network Model Producing Optimal
Health for All
Health System 1.0
Health System 2.0
Health System 3.0
From Neal Halfon, 2012Breslow, L. "A Life in Public Health.”2004 Springer Publishing Co. NY, NY Dr. Breslow passed away April 10, 2012 at age 97
Howard K. Koh, M.D., M.P.H. & Kathleen G. Sebelius, M.P.A.: Promoting Prevention through the Affordable Care Act nnejm.org september 30, 2010 )
Americans receive only about half of the preventive services that are recommended
Many of the 10 major titles in the Affordable Care Act advance a prevention theme through a wide array of new initiatives and funding.
Theme 3: Advancing Translational Science
FDR: A Preventable Death?Blood Pressure Readings 1944-1945
Theme 3: Advancing Translational Science
Feb 1945 260/150
DEATH: 4.12.45 300/190
10.1.40 Dedicated NIH
Bethesda Campus
3.27.44 186/108
4.1.44 200/108
11.18.44 210/112
11.27.44 260/150
The initial findings from the Framingham heart study were published 50 years ago.
By 1961, we knew that the major risk factors for CHD included:
• Tobacco smoking• High blood pressure• High serum cholesterol• Diabetes
Theme 3: Advancing Translational Science
• Death rates from heart disease have fallen since 1950
• ~30% reduction for all cardiovascular diseases combined
• Nearly ½ of decline due to prevention & treatment of CV risk factors (smoking, high BP, cholesterol)
Public Health Impact: From NHLBI
Theme 3: Advancing Translational Science
Source: New York Times, April 24, 2009
600
500
400
300
200
100
01960 1970 1980 1990 2000 2005
Heart Disease
Cancer
StrokeAccidental
InjuriesAlzheimer’s
Annual U.S. Deaths Per 100,000 People Of All Ages
Over Time
Awareness, Treatment, and Control of Hypertension in 2004 NHANES
Theme 3: Advancing Translational Science
Awareness
Treatment
Control
0 10 20 30 40 50 60 70 80
LatinoBlackWhite
Even at Current Levels….
Awareness: 80% Treatment: 70% Control: 50%
. 8 X . 7 X . 5 = . 28
Only 28% of people with high blood pressure are being successfully treated.
Theme 3: Advancing Translational Science
Behavioral reminders for cholesterol treatments are estimated to prevent 7X more deaths than replacing older cholesterol-lowering drugs with more potent medicines
Non-Technical Solutions
Theme 3: Advancing Translational Science
Source: Woolf & Johnson 2006
vs.
Is Informed Consent “Real”?
In a survey of consecutive patients scheduled for an elective coronary revascularization procedure at Yale New Haven Hospital in 1997-1998:
• 75% believed PCI would help prevent an MI
• 71% believed PCI would help them live longer
Source: Holmboe ES. JGIM 2000; 15:632
Theme 3: Advancing Translational Science (Primary Care)
While in the latest meta-analysis in 2009 (61 trials, 25,388 patients):
“Sequential innovations in catheter-based treatment for non-acute coronary artery disease showed no evidence of an effect on death or myocardial infarction when compared to medical therapy.”
Is Informed Consent “Real”?
Theme 3: Advancing Translational Science (Primary Care)
Source: Trikalinos TA. Lancet 2009; 373:911)
Is Informed Consent “Real”?
In a survey of consecutive patients consented for an elective coronary angiogram and possible percutaneous coronary intervention at Baystate Medical Center in 2007-2008
• 88% believed PCI would help prevent an MI
• 76% believed PCI would help them live longer
Source: Rothberg MB. Annals Intern Med 2010; 153:307)
Theme 3: Advancing Translational Science (Primary Care)
Office of Behavioral and Social Sciences Research (OBSSR)
Based on trans-NIH need → new funding opportunity announcements:
• Practical Interventions to Improve Medication Adherence in Primary Care (R01, R21)
• Behavioral Interventions to Address Multiple Chronic Health Conditions in Primary Care (R01)
• Systems Science and Health in the Behavioral and Social Sciences (R01, R21)
Theme 3: Training the Next Generation of Behavioral and Social Scientists
• K-12• The undergraduate curriculum• The PhD program of the future• The 2011 AAMC report of the future of the
medical school curriculum• The 2015 MCAT