1

Introduction

We are not students of some subject matter but students of problems. And problems may cut right across the borders of any subject or discipline.

Karl Popper

Biomedical and behavioral research scientists, among others, have long recognized the value of interdisciplinary research and collaboration. Many public and private reports over the last 25 years have detailed the need for and recommended development of interdisciplinary training activities to produce scientists capable of working on complex problems, but cooperative efforts remain difficult to achieve.

The history of science and technology demonstrates that many important advances have come from an interdisciplinary approach. Examples abound: plate tectonics, which brought together geologists, oceanographers, paleomagnetists, seismologists, and geophysicists to advance the ability to forecast earthquakes and volcanic eruptions; laser surgery, which involved ophthalmologists, anatomists, and physicists, and has saved thousands of people from severe vision impairment or blindness; “designer” seeds, which were developed by geneticists, bioengineers, and botanists to create crops that resist damage from insects and herbicides; and transistors, with which chemists and physicists revolutionized the technology of electronic devices. Examples in neuroscience include the cloning of the gene associated with Huntington's disease, which required the work of neurologists, psychologists, sociologists, and geneticists; elucidation of important aspects of the pathophysiology underlying Alzheimer's disease, which required the expertise of neuropathologists, molecular biologists, neurologists, geneticists, and protein chemists; development of medical and surgical treatments for Parkinson's disease, which stemmed from the efforts of neurologists, neuropharmacologists, neuropathologists, neurophysiologists, and



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Bridging Disciplines in the Brain, Behavioral, and Clinical Sciences 1 Introduction We are not students of some subject matter but students of problems. And problems may cut right across the borders of any subject or discipline. — Karl Popper Biomedical and behavioral research scientists, among others, have long recognized the value of interdisciplinary research and collaboration. Many public and private reports over the last 25 years have detailed the need for and recommended development of interdisciplinary training activities to produce scientists capable of working on complex problems, but cooperative efforts remain difficult to achieve. The history of science and technology demonstrates that many important advances have come from an interdisciplinary approach. Examples abound: plate tectonics, which brought together geologists, oceanographers, paleomagnetists, seismologists, and geophysicists to advance the ability to forecast earthquakes and volcanic eruptions; laser surgery, which involved ophthalmologists, anatomists, and physicists, and has saved thousands of people from severe vision impairment or blindness; “designer” seeds, which were developed by geneticists, bioengineers, and botanists to create crops that resist damage from insects and herbicides; and transistors, with which chemists and physicists revolutionized the technology of electronic devices. Examples in neuroscience include the cloning of the gene associated with Huntington's disease, which required the work of neurologists, psychologists, sociologists, and geneticists; elucidation of important aspects of the pathophysiology underlying Alzheimer's disease, which required the expertise of neuropathologists, molecular biologists, neurologists, geneticists, and protein chemists; development of medical and surgical treatments for Parkinson's disease, which stemmed from the efforts of neurologists, neuropharmacologists, neuropathologists, neurophysiologists, and

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Bridging Disciplines in the Brain, Behavioral, and Clinical Sciences neurosurgeons; and development of medical and surgical treatments for temporal lobe epilepsy, which resulted from the efforts of neurologists, electroencephalographers, neurophysiologists, neuropharmacologists, and neurosurgeons. The need for interdisciplinary research appears to be increasing. Newly emerging health problems, as well as those that have plagued us over time, are proving to be surprisingly complex as scientists and healthcare providers begin to recognize and appreciate the intricate interplay among environment, behavior, and disease. One need only point to HIV infection, heart disease, and drug abuse (including tobacco use) as three prime examples of the intersection of behavior and health. Within broad fields, such as mental health research, the need to understand the entire human organism—not just one part of it—is driving disciplines toward each other as scientists seek better ways to prevent, diagnose, treat, and control such conditions as schizophrenia, bipolar affective disorders, and learning disabilities. Many of the chronic conditions that challenge us today do not respond well to the single investigator, single discipline model that worked well in the past, as in the paradigm of infectious disease.3 Solutions to current and future health problems will likely require drawing on a variety of disciplines and on approaches in which interdisciplinary efforts characterize not only the cutting edge of research, but also the utilization of knowledge. The next generation of scientists must be prepared to integrate the advances of rapidly progressing disciplines. The basis of many health problems is not well understood, and it is increasingly recognized that many disorders have a wide array of causes. Defining the causes of disorders is itself an important emerging field, and fuller understanding will require input from many disciplines. Furthermore, addressing the burden of illness requires understanding of both the biology of the disorder and the cultural and psychosocial aspects of living with it. The problems are complicated, and the solutions are not easy to come by; this might explain why, despite the good intentions and fine recommendations of numerous previously convened groups, change has been slow to come. Long-held biases, beliefs, educational practices, and research funding mechanisms have created a system in which it is easier to conduct unidisciplinary than multidisciplinary work. Creation of environments in which interdisciplinary research and training occur will probably require many changes and multiple integrated approaches. Although it might be difficult, it is well worth the effort because many of today's disciplines (e.g., neuroscience, biochemistry, and bioinformatics) started as interdisciplinary efforts and many of today's interdisciplinary efforts will become tomorrow's disciplines. INTERDISCIPLINARY RESEARCH Over the last 10 years, as interdisciplinary research has been discussed with increasing frequency, several authors have offered definitions of interdisciplinary research as a first step to developing a common understanding of its chal-

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Bridging Disciplines in the Brain, Behavioral, and Clinical Sciences lenges. The dictionary defines it as involving two or more academic, scientific, or artistic disciplines. Some have made distinctions among the terms interdisciplinary, multidisciplinary, and transdisciplinary.7 For the purposes of this report, the following definition (modified from Luszki, 1958) of interdisciplinary research was adopted: Interdisciplinary research is a cooperative effort by a team of investigators, each expert in the use of different methods and concepts, who have joined in an organized program to attack a challenging problem. Ongoing communication and reexamination of postulates among team members promote broadening of concepts and enrichment of understanding. Although each member is primarily responsible for the efforts in his or her own discipline, all share responsibility for the final product. INTERDISCIPLINARY TRAINING Interdisciplinary training encompasses many approaches, from broadening the graduate and postgraduate education of students so that they can understand more than one discipline to exposing a midcareer single discipline trained investigator to a second discipline to broaden her or his research capabilities. Regardless of the method, the outcome is to produce individuals who are capable of research focused on complex problems that require interdisciplinary solutions—in short, interdisciplinary research. Training in a single discipline is most likely to lead to future research with the tools of that discipline. Interdisciplinary training broadens the possibilities by providing additional tools. Training does not necessarily predict a researcher's approach throughout a career. Some scientists trained in traditional disciplines go on to conduct interdisciplinary research, and some trained in interdisciplinary programs go on to conduct focused research in a single discipline. The human factors involved in making these decisions are complex and unpredictable, as are the situations that trigger them. However, it is generally expected that interdisciplinary training will lead to more interdisciplinary research than will single discipline training and that providing a broad-based interdisciplinary background will facilitate the integration of disciplines by making concepts more accessible. TRANSLATIONAL RESEARCH One of the important aspects of interdisciplinary research is translating findings from the laboratory to the clinic or from the clinic back to the laboratory. One historic example is the discovery of the gene mutation in sickle cell anemia: a clinical investigator communicated his findings to a physical chemist; the chemist then tested his hypothesis in the laboratory and provided an explanation for the clinical findings (see chapter 2). This type of research requires both clini-

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Bridging Disciplines in the Brain, Behavioral, and Clinical Sciences cal and basic science input—sometimes difficult to achieve. Basic scientists and clinical investigators not only speak different languages, but often are not fully aware of the scientific problems that activate disciplines outside their own. Can we continue to interest a subset of basic scientists in focusing their technologies and perspectives on problems that ultimately will help us to understand specific illnesses? Can we enhance the exchange of information between basic and clinical scientists and encourage their application of each other's findings? INTERDISCIPLINARY RESEARCH IN THE BRAIN, BEHAVIORAL, AND CLINICAL SCIENCES Information emerging from the behavioral sciences, genetics, molecular biology, and neuroscience is revealing the interconnectedness of the questions being asked. Who poses the questions is likely to determine how the questions are answered and what tools are used. Collective framing of the questions could lead to better answers. At the very least, some scientists are recognizing that the tools of other disciplines might be useful in their own work. For example, psychologists increasingly are using artificial intelligence, brain imaging, and molecular biology to map behaviors. Cognitive scientists are using imaging to measure brain blood flow and metabolism in efforts to examine memory and attention. Psychiatric researchers are turning to epidemiologists to help them to identify risk factors, which in turn will lead to appropriate treatments or preventive interventions. Interest in promoting interdisciplinary research in the brain and behavioral sciences is not new. As far back as 1951, a committee on research methodology in mental health research reported to the Research Study Section of the National Institute of Mental Health (NIMH) suggesting a series of interdisciplinary work conferences to explore the “problem of interdisciplinary team efforts.”6 The Mental Health Study Act of 1955 put forward the policy of solving “the complex and interrelated problems posed by mental illness by encouraging the undertaking of nongovernmental, multidisciplinary research” into all aspects of mental illness (see Joint Commission on Mental Illness and Health, 19615). In 1961, the Joint Commission on Mental Illness and Health reported findings and recommendations for the national mental health program. 5 One recommendation stated, “efforts should be made to increase contacts between researchers and practitioners so as to increase mutual understanding of each other 's problems and approaches.” In 1961, the predecessor of the National Institute of Neurological Disorders and Stroke funded the first program projects and clinical centers, which provided environments for interdisciplinary research. Shortly after, Schermerhorn8 published a psychiatric index for interdisciplinary research to facilitate literature searches for investigators interested in collaborating outside their own fields.

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Bridging Disciplines in the Brain, Behavioral, and Clinical Sciences Despite nearly 50 years of reporting on the need to do more, in 2000 the necessity of interdisciplinary efforts to integrate the brain, behavior, and clinical sciences is even more pronounced. Norman B. Anderson, director of the NIH Office of Behavioral and Social Sciences Research (OBSSR) has stated that “we simply will not have a complete understanding of behavioral or biological processes by studying [biology and behavior] separately” (as quoted in Azar 1998,2 see also Anderson, 19981). The Public Health Service has documented that many of the leading causes of illness and death in the United States have social, behavioral, and lifestyle components, such as tobacco use, lack of exercise, poor diet, and alcohol abuse. Numerous studies have also documented that psychological stress is linked to a variety of health outcomes, and researchers and public health officials are increasingly interested in understanding the nature of this relationship. In addition, sociologists have recognized the changing age, ethnic, racial, and cultural composition of America's population;4 the increasing diversity of the population generates a need for interdisciplinary collaborations among researchers to understand the multifaceted biological, psychological, and social issues that are generated. The breadth of expertise needed in many fields of research—such as mental illness, drug abuse and addiction, and aging—spans many disciplines, including behavioral science, neuroscience, pharmacology, genetics, epidemiology, computer science, engineering, medicine, social structures, law enforcement, and the mass media. Through interdisciplinary investigations, behavior and responses to environmental conditions can be usefully linked to neurobiological processes and brain structures. Many fields of inquiry require approaches and methods that can be linked to a more complete understanding of complex relationships among brain mechanisms, behavior, and pathology. Current advances in clinical and behavioral research—if better integrated with research in molecular biology, neurochemistry, and other neuroscience research—might have a substantial effect on numerous health-related problems. COMMITTEE PROCESS The present study was requested by the directors of the NIMH, OBSSR, the National Institute on Nursing Research, and the National Institute on Aging in response to the need for interdisciplinary research to bridge the gaps among the brain, behavioral, and clinical sciences. The NIH institutes are interested in developing interdisciplinary training programs to increase the number of scientists capable of studying brain/behavior problems. Creating this new breed of scientists might require rethinking of the training process, including redesigning research training programs and funding mechanisms to support interdisciplinary training, research, and practice.

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Bridging Disciplines in the Brain, Behavioral, and Clinical Sciences In remarks to the committee on Building Bridges in the Brain, Behavioral, and Clinical Sciences at its inaugural meeting, OBSSR Director Anderson indicated that this study is directly related to one of the major goals of his office: to integrate a biobehavioral or interdisciplinary perspective across NIH. He expressed the need for behavioral health researchers who integrate the science in a multilevel approach. At the same meeting, NIMH Director Steven Hyman cited numerous examples where limited interaction among scientists in different disciplines is hindering progress (e.g., mapping behavior onto the brain, understanding the genetic basis of behavior, or relating functional imaging of the brain to clinical phenomena). Hyman indicated that the “old models of training are not providing what we need, and will need, to make the best of new knowledge and technology.” In requesting this study, the sponsors asked the committee to: Examine the needs and strategies for interdisciplinary training in the brain, behavioral, social, and clinical sciences to enhance the translation of brain/behavior to clinical settings and vice versa. Define necessary components of true interdisciplinary training in these areas. Examine the barriers and obstacles to interdisciplinary training and research. Review current educational and training programs to identify elements of model programs that best facilitate interdisciplinary training. The committee had to consider some complex questions. For example, assuming that interdisciplinary health and behavioral research contributes to scientific knowledge, there is still no consensus about the most appropriate strategies for strengthening the capacity of the scientific community to conduct such research. Is it more productive to address the weakness of the knowledge base by strengthening individual disciplines or by encouraging interdisciplinary research? Is there a benefit to be gained by forcing integration, that is, causing fields to work together, or must this occur naturally? To address its charge, the committee began by defining interdisciplinary research as that described in the Interdisciplinary Research section in this chapter. It identified translational research as a subset of interdisciplinary research that translates information between clinical settings and basic research laboratories. Within the context of translational research, clinician-scientists' training was considered as a possible method for producing scientists that can bridge the gap between clinical and basic sciences. The committee gathered information through a workshop, interviews, a review of selected training grants, and a survey of the literature. During the workshop, Opportunities for Interdisciplinary Training (Appendix A), 11 directors of current interdisciplinary educational programs were selected to present their

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Bridging Disciplines in the Brain, Behavioral, and Clinical Sciences training methods and describe barriers they had to overcome. Speakers were invited to two of the four committee meetings to provide additional insight (Appendix A). Interviews and consultations were conducted with representatives of pharmaceutical companies, foundations, government agencies, and academic institutions (Appendix B) and with the directors of 10 NIH institutes (Appendix B). The committee reviewed 137 training programs (Appendix C) identified as interdisciplinary by IOM staff, committee members, or funding agencies; and it analyzed over 250 Requests for Applications (RFAs) or Program Announcements (PAs). It also reviewed such written materials as commentaries, editorials, training program descriptions, and reports from professional organizations. The task of the committee is based on the premise that interdisciplinary research and training are important. The committee obtained the opinion of nine NIH institute directors on the requirement for this approach. The responses unanimously supported the need, although many acknowledged an absence of data to support this belief. With this input, the committee focused on how, rather than if, interdisciplinary research and training should be pursued. The committee broadly interpreted its charge as a request to provide guidance on how to bring together scientists from different fields to explore new frontiers and to train new scientists so they would be prepared to interact with multiple disciplines. While the report focuses on examples from brain and behavioral sciences, the principles that developed from the deliberations should be widely applicable in scientific research. Much of the committee effort was focused on interdisciplinary research and training programs generally and on review of a representative sample of specific programs. In reviewing programs, the committee examined the role of university structures and the availability of training and mentors in influencing change. Changing academic structures and practices to support interdisciplinary research is a long and painstaking process that requires involving and educating academic decision makers, rewarding outstanding interdisciplinary scientists, and attracting excellent behavioral and biological scientists to explore interdisciplinary approaches. To that end, the committee examined means of encouraging interdisciplinary activities and overcoming obstacles. Because evaluations of interdisciplinary training programs are scarce, the committee could not specify the “necessary components” or identify the elements that “best facilitate” interdisciplinary training. Instead, after reviewing existing programs and consulting with experts, the committee identified approaches that were likely to be successful in providing direction for interdisciplinary endeavors at various career stages. The committee is aware of costs that might be incurred in implementing its recommendations. In many instances, it will be a matter of shifting resources; in others, new resources will be needed. Until program plans are established, detailed accounting cannot be developed.

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Bridging Disciplines in the Brain, Behavioral, and Clinical Sciences SCOPE AND STRUCTURE OF THIS REPORT This report presents recommendations regarding the overall need for interdisciplinary scientists in behavioral science and neuroscience, the type and extent of training and funding mechanisms that might be needed to support interdisciplinary training programs and research, and the overcoming of barriers to the development and support of interdisciplinary education, programs, and research. Chapter 2 begins by providing concrete examples of health problems that require an interdisciplinary approach. It provides the context of the rest of the report. Chapter 3 describes the obstacles to interdisciplinary research and training, ranging from personal obstacles to institutional barriers. It recommends approaches to overcome these obstacles. Chapter 4 describes several approaches to interdisciplinary training. It reflects on the programs reviewed by the committee and the lessons learned. It recommends approaches to improving the number and quality of such programs. Chapter 5 brings together the committee's vision of interdisciplinary training and defines the need for future assessments of training programs. REFERENCES 1Anderson NB. 1998. Levels of analysis in health science. Ann NY Acad Sci 840:563–576. 2Azar B. 1998. Federal agencies encourage more cross-disciplinary work. APA Monitor 29[Online]. Available: http://www.apa.org/monitor/may98/cross/html. 3Bruhn JG. 1995. Beyond discipline: Creating a culture for interdisciplinary research . Integr Physiol Behav Sci 30:331–341. 4Burton LM, Dilworth-Anderson P, Bengtson VL. 1991. Theoretical challenges for the twenty-first century. Creating culturally relevant ways of thinking about diversity and aging. Diversity Fall/Winter:67–72. 5Joint Commission on Mental Illness and Health. 1961. Action for Mental Health. New York: Basic Books, Inc. 6Luszki MB. 1958. Interdisciplinary Team Research Methods and Problems. Vol. 3 of the Research Training Series Edition. New York: New York University Press. 7Rosenfield PL. 1992. The potential of transdisciplinary research for sustaining and extending linkages between the health and social sciences. Soc Sci Med 35:1343–1357. 8Schermerhom RA. 1964. Psychiatric Index for Interdisciplinary Research: A Guide to the Literature, 1950–1961. Washington, DC: US Department of Health, Education and Welfare.