Strategic Directions for the Office of Behavioral and Social Sciences Research Robert M. Kaplan 2012 Summer Institute on Social and Behavioral Intervention.

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 27 Institutes and Centers, many offices and programs…..

Small Subset of NHLBI Logos

No wonder the pubic is confused

• 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

THEME 2Behavioral and Social Science in an Evolving Health Care System

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.

U.S. Coronary Bypass Rates

Theme 3: Advancing Translational Science (Primary Care)

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

Training Programs and Meetings

What do we want: When do we want it?

THANK YOU.

Questions and Suggestions?

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