the resources are to go obviously requires a resetting, if you will, of the thermostat.”

Another needed balance is between reductionism and integration. “The 20th century was, and maybe the first decade of the 21st century will be, a continuation of the biomedical reductionist approach,” he said. “But biomedicine is already beginning to turn the corner. Once you start talking about gene products, protein structure, the structure of cells, the structure of organs, the mind in terms of neuroscience, you will see serious integration beginning to take place.”

There are some synergisms here that we should take advantage of, Dr. Shine said. “Those in public health need to piggyback to some extent on what happens in biomedicine and the health care delivery system, and those in biomedicine and the health care delivery system need to work with colleagues in public health, and not make this an either-or kind of a proposition.”

But with regard to another trade-off mentioned at this symposium—of advocacy versus science—Dr. Shine urged researchers to stick with science. “An enormous problem in the entire field of the social and behavioral sciences arises from the notion that we mix everything into it—poverty, income redistribution, all kinds of stuff that has political connotations,” he said. “But the best way we can address these kinds of problems is by doing the very best science—objective, well-placed, evidence-based science.” Providing such solid analysis will in the long run be far more persuasive to the media, the public, and its leaders, he insisted, than when researchers complicate matters by inserting themselves into the political process.

Mixing beliefs with facts can cause complications even closer to home. The six NRC and IOM studies we have talked about today were not easy to do, Dr. Shine noted. In fact, he considered them to be among the hardest studies he has been involved with during his nine and a half years at IOM. “As I look back at why they were hard, it wasn’t because the data were not sufficient,” he said, “but because many of the people on our committees—and God bless all of them, 104 plus the chairs; they did a splendid job—came with belief systems that may or may not have been based on data.”

Referring to his point about language at the beginning of these remarks, Dr. Shine concluded, “It is very important that we enhance our understanding of each other, and that in our deliberations we work very hard to look at the data.”



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