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Integrative Research Infrastructure for Food' Agriculture' and Health During the first panel presentation and discussion session, representatives of institutions with experience in integrative research programs spoke. The panel members were from three universities, a food manufacturer, and a private foundation, and they discussed a variety of programs in their institutions that successfully integrate research and education in traditionally independent fields, such as agriculture, food, and health. They also described recent scientific breakthroughs that have opened up new opportunities in their work, and funding and policy obstacles that hinder progress. MODEL UNIVERSITY PROGRAMS IN FOOD-HEALTH INTEGRATION Programs at the three universities represented on the panel the University of Minnesota, Cornell University, and the University of Maryland modeled some of the ideals espoused throughout the workshop: close collaboration among agricultural, medical, and ecology schools at a land-grant university; a graduate nutrition program that draws on the expertise of 35 faculty in 22 fields at a 23

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24 EXPLORING A VISION private university; and a medical school that makes nutrition education a key component of its curriculum. Role of the Public University It is the role of public universities to provide students with integrated studies on nutrition and health and to collaborate with outside institutions, government agencies, and industry to advance such research, argued Charles Muscoplat, Vice President of Agricultural Policy and Dean of the College of Agricultural, Food, and Environmental Sciences at the University of Minnesota. "The constituents and genes in our food have an intimate relationship with the constituents and genes in our bodies. Similarly, the research in agriculture and food must be integrated with our research on nutrition, treatment, and disease prevention and health," he said, making the case for integrated research and collaboration. Muscoplat added that the University of Minnesota is one of the few land grant research universities that in a single metropolitan location integrates the research strengths of its College of Agricultural, Food, and Environmental Sciences; College of Human Ecology; and the seven colleges within its Academic Health Center, and has a host of programs including partnerships with government and industry that integrate agriculture, nutrition, and health research to promote better public health. Those programs include a research center dedicated to microbial and plant genomics; a biotechnology research alliance with the Mayo Clinic and the state of Minnesota; a carcinogenesis prevention program focused on discovery of naturally occurring and synthetic chemopreventive agents; an obesity center; a center for studying how plants and plant products may be used to improve human health and nutrition; the Hormel Institute, which is recognized worldwide as a center for lipid research; the Center for Spirituality and Healing, which integrates medical and spiritual aspects of care; a partnership with six tribal colleges in Minnesota, North Dakota, and Wisconsin to create culture-specific nutrition-education programs in conjunction with Native American colleges; and collaborative ventures with major food manufacturers and retailers, such as General Mills and Super Value. Colleges of agriculture and affiliated colleges and medical schools should come together to use nutrition as a focal point to enhance curriculum and preparation of students, Muscoplat suggested. They could increase the number of graduates who educate the public in nutrition as a vehicle for the prevention of disease and who work in nutrition therapy, enhance the engagement with underserved constituents, enhance education and nutrition of current students and health-care professionals, and address nutrition issues that affect selected populations, such

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INTEGRATIVE RESEARCH INFRASTRUCTURE 25 as the elderly, Native Americans, new immigrants, and children. Emphasis should be on outreach to the K-12 grade systems, social-service providers, and government leaders, he added, pointing out that there are opportunities for adjusting disease prevention through policies related to school-lunch programs and food-stamp programs, for example. Mullidisciplinary Mode} for Nutrition Education Cornell University has established a multidisciplinary model of studies related to nutrition, according to Cutberto Garza, a Professor in Cornell University's Division of Nutritional Sciences and Director of the United Nations University's Food and Nutrition Program. Cornell has found that the core of nutrition knowledge comes at the interface of several basic disciplines, such as biochemistry, physiology, immunology, genetics, bioinformatics, and cell biology. He stressed that the problem-based rather than discipline-based nature of nutrition requires integration if nutrition is to realize its potential in improving the health of the American public (see Figure 5~. Cornell achieves such integration by bringing together about 35 faculty members in the various disciplines into one academic unit the Division of Nutritional Sciences. Its faculty members belong to more than 20 other fields of graduate study across the university. Students receive training in the core subject of their interest and become well versed in at least two other minor subjects of study (see Figure 3-1~. In the 60 years that the integrative model represented by the Division of Nutritional Sciences and its predecessor, the Graduate School of Nutrition, has been in place at Cornell, it has proved to be successful in achieving integration of the biologic, physical, and social sciences. Garza said that research at the university is similarly integrated, thus attracting funding from diverse sources, including USDA, NIH, and the private sector. He added that research would be further facilitated if USDA truly embraced a much more balanced approach that recognizes food and nutrition in addition to agriculture and if NIH embraced a greater health-promotion agenda, rather than focusing on combating disease. Nutrition Education for Physicians: One Approach The typical student entering medical school has had very little exposure to agriculture, nutrition science, and many of the health-related struggles confronting their future patients. The burden on universities to fill those gaps in their education, said David Mallott, Associate Dean for Medical

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28 EXPLORING A VISION Education at the University of Maryland School of Medicine. Mallott gave several reasons for the gaps. Medical students, like much of American youth, are overwhelmingly suburban and have never been to a farm, except perhaps a pick-your-own facility. Starting in high school, many students gravitate to high- technology, subcellular scientific fields, such as genetics, with little appreciation of the larger ecologic picture into which one might put nutrition and nutrition science. This trend is compounded by the lack of nutrition in the undergraduate curriculum of the average premedical student. Medical students have little awareness of nutrition science, and medical schools begin teaching nutrition often too late to have a significant impact. Moreover, medical students and physicians are generally healthy and have access to good health care and health information, which can make it difficult for them to empathize with patients who do not, he said. It is essential to break down those barriers, Mallott stated. The University of Maryland School of Medicine's approach to nutrition education starts in the first month. As part of the introduction to clinical practice, there are a series of life-cycle-based lectures, supplemented by a series of activities to engage the students, Mallott explained. The curriculum includes a practicum in the first year, in which where each student is given an imaginary budget and asked to go food-shopping for an impoverished inner-city mother and her children. Students later receive "heart-smart cooking classes" and an assignment to spend time at a rural health-education center, where they study the eating habits of patients and their families. The purpose is to get them to see why individual people eat what they do. Noting that the supreme commodity in medical education, and in the medical field itself, is time, Mallott asked the workshop participants to be mindful that whatever integrative function is needed has to be packaged for easy digestion by the medical world. FOOD-HEALTH INTEGRATION IN A PRIVATE ENTERPRISE Eric Gugger, Technical Manager of the Nutrition Science Group at the General Mills' Bell Institute of Health and Nutrition, provided an industry perspective on the types of nutrition-related research sponsored and funded by food companies, sometimes in partnership with universities and other entities. He also explained how consumer interest has led the food manufacturer to use health claims to help market its products. General Mills, one of the largest U.S. food companies, with brands that include Cheerios, Pillsbury, Betty Crocker, and Yoplait, recently has been able to make health an economic driver. Gugger noted that the company uses product packaging to convey messages to consumers about products' potential health

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[NTEGRATIVE RESEARCH INFRASTRUCTURE 29 benefits. The messages are most evident on boxes of cereals like Total and Cheerios, which tout benefits such as lower cholesterol, reduced risk of heart disease, and weight loss benefits that are supported by decades of research and are well understood by consumers, he said. The company also uses press releases and commercials, which give it more flexibility to discuss the results of diet-related studies, as well as handouts, dispensed through dietitians and nurses, with information on how a cereal like Cheerios would fit into the American Heart Association guidelines (see Box 3-1~. General Mills marketing research has determined that consumers respond best to familiar foods or products that are identified as having a recognizable and familiar health benefit. They do not want to pay more for health benefits, however, and are not interested in products targeted specifically to health benefits or that contain additional ingredients that produce health benefits. "Scientific research is the foundation of our health messages," Gugger said, noting that the company relies on published studies in addition to company- funded research. General Mills tends to fund product- or platform-specific research rather than basic research, which is funded when an issue or food product is of particular importance or has an advantage in the marketplace. It also funds clinical trials at universities and through contract research organizations, in-house dietary-intake research, and epidemiologic research, . ~ .................. . ~ ............. ... ..... ............. ,55555 ~ _ .................................................................................................... .................. ... . ~ ...... . in. . . ...... .... . . .. ..... ............... . ..... . ...... a a ~ ....... ..... ..... .......................... ... . . . . . . .. ... ~ . . . . . ................ .............................. .... . . . . . . . . . . . . . . . . . .... . . . . .. . . . . . ..... ..... . . ... . ~ . . . ~ ........................................ . ~ a . ~ .............. ......... ~ . . h ..... .............. . ~ ......................... a . ~ ..... .... . . ~. . . .. .... ....... ....... . . .. ....... ...... 27 The Bell Institute of Health and Nutrition. 2003. Available at ~C:~ [October 2003].

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30 EXPLORING A VISION when related to product or platform. Gugger said General Mills is seeking more research on diet and diet patterns versus specific compounds, on whole foods, and on health outcomes for the consumer that can be conveyed in a positive manner. A MODEL FOR INTEGRATING TWO DISCIPLINES John Linehan, Vice President for Biomedical Engineering Programs at the Whitaker Foundation, described how the private, nonprofit foundation served as a catalyst for the development of a new interdisciplinary field of study biomedical engineering that has since become a major discipline in many colleges and universities and has led to important breakthroughs in the study of genetics. The foundation efforts to promote biomedical engineering served as a springboard for discussion of the integration of such fields as agriculture and public health, and some participants later cited the foundation's achievements and methods as a possible model. The foundation decided in the late 1980s to close down, and therefore began to invest all its funds into the development of the newly emerging field of bioengineering, which incorporated physics, chemistry, mathematics, and biology. The foundation started in 1975 by awarding seed grants to young investigators for initial research to generate preliminary data to be used in developing more traditionally funded research programs through NSF and NIH. Although successful, it was slow in producing results, so the foundation later decided to offer larger competitive development and leadership awards to universities, which had to compete for the funds. Specifically, the universities were asked to propose programs to further biomedical-engineering education. The funding program was set up with the following elements: The foundation required matching funds, but it placed no cap on how much it would invest. It was flexible it avoided prescribing whether the funds had to go toward startup costs, new buildings, or hiring of new faculty. If a proposal included a new building, the foundation would not be the major investor, but would be willing to be the first investor. Universities were required form departments to qualify for some of the major awards. This policy was put in place with the recognition that formalized infrastructure was needed to ensure the sustainability of the . . . . ~n~t~at~ve. According to Linehan, universities viewed the program as a great opportunity, because "this was at the time of the molecular revolution and the computer

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[NTEGRATIVE RESEARCH INFRASTRUCTURE 31 revolution. He imagined them saying, "if we are ever going to do something in an accelerated way, this is the opportunity to do it." Eighty programs applied for the grants, submitting very detailed plans; 15 were involved in extensive follow-up site visits by foundation staff. Bioengineering education and interdisciplinary research and education have flourished as a result of the program, Linehan said. Departments were formed in colleges of engineering, as bridge departments between medical and engineering schools, or with faculty who had joint primary appointments or funding. One example is the 1998 creation of a new biomedical engineering department that bridges Georgia Institute of Technology's College of Engineering and Emory University's School of Medicine; it now has over 20 active faculty members. Linehan emphasized the catalytic role of new technologies that are driving bioengineering, in such fields as cell signaling, functional genomics, and high- throughput phenotyping. He noted that "when the educational programs exist, the young men and women will come, and if they come in sufficient numbers and are of sufficient quality, then the field will be secure in the future." .............................................................. ... .... . ... ~~ 7~ 7~ ......................... ... ... . . . ...... _ .... . . . .. . . ..... .. ..... . . . . ...... ... .... . .......................... .. ...... ... ........ ...... .......... _ ................. . ~ . t _ ........ ......... ............... ....... ... .............. _ .................. _ .............. ........... . ~ c _ .. .... ..~ .... . . ..................... .............................. . . ..... . . . . ...... . .... . . . . . . ...... . . . . ........ . . . . . . . ....................................................................................................... ...................................................................................................... ... $~C ~ en - C_ ......................................................................... . }n .. ......... .......................... . . - . . . . ...... ....... . . A . ...... . . . . . . . . . ... ....... ...................... . . ......... . . . . . . . . . . . . . .......... ...... ~ 0 ................................... . . . . . . . . . ~. . ............ ~ _ ..................................... ....................................................................................................................................................................................... ...................................... . _. ..... .. . . . . . . .................. . _ .. ....................... .. ... . . . ~ . ... ... .. . . . .... ... ....................................................................................................... 28 The Whitaker Foundation. 2003. Biomedical Engineering Educational Summit Meeting. Available at ~ [September 2003].

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32 EXPLORING A VISION OPPORTUNITIES AND OBSTACLES Responding to audience questions, the panelists discussed current and future trends in food and health research, as well as obstacles to progress. Recent breakthroughs in genomics are opening up a new avenue of diet-health researchone that is shifting the focus of health care from intervention to prevention. Muscoplat noted that changes are needed in food and health funding structures to clear the way for interdisciplinary studies and in agricultural policy to support a new paradigm based on benefits to citizens and consumers. Genomics and the Diel-Health Nexus The public-health focus on nutrition and health is expected to increase steadily in the next decades, Garza said. He attributes the likelihood of this increasing emphasis in large part to recent advances in genomics. Public health will move steadily from crisis-driven interventions to increasing emphasis on preventive medicine as scientists understand better how nutrition and other environmental factors affect human health and use that knowledge to target treatment to individuals and groups, Garza said. Preventive therapies that include nutrition strategies will be used increasingly as scientists gain further insight into single- nucleotide polymorphisms, haplotypes, and other epigenetic changes that will help us understand individual and population risks of diet-related diseases. Agricultural Production Policies Agricultural policies have inadvertently resulted in some adverse consequences for the United States, on public health, the ecosystem, world trade, and rural communities. Muscoplat said it is time for the United States to shift to a new agricultural paradigm one based on what is both good for consumers and profitable for farmers. In the future, the "from farm to table" paradigm will be shifted to "from table to farm" what we should eat to be healthy will drive what is produced, instead of production driving consumption. Public Education As a growing field, food and health knowledge is ever-changing, and it is a challenge to keep educators, clinicians, and the public up to date on the latest nutrition and health recommendations. Mallott suggested that educators need to focus more on the process of continuous learning, to understand better how to gather, incorporate, refine, and evaluate knowledge from formal and informal

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[NTEGRATIVE RESEARCH INFRASTRUCTURE 33 sources. Without such knowledge, consumers will not drive the production and development of healthful foods, and physicians will not be able to advise their patients accurately on healthy choices. Muscoplat pointed out that modifying human behavior with regard to diet and health has proved far more challenging than expected taste, convenience, abundance, and price all complicate lifestyle choices. He reminded listeners that low-fat diet recommendations intended to reduce heart disease and other diet- related major diseases were put out 30 years ago, and that rates of obesity have since increased significantly. He questioned whether the cause of that trend is the practices and products of the current food-production system whether science, the marketplace, consumer behavior, and agricultural policy interact to produce unintended, unhealthful consequences. He recommended a global, multidisciplinary, geopolitical perspective to solve this complicated problem. Preventive Medicine Edward P. Richards, Director of the Louisiana State University Law Center Program in Law, Science, and Public Health, reminded panelists of the impact of legal, economic, and insurance issues on American health and its health-care system. As examples, he specifically identified the short-term contractual nature of insurance policies as shaping short-sighted, responsive health-care practices, and the pharmaceutical industry's interest in genomics based on commercial uses rather than therapeutics. Panelists reiterated the importance of those concerns, which perpetuate a curative rather than preventive perspective, and monetize problems and outcomes that should be looked at in terms of sustainability and social benefit. Mallott, speaking as a psychiatrist, included nonrational dietary and lifestyle choices made on non-rational bases and the youth-oriented culture as also playing important roles in a disease-oriented rather than wellness-oriented system. Food Safety One participant felt that foodborne disease presented a key opportunity to focus on preventive measures. The food supply in the United States is one of the safest in the world, but the CDC estimates that each year 5,000 Americans die from foodborne illness, 76 million get sick, and more than 300,000 are hospitalized, some with long-term health consequences.29 Some populations, such as children and the elderly, are especially vulnerable, and discussants felt 29 For more information on food safety, see: http://www.cdc.gov/foodsafety/

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34 EXPLORING A VISION that science has the ability to help lift the burden of food safety from the consumer to the elimination of hazards early in the food system. Disease surveillance and other food-safety efforts have increased as a secondary result of counterterrorism efforts since the 2001 bioterrorism events, but there are still improvements to be made, Mallott felt, in that cases of foodborne disease were still going unrecognized and uncounted. The opportunity to take a broader view of the food system and its vulnerabilities and to strengthen the whole system should not be lost, Garza added. Institutional Coordination Panelists encouraged funding agencies to engage with each other and to designate specific grant opportunities for interdisciplinary research in food and health and suggested that grant review include evaluative criteria for determining the extent of crosscutting science. Cited as an example was the successful experience of the NIH Bioengineering Consortium (BECoN),30 which consists of senior-level representatives of all the NIH institutes, centers, and divisions plus representatives of other federal agencies concerned with biomedical research and development. Linehan directed attendees to a symposium on promoting team research that BECON recently organized.3i Some audience members and panelists suggested that the National Academies had the opportunity to set examples of better integration of agriculture and nutrition. The National Academies' newly launched partnership with the Reck Foundation to push the frontiers of science through a joint program of focused symposia and seed grants may be a useful platform for advancing interdisciplinary food and health research, some participants offered. 30 For more information on BECON, see:http://www.becon.nih.gov/becon.htm 3} The Symposium on Catalyzing Team Science was held on June 23-24, 2003 at the NIH Natcher Conference Center. Its goal was to examine the forces encouraging and discouraging team approaches to biomedical research and to explore how NIH, academe, and others can stimulate and reward team efforts. About 350 attendees participated in the plenary presentations, topical breakout sessions, and case studies of effective team science. A draft summary of the symposium is available at: http://www.becon.nih.gov/symposium2003.htm