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Bridging Disciplines in the Brain, Behavioral, and Clinical Sciences Bridging Disciplines in the Brain, Behavioral, and Clinical Sciences Terry C. Pellmar and Leon Eisenberg, Editors Committee on Building Bridges in the Brain, Behavioral, and Clinical Sciences Division of Neuroscience and Behavioral Health INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C.
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Bridging Disciplines in the Brain, Behavioral, and Clinical Sciences NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, DC 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. This project was supported by Task Order No. 52, under Contract No. N01-OD-4-2139 from the National Institutes of Health. International Standard Book Number 0-309-07078-3 Additional copies of this report are available from the National Academy Press , 2101 Constitution Avenue, N.W., Washington, DC 20418; call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area), or visit the NAP on-line bookstore at www.nap.edu. The full text of this report is available on line at: www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2000 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.
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Bridging Disciplines in the Brain, Behavioral, and Clinical Sciences “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe INSTITUTE OF MEDICINE Shaping the Future for Health
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Bridging Disciplines in the Brain, Behavioral, and Clinical Sciences THE NATIONAL ACADEMIES National Academy of Sciences National Academy of Engineering Institute of Medicine National Research Council The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. William A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. William A. Wulf are chairman and vice chairman, respectively, of the National Research Council.
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Bridging Disciplines in the Brain, Behavioral, and Clinical Sciences COMMITTEE ON BUILDING BRIDGES IN THE BRAIN, BEHAVIORAL, AND CLINICAL SCIENCES LEON EISENBERG, M.D. (Chair), Harvard Medical School RICHARD F. THOMPSON, PH.D. (Vice-Chair), University of Southern California GAURDIA BANISTER, PH.D., R.N, C.A.C., Seton House at Providence Hospital (until 9/99) MICHAEL V. L. BENNETT, D. PHIL., Albert Einstein College of Medicine LINDA M. BURTON, PH.D., The Pennsylvania State University DEBORAH J. COTTON, M.D., M.P.H., Boston University School of Medicine SID GILMAN, M.D., University of Michigan Medical School ROBERT J. HAGGERTY, M.D., University of Rochester School of Medicine THOMAS R. INSEL, M.D., Emory University GLORIA L. KRAHN, PH.D., M.P.H., Oregon Health Services University (after 9/99) PETER R. MACLEISH, PH.D., Morehouse School of Medicine PAMELA H. MITCHELL, PH.D., R.N., University of Washington, School of Nursing RICHARD D. TODD, PH.D., M.D., Washington University, School of Medicine MYRNA M. WEISSMAN, PH.D., College of Physicians and Surgeons of Columbia University Board on Neuroscience and Behavioral Health Liaison ELLEN FRANK, H.D., University of Pittsburgh School of Medicine Study Staff TERRY C. PELLMAR, PH.D., Study Director DEBORAH YARNELL, Research Associate AMELIA MATHIS, Project Assistant LINDA V. LEONARD, Administrative Assistant NORMAN GROSSBLATT, Manuscript Editor CARLOS GABRIEL, Financial Associate
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Bridging Disciplines in the Brain, Behavioral, and Clinical Sciences BOARD ON NEUROSCIENCE AND BEHAVIORAL HEALTH JOSEPH T. COYLE, M.D. (Chair) Harvard Medical School ELLEN FRANK, PH.D. (Vice-Chair), University of Pittsburgh School of Medicine RICHARD J. BONNIE, L.L.B., University of Virginia School of Law WILLIAM E. BUNNEY, M.D., University of California at Irvine MARGARET A. CHESNEY, PH.D., University of California at San Francisco School of Medicine RICHARD G. FRANK, PH.D., Harvard Medical School ANNM. GRAYBIEL, PH.D., Massachusetts Institute of Technology BEATRIX A. HAMBURG, M.D., Cornell University Medical College BEVERLY B. LONG, M.S., M.P.H., World Federation for Mental Health, Atlanta, Georgia KATHLEEN R. MERIKANGAS, PH.D., Yale University STEVEN M. MIRIN, M.D., American Psychiatric Association, Washington, D.C. STEVEN M. PAUL, M.D., Lilly Research Laboratories, Indianapolis, Indiana RHONDA J. ROBINSON-BEALE, M.D., Blue Cross/Blue Shield of Michigan, Southfield STANLEY J. WATSON, M.D., PH.D., University of Michigan STEPHEN WAXMAN, M.D., PH.D., Yale Medical School KENNETH B. WELLS, M.D., M.P.H., Neuropsychiatric Institute, University of California at Los Angeles NANCY S. WEXLER, PH.D., Columbia University ANNE B. YOUNG, M.D., PH.D., Massachusetts General Hospital, Boston Staff TERRY C. PELLMAR, PH.D., Director CAROLE A. CHRVALA, M.A., PH.D., Senior Program Officer JANET E. JOY, PH.D., Senior Program Officer DEBORAH O. YARNELL, Research Associate JOHN A. ROCKWELL , Research Assistant ALLISON L. FRIEDMAN , Research Assistant LINDA V. LEONARD, Administrative Assistant AMELIA B. MATHIS , Project Assistant/Senior Secretary WENDY BLANPIED , Project Assistant
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Bridging Disciplines in the Brain, Behavioral, and Clinical Sciences Preface As never before, behavioral and neurological diseases are moving to the forefront of public health concerns; witness the Surgeon General 's Report on Mental Health. Many of the leading causes of morbidity and mortality in the United States are recognized as having major social and behavioral determinants. Psychological stress has been linked to many health outcomes; researchers and public health officials are becoming increasingly interested in unraveling the mechanisms behind this relationship. Sociologists have identified changes in the age, ethnic, racial, and cultural makeup of the American population, changes that have an impact on biological, psychological, and social processes. As scientists and health care providers examine the intricate interplay among genes, environments, behaviors, and diseases, health problems newly emerging, as well as those that have plagued us over time, present complex challenges for research. The biomedical advances of the past decades have dramatically increased our understanding of the links between behavioral and neural processes and disease. These advances make it clear that fuller understanding demands the integration of knowledge and concepts from multiple disciplines. To make that understanding possible, we must create an environment to promote interdisciplinary research and training. Although its importance has been stressed many times in the past decades, there is now a groundswell of support for interdisciplinary research. Universities, funding agencies, and groups of investigators are looking for ways to make it occur. New research centers are being created with the specific goal of promoting interactions among the disciplines.
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Bridging Disciplines in the Brain, Behavioral, and Clinical Sciences Peer review at NIH has been recently revamped, in part to facilitate interdisciplinary research. Nonetheless, obstacles persist. This Committee was charged with examining the need for interdisciplinary research and training, identifying the obstacles that stand in the way, and defining the components of training necessary to create scientists able to bridge disciplines in the brain, behavioral, and clinical sciences. The committee includes members with expertise ranging from sociology to neurophysiology, from basic science to the clinic, from investigators with a single discipline to leaders of broad interdisciplinary programs. We met four times. At our first meeting, we heard from the Directors of the National Institute of Mental Health and the Office of Behavior and Social Science Research. They described their goal of developing scientists able to bring an integrated approach to the health problems facing today's society. NIH and NSF program officers described the mechanisms currently available to fund training programs. At the workshop we convened, university and industry program directors described their existing training programs and the obstacles they encounter. We discussed potential solutions with an invited panel of scientists and university administrators. The directors of several NIH institutes were invited to comment on whether and why they felt interdisciplinary research and training were necessary. There was a clear consensus that such is an appropriate direction for today 's science, but the evidence on the best way to proceed is limited. IOM staff read through dozens of funded grant proposals, reviewed program descriptions and brochures, and talked with program directors to learn the scope of the mechanisms currently in use. They reviewed hundreds of requests for applications to identify the interests and opportunities of the funding agencies. Early in our deliberations we agreed that that interdisciplinary research itself is not the goal; rather the need for it emerges from research questions. Some problems are best tackled with the methods and concepts of a single discipline; others require integration across disciplines. It is important to define the issues appropriate for interdisciplinary techniques and to carefully consider the disciplines that should be involved in developing the solutions. Examples of interdisciplinary efforts are diverse. They include the collaboration of investigators working together on a difficult problem, the stimulation of thought and direction that occurs with facilitated interactions, the translation of clinical and basic science findings through exchanges between clinicians and researchers. Because definitions of interdisciplinary research are so varied, identifying interdisciplinary publications, grants, training, and research proved to be extremely challenging. Furthermore, data on the successes (or failures) of existing funding mechanisms are limited. Without outcome data, we cannot assert definitively what are the “best” or the “necessary” approaches to encourage interdisciplinary training. For future evaluations, this gap needs to be filled. It will not be easy to develop mechanisms to track training outcomes, but to do so is essential and merits a major investment of effort.
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Bridging Disciplines in the Brain, Behavioral, and Clinical Sciences Training in existing single disciplines should be broadened so that all graduates become aware of the ideas and methods at the borderlines of their own fields. On the one hand, basic scientists should be introduced to the scope of clinical problems; clinical investigators should be kept abreast of laboratory research. The aim is to create “informed consumers,” able to understand other disciplines and to recognize ideas applicable to their own work. The many obstacles that discourage interdisciplinary efforts are summarized in our report. The point we emphasize here is that they can be surmounted with the support of universities and funding agencies. With appropriate incentives, trainees can be encouraged to broaden their horizons. Not all those trained with an interdisciplinary perspective will do interdisciplinary research, but the education they receive should provide the capacity to integrate information from other disciplines when, and as, it becomes appropriate over a lifetime in research. Funding agencies can deploy the large variety of mechanisms available to them to promote interdisciplinary training in order to overcome obstacles and enhance research. Because interdisciplinary research is flourishing at many universities, some might feel that additional attention is unnecessary. We believe that despite this activity, there is a need to set directions, facilitate training, and evaluate the programs. We view our recommendations as guidelines to enhance training opportunities for all scientists and allow them to participate in interdisciplinary efforts to solve today's complex health problems. Leon Eisenberg Chair
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Bridging Disciplines in the Brain, Behavioral, and Clinical Sciences Acknowledgments The committee wishes to thank the many people who contributed to this report. Terry Pellmar, as Study Director, made the work of this Committee possible by her intellectual clarity, her resourcefulness in identifying and providing background materials, and her diligence in keeping us on task. Deborah Yarnell's assistance as research associate was exceptional. She was tireless in tracking down information, identifying programs, and obtaining interviews. Her insights and her dedication were much appreciated. Amelia Mathis took wonderful care of the committee, handling their travel and meals and all the meeting logistics. Wendy Blanpied was invaluable in her program support, especially for the workshop. We also thank Linda Leonard for administrative assistance, Kathi Hanna for consultation and writing, Carlos Gabriel for financial accounting, Claudia Carl for guiding the report through review, Norman Grossblatt for expert editing, Susan Fourt for help with library resources, and Linda Kilroy for contract support. Clyde Behney provided valuable guidance throughout the study process. Many other individuals from government, private industry, foundations, and academia provided expert consultation and are acknowledged in Appendix B. REVIEWERS This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council's Report Review Committee. The purpose of this independent review is to provide candid and critical comments that
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Bridging Disciplines in the Brain, Behavioral, and Clinical Sciences will assist the institution in making the published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their participation in the review of this report: Boris Astrachan, University of Illinois; Jack D. Barchas, Weill Medical College of Cornell University and Weill Cornell Medical Center; Samuel H. Barondes, University of California at San Francisco; Michael Gazzaniga, Dartmouth College; Zach W. Hall, University of California at San Francisco; Robert Langer, Massachusetts Institute of Technology; Joe L. Martinez, Jr., The University of Texas at San Antonio; and Anne Petersen, W. K. Kellogg Foundation. While the individuals listed above have provided constructive comments and suggestions, it must be emphasized that responsibility for the final content of this report rests entirely with the Committee on Building Bridges in the Brain, Behavioral, and Clinical Sciences and the Institute of Medicine.
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Bridging Disciplines in the Brain, Behavioral, and Clinical Sciences Contents EXECUTIVE SUMMARY 1 1 INTRODUCTION 15 Interdisciplinary Research, 16 Interdisciplinary Training, 17 Translation Research, 17 Interdisciplinary Research in the Brain, Behavioral, and Clinical Sciences, 18 Committee Process, 19 Scope and Structure of This Report, 22 2 THE POTENTIAL OF INTERDISCIPLINARY RESEARCH TO SOLVE PROBLEMS IN THE BRAIN, BEHAVIORAL, AND CLINICAL SCIENCES 23 Neuroscience: Evolution of a Discipline, 24 Disciplinary Work Provides a Foundation, 24 Translational Research: To the Clinic and Back Again, 26 The Story of Patient HM, 26 Interdisciplinary Research: Making Progress, 27 Interdisciplinary Research: Future Directions, 29 Effective Funding Initiatives in Interdisciplinary Research, 31 PET Centers, 33 Findings and Recommendations, 33
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Bridging Disciplines in the Brain, Behavioral, and Clinical Sciences 3 BARRIERS TO INTERDISCIPLINARY RESEARCH AND TRAINING 41 Attitudinal Barriers, 41 Communication Barriers, 42 Academic and Professional Barriers, 45 Funding Barriers, 47 Career Barriers, 49 Findings and Recommendations, 53 4 INTERDISCIPLINARY TRAINING PROGRAMS 58 Undergraduate Programs, 59 Predoctoral and Postdoctoral Training, 59 Early Career Opportunities, 73 Midcareer Education, 73 Interdisciplinary Training for Underrepresented Populations, 80 Collaborations Among Funding Agencies, 86 Findings and Recommendations, 89 5 THE FUTURE OF INTERDISCIPLINARY RESEARCH AND TRAINING 99 Innovative Approaches and Opportunities, 100 Evaluation, 101 A Vision of Interdisciplinary Training, 105 Findings and Recommendation, 107 APPENDIXES A Meeting and Workshop Agendas, 109 B Interviews and Consultations, 114 C Reviewed Training Programs, 117 D Select National Institutes of Health Mechanisms for Training and Research Support, 127