"There is a need for the field to change the way we envision the future," said NIH director Dr. Elias Zerhouni in opening remarks. "Science must reduce problems to their constituent elements and use valid measures, but this is not always possible. We do not know how all systems work. Yet a systems approach on what will make change is the core challenge of this office. Behavior is an emerging property from subsystems of which we do not have a deep understanding."

As part of the Office of the Director, OBSSR is charged with increasing the scope of and support for behavioral and social sciences research across all of NIH. Officially opened on July 1, 1995, it was established

OBSSR’s Dr. David Abrams

by Congress in recognition of the key role that behavioral and social factors often play in illness and health.

"Health care has to change," Zerhouni stressed. "Health care is not sustainable. No single discipline has the answers. We need to change our philosophical and conceptual model of what health care is. The 5,000-year-old relationship between patient and doctor is changing before our eyes."

New solutions are needed, he declared. "When you look at the next 25 years and you look at every prediction, clearly we are on a path to a collision. Health care as we know it is not sustainable."

A systems approach is required. The key, Zerhouni said, "is we need a new vision of how medicine and health will evolve — predictive, personalized, pre-emptive and participatory medicine." He added, "It's hard to see how the NIH will succeed without participation from patients, their communities, their political environment, their behavioral change factors and their social environment. If we do not understand that [medicine] needs a comprehensive, interdisciplinary solution, we will fail."

When we study the roots of disease and disability, Zerhouni observed, we often find them in personal behavior or socioeconomic and human-created environmental influences. Both domains are addressed by behavioral and social sciences research, which he lauded for its clear impact on public health. He offered two examples: the recent drop in cancer rates, largely due to decreased tobacco use in males, and the benefits of diet and exercise — more effective than drug therapy — in preventing the onset of type 2 diabetes. Ten percent of the NIH budget is invested in social and behavioral science, he noted.

Dr. Norman Anderson, founding OBSSR director, and Dr. Raynard Kington, NIH deputy director and former OBSSR director, offered background history and beginnings of the office and outlined its role at NIH.

Kington pointed out one challenge related to the rigor of measurement of behavioral and social causal factors and outcomes. He said there is "even bias in the language of how these challenges are described by those outside of the fields." The same types of problems in measurement in the biomedical sciences are referred to "as challenging and complex" but when they occur in the behavioral and social sciences, they are often referred to as "fuzzy and poorly defined."

In spite of his criticism of both the biomedical community and its continued pockets of resistance to acceptance of behavioral and social sciences as essential to the NIH mission, and the social and behavioral sciences for their pockets of resistance to self-criticism and self-correction, Kington sees great opportunities for OBSSR in helping NIH achieve the four Ps described by Zerhouni.

Kington also sees the need for more scientists adequately cross-trained to bridge the behavioral, social and biomedical sciences. "There is no area with greater need than the area of gene-environment interaction where there are enormous possibilities for new areas of research," he said.

Anderson recalled that he was often asked "why is such an office (OBSSR) here?" He reminded listeners that, when he headed the office, he was fond of paraphrasing the late President John F. Kennedy: Ask not what NIH can do for behavioral and social sciences research; ask what social and behavioral sciences research can do for NIH.

As special assistant to the OBSSR director, Dr. Ronald Abeles fosters behavioral and social research across NIH.

"Scientific advances could be accelerated by greater attention to behavioral and social sciences factors and their interactions with biomedical variables — many of the same things Dr. Zerhouni spoke about," Anderson explained. He offered three justifications for increased attention: behavioral and social factors are major contributors to health and illness; behavioral and social factors represent important avenues for diagnosis, treatment and prevention; and by focusing more on behavioral and social factors, NIH would be more effective in fulfilling its mission.

Abrams proposed a new conceptual synthesis for understanding patterns of population health and disease, a model that is "interactive and dynamic. The key conceptual integration for the future of our science," he suggested, is that "the dominant and successful biomedical models on the one hand and the strong socio-ecological models of public health on the other hand are really two sides of the same coin." A full conceptual integration of these two powerful 20th century paradigms is now emerging, he said. "This represents an extraordinary opportunity.Behavior is the bridge between biology and society. You have to see behavior as a bridge. You can't get under it or around it. You have to cross it."

Abrams noted that research has saved millions of lives and billions of dollars through preventing, reducing or treating tobacco use behavior, HIV/AIDS, cardiovascular disease, cancers, addictions and mental illness, and giving us the tools to tackle the rising epidemic of obesity and diabetes. "NIH used prevention and reduction of risky behavior to improve the nation's health and well-being. But there is still much work to be done."

Over the anniversary's 2 days in Bldg. 45, there were nearly 500 attendees, including 30 speakers, one of whom was 2002 Nobel laureate Dr. Daniel Kahneman. He said NIH "is primarily a bench science institution. How can we change the institutes and centers and the study sections? How can we influence the agency? Our job is not done until solutions are disseminated and health improves."

"This is a conference that is bringing in seminal work from researchers in diverse groups," said NCI's Audie Atienza, "and promoting partnerships among them."

The focus of the final plenary session was a town-hall style meeting on OBSSR's strategic prospectus to guide future priorities for research funding. The moderator, Dr. Allan Best, called for and received dozens of suggestions from the audience, from the creation of a primary health care prevention system, to a call for strong basic science, to more partnerships with business, the community and the public.

Abrams concluded by saying the vision of OBSSR is to mobilize the biomedical, behavioral, social science and population science research communities as partners to solve the most pressing health challenges faced by our society.

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