Presentation on theme: "Strategic Directions for the Office of Behavioral and Social Sciences Research Robert M. Kaplan 2012 Summer Institute on Social and Behavioral Intervention."— Presentation transcript:
Strategic Directions for the Office of Behavioral and Social Sciences Research Robert M. Kaplan 2012 Summer Institute on Social and Behavioral Intervention Research Columbia 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?
fundamental knowledge application of that knowledge “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
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.
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.. LUCAS microscope Photos from Karin Nielsen and Aydogan Ozcan Computer software automatically interprets images at remote site Cell phone transmits image Karin Nielsen, UCLA, FIC, R24TW008811 A. OZCAN, 1R21EB009222-01 LUCAS- Mobile Microscope Problem: 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 2 Behavioral and Social Science in an Evolving Health Care System
The Evolving Health Care System The 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, 2012 Breslow, 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
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 0 196019701980199020002005 Heart Disease Cancer Stroke Accidental Injuries Alzheimer’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
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
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