Questionnaire

Given the state of the economy, it may not be the best time to oversee a major coordinating research office at the National Institutes of Health. In January, when psychologist Robert Kaplan, PhD, took the helm of the NIH Office of Behavioral and Social Sciences Research (OBSSR), he fully recognized the office’s financial uncertainty, since the institutes’ budgets aren’t likely to grow as the country continues to recover from the recession.

But Kaplan doesn’t see that as an excuse to shy away from advancing a rigorous research agenda. If anything, it’s a promising time for psychological research as NIH’s institutes continue to recognize the importance of behavioral science and interdisciplinary work and are forging new partnerships to accomplish new research goals, despite the down economy, he says.

Kaplan, a health psychologist, has been involved with APA for about 38 years. He is a fellow of several APA divisions, a former president of Div. 38 (Health) and a former editor of Health Psychology. He taught at the University of California campuses in Los Angeles and San Diego for 35 years before leaving to become the OBSSR director. His research career has focused on behavioral medicine, health outcome measurement and improving health services, including serving as principal investigator for both the California Center for Comparative Effectiveness and Outcomes Improvement and the UCLA/RAND CDC Prevention Research Center.

APA CEO Norman B. Anderson, PhD, who served as OBSSR’s first director between 1995 and 2000, talked with Kaplan about OBSSR’s growing role within NIH and his plans for guiding the office through rough economic times and increasing collaboration with other institutes and centers.

What attracted you to working for the federal government?

I’d been working in the academic community almost my entire life. My father was a university professor. I had studied public policy, so I thought this was an opportunity to make a difference from the inside. I had been an NIH grantee for 35 years and during that time I had been a successful grant applicant. but I’d also been unsuccessful. I felt that I had a sense for what it’s like for people in the research community to apply for grants and struggle with the system.

Have you had much interaction with the institute directors yet?

I have, and I’ve found the institute directors very open to what we’re doing. Most of the institutes have a program in behavioral and social sciences. The bigger ones, of course, have the largest programs, but even small institutes have something going on relevant to behavioral and social science.

OBSSR has a $27 million budget — 10 times more than when I started there in 1995. But in terms of NIH scale, the budget is not in great shape. How will OBSSR get the most out of it?

One of the things that people don’t understand about OBSSR is that the most important number is not our budget; it’s the amount that we’re spending on social and behavioral science research throughout the NIH institutes. At OBSSR, we work with the institutes and centers to try to leverage the little money we have into collaborative efforts and other activities across all the institutes. We like to think of ourselves as a broker who brings ideas to the institutes and centers and persuades them to invest more in behavioral and social science research.

The Behavioral and Social Sciences Research Coordinating Committee meets with the directors of the other NIH institutes, identifies areas where behavioral and social science could inform the institutes’ research platforms, and recommends scientific, programmatic and policy collaborations that could be beneficial. For example, OBSSR is working with the National Heart, Lung, and Blood Institute and the National Institute of Child Health and Human Development on the Childhood Obesity Prevention and Treatment Research program to identify effective strategies for curtailing the country’s childhood obesity epidemic.

OBSSR also funds scientists at universities and research centers and helps them to partner with NIH to create interdisciplinary research opportunities. For instance, OBSSR partnered with researchers at the University of Michigan to create the Network on Inequality, Complexity and Health to look at how health disparities originate in populations.

Do you foresee OBSSR’s budget improving anytime soon?

It’s a little too early to say, but it’s very hard to be optimistic right now. We’re working as hard as we can to keep our fair share of the budget. One of the areas worth mentioning is figuring out how to control health-care costs. The liberals argue that the government must control the cost of Medicare and the conservatives say we must control the costs through some kind of private system. The common ground is that we have to control escalating health care costs. Well-trained behavioral and social scientists can make very important contributions toward solving these problems.

Broadly, what would you like to accomplish during your tenure?

NIH has always supported basic sciences such as cell biology, biochemistry and genetics. These serve as the building blocks for biological and medical interventions. Similarly, there is a basic science that underlies behavioral and social interventions. The translation from the basic science to application has not been as well recognized at the NIH as it could be. So we’re very interested in investing in the basic behavioral science piece. To that end, we have created the OppNet program, which is a program that helps coordinate funding and research collaboration to support basic behavioral and social sciences research throughout NIH.

We’re also interested in developing connections between basic behavioral science research and applications in primary-care services. We think this is going to be an important new emphasis for us. For example, we are interested in shared medical decision-making. Patients commonly encounter complicated medical decisions. As patients, we are confronted with very complicated information and choices between alternatives, each of which has risks and benefits. We’re interested in how those cognitive processes work, how people use that information, and how better communication of risks and benefits might help people make informed decisions about their own health.

How does OBSSR choose its research targets?

We look to big public health problems for which we do not have clear research. Preventive medicine offers a good example. The United States Preventive Services Task Force grades preventive services on the basis of the evidence that supports them. An “A” means there are multiple randomized clinical trials that support it, a “B” means it’s supported by clinical trial evidence but not multiple trials, and so on. Counseling services to prevent tobacco use in pregnant women received an “A” grade; screening for obesity in adults received a “B” grade. These grades are important because all services receiving an “A” or “B” grade will be covered under the Affordable Care Act. Services getting “C” or “D” grades will not be covered.

And then there’s a category “I,” which means “insufficient evidence.” There are different pathways to an “I” grade. A service can get an “I” when there are multiple studies that conflict with each other, but one of the most common reasons for an “I” is that no one has done the study. For example, routine screening for dementia received an “I” for insufficient evidence. So we’ve been thinking that we need to invest more in determining whether the “I” services are valuable.

How do you plan to confront the growing demand for and use of new technologies?

We have a whole series of activities that we’re going to be ramping up over the next year looking into the use of modern technology and engineering studies to help improve human health. We have an upcoming conference in San Diego looking into mobile health technologies. We’re partnering with the engineering firm Qualcomm to explore how electronic devices might be used to improve health behaviors, such as by incorporating smart phones into health monitoring or by using mobile sensors to track health conditions and relay that information to physicians.

We’re also working on modernizing medical information and electronic records. In the United Kingdom, for example, about 90 percent of the population shares its medical records electronically. Here in the United States, we’re quite a way behind that but it is ramping up and we’re expecting to see many, many more people have their health information in electronic medical records.

But a big problem is that very little social or behavioral information is collected in electronic medical records. Not only do we need more, but the information that is collected needs to be standardized. Information about tobacco use, alcohol, stress, and depression is not collected in a consistent way. We’re trying to gain some consensus on what questions should be asked and what the core measures should be.

What is the greatest challenge you see in moving forward with your social and behavioral sciences agenda?

We haven’t always translated our research findings to the public very well. For example, if you look at a problem like cardiovascular epidemiology, we know each year 850,000 people have cardiovascular disease events in the United States. Ever since the first results from the Framingham Heart Study were published 50 years ago, we have known that the big risk factors for dying or coronary disease are smoking cigarettes, having diabetes, and having high cholesterol and blood pressure. Big clinical trials have shown us that if you lower blood pressure and lower cholesterol, you lower the chances of death from these problems. But only about a quarter of people in this country who have high blood pressure have it under control, even though we know from numerous studies that just about anyone can achieve normalized blood pressure using appropriate medications. We need ways to translate that information so we can achieve the benefits of population health. Better medications are only part of the answer. The real challenge is behavioral — getting people to use their medications appropriately.

The dominant culture at NIH is biomedicine. What are your thoughts on how to further integrate behavioral and social sciences with biomedical research?

If you look at the big NIH clinical trials, almost all of them have some behavioral and social science component. There are quality-of-life outcome measures, there are methodological issues such as adherences and following protocols, and so forth. I’ve been pleased to see a lot of integration in the sensory sciences. The National Eye Institute and the National Institute on Deafness and Other Communicative Disorders are funding studies quite relevant to psychophysics. There is a lot of psychoneuroimmunology, the interaction between psychological processes and the body’s immune system. It seems like those connections are being made in the grant applications, but we certainly could go much further in establishing these connections.

How can APA help OBSSR achieve its mission?

We are the office of behavioral and social science research, so we have a fairly broad range of activities that span the entire breadth of those sciences. APA members frequently address the kinds of questions we’re asking. What we need most is a steady flow of creative, high-quality science. APA does a great job of stimulating this science and we look forward to continuing applications from APA members. We are also interested in training programs that will create the next generation of new scientists. We appreciate all the consultation that we get from APA, and we look forward to continuing to work together.