The Importance of Basic Behavioral Science to Health

From time to time, APS is asked to comment on various happenings at federal research agencies. This often takes the form of an invitation to APS Executive Director Alan Kraut to make a presentation. Following is a recent example of one such presentation, on an issue that APS has long been advocating – support for basic behavioral science at the National Institutes of Health, particularly at the National Institute of General Medical Sciences (NIGMS).

NIGMS is the only one of 27 NIH Institutes and Centers specifically charged by law with funding non-disease specific research and training, including basic behavioral research and training. The problem is, it doesn’t fund our science.

That troubling situation led us to work with Congress over the past five years where we raised the question: Why doesn’t NIGMS fund basic behavioral science? We raised it in yearly NIH testimony, in presentations to the National Academy of Sciences (NAS), in various informal Congressional office visits, and many times in these very pages. And the question echoed from Congress and NAS, until finally NIH was compelled to convene a NIH workgroup of distinguished behavioral researchers, including two APS Presidents, to take a more careful look at the role of basic behavioral science throughout NIH. Since APS was at the heart of why this committee came about, Kraut was asked to talk to the Committee at their first meeting in April about basic behavior and our concerns. The following is a transcript of his speech:

There are two issues that I want to raise with this NIH Committee today. The first is the importance of behavioral science in health. The other is the need for broader support of basic behavioral research at NIH, particularly the National Institute of General Medical Sciences.

There probably is one overriding NIH “Truth” that all of us here would “hold to be self evident”: In any picture of health, a core finding is that behavior is central to many, maybe to most of our nation’s leading health concerns, such as heart disease, stroke, lung disease, obesity, AIDS, suicide, teen pregnancy, drug abuse, depression, neurological disorders, alcoholism, violence, and accidents. In all of these and more I could have listed, behavior is a critical, if not the critical, factor.

And if we encourage behavioral science, with all the sub- and cross- and inter-disciplinary perspectives that implies, we will be addressing many of the daunting health concerns facing our nation.

I know most of the people in this room are saying, “Of course.” But not so fast. Let me pause for a minute and give my sense about the range of NIH behavioral science – it’s something that divides how we here might think about behavior with how many think in the rest of the world of NIH.

When we talk about behavioral research, we generally don’t just mean applied or clinical research. For all the conditions I just listed, there is a basic science of behavior:

Before you address how to change attitudes and behaviors around AIDS, you need to know how attitudes develop and change in the first place;
Before you can change decisions about any risky behavior, you need to know how judgments and decisions are made on a range of topics;
Before you address memory decline in the elderly, you need to know the basics of learning and memory and how that changes with age;
And before you address the complexity of the interactions among genetics, the brain, and, say, schizophrenia, you need to know the basics of cognition, emotion, culture, you need to know behavioral and cognitive neuroscience, and behavioral genetics.

I believe you all would agree with me, but I can’t tell you how hard it has been to convey the importance of basic behavioral science in any sophisticated sense to high-ranking non-behavioral administrators at NIH. Not to simplify too much, but when NIH higher-ups think of behavioral research, with few exceptions, they think of applications, such as the following:

A vaccine is ready and now the behavioral question is how to convince parents to bring their children in for inoculation. But, just as the development of that vaccine was built on basic research in virology and molecular and cellular biology, a persuasive message to parents builds on basic research in cognitive, developmental, and social psychology.

The same is true for questions such as: How do you get TB patients to stay on their course of treatment? What are the behavioral aspects of controlling blood pressure? How are minorities disadvantaged in access to health care? Or, even more cross-disciplinary questions like, what about combined behavioral and pharmacological treatments for depression or anxiety disorders? Or, more generally, what do we need to know about basic behavior, biology, and their interaction to better understand Alzheimer’s, or diabetes, or deafness, or SIDS, or learning disabilities, or addiction, or any of the hundreds of disorders NIH studies?

Let me make this NIH disconnect between basic behavioral science and health even more concrete. Cognitive psychologist Danny Kahneman of Princeton University was awarded one of last year’s Nobel Prizes. His research on judgment and decision-making has enormous implications for health. Some of his and Amos Tversky’s early work even focused on judgments of pain in medical procedures, but their work also has straightforward implications for assessing how people see their own health risks, implications for patient compliance, for deciding when to see a physician, or for how physicians make diagnoses.

Or, on an even more direct clinical course, when I talk to parents of those with schizophrenia, they often tell me that among the many serious problems their adult children have, one of the most troubling is that they just plain make bad decisions – on everything from whether to take their medications; to not telling the truth about their symptoms; to self-medicating with illegal drugs and alcohol.

To me, this all means that basic research on judgment and decision-making should have been encouraged at NIH all along. But Kahneman and Tversky’s collaborations never were funded by NIH. And current NIH higher ups have told me they still don’t think this kind of basic work is so relevant – that, of course, they say, one could make the case that any behavioral approach might have health links, but that potential links alone shouldn’t make for an NIH priority.

I maintain that such a view would never occur in any other area of non-behavioral research that is so directly related to health. Okay, end of rant about the range of behavioral science being a dividing line, except to say that we are seeing more and more pressure on NIH to do less and less basic behavioral science. And that’s where this NIH lack of understanding, or this narrow view of relevance, or whatever you want to call it comes into play.

Without people who appreciate the range of behavioral science in leadership positions within NIH institutes and centers, then behavioral science isn’t at the table when the big decisions get made. And there is no doubt in my mind that this appreciation is sorely lacking at many institutes.

Advisory groups such as yours become even more important under these circumstances.

I know that at least two of you – Richard Davidson from the University of Wisconsin, and James Jackson from the University of Michigan – also are part of a committee formed by the National Institute of Mental Health (NIMH) to address basic science there – both behavioral and biological. That committee is preparing recommendations for a May presentation at the NIMH advisory council. Right now, I would have to say that the NIMH director is determined to move the Institute away from its level of basic science and toward more clinical research. I think within that decision, basic behavioral science is even more vulnerable.

You see, NIMH today is the single largest funder of basic behavioral science in the federal government, and that mission, one that probably we take for granted these days, is something we wouldn’t want to see cast aside so easily.

BASIC BEHAVIORAL SCIENCE AT NON-TRADITIONAL NIH INSTITUTES
And that brings me to my second point: Other NIH institutes need to step up in their support of basic behavioral science – not just to make up for whatever reductions are coming in NIMH – but because basic behavioral science is their responsibility, as well. And that goes to the core of why this committee was formed.

You know that NIH funds more than $28 billion in health research a year. That’s a lot of money!

And over the years, behavioral science has done pretty well with some of that money. This chart shows roughly how much NIH says each Institute spends on behavior – at least how much they spent in 2001.
Aging $194.8
Alcohol Abuse and Alcoholism $163.7
Allergy and Infectious Diseases $30.0
Arthritis and Muscloskeletal and Skin $17.3
Biomedical Imaging and Bioengineering $0.0
Cancer $238.2
Child Health and Human Development $222.1
Complementary and Alternative Medicine $0.0
Deafness and Other Communication $71.0
Dental and Craniofacial Research $22.8
Diabetes and Digestive and Kidney $38.0
Drug Abuse $342.8
Environmental Health Sciences $9.5
Eye $49.2
General Medical Sciences $0.0
Heart, Lung, and Blood $113.5
Human Genome Research $10.7
John E. Fogarty International Center $5.0
Library of Medicine $1.3
Mental Health $358.7
Minority Health and Health Disparities $1.5
Neurological Disorders and Stroke $55.7
Nursing Research $85.6
Office of the Director $21.0
Research Resources $48.1
Behavior and social science research by NIH Institute. The figures, in millions, represent the latest count, which took place in 2001.

Now, this is not all for basic behavioral science, but for behavior writ large. But notice the amount of support listed for NIGMS – the National Institute of General Medical Sciences – $0.0. My view is that this is the issue that is behind the creation of your committee.

You see, NIGMS is known as the basic science institute of NIH. Consider this statistic: About 40 percent of all NIH predocs on training grants are supported by NIGMS. 40 percent! That is an enormous amount of NIH’s basic science training, and I have been making the case here that an enormous amount of important behavioral science related to health is basic.

But, I can’t tell you why it is that a $1.9 billion institute that supports only basic science supports no behavioral science. I am more perplexed when I read the NIGMS legislative mandate:

“The general purpose of NIGMS is the conduct and support of research [and] training … with respect to general or basic medical sciences and related natural or behavioral sciences …” (US Code Title 42 Chapter 6a Subchapter III Part C subpart 11 Sec. 285k.)

In fact, NIGMS once did have a tradition of supporting behavioral science and training. And with that in mind, we began raising the issue of NIGMS again supporting behavior in our Congressional and federal agency visits. The result has been that Congress got interested.

In every year since 1999, both houses of Congress have addressed this issue as part of the annual NIH budget process, with the Senate constantly encouraging NIGMS to support behavioral research as part of its mandate to support basic research; and the House not only linking NIGMS and behavioral research and training, but also encouraging the Institute to consult with the science community and other institutes to identify priority areas in behavioral science.

A high point of Congressional action came just this past year when three senior Senators – Senator Daniel Inouye, D-HI, a longtime supporter of behavioral science; Senator Arlen Specter, R-PA, the Appropriations Chairman for all of NIH, and probably the key NIH person in all of Congress these days; and Senator Tom Harkin, D-IA, the highest ranking Democrat on NIH Appropriations – had a conversation about basic behavioral science at NIGMS in the debate on NIH in the US Senate.

And this was all interspersed with a series of letters sent to NIH by Representative Patrick Kennedy, D-RI, of the House NIH Appropriations Committee, encouraging support for basic behavioral research, something that the then new Director of NIH Elias Zerhouni seemed to be much more accepting of than past administrators.

Rep. Kennedy followed up by requesting a meeting with NIH to talk specifically about basic behavioral science at NIGMS, and he convinced his colleague Rep. Brian Baird, D-WA, one of only a few psychologists on the Hill, to join in this meeting.

It was at that Congressional meeting that NIH Deputy Director Raynard Kington reported that NIH would convene your committee to conduct a study on the role of basic behavioral science at all the NIH institutes.

Kennedy and Baird agreed to your workgroup being formed. But they also wrote back, saying that, study or no study, at the end of the day, it was going to be difficult to convince them that the National Institute of General Medical Sciences should not be following their own law.

In fact, Reps. Baird and Kennedy are so interested in behavior at NIGMS, that they even offered to introduce legislation on it, something that for now they are willing to wait on for a bit, particularly for this committee’s report. So, I know they are anxious to see your results.

I see this all as good news. I hope you do, too. If I didn’t believe in the importance of psychological science, I wouldn’t be in this business. I am sure you feel the same way about your discipline. And the more our disciplines are showcased, as I know they will be in your report, the more evident to others our collectively felt “Truth” will be.

Other news that should be encouraging to this committee is that APA’s Norman Anderson and I recently met with then-new NIGMS Director Jeremy Berg and he presented us with a refreshingly changed view about NIGMS and behavior. Certainly, there were many caveats about budget and levels of behavioral expertise within the Institute, but Berg also presented us with a knowledge about behavior at both a basic and applied level.

My point in presenting this context and background is to highlight just how important your work over the next months is going to be viewed – not only from within the social and behavioral science community, but outside it as well.

There is support for us in the highest reaches of Congress and, potentially, a more welcoming posture for behavior by the NIH Director and at other NIH institutes, like NIGMS.

Yes, it’s true that there still are not enough behavioral colleagues at decision-making positions within NIH, and there are always going to be those that attack our science, but that makes your work all the more important. I wish you good luck.

NIH Basic Behavior Advisory Committee
Linda J. Waite (chair)
Richard Axel
Maja Bucan
Laura L. Carstensen
Richard J. Davidson
Susan T. Fiske
William T. Greenough
Frances Degan Horowitz
James S. Jackson
Robert W. Levenson
Bruce S. McEwan
Jane Menken
James P. Smith
David Takeuchi