I have been fortunate to serve the NIH’s behavioral and social sciences research mission for the past 17 years, and I have been privileged to serve as its Associate Director for Behavioral and Social Sciences Research and Director of OBSSR for the last seven years. As I prepare to step down as OBSSR Director, I thought I’d reflect on some successes (and non-successes) and the challenges ahead.
From my early years camping and hiking as a boy scout, I was taught to “leave a place better than you found it.” With the contributions of many of you, I feel comfortable that I am leaving the NIH behavioral and social sciences better than I found them. As I reflect on my time at NIH, I am reminded how often I have stumbled into amazing opportunities to work with exceptional scientists to advance the behavioral and social sciences at the NIH. I want to highlight a few of these opportunities because they illustrate some of the accomplishments of the behavioral and social sciences at the NIH and beyond and some of the challenges that lie ahead.
One of my first assignments after joining NIH in 2005 was to represent NIMH on a new Roadmap project called PROMIS (Patient-Reported Outcomes Measurement Information System), and I was fortunate to serve as the chief science officer on this project for a number of years. This was the first behaviorally oriented Roadmap (Common Fund) initiative, and it has been highly successful in advancing patient reported outcomes assessment to encourage data integration across studies using modern psychometric theory. Together, we have made considerable progress improving the precision and accuracy of the assessment of social and behavioral phenomena, but we must continue to encourage adoption of improved measurement approaches over the status quo, discourage the proliferation of new measures insufficiently grounded and linked to prior measurement approaches, and increase our commitment to improving the measurement of social and behavioral phenomena. I have quoted Lord Kelvin more than people can likely tolerate, but it is true that “the grandest discoveries of science have been but the rewards of accurate measurement,” and measurement innovation is crucial to new discoveries in the social and behavioral sciences.
I came to NIH with some private sector experience in digital technologies, and I soon became part of a small band of NIH colleagues with a vision of how digital technologies could transform health research, particularly behavioral and social sciences research. Together in those early years, we held meetings to connect researchers with private technology firms, created the mHealth Training Institute, collaborated with the FDA on mobile health guidance, supported mHealth research resources, and generated numerous FOAs to encourage mHealth research. In two short decades, this field has grown from proof-of-concept studies on personal digital assistants (remember Palm Pilots) to being an integral component of most social, behavioral, and clinical research supported by the NIH. More recently, OBSSR and IC partners developed the Intensive Longitudinal Health Behaviors Network (IHLBN), a consortium of health behavior researchers who have leveraged the latest capabilities of real-time sensor technologies and computational modeling approaches to shift our understanding of human behavior from between-person, individual differences perspective to a temporally-dense, within-person perspective. Moving forward, we need to develop the technologies we need, not just the ones we can; continue to subject new digital health technologies to rigorous validation; free proprietary digital data, whether held by the private sector or by the government, to strengthen our population health research; and expand social and behavioral research capacity in digital technologies and in advanced computational approaches. OBSSR’s TADA-BSSR T32 program is one of what I hope are many training efforts to integrate data science into the fiber of what it is to be a behavioral and social scientist.
Soon after becoming OBSSR Acting Director in 2014, I had the opportunity to become involved in the formation of NIH Precision Medicine Initiative (PMI). Now branded as All of Us, this historic program seeks to gather data on over one million people living in the US to make advances in tailoring healthcare to the individual. There have been many other large NIH-wide initiatives including ECHO, ABCD, BRAIN/Blueprint, and HEAL. For these and other large initiatives, OBSSR has worked to ensure that behavioral and social science research priorities are integrated into these NIH-wide projects. The integration of behavioral and social sciences within the NIH biomedical research enterprise has been an OBSSR priority since its inception, and the integration efforts of OBSSR during my tenure as director have reinforced for me the value of the office being proactive in incorporating relevant social and behavioral research questions into each and every research project. In response to Congressional direction, a Council of Councils working group is currently addressing how to integrate better the social and behavioral sciences within the NIH biomedical research enterprise. My hope is that this working group report, to be released in 2022, will provide clear motivation and direction for every NIH initiative to consider during its formation, not as an afterthought, the role of social and behavioral influences on the initiative’s goals.
One role of the OBSSR Director that I did not relish was being a “salesman” for the behavioral and social sciences. The pressing public health and societal issues of recent years, however, made the value of rigorous and impactful social and behavioral sciences an easy sell. Increases in violence, particularly in our urban areas, have disproportionately impacted young black men for whom firearm violence is their leading cause of mortality. After years of inadequately supported research on firearm violence, Congress provided funding specifically for firearm violence prevention research beginning in FY20 ($12.5M in FY20 and FY21, and $25M proposed in appropriation mark-ups for FY22). OBSSR has provided NIH leadership for this important area of behavioral and social sciences research, positioning this research as a public health issue requiring a concerted public health approach.
Violence also was the impetus for the racial and social unrest our country has experienced since the George Floyd murder. This tragic event, however, focused national attention on the structural, systemic, and cultural racism that continues to exist in our society. It has also focused NIH’s attention to this issue, coordinated by its UNITE initiative, to encourage more research on health inequities, eliminate the funding disparities experienced by underrepresented minority researchers, and increase the diversity of NIH’s own workforce. Fortunately, social and behavioral sciences have been studying discrimination, prejudice, and structural racism for over half a century, and the insights from this body of research provide a strong scientific basis for addressing this issue.
And of course, there was the COVID pandemic, the response to which the behavioral and social sciences have had much to contribute. Our mitigation strategies are social and behavioral in nature. The public health frustration over the past two years has been less about what we need to do to reduce transmission and more about how to get people to do it. The impacts of COVID and its mitigation have also been primarily social and behavioral in nature, impacting social relations, work, economic security, and healthcare access. And these impacts have been disproportionately borne by those who already experience health inequities. I feel a particular sense of pride in how rapidly and productively the behavioral and social sciences contributed to controlling the pandemic. At OBSSR, we helped create a COVID Survey Repository available on the DR2 and PhenX platforms, released a NOSI to encourage supplements addressing COVID and funded numerous research supplements, assisted in leading the Social, Behavioral and Economic Impacts of COVID initiative, participated in the development of the RADx-UP initiative, and convened an expert panel that generated a “best practices” report on encouraging vaccination.
As I reflect on how the behavioral and social sciences responded to these public health crises of violence, racism, and the pandemic, a few lessons are evident. First, we must be better prepared with a foundation of prior research that will facilitate an empirically grounded initial response until more targeted research can be performed. We have a strong empirical foundation in the racism area, but less so in the violence and in the respiratory infectious disease management areas, and this has limited having a robust, empirically based initial response to these public health emergencies. Second, although very few people believe that common sense can guide gene-editing or brain surgery procedures, everyone seems to have a common-sense perspective on how to address these societal public health problems. Unfortunately, common sense is flawed by confirmatory and cognitive biases and by the idiosyncrasies of personal experience. We must better communicate the value of a rigorous scientific approach to these problems that embraces the counterfactual and attempts to disprove our commonsense beliefs until shown otherwise by the data. Third, our field cannot be satisfied with understanding these phenomena if we are to make substantial contributions to addressing these problems. We must shift our research priorities from explanation to proactive prediction, preemption, and effective interventions.
In our 2017 OBSSR Strategic Plan, I said that “I cannot imagine a more exciting time than now to be a behavioral and social science researcher.” That sentiment is even stronger now, and I am confident that the next generation of behavioral and social science researchers will advance the field in ways I cannot even imagine. I am grateful to have had the opportunity to represent our sciences over the past seven years. Thank you for your support.