interdisciplinary research case studies from health and social science

Interdisciplinary Research: Case Studies from Health and Social Science

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This newly updated and revised 2008 edition of Interdisciplinary Research is a practical guide to the most effective avenues for collaborative and integrative research in the social, behavioral, and bio-medical sciences. This book provides answers directly from researchers who have carried out successful interdisciplinary programs. The editors give a concise account of the lessons that can be taken from the book, and then present a series of case studies that reveal the most successful interdisciplinary research programs. Each of the chapter authors has carried out innovative, collaborative programs, and all give compelling accounts of the benefits of interdisciplinary research and the central strategies required to achieve them. Buy from Amazon

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• PART I: HOME IS WHERE THE HEART IS: THE SOCIAL WORLD AND CARDIOVASCULAR HEALTH AND DISEASE
• 1. Domain Introduction
• 2. A Contemporary Perspective on Multilevel Analyses and Social Neuroscience
• 3. Risk of Hypertensive Heart Disease: The Joint Influence of Genetic and Behavioral Factors
• 4. Status, Stress, and Heart Disease: A Monkey's Tale
• PART II: MIND MATTERS: AFFECTIVE AND COGNITIVE NEUROSCIENCE
• 5. Domain Introduction
• 6. Affective Neuroscience: A Case for Interdisciplinary Research
• 7. Visual Mental Imagery: A Case Study in Interdisciplinary Research
• 8. Plasticity and Health: Social Influences on Gene Expression and Neural Development
• PART III: POSITIVE HEALTH: WHAT NOURISHES WHO FLOURISHES?
• 9. Domain Introduction
• 10. Thriving in the Face of Challenge: The Integrative Science of Human Resilience
• 11. Integrating Psychosocial Factors with Biology: The Role of Protective Factors in Trajectories of Health and Aging
• 12. Religion, Spirituality, and Health: The Duke Experience
• PART IV: IN SEARCH OF METHUSELAH: POPULATION PERSPECTIVES ON HEALTH AND LONGEVITY
• 13. Domain Introduction
• 14. Social Resources and Health
• 15. A Journey through the Interdisciplinary Landscape of Biodemography
• PART V: A TALE OF TWO CITIES: PREVENTION AND MANAGEMENT OF HIV/AIDS
• 16. Domain Introduction
• 17. Learning to Cope with HIV/AIDS
• 18. The Evolution of HIV Prevention in San Francisco: A Multidisciplinary Model
• Closing Commentary: Fostering Interdisciplinary Research: The Way Forward.
• (source: Nielsen Book Data)

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Interdisciplinary research: shaping the healthcare of the future

Stephen w smye, alejandro f frangi.

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Address for correspondence: Prof Stephen Smye, University of Leeds School of Medicine, Worsley Building, Leeds LS2 9JT, UK. Email: [email protected]

The hospitals of the future will be shaped by scientific and technical advances made across a wide range of disciplines because complex problems in healthcare cannot be addressed successfully by a single discipline. This paper considers how interdisciplinary research is being promoted and the prospects for developing stronger and deeper collaborations between medicine, health and other disciplines, drawing on case studies from mathematics, physics and engineering. The anticipated impact of greater interdisciplinarity on clinical training and the provision of care is also reviewed. While the role and training of clinicians in the provision of care will continue to evolve, they will remain leading members of a much broader and more diverse interdisciplinary team, alert to the value of deep and sustained interdisciplinary research.

KEYWORDS: research, partnerships, interdisciplinary

Introduction

Medicine has a long history of drawing on other disciplines to make significant advances in clinical care. Examples of clinical advances driven by disciplines other than medicine abound, for example, many techniques and technologies which underpin modern clinical imaging originated in the physics laboratory; radiotherapy is founded on the pioneering work of the physicist and chemist, Marie Curie, and the engineer and physicist, William Roentgen. The ground-breaking work of Franklin (chemist), Crick (physicist), Watson (biologist) and Wilkins (physicist) in determining the structure of DNA is now secure in the public record. The impressive advances in microscopy, which have been central to our understanding of biology, were driven in part by advance in physics and the demands of materials scientists.

In more recent times, the value of mathematics as a framework for understanding the burgeoning data sets arising from new, clinically informative, measurements is increasingly recognised and has led to a notable migration of mathematical physicists with doctorates in areas such as string theory, cosmology and quantum field theory into medicine where their mathematical skills are being used to, for example, advance epidemiological modelling, develop novel clinical trials and understand tumour dynamics. 1–4 Artificial intelligence, which has manifold applications in healthcare, originated, in part, from Turing's 1950 paper Computing machinery and intelligence and is underpinned by advances in fundamental computer science. 5

The report commissioned by the Engineering and Physical Sciences Research Council and produced by an expert panel chaired by Prof Patrick Maxwell in 2014, on the importance of engineering and the physical sciences to medicine gives numerous examples of interdisciplinary research and noted that ‘During the last 35 years, 11 of the Nobel prize-winners for medicine have had a background in chemistry, physics or engineering.’ 6

Examples of interdisciplinary research are not limited to the science, technology, engineering and mathematics (STEM) subjects; social, economic and behavioural sciences play a prominent role in improving public health and clinical practice. The role of the arts and wider humanities has been the focus of several recent initiatives. 7

At the time of the founding of the Royal College of Physicians in 1518, individual physicians often embodied interdisciplinarity. The subsequent advances in medical science have led to an almost inevitable stratification of the research community and the emergence of specialty-specific clinical practice and research endeavour. While this focused approach to research has undoubtedly led to significant progress, it has also been widely recognised that the ‘silo-thinking’, which may be associated with a uni-disciplinary approach, can be very limiting and misses the real opportunities for advance provided by disciplines other than medicine or indeed biology. Interestingly, a citation-based analysis of interdisciplinary research over the period 2001–2010 undertaken by Van Noorden and colleagues demonstrates that interdisciplinary research is increasingly prominent, particularly in ‘health’ but that ‘clinical medicine’ is strongly uni-disciplinary in the sense that ‘Clinical medicine papers rarely cite, or are cited by, other disciplines, perhaps because they deal with specialised medical practice.’ (Fig 1 ). 8 This suggests there is more to be done to promote interdisciplinary approaches.

Measure of interdisciplinarity of fields. Reproduced with permission from Van Noorden R. Interdisciplinary research by the numbers. Nature 2015;525:306–7.

Rylance rehearses the drivers of interdisciplinary research; complex problems are not amenable to single-discipline investigation, discoveries are more likely at the boundaries between disciplines, and single disciplines derive a general benefit from engagement with those outside their field. 9 Rylance also summarises the reasons given for being reticent to embrace interdisciplinarity; such research is often regarded as inferior to that in a single discipline (with publication metrics being cited as the rationale for this) that promoting interdisciplinarity can sometimes be at the expense of the individual disciplines. 9

Wu, Wang and Evans further demonstrate that science and technology can be disrupted by small teams, yet larger and often interdisciplinary teams are crucial to demonstrate impact and change practice. 10 Their results also suggest the need to support the critical role small teams appear to have in paradigm shifts and challenging the frontiers of knowledge. Here, we make the case that hospitals of the future will be shaped by a deep and sustained interdisciplinary approach to healthcare research. The term ‘interdisciplinary’ is used in slightly different ways, often interchangeably with the terms ‘cross-disciplinary’, ‘multidisciplinary’ and ‘transdisciplinary’. In this paper, we use the term ‘interdisciplinary’ to refer to the full spectrum of activities which span more than a single discipline. Medicine is here considered as a single discipline, and the focus of the paper is on the contributions being made to clinical care from disciplines outside medicine. The paper briefly summarises some of the key principles underpinning high-quality, interdisciplinary research and notes several recent initiatives designed to promote productive research collaborations between medicine and other disciplines. The paper then illustrates some of these principles with reference to the collaborations between medicine and the physical, engineering and mathematical sciences. The implications of interdisciplinary research for clinical training are briefly reviewed. The paper concludes with some speculation about future developments in interdisciplinary research, which may significantly impact future healthcare.

A useful compendium of recent reports on interdisciplinary research has been curated by UK Research and Innovation (UKRI). 11 Principles and processes which underpin successful interdisciplinary research are increasingly recognised and are set out in detail by Brown, Deletic and Wong. 12 We select three of particular importance to medicine and summarise them.

Promote depth, so a researcher becomes ‘T-shaped’: someone with real credibility in their field but who can look beyond it. The implications for career development, particularly for early career researchers, are significant and require careful management if career progression is not to be delayed. 12 In the UK, recent reports on ‘team science’, including a report from The Academy of Medical Sciences, have helpfully contributed to addressing this important aspect of interdisciplinary research. 13

Focus on a ‘grand challenge’: grand challenges abound in medicine and, almost by definition, addressing a grand challenge requires researchers to look beyond their field. Cancer Research UK, working with the National Cancer Institute, has been in the vanguard of this approach with global teams, comprising many disciplines, each funded on a scale that reflects the significance of the scientific question. 14 The Council for Science and Technology recently advised the prime minister on creating ambitious, goal-oriented research and development programmes based on seven principles for science and innovation ‘moon-shots’. 15

Nurture dialogue across traditional boundaries: interdisciplinary seminars, collocated research groups and facilities, PhD cohorts with cross-disciplinary supervisory teams and shared coffee lounges drive better mixing with other disciplines. Even in large teaching hospitals with established university partnerships, promotion of mixing between disciplines is not always easy and is often severely time limited. The issue of protecting clinician time for research, including research which involves cross-disciplinary collaborations, is widely recognised and solutions are being proposed. 16,17 Interdisciplinary collaborations are often best supported by a programme of engagement planned and supported by established research platforms, including those funded by the National Institute for Health Research (NIHR); for example, in Leeds, the NIHR Surgical MedTech Cooperative drives collaborations at scale between clinicians, physicists, engineers, industry and patients aimed at addressing unmet needs (Fig 2 ). 18 Further upstream in the research pipeline, the Bragg Centre for Advanced Materials Research has a regular programme of events which promote novel interdisciplinary approaches to key clinical topics, such as drug targeting and delivery. 19

Leading from the front: future hospitals are not defined by new technology but by a culture shift in understanding the scope of care provision, their boundaries and the speed of change in which a culture of constructive questioning is encouraged. 20,21 Leaders and middle managers are key agents in this transition by providing the incentives and recognising the needed space and upskilling for a successful transition. A transition that requires the recognition that clinical research and innovation is a statutory right and duty of NHS practitioners to stay current and provide the best patient care. The NIHR is working closely with NHS England, regulators and the medical royal colleges to ensure research becomes embedded in clinical care.

Interdisciplinary working in the NIHR Surgical MedTech Cooperative at Leeds aimed at addressing unmet needs. NIHR = National Institute for Health Research; RCTs = randomised controlled trials. Adapted from a diagram produced by Vee Mapunde, University of Leeds and Leeds Teaching Hospitals NHS Trust.

National and international programmes aimed at driving interdisciplinary collaborations at scale, and reflecting these principles, are numerous.

The UKRI-funded Physics of Life network (PoLNet3), now in its third cycle, which also includes a programme of events, funded by the Rosetrees Trust, aimed at strengthening clinical engagement with the biological physics and related communities in the basic sciences (the Physics of Medicine). 22 A summer school focusing on biomedicine is planned. The Rosetrees Trust have an established history of supporting deeply-interdisciplinary research.

UKRI funds a wide range of fellowship schemes, many of which are aimed at interdisciplinary research. 23

NIHR funds fellowships that are well-suited to those looking to collaborate with other disciplines. 24

The Engineering and Physical Sciences Research Council (EPSRC) has a very strong grants programme for the healthcare technology, including funding for interdisciplinary fellowship and networks, aimed at developing new approaches to some of the grand challenges in healthcare. 25

EPSRC also funds hubs for mathematics in healthcare: the Exeter Hub for Quantitative Modelling in Healthcare, for example, includes clinicians and aims to develop new methods for managing and treating diabetes, mental health and microbial disease using predictive mathematical models. 26

Cancer Research UK's Multidisciplinary Award scheme: the scheme is co-funded by EPSRC and requires at least one investigator from the engineering or physical sciences. 27

In the USA, the National Cancer Institute's (NCI's) Physical Sciences in Oncology Initiative seeks to establish research projects that bring together cancer biologists and oncologists with scientists from physics, mathematics, chemistry and engineering to address some of the major questions and barriers in cancer research. 28

Making an impact in the clinic

There are numerous examples of interdisciplinary research that make a difference in the clinic or have the potential to do so. The following examples illustrate how interdisciplinary groups addressing a clinical question to which the answer really matters can make significant advances. All major disease areas can furnish examples, with cancer particularly prominent and well-supported by research funding schemes which drive interdisciplinarity.

One of the most striking demonstrations of the clinical impact of interdisciplinary research in cancer is provided by the Moffitt Cancer Centre's NCI-funded programme on cancer biology and evolution (CBE) which includes a particular focus on the problem of treatment resistance and is described as:

... emerg[ing] from systematic in-house collaborations of mathematicians, evolutionary biologists, and basic and clinical cancer researchers. Although these research teams investigate cancer via traditional means, they include mathematicians and theorists who integrate multi-scalar data through quantitative models founded on evolutionary first principles.

The overall goals of CBE are to investigate and define the complex dynamics that govern the biology and therapeutic responses of cancer, and to deliver new agents and strategies to prevent and treat refractory or relapsed malignancies. 29

While the role of evolutionary dynamics is well-recognised in the emergence of treatment resistance in cancer (and draw significantly on earlier work on the role of selection in ecological systems), the Moffitt centre has used these approaches to design novel drug trials. These trials are based on the observation that using the ‘maximally tolerated dose’ is likely to accelerate the emergence of resistance clones in the tumour. This process can be modelled mathematically, thereby enabling the trajectory of the tumour's clonal evolution to be predicted. A treatment regimen, which uses a lower dose, stopped after achieving a pre-determined tumour response and only restarted when tumour growth reaches a pre-set level, has clear theoretical advantages in slowing the rate of emergence of resistant clones and mathematical simulations suggest that ‘driving tumour evolution into periodic, repeatable treatment cycles provides a path forward for multidrug adaptive therapy’ (Fig 3 ). 30 Clinical trials based on this approach are now underway, and early results are promising. 31

Cancer clonal evolution under therapy. a) Sequential, nonadaptive therapy . Conventional sequential therapy of two treatments selects for a clone resistant to treatment one (red) upon tumour relapse and subsequently a clone resistant to treatment two (green). b) Single drug adaptive therapy. Adaptive therapy maintains a stable tumour volume by introducing treatment holidays. Drug-sensitive clones (blue) suppress the growth of less-fit resistant clones (red). However, resistance still eventually occurs. c) Two drug sequential adaptive therapy. One proposed adaptive multidrug strategy is to alternately switch between drugs during each on–off cycle of tumour burden. d) Two drug concomitant adaptive therapy. An alternative multidrug adaptive strategy is to administer both drugs simultaneously during each on-off cycle, leading to a doubly resistant clone (yellow). Adapted with permission from West J, You L, Zhang J et al . Towards multidrug adaptive therapy. Cancer Res 2020;80:1578–89.

Targeting cytotoxic drugs to tumour tissue while avoiding the toxicity in normal tissue is another major problem in cancer treatment and one benefiting from novel approaches rooted in the physics, chemistry and applications of nanomaterials, combined with imaging techniques; for example, recent collaborative work, which included researchers in the schools of medicine, chemistry and physics and astronomy at Leeds University has demonstrated that ultrasound-triggered therapeutic microbubbles enhance the efficacy of cytotoxic drugs by increasing circulation and tumour drug accumulation, while also limiting bioavailability and toxicity in normal tissues. 32

Even some of the most fundamental areas of research in physics offer opportunities for clinical translation; for example, Ben Varcoe, professor of quantum information science at Leeds University, uses an error correction mechanism drawn from quantum optics to improve the signal-to-noise ratio of magneto-cardiography significantly and thereby develop a device for clinical use. 33 This work has been undertaken in close collaboration with cardiologists and emergency medicine physicians.

Other examples abound: understanding diseases of the eye has benefited from imaging, laser physics, sensor technology and image analysis, optical coherence tomography is one such example that has been rapidly adopted in clinical practice to good effect in ophthalmology. 34 The use of a novel near-infrared spectral imaging technique, developed in a physics laboratory, shows promise in the early detection of dental caries. 35

There are, of course, many other examples of clinical translation from the physical sciences into the clinic but one particular field is perhaps rather wider in scope: computational medicine. Computational medicine applies methods from computational sciences, engineering and mathematics and to improve our understanding and treatment of human diseases. 1,36,37 Could it reduce the scale and duration of expensive conventional trials? This entirely new paradigm can reduce, refine or replace conventional trials by developing in silico trials, which perform entirely, or in part, in patient-like computer simulations modelling aspects of medical device, drug effect or clinical intervention. 38 Our recent work has shown how these approaches replicate findings of conventional trials and provide additional insights not accessible through conventional trials without posing risks to human or impacting animal welfare (manuscript in preparation).

The value of interdisciplinary collaborations is not limited to biomedical research. The long-established discipline of operational research is increasingly recognised as a robust approach to designing clinical services in hospitals and entails significant interdisciplinary collaborations. 39 We might anticipate wider use of this approach in, for example, determining the scale and location of hospitals in future, drawing on the work of major programmes such as the Infrastructure Transitions Research Consortium (ITRC), a consortium of seven UK universities led by the University of Oxford, which has drawn together a wide range of disciplines and created a globally unique set of simulation models and methodologies which enable long-term cross-sectoral planning of sustainable and resilient infrastructure systems. 40

Clinicians for future healthcare

If interdisciplinary research is driving clinical advances, what are the consequences for clinical training, particularly given the burgeoning demands made on the curricula for all clinicians including doctors, nurses, clinical scientists and allied health professions? The principle of the ‘T-shaped’ researcher alluded to earlier may be helpful here: clinical skills must indeed remain core to the training programmes and, for doctors in particular, it would be unwise to freight the curriculum with advanced training in areas such as nanoscience and AI. However, one trend that is already, and rightly, evident for all professions is increased emphasis on data science and quantitative techniques, particularly as the volume of useful data increases. 41 Key to making progress is the appreciation by all clinical staff of the role of interdisciplinary research and that a strong research culture comes with positive patient, staff and organisational benefits. 20,42 As indicated earlier, some of the most compelling examples of progress being made are where a clinician has a ‘hunch’ that an answer to a particular clinical question may already exist, at least in part, in another area of science. The role of clinical scientists in hospitals (in both laboratory services and medical physics) is key here. These professions are well-placed to play a brokering role in bridging the gap between the basic sciences and clinical practice.

All this may give the impression that the professional composition of the healthcare workforce will remain unchanged; this is not likely for many reasons, but here it is worth noting that as interdisciplinary research continues to develop, new ‘professions’ will emerge, might we see the emergence of ‘clinical mathematicians’ or ‘computational doctors’, for example? The Moffitt Cancer Centre suggests this might occur.

Many would agree that predicting the future is fraught with difficulty. Still, in the spirit of the Future Healthcare Journal , it may be worth noting one particular development likely to have a significant impact, perhaps in the not-so-distant future; the rapidly increasing power of computing that is being driven by developments in basic science, including quantum computing. 43

Quantum computing is another example of how a theory (quantum theory) can ultimately lead to very significant translational impact across a wide range of disciplines: in this case, a genuinely immense increase in computing speed. This increase in computing speed, combined with the widening range of informative clinical measurements in real-time derived from wearable technology, as well as genomic, proteomic, metabolomic, imaging, behavioural and socio-economic data, is likely to make possible a full-scale simulation of a patient trajectory and life course. 44 In effect, the patient will have an avatar or digital twin who will never be late for an appointment and on whom it will be relatively straightforward to evaluate the impact of different treatments using in silico modelling. 45 This deeply interdisciplinary approach will profoundly impact the way clinical research is conducted and health services are delivered.

It is widely recognised that healthcare systems will face unprecedented demands driven by changing demographics, while at the same time being reshaped by an increasing emphasis on provision of care in community settings. The integration of scientific and technological breakthroughs with new and emerging care pathways will bring exceptional opportunities to improve clinical outcomes, though attention must also be paid to the attendant risk of deepening health inequalities. In a sense, interdisciplinary research is simply what is needed to make progress in addressing these long-standing and significant challenges; a hallmark of a serious attempt to answer the difficult questions in healthcare. Of course, advances made by interdisciplinary research will raise challenges (including ethical dilemmas) though interdisciplinary approaches may be better suited to addressing some of the difficult ethical problems that will arise. While the role of clinicians will continue to evolve, they will remain vital members of a much broader and more diverse interdisciplinary team, with exciting opportunities to engage with a wide range of different disciplines and playing leading roles in the healthcare of the future.

Acknowledgements

We also acknowledge useful discussions with Professors Stephen Evans and David Jayne, and Vee Mapunde (University of Leeds) and Professor John Girkin (Durham University).

Conflicts of interest

Stephen Smye is a professor in the School of Medicine at the University of Leeds and specialty cluster lead with the NIHR Clinical Research Network (until April 2021) based at King's College London. He receives funding from the UKRI-funded Physics of Life Network (standard grant EP/T022000/1) and from the Rosetrees Trust ‘Physics of Medicine; building a network at the interface between medicine and the physical sciences’ (grant PGS19-2/10092). This support is gratefully acknowledged.

Alejandro Frangi is diamond jubilee chair in computational medicine and Royal Academy of Engineering chair in emerging technologies at the University of Leeds. He acknowledges support from the Royal Academy of Engineering under a RAEng chair in emerging technologies (CiET1919/19). EPSRC partially supports his interdisciplinary work through grants TUSCA (EP/V04799X/1) and MedIAN Network (EP/N026993/1) and Cancer Research UK through the Cancer Research UK Radiation Research Centre of Excellence at the University of Leeds ( C19942 /A28832).

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Expanding the Boundaries of Health and Social Science: Case Studies in Interdisciplinary Innovation

Hayden b bosworth , ph.d..

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Research has become more interdisciplinary, and the interface between biological, behavioral, social, and health sciences has resulted in significant improvements in these health-related fields. Many of the most pressing health problems—cardiovascular disease, drug and alcohol abuse, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), diabetes, cancer, chronic obstructive pulmonary disease, and affective disorders are social as well as biological phenomena that require an interdisciplinary approach. John Rowe, in the introduction of this interesting and unique book, defines interdisciplinary research as “a true collaboration—a melding of disciplines—various approaches are generally applied simultaneously over a substantial period of time rather than sequentially.”

The book is organized into 5 parts: social environment and cardiovascular health and disease, affective and cognitive neuroscience, positive health, population perspectives on health and longevity, and the prevention and management of HIV/AIDS. The case studies from prominent researchers' actual experiences provide a basis for better understanding the conditions and interventions that promote successful interdisciplinary collaboration.

Chapter 1 is an introduction to the section on social environment and cardiovascular health and disease. Gary Bernston and John Cacioppo (Chapter 2) review their work on the organization of the nervous system and how it controls the heart's response to various stressors. It is clear from their work that a link between psychological and biological processes cannot be comprehended fully by a single-level analysis and requires an interdisciplinary approach. Kathy Light and colleagues (Chapter 3) similarly focus on cardiovascular reactivity, but they have examined its relationship to hypertension and predisease indicators of hypertension such as left ventricular mass. They review their findings on genetic and behavioral risks for hypertension from their University of North Carolina Stress and Health Research Program. In Chapter 4, Jay Kaplan and Stephen Manuck discuss their research examining the interactive effects of social status and social environment on the contribution to cardiovascular disease. They demonstrate, using cynomogus monkeys, that social disruptions and instability promote coronary atherogenesis.

Chapters 5 through 8 address the relationship between affective and cognitive neuroscience and span a range of levels; the authors review research that extends from molecular approaches in animals to brain imaging in humans. Davidson (Chapter 6) presents an overview of recent findings on the neural substrates of emotion. In Chapter 7, Kosslyn presents how visual mental imagery has progressed from a time of introspective analysis alone to an examination of the underlying brain circuitry. The authors outline how a combination of behavioral methods, computational modeling, and brain imaging provided the requisite tools to understand the mechanisms that underlie mental imagery. In Chapter 8, Dr. Meaney discusses the effect of parental care on the psychology and biology of offspring. The use of rodents provides a detailed model of how early environmental influences can induce changes in the biology of the offspring at the level of gene expression.

Authors of Chapters 9 through 12 discuss how social and behavioral scientists together with biomedical researchers advance knowledge of positive health. Positive health is focused on the nature, antecedents, and consequences of human flourishing. Chapter 10 by Ryff and Singer addresses the topic of human resilience using a biopsychosocial approach. Resilience is the capacity to maintain or regain health and well-being in the face of adversity. Seeman draws on both social epidemiology and neuroendocrinology in Chapter 11 to address the protective effects of psychological strengths, social ties, and social support on health. Chapter 12, by George, examines the relationship between religion, spirituality, and health.

Chapters 13 through 15 examine the biodemography of aging, which examines the biology of human life, which creates the conditions under which social factors affect health and longevity. In Chapter 14, Michael Marmot examines how social resources such as social status affect biological functioning, illness, and length of life. Demographer Jay Olshansky and biologist Bruce Carnes examine in Chapter 15 the population consequences of the biological etiology of disease and death for individuals.

Chapters 16 through 18 summarize and present case studies, describing how interdisciplinary teams of investigators confront HIV/AIDS. The case studies provide cogent examples of how a range of behavioral and social science approaches have been used to tackle one of our most important public health problems. Schneiderman and Antoni in Chapter 17 largely focus on group-based, cognitive-behavioral stress management interventions among HIV-infected individuals. Drs. Chesney and Coates, in Chapter 18, discuss the Center for AIDS Prevention Studies and its various notable findings such as identifying important variables associated with medication nonadherence in HIV-seropositive patients. Chapter 19, by Patricia Rosenfield and Frank Kessel, is a nice summary of the work presented in the chapters and an informative discussion on barriers and facilitating factors of interdisciplinary research.

While the actual research endeavors of the authors are interesting, the most appealing aspect of the individual chapters is the authors' discussion of the development of their interdisciplinary research endeavors. This was particularly the case with the descriptions of the impediments and facilitating factors they encountered.

It is clear that there was a consistent overlap in factors across the various researchers' careers that help facilitate successful interdisciplinary research groups. One key was having an environment that permitted and encouraged interdepartmental collaborations. Intellectual breakthroughs are encouraged by institutional support and rarely occur spontaneously. A facilitative environment often occurred because of mutual respect and appreciation of colleagues from various backgrounds, as well as the willingness to take risks into uncharted territories. Successful interdisciplinary research programs included investigators who did not perceive boundaries between fields and disciplines and respected each other. For example, Bernston and Cacioppo discuss their mutual respect for each other's research and the dissatisfaction and frustrations they had prior to working together. Another key was having interdisciplinary studies that were assisted by novel and important technological advances. For example, investigators who use brain-imaging methods, as discussed in Chapter 6, require an extraordinary confluence of disciplines, including psychology, neuroscience, physics, and radiology. A third factor was that interdisciplinary research often began during investigators' training. For example, Davidson, in Chapter 6, describes how as a graduate student at Harvard he pursued work in personality and experimental psychopathology and then supplemented this work in neuroanatomy at MIT and behavioral neurology at Harvard Medical School. Mentorship and training often continued after graduate training. Drs. Seeman and Olshansky discuss how they obtained funding through career development awards from the National Institute on Aging Special Emphasis Research Career Award (SERCA). Through the SERCA funding, Dr. Seeman was able to develop a program of training in neuroendocrinology to enhance her abilities to explore models of development that focused on biological mechanisms through which psychosocial factors may affect trajectories of health. Dr. Olshansky used the career development award to pursue an independent course of study in the fields of evolutionary biology, molecular biology, epidemiology, and statistics. In addition, the career development awards allowed both to develop working relationships with researchers outside their own disciplines.

It is also worth recognizing that, in the development of the various described research programs, each author and research team had to overcome many obstacles. Many included review panels at journals and funding agencies that could not appreciate and understand the interdisciplinary nature of the proposed research. Other obstacles included time constraints. It is clear from all the authors that collaborative research typically is more time-intensive and requires more effort than independent disciplinary work; however, as these authors can attest, it is worth the effort. With any important research there is, occasionally, politics involved. Drs. Marmot and George, in their respective chapters, for example, discuss how the political climate influenced their research and ways they conceived of presenting their work that were more acceptable. Finally, in interdisciplinary research, technical communication can be a big problem initially but can be overcome with persistence and training. The description of these obstacles and the anticipation of the problems will hopefully inspire continued development of these interdisciplinary approaches.

The book is likely to be of value not only to scientists but also to decision makers in universities, institutions, and funding agencies. The authors not only summarize interesting and important bodies of work, but also highlight bumps and directions along the winding road they took to achieve such success in their respective interdisciplinary fields.

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14  Social Resources and Health

• Published: April 2008
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This chapter explores the history of an interdisciplinary research program on the social, economic, cultural, and psychological determinants of health and the biological pathways by which they operate. The study dealt with the inevitable resistance to interdisciplinary research by, initially, breaking it up into small nonthreatening chunks and only later attempting to prove that the whole was greater than the sum of parts. A particular problem was that the research was addressing social inequalities in health. When the political climate was unfavorable, such research was seen to be, at best, irrelevant and, at worst, threatening. When the political climate in Britain changed, yesterday's pure academic research became today's applied science.

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