June 16, 2004

Volume 23, Issue 11

Recognizing the lack of control the NIH Director has in running the agency (the subject of a congressionally-mandated study by the National Academies); Barton stressed his desire to, “on a bipartisan basis through these hearings, to come up with a legislative package to reauthorize NIH.”  Most of the programs at NIH have not been reauthorized in a number of years; he noted, and he indicated his desire to come up with “some legislative reforms that make it easier for NIH to do its function.” (See Update, August 11, 2003).  Refuting recent press accounts that “Congress is out to get NIH,” Barton stressed that “nothing could be further from the truth. . .Our goal is to have an NIH reauthorization package ready to move through this committee in this Congress.”

Noting that  “the priority setting process at NIH and within individual institutes has drawn questions . . . from members of Congress, as well as patient advocacy groups and others, Health Subcommittee Chairman Michael Bilirakis (R-FL) expressed his belief that “much of the criticism has arisen because [the NIH’s] priority setting process is extremely complicated, especially the grant approval process.”  In addition, he noted, “NIH lacks transparency in many of their decision-making procedures.”   He further expressed his hope that the hearing would “give members an opportunity to really understand what criteria is used to determined which grants are funded and why.”

Expressing his appreciation to the NIH contingent, Ranking Member Sherrod Brown (D-OH) emphasized that it was “incumbent upon the Congress to ensure that NIH resources are allocated in a manner that is reasoned, efficient, and fair.”  The Congress also has a “requisite obligation to ensure ample funding overall for NIH,” he noted, referencing a memo recently leaked to the press that indicates that the president plans to cut 600 million from NIH in 2006.  “We need to be aware that NIH cannot evolve without the resources to do so.   Prioritizing research doesn’t mean anything if [NIH] can’t fund it,” he asserted

Congressional Self Restraint Urged

In his opening statement, Rep. Henry Waxman (D-CA) stressed that Congress, with NIH’s guidance, must decide how much to appropriate to the general research areas covered by each of the institutes and centers.  He emphasized the need for Congress, “after it has exercised its oversight responsibilities, to step back and allow NIH scientists to decide what specific research projects will produce the greatest gains for our humanity.” 

Waxman expressed his increasing concerns regarding “congressional interference in NIH decisions to fund specific research grants . . . As the members of this subcommittee look into NIH’s work, I hope we will all exercise self-restraint.”  He noted that  in the past, “some members of Congress have given in to  a temptation to substitute their scientific judgment for that of the peer review process,” a “very perilous activity.” Alluding to the attempt in July 2003 during consideration of the House Labor, Health and Humans Services Appropriations bill to rescind the funding for five previously peer-reviewed approved grants pertaining to sexual behavior and function funded by NIH and the continuing inquiries from members of Congress about these grants, Waxman underscored the “need for funding decisions to be based on whether such research will or will not help us learn how to stop the spread of serious diseases and reduce human suffering.”

Waxman declared that he is “pleased” that Dr. Zerhouni has affirmed both the scientific importance of research on sexual behavior and his continuing support for the peer review process at NIH (See Update, February 9, 2004).  “And I hope that from this subcommittee that we will have continuation of the policy to support a process whereby our best scientists pursue the research that they have determined the best chance to save many lives,” he concluded.

Scientific ‘Witch Hunts’ Discouraged

Rep. Lois Capps (D-CA) reiterated her support for NIH’s support of research pertaining to sexual behavior and function.  “Some of our colleagues … have raised questions about NIH grants on human sexuality.  Congressional oversight is important, but it is critical, I believe, that we be very serious about keeping politics from interfering with science,” stated Capps.  “We here should not try to micromanage scientists about how to conduct their research, and we should not engage in witch hunts to discourage research in particular areas.” (See Update, April 19, 2004)

Suggesting that he was speaking “from a very conservative area of the country,” Rep. John Shimkus (R-IL) explained that “we talked about this at the last bicameral hearing we had on the Senate side last year that it helps us in rural America if the grants that issued passed the common sense test” (See Update, October 6, 2004).  Shimkus asked Zerhouni if there “is a way that [NIH] can, through this evaluation process, bring some sense or explanation on those that don’t.”

Responding, Zerhouni noted that it was “a very important question” and that the NIH “found after [its] review that we could do a lot better in making sure we communicate transparently and also fully about the importance or lack thereof of particular research.”  He explained that since the review he has, in conjunction with all of the directors in NIH’s extramural offices, issued new requirements for elucidating in plain language both the public relevance as well as the importance of the research scientifically so that that is available in clearly understandable language, both to the public and to the multiple review levels in place.

“The common sense test that you rightly bring up is something that we’re quite concerned about, because we depend on the support of all taxpayers,” Zerhouni acknowledged.  “We need to make sure that whatever we do makes scientific sense and public health sense.”  Applauding the effort, Shimkus cautioned that as the NIH moves to more transparency, he hoped “that it helps and doesn’t hinder, because, again, many of us would question the common sense application of some of these grants.  More transparency may make it more difficult to defend the NIH,” he acknowledged.

“Obviously, in areas such as HIV/AIDS, it’s a sexually-transmitted disease, it’s a disease that is transmitted by injection drug use, by a variety of other mechanisms,” Fauci added.  “So we cannot avoid addressing the issues that are at the very foundation of why millions and millions of people are getting infected.  That is the reason why we are sensitive to the issues you bring up, really quite sensitive, but we need to let the science drive the question if we are going to be able to get a handle on this very devastating sexually-transmitted disease,” he concluded.

Responding to the comments made by Shimkus, Rep. Ted Strickland (D-OH), a minister, college professor, and one of four psychologists in the Congress, noted that “the common sense test is not relevant because it’s common, and that which is easily or readily understood or appreciated is not, it seems to me, the major domain of the scientific inquiry. You want to look at that which is not common or easily or readily appreciated or understood.  It seems to me that is what the scientific inquiry is all about,” Strickland explained.

Requesting an explanation of the peer review process and why it is considered the gold standard worldwide for determining the scientific quality for members of the Subcommittee, Capps, a nurse, noted that grant applications may sound inappropriate when summarized in one paragraph.  “Some of this supports science around esoteric projects, but underlying it is the need to understand the millions of Americans who have suffered from HIV/AIDS, sexually-transmitted diseases, sexual dysfunction, mental health consequences of abuse and various hard topics to get a hold of,” she explained

Explaining the peer review process and how it works, Zerhouni noted that this is one of the most common questions he gets as he travels around the world — How is the NIH’s peer review process so effective in identifying areas of science?  He added that over 105 Nobel prizes have come through the agency’s peer review process.

Indicating the level of congressional scrutiny applied to NIH’s research portfolio, Rep. Joseph Pitts (R-PA) “could not resist” mentioning the abstract of a research proposal on dorm room wall decorations of college students.  “When a multiyear grant is awarded by an institute, what, if any, authority do you have as NIH director to make a change if it is determined at a later date that this project is of less significance given current public health needs,” he asked the director.

The dorm room decorating study was a small grant funded over three years ago.  It is no longer active, Zerhouni stated.   The research was thought useful at the time by the review committee because they believed it could provide a diagnostic  test of college students who may be developing or experiencing mental health or personality disorder problems.  

Zerhouni added that he would like to have processes in place that will give Members of Congress assurances that the research has been reviewed, its scientific merit established, and it is clearly explained.  He pointed out that if one only reads the title of this particular grant, it would obviously make no sense.  But if you look at the justification for the research proposal, you realize that psychological tests that look at drawings, for example, that children use on their walls tell us something about the mental state of an individual. 

CRISIS COMMUNICATION FOCUS OF COSSA BRIEFING

On June 7, just days after the death of the “great communicator,” former President Ronald Reagan, COSSA held its second congressional briefing, Risk and Crisis Communication:  Building Trust and Explaining Complexities When Emergencies Arise, before a standing room only crowd on Capitol Hill.  The briefing was cosponsored by the National Communication Association and the American Sociological Association.  

Welcoming the audience, COSSA Executive Director and moderator of the event Howard Silver, noted the passing of President Reagan and pointed out that the former president was responsible for the existence of the Consortium.  The social science associations decided to respond to his administration’s initial budget proposals to severely reduce spending for social and behavioral science research.  That response resulted in the formation of COSSA as an advocacy group.

Twenty-three years later, Silver suggested, the Bush Administration’s science adviser, John Marburger, and many others have repeatedly highlighted the importance of the social, behavioral, and economic sciences to America’s economic and homeland security.  In addition, Marburger and the National Research Council (NRC) of the National Academies have emphasized the importance of communicating warnings about attacks.  The NRC report Making the Nation Safer has declared that “warning systems should be carefully designed with respect to who issue the warning, optimal lead time of warning, unambiguous language and moderated emotional tone.”  The report also discussed the role of the media in defining the nature, scope, and level of threat in critical situations, in disseminating both reliable and unreliable information, and in calming the population.  Further, the recent hearings in New York City conducted by the 9/11 Commission underscored the need to be able to communicate well in a crisis.  For these reasons, COSSA invited three distinguished social scientists to discuss their research results relating to these issues.

Measuring Risk/Crisis Communication

H. Dan O’Hair, professor of communication at the University of Oklahoma, began by explaining to the audience that “academically speaking, risk communication is  the exchange of information among interested parties about the nature, magnitude, significance or control of a risk.”  The public, O’Hair noted, generally think of risk as something we can manage.  “We manage and hedge against risk in our personal lives,” he explained.  For the academic and the practitioner communities, “crisis communication (also known as emergency communication) is organized, analysis, planning, decision-making, and assignment of available resources to mitigate, prepare for, respond to, and protect property and the environment when an emergency or disaster occurs.”  Distinguishing crisis communication from risk communication, O’Hair explained that the former is about an event that has occurred, whereas the latter is a projection of what might occur.

O’Hair discussed research that demonstrated that the public does not just hear a message and then goes and does exactly what the message asks.  They think about it and they analyze it and maybe they will respond to it.  O’Hair also talked about two challenges that face risk and crisis communication practitioners and researchers:  1) varying expectations of the public and 2) advances in communication science. 

The public, O’Hair explained, has expectations that public officials will communicate with them about risks and about crisis.  But, what is it about a selective public that risk and crisis communicators need to know about, he submitted.  First, source credibility – Do they trust the individual that is communicating the message?  Second, risk crisis source match – Do we have the right person for the right crisis and the right risk?  And third, media preferences -- Research since 9/11, he related, has found that the preponderance of people in the public prefer TV news and cable during a crisis event.  After the outrage has subsided, however, they turn to other media sources (Internet, newspapers, and interpersonal communication) to seek information and verify their perceptions and emotions felt initially.  What is needed, O’Hair explained, is the development of advanced models for understanding how the public comes to trust risk and crisis sources and how they use risk and crisis information.

Regarding advances in communication science, the second challenge, O’Hair related that over the past 10 – 15 years there has been an explosion of communication science research that is specific to how public officials communicate to the public, hoping to evoke some kind of response.  He also discussed five theories associated with taking evaluation and assessment to the next level to advance communication science.  Given that there is an “embarrassment of riches” in the accumulation of communication science over the last 10 – 15 years, he emphasized that: “We need to take advantage of it and build stronger models . . . We’ve got to start triangulating our research. That is the people in sociology, anthropology, public policy, political science and communication all need to start together and cross-referencing each other’s work.”  Finally, he concluded, “we need to cultivate partnerships,” with public policy makers, researchers and practitioners.”

Role of Science, Technology, and Media

Havidan Rodriguez, the director of the Disaster Research Center and professor  in the department of sociology and criminal justice at the University of Delaware, discussed the role of science, technology, and the media in communicating risk and warnings.  The Center was the first social science center devoted to the study of hazards and disasters in the world and just celebrated its 40^th anniversary.

Rodriguez explored what needs to be done and how we engage and respond to our communities.  Echoing O’Hair in calling for a multidisciplinary approach, he noted the “need to develop a holistic model to communicate risk and warnings which takes into account the contributions of different disciplines.”

He also identified the need to not only consider the role of new and emerging technology and how that enhances communication, but how it also creates problems in communicating warnings and crisis information to the general public.  In order to communicate with our communities, he related, we must know who these communities are, citing the changing socio-economic and demographic changes that are occurring in the U.S.   In many of these communities the primary language is not English,  their ideas, values and cultures are not the traditions in the society at-large.

Social scientists, said Rodriguez, are needed to better understand and expand our knowledge regarding how individuals and how organizations perceive and respond to, for instance, forecasts, warnings, and risk information.  We know, he explained that “disaster behavior and perception of risk, varies according to income, to education, to race, to ethnicity, and to the location of the residents or individuals.”  These are important variables that we need to take into consideration, he emphasized. 

To do this, we must provide information to the community in a form that is comprehensible and useful.  It must be perceived as relevant to them, he stressed.  “This information must make me aware of my risk; I [must] recognize my risk, and the potential outcomes,” Rodriguez explained.

He noted that technological innovations -- earth observational systems, Geographical Information Systems (GIS), global positioning systems (GPS), remote sensing, and cellular phones -- have dramatically altered and transformed the way we communicate.   While this may seem to be a good thing, he noted that “access to multiple sources of information can create confusion and uncertainty, particularly if it is inconsistent, contradictory and inaccurate.” 

Rodriguez concluded by noting that “risk and disasters are socially-constructed phenomena influenced by our cultural norms, our prejudices, our values, and therefore it is important to take the social sciences into consideration. . .If we continue to focus on the development of technology while ignoring societal impacts and the social factors that influence disaster behavior and response in the communication processes, we are going to go in the wrong direction.”

Earning Trust and Productive Partnering

with the Media and Public

Katherine Rowan, professor of communication at George Mason University, examined the research on effective risk, crisis, and emergency communication and how it can be translated into strategies and steps for communicating effectively with the public.

According Rowan, some of the emergency communication challenges practitioners confront include alerting people without panicking them, fostering emotional resilience when a disaster strikes, communicating preparedness for terrorist attacks, chemical, and biological and nuclear, and reducing media sensationalism.

In social science parlance, noted Rowan, this is “trying to take people’s feelings and perspectives and change lay theories about how we communicate in mass approaches that will be more likely to result in safe behavior.” 

One important function  that the briefing can serve, Rowan emphasized, is to connect the attendees to each other.  She explained how a memory aid or pneumonic could help the attendees to put the information from the briefing together to use if you happen to be an emergency spokesperson.  One such approach she noted is something called the CAUSE model.  It is a memory aid to think about classic tensions or obstacles in risk and crisis situations.  CAUSE stands for:  Confidence (in communication), Awareness (of danger), Understanding (of danger), Satisfaction (with solution), and Enactment (of safety steps).

Rowan noted that “frequently the most important problem when we are talking about some sort of physical danger is the fact that [the public] is more afraid of the officials.”  Thus, a difficult challenge for officials is to “earn the trust of those who are afraid of physical danger, but, frankly, unfortunately, of [officials] as well.”

A second important challenge, said Rowan,  is how do you create awareness of the danger?  An individual trusts the communicators, but sometimes do not literally hear the warning signal.  A third challenge is that the person understands the message.  This relates to Rodriguez’s concern with the diversity of the American population.

The fourth challenge is satisfaction with solutions.  “We all know about the dangers of terrorism, but we clearly disagree about how best to manage them.”  So we need to find agreement on how to manage dangers.  “Last, and not at all least, sometimes we need to move from agreeing that something is a good idea to actually doing it.” Rowan explained.

For example, she explained how risk and crisis communicators tell us that everybody should have a survival kit with them in their home, their office, and their car.   That is, we should have three days work of water, three days worth of food.  We should have a radio that runs on batteries.  If we had those survival kits, we would be less likely to tax emergency systems, she asserted.   But, it was clear from the audience that most people have not complied with this warning.

The CAUSE memory aid allows communicators to think about their challenges.  What are you trying to get across?  Why is that message going to be hard for them to understand? Is it mainly because they don’t trust me?  Is it because they just haven’t heard it? It is usually something about trust in the spokesperson that affects the response, Rowan explained.

According to Rowan, risk and crisis communication research suggest confidence is earned when emotions are legitimated.  In addition, she noted, confidence is earned when people can monitor officials and their attempts to figure out the situation. 

Finally, she emphasized the need to partner with the media, stressing the need to understand what the media does well.  Media, said Rowan, “are really good at creating awareness of information. . . They are far less good at getting deep understanding and deep comprehension.”  They can, but that is not their strength, she added.  

COSSA will prepare edited transcripts of the seminar,  which included a lively question and answer period, during which all three speakers questioned the current color-coded homeland security warning alert system.  These should be available by late July.  If you would like to request a copy, please e-mail cossa@cossa.org. 

NAS: Behavioral  AND SOCIAL SCIENCE SHOULD BE INCLUDED IN the MEDICAL SCHOOL Curriculum

According to the recently released National Academy of Sciences’ report, Improving Medical Education:  Enhancing the Behavioral and Social Science Content of Medical School Curricula, “No physician’s education would be complete without an understanding of the role played by behavioral and social factors in human health and disease, knowledge of the ways in which these factors can be modified, and an appreciation of how personal life experiences influence physician-patient relationships.”  Funded by the Robert Wood Johnson Foundation, the study was commissioned in response to the growing recognition of the role played by social and behavioral factors in health and disease. 

The report by the Committee on Behavioral and Social Sciences in Medical School Curricula, led by Neal A. Vanselow, Tulane University Health Sciences Center, emphasizes that “human health and illness are influenced by multiple interacting biological, psychological, social, cultural, behavioral and economic factors.  The social and behavioral sciences have contributed a great deal of research-based knowledge in each of these areas that can inform physicians’ approaches to prevention, diagnosis, and patient care.”

It identified 26 topics in six social and behavioral science domains that it believes should be included in medical school curricula. These domains include:  (1) mind-body interactions in health and disease, (2) patient behavior, (3) physician role and behavior, (4) physician-patient interactions, (5) social and cultural issues, and (6) health policy and economics.

The report also included a review of the approaches used by medical schools to incorporate the social and behavioral sciences into their curricula, development of a prioritized list of topics for future inclusion in those curricula,  and an examination of ways in which barriers to the incorporating social and behavioral topics can be surmounted.

The report notes that “although the scientific evidence linking biological, behavioral, psychological, and social variables to health, illness, and disease is impressive, the translation and incorporation of this knowledge into standard medical practice appear to have been less successful.”  Accordingly, observes the report, “To make measurable improvements in the health of Americans, physicians must be equipped with the knowledge and skills from the behavioral and social sciences needed to recognize, understand, and effectively respond to patients as individuals, not just to their symptoms.

Noting that current educational practices are uneven in their comprehensiveness and clinical applicability, the report emphasizes that “applying the behavioral and social sciences to medicine should not be a marginal effort, but part of mainstream medical education.  Improving Medical Education makes five recommendations:

1.   Develop and maintain a database on behavioral and social science curricular content, teaching techniques, and assessment of methodologies in U.S. medical schools.

2.   Provide an integrated, 4-year curriculum in the behavioral and social sciences that at a minimum include the six high-priority domains identified by the Committee.

3.   Establish a career development award strategy to produce leaders in the behavioral and social sciences in the medical schools. 

4.   Establish curriculum development demonstration project awards at U.S. medical schools. 

5.   Increase behavioral and social science content on the U.S. Medical Licensing Examination to ensure that it adequately reflects the topics in the behavioral and social sciences recommended in the report.

CENTER FOR ADVANCED STUDY SEEKS NEW DIRECTOR

The Center for Advanced Study in the Behavioral Sciences announces a search for a new director.  Current director Doug McAdam will return to the sociology department at Stanford University. 

The search committee will be chaired by Patricia Albjerg Graham of the Harvard Graduate Schools of Education.  Other members of the committee are Craig Calhoun of the Social Science Research Council and Harriet Zuckerman of the Andrew W. Mellon Foundation.  Stephen Stigler of the University of Chicago and Chairman of the Center’s Board of Trustees will serve on the committee ex-officio.

The new director will assume the position in September 2005 and will be responsible for the Center’s central leadership, fundraising, and the management of its physical facility in the hills above the Stanford campus.  The Center has been a vital setting for interdisciplinary scholarship.  Each year it hosts up to 48 resident Fellows chosen from among the most promising and/or distinguished representatives of the social and behavioral sciences and related fields in the humanities.

Those with interest in the position or in nominating people for the position should write to:  Director Search, Center for Advanced Study in the Behavioral Sciences, 75 Alta Road, Stanford, CA 94305-8090.  For more information about the Center go to: http://casbs.stanford.edu

Inside . . .

             Update

Spending Panels Start to Move FY 2005 Appropriations

Restructuring Of NIH; House Hold Hearing On NIH Priority Setting

Crisis Communication Focus Of COSSA Briefing

NAS: Behavioral and Social Science Should Be Included in the Medical School Curriculum

Center for Advanced Study Seeks New Director