of the Friends of the
Canadian Institutes of Health Research (FCIHR)
April 30, 2001
1:30 – 4:00 p.m.
Westin Harbour Castle, Toronto
A Summary of the
Proceedings
Arnold Naimark,
University of Manitoba
The
mandate of the Canadian Institutes of Health Research covers the full spectrum
of health research from molecules to populations and from biological systems to
social organizations. The CIHR is thus
by definition multi-disciplinary in its scope, and its structure and organizing
principles are designed to reflect this attribute. The intent however is to go beyond mere multidisciplinarity (i.e.
support of a variety of kinds of health research) to interdisciplinarity,
meaning the support and fostering of research in which investigators from
various disciplines interact with each other to tackle important research
questions that cannot be addressed effectively otherwise. Creating the conditions and designing the
strategies by which interdisciplinary research can flourish are challenging
tasks that require a sound understanding of the factors that are either
conducive or inimical to its development.
These factors include elements that involve funding agencies and the
institutions under whose aegis the research is carried out.
The Friends of CIHR - an organization that seeks to
promote the achievement of the broad aims of the Canadian Institutes of Health
Research including its special commitment to interdisciplinary research –
organized a symposium to bring together some of the key players involved in
fostering interdisciplinary health research.
They addressed the topic from two perspectives: the special nature of
interdisciplinary research and emerging models for facilitating it.
In his welcoming remarks Dr. Aubie Angel, President
of FCIHR, noted: “This is our first conference as a new association and we
thought that it was important to encourage our medical schools and our health
research institutes and teaching hospitals to facilitate collaborations. We hope that this symposium will help
provide a deeper appreciation of the meaning of interdisciplinarity by
examining various challenges and strategies to achieve the expanded mandate of
CIHR.”
The
symposium consisted of two sessions; the first dealing with the challenges inherent
in interdisciplinary research and the second with strategies for fostering such
research.
The
following summary of the proceedings touches only the highlights of the
excellent presentations and the lively discussions that took place.
Session 1:
Dealing with Challenges
The
session was chaired by Dr. Kevin Keough, Chief Scientist in Health Canada,
who
noted that the creation of CIHR was based on the premise that an agency was
needed to support health research at all levels (from molecules to populations)
and foster the full range of research strategies including interdisciplinary
research. He also observed that, while
interdisciplinary research is essential for solving certain kinds of important
problems, it involves special efforts to assemble and manage interdisciplinary
teams of researchers and an adaptation on the part of researchers to working in
a collaborative mode.
1.1 Definitions – What is meant by
interdisciplinary research and does it make a difference?
David
Naylor, Dean of Medicine, U of Toronto addressed this question by referring to Rosenfield’s classification of
research collaboration among disciplines (Social Science and Medicine, 1992)
into three types:
Naylor suggested that the failure to develop a
shared analytical framework may be a critical limiting factor in realizing the
full potential of collaborative research.
He then illustrated some of the features of collaborative research by
reference to his own experiences in establishing a clinical epidemiology unit
consisting of researchers from several disciplines. He used as an example of the benefit of working in an
interdisciplinary/transdisciplinary mode the effort in his unit to address the
problem of determining what is a significant clinical difference. The collaboration of a cognitive
psychologist, decision scientist and clinical trialists led to an analytical
approach (The Treatment Trade-off) that would not likely have emerged
otherwise.
Dr.
Naylor described the important influence of the evolution of convergence in
science as a driver of increasing interdisciplinarity and
transdisciplinarity. In evaluative
clinical sciences, he described how studies on variations in clinical practice
led to exploring variations in the incidence and severity of disease and
eventually to delineating the social determinants of health status – an
evolution in which an ever-widening circle of social scientists and community
health specialists were involved.
Similar convergence is emerging in the area of
genomics where not only the boundaries between basic biological disciplines are
disappearing but where social scientists and geneticists are working together
on the societal implications of basic discoveries including the interaction of
genetics and the environment and the life-course effects of influences on fetal
development. Technological advances
(e.g., bioinformatics) also act as a stimulus to convergence of physics,
chemistry and biology. Naylor concluded by observing: “This kind of convergence
speaks to the way in which, despite our own resistance, sometimes shifts in scientific
thinking and transformative paradigms will drive us to be more
transdisciplinary than we would have imagined….In the CIHR, we have a set of
structures that are likely to move ..(ultimately).. to a more transdisciplinary
approach. ... I remain optimistic that some of the greatest advances in the
next 20 to 30 years will actually come from the convergence of disciplines
driven by both new funding structures as well as changes in scientific
thinking.”
1.2 Unique challenges to interdisciplinary
research: Effects of discipline,
science, culture and region.
Cam Mustard, Scientific
Director, Institute for Work and Health, University of Toronto illustrated the effects of discipline, science,
culture and region, by reference to his recent experience as Scientific
Director of the Institute. The
Institute is non-profit, self-governing, affiliated with three universities in
Ontario, and has a staff of about 70 of whom about 20 are scientists. The Institute’s research mandate is to
advance understanding of the causes of disability and illness as they arise in
our working lives and to evaluate the treatment of disabilities in order to
facilitate productive re-engagement in work
life.
Within the Institute are a number of
clinicians and researchers with expertise in clinical medicine, rehabilitation,
epidemiology, public health, biostatistics, sociologiy, psychology,, economics
and chiropractic. Mustard noted that
the potential for conflict is always present and needs to be managed, including
by reminding the various members of the Institute of the importance of the
common mission and the value of constructively collaborative work in solving
complex “real world” problems. Tensions
in the organization have arisen around:
The environment in the Institute results in a
process of natural selection. Those who
can adapt to the interdisciplinary characteristics and the tensions they
generate stay on; those who can’t, leave.
This has implications for recruitment in that it is desirable to select
recruits who are likely to adapt successfully. Clarity of the mission and
explicit understanding of the working style are important, as is some prior
experience in working with other disciplines.
In closing Mustard noted the importance of core
funding in providing the ability to facilitate interdisciplinary research. He also noted that with CIHR’s commitment to
interdisciplinary research “…(one can) now conceive of ways ..(to) .. put
problems together in their totality into the peer review process, rather than
breaking them up into a series of disciplinary questions.”
1.3 When ethical constructs collide.
Henry
Dinsdale, Professor Emeritus, Queen’s University began with general comments about some of the
tensions that have arisen in the context of the industrialization of clinical
research as seen in the rapid expansion of clinical trials. He noted that until recently 80 percent of
trials in the United States were conducted in academic medical centers. Currently only 35 percent are conducted in
such centers with a rapidly increasing proportion being done in community practices
where the physicians involved are simply acting as patient recruiters with no
involvement or responsibility for the scientific direction of the work, its
ethical oversight or the manner in which trial results are used.
Dinsdale
then noted some of the interdisciplinary tensions surrounding the formulation
of the Tri-Council Statement on Ethics Involving Research on Human Subjects and
its practical applications. Some of
these have to do with the concern that the approaches used in the biomedical
sciences may not be suitable for some of the social sciences. He cited the example of the requirement that
the research protocol must be for a specific and clearly understood
question. Yet some anthropologists and
sociologists will argue that in some cases the research question and
methodology may have to evolve through an iterative process involving the
subjects themselves. Another example of
differences in ethical perspective noted by Dr. Dinsdale involved the
definition of minimal risk. He observed
that the effort to evaluate the Tri-Council Statement’s effects with a view to
refining it (including reconciliation of different disciplinary perspectives)
lost some momentum when attention had been focused on the creation of CIHR and
he called for the effort to be reenergized.
In the final part of his presentation Dr. Dinsdale mentioned work done by a task force for the National Council on Ethics in Human Research (an organization whose main role is to be a resource for research ethics boards) on the oversight of research ethics boards. The main thrust is on the development of a system of accreditation that would serve to reassure the public that ethical review systems are in place and working effectively. The key elements of the accreditation process are that it is voluntary, peer based, employs sound standards and criteria, operates at arms length from vested interests, is transparent, flexible, simple and has “buy-in” by major stakeholders. Dinsdale noted that accreditation processes can have an important educational function through which some of the differences in the ethical perspectives of various disciplines can come to be better understood and misunderstandings corrected.
DISCUSSION Session 1
Question (Dr. Dorothy Pringle):
Dr.
Dorothy Pringle asked if the existence of special administrative structures
such as institutes was a key to successfully moving to a transdisciplinary
approach.
Response (David Naylor):
Dr.
Naylor agreed that structural strategies are part of the answer but he observed
that other influences were also important.
He categorized the drivers of interdisciplinarity as including:
He
observed that no single driver may be sufficient or necessary. He cited the convergences going on within
existing academic departments in universities.
Response (Cam Mustard):
Mustard
noted that there are probably several explanations for why these organizations
(institutes) popped up outside the universities, in addition to the fact that
it is easier to create a convergence of different disciplines in a "green
field" situation rather than try to weld it together within the
university.
Question (Dr. H.
Friesen):
Dr.
Friesen inquired about the emergence of commercial Research Ethics Boards
Response (Henry Dinsdale):
Dr.
Dinsdale noted that some commercial REBs are well-established, and respected
but we don’t know enough about others. He suggested, in particular, that one
needs to know if the scientific component of proposals gets as much attention
in commercial REBs as in institutionally based REBs. In some countries and in Alberta commercial REBs are either
prohibited or unnecessary because of special arrangements.
Question (Dr. Henry Friesen):
Dr.
Friesen asked if a focus on interdisciplinary research is a detriment to
academic career advancement (e.g.; in consideration of promotion and tenure)
Response (Cam Mustard):
Dr.
Mustard indicated that it is too early to tell if career advancement is affected by working researchers in
cross-disciplinary areas and it is not yet clear that effective mechanisms
exist to evaluate them.
Response (David Naylor):
Dr.
Naylor agreed and added the particular need to develop a better appreciation of
contributions to team research and the multi-author publications that
result. He felt that career progress
was not blocked by involvement in interdisciplinary work but tended to be
slower than the norm for other academics
Comment (audience member):
The
individual is a cognitive psychologist working in an academic medical center
housing a research institute who holds appointments in two clinical
departments. He found the departments to be more supportive of collaborative
research than the institute.
Comment (Raisa Deber?) –
Professor
Deber sits on a health research REB and raised a concern about a lack of
proportionality in the rules of procedure.
The result is that research involving relatively trivial interventions
must follow the same procedures as proposals for more complex and serious interventions
thereby creating unnecessary impediments.
Response (Henry Dinsdale):
Dr.
Dinsdale suggested that problems of that sort would benefit from ongoing
dialogue among institutions and their REBs so that approaches that are
effective in providing for proportionality can be widely shared and
adopted.
Question (audience member):
The
audience member asked Dr. Naylor if universities have been able to adapt their
policies on graduate studies to be “truly interdisciplinary”
Response (David Naylor):
Dr.
Naylor identified several examples within the University of Toronto where
interdisciplinary graduate studies were being actively fostered. However he expressed misgivings about the
continuation of schools of graduate studies in universities, given an adequate
external regulatory environment with a council of graduate studies as an
accreditor. He viewed as preferable
“driving ..(the control)..down to the front lines of scholarship..(by)
vesting the responsibility for graduate
studies within faculties and the re-creation of inter-faculty graduate programs
and interdepartmental programs”.
Rapporteur's Note:
Not
all provinces have external accreditation mechanisms for graduate studies.
Session 2: New Models
Chair: Dr.
Peter Walker, Dean of Medicine, University of Ottawa
2.1. CIHR:
21st Century Models
Dr.
Stephanie Atkinson, Member, Governing Council of CIHR observed
that
the mandate of CIHR is not only broad in terms of the disciplinary scope but includes the facilitation of the transfer of the knowledge gained to practice, education, advocacy and policy and an evaluation of the impact of the research in improving the health of the population and in contributing to economic growth. The CIHR sees itself as being pro-active, integrated, innovative and competitive. It has evolved an organizational structure that supports central functions (peer review, ethics, partnerships, finance planning, evaluations, clinical research and international linkages) and distributed functions associated with the various institutes (scientific directors and institute advisory boards) and CIHR University Delegates. A major feature of all of these groups is their diversity in terms of representing the CIHR’s four thematic pillars and various societal sectors (voluntary organizations, government, industry)
Dr. Atkinson described the funding structure of CIHR, the expansion of the membership and the number of peer review committees in order to include representation of the four thematic pillars. She made special note of the fact that the peer review committees are at arms length from both the Governing Council and from the Institutes. The strategic programs of CIHR include those inherited from MRC (HIV/Aids, human genome, hepatitis C, etc.) and the transition programs established to get the health research community ready for the new CIHR mandate. The latter were illustrated by reference to activities associated with the IHRT (interdisciplinary health research teams) and the CAHR (community alliance health research) programs that were designed to be interdisciplinary from their inception. Going forward, strategic initiatives will be developed at the Governing Council and Institute levels. Proposals for such initiatives will be peer-reviewed but likely by special committees to avoid an excessive burden on the regular peer review committees. Both Innovations in programming are anticipated in a variety of areas including in capacity building and in industry-related programs that are broad in scope and critically evaluated.
Dr.
Atkinson concluded her remarks by identifying two linked major challenges
facing CIHR in meeting the objective of being internationally competitive: the
realization of the next major tranche of funding from the Government of Canada
and convincing Canadians that supporting CIHR is a valuable investment in
improving their health status.
2.2. From
Medicare to Home and Community (M-THAC): A Community Alliances for Health
Research Project of CIHR. .
Prof. Raisa Deber, Director
of M-THAC described the project
that was officially launched on May 10, 2001. It is based in the Department of Health Management and
Evaluation (University of Toronto), and draws researchers from a number of
different organizations/universities and variety of disciplinary
backgrounds. The objective of the Community
Alliances for Health Research (CAHR) Program of CIHR is to sponsor excellent
research relevant to community groups and agencies. It includes a strong emphasis on training dissemination and
partnership. The M-THAC program is one
of 19 projects recommended for funding.
The funding allocated to M-THAC was $225,000 per year for 5 years, a sum
too small to fully fund research projects. It is therefore being focused on
infrastructure to facilitate and disseminate research, with a strong emphasis
on student training and working with community partners.
Within
the overall objective of fostering research and partnership in a way that
informs policy and service delivery, M-THAC will examine the effects of moving
health care from institutions into the community. The examination will involve three themes:
·
A systems level
analysis of the effects of moving health care from doctors and hospitals to the
community.
·
Evaluation at the
level of service delivery (e.g. best practices; supply and demand for
services).
·
Human resource issues.
Prof.
Deber went on to describe the range of scientific and professional disciplines
involved in the project and the three broad categories of partners: national
organizations, regional partners in Toronto and other parts of Ontario
including professional colleges and
both for-profit and not-for-profit service providers, and an international partner. She also described the training programs,
in which students can be involved either as a research associate on a
particular project or as an M-THAC fellow, and she outlined M-THAC’s role in
knowledge dissemination.
Prof.
Deber identified lessons learned in developing M-THAC:
·
The existence of
sharply differing views of intellectual property and the implications of such
differences for working in a collaborative mode require that this matter be
addressed at the beginning of the engagement of researchers in the project.
·
The need to defend the
validity of qualitative research and a broad view of what constitutes valid
evidence
·
In working with
partners it is important to guard against promising more than can be delivered;
to avoid being co-opted by the special interests of partners; and, to make sure
that partners understand that they do not control the results emanating from
research, and that in working with them researchers are not working for
them. She emphasized that in any such
endeavor, partners need to recognize that this type of integrity is essential
or the enterprise has no credibility. Clarity at the outset is essential; the
M-THAC partners fully recognize the above points, and have been highly
supportive.
2.3 The
Institute of Neurosciences, Mental Health and Addiction (INMHA) of CIHR: Unique
Challenges and Opportunities.
Dr. Rémi Quirion, Director,
of INMHA. began by showing a graphic in which the 13
CIHR institutes are portrayed as pieces of a puzzle that must fit together to
achieve the interaction that is a central feature of the concept of CIHR. The INMHA is the largest institute in terms
of current funding to individual scientists.
Its Advisory Board represents a variety of scientific disciplines and
voluntary organizations. Dr. Quirion
noted that the INMHA covers scientific territory that in the US is covered by 6
NIH Institutes and indicated that the CIHR arrangement was more likely to
foster interdisciplinary research than the NIH arrangement. He further observed that in his round of
visits to universities across Canada there was great interest expressed by
scientists in developing research collaboration across disciplines. Two other important objectives are to
enhance training in the field of neurosciences, mental health and addiction and
to assist in reducing the social stigma often associated with brain disease.
Among
the challenges facing the INMHA is the very size of the neuroscience enterprise
and the fact that there are several excellent scientists in the field in Canada
who are not represented in the CIHR database and who need to be integrated into
collaborative arrangements. Dr. Quirion
felt that meeting the challenge of obtaining cooperation from a variety of
disciplines relevant to neuroscience, mental health and addiction was
progressing faster than he had expected.
He also noted that the challenge of ensuring that the INMHA gets its
fair share of resources is likely to be complex but so far there is a generally
positive attitude amongst his fellow institute directors and he has identified
several opportunities for inter-institute collaboration.
Dr.
Quirion described two programs of special note launched by the institute: the
Brain Star Program to provide recognition and encouragement to young scientists
and a strategic grants program in 4 areas.
2.4 Researchers and Decision Makers:
Promoting Linkage and Exchange.
Dr.
Kevin Smith, Vice-President, St. Joseph’s Hospital, Hamilton expressed the view that fundamental to the success
of the research enterprise is still the individual researcher asking an
important question with methods that are state-of-the-art and with an
infrastructure that allows them to ask those questions in a meaningful
way. Decision makers generally do not
recognize or care much about the niceties of the distinction between
multidisciplinary, interdisciplinary, and transdisciplinary types of
research. Styles of research are less
important to decision makers than the relevance of research outcomes to the
kinds of issues about which they must make decisions..
He observed that attitudes about relevance and
accountability amongst scientists have changed in recent years. Whereas formerly scientists would claim they
are primarily accountable to peers in their respective disciplines, they now
often include accountability to funders, to institutions and to the
public. This bodes well for building
linkages between researchers and decision makers that can not only aid in the
knowledge transfer function but can also help in establishing an agenda for
policy-relevant research. On the
decision maker side, Dr. Smith noted a significant interest in collaborating in
the research process in an appropriate way.
It
is important to recognize that researchers and decision makers respond to
different motivators when it comes to research. Researchers are mainly driven by what they believe to be the
scientific importance of a particular line of investigation. A decision maker’s interest on the other hand
may be sparked by media attention to some untoward occurrence in the health
care system that arouses public concern.
The “evidence” used by decision makers includes not only the knowledge
acquired through research but also the concerns of the public and a sense of
the public acceptability of various potential courses of action
Dr. Smith identified several strategies for increasing the capacity of decision makers in the health system to understand and promote relevant research including:
· building a research component into the training programs for health system managers
· adopting a recruitment philosophy - shared by the highest level of institutional governance - that seeks out institutional leadership with a core commitment to evidence-based decision-making
· creating opportunities for researchers and decision makers to interact and to gain a greater appreciation of their respective cultures and expectations
· creating mechanisms for mentorship and career development in policy-relevant research
· developing a “marketing plan” that communicates the importance of policy-relevant research for improving the health care system in ways that are suitably tailored to the needs of particular audiences (the public, governments, media, industry etc.)
Dr.
Smith noted that the CIHR could play an important part in implementing one or
more of these strategies. There
are also opportunities for hospital and university research centres to
contribute to linkage and exchange by investing in faculty development focused
on interdisciplinary collaboration since the issues confronting the health care
system require an interdisciplinary approach.
Comment (Raisa Deber)
Prof.
Deber cautioned against going overboard on interdisciplinarity. The nature of the research problem should
determine what kinds of disciplines are required to tackle it. She stated: “There is still an enormous need
for well-trained people working at the fundamental level within a single
discipline…. you can’t just have everybody be a jack- of-all-trades.” She also noted that decision-makers are
often influenced as much or more by values and ideology than they are by
objective knowledge and that one cannot assume that decision making is a purely
technical enterprise. In response to a
query from Dr. Smith she said her comments were not intended to discourage
dialogue but were a call for realistic expectations.
Dr. Aubie Angel closed the Symposium by thanking the
presenters and the discussants for their animated participation. He noted that the topic should be pursued
further and in other forums in order to explore.fully the evolution of
interdisciplinary research., . It is
also clear Dr. Angel also noted that national meetings of organizations central
to the academic health sciences enterprise offer excellent venues to discuss
opportunities and issues that relate health research to advanced health care.
Accordingly, and as part of its mission to promote a robust health research
agenda for Canada, the FCIHR will
continue to sponsors symposia on timely topics.