Divided Attention: OBSSR’s Chief Named Acting Director of NIAAA

The highest ranking behavioral science official at the National Institutes of Health (NIH) is now also an acting institute director. Sounds ripe for a case study in divided attention and individual capacity for multitasking.

Soon after the start of the new year, Raynard S. Kington, currently serving as director of the NIH Office of Behavioral and Social Sciences Research (OBSSR), also assumed the helm as acting director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), a research institute with a budget of $384 million in FY 02. Approximately one third of NIAAA’s budget goes to psychologists, who also make up one-third of the institute’s almost 800 principal investigators. NIAAA’s previous director, Enoch Gordis, retired from that post after 15 years.

In addition to the vacancy at NIAAA, two other NIH institutes that are key supporters of behavioral science research have also lost their directors: the National Institute of Mental Health, where APS Fellow and Charter Member Richard Nakamura is serving as acting director; and the National Institute of Drug Abuse, where until late last year, APS Fellow and Charter Member Alan I. Leshner had served as director for seven years. Leshner is now the executive director of the American Association for the Advancement of Science. The virtual simultaneous departure of the directors of these three institutes is seen as a troubling gap in leadership, which in turn has raised concerns about the status of behavioral science at NIH and has led to speculation about the possible merger of two or even all three of the institutes. (See Observer, January 2002.)

Kington, who has served as the OBSSR director for just over a year, said he’ll enjoy wearing two hats, even though it means no vacations for the next eight to 11 months. He believes the temporary post at NIAAA is a good fit because of his background as an internist and public health specialist as well as his experience at OBSSR, where he interacts with a range of institutes to strengthen their commitment to basic and applied behavioral science.

OBSSR’s official mission is to “stimulate behavioral and social sciences research throughout NIH and to integrate these areas of research more fully into others of the NIH health research enterprise, thereby improving our understanding, treatment, and prevention of disease.” Located within the office of the NIH director, OBSSR has a budget of approximately $23.7 million, a microscopic amount in the $23 billion budget for NIH. OBSSR does not have grant-making authority; instead, it cajoles, coordinates, prods, and otherwise tries to convince the research institutes at NIH to do more behavioral and social science research.

“NIAAA covers a broad array of research from biomedical, alcoholism and alcohol abuse, clinical trials, and behavioral research, which is obviously an integral part,” he stated. “It is very much consistent with the model of the type of work I promote at OBSSR.”

INITIATIVES CONTINUED
As acting director, Kington plans to focus on initiatives launched during Gordis’ tenure, such as the reduction of underage drinking and college-binge drinking. The institute also recently issued a number of Requests for Applications (RFA) on alcohol health disparities, alcohol-related HIV prevention intervention, and clinical interventions for alcoholism, plus another RFA for an interdisciplinary study to broaden our understanding of alcoholism.

Kington said the latter stems from the immense need to train researchers who can speak more than one scientific language. “As science advances, we see that the lines of demarcation across disciplines are arbitrary and ultimately can serve as impediments” to progress, he said. “The behavioral science community and those in other disciplines have to address the problem by encouraging the training of individuals who are able to cut across disciplines.”

NIH is doing its part to help to break down some of the barriers that limit opportunities for young researchers in all disciplines by introducing new initiatives such as the Loan Forgiveness program, which allows NIH to pay up to $35,000 a year to pay back the educational loans of individuals committed to research careers. NIH is also looking at increasing the stipends of trainees.

Kington’s background reflects his interest in interdisciplinary approaches to health research. He came to NIH from the Centers for Disease Control and Prevention where he led the National Health and Nutrition Examination Survey, a comprehensive, ongoing survey of the health status, health behaviors, and diet of people in the United States. Kington earned undergraduate and medical degrees from the University of Michigan and completed his residency training in internal medicine at Michael Reese Medical Center in Chicago. He attended the University of Pennsylvania as a Robert Wood Johnson Clinical Scholar, earning his MBA and his PhD in Health Policy and Economics from The Wharton School. Kington’s research has focused on social factors as determinants of health. His research has included studies of the role of socioeconomic status in explaining differences in health across populations; the determinants of health care services utilization; the health status and health behaviors of Hispanic populations; and the economic impact of health care expenditures among the elderly.

MERGER NOT LIKELY
With the future of these and similar programs at stake, Kington is confident NIAAA will fare well in the upcoming FY 03 federal appropriations process. Even though NIAAA’s increase is far less than the average NIH institute increase, he believes funding increases for NIAAA, compared with other institutes, have been fair, particularly because of Gordis’ success in building a solid research infrastructure for NIAAA across a range of disciplines. “That scientific grounding is often what determines perceptions here at NIH,” he explained.

For the time being, Kington said he is also assured of NIAAA’s position within the structure of NIH despite talk of a possible merger of NIDA and NIAAA into a single institute, Kington doubts it would happen for some time. “[Ruth Kirschstein, the acting director of NIH] dealt with that issue when she formed three different search committees to fill the directorships of these positions,” he said. “The broad issue of how NIH is structured, including how the neuroscience and addition work is organized, will be addressed in the larger National Academy of Science report.” An NAS committee charged with issuing a report on the structure of NIH is currently being formed. The report is due one year after the appointment of a new NIH director.

Kington also doubts the institutes’ vacancies will lead to decreased support and visibility for behavioral science at the NIH.

“All three institutes have strong staffs and active research agendas that are being pursued. I think that all of that bodes well for those institutes advancing,” he explained. “I just can’t see how that would harm behavioral scientists as a whole.”

“Behavioral sciences are at the table,” he added. “To think that they would not be, given the state of the science, is just not plausible.”

BLURRED LINES
At NIAAA, Kington said behavioral research is a recognized part of alcoholism research. At the same time, he noted, it’s getting harder to make strict judgments about the difference between behavioral and biomedical research.

With research suggesting a genetic component to alcoholism and alcohol abuse and physiological dependency as a key factor in alcohol intake, the lines are becoming more and more fuzzy between what is considered behavioral and biomedical research. In turn, Kington said, NIAAA is pushing to build a research portfolio that cuts across the spectrum. The institute currently is supporting Project COMBINE, a multicenter, randomized clinical trial that will evaluate combinations of three interventions for treating alcohol dependence. The goal is to determine whether improvement in treatment outcomes can be achieved by various combinations of drug and behavioral interventions.

Many other NIH institutes are conducting major combined trials that have clinical and behavioral components, Kington said. The National Institute of Diabetes and Digestive and Kidney Diseases recently conducted a trial for preventing Type-II diabetes that found the behavioral strategies were more effective than medication. National Heart, Lung, and Blood Institute researchers are testing whether or not an intervention geared toward behavioral and social issues in post-myocardial infarction patients could have an impact on survival.

“In many ways, those examples and others show a willingness by the institutes to look at behavioral interventions rigorously and examine their impact on hard clinical outcomes,” he said. “There are very few who really don’t have a behavioral component, but I think the science itself is progressing so rapidly that it’s more increasingly untenable for institutes who do not appreciate behavioral science.”

Kington concludes it is necessary to keep a behavioral component in existing institutes, rather than establish a separate behavioral institute as some have suggested in the past. “Separating it implies that it is not an integral part of everything that should happen.”

At OBSSR, Kington and his staff are looking at ways to promote this connection. One example is an initiative to train behavioral and social scientists in conducting randomized clinical trials.

HIS OTHER DAY JOB
Besides running NIAAA, Kington is working on a number of initiatives at OBSSR. In addition to the clinical trials initiative, the office is working with individual institutes to develop interdisciplinary training programs, which Kington expects will come to fruition over the next year.

Among the office’s other projects is future research on the economic impact of health disparities in the United States. The office also recently reissued a methodology program announcement intended to advance a wide array of methodological issues, and released a program announcement soliciting studies of the measurement of community characteristics that broadly affect behaviors, clinical outcomes and health outcomes.

As for projects conducted jointly by NIAAA and OBSSR, Kington said the two are working together to develop a project on the interaction of social and behavioral conditions with genetic factors to affect the incidence of disease.

Kington is also going to be looking into doing other joint OBSSR-NIAAA projects as well as maintaining the amount of cross-NIH activities for NIAAA already in place.

“Clearly what I do at NIAAA is informed by my past experience and ongoing activities at OBSSR,” he said.