Multidisciplinary Initiatives--Women's Health Research as a Model


How do you lower barriers to interdisciplinary research? Start by creating a cadre of new investigators committed to working across professional and scientific boundaries, then build a structure for large-scale research projects. In the last few years, the National Institutes of Health's (NIH's) Office of Research on Women's Health ( ORWH) has been an innovator in stimulating interdisciplinary research through funding initiatives.

In 1999, ORWH published its Research Agenda for the 21st Century. This document identified not only areas of research need but also research strategies, one of which is to foster multidisciplinary collaborations. For too long, investigators in different scientific and professional disciplines had worked in isolation, without the benefit of outside perspectives and approaches. From the funding viewpoint, in women's health as elsewhere, important topics sometimes have fallen between the clearly defined mission priorities of individual NIH institutes and centers. In terms of professional development, newly trained clinicians and scientists have often needed advanced mentored research experience before they were ready for independent careers, but funding for this critical interval was sparse. ORWH used its overarching position as an NIH-wide office to create innovative programs to bridge these gaps.

The first ORWH program to take this bridging approach was a career-development grant program, Building Interdisciplinary Research Careers in Women's Health (BIRCWH). It uses the K12 mentored research scientist program award, an umbrella mechanism in which each grantee institution assembles a team of mentors, plans its programs, then recruits and selects its own scholars. The structure resembles a training grant for early career scientists, especially--but not exclusively--for clinicians. The request for applications (RFA) used the ORWH agenda to devise a starting set of multidisciplinary topic areas, without being overly prescriptive. The investigators were encouraged to use their own creativity in bridging gaps in women's health research, including sex/gender similarities and differences.

The first group of 12 awards, each approximately $500,000 per year for 5 years, were made in 2000. By the fall of 2002, 69 scholars had been appointed; collectively, they had published 62 papers and 31 abstracts and had made 42 presentations. They had successfully competed for six NIH grants (five K awards, one R01) and 19 private-sector or institutional awards.

A second round of competition in 2002 resulted in 12 more awards. A total of 14 NIH institutes and centers, plus the Agency for Healthcare Research and Quality (AHRQ) cosponsored the RFAs. This partnership reflects the breadth of the initiative, including basic, translational, clinical, or health services studies in biomedical or behavioral sciences. Each junior faculty scholar is appointed for a period of at least 2 but no more than 5 years and works with an established mentor on a project that must be multidisciplinary--that is, one that brings together distinct scientific disciplines or approaches to a research problem relevant to women's health.

Some examples of the scholars' projects are: effects of estrogen on cardiac fibrosis after myocardial infarction, depression and the growth-hormone axis, substance abuse, stress and nicotine, cardiovascular risk in spinal cord injury, and pharmacogenomics and the treatment of breast cancer in elderly women. At the University of North Carolina, Chapel Hill, BIRCWH principal investigator Eugene Orringer says: "During the initial 2 years of this award, we have been able to recruit 11 truly exceptional young people to our faculty, all of whom are committed to the conduct of research in the area of women's health ... and many of them have already been successful in competing for their own individual research grants." He goes on, "By identifying senior investigators and uniting them as mentors for the BIRCWH scholars, we have fostered the development of numerous important, multidisciplinary collaborations that cut across the entire Health Affairs campus. Furthermore, by its very design, the BIRCWH Program has fostered diversity, with our BIRCWH Scholars holding Ph.D.s, clinical degrees, or, in some cases, both."

Building Bridges

ORWH programs create bridges in seven different ways:

  • Career stage--bridging the transition from training to independence

  • Institutional--bridging multiple academic and health schools and departments at the grantee sites

  • Intellectual--bridging scientific approaches, such as genetics, physiology, psychology, pharmacology, epidemiology, and more

  • Translational--bridging basic with clinical research

  • ORWH--bridging its mission goals of research on women's health, women in biomedical careers, and inclusion of women as research subjects

  • NIH--bridging the areas of interest of the NIH institutes and centers, allowing them to support research on important topics that may not fall neatly into their defined missions

  • Department of Health and Human Services (DHHS)--bridging the missions of NIH with AHRQ and the Food and Drug Administration (FDA) and integrating traditional NIH clinical research with health services, outcomes, and medical-effectiveness research.

  • According to Alan Gintzler, program director of the new BIRCWH program at the State University of New York Downstate Medical Center, "While other NIH programs have supported women's health-related research, supporting the training of young investigators in this pursuit is novel and should ensure that there will be adequate research interest in the pipeline."

    In 2002, ORWH established another new program, Specialized Centers of Research (SCOR) on Sex and Gender Factors Affecting Women's Health. These, too, are multidisciplinary by definition: The RFA for this program was cosponsored by multiple NIH Institutes and yet another DHHS partner agency, FDA. SCORs are designed to complement existing programs such as BIRCWH, but each has a distinct disease focus as an integrating theme for several basic and clinical research projects. Eleven sites received awards totaling approximately $11 million per year for 5 years. The themes cover a broad range of topics illustrating the type of important problems that might be underresearched because they are "in-between" disciplines or departments. Some examples are sex and gender differences in substance-abuse relapse and sex and gender factors in the pathophysiology of irritable bowel syndrome and interstitial cystitis.

    At the University of Maryland Dental School, the SCOR has as its theme sex differences in experiencing pain. Principal investigator Joel Greenspan says: "Now that the center is a reality, we'll have the infrastructure to advance our research in a more inclusive and coherent manner than we might have had as individual investigators working on our own projects. The requirement that the SCOR necessarily includes both basic science and clinical projects will be valuable for advancing scientific discoveries out of the lab and into a clinical environment."

    Donna Vogel is director of the Fellowship Office at the National Cancer Institute and co-chair of the ORWH Research Subcommittee.

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