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Bringing Community Into Translational Research

(Image: Comstock Medical)

The traditional notion of translational research is that it's purely biomedical, bridging the gap between bench science and the clinic. But translating research--taking an innovative scientific idea from the lab, through clinical testing, then into clinics and the community--takes a village of talented scientists from a variety of fields, including social science.

"You don't get a whole lot of understanding when you're engaged in parallel play in a sandbox. It's when you're playing together that you create something that's greater than the sum of your individual contributions." –Lawrence Palinkas

To develop a therapy that's effective and widely implemented, scientists need to understand the people who might benefit from it and figure out the best way to place that treatment in the context of their lives and communities. That work, in which social scientists play important and diverse roles, requires fluency in a wide range of skills and disciplines. "I'm often mistaken for a family physician, a clinical psychologist, and a social worker," says anthropologist Lawrence Palinkas, a professor in the School of Social Work at the University of Southern California in Los Angeles, "in part because I can speak their language and have [a] rapid understanding of what they're trying to do."

But entering the social science realm of translational research--or the translational realm of the social sciences--isn't just about finding the right graduate program. The researchers interviewed for this article come from fields and departments as diverse as anthropology, psychology, and medicine. Pursuing a career in translational social science research means acquiring the mentoring, coursework, and work experience appropriate to the research questions you want to address.

Playing together in the sandbox

(Courtesy, Christopher Masi)
Christopher Masi

The National Institutes of Health's (NIH's) Roadmap for Medical Research acknowledges the importance of behavioral and social science research, and the agency's Clinical and Translational Science Awards require a behavioral science component in the programs of awardee institutions. "The Roadmap was a big push to help connect basic scientists with social scientists," says Christopher Masi, an assistant professor in the University of Chicago Department of Medicine.

Research methods from anthropology, sociology, and psychology underlie this work. These methods include the quantitative--statistical analysis of epidemiological and survey data applied to understanding population trends--and the qualitative, which includes using observation and personal interviews to form a more complete picture of the lives of individuals within a population.

Such an interdisciplinary approach requires more than just taking ideas from a foreign field back to your home turf, Sarah Gehlert, director of the Center for Interdisciplinary Health Disparities Research (CIHDR) at the University of Chicago, said in February during a panel discussion on translational research at the AAAS annual meeting in Chicago. "Instead, you talk together in a new space and share the best of your theories and analytical strategies." Palinkas expresses a similar viewpoint: "You don't get a whole lot of understanding when you're engaged in parallel play in a sandbox. It's when you're playing together that you create something that's greater than the sum of your individual contributions."

Gehlert started her research career in anthropology, studying the development of cancer at an 8500-year-old archaeological site in South America. Surrounded by deformed skulls, "I began to think that anthropology was too esoteric," she says. "I wanted to work with living people." After finishing her Ph.D. in social work, for which she examined psychosocial factors in epilepsy, she moved to the University of Chicago, where she continued her epilepsy research while leading a training program in maternal and child health and studying social factors related to contraception.

(Courtesy, Sarah Gehlert)
Sarah Gehlert

In 2002, NIH put out a call for research applications to look at health disparities--differences in health and health care outcomes among diverse populations--from a transdisciplinary perspective. Masi, a former student of Gehlert's, and University of Chicago oncologist and geneticist Olufunmilayo Olopade asked Gehlert to work with a group they were forming to look at health disparities in breast cancer. "I agreed to serve as PI [primary investigator], because it brought together my interests in women's health, cancer, and health disparities," Gehlert says. "They needed someone who could hold a group together and work across the spectrum from community health to biology."

The resulting center, CIHDR, was funded in 2003. Its research includes a cluster of related interdisciplinary projects that examine disparities in breast cancer mortality between African-American and Caucasian women using animal models, molecular characterization of tumors, and behavioral research focused on social-environmental factors. Gehlert's study follows 230 African-American women with breast cancer who live on the south side of Chicago. She and her colleagues interview each of these women for several hours every 6 months to try to understand the effects of genes, crime, poverty, and isolation on their disease outcomes.

A different kind of clinician-scientist

Masi got his initial training as a physician but became interested in the impact of social factors on health during his medical fellowship at the University of Chicago Medical Center. He was especially interested in the relationship between lower socioeconomic status and worse health outcomes among his patients. At the time--the early 1990s--research at the intersection of social science and medicine was relatively new, Masi says. With the goal of getting well-recognized training in the social sciences (and with a generous scholarship to support his efforts), he pursued a Ph.D. in social services administration and continued clinical work at a community hospital.

Masi is now working with his mentor, John Cacioppo (from the University's psychology department), on a project looking at the psychosocial and genetic effects of aging on estrogen metabolism. Along with a team of clinicians, behavioral and social scientists, and biomedical researchers, they collect and analyze physiological data; survey data that assess psychosocial factors such as stress, loneliness, and discrimination; and patient food diaries. In addition, they administer active stress tests that involve mental calculations, monitoring blood pressure before and after. Masi still spends a quarter of his time working as a primary-care physician. "I get a lot of insight from working with patients, seeing what factors seem to be associated with good health and what factors seem to be associated with poor health," he says.

Personal experience meets research expertise

(Courtesy, Kimlin Ashing-Giwa)
Kimlin Ashing-Giwa

An interest in health disparities also led clinical psychologist Kimlin Ashing-Giwa to translational research. Growing up in a minority community in Trinidad, Ashing-Giwa saw the toll that her father's cancer diagnosis  took on her own family when she was 12 years old. Those experiences led her to become a scientist, she says, because she wanted to broaden the reach of scientific research to underserved populations. Her Ph.D. research focused on mental health in minority communities, and she eventually took a position at the University of California, Los Angeles (UCLA), where she focused on sexual health among similar populations.

In 1994, that work brought her in contact with Patricia Ganz, a UCLA oncologist interested in breast cancer survivors. Ganz was looking for a minority investigator to help study cancer disparities in underserved communities and hired Ashing-Giwa, who found a new outlet for her skills and experience. She worked with Ganz for 3 years as a junior scientist, learning about cancer and chronic disease and charting a course in the relatively new field of psycho-oncology before applying for her own research funding. Although she had the social science training to study health disparities, she hadn't previously connected that work with her own cancer experience, she says. When she did, "I realized that this was my life work."

In 2005, she became the founding director of the Center for Community Alliance for Research and Education at City of Hope National Medical Center in Duarte, California, where she works with doctors, community leaders, and other scientists. Her work has many components: helping community cancer advocacy organizations write research grants, educating community organizations about cancer research, and matching patients from minority communities with clinical trials.

Embracing the applied in science

Traditionally trained social scientists who want to work in translational research have to tailor their skills to the needs of a multidisciplinary environment, Palinkas says. Anthropologists are usually trained to be "lone wolves" in collecting and analyzing data, he says. For them, a team approach might not come naturally. After he finished his anthropology Ph.D. in the early 1980s, he decided to shore up his quantitative research skills by doing a postdoc in epidemiology at the Naval Health Research Center in San Diego, California.

(Photo: Cynthia Howe)
Rebecca Winitzer

Rebecca Winitzer's curving path toward translational research has yielded experience in several disciplines. She was premed in college but soon turned toward public health and pursued master's degrees in public health and clinical social work. Although one of her public health mentors wanted her to pursue a Ph.D. immediately, she instead took some time to get real-world experience. She's glad she did: "I think working in the field is really important," she says. "When you just go from program to program, you don't see problems in action." She's now a 2nd-year Ph.D. student at the University of Chicago School of Social Services Administration , and she says her time working in the clinic with children, adolescents, and families has focused her research goals.

Finding and focusing hard on the research question that you'd like to address is more important than getting a degree from a particular program or in a particular field, Gehlert says. Consequently, it's important that the program you choose give you the flexibility to shadow clinicians and to take a variety of courses in areas such as genetics, health behavior, and clinical practice. Physicians or medical students might want to look for M.S. or master's of public health programs to supplement their clinical training, Masi says. But more important is "collaborating with a successful and energetic mentor in the social sciences who appreciates the interest of a physician in his or her work."

Opportunities and optimism

The majority of the job opportunities at the intersection of social science and translational research are within academia--medical schools or schools of public health or social work--but job opportunities also exist at government agencies and private foundations and research institutes, Palinkas says. Still, Winitzer is aiming for academic employment--and she's optimistic about her job prospects. "[The academic job market in] social work is better than so much of academia," she says. Her research focus on health insurance--on how differences in coverage affect families and children with special needs--is timely.

The kind of work these scientists do seems to nurture a level of commitment that often boils over into advocacy, Masi says. "At the end of the day, when we establish a strong link between psychosocial factors and health, what do people do with those results?" he asks. He believes those scientists "have a responsibility to raise the profile of the importance of social factors to health."

Sarah Webb writes about science, health, and technology from Brooklyn, New York.

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