IJE Advance Access originally published online on September 19, 2006
International Journal of Epidemiology 2006 35(5):1119-1122; doi:10.1093/ije/dyl200
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Editorial |
It's not easy being interdisciplinary
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pine Ave West, Montreal QC H3A 1A2, Canada
E-mail: john.lynch{at}mcgill.ca
It is no surprise that in a world dominated by business models and bottom lines that talk of interdisciplinarity is on the rise in science, as we are increasingly encouraged to be innovative through collaboration that ‘leverages’, ‘exploits’, and ‘optimizes’ resources. If you have not already heard these words around your workplace, you probably soon will. In fact, interdisciplinarity is now being studied as a scientific phenomenon in its own right1 as scientists and organizations struggle to figure out how to be—well, interdisciplinary.
In epidemiology and health research more generally, there is also a growing sense that we need more interdisciplinarity to help produce better answers to questions about causes and cures. It seems to me that, in significant ways, epidemiology is already an interdisciplinary endeavour. This is because, first, epidemiology is practised by people from diverse disciplinary backgrounds, and, second, it is intended to be applied—towards improving individual and population health. Epidemiologists describe distributions of health states in populations, make inferences about the causes, and intervene to change those causes to improve population health. Interdisciplinarity—whether residing in an individual whose knowledge spans disciplines or multiple individuals on a team who collectively span disciplines—is neither necessary nor sufficient to produce useful epidemiology. But like it or not, we are being induced to be even more interdisciplinary. Nowhere is this more evident than in striving to understand gene–environment interaction and to figure out how such knowledge can be applied to improve individual and population health.2 The general tendency seems to be that the need for interdisciplinarity increases as we move from description, to causal inference, to applications in interventions and policy change.
The IJE is a prime example of a journal oriented toward interdisciplinary research in epidemiology. I am reliably informed that one of the editors has been accused of being a social scientist masquerading as a geneticist and as a geneticist masquerading as a social scientist—that seems like testament to interdisciplinarity. It is not surprising then that the editorial board of the IJE also spans many disciplines. And so it is common and welcome to see the influences of anthropology, medicine, sociology, economics, history, politics, genetics, mathematics, biology, and other disciplines in papers, editorials, and commentaries in the IJE. And that is what helps make the IJE such an interesting and compelling read.
What makes the contributions in the IJE interdisciplinary? Is it because of the range of exposures that are included? Is it because of the use of ideas from other disciplines to broaden conceptual models, and better explain and contextualize results? Is it because of the academic qualifications of the first author or the array of disciplines represented on the author list? Is it the application of methods developed in adjacent disciplines? Is it because of the background processes by which the idea for the research was generated? I really do not know nor do I think it matters. These may all be useful hints to help us recognize interdisciplinary research when we see it. There are several examples of interdisciplinary research informing epidemiology in this issue of the IJE. For instance, Vineis and Berwick3 apply ideas from another discipline when they bring evolutionary biology to bear on proposing a ‘Darwinian’ model of carcinogenesis. Catalano, who is an economist by training, and Bruckner use time series analysis to show that early life environmental insults reduce subsequent lifespan—an example of ‘diminished entelechy’.4 Hoosseinpoor et al.5 apply novel methods to help advance understanding of the determinants of social inequalities in infant mortality in Iran, by decomposing the concentration index for infant mortality into its components parts. It is rare to see concentration indices used in epidemiology, despite some useful characteristics, let alone decomposing them into their constituent parts.6 This novel interdisciplinary work in epidemiology relies on techniques first used over 30 years ago in labour economics.7
Terminology
Figure 1 tracks the rise of publications using the words ‘multi-’, ‘inter-’, and ‘transdisciplinary’ in the title, abstract, or keywords of research included on the Web of Science. (http://portal.isiknowledge.com/portal.cgi; accessed August 1, 2006) The different terms are used, sometimes interchangeably, in scientific literature to describe the general phenomenon of research and practice that embraces different disciplines. It is interesting to scan through these citations from the first use of the term ‘interdisciplinary’ in 1944. Much of the earlier material, up to the 1980s, that discusses cross-disciplinary issues focuses on better solutions to very applied problems, especially with regard to the need for ‘multidisciplinary teams’ for case management and treatment, in psychiatry, aging, and disability. This resonates with the idea expressed earlier, that the need for interdisciplinarity is greatest in the applied arenas of intervention and policy change.
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‘Multidisciplinarity’, the most common term with over 18 000 citations by 2006, literally refers to ‘many’ disciplines. While it remains the most common term, I think it is fair to say that its use in epidemiology and health research has started to wane. Perhaps we quickly realized that simply bolting other disciplines onto our research like some multidiscipline Mechano set, which had a genetics piece, a psychology piece, a social piece and a biology piece, did not really deliver what we were after. Simply having the pieces did not mean they were articulated or informed each other. In the spirit of multidisciplinarity, some of us have no doubt canvassed around for a willing economist, or geneticist, or exercise physiologist to sign on to our proposal. It looks very multidisciplinary on paper but sometimes it does not work very well in practice. There is sometimes little real intent to span disciplines and often little serious consideration of, or budgeting for, infrastructure to get people to actually work together collaboratively.
So now we tend to think more of ‘interdisciplinary’ research, which literally means ‘between’ disciplines and invokes notions of exchange—something is actually transferred across disciplines—that makes for better epidemiology. This term draws attention to the importance of research process and output over what appears on paper as research structure. The latest term—‘transdisciplinary’ research—first appeared in 1970, and by 2006 there were about 600 cites. It describes research that ‘transcends’ disciplines, that cuts across disciplinary boundaries, even including non-scientific sources of knowledge, synthesizing and integrating knowledge as it goes, and perhaps even leaping tall buildings in a single bound. Doing transdisciplinary research seems like a great idea, but it is not yet clear what sort of creature this really is, or how it is deliberately created. Transdisciplinary research would appear to be also related to what is being called ‘translational’ science in biomedicine8—a bench to bedside integration of knowledge and practice. This sort of research in epidemiology and biomedicine is intended to take knowledge and better apply it to clinical practice, intervention, and policy. There is a recent issue of the WHO Bulletin devoted to such translational efforts.9 In my own research environment in Canada, it is virtually impossible to receive a grant without including something on ‘knowledge translation’ activities. While this sometimes ends up being nothing much more than ‘hit counts’ on a website and a newsletter for participants, there is a genuine concern that some of what we know from epidemiology does not inform policy to improve health.
It remains to be seen how well the very substantial ‘know-do gap’ in population health—i.e. the gap between what we already know about the causes of mortality and morbidity (no further research required), and the policy actions we take to mitigate those causes—can be narrowed by making research more transdisciplinary, translational, and directly policy and practice relevant. It is an open question whether the outputs of applied research (in terms of saving lives through effective implementation) done by interdisciplinary groups is better than that done by single discipline groups. Nevertheless, the sense is that, if only we can ask more policy-relevant questions and then somehow synthesize the work into intellectually digestible bite-sized portions, then policy makers will begin to listen and make more informed decisions. Perhaps. The semantic shift from multi- to inter- and now transdisciplinary research does in some ways reflect the tasks of epidemiology. We need to describe population health and then understand the causes of disease and disability from multiple perspectives, and we then need to effectively translate that knowledge into action.
Challenges
A cursory glance through the websites of funding agencies in many countries reveals how the language of interdisciplinarity has slipped into the research and practice lexicon. Many agencies have created specific funding mechanisms to foster interdisciplinary and team grants. For instance, the US National Institutes of Health (NIH) in their ‘NIH Roadmap for medical research’ discuss how traditionally organized biomedical science with its proponents housed in separate academic silos may impede advances. Artificial organizational barriers, in both academic and funding environments, need to be removed to create new generations of interdisciplinary scientists so that ‘... a true meeting of minds can take place: one that broadens the scope of investigation into biomedical problems, yields fresh and possibly unexpected insights, and gives rise to new interdisciplines that are more analytically sophisticated.’ (http://nihroadmap.nih.gov/interdisciplinary/).
So everyone seems to agree, more or less, that interdisciplinarity is a laudable goal. Whether we will actually achieve the Spockian levels of ‘mind-melding’ exchange implied above remains to be seen. Nevertheless, funding agencies assume interdisciplinarity can be purposefully created and so provide direct support but without much guidance as to how it can be created and how we might know if it has been created. Here are some issues.
- Training interdisciplinary individuals. There can be little interdisciplinary epidemiology without interdisciplinary epidemiologists. We are all impressed with research that exhibits broad scope and includes work from adjacent disciplines and applies it imaginatively to epidemiology. Individuals who do epidemiology come from many disciplinary backgrounds—medicine, social sciences, biology, etc—and many hold multiple degrees that evidence their training in different disciplines. This author has academic qualifications in three disciplines, although that perhaps had more to do with fear of leaving university and having to get a real job. Training in medicine over the last 30 years has become more interdisciplinary, with many physicians taking intercalated degrees in other disciplines in recognition that clinical medicine is an interdisciplinary activity.
Individuals need to be familiar with and open to work in other disciplines but it takes a great deal of time and effort to fully engage another discipline, to sufficiently understand its language, concepts, substance, and methods so as to embrace its relevance and application to epidemiological questions. It is hard enough to keep up with your own discipline let alone others. Many training programmes in epidemiology explicitly recognize this and seek to broaden the intellectual base of the discipline by exposing students to the substance and methods of other relevant disciplines. We offer a range of courses and sometimes even integrative seminars but the process, which leads students to embrace interdisciplinarity, is opaque and unpredictable and needs to be balanced against ensuring they are properly trained in epidemiology.
- Creating interdisciplinary groups. Choosing and inducing collaborators from other disciplines to work with us is the starting point. Obviously we want to work with competent bright people but group cohesion and smooth functioning are also important and people need to be committed to working across disciplines. Personalities are important to consider in successful interdisciplinary collaborations. There has to be a degree of mutual respect, willingness to listen, and commitment to work together. In the US you can always buy out part of a collaborator's salary, which seems a powerful inducement although by no means does this ensure they will actually do anything. In most other countries such direct rewards for interdisciplinary collaboration are more restricted and rely on collegial good will, but the benefits of being involved in an interdisciplinary project are often not clear. ‘What's in it for me?’ is a common response to an invitation to collaborate. Even if you can induce collaborators how do you ensure the group works well together? Successful interdisciplinary groups need to develop their bonding, bridging, and linking social capital. Investments in social capital are crucial for interdisciplinary groups to work well together, lest we be reduced to working only with our mates.
Interdisciplinary epidemiology is fostered by genuine interchange with colleagues but such collaborations are sometimes difficult because of fundamental differences in philosophy about the goals of scientific research, differences in language, concepts, and methods. I recall sitting in meetings as an interdisciplinary collaborator with colleagues who were more than happy to attempt to interpret 3-way and 4-way multiplicative interaction models in a relatively small dataset. I voiced my opinion about the uncertainties of multiplicative vs additive statistical interaction and difficulties of ‘modeling air’ but the difference in analytic approach was so basic it could not be overcome and the collaboration withered. Nobody had the time or incentives to bridge the disciplinary differences. It is interesting to see how other disciplines view the potential for collaborating with epidemiologists. Some are quite positive about the possibilities,10 others less so because of fundamental philosophical differences.11
- Planning interdisciplinary studies. Most would agree the causal chains that generate ill-health span multiple levels, from social conditions to genetics and biology, and often act over the lifecourse of individuals and generations. At one level, including multiple disciplinary perspectives on the causes and cures of disease is obvious and laudable. Nevertheless, attempting to include such diverse causal processes sometimes generates difficulties of its own. At the extreme, capturing complex multilevel and multi-time point exposures requires measuring everything and careful judgement has to be exercised in how much to include in study protocols. Does doing justice to interdisciplinarity mean we need to properly measure all the relevant social, psychological, environmental, behavioural, and biological exposures? If we really did that we would need to employ participants as full-time study subjects. And how would we statistically handle all that data anyway? Sometimes, the desire to be inclusive of other disciplines means we collect a little bit of information from each area. We cut down the full 90 item questionnaire to three items and hope that captures the relevant exposure. There are indeed expensive examples in the UK, US, Canada, and elsewhere of the delicate balance that needs to be struck between broad interdisciplinary coverage of relevant exposures, participant burden, and cost. One could argue that an imperative to increase interdisciplinarity in epidemiological studies may actually help generate difficulties lest we end up measuring almost everything but almost nothing very well. And that has implications for our ability to make causal inferences because of problems with unmeasured and residual confounding.12
- Institutional barriers to interdisciplinarity. Academics and researchers generally work within institutional disciplinary environments. Epidemiologists usually work in medical or public health schools not in departments of genetics, biology, or economics. They are promoted based on parochial performance standards that may not apply in other departmentally based disciplines. For example, the value of a multi-authored publication in a medical journal is not necessarily the same in epidemiology as in sociology, where the emphasis is traditionally on single authorship. Even genuine attempts to foster interdisciplinarity within institutions by joint faculty appointments are difficult because academics from different disciplines have different expectations about what constitutes valuable knowledge generation.
Conclusion
The first paper on interdisciplinarity that appeared on my search of the Web of Science was written by Josef Brozek and Ancel Keys in 1944.13 Their paper was motivated by the idea that, ‘In applied fields a genuine cooperative approach is indispensable.’ (p. 507) Brozek was an eminent psychologist and the name Ancel Keys will be familiar to many, as one of the founders of cardiovascular epidemiology. They were working together at the Laboratory of Physiological Hygiene in Minnesota on human experiments manipulating dietary intake. Keys' earlier work on subsistence diets had given US soldiers in WW2 the much bemoaned ‘K rations’, which had apparently been described as ‘better than nothing, but not much better’. Keys' later research offered an improved epicurean profile that highlighted the importance of the now well known ‘Mediterranean diet’ to cardiovascular health. Keys had undergraduate degrees in economics/political science and biology, followed by two PhDs; one in oceanography and another in physiology. It would appear he was an interdisciplinary individual working in an interdisciplinary team. Brozek and Keys concluded their 1944 paper with three recommendations for increasing interdisciplinarity, ‘... (1) facilities for getting acquainted with the problems and methods of the neighbor fields, (2) study of the ‘science of science’ which provides the necessary philosophical perspective, and (3) development of social skills required for a stimulating and efficient scientific cooperation.’ (p. 512)
At the highest levels of biomedical science, there are calls for more interdisciplinarity. Now we are left with the struggle to better understand and implement the processes by which interdisciplinary research is purposefully created and used. As always, history is informative. Reflecting on Brozek and Keys,13 suggests that the challenges of interdisciplinarity remain largely the same as they were over 60 years ago. Reflecting on major successes in epidemiology might lead us to ask, whether aetiological research done in the past would have been ‘better’ with an interdisciplinary approach? The research on smoking and lung cancer provided a clear answer on the cause that did not require interdisciplinarity. But when it came to the answer on how to cure the problem—to save lives and change policy and practice—this continues to require the vast edifice of science in adjacent disciplines that built on the early epidemiological findings of a causal relationship. And maybe this is one of the keys to interdisciplinarity in epidemiology: are we yet doing enough to link with other disciplines in understanding the social, psychological, economic, and political factors that more fully explain any robust causal relationships that we find in epidemiological studies and apply that knowledge to effective action?
Acknowledgments
Shah Ebrahim provided insightful ideas that were included in this editorial.
References
1 Cummings J, Kiesler S. Collaborative research across disciplinary and organizational boundaries. Soc Stud Sci 2005;35:703–22.
2 Davey Smith G, Ebrahim S, Lewis S, Hansell AL, Palmer LJ, Burton PR. Genetic epidemiology and public health: hope, hype, and future prospects. Lancet 2005;366:1484–98.[CrossRef][Web of Science][Medline]
3 Vineis P, Berwick M. The population dynamics of cancer: a Darwinian perspective. Int J Epidemiol 2006;35:1151–59.
4 Catalano R, Bruckner T. Child mortality and cohort lifespan: a test of diminished entelchy. Int J Epidemiol 2006;35:1264–69.
5 Hoosseinpoor A, van Doorslaer E, Speybroeck N, Naghavi M, Mohammad K. Decomposing socioeconomic inequality in infant mortality in Iran. Int J Epidemiol 2006;35:1211–19.
6 Wagstaff A, van Doorslaer E, Watanabe N. On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam. J Econom 2003;112:207–23.[CrossRef][Web of Science]
7 Oaxaca, R. Male–female wage differentials in urban labor markets. Int Econom Review 1973;14:693–709.[CrossRef]
8 Zerhouni E. Translational and clinical science—time for a new vision. New Engl J Med 2005;353:1621–23.
9 Bulletin of the World Health Organization 2006;84:559–681.
10 Trostle JA, Sommerfled J. Medical anthropology and epidemiology. Annu Rev Anthropol 1996;25:253–74.[CrossRef][Web of Science]
11 Inhorn M. Medical anthropology and epidemiology: divergences or convergences. Soc Sci Med 1995;40:285–90.[CrossRef][Web of Science][Medline]
12 Lawlor D, Davey Smith G, Ebrahim S. Commentary: The hormone replacement–coronary heart disease conundrum: is this the death of observational epidemiology? Int J Epidemiol 2004;33:464–67.
13 Brozek J, Keys A. General aspects of interdisciplinary research in experimental biology. Science 1944;100:507–12.
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