Frontiers Magazine
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22
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Evoke the idea of interdisciplinary science in any given room of researchers, and you will likely get as many opinions as there are disciplines. As the scientific community struggles to define what exactly can be considered “interdisciplinary,” there is also a serious discussion on whether interdisciplinary research is the latest fashion or the future of scientific inquiry. In the field of public health, interdisciplinary initiatives are undeniably appropriate given its immense scope. The question remains, though: what advantages do interdisciplinary approaches offer that traditional ones cannot? Dr. William G. Powderly, Director of the Institute for Public Health (IPH) at the Washington University School of Medicine (WUSM), weighed in with perspectives gained from his work in infectious diseases, in particular, HIV. “At the beginning, you had a situation where you had a fatal disease, where the key was to find effective treatment,” Powderly said. Over a 10 year period, extensive study into the biological and genomic structure of HIV led to the development of antiretrovirals that were very effective in controlling HIV. The development of these antiretroviral drugs is undoubtedly a scientific success, but Powderly has seen a different picture emerge after the drugs hit the market. According to a 2011 study from the Center for Disease Control, in the United States alone, an estimated 1.2 million people are living with HIV infection. Of the nearly 80 percent of people who are aware of their infection, about 50 percent have remained in the medical care system. And of the people who have remained in care, 77 percent have demonstrated viral suppression after treatment. Yet when these results are taken together, only 28 percent of all people living with HIV in the United States are able to control the infection successfully. In trying to explain these results, Powderly realized that approaching the problem of HIV from a purely biological perspective was incredibly limiting. “What you start to realize is that under the biological model, you would say you make the diagnosis, you
We actually have to address why the system doesn’t work,
- Dr. William G. Powderly
put people on treatment, and you get a successful outcome,” Powderly said. “If you take it in a broader context, you realize that the factors that lead to failure are actually not traditional biological models, but are more social.” Under what Powderly calls the “biological model,” a number of reductionist assumptions are made: first, that all people infected with HIV present themselves to the medical system, and second, that controlling HIV only involves controlling the action of the virus in isolation from the individual. In reality, while researchers and clinicians are working tirelessly to control the action of HIV, a large majority of people infected with HIV fall through the cracks of our medical system. “We actually have to address why the system doesn’t work, the reason why we don’t translate the benefit of a biomedical science into a broader healthier community,” Powderly said. “And this requires going outside the discipline of biomedical science.” To this end, Powderly cited how the insights of behavioral scientists can help investigators understand the reasons why many people do not get tested for HIV and why they do not seek care. In addition, insights from economists and political scientists can help establish and finance health care systems that work. And within the field of medicine, HIV is becoming better understood within the context of mental health and addiction; mental health specialists integrate their work with traditional HIV treatment to combat the disease more comprehensively. The organization of interdisciplinary programs makes these collaborations possible. Powderly believes these programs allow for problems