On Multidisciplinary Research
“ ‘Multidisciplinary’ is what everyone says but no one actually does.”
The first presentation of our mini-orientation at Tulane University began on this weary note and perhaps without realizing it, there I was, nodding – an unspoken “That’s the way it is,” to the reality I often saw but in no way felt qualified to change.
Several of the world’s most serious health problems are caused by a multiplicity of factors: poverty exacerbates health conditions like TB and limits access to appropriate care even though effective treatment exists. Mental health issues, like substance abuse, complicate the ugly web of risk behaviors, stigma, domestic violence, medication adherence, and (again) poverty associated with HIV/AIDS.
Yet we already know this.
The point is that few treatments adequately tackle this web in a multidisciplinary manner, often to the detriment of more innovative and effective strategies. Research and anecdotal evidence reveals, for example, that adherence to a medication regimen is delicately balanced on a steady source of income or status quo mental health functioning. A disruption to any of these can cause the precipitous cascade of an otherwise controllable illness. Still, most research continues to focus heavily on one dimension of a health problem that is acknowledged to be multidimensional, as if an outdated ode to the magic bullet.
But as a Fogarty Scholar at the Institute of Clinical Effectiveness and Health Policy (IECS) in Buenos Aires, my foreign counterparts have provided me with a different model. This was evident from my first day, as we went around the room for introductions.
Hi, my name is Joaquín. I am an economist. The rest followed accordingly: Luz, a biostatistician. Nina, a sociologist. Agustina, an obstetrician. Ana María, a midwife. Tomás, an epidemiologist. Alejandro, a nurse. Not to mention the slew of adjunct legal experts, policy decision makers, microbiologists and anthropologists who flock through the doors for further research collaboration (though no Joe the Plumber has stepped in just yet). Add in rich international collaboration, and what results is an environment fertile for the wellspring of new ideas.
A case in point has been the discussions in our weekly project meetings. A presentation on tobacco and poverty in different countries invites a diversity of feedback, such as the suggestion to include purchasing power parity or the Big Mac index for a more refined income level stratification. The ongoing projects at IECS range from cardiovascular disease to Chagas’ to caesarean section and methodological approaches are tailored to the research question, as each expert provides his recommendations. These range from qualitative analyses for focus group data to discrete choice experiments, derived from economics to quantitatively determine the relative weight of multiple factors associated with healthcare decisions.
Though still few, multidisciplinary approaches seem to be growing, such as the use of microfinance strategies plus educational programs to reduce risk behaviors and intimate partner violence in HIV/AIDS.1 IECS has modeled this type of multidisciplinary approach to research that I had as yet never been exposed to, and the quality and productivity of the center speaks to the powerful impact of this approach.
1 Pronyk, PM, Hargreaves, JR, Kim, JC, Morison, LA, Godfrey, P., et al. (2006). Effect of a structural intervention for the prevention of intimate-partner violence and HIV in rural South Africa: a cluster randomized trial. Lancet, 368, 1973-83.
