XXXII. Interdisciplinarity and Community-Based Participatory Research

As Bose came to understand and social activists like Martin Luther King discover in their work, the human tendency to create systems to preserve privilege and power are not expressed exclusively in archaic systems of social and religious hierarchy. Many other structures, though not as elaborately worked out as the Indian system of caste, devolve almost naturally and inevitably from this human propensity for control to create “clubs of the initiated.” These eventually stunt growth; and have done so across a wide span of human endeavor, including the sciences. Just as the leaders of “religious right” confound ignorance with faith, the leaders of these “clubs” confuse membership (often entailing affiliation with “elite” institutions and placement in special structures that they have created) with merit. The absence in major general medical journals of results from the Mumbai Cohort Study; well designed, uniquely positioned to pose and answer important public health questions, and one of the largest cohorts in the world, may reflect this subtle prejudice. Results from the study are widely published in highly ranked specialty journals such as the American Journal of Epidemiology and the International Journal of Epidemiology. So, it is not for lack of technical excellence that manuscripts are summarily rejected, without review, by mainline general medical journals in the West.

Blind spots inevitably exist within specific domains of scientific expertise and breakthroughs often come from the fresh perspectives of non-experts, as pointed out in Dr. Harold Varmus’ Book, The Art and Politics of Science, and was evident in the early discovery that tobacco causes cancer by one of my mentors, Dr. Ernst Wynder, when he was a medical student at Washington University! Recognizing this, the Cancer Prevention and Control Program is strongly committed to interdisciplinary science. Our nine core faculty represent four different departments in two schools at USC. Our pending Center of Biomedical Research Excellence application to the National Center for Research Resources will add seven new faculty from six schools within USC. Affiliate members represent nearly 20 departments in five different universities across South Carolina. In order to work together effectively we need to create intellectual oases where we can meet to discuss and exchange ideas in nonjudgmental ways. It also means that we need to get to know enough about what each other are doing so that our understanding is not superficial, even if we may not be able to function as bona fide experts in the “new” area. While talking about this is simple enough, doing it is another matter. Egotistical attachments to very deeply ingrained senses of order and worth are hard to break. It is rare to find people who can give these up at all, let alone easily. So, we work hard to maintain a respectful, inquisitive attitude towards each other as well as colleagues we invite in as collaborators.

We also are committed to community-based participatory research (CBPR), a collaborative approach to research that equitably involves partners in the research process and recognizes the unique strengths that each brings. CBPR emerges from a tradition in environmental health and social justice that encourages social activism and recognizes unique strengths and perspectives through active participation in the research process. The National Cancer Institute (NCI)-funded South Carolina Cancer Disparities Community Network is the main, but not exclusive, vehicle through which we do CBPR. Dr. Leslie Cooper, our Program Office at the NCI and an important team member, is pictured with Dr. Cheryl Armstead, CPCP core faculty member from Psychology, in the Congaree Swamp National Park, located in a very rural area of Lower Richland County just 25 kms (15 miles) from the University of South Carolina in downtown Columbia. By defining team building around projects more broadly to encompass CBPR we honor the community by acknowledging that it has special expertise and specific ways of collecting information and transmitting knowledge. In that sense the community, too, represents disciplines of thought and conduct that embody intellectual domains worthy of equal partnership. In the photo to the right Ann Pringle Washington, President of the Eastover-Lower Richland Business Association, with whom we work on issues ranging from organic farming to healthcare, is second from the right, flanked by Leslie and Cheryl. In a recently published article we describe the important philosophical and practical similarities between CBPR and interdisciplinary research (Hebert JR, †‡Brandt HM, ‡Armstead CA, *‡Adams SA, ‡Steck SE. Interdisciplinary, translational, and community-based participatory research: finding a common language to improve cancer research. Cancer Epidemiol Biomark Prev 2009;18(4):1213-1217.).

I explain to our community-based colleagues that, as with all human interactions, everyone enters the field of play with preconceptions and prejudices. This is not restricted to university members in relation to non-university members. When I have described some of the preconceptions and prejudices that I have witnessed (or even harbored!) to community members they quickly see the universal nature of the problem. The example on squamous cell cancer of the esophagus that we provide in the article is a mea culpa call to attention regarding the blind spots that we encourage when we work in relative isolation to produce academic products at high speed for personal professional advancement. I want to be clear that I do not think that academic promotion is a bad thing; indeed, I appreciate that is necessary for survival. However, we must be committed to supporting people doing this in a principled way that will lead to reductions in cancer-related health disparities. An important part of the process entails working together to overcome our own feelings of superiority and inadequacy, and acting courageously in support of others who have chosen this noble path.