Social scientists in the health research field: A clash of epistemic habitus (original) (raw)

Social Scientists and Humanists in the Health Research Field

A Clash of Epistemic Habitus 1,2{ }^{1,2}

Mathieu Albert and Elise Paradis

UNIVERSITY OF TORONTO AND UNIVERSITY OF CALIFORNIA SAN FRANCISCO

Introduction

Over the course of the late twentieth century, academic science has evolved from a logic of science for its own sake where the search for truth had intrinsic value (Friedland and Alford 1991) to a logic where science has become increasingly evaluated on the basis of it economic value and societal usefulness (Gumport 2000, Popp Berman 2012a, 2012b, Slaughter and Leslie 1997). The view of science that underpins this vision is one where scientists tackle so-called “real-world problems” and find solutions that benefit society in varied ways, what Gibbons and his colleagues call “Mode 2” knowledge production (1994) and Ramirez (2006, 2010) has characterized as the shift toward the socially useful university: one that behaves like a rational actor and shows its importance for the broader society.

Canada has followed these global trends. Since World War II, Canada’s science policy agenda has emphasized collaborative research, in the hopes of increasing the utility and use of academic knowledge. A cluster of new policy and funding initiatives based on a market logic were implemented to facilitate interdisciplinary research, accelerate collaboration and commercialize academic research (Albert and McGuire2014, Cameron 2004, Fisher et al. 2001, 2005, Polster 2002, Snowdon 2005).

The value and contribution of interdisciplinarity to the knowledge production exercise is now taken for granted, and only rarely contested (among the few critical perspectives on interdisciplinarity see Cooper 2012, Moore 2011, Hoffman 2011, Jacobs and Frickel 2009, Laberge et al. 2009, Weingart 2000). Proponents believe it is a means to maximize innovation and economic growth and see it, in its ideal or idealized form, as a proven way to generate “better” research and better solutions 3{ }^{3} (for example, see Committee on Facilitating Interdisciplinary Research 2004, Frodeman et al. 2010, Hadorn et al. 2008, Hall et al. 2012). Better research is thought to arise from interdisciplinarity when a plurality of approaches are brought to the study of a “problem” by a diverse set of researchers brought together in research teams, centres, departments or faculties. One of the assumptions made by this model is that researchers from all disciplines will equally contribute to the research design and participate in the study of the problem, but our research suggests that several structural barriers limit social scientists’ and

humanists’ ability to be full contributors in the health research field. Indeed, these barriers make it impossible for their excellence to be recognized, and their epistemes to enrich and transform health research.

In the health research field, interdisciplinarity is also increasingly valued and can be seen in the transformation of both research funding and at the level of medical school faculty. Many funding agencies have developed programs specifically to intensify interdisciplinary research, and some were created for this specific purpose. For example, in 2000, the Canadian Institutes of Health Research (CIHR) was established with an express mandate to forge a health research agenda across disciplines (Government of Canada 2000). Seven years later, the U.S. National Institutes of Health created nine interdisciplinary research consortia “as a means of integrating aspects of different disciplines to address health challenges that have been resistant to traditional research approaches” (NIH 2007). Within medical schools in the United States and Canada, the number of faculty with PhDs has grown impressively (from 21,932 in 1997 to 30,363 in 2008, a 38%38 \% growth in 11 years), showing a growing commitment to research and a diversification of their staff. Within clinical departments in particular, the number of PhDs grew by 50%50 \%, from 11,479 to 17,182 during the same period (AAMC 1998, 2009).

In this chapter, we would like to trouble what we believe is the embellished story of interdisciplinarity. It is not fully demonstrated, we argue, that interdisciplinary research finds holistic solutions to “real,” complex “problems” through the equal contributions of scholars across a range of disciplines. We focus on the untold story of social scientists and humanists who work in medical schools to show how interdisciplinarity has mostly resulted in these scholars’ adaptation to the rules of the health research field dominated by the biomedical sciences, rather than in a transformation of the health research field to be inclusive of their different epistemic habitus. We use neo-institutional theory and Pierre Bourdieu’s social theory to show how the discourse of interdisciplinarity is decoupled from-i.e., does not fit-its actual practice, and how the interdisciplinary health research field creates new power hierarchies or reproduces old ones among scientific disciplines.

Using a broad range of data (institutional, financial and interview data), we question the feasibility and expected outcomes of interdisciplinarity by showing how the different disciplines that discursively constitute the interdisciplinary health research field (biomedical sciences, health services, epidemiology/public health, the social sciences and humanities) actually hold different levels of legitimacy and thus differential scientific authority to define and lead research agendas. In the Canadian context, this disparity manifests itself through a broad range of symbolic and organizational acts of domination. We organize these data using the different types of decoupling outlined by Bromley and Powell (2012), making visible the gaps among the policy, practices and purported outcomes of interdisciplinarity. First, we focus on the underrepresentation of social scientists and humanists on various decisional and advisory committees in the country’s largest interdisciplinary health research funding agency. Second, we explore the financial decoupling faced by social scientists and humanists, which limits their ability to fully participate in the health research enterprise, disseminate their work and network with other health research colleagues. Third, we discuss the everyday professional experiences of social scientists and humanists working in medicine to show how the practice of interdisciplinarity sometimes gets in the way of doing better science.

Two major aspects of our study distinguish it from previous research on interdisciplinarity. First, many studies have favored ethnographic and phenomenological approaches without consideration of the structural aspects of research environments and the power relations that result. Several of these studies have as an objective the improvement of the interdisciplinary collaborative process through the identification of the elements enabling or limiting collaboration (see, for example,

Dewulf et al. 2007, Jeffrey 2003, Lau and Pasquini 2004, Lélé and Norgaard 2005, Maasen 2000). In contrast, our study is rooted in the principle that research environments are inherently structured, such that the question of power must necessarily be taken into consideration if we are to understand relationships among disciplines, and the organization of scientific work. Our study thus moves away from interactionist approaches that focus solely on visible interactions among actors (as though they were living in a cultural and structural vacuum) and is inspired by Pierre Bourdieu’s (1987) “constructivist structuralist” approach. According to this approach, actors are embedded in a social universe where social and symbolic structures, which predate their own entry into this universe, influence actions and social relations. Actors contribute to the reproduction of these structures or transform them based on their own practices and on the power they hold within this structure.

A second distinctive aspect of this study is the environment it is concerned with: faculties of medicine. Several studies of interdisciplinarity have focused on emerging or temporary interdisciplinary teams, for example the creation and functioning of new teams or interdisciplinary research centers (for example, Jeffrey 2003, Stokols et al. 2003). Because of their recent development, these environments are typically only partly institutionalized. The power relations among disciplines, while present (MacMynowski 2007, Williams et al. 2002), are not fully cemented into an established social order. In contrast, faculties of medicine are highly institutionalized and hierarchical organizations where various structural mechanisms (standardized evaluation criteria, policies governing the supervision of graduate students based on funding held by scientists, temporary and non-tenured faculty positions, etc.) maintain and reproduce the social order. Social science and humanities researchers who join a faculty of medicine thus enter a material and symbolic space that was stratified prior to their entry. Consequently, the challenges they face and their work experiences are likely to be different from those they would face in a transient context where norms are still emerging.

Theoretical framework

To make sense of this situation-the gap between the discourse on interdisciplinarity and its actual practice, and the perpetuation of the power hierarchy it creates in the academic context-we turn to neo-institutional theory, Bourdieu’s concepts of doxa and to our own Bourdieu-inspired concept of epistemic habitus.

Neo-institutionalist scholars study, among other things, the way new cultural ideas, such as human rights, education for all, science for development, emerge, diffuse and become taken for granted (Emirbayer and Johnson 2008, Finnemore 1993, Powell and DiMaggio 1991, Meyer et al. 1997). Interdisciplinarity is one such cultural idea: it emerged after World War II and was crystallized in a 1972 OECD report titled Interdisciplinarity: Problems of Teaching and Research in Universities (Klein 1990). Interdisciplinarity was adopted more broadly as a research ideal by science policy-makers during the following decades, and integrated with Innovation System policies (see Albert and Laberge 2007, Shariff 2006). While academics have built distinctions between inter-, multi-, and trans-disciplinary research (for example, Rosenfield 1992), interdisciplinarity is the most frequently used term in health research (Paradis and Reeves 2012), and is often used as an umbrella term that includes the other subtypes of research by both academics and lay people. Thus, we use interdisciplinary here to denote the broader, more inclusive version of cross-disciplinary interaction.

In their classic paper, Meyer and Rowan (1977) offer an explanation for the gap between formal policy and actual practices. They theorize modern organizations as the "dramatic enactments of the rationalized myths pervading modern societies, rather than as units involved in

exchange-no matter how complex-with their environments" (1977:346). Societal beliefs are seen to have a concrete impact on both individual and organizational practices. For organizations such as universities, environmental or institutional pressures come from codified law, from soft laws such as standards, ratings, rankings, rights-based claims, general social or professional norms, and from the need to secure legitimacy (Bromley and Powell 2012, Ramirez 2006, 2010). Decoupling or loose coupling can occur when institutional discourses and demands suggest a course of action that is not closely aligned with organizational goals and everyday practices (Bromley and Powell 2012).

Bromley and Powell (2012) distinguish between two different “types” of decoupling: policy/practice decoupling and means/ends decoupling (see Figure 21.1, adapted from Bromley and Powell). Policy/practice decoupling explains the gap between policies and their enactment. It can highlight whether and why policies are unimplemented or routinely violated, and the lacking fit between policies and their implementation. Means/ends decoupling explains the gap between the practices and their purported outcomes. It can highlight how changing practices does not yield the expected outcomes, and how ultimately new policies may fail to achieve their goals. Means/ends decoupling happens when formal structures have real organizational consequences, work activities are altered, and policies are implemented and evaluated, but scant evidence exists to show that these activities are linked to organizational effectiveness or outcomes (Bromley and Powell 2012: 14).

In the case of interdisciplinarity, we see “policy” as the governmental initiatives to promote interdisciplinarity, as well as the content of these policies (i.e., discourse) that frame interdisciplinarity as a privileged way of finding “real-world” solutions to “real-world” problems; “practices” as the daily enactment of interdisciplinarity (collaborative research/problem-solving, multi-disciplinary evaluation of research activities, etc.); and putative “outcomes” as increased knowledge production and “better,” more innovative and economically-generative research (for example, increased number of patents, science-inspired technology, economic growth).

Figure 21.1 Two types of decoupling
Source: Adapted from Bromley and Powell (2012)

While the concept of decoupling is useful in highlighting the discrepancy between the call for interdisciplinarity from policymakers and its actual practice, it does not help us understand how this gap may be generated and how it may unintentionally serve as a means for reproducing the hierarchy between disciplines. Pierre Bourdieu’s concept of doxa (1987) and our concept of epistemic habitus, inspired by Bourdieu’s concept of disciplinary habitus (2004), may help understanding these processes. Doxa is for Bourdieu “a set of fundamental beliefs which does not even need to be asserted in the form of an explicit, self-conscious dogma” (Bourdieu 2000: 16). Doxa thus refers to the taken-for-granted assumptions or shared beliefs within a field. In Raisons Pratiques (1994), Bourdieu adds a political dimension to this definition of doxa by specifying that it is the particular worldview of the dominant group that is imposed onto all members of the group and perceived as universal. In this sense, doxa could be seen as an arbitrary viewpoint made natural and according to which social actors model their actions.

Building on Bourdieu’s concept of disciplinary habitus, the concept of epistemic habitus (Albert et al. 2014) emphasizes that scientific practices are the result of a socialization process. The concept of epistemic habitus retains from Bourdieu’s original concept the notion that scientists internalise a system of schemes of perceptions, judgments and practices through their academic training and professional experience. This internalization provides scientists with a practical sense that orients their actions in accordance with the field’s doxa (Bourdieu 2004). Unlike Bourdieu, we focus on the epistemic schemes of thought acquired by scientists through their academic education, research activities, and career paths, regardless of their current disciplinary and/or departmental affiliations. Epistemic habitus varies within the interdisciplinary health research field and, we argue, contributes to the decoupling of goals and outcomes and of means and ends.

Methods

We used two methods of data collection: document and policy analysis and semi-structured interviews. The purpose of the document and policy analysis was to explore whether policy/practice decoupling occurs in the health research field. We used a wide array of documents produced by the Canadian Institutes of Health Research (CIHR), including annual reports (2000-2011), international review panel reports (2006, 2011), responses from the CIHR to the international review panel reports (2006,2011)(2006,2011), discussion documents on funding (2012) and other documents posted on the funding agency website. To explore the financial impediments faced by social scientists and humanities scholars working in faculties of medicine, we collected data about average annual granting amounts at the Social Sciences and Humanities Research Council of Canada (SSHRCC) and at CIHR, the costs related to various academic activities such as conferences registration, publication in clinical journals, and supervision of graduate medical students. We compared these cost with those incurred to engage in social scientific and humanities-based academic activities such as conferences.

To investigate means/ends decoupling, we conducted semi-structured interviews with twenty social scientists and humanists working in nine faculties of medicine across Canada. Inclusion criteria were: holding a doctoral degree from a social science or a humanities department (for example, anthropology, sociology, human geography, education, history) and having held a primary appointment in a faculty of medicine for at least two years. To increase the likelihood that respondents’ epistemic habitus was characteristic of “traditional” social scientists’ and humanities scholar’s schemes of thought and scholarly practices, we excluded faculty members who had received their training in departments or programs such as nursing, epidemiology, statistics, and health promotion. Faculty members who had MD degrees with additional

training in qualitative research or epidemiology were also excluded. This strategy was developed to target individuals who had internalized the logic of one of the social science (sociology, anthropology, etc.) or humanities (history, philosophy, literature, etc.) fields through their academic training and acquisition of epistemic habitus, rather than that of medical fields such as epidemiology or nursing. In more practical terms, we targeted participants whose epistemic habitus values scholarly practices such as theory-based research, critical social science and the publishing of books, book chapters and extensive peer-reviewed articles ( 8000 words or more, which is standard in the social sciences and the humanities). Resume and publications of all potential participants were examined before their inclusion in our sample. In person and phone-based interviews lasted between 60 and 90 minutes and were audio-recorded with the participants’ consent. Follow-up interviews were conducted when further clarification was needed. The interview data were analyzed using thematic content analysis.

Results

The next section illustrates decoupling between discourses and practice in CIHR leadership committees by illuminating the representation imbalance between social scientists and humanists and biomedical scientists.

Decoupling at the Canadian Institutes for Health Research

In 2000, the Government of Canada decided to replace the Medical Research Council of Canada with the Canadian Institutes for Health Research (Government of Canada 2000) to promote interdisciplinary research on a wide range of determinants of health rather than research restricted to a more traditional biological focus. The Canadian Institutes of Health Research Act stated the goal of the agency as follows:

The objective of the CIHR is to excel, according to internationally accepted standards of scientific excellence, in the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products and a strengthened Canadian health care system, by (…) encouraging interdisciplinary, integrative health research (…) that include bio-medical research, clinical research, research respecting health systems, health services, the health of populations, societal and cultural dimensions of health and environmental influences on health, and other research as required.

CIHR Act 2000: 3-4; our emphasis
While the CIHR Act does not explicitly mention “social sciences” and “humanities,” it has been widely, if not unanimously, understood by social scientists and humanities scholars (and by the broader Canadian scientific community) that the inclusion of the “societal and cultural dimensions of health” in CHIR’s sphere meant the inclusion of traditional disciplinary-trained social scientists and humanities scholars into the realm of health research (see Graham et al. 2011, Plamondon 2002). This is also the Social Science and Humanities Research Council’s (SSHRCC’s) interpretation of CIHR’s mandate, set in SSHRCC’s 2009 decision to stop funding health-related social science and humanities research projects and redirect them to CIHR. This decision has had structural consequences, which we discuss later.

With a budget close to one billion dollars for 2012-2013, CIHR is the largest funding agency for health research in Canada. Therefore, decisions made by leadership committees regarding issues such as research priorities, strategic development and budget allocation have a

significant impact on health research in Canada. In light of the interdisciplinary mandate given to CIHR by the federal government, one would assume governance committees would include representation from all disciplines and research sectors, including members of the social sciences and humanities community. To assess academic representation, two of CIHR’s executive committees, the Governing Council and the Science Council, and two International Review Panels instigated by CIHR were evaluated. As Figure 21.2 shows, the leadership space is almost entirely populated by scholars with biomedical backgrounds.

According to the CIHR Act (2000, updated version, March 18, 2013), CIHR’s Governing Council consists of no more than eighteen Canadians who are appointed by the Governor in Council to renewable three-year terms (CIHR Act 2000). The Governing Council is an advisory body to the President of the CIHR. Its role is to oversee the direction and management of CIHR, to develop strategic directions, goals and policies; evaluate the agency’s overall performance; and approves the budget (CIHR 2012). As a formal matter, “Council members [are supposed to] represent a wide range of backgrounds and disciplines, reflecting CIHR’s broad mandate and vision” (CIHR 2011a: 72). From 2002 to September 2012, this “wide range” of members included: 31 biomedical scientists, 14 individuals with no academic appointments 4,2{ }^{4}, 2 epidemiologists/population health scientists, 1 health services researcher and 2 social sciences or humanities scholars (see Figure 21.2). In total, since the creation of the CIHR in 2000, 50 individuals have served on the Governing Council; only 2 of those were from the social science and humanities community.

The second executive committee we examined is the Science Council. This committee consists of the CIHR President, the Chief Scientific Officer, the Vice-President Knowledge Translation & Public Outreach, the Executive Vice-President, the Director of Ethics, the Chief Financial Officer and thirteen Scientific Directors of the CIHR Institutes. 5{ }^{5} The mandate of the Science Council is to provide “scientific leadership and advice to Governing Council on health research and knowledge translation priorities and strategies,” and to recommend “investment strategies in accordance with CIHR’s 5-year Strategic Plan” (CIHR 2011b).

Figure 21.2 Number of members with specific background, by committee
Notes: * Includes basic and clinical research.
** Includes scholars using qualitative or quantitative methodological tools such as interviews, focus groups, observation, survey, without engaging in any scientific or conceptual social analysis. Typically, this type of research is conducted by researchers who have no formal training in any of the social science disciplines.

It also approves funding decisions for “all funding opportunities and initiatives,” recommends “effective and efficient allocation of research funds” to the Governing Council and oversees “policies, programs and processes which enable delivery of CIHR’s strategic plan.” In November 2011, members of the Science Council included: 13 biomedical scientists, 2 individuals with no academic appointments 6,2{ }^{6}, 2 health services researchers, 1 epidemiologist/ population health scientist, 3 researchers involved with descriptive, non-theory based social research (excluded as per our definition in the Methods section earlier; also see Figure 21.2 for inclusion criteria), and zero social sciences or humanities scholars (see Figure 21.2).

Finally, we examined two external committees mandated by the CIHR’s Governing Council in 2006 and 2011 to undertake a review of CIHR. The specific role of these International Review Committees was to evaluate the internal structures and performance of the CIHR (CIHR June 2006), to assess CIHR’s effectiveness in fulfilling its mandate as outlined in the CIHR Act, and to suggest how the CIHR might more effectively achieve its mandate (CIHR June 2011). Again, scientific representation on those two committees was not evenly distributed across disciplines: altogether members of the two review panels included 22 biomedical scientists, 10 epidemiologist/population health scientists, 3 health services researchers, 2 social sciences or humanists and 1 committee member with no academic appointment (see Figure 21.2).

In sum, across the four committees we assessed, biomedical scientists dominated representation with about 60%60 \% of votes; epidemiologists had between 4%4 \% and 26%26 \% of votes; health services research between 2%2 \% and 10%10 \%; and social scientists and humanities researchers controlled between 0%0 \% and 5%5 \% of votes. Meanwhile, individuals without any academic appointments possessed between 3%3 \% and 29%29 \% of votes.

While CIHR was created with the mandate to foster interdisciplinary research and support the entire spectrum of health-related research (Government of Canada 2000), our data show that this call for inclusiveness has not yet materialized in CIHR’s leadership committees. We interpret this gap as an occurrence of decoupling between the rhetorical push for interdisciplinarity and its practice at the CIHR governance level.

Building on the large body of work on symbolic boundaries (Bourdieu 1984, 2004, Gieryn 1999, Lamont and Molnar 2002) and work on the cultural dimension of disciplines and scientific practices (Albert et al. 2008, 2009, Becher and Trowler 2001, Knorr-Cetina 1999), we argue that the social scientists and humanities scholars representation deficit on CIHR committees is likely to induce decisions-skewed by biomedical scientists epistemic habitus-that will maintain the current social and doxic order of the health research field. An example of this can be seen in the recommendations made by the 2011 International Review Panel. While many of the recommendations were intended to bolster the biomedical research community, no one addressed issues related to social science and humanities research. The Review Panel recommended that CIHR “provide sufficient funding for randomized controlled trials,” to pay “particular attention to clinical investigators who must balance clinical service obligations with research,” “to establish Centres of Excellence of Clinical and Translational Research,” and to “catalyze new areas of research…, including the domains of mathematics, physics, computer and materials sciences, bioinformatics and certain engineering disciplines such as bioengineering.” Recommendations were also made “to facilitate the development of a national bioinformatics strategy” and to explore “areas such as ecology, operations research or the study of complexity” (CIHR 2011c). The CIHR Governing Council accepted these recommendations (CIHR 2011c).

We believe it is unlikely that this striking oversight of the social sciences and humanities is the result of intentional acts of discrimination or the conscious performance of boundary-work.

Given the scholarship on professional socialization, it seems more likely to reflect biomedical scientists’ taken-for-granted assumptions about how interdisciplinary research in health should develop. As members of a socio-cultural community (i.e., epistemic community), biomedical scientists envision the world and act accordingly through the cognitive categories they have internalized, i.e., through their epistemic habitus (Albert et al.2014). The enactment of biomedical scientists’ taken-for-granted assumptions through the Review Panel recommendations and CIHR Governing Council concurring response is likely to further legitimize the current power hierarchies among disciplines in health research and reinforce the institutional arrangements privileging biomedical science.

Financial decoupling: access, inclusion and exclusion

Another manifestation of the decoupling between policy and practice can be seen in the gap between the pro-interdisciplinary inclusiveness discourse and the financial barriers social scientists and humanists confront in their efforts to fully participate in the health research enterprise. Financial decoupling, we argue, is a consequence of the discordance between the field’s logic (its dominant doxa) and the epistemic habitus of researchers who joined the health research field after prolonged disciplinary socialization in the social sciences or humanities. In the current organizational and symbolic order of academia, the financial resources necessary to function in the health research field surpass the resources social scientists and humanities scholars are accustomed to having and actually need to carry out their research projects.

Social scientists and humanities scholars in medicine in Canada have until 2009 applied to and obtained grants from the Social Sciences and Humanities Research Council of Canada (SSHRCC). SSHRCC grants are awarded based on the accepted rules of the games in the social sciences and humanities, where research requires few or no instruments or laboratories, and is simultaneously less intensive in human capital. Indeed, in the social sciences or humanities, a faculty member typically hires a few modestly paid graduate students to help do the work; in contrast, biomedical science projects often include project managers, lab managers, several research assistants and graduate students. Consequently, the sums awarded by SSHRCC are typically much smaller than those awarded by CIHR, its equivalent funding body in medicine, such that the funds social scientists and humanities scholars in health research are typically much smaller than those of their clinical or biomedical colleagues.

Looking at data from each body’s recent annual reports, we get insight into the size of this funding gap. In fiscal year 2010-2011, SSHRCC awarded 19M19M\19M 19 \mathrm{M} in funding across 370 health and related life sciences and technologies grants 7{ }^{7}, for an average of 51,35151,351\51,351 51,351 per grant (SSHRCC 2011). In contrast, in fiscal year 2010-2011, CIHR funded 14,139 researchers with 753M753M\753M 753 \mathrm{M} (CIHR 2011a). First-year awarded amounts averaged 134,000134,000\134,000 134,000, but these grants are often multi-year grants, which potentially close to doubles or triples the amount per grant; furthermore, on average, CIHR awardees hold 162,000162,000\162,000 162,000 of funding annually. Unfortunately, the data are not perfectly comparable, but the lowest possible ratio of the (underestimated) CIHR funding to SSHRCC funding in health is 2.6:12.6: 1, and could be as high as 5:1. Success in the interdisciplinary health research domain defined by CIHR thus implies at least 2.6 times more grant support for researchers than provided by SSHRCC on average in health and related life sciences and technologies. While we don’t dispute the fact that biomedical and clinical research currently costs more than social science and humanities research, we argue that this higher cost is the result of a symbolic struggle over which research is important and which is not, or less, and thus should not be taken for granted. There could be another symbolic orderanother doxa-where the value, legitimacy and primacy of biomedical science is lower than

those of the social sciences and humanities (Frank and Gabler 2006). For this to happen, the balance of power in the health research domain would need to change dramatically. As noted by Bourdieu (1988, see also Wacquant 1993), however, this change would be dependent on similarly dramatic changes in the field of power.

The distribution of money across the discursively constructed “themes” of the interdisciplinary medical research domain funded by CIHR also provides revealing information about interdisciplinary power dynamics. In its 2010-2011 annual report, CIHR indicates the following spending: 475M475M\475M 475 \mathrm{M} for biomedical research; 58M58M\58M 58 \mathrm{M} for health systems/services research; 129M129M\129M 129 \mathrm{M} for clinical research; and 91M91M\91M 91 \mathrm{M} for social, cultural, environmental and population health (including epidemiology). A further 213M213M\213M 213 \mathrm{M} was awarded to research projects that did not specify a theme. In proportion to the full budget, then, biomedical and clinical researchers reap 63%63 \% of all funding; among theme-assigned projects, 80%80 \%, in contrast with 9%9 \% and 12%12 \% respectively for social, cultural, environmental and population health research. Although we do not have data on what percentage of applications were successful across areas of research, it is clear that the interdisciplinary field of medicine is dominated by biomedical and clinical science.

Indirect support for this claim can be seen in the recommendations made by the CIHR International Review Panels, as we have seen earlier, to increase the level of resources allocated to clinical and biomedical sciences, despite the fact that they already receive the greatest share of CIHR funding (CIHR 2011c). Further support can also be found in the fact that only 18%18 \% of the interdisciplinary peer-review committees at the CIHR (10 of 54) include panelists with some expertise in social science and/or humanities (Albert et al. 2009). Those committees include, for example, the Health Policy & Systems Management Research committee, the Humanities, Law, Ethics & Society in Health committee, and the Health Services Evaluation & Interventions Research committee. Biomedical research committees (such as Randomized Controlled Trials and Microbiology and Infectious Diseases) constitute the majority of committees at CIHR and do not count panelists with expertise in the social sciences and humanities.

Figure 21.3 CIHR funding allocation per research domain for fiscal year 2010-2011 ($ millions)

One could argue that the recent Canadian reforms that have forced social scientists and humanities researchers to apply to CIHR instead of SSHRCC could benefit them. Indeed, they can now theoretically obtain 2.6 times more money for the same research. The reality of professional/epistemic habitus suggests a different outcome, however. Researchers internalize the requirements, or doxa, of their field through exposure, and by the time they graduate from their PhD program, they have been socialized into one set of expectations defined importantly by their own advisors’ habitus and understanding of field norms. As such, even if it is possible for any researchers to do as we did-compare average grant amounts across granting agenciesand infer that future grants should be revised and matched to the new agency’s funding levels (i.e., at least 2.6 times higher), the likelihood that a researcher would do so is absurdly small, especially in the first few years after the sea change for two main reasons. First, unless one has been exposed to granting practices in biomedical research (probably not the case for most social science and humanities scholars), he or she may not envision a potential systemic funding discrepancy. Second, the research problems he or she chooses to investigate and how he or she will actually study them (for example, as an individual researcher or as a team leader with multiple graduate students and research assistants) are dictated by his or her field of inquiry and epistemic habitus. Externally dictated changes in funding availability are unlikely to transform the grant-writing and research practices of social scientists and humanities researchers in the face of such a newfound largesse.

The size of grants in the social sciences and humanities has serious consequences for those who try to compete in the field of the biomedical sciences. For example, if they want to be seen as productive by colleagues from an altogether different background, social scientists and humanities scholars need to publish in clinical journals and attend clinical conferences. The Canadian Medical Association Journal, the leading clinical journal in Canada and fifth international in terms of impact factor, recently announced changes to its publishing policy: beginning in January 2013, it will charge fees of 2,7502,750\2,750 2,750 per article (CMAJ email to EP). CMAJ cites the need to provide free access to research: an “author pays” model, instead of a “reader pays” model (Fletcher 2012). We know of no social science or humanities journal that asks fees for publication.

Similarly, the registration fees for clinical and clinical-type conferences such as medical education conferences also contrast starkly with those of social sciences and humanities conferences. For example, the early registration fee for the Association of American Medical Colleges’ 2012 annual conference was US 600600\600 600; early registration fee for members of the Association for Medical Education conference in Europe was €498€ 498 (US$652); early registration fee for the 2012 Canadian Conference on Medical Education was CND$695 (US$702); and a British Medical Journal conference (2013) on evidence-based medicine cost £495£ 495 (US$797). In contrast, the American Sociological Association 2013 conference non-member early registration fee is US 360360\360 360, the Modern Language Association 2013 conference early registration non-member fee is US 270270\270 270, the American Historical Association non-member early registration fee is US 212212\212 212, and the American Anthropology Association non-member early registration fee for the 2012 conference is US 383383\383 383. The significantly higher registration fees for clinical and clinical-type conferences may operate as a structural obstacle for social scientists and humanists who attempt to share their work to the medical world and gain visibility (and eventually status) within this community, or require a conscious effort to write conference and publishing fees as line items in grants.

Another contributor to academic success is a scholar’s ability to recruit and retain talented graduate students. In a Canadian Faculty of Medicine (Institute of Medical Science 2008), faculty members need to secure a minimum of 25,00025,000\25,000 25,000 per year for two years for a Master student (total =$50,000=\$ 50,000 ) and 27,00027,000\27,000 27,000 per year for five years for a PhD student (total == 135,000135,000\135,000 135,000 ). When students are unable to capture external funding, it is the supervisor’s responsibility to provide financial support out of his or her grant. The barrier is then two-dimensional-financial and symbolic-and hinders social scientists’ and humanists’ ability to build their reputations as graduate student supervisors. As noted earlier, the 2.6:1 ratio of CIHR to SSHRCC means that, as a proportion, students are more expensive to social scientists and humanists than they are to biomedical researchers. The same master’s student annual salary constitutes 49%49 \% of the average SSHRCC health-related grant, but only 19%19 \% of the average first-year CIHR grant. To make matters worse, many medical students and other health research graduate students are told that the social sciences and humanities are a distraction from their other professional goals.

The gap between the financial resources that social scientists and humanists typically can access and the cost associated with academic life in the health research field may constitute a serious obstacle to the acquisition of scientific legitimacy within this field. Decoupling here plays out as discordance between the inclusive interdisciplinary discourse and the resources needed to actually achieve the inclusiveness of social scientists and humanists in medical schools. This financial decoupling can be seen as a specific form of policy/practice decoupling identify by neo-institutionalist scholars: while in theory, interdisciplinary policies foster the diversification of research, the absence of mechanisms to achieve financial inclusiveness has the effect to further reinforce pre-existing epistemic hierarchies.

We will now turn to the social scientists and humanists themselves and explore whether or not they experience discordance between faculties of medicine’s expectation with regard to productivity and their own disciplinary-learned expectations, i.e., with their own epistemic habitus. We will focus on evaluation criteria; the central elements of academic life.

Decoupled academic experience of social scientists and humanists in faculties of medicine

Interview data suggest that most social scientists and humanists see themselves as misfits or outsiders in their work environment. Researchers mention evaluation criteria to assess productivity as one of the key reasons for that alienation. These criteria are perceived as incongruous with those they have been accustomed to in their domain for several reasons. For some, the concrete ways to measure productivity in their clinical department comes as a cultural shock. The two following quotes represent well the overall description made by participants:

The metrics I’m measured on are very simplistic, and it can be boiled down to one word: volume. The key thing that people here value is lots of stuff, so lots of publications, lots of grants, lots of presentations, lots of students, so it’s about a volume game.

SSH20

The dominant definition of excellence equates productivity with quality, to some extent. Well, I’m not sure that there’s any consistent understanding of quality other than the impact factor of the journal that you might publish in, or receiving peer-reviewed grants. So I think predominantly it becomes a quantitative assessment of how many grants you’re pulling in and how many papers you’re publishing.

As these quotes suggest, the social scientists and humanists we interviewed feel that the predominant criteria according to which they are assessed is the number of papers they write

and grants they receive. Do they have the perception that the content and quality of their work is taken into account by their assessors? Again, here are some representative quotes:

One of the things that bothers me immensely about the particular environment that I work in is that one’s academic excellence is very much dictated by number of publications regardless of the quality of the publications.

SSH03

I had a paper published in the American Journal of Sociology two years ago. This journal is one of the top journals in North American sociology, but here it’s irrelevant. Irrelevant. My colleagues, biostatisticians and epidemiologists, they just don’t have a clue, not a clue.

SSH15

For most of our participants, being in medicine implies something similar to moving to another country, a country with its own rules, expectations, value system, and legitimate strategies to establish reputation. For all participants in our study, adaptation was necessary. For some, adaptation was successful, for others it failed. Let’s look first at a quote illustrating success. The first quote is from a full professor who has been in a faculty of medicine for thirty years:

To be fair, for all my criticisms and so on, I have become a full professor, and I have been respected, and I am sought after. I’ve succeeded, right? So they can’t have been that hard on my social science, because I did write social science. I didn’t really compromise.

SSH05

However, when this participant provided contextual details, the flavor of his experience changed:

Because my career took place at a time when I could survive-and I did survive, and I did thrive-I have never felt as though I couldn’t end up saying what I wanted to say, but that’s largely to do with the time I’ve been here. I don’t think it’s the same anymore, I think it’s increasingly getting harder to do social science research. … You can’t go anywhere with sociological imagination anymore, and if as a student you’re going to get out of here in a decent amount of time, if you’re going to get funding, if you’re going to get off to a decent start, you have to better just align yourself with where things are at now. There are very few people that are willing to take a risk and do a really social science-y kind of thing.

SSH05

The second quote from this participant suggests that despite the rise of the interdisciplinary discourse in Canada, it has become harder for social scientists and humanists to have a satisfying career in medicine over time. This increased difficulty illuminates Bromley and Powell (2012) means/ends type of decoupling: the discourse of interdisciplinarity has led to the growing presence of social scientists and humanists in the health research field as well as to the transformation of the governmental funding mechanisms, but has not delivered on the purported benefits of interdisciplinarity. Indeed, the push for interdisciplinarity has made it harder for social scientists and humanists to be evaluated by their peers and to be successful according to the norms they were socialized into: their epistemic habitus. While engaging in interdisciplinary research, social scientists’ and humanists’ inputs are often devalued, and the space for true multi-disciplinary research has shrunk with the growing cross-disciplinary

competition for funds at CIHR. Social scientists and humanists are separate, and unequal. Consequently, several have had to compromise or dilute their work to fit the dominant publication model in medicine, that is articles in the range of 3,000−4,0003,000-4,000 words, characteristically without theoretical grounding or substantive literature review and discussion.

The following two junior social scientists are currently experiencing these constraints and therefore do not seem to have the same positive experience that their senior colleague had. These two quotes are representative of many participants’ dissatisfaction with their work environment and own career as it developed within this environment:

I plateaued and now what happened to me is, I don’t give a shit, so I’m kind of coasting downward in terms of trajectory. I’m not in an upward swing, because in a way I’ve kind of just given up. I find myself in a game that I can’t stand. I can’t stand the basic struggle for legitimation, I’m really repulsed by what these criteria to be legitimate in this context are. I can hardly wait to retire. I just want out.

SSH15

I need to think about where I’m going from here. Obviously I need to look into other work. I’m demoralized. I sat down with my supervisor a couple months ago and said, ‘I’m really demoralized.’

SSH02

We can draw a provisional conclusion from our interview data: although interdisciplinarity is high on the agenda of the Canadian health research funding agencies and faculties of medicine, it is not clear to what extent social scientists and humanists can contribute to interdisciplinary dialogues given how standards of excellence vary so much between disciplines and the continued asymmetry in financial means, access to graduate students, and so forth. Their legitimacy and scientific authority are not recognized by the dominant epistemic habitus in the health research field. As a result, many such scholars have had to learn to play the scientific game according to rules decided by biomedical scientists for biomedical scientists in order to be successful. This move has diluted their own standards of excellence and led them to become a different type of scholar (i.e., to acquire a new epistemic habitus). The experience of biomedical scientists has not been so tainted by the standards of the social sciences and humanities. Adaptation has been mostly unidirectional (on the issue of unidirectional adaptation see medical anthropologists’ account of their experience working in interdisciplinary health research teams, Barrett 1997, Foster 1987, Lambert and McKevitt 2002, Napolitano and Jones 2006, Williams et al. 2002).

Conclusion

Decoupling and power relationships in medical schools and in the broader health research field can take multiples forms and manifest themselves in various sites. In this chapter we have focused on a limited set of manifestations of decoupling, concentrating on the variety of epistemic habitus represented on CIHR leadership committees and on financial decoupling because they make visible the discrepancy between the calls for interdisciplinarity and the structural constraints social scientists and humanists face in faculties of medicine and health research more broadly. Furthermore, as we have shown with our interview data, these structural constraints are discordant with the lavishness of the discourse about the collaborative and the spirit of openness inherent to interdisciplinarity. To be successful and build the scientific legitimacy and authority

recognized by the dominant biomedical epistemic habitus, many social scientists and humanists have had to adapt to a new social structure. Several among those who were unable to engage in such adaptation faced discouragement and disillusion with the game of science.

Neo-institutional theory has typically focused on the mechanisms of compliance and harmonization within organizations-through normative, mimetic and coercive forces (DiMaggio and Powell 1983). While we recognize the importance of these forces, the story we are telling here highlights the importance of habitus in slowing down or thwarting change and adaptation among individuals. Indeed, habitus is developed through a socialization process that is field-specific, and is therefore embodied, durable, unconscious, and idiosyncratic. Social scientists and humanists in medicine have entered a field that has been structured without them, whose rules and power structures are unknown to them. Through our document and policy analysis, we have shown the structural forces at play in the interdisciplinary health research field, and the power relations they re/produce. With our interviews, we document social scientists’ and humanists’ experience of dissonance as it specifically relates to their epistemic habitus: their attempts to adapt to the doxa of their new field, and their frustrations with rules of the game that according to several, disadvantages them. In their chapter on gender in the knowledge economy, our colleagues Vardi and Smith-Doerr (Chapter 22, this book) have highlighted similar processes; how “gendered organizations” and the gendered structure of competition negatively impact women. The potential of the knowledge economy to reshape work practices and institutionalized hierarchies has not materialized into equal opportunities for women.

In their case, as in ours, decoupling does not necessarily result from an intentional or conscious act of discrimination against or belittling of a group: women or social scientists and humanists. Instead, we argue that in many cases it is an unforeseen and undocumented consequence of the doxa of the health research field, that is the field-specific taken-for-granted and unformulated assumptions about the natural order of things within the biomedical and clinically dominated research field. Taken-for-granted assumptions get materialized in structural arrangements that legitimize and facilitate some practices while delegitimizing and discouraging others. In this sense, structural arrangements are also structuring forces shaping actors’ practices. Whether it is intentional or not, the decoupling of pro-interdisciplinarity discourse and current social structures puts social scientists and humanists in the uneasy position of “misfits.” The institutional setting within which they find themselves (the reward system, the standard knowledge production practices, the lab structure of their working environment, the pressure to capture large grants, work in teams, and publish in high impact factor journals, etc.) is often in dissonance with their epistemic habitus. Trying to advance their career within this system structurally confines social scientists and humanists to a position of inferiority before the biomedical and clinical scientists, as the system has not been created to espouse their own academic practices, but rather those of the more powerful group.

Another potential impact of the dissonance between the health research field logic and social scientists’ and humanists’ epistemic habitus is what David Hess has called “undone science” (2007). In the context of this chapter, “undone science” is the health-related social science or humanities research that could be done but is not because of the structural constraints exerted by this logic upon social scientists and humanities scholars. Social scientists’ and humanists’ embeddedness in the health research field orients and constrains their research. It allows them to ask certain types of questions (How can we change people’s behavior to make them eat better?), but makes it less likely they will ask others (How would a better redistribution of resources across society benefit population health?). The fact that SSHRCC stopped funding health-related research in 2009 has meant that social scientists and humanists’ work is not evaluated by their peers, but rather by scientists whose epistemic habitus may clash with

theirs. The consequent dilution, transformation, or partial disappearance of health research inspired by the social science and humanities epistemes is thus practically unavoidable in the current Canadian context. As made clear by Bak (Chapter 23, this book), the focus on a specific set of research questions-be they inspired by utilitarian and nationalistic goals or by a specific scientific episteme-has important impacts not only on the type of research that gets funded, but also on the work lives of scientists and their satisfaction with their jobs.

If health research funding agencies and faculties of medicine are serious about fostering interdisciplinary or multi-disciplinary departments and institutes in which social scientists and humanists will thrive, they need to make room for different research practices. Otherwise, interdisciplinarity in health research may result in being an empty mantra with the real effect of subordinating non-clinicians and non-basic scientists to the rules of the powerful.

To our knowledge, our research is the first to look at interdisciplinarity within an institutional context and to take into consideration institutionalized power relationships. Existing work has been mostly preoccupied with scientists’ interactions within research teams and research centers rather than with cross-disciplinary long-term relationships within a structured organizational field. To strengthen and nuance our preliminary findings and conclusions, further research should adopt a longitudinal approach to see if social scientists and humanists adapt or can change the structure of the field and create conditions where they can join interdisciplinary endeavors without having to leave their epistemic habitus in the cloakroom. Similarly, further research could compare the experiences of social sciences and humanities scholars across countries, but also across departments.

Notes

1 Authors listed in alphabetical order.
2 This research was supported by the Canadian Institutes of Health Research, grant # KTE-72140 and the Social Science Research Council of Canada. The authors wish to thank Kelly Moore and Daniel Kleinman for their insightful feedback on several versions of this chapter.
3 Epistemologically, one may argue that this position is rooted in naïve empiricism. Such arguments assume that the nature of reality is such that its intrinsic features can only be grasped by interdisciplinary approaches. This realist epistemological position implies an objective reality that can be revealed with the proper tool (see Weingart 2000), rather than a reality that is constructed and thus always elusive and amenable to various scientific (re)constructions.
4 Individuals with no academic appointments include representatives from the ministry of health, the business and pharmaceutical sectors and the health management system sector.
5 CIHR is structured around thirteen virtual geographically distributed institutes that each supports health research in biomedical, clinical, health systems and services and population health. Scientists funded by CIHR become members of one or more institutes. Directors of those institutes are considered scientific leaders in their respective domain.
6 Individuals with no academic appointments include members of the CIHR management team.
7 Although SSHRCC has stopped funding health-related projects in 2009, these data represent amounts received by ongoing projects funded before or in 2009, as well as projects focused on health-related technologies, broadly understood.

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