How and Why Are Biomarkers Relevant in Research on Complementary and Integrative Health? An Interview With an Expert in Biobehavioral Research

Patricia Kinser, PhD, WHNP-BC, RN, Complementary and Integrative Medicine Special Interest Group (CIM SIG)

Interest in complementary and integrative health (CIH) research has increased exponentially in recent years. Further, researchers have recognized the importance of using objective measures to determine mechanisms of action and effects of interventions. In response to readers’ requests for content from experts in the field, we have interviewed an expert in biobehavioral research, Theresa Swift-Scanlan, PhD, RN, to talk about her views on the role of biomarkers in CIH research. Dr. Swift-Scanlan is a senior scientist at the Virginia Commonwealth University School of Nursing, where she is the Director of the Biobehavioral Research Lab and the Ellen Fontaine Winston Distinguished Professor.

CIM SIG: Can you tell me why you became interested in biobehavioral research and biomarkers?

Dr. Swift-Scanlan: I began my career as an environmental scientist/molecular biologist and pursued nursing as a second career. What attracted me to the science and practice of nursing was its holistic emphasis on considering individual health within the context of one’s environment. Therefore, it was natural for me to segue into conducting biobehavioral research by incorporating measures at the biological/cellular level (“biomarkers”), with clinical, psychological, behavioral, and environmental “exposures” of interest.

CIM SIG: Is biobehavioral research relevant for all disciplines?

Dr. Swift-Scanlan: Biobehavioral research is appealing because, by necessity, it involves synergistically working with multiple disciplines to address the complex interplay of varied influences on health states.

CIM SIG: What is your current research focus?

Dr. Swift-Scanlan: My current research focuses on the identification of genetic and epigenetic markers to improve risk assessment for complex illnesses such as breast cancer and neurodegenerative disorders. I am particularly motivated to understand how such markers can be utilized in the clinical setting to guide prevention, treatment, and/or behavioral interventions to improve health outcomes.

CIM SIG: Why are biomarkers important for inclusion in CIH intervention research?

Dr. Swift-Scanlan: First let me say that I don’t believe biomarkers should be compulsory or required for intervention research. However, for those that have the yen and the interest, biomarkers can have multiple advantages simultaneously. For example, biomarkers can serve important roles in early detection and risk prediction, as surrogate indictors of health states, but also as targets for individualized interventions. Additionally, they are often more feasible in terms of timeliness and cost to measure than “true” endpoints or final outcomes.

CIM SIG: What advice would you give to a researcher who is embarking on CIH research and hopes to integrate biomarkers into the study design?

Dr. Swift-Scanlan: Here are my recommendations:

1. Critically scan the literature to identify biomarkers that have been associated with your population and health state of interest. Are there gaps in our understanding of the role of specific biomarkers? If so, you have the opportunity to shape your study design to address important gaps, and thus make invaluable contributions in your field.
    
2. If you are new to biomarker research, the jargon and mechanics of biological and molecular measures can initially be intimidating, and diving into the literature on cytokines, psychoneuroimmune pathways, genetics, epigenetics or various “omics” studies may be a little overwhelming. I recommend actively engaging with resources available through academic settings, professional organizations and meetings, and colleagues in other disciplines with expertise in biomarker research. For example, most academic settings support both didactic “hands on” training and experiences with molecular, cellular and physiologic assays as well as analysis. Additionally, NIH has wonderfully informative, educational modules on all aspects of cell biology and genetics.
    
3. “You don’t have do it alone:” I can’t emphasize enough the necessity of forming collaborative relationships with colleagues from other disciplines. It is not uncommon for successful biobehavioral researchers to have collaborative teams with wide-ranging expertise in nursing, medicine, epidemiology, epigenetics, molecular methods, nanoscience, pharmacogenomics, bioinformatics, or statistics.