a breakthrough·freak…

Posted on Tuesday 22 September 2015

Tom Insel explains why he’s ready to give Silicon Valley a try.
MIT Technology Review
By Antonio Regalado
September 21, 2015

We are at a really interesting moment in time. Technology that already has had such a big impact, on entertainment and so many aspects of our lives, can really start to change health care. If you ask the question “What parts of health care can technology transform?”–mental health could be one of the biggest.

Technology can cover much of the diagnostic process because you can use sensors and collect information about behavior in an objective way. Also, a lot of the treatments for mental health are psychosocial interventions, and those can be done through a smartphone. And most importantly, it can affect the quality of care, which is a big issue, especially for psychosocial interventions.

What do you mean by treating over the phone? One of the best treatments for depression is cognitive behavior therapy. It’s building a set of skills for managing your mood. You can do it with a phone as well as face to face. A lot of people with severe depression or social phobia or PTSD don’t want to go in to see someone. This lowers the bar.

Is it possible to diagnose mental illness with a phone? I’d say you can collect information over the phone that can help people manage their own treatment. Your question rests on a paradigm that is completely shifting. The old paradigm is you go to the doctor and they write a prescription. Whether you call it a diagnosis or just identifying the issue, there is an awful lot that can be done online. There is an attachment for your smartphone than can see the tympanic membrane, and pediatricians can make a diagnosis [of ear infection] online. It’s a world where you want to get the right treatments at the right time for the right people. As a consumer, you are close to the source of the information. All of this is a different paradigm that we are moving into.

Is Alphabet’s approach to mental illness going to be primarily technological or biological? I don’t know that. We are going to explore what the opportunities are. We know their sweet spot is in data analytics. What they do really well is figure out how to analyze data. The opportunity is to take that skill and answer biological questions. What that means in terms of what projects the life science team takes on in mental health is totally undefined. Part of my move there is to figure it out.
As a medical student in the 1960s, I was in a new place and the only people I knew were other medical students. A couple of my early friends were local, had grown up in the town. Through them I met their longtime friends who weren’t in medicine. One such person was the son of a successful businessman, and his path was set for life. But, in spite of my own aversion to business, we really hit it off. One day, he explained why, and gave me a phrase that’s still with me. He casually quipped, "You’re a breakthrough·freak – just like me." I’d never thought of it that way, but it was completely on target. I read science fiction [the sciency kind]. I kept up with the latest science advances and technologies, and fantasized about where they might lead. I was in medical school as a prelude to a research career. He had casually nailed my diagnosis.

Much later, I was forced to practice medicine by being drafted into the Air Force after an Internal Medicine Residency and an NIH Research fellowship. Within a short period of time, I realized that practicing medicine was not only relevant and engaging, it got me out of my head. Did I want to do something that actually mattered, or spend my life being just a breakthrough·freak? How that had come to be and how it translated into the rest of my life is another story. But for this moment, my point is that I know a breakthrough·freak when I see one. And Tom Insel has a terminal case. I hasten to add that there’s nothing wrong with being a breakthrough·freak. Probably most breakthroughs are made by breakthrough·freaks repurposed as visionaries [and I’d bet that Google is filled to overflowing with examples].

Reading Insel’s blogs for a number of years, he bounces from thing to thing leaving a trail of projects in a string behind him. Google is actually a much better fit for a serial breakthrough·freak than the NIMH. He will likely be part of a  think·tank rather than the man in charge, and that might just work [though I’m betting there will be a bunch of pop-psychology apps coming our way]. But maybe he’ll land on something visionary after all…
    September 23, 2015 | 2:43 PM

    “You can do it with a phone as well as face to face. A lot of people with severe depression or social phobia or PTSD don’t want to go in to see someone. This lowers the bar.”

    Yeah, it lowers the bar, all right.

    A lot of alcoholics don’t want to leave the bar to see a therapist. Maybe we should have an app so we can play an online drinking game with our clients while they are down at Bud’s Tavern. That would give us an objective measure of how wasted they are– and how wasted we need to get, because after reading this post, I could use a little snort myself. Who needs boundaries?

    Why doesn’t Insel check in with Bruce Perry or Dan Siegel or Gabor Mate about whether it’s such a good idea for humans to spend more time engaging with technology instead of face-to-face social interaction. Or ask some parent whose kid won’t stop playing Minecraft, even though all the “experts” say that is one of the safe ones. Looky monkey! Bright shiny toy!

    Reading drivel like this is like listening to Elon Musk raving about nuking Mars– it just makes me want to go be a witchdoctor somewhere in the jungle.

    Sorry. Rant = off.

    September 23, 2015 | 5:27 PM

    This is perfect for Insel. Silicon Valley has a long, long tradition of vaporware — promising, intensively hyped concepts that don’t deliver.

    September 23, 2015 | 8:10 PM

    “Reading drivel like this is like listening to Elon Musk raving about nuking Mars– it just makes me want to go be a witchdoctor somewhere in the jungle. ”

    ya mean BOY GENIUS ELAWN ain’t that much of one?

    god damn ponzi needs to POP!

    September 23, 2015 | 8:49 PM

    Hey smart phones, data analytics and whatever. This is “modern” psychiatry: Distance yourself from the patient and his or her experience at all costs. Relationship? Analysis of the transference as a means of gaining knowledge to help a patient learn about him or herself? God, what a foreign notion! They did that stuff in the Dark Ages of Psychiatry! There is no place for that in Our Brave New Insel-ian World! I find it ironic that Insel is championing this “new” paradigm as he reportedly never treated a patient in his career. As Vonnegut would say: “And so it goes.” Psychiatry’s Slaughterhouse Five.

    James O'Brien, M.D.
    September 24, 2015 | 2:03 PM

    As far as Musk goes, you can be innovative genius and supreme BS artist at the same time, and I think he is. The car is an amazing work of engineering and a joy to drive but look at how much it’s subsidized and despite that, the company is burning through cash like there’s no tomorrow.

    I think a lot of the same dynamic applies to many psychiatric leaders, although the genius part is not quite there.

    September 24, 2015 | 4:34 PM

    i think making a sustainable product is hard, period. so i won’t wade into elawn and his tesla thing.
    what i will say is: he started out as a bit player for Paypal and miraculously ended up as a billionaire with a car company that you aptly noted is burning through cash.

    sustainable vehicles are undoubtedly a pressing need. whether tesla (or any current offerings, for that matter) are the solution is another.

    if psychiatry can’t even get proper funding for rigorous clinical trials investigating mental disease, i am hard pressed to believe they’d spend the cash necessary on funding a proper sustainability initiative.

    this is in no small part due to “old money”. there have been rumours of nuclear phenomena being dismissed in the name of science, but reality suggests that it was due to profits (surprise).

    September 25, 2015 | 3:01 AM

    Has anyone read Insel’s current blog post? Might as well consider what he describes here inevitable. He’s going to a a private company and will no doubt have a budget like his NIMH budget, but be answerable to one a few people. He went on the grand tour this summer, job-hunting no doubt.

    “…fascinating previews of this new world… [included the] publication of results from a collaboration between Columbia University and IBM.4 The team, led by Gillinder Bedi and Cheryl Corcoran, was looking for a biomarker to predict which clinically high-risk youth would convert to psychosis over a two- to three-year follow up period from an initial interview.

    [but as usual they couldn’t find one ??????]

    Rather than depend on a protein in blood or a brain scan [because they can’t, even though that sounded like they can], they used an innovative big data approach to analyze the speech from the initial interview. The approach, developed by Guillermo Cecci at IBM, maps semantic coherence and speech complexity as a window into the earliest stages of disorganized thought. [incoherence predicts disorganization]

    While analysis of previous clinical features have yielded, at best, 80 percent prediction, this automated analysis of unstructured speech was reported to be 100 percent accurate for identifying who would convert to psychosis during the follow up period. This is a small study (34 participants with 5 developing psychosis), but it serves as a preview of what we might see as the power of technology is applied to provide objective measures of behavior and cognition.” [preview of a future when the a team resembling old fashioned dogcatchers drives around with a sensitive microphone and tranquilizer darts, and anyone within range falls silent.]


    James O'Brien, M.D.
    September 25, 2015 | 11:18 AM


    Scientific skills and business skills are separate talents. The original Nikola Tesla was possibly the greatest genius since Newton but he died broke.

    If this Tesla doesn’t start making money soon, it will be broke very shortly.


    TIVO was a great innovation that lost the war. BMW, Porsche, Mercedes Lexus are coming soon. I would say Audi too but it just got kneecapped.

    By the way the analyst who recommended that stock given these fundamentals is a crock. We live in a world of hype not facts.

    That being said the Model S is a wonderful car and is deserving of most of the hype. Where it doesn’t actually deserve that hype is on the environmental front. How green the car is depends on the source of electricity. In Indiana, a Tesla is basically a coal powered car. In South Carolina, nuclear, in California, natural gas. Besides most of the environmental cost of any car is its manufacture. So if you want to be green drive your car, any car, into the ground.

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