As a child growing up in the pre-TV, pre-Internet 1940s, information gathering was harder work than it is now. There was a Compton’s Encyclopedia and a Webster’s Dictionary on the shelf in the Dining Room; the Bookmobile came once a week; and every Sunday, there were "the funnies" – the comics section of the Newspaper. My favorites were the cartoon satirists Al Capp [Li’l Abner] and Walt Kelly [Pogo]. I didn’t know what a satirist was, but I could tell that these two were different from the others – deep truths hidden within.
Kelly’s Pogo Possum and innumerable other swamp critters carried on endless dialogs about matters of deep political and philosophic importance, some of which I occasionally understood. But there was one character that was not anthropomorphized, Pup Dog, a gleeful puppy whose only utterances were an occasional "Wurf!" He ran around just being what he was – a playful puppy. And then one Sunday, Pup Dog spoke, saying "poltergeists make up the principal type of spontaneous material manifestation." I was as awed as Kelly’s creatures that he’d spoken. For weeks, the swamp denizens pondered the meaning of Pup Dog’s words, which he occasionally repeated for emphasis. Me too, but I had a secret weapon – Webster’s Dictionary. I figured it out. It said "ghosts are ghosts." And after a bit, I got it that it meant just because something has big words doesn’t mean it’s profound.
The lesson must have been important because I still remember the phrase. I recall thinking about it later in my life – like in the "pseudointellectual" period of adolescence, or later when I would encounter academics who overdid the big word thing, or the psychoanalysts who overused jargon. I even recall remembering it the first time I heard Charlie Nemeroff give a talk after he arrived at Emory as chairman.
Lest you think that I built my whole life around the Pogo comic strip, I have to mention the character from Al Capp’s Li’l Abner that was equally important. His name was Joe Btfsplk, and his image pops into my mind around certain people. His appearance in my mind’s eye has become a cherished diagnostic tool, leaving the DSM-anything in the shade.
So back to "poltergeists make up the principal type of spontaneous material manifestation." Years later, I was taking a Logic course and we were studying Logical Fallacies. One day, the professor [a Joe Btfsplk kind of guy] was explaining Tautology. He said it wasn’t exactly a Fallacy, but it was used as one in rhetoric. He said it was "saying the same thing twice" a non sequitur ["it does not follow"] because it didn’t really say or prove anything. I, of course, immediately thought of Pup Dog’s non-profound phrase. Well I thought of it recently, when I was reading Dr. Krystal’s blog about Dr. Angell’s pieces in the NYRB. It was when I read this phrase in his conclusion, "Instead she attacks the one clear path to better diagnoses and more effective pharmacotherapies, translational neuroscience." I didn’t see that Dr. Angell was attacking transitional neuroscience, but the part that stuck was a question, "How is translational neuroscience the path to better diagnoses and more effective pharmacotherapies?" and I thought of Pup Dog. I don’t know if "Instead she attacks the one clear path to better diagnoses and more effective pharmacotherapies, translational neuroscience" would be qualified as a formal Tautology, but it’s close enough for government work.
Translational Medicine is all the rage. The NIH has a National Center for Advancing Translational Sciences [NCATS], lead by Dr. Tom Insel, also Director of the NIMH. Essentially the term refers to programs that move the findings of research into the clinical arena quickly – "from bench to bedside." There are grant awards, centers, RFAs [Request for Applications] – lots of money flowing. The point is to connect basic research to clinical medicine and vice versa. In neuroscience, the idea is to turn the findings of neuroscience into "novel and innovative" treatments for patients.
My problem with the whole idea of Translational Neuroscience is that it focuses on turning new discoveries into clinical applications quickly. But which new discoveries do they have in mind? Translational anything isn’t about discovery, it’s about development. And considering our track record with adverse effects, even if we had some new discoveries to speed up, I’m in no hurry to get them on the pharmacist’s shelf until they’re more tried and true than the more recent generations of drugs. So "the one clear path to better diagnoses and more effective pharmacotherapies, translational neuroscience" is a tautology, saying the same thing twice. Translational Medicine is about creating a path from basic discovery to clinical usefulness. "The one clear path is the path" doesn’t make any sense. And I have a broader complaint. Keeping researcher’s close to what we know [which is what translational neuroscience does in practical terms], leaves out the biggest domain in neuroscience, what we don’t know and haven’t even thought of. I think that’s Dr. Fibiger’s point and it’s a good one [Psychiatry, The Pharmaceutical Industry, and The Road to Better Therapeutics, fresh air…, lessons learned?…]. We don’t even clearly know which mental illnesses have a biological substrate. We don’t really know if existing drugs treat underlying disease or are symptomatic treatments. All we really know is that we’ll never find out with diagnoses like Major Depressive Disorder that define a hopelessly heterogeneous population. Psychiatry embraced the neoKraelelinian tenet that said "The focus of psychiatric physicians should be on the biological aspects of illness" before we defined which illnesses had biologic aspects to focus on.
hat tips to 
Terms like translational neuroscience and bench to bedside have by now become empty tropes. They were promoted by former NIMH director Steven Hyman, who left after 10 years to become provost of Harvard University under president Larry Summers (Larry who?). The two of them were made for each other.
Thomas Insel then stepped into Hyman’s shoes at NIMH, with Charles Nemeroff’s support, and kept the patter going. Hyman and Insel combined to throw over $5 million to Nemeroff for the infamous Emory-GlaxoSmithKline-Mount Sinai School of Medicine- NIMH Collaborative Mood Disorders Initiative. They did this through an RFA that explicitly emphasized innovative models of drug discovery and translational benefit for patients through partnerships of academic centers with commercial drug makers. This farcical boondoggle promised all manner of translational research, novel and innovative treatments, but it failed catastrophically in its grandiose objectives. It achieved no rapid progression of effective clinical tools and pharmaceuticals from the laboratory into the marketplace and into patient care, nor did it accelerate antidepressant drug development or yada, yada, yada. The actual productivity was pitiful… just pitiful. This is how scarce federal research dollars are squandered and this is a major reason why the pipeline is empty.
So, when Dr. Krystal talks up the supposed benefits of translational neuroscience he should reflect more thoughtfully on this farcical history.
A psychiatrists reaction to my psychotic episode: You must take what I prescribe for life or you will become psychotic again.
My neurologists reaction: Maybe it will only happen once. Can’t say whether it is or is not related to the new lesions. I wouldn’t worry too much about it.
Who are these translation neuroscientists, exactly? It’s difficult to make a definitive diagnosis of MS. How do they think they’re going to find the biological basis of brain disease? Some of them appear to be more concerned with proving this to themselves than they are to helping patients. Most of them probably just drank the Kool-Aid and are convinced that they’re on the verge of something great.; which is why I believe that before one begins studies for any field that they must study the history of that field along with the historiography..
A lot of the medicines do help a lot of people, but I don’t see why it’s necessary to label people as having a chronic and incurable condition, by psychiatry’s reckoning, in order to make attempts to relieve mental suffering. That they keep trying so hard to prove that all mental suffering is a biological illness unrelated to the rest of life is getting obscene. One has to have a really privileged place in society to be that out of touch.
In a comment on an earlier post, Stan listed Dr. Krystal’s conflict of interest declaration and wondered what it had been before. This one is from earlier this year:
1) Consultant for Aisling Capital, LLC, AstraZeneca Pharmaceuticals, Brintnall & Nicolini, Inc., Easton Associates, Gilead Sciences, Inc., GlaxoSmithKline, Janssen Pharmaceuticals, Lundbeck Research USA, Merz Pharmaceuticals, MK Medical Communications, Medivation, Inc., Naurex, Inc., Pfizer Pharmaceuticals, and Teva Pharmaceutical Industries, Ltd.;
2) Scientific advisory board/consultant for Abbott Laboratories, Bristol-Myers Squibb, Eli Lilly and Co., Lohocla Research Corporation, SK Holdings Co. Ltd., Takeda Industries, and Transcept Pharmaceuticals;
3) Exercizable warrant options for Tetragenex Pharmaceuticals (value less than $100);
4) Research support to Department of Veterans Affairs for Janssen Research Foundation (provided drug and some study support to the Department of Veterans Affairs);
5) Derives income greater than $10,000 as the Editor of Biological Psychiatry;
6) Board Of Directors for the Coalition for Translational Research in Alcohol and Substance Use Disorders;
7) President-Elect for the American College of Neuropsychopharmacology; and
8) has the following patents and inventions:
a) Seibyl JP, Krystal JH, Charney DS. Dopamine and noradrenergic reuptake inhibitors in treatment of schizophrenia. Patent #:5,447,948. September 5, 1995;
b) co-inventor with Dr. Gerard Sanacora on a filed patent application by Yale University related to targeting the glutamatergic system for the treatment of neuropsychiatric disorders (PCTWO06108055A1);
c) Intranasal Administration of ketamine to Treat Depression (pending).
Looks like he’s getting a piece of the action himself…
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As I understand it, translational neuroscience means mining public-funded research in universities for pharmaceutical products.
As for “the one clear path to better diagnoses and more effective pharmacotherapies, translational neuroscience,” my decoder ring reads: “the one clear path to better diagnoses and more effective pharmacotherapies is research,” with which even Marcia Angell would surely agree, making it an ingredient of a different fallacious argument, the “straw man” variety.
At Kings College, London, *Translational Neuroscience* has meant continued development of Cognitive Remediation Therapy– Dr. Janet Treasure and Dr. Kate Tchanturia have published widely on the application of neuroscience to cognitive development and the positive results using this therapy (barely known in the U. S.) for patients with anorexia nervosa. Just chiming in to say that , like many of the more subtle, purely human aspects of *mental illness*, neuroscience is poorly understood in the U.S.— the clinical applications are a far cry from magic bullets and assembly line patient care— the two mainstays of American psychiatry.
I remember reading that many of the major pharmaceutical companies were heading towards a “patent cliff”. Lilly seemed to be particularly vulnerable to having many of their drugs come off patent in a short time period. Voila! A new, fast paced, method for putting new drugs into the marketplace. Combined with new fast track rules at the FDA, and the (business) problem is solved. I’m not sure if that solves the medical problem, though.
I love Pogo and his bunch of wise little critters. They had, and have, wisdom far beyond my years when re-re-reading that tattered anthology of mine.
The U.S. is penny wise and pound foolish when it comes to any mental issues. Although traumatic brain injury is the signature injury of the Iraq and Afghanistan wars, soldiers rarely get the neurological rehabilitation treatments they need.
http://www.propublica.org/article/at-fort-bliss-brain-injury-treatments-can-be-as-elusive-as-diagnosis
Those treatments are labor intensive and time-consuming. Part of the seductiveness of drug therapy is how much it cuts down on the time that professionals spend with their patients. Over time, it seems the chickens are coming home to roost and the U.S. is being forced to face the fact that we can’t afford drug treatments that don’t work and that cause more problems.
Most Europeans believe that stress and poverty is definitely related to mental problems. Here in the U.S. people with money and power have a lot to gain by pretending that we’re all equally blessed socially, so people who unable to be well in our society must be biologically defective. With enough pressure, I believe anyone can crack.