1 Boring Old Man

Brain expert: Why I jumped ship to Google

Silicon Valley offers a fresh way to tackle conditions such as schizophrenia says US mental-health expert Thomas Insel

The New Scientist

By Sally Adee

Nov 4, 2015

Why did you leave the National Institute of Mental Health to work for Google?

I have to confess that after giving heart and soul to mental-health problems over the last 13 years working in government, I have not seen any improvement for either morbidity or mortality for serious mental illness – so I’m ready to try a different approach. If it means using the tools available in the private sector, let’s go for it.

Are you saying Google is a better place to do mental-health research than the NIMH?

I wouldn’t quite put it that way, but I don’t think complicated problems like early detection of psychosis or finding ways to get more people with depression into optimal care are ever going to be solved solely by government or the private sector, or through philanthropy. Five years ago, the NIMH launched a big project to transform diagnosis. But did we have the analytical firepower to do that? No. If anybody has it, companies like IBM, Apple or Google do – those kinds of high-powered tech engines…

I was raised in a different research environment in my Internal Medicine days in Memphis Tennessee than I’ve seen in these years of research in Psychiatry. Memphis is in the upper reaches of the Mississippi. West Memphis Arkansas was once the Malaria capital of the US – the point being Mosquitoes. And where there are Mosquitoes, kids get Impetigo [a skin super-infection with Streptococci]. So we saw more Glomerulonephritis and Rheumatic Fever in kids and the chronic deadly versions in adults than anywhere. These are post-streptococcal diseases [once endemic but now rare]. The hemoglobinopathies like Sickle Cell disease were also prevalent in our area. So a lot of our researchers were Streptococcologists and Hematologists. The point is that research often starts with observations, like these epidemiological findings. The researchers flock and make other observations with clinical immersion.

Another example: My mentor had noticed some odd inclusions in electron micrographs of the capillaries of Lupus patients. We started a study doing electron microscopy of capillaries in Lupus, and the controls were other patients with non-Lupus connective tissue disorders. The study was a great success. The inclusions turned out to be insignificant artifacts, but what he found was that the patients with Scleroderma [in the control group] had a dramatic decrease in capillary density. That was a significant finding, but hardly the point of the study – an observation along the way. The classic example is the discovery of Penicillin. Alexander Fleming, a veteran of WWI, was involved in looking for antimicrobial agents, having seen so much sepsis in that war. He sure wasn’t studying dirty petri dishes. But when he saw a bacteria-free ring around a mold in a dirty petri dish, he knew what he was looking at – an observation along the way.

Insel’s and Hyman’s NIMH was built aiming for results. Translational research, meaning something that could race from bench to bedside. Focused research, meaning that one looked at what the higher-ups wanted and made up a proposal to fit. No career researcher grants – locating people with "the knack" and supporting them to follow their noses [eliminating the explorer class]. Insel’s NIMH was big on technology [like his comments above]. So the ordinate axis of his grand clinical neuroscience plan was literally technologies:

Here, he’s blaming the failure of his RDoC on inadequate technology [I think it’s more likely just a lousy idea myself]. So we have technology driven projects. He may be closer to the mark with identifying pre-psychotic states, but if he is, it’s a lucky guess without confirmation so far – exploratory. But I hold my point. He starts with the desired end rather than where we are. And that’s what his NIMH has produced – flat predictable results. The recent RAISE study is an example. Pay a lot of attention to initial episode psychotic patients and it helps. The earlier you start, the better the outcome. I knew that already. So did you.

As in love as he is with academic/industry partnerships, he has ended up with an NIMH that has done a lot of PHARMA’s work for them and colluded, if even unwittingly, with the rise of an academic/pharmaceutical complex the likes of which we’ve never seen; in a specialty [psychiatry] that we would’ve never dreamed might go down that path; achieving pockets of corruption beyond our previous imagination. And to my knowledge, Insel has never even mentioned any of that.