{"id":17338,"date":"2011-12-18T11:48:03","date_gmt":"2011-12-18T16:48:03","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=17338"},"modified":"2012-04-27T21:38:33","modified_gmt":"2012-04-28T01:38:33","slug":"good-riddance","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2011\/12\/18\/good-riddance\/","title":{"rendered":"good riddance&#8230;"},"content":{"rendered":"\n<p align=\"justify\">I was looking around for some recent Tom Insel writing that was fully available on-line, and ended up at his <a href=\"http:\/\/www.nimh.nih.gov\/about\/director\/index.shtml\" target=\"_blank\"><strong><font color=\"#000099\">Director&#8217;s Blog<\/font><\/strong><\/a> on the NIMH website. These are his December offerings with a plug for what&#8217;s coming next:<\/p>\n<ol>\n<li> <a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/wp-admin\/\"><strong><font color=\"#200020\">Antidepressants: A complicated picture<\/font><\/strong><\/a><sub> [December 06, 2011]<\/sub><\/li>\n<li> <a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/wp-admin\/\"><strong><font color=\"#200020\">Treatment Development: The Past 50 Years<\/font><\/strong><\/a><sub> [December 14, 2011]<\/sub><\/li>\n<li>&quot;<em>In  the next blog, I will suggest that what many are calling a &#8216;crisis in   medication development&#8217; may be an opportunity for NIMH innovation<\/em>&quot;<\/li>\n<\/ol>\n<div align=\"justify\">The offering on antidepressants was a response to the October <a href=\"http:\/\/www.cdc.gov\/nchs\/data\/databriefs\/db76.pdf\" target=\"_blank\"><u><strong><font color=\"#200020\">CDC Report<\/font><\/strong><\/u><\/a> on antidepressant use in America reporting that 10+% are taking antidepressants. <\/div>\n<div align=\"center\"><img loading=\"lazy\" decoding=\"async\" width=\"350\" vspace=\"4\" height=\"236\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/cdc-nchs-76.gif\" \/><\/div>\n<div align=\"justify\">Insel says,<\/div>\n<ul>\n<div align=\"justify\"><font color=\"#7f6f57\"><sup>&quot;We know that depression is a very heterogeneous syndrome.&quot; &quot;A true understanding of the nature of these different forms of  depression and <strong><font color=\"#660033\">the ability to predict who will benefit from the various  treatments available depends on a better understanding of the biology of  depression, either directly or indirectly through the use of &#8216;biomarkers.&#8217;&quot;<\/font><\/strong><\/sup><\/font><\/div>\n<\/ul>\n<div align=\"justify\">ending with, <\/div>\n<ul>\n<div align=\"justify\"><font color=\"#7f6f57\"><sup>&quot;As we engage ourselves in efforts to gain a deeper understanding of the  biology of depression, it is important to remember that optimal  treatment for depression does not begin or end with medication. Treating  depression is an art that requires many tools. We will not save lives  by dismissing any of the tools we currently have available, even as we  endeavor to develop better ones. A quality treatment plan for depression  includes a thorough assessment, a comprehensive treatment plan that  includes choices tailored to and guided by the individual &mdash; whether that  be medication, psychotherapy or both &mdash; and careful, frequent follow-up.&quot;<\/sup><\/font><\/div>\n<\/ul>\n<div align=\"justify\">That last part was unexpected &#8211; &quot;<em>art<\/em>&quot;? &quot;<em>many tools<\/em>&quot;? &quot;<em>choices tailored to and guided by the individual<\/em>&quot;? &quot;<em>whether it be medication, psychotherapy, or both<\/em>&quot;? This from Dr. <em>Clinical Neuroscience<\/em>? Hmm&#8230; Well, on to his second December blog [<a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/wp-admin\/\"><strong><font color=\"#200020\">Treatment Development: The Past 50 Years<\/font><\/strong><\/a>]:<\/div>\n<blockquote>\n<div align=\"justify\"><sup><font color=\"#7f6f57\">This is the traditional picture of treatment development: public  sector support of scientific discovery, and private sector investment in  specific compounds and early phase clinical trials, followed mostly by  private and some public funding of clinical trials. This  traditional picture is about to change. <strong><font color=\"#660033\">NIH has announced plans to  create a new institute&mdash;the National Center for Advancing Translational Science [<a target=\"_blank\" href=\"http:\/\/www.nih.gov\/about\/director\/ncats\/index.htm\">NCATS<\/a>].  Pending Congressional approval, NCATS should enable the development of  innovative methods and technologies to enhance the development, testing,  and implementation of diagnostics and therapeutics important for a wide  range of human diseases and conditions, including mental disorders.  NCATS would also support studies of the process of R&amp;D, including a  collaboration with the Food and Drug Administration to help identify  barriers to progress and provide science-based solutions to reduce costs  and the time required to develop new drugs and diagnostics.<\/font><\/strong> This should  help reduce the &ldquo;bottleneck&rdquo; that occurs in the treatment development  pipeline.<\/p>\n<p>       But change is coming from another direction as well,  especially for psychiatric medications. Over the past year, several  companies, including Astra Zeneca, Glaxo-Smith-Kline, Sanofi Aventis,  and recently Novartis, have announced either a reduction or a  re-direction of their programs in psychiatric medication R&amp;D. Some  of these companies [such as Novartis] are shifting from clinical trials  to focus more on the early phases of medication development where they  feel they can identify better targets for treating mental disorders.  Others are shifting from psychiatry to oncology and immunology, which  are viewed by some as lower risk.<\/p>\n<p>        There are multiple explanations  for these changes. For instance, many of the blockbuster psychiatric  medications are now available in inexpensive generic form. In addition,  there are few validated new molecular targets [like the dopamine  receptor] for mental disorders. Moreover, new compounds have been more  likely to fail in psychiatry compared to other areas of medicine.  Studying the brain and the mind has proven to be much more difficult  than the liver and the heart. Most experts feel the science of mental  disorders lags behind other areas of medicine. The absence of  biomarkers, the lack of valid diagnostic categories, and our limited  understanding of the biology of these illnesses make targeted medication  development especially difficult for mental disorders.<\/font><\/p>\n<p>        <strong><font color=\"#660033\">Given the  industry&rsquo;s lack of innovation over the past three decades and the  history of aggressive marketing of psychiatric medications, some might  understandably say, &ldquo;good riddance.&rdquo;<\/font><\/strong><font color=\"#7f6f57\"> But by almost any measure we need  better treatments, both medications and psychotherapies, for the entire  range of mental disorders. It is never a positive sign for those with  mental illness when thousands of scientists and millions of dollars are  shifted away from research on these disorders.<\/p>\n<p>       What can NIMH do  about this? Without the large budget and the scientific expertise for  medication development, how can NIMH compensate for the pharmaceutical  industry&rsquo;s shift in focus? <\/font><strong><font color=\"#660033\">Is it appropriate for NIMH to invest public  dollars in an area that many pharmaceutical companies have deemed too  risky for investment?<\/font><\/strong><font color=\"#7f6f57\"> In the next blog, I will suggest that what many  are calling a &ldquo;crisis in medication development&rdquo; may be an opportunity  for NIMH innovation&#8230;<\/font><\/sup><\/div>\n<\/blockquote>\n<div align=\"justify\"><a href=\"http:\/\/en.wikipedia.org\/wiki\/Thomas_R._Insel\" target=\"_blank\"><u><strong><font color=\"#200020\">Tom Insel<\/font><\/strong><\/u><\/a> has had a non-clinical career. There&#8217;s nothing wrong with that, except that it gives him a skewed view. After finishing his residency in 1979, he went to the NIMH where he notably worked on the psychopharmacology of Obsessive Compulsive Disorder. When he lost his position there in 1994, he took a position as Director at Yerkes Primate Center in Atlanta working on the hormonal influences in social behavior of Voles. In 1999, his contract was not renewed at Yerkes and he became Director of a &quot;a new $40 million National Science Foundation Science and Technology  Center, the Center for Behavioral Neuroscience. This new program used  behavioral neuroscience to develop a cross-institutional training and  research effort for 7 colleges and universities in Atlanta.&quot; In 2002, he was unexpectedly selected to head the NIMH. I need hardly to remind anyone that was in Atlanta that this was the heyday at Emory and beyond of Emory&#8217;s chairman, <strong><font color=\"#200020\">Dr. Charlie Nemeroff<\/font><\/strong>, &quot;Boss of Bosses&quot; [1991-2008] who surely was involved in Insel&#8217;s moving from place to place, including his move to the NIMH [many see Nemeroff&#8217;s recovery job at Miami as the favor repaid by Insel]. It was also the heyday of the brave new world of &quot;Clinical Neuroscience&quot; [1980-2008]. And Tom Insel didn&#8217;t originate the idea of <strong>Translational Science<\/strong>, but he has been one of its ardent Apostles:  <\/div>\n<ul>\n<div align=\"justify\"><sup><strong>Translational science<\/strong> is a <span class=\"mw-redirect\">cross disciplinary<\/span> <span class=\"mw-redirect\">scientific research<\/span> that is motivated by the need for practical applications that help people. The term is used mostly in the <span class=\"mw-redirect\">health sciences<\/span> and refers to things like the discovery of new drugs  that directly help improve human health. Thus, translating bench  science to bedside clinical practice or dissemination to  population-based community interventions. In the United States, the National Institutes of Health  have implemented a major national initiative to leverage existing  academic health center infrastructure through the Clinical and  Translational Science Awards.<\/sup><\/div>\n<\/ul>\n<div align=\"justify\">My own biases are as obvious as Insel&#8217;s. After the recent past, my reflexes say &quot;Good Riddance&quot; with the emphasis on &quot;Riddance.&quot; And Translational Science seems to me to be &quot;pushing a rope.&quot; It&#8217;s not my idea of how science works [since the days when Alchemy ended]. The <em>Manhattan Project<\/em> wasn&#8217;t science. The science was already there and the <em>Manhattan Project<\/em> just made it happen. Same thing with DARPA [and our Sputnik] or NASA. You can push implementation, but I&#8217;m not convinced &quot;pushing science&quot; is a good idea.<\/div>\n<p align=\"justify\">I&#8217;m sure that Tom Insel is not the right person to answer the question, &quot;<strong><font color=\"#660033\">Is it appropriate  for NIMH to invest public  dollars in an area that many pharmaceutical  companies have deemed too  risky for investment?<\/font><\/strong>,&quot; or say &quot;<strong><font color=\"#660033\">It is never a positive sign for those with  mental  illness when thousands of scientists and millions of dollars are   shifted away from research on these disorders.<\/font><\/strong>&quot; Like the situation with Drs. David Kupfer and Darrel Regier and their DSM-5 revision, these are people who have spent their lives cheerleading the &quot;up-side&quot; of the DSM-III &quot;Clinical Neuroscience&quot; Psychopharmacology revolution while overlooking [or not seeing] its very tawdry under-belly. And they&#8217;re still riding the bus&#8230;<\/p>\n<p>We await Dr. Insel&#8217;s proposals [&quot;<strong><font color=\"#660033\">an opportunity  for NIMH innovation<\/font><\/strong>&quot;] with a very wary eye&#8230;<\/p>\n<div align=\"justify\" \/>\n","protected":false},"excerpt":{"rendered":"<p>I was looking around for some recent Tom Insel writing that was fully available on-line, and ended up at his Director&#8217;s Blog on the NIMH website. These are his December offerings with a plug for what&#8217;s coming next: Antidepressants: A complicated picture [December 06, 2011] Treatment Development: The Past 50 Years [December 14, 2011] &quot;In [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-17338","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/17338","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=17338"}],"version-history":[{"count":25,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/17338\/revisions"}],"predecessor-version":[{"id":22762,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/17338\/revisions\/22762"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=17338"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=17338"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=17338"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}