{"id":57376,"date":"2015-05-31T13:21:07","date_gmt":"2015-05-31T17:21:07","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=57376"},"modified":"2015-05-31T13:49:55","modified_gmt":"2015-05-31T17:49:55","slug":"lets-pretend","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2015\/05\/31\/lets-pretend\/","title":{"rendered":"let&#8217;s pretend&#8230;"},"content":{"rendered":"<div align=\"justify\" class=\"small\">I&#8217;ve mentioned this before, but it won&#8217;t seem to go away. When I opened the program guide for the 2015 APA Convention, this immediately caught my eye:<\/div>\n<div align=\"center\"><img decoding=\"async\" width=\"180\" vspace=\"7\" border=\"1\" src=\"http:\/\/1boringoldman.com\/images\/nnci.jpg\" \/><\/div>\n<div align=\"justify\" class=\"small\">If you don&#8217;t know or recall what this is about, I&#8217;d suggest reading <a href=\"http:\/\/1boringoldman.com\/index.php\/2015\/03\/13\/yellow-brick-roads\/\">yellow brick roads&hellip;<\/a> where I first met the <strong><font color=\"#200020\">NNCI<\/font><\/strong> [on Friday the 13th in March of this year] in a <strong><font color=\"#990000\">JAMA: Psychiatry<\/font><\/strong> article <img decoding=\"async\" width=\"84\" hspace=\"4\" border=\"1\" align=\"right\" src=\"http:\/\/1boringoldman.com\/images\/tomorrow.jpg\" \/>[<a target=\"_blank\" href=\"http:\/\/archpsyc.jamanetwork.com\/article.aspx?articleid=2174543\">The Future of Psychiatry as Clinical Neuroscience: Why Not Now?<\/a>], and I&#8217;ll pick up where I left off there. In March, I called my post &quot;yellow brick roads&quot; because it reminded me of Dorothy and friends heading off to Oz filled with great hope only to discover that Oz the Magnificent was a huckster. This time, my image was of that poignant scene from <em><font color=\"#200020\">Caberet<\/font><\/em>, where the beautiful blonde boy sings &quot;<em><font color=\"#200020\">Tomorow Belongs To Me.<\/font><\/em>&quot;<\/div>\n<p>            <\/p>\n<div align=\"justify\" class=\"small\">So <a target=\"_blank\" href=\"http:\/\/www.nncionline.org\/\">NNCI<\/a> is funded with an <a target=\"_blank\" href=\"http:\/\/projectreporter.nih.gov\/project_info_description.cfm?projectnumber=3R25MH101076-02S1\">R25 Training Grant<\/a> from the NIMH passed to a group of Directors of Residency Training in Psychiatry to develop a Neuroscience Curriculum for psychiatry residents for &quot;<font color=\"#200020\">INTEGRATING A MODERN NEUROSCIENCE PERSPECTIVE INTO EVERY FACET OF CLINICAL PRACTICE<\/font>.&quot; From their website:<\/div>\n<div align=\"center\" class=\"small\"><img loading=\"lazy\" decoding=\"async\" width=\"520\" vspace=\"7\" height=\"196\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/nnci.gif\" \/><\/div>\n<div align=\"justify\" class=\"small\">I was intrigued to &quot;<em><font color=\"#200020\">Learn to talk with patients about neural pathways underlying specific disorders<\/font><\/em>&quot; but I would&#8217;ve had to sign up and\/or pay. But here&#8217;s the facilitator&#8217;s guide which gives a snapshot of how this all plays out, and about how the role playing fits into the training.<\/div>\n<hr width=\"95%\" size=\"1\" \/>\n<div align=\"justify\" class=\"small\">So here&#8217;s the timeline lead-in:<\/div>\n<ul>\n<div align=\"justify\" class=\"small\"><strong><font color=\"#200020\">2002:<\/font><\/strong> Tom Insel is chosen as Directer of the NIMH<\/div>\n<div align=\"justify\" class=\"small\"><strong><font color=\"#200020\">2004-2008:<\/font><\/strong> DSM-V Symposia &#8211; NIMH\/APA funded [see <a href=\"http:\/\/1boringoldman.com\/index.php\/2014\/01\/03\/dsm-5-retrospective-i\/\" target=\"_blank\">DSM-5 retrospective I&hellip;<\/a>]             <\/div>\n<div align=\"justify\" class=\"small\"><strong><font color=\"#200020\">2005:<\/font><\/strong> Insel&#8217;s article about Psychiatry becoming Clinical Neuroscience with his own <a href=\"http:\/\/1boringoldman.com\/images\/insel-1.gif\" target=\"_blank\">schedule for discovery<\/a> [<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1586100\/\" target=\"_blank\">Psychiatry as a Clinical Neuroscience Discipline<\/a>]<\/div>\n<div align=\"justify\" class=\"small\"><strong><font color=\"#200020\">2012: <\/font><\/strong>The RDoC is launched by the NIMH   <\/div>\n<div align=\"justify\" class=\"small\"><strong><font color=\"#200020\">2012:<\/font><\/strong> Insel&#8217;s second article on psychiatry as Clinical Neuroscience [<a href=\"http:\/\/www.nimh.nih.gov.proxy.library.emory.edu\/about\/director\/2012\/the-future-of-psychiatry-clinical-neuroscience.shtml\" target=\"_blank\">The Future of Psychiatry (&thinsp;=&thinsp;Clinical Neuroscience)<\/a>] <\/div>\n<div align=\"justify\" class=\"small\"><strong><font color=\"#200020\">2015:<\/font><\/strong> The roll out article for the NNCI in JAMA: Psychiatry [<a href=\"http:\/\/archpsyc.jamanetwork.com\/article.aspx?articleid=2174543\" target=\"_blank\">The Future of Psychiatry as Clinical Neuroscience: Why Not Now?<\/a>]<\/div>\n<\/ul>\n<div align=\"justify\" class=\"small\">Leading up to this <font color=\"#200020\">NIMH Director&#8217;s Blog<\/font> published the day before the APA Convention last week [where <font color=\"#200020\">NNCI<\/font> presented the session for residents].<\/div>\n<blockquote>\n<div align=\"center\" class=\"big\"><a target=\"_blank\" href=\"http:\/\/www.nimh.nih.gov\/about\/director\/2015\/training-for-the-future.shtml\">Training for the Future<\/a><\/div>\n<div align=\"center\" class=\"big\"><strong><font color=\"#200020\">NIMH: Director&rsquo;s Blog<\/font><\/strong><\/div>\n<div align=\"center\" class=\"middle\">by Tom Insel<\/div>\n<div align=\"center\" class=\"small         \">May 15, 2015<\/div>\n<p align=\"justify\">&#8230;Until recently these young physician-scientists often discovered that their residency training was completely disconnected from their rigorous scientific background. Psychiatry training comprised required instruction on psychodynamic theory, psychopharmacology, and psychotherapy but little that linked to their interests in brain circuits or brain function. Faculty taught largely what they were taught twenty years ago. There were exceptions&mdash;NIMH supports several residency programs to offer research tracks for a few residents to pursue science during their clinical training years&mdash;but for most young psychiatrists, training in 2015 is hardly different from training in 1995.<\/p>\n<p align=\"justify\">A small band of psychiatrists who are involved in residency training,  led by David Ross at Yale, Melissa Arbuckle at Columbia, and Michael  Travis at Pittsburgh, set out to change this with the creation of the  National Neuroscience Curriculum Initiative [NNCI]. This online set of  teaching modules is grounded in principles of adult learning and  innovative teaching methods. Take a look at <a target=\"_blank\" href=\"http:\/\/www.nncionline.org\">http:\/\/www.nncionline.org&nbsp;<\/a>.  You can see the case conferences, experiential learning modules, and a  course on neuroscience in the media that the NNCI uses as a toolkit to  help residents navigate the new world of brain science.         <\/p>\n<p align=\"justify\">Why would residents want to know about modern clinical  neuroscience? After all, there are very few useful neuroscience-based  diagnostic tests or treatments. What Dr. Ross and his colleagues  discovered was a hunger for the information from modern brain science.  At the annual meeting of residency training directors, the NNCI workshop  has been a standing room only event for the past two years. Over 200  individuals from around the country have signed up to be part of the  NNCI &ldquo;learning collaborative,&rdquo; a group that helps test and develop  teaching materials, and more than 25 residency programs have  incorporated NNCI material into their training.<\/p>\n<div align=\"justify\">It&rsquo;s true that most of the neuroscience and genomics findings  are not yet actionable for psychiatry. No one doubts that the brain is  the organ of affect and behavior, but no one can point to a biomarker  that is essential for clinical practice. In the short-run, we may do  much more to bend the curve on suicide mortality by changing public  policy [such as through restricting access to means] rather than finding  a biomarker for suicidality. But in the long-run, and we need a  long-run strategy, policy will hit a wall and we will need better  diagnostics and therapeutics. That is where this new initiative can make  a difference. The research of 2015 suggests that the clinician of 2025  and certainly the clinician of 2035 will need to know about cortical  dynamics, neural networks, and genomic variation. Those entering the  field today will need to know how to think about the brain and how to  critique brain science. By changing the training of the next generation,  we not only prepare for the future, we create it. <\/div>\n<\/blockquote>\n<div align=\"justify\" class=\"small\">At this point, if you buy his story, you can move on and read something else, because I don&#8217;t and my take is likely to sound crazy. But here&#8217;s why I don&#8217;t buy it. Insel&#8217;s blog implies that this curriculum is to prepare the residents for some future time when we know how the neuroscience connects with some aspect of clinical psychiatry. Only when they say: <\/div>\n<blockquote>\n<div align=\"justify\">&quot;<font color=\"#200020\">INTEGRATING A MODERN NEUROSCIENCE PERSPECTIVE INTO <u>EVERY<\/u> <u>FACET<\/u> OF CLINICAL PRACTICE,<\/font>&quot;<\/div>\n<\/blockquote>\n<div align=\"justify\" class=\"small\"> It sounds as if there might be a more broad-based objective. And this has a different ring too: <\/div>\n<blockquote>\n<div align=\"justify\">&quot;The overarching goal is that residents will incorporate a modern   neuroscience perspective as a core component of <u>every formulation and   treatment plan<\/u> and bring the bench to the bedside.&quot;&nbsp;&nbsp; <\/div>\n<\/blockquote>\n<div align=\"justify\" class=\"small\">Or perhaps this one:<\/div>\n<blockquote>\n<div align=\"justify\">&quot;This module is designed to highlight how clinicians can <u>integrate a  neuroscience perspective&nbsp;directly into patient care<\/u>. Each session will  begin by reviewing current theories regarding the&nbsp;neurobiological and\/or  genetic underpinnings of a particular psychiatric disorder. <u>We then  use&nbsp;role-play exercises in order to help residents incorporate relevant  neuroscience into their own&nbsp;emerging clinical &ldquo;voice&rdquo;.<\/u> In addition, we  demonstrate how this knowledge can inform [and in&nbsp;some cases transform]  our understanding of patients, their symptoms and potential  treatment&nbsp;options.&nbsp; We also discuss how this approach may be used to  potentially strengthen the&nbsp;process of therapeutic communication. &quot;   <\/div>\n<\/blockquote>\n<div align=\"justify\" class=\"small\">As a matter of fact, it&#8217;s everywhere, throughout the whole NNCI site. And, by the way, that first quoted paragraph up there from his blog just isn&#8217;t true. Neuroscience and psychopharmacology dominate the residents&#8217; training program didactics.<\/div>\n<p align=\"justify\" class=\"small\">So my version of this story is very different from his. The way I read it, Dr. Insel who has never practiced psychiatry and has spent his career either in a lab or directing research programs thinks that clinical psychiatry is about dealing with brain disease and has used his position at the NIMH to press that opinion for his thirteen year tenure. He wanted to change psyciatry into a brain-based Clinical Neuroscience from the outset and set out a grandiose scheme about how that might go. He allocated generous funding to the APA&#8217;s similar effort with the DSM-V in a series of quickly forgotten symposiums. He&#8217;s been extremely controlling in directing funding towards that goal in all of the NIMH dealings. In spite of a lackluster record throughout his reign, he continues to pursue his dream. When the DSM-V flopped, he fled to his as-yet-unknown RDoC program. Now he&#8217;s funding and shepherding a program to implement his Clinical Neuroscience in the training of psychiatry residents. Like the DSM-V Task Force, he&#8217;s still championing it as if it&#8217;s a reality instead of an already tired term for untold millions of research dollars wasted. And now the NIMH has granted the NNCI $150,000 to teach people how to talk the Clinical Neuroscience talk to patients pretending that it&#8217;s backed by solid science.<\/p>\n<div align=\"justify\" class=\"small\">So my read is that this blog is ingenuous at best, bordering on conscious deceit, and he is continuing to abuse his power as he has done now for over a decade. This time he&#8217;s sticking his nose where it doesn&#8217;t belong and attempting to perpetuate his pet agenda into the future&#8230;<\/div>\n","protected":false},"excerpt":{"rendered":"<p>I&#8217;ve mentioned this before, but it won&#8217;t seem to go away. When I opened the program guide for the 2015 APA Convention, this immediately caught my eye: If you don&#8217;t know or recall what this is about, I&#8217;d suggest reading yellow brick roads&hellip; where I first met the NNCI [on Friday the 13th in March [&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":[5],"tags":[],"class_list":["post-57376","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/57376","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=57376"}],"version-history":[{"count":25,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/57376\/revisions"}],"predecessor-version":[{"id":57401,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/57376\/revisions\/57401"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=57376"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=57376"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=57376"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}