{"id":60509,"date":"2015-10-11T16:00:08","date_gmt":"2015-10-11T20:00:08","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=60509"},"modified":"2015-10-11T23:23:35","modified_gmt":"2015-10-12T03:23:35","slug":"a-reset-button","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2015\/10\/11\/a-reset-button\/","title":{"rendered":"a reset button…"},"content":{"rendered":"
Tom Insel came to the NIMH at the height of the rise of neuroscience. It was a new century. The future DSM-5 team was just setting its sights on finally adding the hard science fixings to the psychiatrized brain. The drugs were steadily pouring from the pharmaceutical pipeline and were hitting the top of the charts in sales. New drug strategies were closing in on the treatment resistant cases. With the human genome cracked and a maturing of neuroimaging, it was just a matter of time before the dream of the new  psychiatry would be a reality. A few years into his reign, Dr. Insel announced this new paradigm, Psychiatry was to become Clinical Neuroscience<\/font><\/a>:<\/div>\n
<\/a><\/div>\n
But in spite of Tom Insel’s cheerleading for this brave new world, things just didn’t go as planned. Scandals, scoundrels, and corruption coupled with a flatlining research took away some of the glow. Yet against a growing gradient, Insel was steadfast in insisting on keeping the NIMH focused on the quest for breakthroughs in neuroscience. Then in the summer of 2011, it became common knowledge that PHARMA was pulling out of CNS drug development; the pipeline had dried up; and there was a collective groan heard throughout the land. Insel joined the attempts to woo PHARMA back and began to look for possible innovative<\/font><\/em> strategies for finding new drugs\/treatments. But, even then, he never took his eyes off of his neuroscience agenda:<\/div>\n
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Balancing Immediate Needs with Future Innovation<\/a><\/div>\n
NIMH Director’s Blog<\/font><\/strong><\/div>\n
by Thomas Insel<\/div>\n
January 26, 2012 <\/div>\n

NIMH, like all Institutes at NIH, has an advisory council that meets three times each year. The National Advisory Mental Health Council [NAMHC] is a distinguished group of scientists, advocates, clinicians, and policy experts. Each of our meetings includes a closed session to review individual grants considered for funding and a session open to the public that engages this diverse group in discussions about the larger issues that guide NIMH funding. <\/p>\n

At last week’s session, we heard a recurrent tension around one such larger issue. Some members of Council bear witness to the poor quality of care, the unmet medical need, and the diminishing investments by states on behalf of people with mental disorders. They reasonably ask, “How are we ensuring that the science that NIMH has produced is implemented where the need is greatest?” They also question on the pay-off of genetics research. After all, two decades after the gene for Huntington’s disease was identified, we still have no effective treatments, and Huntington’s disease is genetically far simpler than schizophrenia or bipolar disorder. In contrast to so many neurological diseases, we have effective treatments for schizophrenia and bipolar disorder. NIMH should be investing to ensure these are available.<\/p>\n

The opposing argument runs something like this. There has been no major innovation in therapeutics for most mental disorders since 1960. <\/font><\/strong> Current treatments are not good enough for too many. Rather than investing scarce dollars for incremental improvements or increased dissemination of mediocre interventions, we need invest in the fundamental science of brain and behavior so that we can understand how to develop better treatments.<\/font><\/strong><\/p>\n

While I may have oversimplified the two sides of this debate, the divide is substantial. Some advisors want more funds in services research; other advisors want more funds in basic neuroscience. Some are thinking of the immediate needs; others are focused on the paradigm shifts that may be revealed by another decade of research. And with the NIMH budget stretched, tough choices must be made…<\/p>\n

Sixty years ago, the nation faced a similar short-term vs. long-term debate about polio. The needs were growing and the causes were unknown. Some wanted funds invested only in better services, including improved iron lungs. Others argued for investing in a vaccine with a long-term goal of eradication. As David Oshinsky explains in his outstanding retelling of this debate, the government went with the services approach, leaving advocates and families to raise funds for vaccine development. Let us hope we don’t short-change our grandchildren, sixty years from today, by failing to invest in the long-term promise of more effective diagnostics and therapeutics for mental disorders. <\/div>\n<\/blockquote>\n
It makes a good story, his polio analogy, but it didn’t work like that. Over the last several years, his upbeat rhetoric has been replaced with the monotonous complaint that there were legions of untreated mentally ill people and our drugs weren’t good enough. Yet he ignored the present reality of mental health care and stuck with basic brain research, even raising a billion dollars for the BRAIN Initiative. When I listened to the interview below, I wondered if he knew how it sounded. He says our mental health system is badly broken, yet he’s someone who had a lot to do with what that system has become<\/font><\/em>:<\/div>\n
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Dr. Thomas Insel: Our Mental Health System Is ‘Badly Broken’<\/a><\/div>\n
The American <\/font><\/strong>Conversation<\/font><\/strong><\/div>\n
The Takaway<\/font><\/strong> <\/div>\n
October 07, 2015<\/div>\n
[audio<\/a>]<\/div>\n

Millions of Americans suffer from mental illness. The vast majority<\/a> of them have never been violent and never will be. But over the last few years, a good number of the young men involved in mass murders have suffered from mental illness: Christopher Harper-Mercer<\/a>, the gunman who killed nine people at Umpqua Community College last week, had Autism Spectrum Disorder.<\/p>\n

James Holmes<\/a>, recently sentenced to life in prison for murdering 12 people in Aurora, Colorado, was diagnosed with a disease similar to schizophrenia. Adam Lanza<\/a>, who shot and killed 26 people at Sandy Hook Elementary School, had severe anxiety, obsessive-compulsive disorder, anorexia and a number of other problems.<\/p>\n

As the director of the National Institutes of Mental Health [NIMH], Dr. Thomas Insel<\/strong> has kept track of these headlines. As he steps down from his position after 13 years at the NIMH, Dr. Insel reflects on the recent, great advances in brain science, and his disappointment that these developments have yet to reach a great majority of those who suffer from mental illness.<\/p>\n

"The mental health system is badly broken," Dr. Insel tells The Takeaway. "The problem right now is that we have a lot of people with mental illness that are not treated at all, treated very late, or treated very inadequately."<\/font><\/strong><\/p>\n

In November, Dr. Insel will step down after 13 years leading NIMH for a job at Google Life Sciences. He tells John Hockenberry about his hopes for his new position, and technology’s potential in treating mental illness…<\/div>\n<\/blockquote>\n
Dr. Insel went straight from his psychiatry residency [1976-1979] to the NIMH [1979-1994], then to the Yerkes Primate Center [1994-1999], followed by administrating a translational behavioral neuroscience program [1999-2002], then he finally returned to the NIMH as Director [2002-2015]. I happen to know this history [which is devoid of any<\/u> clinical experience] because I was trying to understand how he had come to have such a simplistic view of mental illness. He apparently believes those population estimates he often quotes are accurate ["… by 20xx<\/u>, depression will be the number x<\/u> cause of xxxxx<\/u>"<\/font><\/em>] [epidemic?]. He seems to have accepted the notion that all mental illnesses are biomedical circuit problems and the solution to the mental health system is badly broken<\/font><\/em> is a new crop of drugs\/treatments and some kind of outreach to find the untreated cases. Having failed to achieve the 2015 goal of "Biodiagnostics" and "Treatment of Core Pathology", he just went ahead and declared a new Biodiagnostic System anyway – the RDoC <\/font>[whatever that is]. <\/div>\n

Tom Insel was a surprise pick as Director of the NIMH in 2002. He came in like a lion<\/font><\/em> championing the cause of Clinical Neuroscience. My guess is that he, the powers that be in the APA, and the DSM-5 Task Force  thought that their bet that scientific advances in genetics and the identification of biomarkers was a slam dunk – and would come in time to complete the biomedical paradigm shift begun in the 1980s. They were dead wrong about that, but unable to alter their trajectory. Dr. Insel has been silent about the set-backs: record fines against the makers of the psychiatric-drugs, the scandals involving psychiatrists in high places, the embarrassment of the DSM-5 and its COI problems, the disappointment in the progress in psychiatric research, ghostwriting and guest authorship, and a growing sentiment that instead of new drug development we should be focusing on the over-use and misuse of the drugs we already have. The refrain, "Dr. Insel reflects on the recent, great advances in brain science…<\/font><\/em>" has been oft-repeated, but I can’t come up with anything that might justify that assertion. Let’s hope that his replacement will be someone who is able to find a reset button that might get us on a new path [and acknowledge the sins of the fathers]. <\/p>\n

So now Dr. Insel exits like a lamb<\/font><\/em> to go play in the Google sand-box…<\/div>\n","protected":false},"excerpt":{"rendered":"

Tom Insel came to the NIMH at the height of the rise of neuroscience. It was a new century. The future DSM-5 team was just setting its sights on finally adding the hard science fixings to the psychiatrized brain. The drugs were steadily pouring from the pharmaceutical pipeline and were hitting the top of the […]<\/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-60509","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/60509","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=60509"}],"version-history":[{"count":53,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/60509\/revisions"}],"predecessor-version":[{"id":60562,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/60509\/revisions\/60562"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=60509"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=60509"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=60509"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}