{"id":60563,"date":"2015-10-12T10:00:21","date_gmt":"2015-10-12T14:00:21","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=60563"},"modified":"2015-10-12T15:39:12","modified_gmt":"2015-10-12T19:39:12","slug":"insels-agenda-insels-theme","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2015\/10\/12\/insels-agenda-insels-theme\/","title":{"rendered":"insel&#8217;s agenda, insel&#8217;s theme&#8230;"},"content":{"rendered":"<div align=\"justify\"><sup>&quot;<em>Major depression is now  recognized as a highly prevalent, chronic, recurrent, and disabling  biological disorder  with high rates of morbidity and mortality. Indeed,  major depression,  which is projected to be the second leading cause of  disability  worldwide by the year 2020,  is associated with high rates  of mortality secondary to suicide and to  the now well-established  increased risk of death due <font color=\"#6d543d\">to comorbid<\/font> <font color=\"#8c7461\">medical  disorders,<\/font> <font color=\"#a99485\">such as<\/font> <font color=\"#c6b4a9\">myocardial infarction and<\/font> <font color=\"#d3d4cd\">stroke&#8230;&quot;<\/font><\/em><\/sup><\/div>\n<div align=\"right\"><sup><a target=\"_blank\" href=\"http:\/\/www.nature.com\/npp\/journal\/v31\/n7\/full\/1301082a.html\">VNS Therapy in Treatment-Resistant Depression<\/a> <font color=\"#200020\">[2006]<\/font><\/sup><\/div>\n<div align=\"justify\"><sup><font color=\"#200020\">by Sally Laden<\/font> <font color=\"#6d543d\">for Charles Nemeroff, Helen Mayberg,<\/font> <font color=\"#8c7461\">Scott Krahl, James McNamara<\/font>, <font color=\"#a99485\"> Alan Frazer, Thomas Henry, <\/font> <font color=\"#c6b4a9\">Mark George, Dennis Charney<\/font> <font color=\"#d3d4cd\"> and Stephen Brannan<\/font><\/sup><\/div>\n<hr size=\"1\" \/>\n<p align=\"justify\" class=\"small\">In my mind, I call it the <em><font color=\"#200020\">global<\/font><\/em><em><font color=\"#200020\">-specter-of-the-mental-illness<\/font><\/em><em><font color=\"#200020\"><em><font color=\"#200020\"><em><font color=\"#200020\">-epidemic<\/font><\/em><\/font><\/em>-official-introductory-paragraph<\/font><\/em>.  It&#8217;s the opener for many articles in our clinical trial literature, Tom  Insel&#8217;s blogs introducing his most recent NIMH neuroscience initiative,  countless psychopharmacology reviews, and sometimes a professional  organizations&#8217; articles about insurance parity. When I read them, they  remind me of a John Birch Society film I endured in college where a  white map of the world was gradually turned bright crimson by the  spreading <em>red menace<\/em> of communism; or the early Steve McQueen film, <em><font color=\"#200020\">the Blob<\/font><\/em>, where a town and its inhabitants are eaten by a growing mass of pink jello from outer space; or a <em><font color=\"#200020\">Zombie film<\/font><\/em> I recently watched [a little bit of] to see what they were about; or almost any <em>post-apocalyptic sci-fi film<\/em>.  The example above is from a ghost-written review article whose guest  authors had undisclosed financial ties to the manufacturer of the  reviewed product.<\/p>\n<div align=\"justify\" class=\"small\">These paragraphs often reference the various reports that say &quot;<em>by 20__ mental illness will be the _th leading cause of ____<\/em>&quot;, implying the coming <em><font color=\"#200020\">global<\/font><\/em><em><font color=\"#200020\">-specter-of-the-mental-illness<\/font><\/em><em><font color=\"#200020\"><em><font color=\"#200020\"><em><font color=\"#200020\">-epidemic<\/font><\/em><\/font><\/em><\/font><\/em> [written in the style of the childhood story of Chicken Little, &quot;<em>The sky is falling!<\/em>&quot;]:<\/div>\n<ul><span class=\"small\">                                     <\/p>\n<li>\n<div align=\"justify\"><a href=\"http:\/\/jama.jamanetwork.com\/article.aspx?articleid=193516\" target=\"_blank\">Burden of Disease &#8211; Implications for Future Research<\/a> [2001]<\/div>\n<\/li>\n<li>\n<div><a target=\"_blank\" href=\"http:\/\/www.who.int\/healthinfo\/global_burden_disease\/GBD_report_2004update_full.pdf\">THE GLOBAL BURDEN OF DISEASE, 2004 UPDATE<\/a>  [2004]<\/div>\n<\/li>\n<li>\n<div><a target=\"_blank\" href=\"http:\/\/www3.weforum.org\/docs\/WEF_Harvard_HE_GlobalEconomicBurdenNonCommunicableDiseases_2011.pdf\">The Global Economic Burden of Non-communicable Diseases<\/a> [2011]<\/div>\n<\/li>\n<p>            <\/span><\/ul>\n<div align=\"justify\" class=\"small\">I  have no idea how these reports are generated or of their accuracy, but  the point is what they&#8217;re being used for. In the case of the opening  quote, it was to promote a product &#8211; a vagus nerve stimulator for  depression. Since using this kind of report as an agenda driven sales  pitch of some kind has become so ubiquitous, it&#8217;s hard not to be  skeptical of an article like this one below in <strong><font color=\"#200020\">Foreign Affairs<\/font><\/strong>.  The article is not very long and available full text on-line, so I  won&#8217;t try to summarize it, just highlight a few points. It&#8217;s there for  the reading:<\/div>\n<blockquote>\n<div align=\"center\" class=\"big\"> <strong><font color=\"#000001\">Darkness Invisible: The Hidden Global Costs of Mental Illness<\/font><\/strong><\/div>\n<div align=\"center\" class=\"big\"><strong><font color=\"#200020\">Foreign Affairs<\/font><\/strong><\/div>\n<div align=\"center\" class=\"middle\">By Thomas R. Insel, Pamela Y. Collins, and Steven E. Hyman<\/div>\n<div align=\"center\" class=\"small\">January\/February 2015<\/div>\n<p align=\"justify\">Four   years ago, a team of scholars from the Harvard School of Public Health   and the World Economic Forum prepared a report on the current and  future  global economic burden of disease. Science and medicine have  made  tremendous progress in combating infectious diseases during the  past  five decades, and the group noted that noncommunicable diseases,  such as  heart disease and diabetes, now pose a greater risk than  contagious  illnesses. In 2010, the report&rsquo;s authors found,  noncommunicable diseases  caused 63 percent of all deaths around the  world, and 80 percent of  those fatalities occurred in countries that  the World Bank characterizes  as low income or middle income.  Noncommunicable diseases are partly  rooted in lifestyle and diet, and  their emergence as a major risk,  especially in the developing world,  represents the dark side of the  economic advances that have also  spurred increased longevity,  urbanization, and population growth. The  scale of the problem is only  going to grow: between 2010 and 2030, the  report estimated, chronic  noncommunicable diseases will reduce global  GDP by $46.7 trillion.<\/p>\n<div align=\"justify\">These  findings reflected a growing consensus among global health  experts and  economists. But the report did contain one big surprise: it  predicted  that the largest source of those tremendous future costs would  be  mental disorders, which the report forecast would account for more  than  a third of the global economic burden of noncommunicable diseases  by  2030. Taken together, the direct economic effects of mental illness  [such as spending on care] and the indirect effects [such as lost   productivity] already cost the global economy around $2.5 trillion a   year. By 2030, the team projected, that amount will increase to around   $6 trillion, in constant dollars &mdash; more than heart disease and more than   cancer, diabetes, and respiratory diseases combined.                            <\/p>\n<p align=\"justify\">These  conclusions were dramatic and disturbing. Yet the report had  virtually  no impact on debates about public health policy, mostly  because it did  not manage to dislodge persistent and harmful  misperceptions about  mental illness. In wealthy countries, most people  continue to view  mental illness as a problem facing individuals and  families, rather  than as a policy challenge with significant economic  and political  implications. Meanwhile, in low-income and middle-income  countries and  within international organizations, officials tend to view  mental  illness as a &ldquo;First World problem&rdquo;; according to that view,  worrying  about mental health is a luxury that people living in severe  poverty or  amid violent conflict cannot afford.<\/p>\n<div align=\"center\"><img loading=\"lazy\" decoding=\"async\" width=\"66\" height=\"18\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/snip.gif\" \/><\/div>\n<p align=\"justify\">People  underestimate the costs and significance of mental illness for many  reasons. At the most basic level, policymakers and public health  officials tend to view mental illness as fundamentally different from  other medical problems. But just like other diseases, mental illnesses  are disorders of a bodily organ: the brain. In this respect, they are no  different from other noncommunicable diseases.<\/p>\n<div align=\"center\"><img loading=\"lazy\" decoding=\"async\" width=\"66\" height=\"18\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/snip.gif\" \/><\/div>\n<p align=\"justify\">Such  steps will go a long way toward reducing the damage mental disorders  inflict on societies and economies all over the world. But for such  measures to succeed, policymakers and experts must first pull mental  illness out of the shadows and into the center of debates about global  public health.<\/p>\n<div align=\"center\"><img loading=\"lazy\" decoding=\"async\" width=\"66\" height=\"18\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/snip.gif\" \/><\/div>\n<\/div>\n<\/blockquote>\n<div align=\"justify\" class=\"small\">No less than two NIMH Directors on this article warning of the <em><font color=\"#200020\">global<\/font><\/em><em><font color=\"#200020\">-specter-of-the-mental-illness<\/font><\/em><em><font color=\"#200020\"><em><font color=\"#200020\"><em><font color=\"#200020\">-epidemic<\/font><\/em><\/font><\/em><\/font><\/em> by Tom Insel of the NIMH and his predecessor, Steven Hyman, now director of the Stanley Center for Psychiatric Research at Broad Institute of MIT and Harvard. In this case, it&#8217;s a pitch for more funding for their specific brand of brain and drug research.<\/div>\n<p align=\"justify\" class=\"small\">In the past, I&#8217;ve accused Dr. Insel of misunderstanding the meaning of his title, <em><font color=\"#200020\">Director<\/font><\/em>. The usual meaning would be <em><font color=\"#200020\">Director<\/font><\/em> as in person who <em><font color=\"#200020\">directs<\/font><\/em> the agency that funds research. He seems to me to think it means <em><font color=\"#200020\">Director<\/font><\/em> as in person who <em><font color=\"#200020\">directs<\/font><\/em> what researchers do. There are lots of checks to keep researchers from following esoteric or trivial projects. Translational research means projects that can be put into clinical use quickly. The NIH\/NIMH powers are big on Translational Research and Translational Centers [a particularly paradoxical mandate given Dr. Insel&#8217;s recent comment, &quot;<em><font color=\"#200020\">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<\/font><\/em>&quot; &#8211; see <a href=\"http:\/\/1boringoldman.com\/index.php\/2015\/10\/11\/a-reset-button\/\">a reset button&hellip;<\/a>]. <\/p>\n<div align=\"justify\" class=\"small\">But Dr. Insel&#8217;s NIMH has taken <font color=\"#200020\">directing<\/font> what researchers do to new heights. One has only to look at the strategic plan and its implementation to see what I mean:<\/div>\n<div>&nbsp;&nbsp;&nbsp;&nbsp;<strong><font color=\"#200020\">Research Priorities<\/font><\/strong><\/div>\n<ul><span class=\"small\">        <\/p>\n<li><a href=\"http:\/\/www.nimh.nih.gov\/about\/strategic-planning-reports\/index.shtml\" target=\"_blank\"><font color=\"#990000\">NIMH Strategic Plan for Research<\/font><\/a><\/li>\n<li><a target=\"_blank\" href=\"http:\/\/www.nimh.nih.gov\/about\/strategic-planning-reports\/strategic-research-priorities\/index.shtml\"><font color=\"#990000\">Strategic Research Priorities<\/font><\/a><\/li>\n<li><a target=\"_blank\" href=\"http:\/\/www.nimh.nih.gov\/funding\/funding-strategy-for-research-grants\/the-anatomy-of-nimh-funding.shtml\">The Anatomy of NIMH Funding<\/a><\/li>\n<li><a target=\"_blank\" href=\"http:\/\/www.nimh.nih.gov\/research-priorities\/rdoc\/index.shtml\">Research Domain Criteria (RDoC) Initiative<\/a><\/li>\n<li><a target=\"_blank\" href=\"http:\/\/www.nimh.nih.gov\/funding\/grant-writing-and-application-process\/concept-clearances\/index.shtml\">Future Funding Recommendations [Concept Clearances]<\/a><\/li>\n<li><a target=\"_blank\" href=\"http:\/\/www.nimh.nih.gov\/funding\/grant-writing-and-application-process\/fy-2015-funding-strategy-for-research-grants.shtml\">FY 2015 Funding Strategies for Research Grants<\/a><\/li>\n<p>        <\/span><\/ul>\n<div><strong>&nbsp;&nbsp;&nbsp;&nbsp;<font color=\"#200020\">Research Areas<\/font><\/strong><\/div>\n<ul><span class=\"small\">        <\/p>\n<li><a target=\"_blank\" href=\"http:\/\/www.nimh.nih.gov\/about\/organization\/dnbbs\/index.shtml\">Neuroscience and Basic Behavioral Science<\/a><\/li>\n<li><a target=\"_blank\" href=\"http:\/\/www.nimh.nih.gov\/about\/organization\/dtr\/index.shtml\">Translational Research<\/a><\/li>\n<li><a target=\"_blank\" href=\"http:\/\/www.nimh.nih.gov\/about\/organization\/dsir\/index.shtml\">Services and Intervention Research<\/a><\/li>\n<li><a target=\"_blank\" href=\"http:\/\/www.nimh.nih.gov\/about\/organization\/dar\/index.shtml\">AIDS Research<\/a><\/li>\n<li><a target=\"_blank\" href=\"http:\/\/www.nimh.nih.gov\/funding\/training\/index.shtml\">Research Training and Career Development<\/a><\/li>\n<li><a target=\"_blank\" href=\"http:\/\/www.nimh.nih.gov\/about\/organization\/dtr\/sbir-sttr-child-psychopathology\/index.shtml\">Small Business Research Opportunities<\/a><\/li>\n<li><a target=\"_blank\" href=\"http:\/\/www.nimh.nih.gov\/about\/organization\/od\/office-of-technology-development-and-coordination-otdc.shtml\">Technology Development and Coordination<\/a><\/li>\n<li><a target=\"_blank\" href=\"http:\/\/www.nimh.nih.gov\/about\/organization\/od\/office-of-genomics-research-coordination-ogrc.shtml\">Genomics Research Coordination<\/a><\/li>\n<li><a target=\"_blank\" href=\"http:\/\/www.nimh.nih.gov\/about\/organization\/gmh\/office-for-research-on-disparities-and-global-mental-health-ordgmh.shtml\">Research on Disparities and Global Mental Health<\/a><\/li>\n<p>        <\/span><\/ul>\n<div align=\"justify\" class=\"small\">It&#8217;s one thing to have checks on trivial or esoteric research or to clarify areas of particular need, but quite another to exert this much control. Truth be told, researchers need to be allowed to follow their own ideas. What&#8217;s happening now is that they look at the lists to figure out what to <em><font color=\"#200020\">re&middot;search<\/font><\/em> and produce proposals that have gratuitous paragraphs explaining how&nbsp; well their proposal fits the <em><font color=\"#200020\">Insel agenda<\/font><\/em>. It would be simple enough to just ask the selection committees to consider <em><font color=\"#200020\">relevance<\/font><\/em> in awarding grants. In a <a href=\"http:\/\/1boringoldman.com\/index.php\/2015\/10\/11\/a-reset-button\/#comment-262902\" target=\"_blank\">comment<\/a> to the last post, Dr. Carroll had a better way of making this point:<\/div>\n<blockquote>\n<div align=\"justify\"><em>In its first almost 40 years, NIMH enjoyed the leadership of five  directors who were astute politicians and administrators. They saw their  job as running interference for the scientists for funding, for  Congressional support, and for public image. None of the first five  Directors had reputations as scientists. They let the field shape the  science through a bottom-up process. Over the last almost 20 years, the  two most recent Directors acted very differently, operating with a  top-down style of management that frequently was abrasive&#8230;<\/em>  <\/div>\n<\/blockquote>\n<div align=\"justify\" class=\"small\"><img loading=\"lazy\" decoding=\"async\" width=\"120\" height=\"125\" border=\"0\" align=\"right\" src=\"http:\/\/1boringoldman.com\/images\/reset-button.gif\" \/>Given the NIMH output during the twenty years under discussion, there&#8217;s little evidence that exerting this much control has been very productive &#8211; too much form without accompanying substance. And it doesn&#8217;t take much reading of the strategic directives above to see that there is a theme to what is considered strategic [we might call it <em><font color=\"#200020\">Insel&#8217;s theme<\/font><\/em>]. Hopefully, the next <em><font color=\"#200020\">Director<\/font><\/em> will have more faith in our research community. Likewise, given the freedom to follow their intuition, they will likely be more committed [<u>and<\/u> more productive]&#8230;  <\/div>\n","protected":false},"excerpt":{"rendered":"<p>&quot;Major depression is now recognized as a highly prevalent, chronic, recurrent, and disabling biological disorder with high rates of morbidity and mortality. Indeed, major depression, which is projected to be the second leading cause of disability worldwide by the year 2020, is associated with high rates of mortality secondary to suicide and to the now [&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-60563","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/60563","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=60563"}],"version-history":[{"count":16,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/60563\/revisions"}],"predecessor-version":[{"id":60579,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/60563\/revisions\/60579"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=60563"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=60563"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=60563"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}