{"id":61097,"date":"2015-11-04T20:30:20","date_gmt":"2015-11-05T01:30:20","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=61097"},"modified":"2015-11-05T14:03:20","modified_gmt":"2015-11-05T19:03:20","slug":"chasing-rainbows","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2015\/11\/04\/chasing-rainbows\/","title":{"rendered":"chasing rainbows…"},"content":{"rendered":"\n

I should’ve just let things lie with my last post – stuck with my bit of sarcasm and moved on. Instead, I clicked on the link that lead to Fusion<\/a>‘s interview of Dr. Insel, and it wound me up all over again. I’ve characterized Dr. Insel as a breakthrough·freak…<\/a>– moving from one shiny object to another without every landing on something that endures, chasing whatever rainbows are on the horizon. Early in his time at the NIMH, I suppose he could get away with that occupying himself with his Clinical Neuroscience fantasies, following the pop-science concepts of the day – evidence-based medicine, translational medicine, personalized medicine, proteionomics, neuroimaging, etc. and riding on the back of the matriculation of various medication trials started by Steven Hyman, his predecessor. His blogs and speeches were like the article below, filled with future breakthroughs just around the corner. And then there was the parallel DSM-5 initiative, funded in part by the NIMH, holding symposia with the same future-think  aiming to transform psychiatric diagnosis by linking clinical syndromes to biological markers.<\/p>\n

But instead of biomarkers, there were other kinds of markers that said that there was a need for a change in direction. In 2004, there was the Black Box warning. Then the results of the big NIMH studies trickled out. None were exciting. The Atypicals were no better tolearated than the first generation antipsychotics. TADS and STEP-BD were lackluster and heavily "spun." STAR*D was too garbled and became quite easily forgotten. By the summer of 2011, the pharmaceutical companies were obviously fleeing CNS drug development in droves, moving to greener pastures [myopia – uncorrected…<\/a>]. Later that year, the DSM-5 Task Force threw in the towel [class action in the air…<\/a>] and admitted that the hoped-for biomedical transformation of psychiatric diagnosis wasn’t going to happen – the long sought data just wasn’t there. Dr Insel made a speech in London trying to keep the dream alive [Brain circuitry model for mental illness will transform management, NIH mental health director says<\/a>] – but his examples were fanciful. The chemical imbalance<\/font><\/em> meme was replaced with the neural circuitopathies<\/font><\/em>, but by then, no bands were playing anymore. As the DSM-5 became increasingly disfavored, the NIMH abandoned it and introduced its own RDoC<\/font>, a nebulous concept. If the biology wouldn’t map to diagnosis, they would map the diagnosis to the biology [my own unapologetic paraphrasing<\/font><\/em>], or something like that. In spite of  meetings, task forces, and multiple schemes to get PHARMA to recant, the death of the pipeline has not been averted. Are these misadventures the reason he’s leaving? <\/div>\n
\n
Why America’s top mental health doctor is moving to Google<\/a><\/div>\n
FUSION<\/font><\/strong><\/div>\n
by Casey Tolan<\/div>\n
October 26, 2015<\/div>\n

After 13 years as the director of the National Institute for Mental Health, Dr. Thomas Insel is starting a new job next week. But it’s not a job you might expect for a respected neurologist and psychologist: Insel will be working at Google, as a leader of the Google Life Sciences division, an independent company under the tech giant’s Alphabet umbrella.<\/p>\n

\"clinicalInsel is moving from the government to Silicon Valley, he told me last week, because he sees the tech sector as the answer to detecting, diagnosing, and treating mental illness. “Technology can have greater impact on mental healthcare than on the care for heart disease, diabetes, cancer or other diseases,” he said in an interview at Chicago Ideas Week. “It could transform this area in the next five years.”<\/p>\n

At the national institute, Insel prioritized funding for research of the most severe mental illnesses, like schizophrenia. He was previously the director of the Center for Behavioral Neuroscience at Emory University, where he studied how brain chemicals affect behavior like infidelity and parental attachment.<\/p>\n

The details of his new job description are still under wraps. “I don’t know what I’m going to be doing, and I think they don’t either,” he said. “They’re an amazingly secretive company.” But he said it was an offer he “couldn’t refuse.” He sees potential in using Google’s analytics and data-mining tools to pilot new research on mental health.<\/p>\n

Right now, he said, America’s system of treating mental illness is “dysfunctional.” He’s disappointed at the high levels of people who don’t get treatment and his failure during his time at the national institute at driving down suicide rates. “We’re not seeing any reduction in mortality in terms of suicide because we’re not giving people the care that they need,” he said. “We would never allow this to happen for cancer, for heart disease, for diabetes.”<\/div>\n<\/blockquote>\n
He has repeatedly said things like this last paragraph without acknowledging that perhaps some of the dysfunctionality has something to do with his own policies. In spite of calls from everywhere, including his own advisory board within the NIMH, he never backed away from his focus on basic neuroscience research over more service oriented projects. Posing the dichotomy in the winter of 2012 [Balancing Immediate Needs with Future Innovation<\/font><\/a><\/strong><\/u>], there was little question where the NIMH was determined to be heading – characterizing basic neuroscience research as investing in the future. And even now, he’s still in the breakthrough<\/font><\/em> mode:<\/div>\n
\n
\"GoogleHe imagines creating “sensors that give you very objective measures of your behavior.” “We do that already for how many steps you’ve had and your activity,” he said, pointing to the Fitbit strapped to his wrist, “but this would be doing it for mood, for cognition, for anxiety. It’s really actually very doable.” The sensors would measure sleep, movement, and have you take clinical tests in order to measure mental health. Other tools could analyze someone’s language use for early signs of psychosis.<\/div>\n

Technology can also be used to treat mental health as well as help detect symptoms. Insel cited the success of companies like Big White Wall, a startup in the United Kingdom. Members post anonymously about their struggles with depression, anxiety, or other mental health concerns, take clinical tests online, and videochat with therapists. It’s been supported by the National Health Service and has made therapy available to people who might never have had it before.<\/p>\n

“This is really potentially transformative,” Insel said. Some research has shown that “giving that treatment online is as effective as face-to-face treatment, and in some cases better, because there are so many people with these disorders who will not come in for treatment.” Other research projects have used digital avatars as stand-ins for human therapists: A potentially life-saving innovation would be making it possible for people to get online therapy right when they’re having a crisis, even if that’s in the middle of the night.<\/p>\n

\"Google<\/p>\n

“So much of what we’ve done in the mental healthcare system is you have a bad night, you make it through till morning and you call and they say, ‘We’ll give you an appointment in two weeks.’ That’s just not how you treat these disorders,” Insel said. Innovations like these are the future of mental health, he said—a future he hopes to keep pursuing at Google.<\/div>\n<\/blockquote>\n
I think most clinicians would agree that there some basics shared across specialties that have to do with a personal engagement, a willingness to listen, and the natural empathic bond that occurs between people. Dr. Insel is not a clinician and never has been. I think that’s why I have such a negative reaction when he begins to talk about matters clinical. So many of the things he comes up with are surprisingly naive. Instead of coming up with ideas like Avatar Therapy or saying things like “giving that treatment online is as effective as face-to-face treatment, and in some cases better<\/font><\/em>,” it would’ve been helpful if he had spent more time and more of the NIMH money on ways to improve our mental health care delivery  and increasing access to systems of care [with actual people]. <\/div>\n

Beyond that, this kind of promo-talk has characterized his blogs and speeches throughout his tenure. Phrases like “potentially transformative<\/font><\/em>” dot every interview and they might as well retire the word "innovation<\/font><\/em>" with him as he has worn it out [along with "novel<\/font><\/em>"]. It’s hard to understand why he has the longest time in grade of any NIMH Director unless the gift of spin has become a requirement for the job. <\/p>\n

A lot of what he seems to be proposing has an NSA-esque flavor, applying text analysis or big data techniques to online communications looking for signs of mental illness. Like waiting room screening and other such proposals, these are intrusive ideas being floated on uncharted waters. I sure hope Google has thought long and hard about allowing America’s highest ranking "breakthrough freak<\/font><\/em>" loose with their data-gathering capabilities. <\/div>\n","protected":false},"excerpt":{"rendered":"

I should’ve just let things lie with my last post – stuck with my bit of sarcasm and moved on. Instead, I clicked on the link that lead to Fusion‘s interview of Dr. Insel, and it wound me up all over again. I’ve characterized Dr. Insel as a breakthrough·freak…– moving from one shiny object to […]<\/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-61097","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/61097","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=61097"}],"version-history":[{"count":30,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/61097\/revisions"}],"predecessor-version":[{"id":61128,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/61097\/revisions\/61128"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=61097"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=61097"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=61097"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}