Back to the Future

FROM THE EDITOR

[[{"type":"media","view_mode":"media_crop","fid":"31382","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_5937250873319","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4311","media_crop_rotate":"0","media_crop_scale_h":"117","media_crop_scale_w":"100","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":" ","typeof":"foaf:Image"}}]]Since this month’s editorial is about the future, I especially want to highlight that this month marks the start of a new collaboration for Psychiatric Times, which will bring our readers the most up-to-date information in our field. In the coming months, we’ll be featuring articles from our partnerships with the Academy of Psychosomatic Medicine, the American Association of Community Psychiatrists, the American Association of Geriatric Psychiatry, the American Academy of Addiction Psychiatry, and the National Network of Depression Centers. Given the explosion of knowledge in psychiatry, it is nearly impossible to keep up with all the cutting-edge knowledge from every subspecialty. We are confident we’ll help make that task more manageable with our exciting new partnerships, and know you’ll find this new feature of value in your practices.

Many of our readers will already know that Tom Insel, the now former director of the National Institute of Mental Health (NIMH), announced in mid-September that he was leaving the NIMH for a position at Alphabet Life Sciences, the company spun off from Google. This isn’t the first time that a senior person from the NIMH, or any of the other National Institutes of Health, has left for private industry. Some people will say, that the time for an NIMH leadership change is overdue. I say, “Good for Tom,” and that it is both worrisome and exciting because of what this particular departure means for our field.

Back in the 1980s Eli Lilly made a corporate decision to substantially build up their neuroscience research capacity. To accomplish this, they hired a group of senior research psychiatrists from the NIMH who were widely seen as leaders in their respective areas. Many thought that with Lilly’s commitment of resources, and the powerhouse of brain power, that incredible advances in somatic treatment, based on a better understanding of brain function, were now closer than ever.

What happened at Lilly was disappointing, and that disappointment, and the lack of new medications and, thus, return on investment, ultimately led Lilly to close up shop on neuroscience. I thought this was a real shame. I had visited Steve Paul, the Lilly neuroscience chief, in the early 1990s in Indianapolis. After signing the requisite disclosure agreements, Steve outlined for me the multipronged research strategy he was implementing. It was ambitious and very exciting. What happened? Probably several things-major breakthroughs take a long time to come to fruition and the fact that even a company like Lilly has finite resources are 2 things that come to mind, although I have no real inside information about their decision.

So, with that sad history, is there hope for anything different this time around? I think no, and yes. First, we’re all too aware of the severe lack of federal dollars for any kind of medical research. Thus, the likelihood of the NIMH really supporting research in the foreseeable future that will lead to a major breakthrough in psychiatry looks increasingly dim. Even with new initiatives every so often, the fact that only about 10% of submitted grants are funded means that the most creative and out-of-the-box ideas are not likely to be funded by the NIMH, even when they come from well-known senior researchers.

Second, since new directors come with their own agendas, the next director, just as Tom did when he arrived, may make major shifts in the priorities for NIMH funding. This set of circumstances makes major breakthroughs from NIMH research less and less likely. Even President Obama’s Brain Initiative, although funded with what appears to be groundbreaking resources, in reality is sorely underfunded given the aims of the project. And the next president, no matter what party, can easily move that project much lower on the priority list.

So, what’s the good part about Tom Insel becoming a “Googler” or should I now say an “Alphabeter”? For starters, money. I don’t mean Tom’s personal salary, which I’m sure is more than the feds were paying. What I mean is the vast amount of wealth that has been amassed by the major players in the tech industry superstars; Google/Alphabet, Apple, and Microsoft come quickly to mind. Each of these companies has vast amounts of cash and an equally impressive storehouse of brain power. And, it’s not just any brain power; it’s people who thrive on complex problem solving, thinking creatively, dreaming big dreams, and having the resources at hand to try to make their visions into reality.

No one would have thought self-driving cars, just to cite a much less complex task than understanding how the brain works, were in the near future. I just drove, however, 1000 miles back home in my new Subaru and about all I had to do was steer-the collision warnings, lane departure warnings, and adaptive cruise control meant I almost never had to step on the gas or the brake during the whole trip. Google has been testing self-driving cars for several years in several cities, and some say that they’ll be on the market within 5 years. What about the brain though?

On September 15, Forbes online posted an article about Tom Insel joining Google’s Alphabet Life Sciences.¹ That report, written by their science staff writer, Matthew Herper, mentioned several other Google initiatives such as their partnership with Novartis to develop a glucose monitoring contact lens for patients with diabetes (no wisecracks about Google Glass-we haven’t seen the end of that yet), and a partnership with AbbVie for antiaging research. These folks, and their tech colleagues in other companies, have some big ideas about using technology to transform medicine. I hope they use it to transform our understanding of how the brain works, and changes.

Tom Insel has often said one of psychiatry’s biggest challenges is understanding how people with different biological substrates can have the same symptoms or people with apparently the same biological substrates can have different symptoms. This in part reflects a school of thought that has been informing psychiatric research for decades (eg, Monte Buchsbaum’s work as long ago as the 1970s).² The work of Eric Kandel and others, though, tells us that it is not just the genetically inherited substrates that are important. It is the interaction of developmental experiences and lifelong learning along with the genetic substrate that both promotes and inhibits a wide range of genetic expression.

So what kind of resources would be needed to really sort this out? Google’s, Apple’s, Microsoft’s, just to name a few. And, they are already at work on very complex aspects of the expression of human biology. As a psychiatrist, a psychoanalyst, and a cognitive neuroscience researcher, I for one would like to understand how we can develop an ability to delink traumatic memories from their concomitant greatly dysphoric affects without months, or more often years, of psychotherapy. If I were in Tom Insel’s shoes, that’s something I’d love to figure out. So good luck, Tom, and don’t forget to write to the folks back home.

References:

1. Herper M. Google Life Sciences hires the government’s top brain scientist. Forbes. September 15, 2015. http://www.forbes.com/sites/matthewherper/2015/09/15/google-life-sciences-hires-the-governments-top-brain-scientist/. Accessed September 16, 2015.

2. Buchsbaum MS, Haier RJ. Biological homogeneity, symptom heterogeneity, and the diagnosis of schizophrenia. Schizophr Bull. 1978;4:473-475.