Dr. Tom Insel left the National Institute of Mental Health after 13 years of being its Director. He was the longest serving Director since Dr. Robert H. Felix, the agency’s founder. Despite controversies Dr. Insel’s appointment spanned over 3 presidencies. He has now left for Google Life Sciences where he will lead attempts at developing technologies for the early detection of health conditions. Dr. Bruce Cuthbert was appointed as Acting Director and now the position has been permanently taken over by Dr. Joshua Gordon.
I think it is now fitting to review some of Dr. Insel’s achievements. My views are biased as I served at the NIMH (well before Dr. Insel’s tenure) and remained in contact with many officials at the organization. It should come as no surprise that anybody who receives a political appointment at an organization is usually not well received by its members. The initial uncertainties and mistrusts to an outsider are usually replaced as the members work together towards fulfilling common goals. Unfortunately, this was not the case with Dr. Insel as the initial comments of his Branch Chiefs at different meetings were, “When is he going to leave? I heard he was looking for a job at an academic institution but nobody seems to want him.”
It is true that Dr. Insel took over the NIMH during a somewhat tumultuous transition, but most of it was of his own making. Dr. Insel belonged to an old boy’s network where he seemingly protected and advanced the causes of his personal friends. One of the major scandals during his tenure was how he provided a recommendation and maintained the grantsmanship standing within the NIMH of a researcher who had repeatedly broken academic and publishing norms (http://bit.ly/2ec5C8J). Dr. Insel’s conduct was enough for Senator Grassley to get involved and request all of the relevant information concerning the relationship between the involved parties.
It is unfortunate that Dr. Insel’s directorship didn’t involve consensus building but rather went with his own way of thinking in a rather undiplomatic manner. He gained the scorn of many members within the psychiatric profession by undermining the diagnostic criteria of the profession when many of these had been propelled by members of his own Institute. Although his claims bore some truth, he tried to implement a new diagnostic venture based on biological markers for which he had illusory hopes but no concrete proofs. Funding for clinical trials during his tenure plummeted and grant applications were less likely to be funded unless they included key words such as “biomarkers” and “individualized medicine”. It is unsurprising to hear the reverberations of the research community that, “Staking all your money on one bet, as the institute did under Dr. Insel, has consequences” (http://nyti.ms/2f1N8XA). Indeed, instead of moving science forwards, his point of views created stagnation.
My own particular regret of Dr. Insel’s tenure came from my own research and personal interest in autism. The Interagency Autism Coordinating Committee (IACC) was established in 2000 as part of the Children’s Health Act. It was reauthorized and chartered as a federal advisory committee in 2006, 2011, and 2014. This was the opportunity to dictate policy and provide some needed direction into ongoing research priorities. Within the NIMH there were many individuals with ample knowledge on autism, including some who had directed the field trials by which the Diagnostic and Statistical Manual classified autism. Instead of appointing a knowledgeable individual, Dr. Insel decided to throw the public spotlight upon himself. In essence, with his decision we had a glorified animal psychiatrist with benchtop laboratory experience taking over the reign of a committee dictating research policy on a human condition for which he had little or no experience. Dr. Insel’s lack of knowledge was proven in the initial directives drafted by IACC. The same proved that there was an egregious lack of representation and knowledge (e.g., confusing imaging with neuropathology) from many research perspectives important to autism. In the end NIMH’s budget became dangerously tilted towards funding research on genetic and animal models all of which had no possibility of making a difference in patients’ lives.
Dr. Insel’s legacy within the NIMH has been one where, for the longest period of time, there has been little relevant research adding to our basic knowledge of autism. All genetic research articles seemingly end with the same conclusion that autism is not a Mendelian trait but rather a multifactorial or complex condition where an interplay of both genetics and environmental factors are apparently at play. Similarly, a recent article indicates that most studies on animal models are underpowered and statistically flawed. For the VPA animal model of autism about 91% of them have reported invalid findings (see: Stanley E Lazic and Laurent Essioux: Improving basic and translational science by accounting for litter-to-litter variation in animal models. BMC Neuroscience 2013, 14:37 or the following link http://www.biomedcentral.com/1471-2202/14/37/abstract )
I hope that the new Director and members IACC can redirect the course of the ship and try to make a difference in patients’ lives through research. I know John Robison, one of its members, is presently trying to make his voice and this point of view heard. We can’t wait another 13 years of inaction and waste hundreds of million of dollars in order to obtain nothing,- our children and patients deserve better, they need our help now.