This past week, the New York Times ran a piece about Dr. Thomas R. Insell, former neuroscientist and current director of the National Institutes of Mental Health (NIMH). It was an interesting piece, centered on public protest and his tendency to break from tradition, but the most interesting aspect to the piece was nested just below the surface. The entire piece, and in fact Dr. Insell’s career, was a beautiful defense of basic science. I’m using the word basic here to refer to science that isn’t attached directly to a treatment, not to imply that it is in anyway simple or less important. In many ways, basic science is another example of a situation where scientists use a word with cultural connotations and are confused to see it misused by people on the outside (think ‘theory’ for one example). No, not simple, but as important as bedrock. All of translational medicine and technology is built upon basic science. To be more blunt, our western way of life is built upon it.
Throughout his career as the director of the NIMH, Dr. Insell has shifted the institute’s focus towards basic science, and for good reason. So much of what we think we know about mental health is based on fuzzy science, and worse, brute force chemical treatments. Many diagnoses are loose, for instance autism, which is why there exists a spectrum whose antipodes are barely recognizable as the same disease. Much of the way we think about treatment is based on 20th century ideas, many of which have failed us in terms of reducing and treating and truthfully understanding mental disease. The common problem here isn’t one of lack of effort, it is misplaced effort. We don’t understand the underlying cause because we don’t understand the underlying organ. Until we have a more comprehensive understanding of the brain, targeted and effective treatments for mental health issues will continue to elude us.
I understand the appeal of funding translational science, it seems logical at face value to throw your money where it will have the most effect now. The translational science seems sexy and exciting, the basic science seems dull and disconnected. We have limited resources; therefore lets direct them towards outcomes. The problem with that idea is one of assumptions. To hold that idea, you assume we know everything we need to know to solve these problems, it’s simply a matter of combining ideas. This is simply false, in most matters, but most specifically with regard to the brain. It is only through funding both translational and basic science that we will ever make real progress on these issues and stave off unnecessary human suffering. Dr. Insell gets it. I, for one, am glad he does.