Friday, September 18, 2015

A Quiet Turn of the Revolving Door - Director of NIMH to Go Directly to Google Life Sciences

Amidst a lot of health care news, the job plans of Dr Thomas Insel, currently the director of the National Institute of Mental Health (part of the US National Institute of Health) made a very small splash.  The most comprehensive account was in the New York Times.

Dr. Thomas R. Insel, the director of the National Institute of Mental Health, announced on Tuesday that he planned to step down in November, ending his 13-year tenure at the helm of the world’s leading funder of behavioral-health research to join Google Life Sciences, which seeks to develop technologies for early detection and treatment of health problems.

As noted in the NYT article, Dr Insel had great influence over the direction of mental health research and policy,

Dr. Insel took over the N.I.M.H. in 2002 and steered funding toward the most severe mental disorders, like schizophrenia, and into basic biological studies, at the expense of psychosocial research, like new talk therapies. His critics — and there were plenty — often noted that biological psychiatry had contributed nothing useful yet to diagnosis or treatment, and that Dr. Insel’s commitment to basic science was a costly bet, with uncertain payoffs.

A Modern Healthcare article documented Dr Insel's specific organizational roles beyond his directorship that could have influenced research and policy,

Insel chaired the Interagency Autism Coordinating Committee, which is a federal advisory committee that coordinates autism research and services and was established by Congress.

Insel also co-chaired the Blueprint for Neuroscience Research, which supported the pioneering Human Connectome Project, a project to map the human brain, and the NIH Brain Research through Advancing Innovative Neurotechnologies program, which aims to accelerate the development and application of innovative technologies to map brain circuits.

Insel also headed up the Common Fund efforts in Molecular Libraries, Single Cell Biology, and Genotype-Tissue Expression.


So Dr Insel clearly helped steer current US government mental health care research and policy towards its current course.  Now he is going directly, not with any sort of delay or waiting period, to a commercial firm poised to take advantage of the current direction of US mental health care research and policy.

Although more subtle than, say, a leader of a government regulatory agency departing for a position at a company regulated by that agency, this, in my humble opinion, appears to be an example of the revolving door.  Certainly it fits the broad 2011 Transparency International definition,

The term ‘revolving door’ refers to the movement of individuals between positions of public office and jobs in the private sector, in either direction.

Despite this, as far as I can tell, no one else so far has referred to this job transfer as an example of the revolving door.

Furthermore, as we noted here, the revolving door can be veiwed as a species of conflict of interest.  Government officials who can look forward to extremely lucrative employment in health care industry may be much more inclined to seem friendly to the industry while in office.  Government officials who just came from industry are likely to maintain their industry mindset and be mindful of their industry friends.

Worse, some experts have suggested that the revolving door is in fact corruption.  As we noted here, the experts from the distinguished European anti-corruption group U4 wrote,

The literature makes clear that the revolving door process is a source of valuable political connections for private firms. But it generates corruption risks and has strong distortionary effects on the economy, especially when this power is concentrated within a few firms.

We have discussed Dr Insel's approach to conflicts of interest before.  Note that Dr Bernard Carroll, posting on this blog, has written extensively about Dr Insel's apparently rather lax approach to conflict of interest issues while he was at NIH raised by the case of Dr Charles Nemeroff.  Look herehere, here, and here.  Recapping these, I noted that Dr Insel later confessed that his statements about these issues "may be viewed as misleading."

Nonetheless, as far as I can tell, no one else so far has used the term conflict of interest in discussing Dr Insel's new job.  The anechoic effect continues.

As we have said endlessly, most recently here, the ongoing and increasing revolving door phenomenon clearly suggests excess coziness between industry and government, now to the extent that industry and government leaders of health care are becoming interchangeable.  This suggests that health care is increasingly run by this cozy ingroup, who very likely put their own interests ahead of those of patients and the public.

The continuing egregiousness of the revolving door in health care shows how health care leadership can play mutually beneficial games, regardless of the their effects on patients' and the public's health.  Once again, true health care reform would cut the ties between government and corporate leaders that have lead to government of, for and by corporate executives rather than the people at large

ADDENDUM (24 October, 2015) - This post was republished in OpEdNews.


Bernard Carroll said...

Insel’s move from NIMH to Google Life Sciences has plenty of people alarmed. What is their agenda? Don’t look for Insel to come up with original scientific ideas. Ethics and Nemeroff aside, at NIMH he was often criticized for a top-down style of management. His Research Domain Criteria (RDoC) initiative foolishly dispenses with clinical diagnoses and substitutes a metaphysical matrix of measures worthy of 16th Century astronomy. Yet, investigators in the field are saluting the new edict for RDoC in order to keep their funding – jumping through new hoops to the detriment of solid, bottom-up research.

A particular concern is that Insel and Google might plan to move in the direction of population screening via computerized adaptive testing for psychiatric conditions, using smart phone apps. Insel’s NIMH funded quite a lot of this dubious effort, as I discussed previously on this blog. Any such move would be seriously ill-advised.

Here are links to my earlier discussion of such testing. and

afraid said...

First do no harm. Sounds like a lie.