Among the most interesting things Insel said was in his discussion of the disappointing results of the various genomic studies. Psychiatry is not alone in having found very few illnesses that correspond to particular genetic variants, but in the context of all the other problems, this failure is more problematic.
Psychiatry may be different from other specialties, however, it the extent to which it has promised much more than it has produced when it comes to the discovery of biochemical causes of disease. And here something Insel said bears particular notice. He went out of his way to point out that there are no variants that map onto disruptions in the metabolism of serotonin or dopamine, the neurotransmitters most familiar to us from the repeated assertions, in doc tors’ offices and advertising and news stories. “It may be that neurotransmitters have nothing to do with pathophysiology or etiology of mental illness,” he added. Which he didn’t have to do, and every word Insel utters is significant, since he decides what studies get funded and therefore the overall direcction of psychiatric research. So what he was saying is, “Don’t come to me with more studies about neurotransmitters. That’s not where it’s at.” Someone will have to break the news to the drug companies that their best advertising strategy is kaput.
What I wonder is, in the 90 minutes that Insel spoke, how many doctors told how many patients that they were suffering from a chemical imbalance or a serotonin deficiency or dopamine surge, which means they have a lifelong illness like diabetes and need to take drugs for it? The disconnect here between waht docs know and what they tell the rest of us is stunning and just plain wrong.
