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Post by Former NIMH Director Thomas Insel: Looking forward to 2011

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It may be a cliché for American science in 2011, but fitting nonetheless: we find ourselves in the best of times and worst of times. Best of times reflects the scientific opportunities that have emerged, with new tools spanning from the genome to the culturome. Many old questions can now be definitively answered and many new questions are emerging based on breakthroughs from 2010 (see previous blog). Worst of times reflects the uncertainties of 2011. We have now completed the first quarter of our fiscal year. Yet we do not know if this fiscal year’s budget will be a 3.2% increase (as requested by the President), a flat budget from last year (as prescribed by the current continuing resolution), a decrease of roughly 5% (as promised by some in the new leadership in the House of Representatives), or a compromise somewhere between these three positions.

How is NIMH managing this budgetary uncertainty? For now, we are assuming the lowest budget, which will likely allow us to fund approximately 10% of the grant applications we receive, as opposed to the more than 15% we funded in 2010. For the past 8 years our goal has been to fund at least 550 new grants each year with that portion of the budget that is not committed to ongoing grants. This year, a 5% reduction in funding will mean roughly 400 new grants. We will endeavor to buffer any potential drops in funding by focusing on the objectives of the NIMH Strategic Plan and tightening our belts in numerous other ways.

Whatever the year may hold in store for the Federal budget, we at NIMH will keep our eyes on the prize: discoveries that can make the most difference for people with mental illness. Here are a few areas to watch in 2011, a year we intend to be the best of times for mental health research.

Human Brain Development
NIMH investments of funds from the American Recovery and Reinvestment Act should yield important new insights this year, as the first maps coming from the Transcriptional Atlas of Human Brain Development project should be available to the scientific community. These maps will highlight differences between prenatal and postnatal brain, changes across adolescence, and unique patterns of gene expression found only in development. And the Neurodevelopmental Genomics project, with brain images and the results of cognitive testing from over 1000 children among 100,000 who have been genotyped, will give new insights into how common variation in genes may influence the development of both brain structure and function.

Genomics and Other High Throughput Technologies
What happened with computers in the last decade – faster, cheaper, better – is happening with technologies to sequence the human genome today. Once cost prohibitive, the price of DNA sequencing has dropped drastically in the past several years. Soon, whole genome sequencing will become the norm in research. With such precise methodology, this will be the year for discovering many new genetic variants associated with mental disorders. To expedite our discoveries, it will be key to share high quality data produced by these sequencing efforts and to build the computational resources to analyze the impending avalanche of data. The NIMH Center for Collaborative Genetic Studies has become the world’s largest repository for DNA samples from individuals with mental disorders and their families. In 2011, with samples from this repository, along with consortia developed with investigators around the globe, we should get our first comprehensive view of the genomic risk for autism, schizophrenia, and bipolar disorder.

The Research Domain Criteria (RDoC) project seeks to organize diagnosis, for research purposes, by what we have learned from neuroscience and genomics in addition to clinical features. In 2011, RDoC will become a major focus for NIMH with criteria emerging for the first elements of the project. We recognize that moving beyond the traditional means of diagnosis in psychiatry, the Diagnostic and Statistical Manual (DSM) will be a difficult cultural barrier for some in the research community, but NIMH is determined to lead the way to a new approach to understanding mental disorders based on pathophysiology as well as observed clinical signs. Of course, this will not be a one year process, but 2011 will mark the launch of studies that will test the feasibility of RDoC and determine whether this approach will be clinically useful.

Translating Basic Science into New and Better Treatments
What about treatments? In 2011, NIMH will support an initiative to leverage and link large existing healthcare networks so that they can be used to conduct comparative effectiveness trials. When completed, this infrastructure will be able to identify, recruit, and enroll participants more efficiently than “one-shot” clinical trials, saving taxpayer dollars and allowing for more rapid translation from bench to bedside. NIMH efforts to strengthen translational research dovetail with NIH Director Francis Collins’s efforts to optimize the agency’s organization for therapeutic development. In December 2010, the Scientific Management Review Board recommended that the NIH realign its resources to establish a new Center devoted to advancing translational sciences. As currently envisioned, the central role of the proposed National Center for Advancing Translational Sciences (NCATS) would be to establish a focused, integrated, and systematic approach for building new bridges to link basic discovery research with diagnostics and therapeutics development.

Focusing on Global Mental Health
As I’ve discussed before, NIMH is increasing its commitment to global mental health. We spent most of 2010 surveying the landscape of opportunities in this area by meeting with the World Health Organization (WHO), non-governmental organizations (NGOs), and other funding agencies involved in global health issues. Working with the Global Alliance for Chronic Disease we will soon complete a priority setting exercise which will identify the best scientific opportunities for NIMH. In 2011 NIMH will begin to implement projects that address these opportunities and we will continue to collaborate with other countries and NGOs on the Mental Heath Global Action Plan (mhGAP); an international effort by the WHO to develop evidence-based mental health ‘packages of care’ that can be easily and efficiently used in developing countries. Increasingly, we are seeing the solutions to global mental health challenges, such as disparities, limited access, and strategies in low resource environments, as solutions for U.S. mental health care as well.

Reinvigorating the Mental Health Research Community
One of the greatest concerns during this period of uncertain funding is the loss of a generation of early stage scientists. Whatever our budget may be in 2011, NIMH will continue to support several exciting grants through the new Biobehavioral Research Awards for Innovative New Scientists (BRAINS). This initiative (based on the successful NIH New Innovator Award program) is intended to support the research and career development of outstanding scientists who are in the early stages of their careers and who are making a long term career commitment to mental health research. NIMH remains committed to expanding opportunities for students from diverse backgrounds, and in 2011 will continue to support mentoring programs for underrepresented minority graduate students in high priority fields for the Institute.

The beginning of the year is a time for reflection and planning. The past year was extraordinary for new insights, many of which I described in the previous blog. The coming year promises even a greater opportunity for innovative science that makes a difference. But one of the most exciting aspects of research is its unpredictability: none of us at NIMH can predict the end of year message for 2011, nor would we want to. Instead, we shall heed the advice of Antoine de Saint-Exupery, “As for the future, your task is not to foresee but to enable it.”