Child Study Center Grand Rounds 05.03.2022

May 18, 2022

Opportunities and Challenges in Mental Health Research

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00:00Invite Doctor Jim Lachman to say
00:02a few words about Doctor Cohen.
00:09Well, I will be brief,
00:10but it's a great honor and
00:11pleasure to be here.
00:13And it's great to see everybody in person.
00:14Although you're all masks and maybe I
00:17can take mine off for just a little bit.
00:19Although I'm not drinking any coffee
00:20at the moment, but we're really
00:23looking forward to your presentation.
00:26And it was wonderful to interact with you for
00:28at least a few minutes during the lunch time,
00:31but I was asked to say a
00:33few words about Donald,
00:35and I guess it made me think of the first
00:37time that I came to the child's study center.
00:39Was actually to meet Donald.
00:41But what was I up to?
00:43I was actually a fellow at the NIH.
00:47As you know, a whatever that two year
00:49program was called back in the day,
00:52and there had been some
00:54interaction and I came up.
00:55And I met Donald,
00:56and he was such an amazing,
00:57brilliant scholar.
00:58I was truly inspired and I'll tell you
01:02one story about him towards the end,
01:04but I think it really he would really enjoy
01:08being present in the audience today for sure.
01:12And as I mentioned,
01:13he also had spent time in the intramural
01:15program at and I age just as I had.
01:17But he's probably best known for his work
01:19with regard to autism and Tourette syndrome.
01:22And he had a real passion for that.
01:24But he also was committed to providing
01:26the best clinical care possible.
01:30And interestingly,
01:30we have a program called the Sona Program,
01:33and you've actually met some
01:34of the individuals who've gone
01:36through that six year program,
01:37and it really was inspired by Donald,
01:39although we call it the solvent program,
01:41and that's because of some of
01:43the donors that actually wanted
01:45to support Al and his work.
01:47But actually the IT should have
01:49been called the culling program.
01:51And basically it was to bring
01:53scholars who were committed to
01:55really advancing our science.
01:57But also to being committed to providing
01:59the best possible clinical care over the
02:02long term for the patients that we serve.
02:05And believe it or not,
02:05you may actually be sitting next to
02:07somebody who was a participant of that,
02:09and there are a number of other
02:11people I think you met with a few
02:13other people that were part of
02:14the some of the program as well.
02:17So before I turn the floor over,
02:20I would just want to say thank you
02:22to Andres Martin and I don't have
02:26a spare copy of this,
02:27but he said that we might be able to
02:29find one and send it along to you.
02:31And this is life with others,
02:33and Bob King and Andres Martin
02:35sort of put this together that I
02:38was honored to actually prepare
02:40some of the introductory remarks,
02:42and I,
02:43I guess it makes me think because I was
02:44reading through some of the comments
02:46that I made that the some of his.
02:47Ancestors actually came from Ukraine,
02:49which is fascinating.
02:53But I guess the one thing that I
02:54wanted to just sort of end with was.
02:56I think the reason that I actually
02:58wanted the child symmetry was that I was
03:01a resident in psychiatry here at Yale.
03:04He was teaching a class.
03:06And what was the class?
03:08It was an opportunity to follow over
03:10the course of development below the
03:13experiences of children and their parents
03:16and literally started with individuals
03:17who are expecting their first child.
03:21And I don't know if you know this
03:23or not or how many kids you've got.
03:25But how long can you go without
03:27thinking about your baby?
03:29It's really pretty phenomenal
03:30in terms of the sort of normal,
03:32obsessive compulsive behaviors
03:34that are part of the reality
03:36of being a new parent anyway.
03:39Each week or every other week he
03:41would actually bring parents in
03:43together with their children to
03:45talk about their lived experience.
03:47And it was really a phenomenal
03:49opportunity for all of us,
03:50and it finally ended with somebody
03:51who was about to go off to college.
03:53And, you know,
03:54listening to what the parents and
03:56the child had to say about you know
03:59adolescence is a whole different story,
04:00but we can.
04:01We can go there,
04:02but Donald was just a remarkable human being,
04:05and I guess we just got an email
04:07of earlier today from another leor
04:09who can't even join us virtually.
04:11But he's over in Israel and
04:14he actually leaves the Cohen.
04:17As the other name.
04:19Paris.
04:22I think it's Cohen Harris for
04:24resilience and believe it or not,
04:26I'm the I'm a professor actually,
04:29thanks to the Harris family,
04:32but I think with that I'm going to
04:34turn over the floor and it would be great.
04:37If there's a way to track down another
04:39copy of this and send this along, thank you.
04:42Thank you for coming.
04:46Thank you so much Jim and and
04:49and you know just to echo,
04:51you know, our whole community.
04:52Thanks for coming in person today.
04:53We really appreciate your time.
04:54Doctor Gordon and it's my great pleasure
04:56to welcome our speaker for today.
04:58Doctor Josh Gordon and the director
05:00of the National Institute of Mental
05:02Health who needs no introduction.
05:04And before becoming the director
05:06of the National Institute of Mental
05:08Health and Doctor Gordon was a faculty
05:10member at Columbia University where he
05:12leads an innovative research program
05:14integrating systems neuroscience.
05:15To interrogate and neural circuits and
05:18understand their contribution to behavior,
05:20and I think a parallel with what
05:22we've heard a little bit about.
05:24Doctor Cohen is Doctor Gordon's commitment
05:27to elevating the next generation of
05:29physicians and physician scientists.
05:31And so he served as the associate
05:33director of the Adult Psychiatry
05:34Residency Training Program.
05:35While at Columbia University and the
05:37New York State Psychiatric Institute.
05:39And just as a small little anecdote.
05:41Most recently I saw Doctor Gordon
05:43present a part of an.
05:45Stage directors panel and he gave
05:47some of his time from the panel
05:50discussion so that he could actually
05:52highlight some of the research and
05:54posters that were being presented
05:55by junior colleagues at ACMP,
05:57which I think serves to demonstrate his
05:59commitment to the upcoming generation
06:00of future researchers and scientists.
06:02So please,
06:02with no further ado welcome Doctor
06:04Josh Gordon.
06:12Thank you Karen,
06:13and thank you all for coming today.
06:15What you're doing it virtually or in person.
06:17It is so nice to be able to
06:19resume these visits.
06:20I've only been doing it now for
06:22about 3 or 4 weeks and it is much
06:25more invigorating than than a
06:26parade of of even wonderful looking
06:28people without masks on zoom.
06:31I'm actually very well familiar
06:33with the Yale Child Study Center,
06:35although I've actually haven't
06:37visited it before,
06:37but my closest familiarity is the fact
06:40that year after year I would lose 2 Yale.
06:43All of the resident,
06:44but the MD PHD's interested in
06:46research for who wanted it to
06:48child track because we just
06:49couldn't recruit into Columbia.
06:51Young sung and Karthik are among the
06:53the two that that that that I lost
06:56just shortly before moving to NIMH,
06:59so it's nice to be back here and and.
07:01Now claims some form of affiliation with you,
07:05so I get to to enjoy some of the
07:08fruits of their labours as as you do.
07:11It's as I said earlier to a group of faculty.
07:14It's it's a pleasure and and a curse that,
07:16as director of NIH I get to talk
07:18about a wide range of science.
07:20That's the pleasure part.
07:21The curse is that I can't possibly
07:22talk about everything we do,
07:23but I'm going to talk about some of what
07:25I see as challenges and opportunities.
07:27And I I chose ones that are
07:29perhaps most relevant to you all
07:32in youth mental health research.
07:33But if there's something that I don't talk
07:35about today that you're curious about,
07:36or something that I do talk about
07:38today that I don't get right because
07:40this isn't my area of expertise.
07:42Feel free to mention it and question it.
07:44I'll try to leave some time at the
07:45end for comments and questions.
07:47The agenda is this.
07:47I'm going to talk to you about an overview.
07:49The anti image just to make sure.
07:51Although most of you will probably
07:52are well familiar with us that
07:54we're all on the same page and then
07:56quickly I'll move into some of the
07:57challenges that we face in in youth
07:59mental health research from a pretty
08:01high level perspective and then talk
08:03about opportunities in progress with
08:05some examples of the things that
08:06we're trying to support at NIH.
08:08I'll tell you in advance that
08:10buried in many of those slides.
08:12We're going to be links to RFA's
08:15that we love for you all to apply to.
08:17You don't have to scribble them down
08:19and just ask Karen and email you
08:21the whole presentation and you can
08:22click on the links directly and then
08:24I'll talk about some things that
08:25we think about when we're when we,
08:27when we think about how we can move
08:28the field forward into the future.
08:30So what about the overreach of the NIH?
08:32So as again,
08:33most of you probably know the NIH
08:35is the lead federal agency for
08:37research on mental illnesses.
08:39We support more than 3000 grants
08:41and contracts at universities
08:42and other institutions.
08:43Really around the globe and our
08:45own intramural research program,
08:47which I guess many of you have
08:49have experienced first-hand
08:50supports about 600 scientists on
08:52mostly in the Bethesda campus.
08:54At the NIH, we envision a world in which
08:57mental illnesses are prevented and cured,
09:00and to achieve that vision we have
09:01a mission which is to transform
09:03the understanding and treatment
09:05of mental illnesses through
09:06basic and clinical research,
09:08paving the way for prevention,
09:09recovery and cure,
09:11we take these words quite seriously.
09:13And that in in both the breadth of what we
09:16try to do and the depth of what we try to do,
09:20we do our best to
09:21communicate that to you all.
09:22And if you haven't taken a
09:23look at our strategic plan,
09:25I recommend you do so.
09:26It helps identify areas that we think
09:29of as priorities and also gaps in the
09:32area that we're not seeing enough.
09:34And if you figure out where your
09:36research belongs in that strategic plan,
09:38it can help in your communication
09:40with program staff and also help
09:42you formulate your aims to make to.
09:44To maximize the degree to which it
09:45overlaps with our stated priorities,
09:47beautiful thing about our current
09:48strategic plan is that it's
09:50a living document.
09:50We don't actually print it out anymore.
09:52I suppose you could,
09:53but you know then it would be old
09:55within a year because we revise it every
09:57year and we're just about to release,
09:58hopefully sometime in early June
10:01the 2022 revisions they reflect
10:03of course changes in priority,
10:05but they also reflect the
10:07progress that we've made.
10:08So we have science highlights now
10:09that are linked to many of our goals.
10:11To give you some illustrations of
10:12the kinds of work that we're doing,
10:14and if you think your work.
10:15Deserves to be highlighted either
10:16in our strategic plan or in the
10:18other documents that we put out.
10:20Please let us know.
10:21We have a great communications team
10:22that is always looking for exciting
10:24science and I have to say child mental
10:26health is an area that you know better
10:28than I really all Americans know is
10:30on the forefront of the minds of
10:32policymakers and the public alike.
10:33So we'd love to feature your research either
10:36in the strategic plan or in in other ways.
10:39So what, what?
10:39What are we trying to do in youth,
10:41mental health research?
10:42And if you'll forgive the hubris of the
10:44non youth mental health researcher.
10:45Tell you about it,
10:46I'll I'll talk to you about some
10:48of what I see as the challenges.
10:50The first challenge,
10:50of course,
10:51is the tremendous burden of the
10:53mental illnesses that we attempt to treat.
10:55These data I'm showing here are for all,
10:58including adults but and of course,
11:01much of the burden is an adult years.
11:02But we also recognize that mental
11:04and substance use disorders have
11:06their origins in early life,
11:07and that everything you do is trying
11:09to reduce that burden throughout
11:10the throughout the lifespan.
11:12So this graph shows you that in
11:14the United States, the total.
11:16Burden of disability.
11:18By disease groups and mental
11:20and substance disorders are the
11:22number 3 cause of disability.
11:23If you look globally at the the
11:25individual disease and their
11:27contribution to disability.
11:28V #1 cause of disability globally
11:31is depression and which is,
11:33you know, tells you two things.
11:36One, it tells you how common
11:37are disorders are and #2.
11:39It tells you because of the
11:40chronicity and young age of onset,
11:41the tremendous burden that is
11:43faced by individuals and societies.
11:45Because of these disorders this gets to that.
11:49Point that I made earlier that
11:50just about every mental illness
11:52has its origins in early life,
11:54and I'll point out that these blue
11:56smears I think probably is the is
11:58is as accurate as we can get anyway.
12:00But these blue smears in terms
12:02of onset belie the fact as we
12:04were discussing earlier,
12:05that even for some of these disorders
12:08with later onset like schizophrenia,
12:09substance use and mood disorders that
12:12there's the origins are are quite
12:14likely to be much earlier in life than
12:16these smears would otherwise indicate.
12:19Another challenge that we face to the
12:21besides the burden of our illnesses,
12:23is the fact that our treatments
12:25are of limited efficacy.
12:26Even if we think about depression,
12:28which we think of anyway
12:31as a reasonably as us,
12:33having reasonably effective
12:35medications and other treatments
12:37for depression are our medications
12:39are only modestly effective.
12:41Of course,
12:41you all know that in adults you
12:43know if you look at some of the
12:45best data on this coming from,
12:47you know, very large trials.
12:48At best,
12:49you're talking about a 30% remission
12:51rate with any one antidepressant
12:53or a 2/3 remission rate with
12:55with multiple over time.
12:59Traditionally antidepressants,
13:01even then half of those people or more
13:03will relapse within the within the year
13:05after in real world practice settings.
13:08This has a curve of course of
13:10children with depression treated
13:12with placebo versus sertraline,
13:14and you can see the extremely
13:15modest effect sizes of our illness.
13:17Actually, if you look at this.
13:19Curve is not so bad, right?
13:20We're on average,
13:21dropping depression symptomatology,
13:23and I forget which scale this is.
13:24But by about 50%.
13:26But of course,
13:27if much of the work there
13:28is being done by placebo,
13:29that means that we have a lot
13:31of work to do to try to develop
13:33treatments that are more effective,
13:35either by tailoring them, by, by,
13:37by, giving them to the right people,
13:39or by getting more effective treatments.
13:43The the rates of these disorders are very,
13:46very high, even in adolescence.
13:49This is a national comorbidity
13:51survey of adolescents showing that
13:53nearly half if not more than half
13:55of adolescents will have a lifetime
13:57prevalence of mental disorder.
13:58That's astounding and and
14:01what's particularly astounding,
14:03of course,
14:03is that you all know that the state
14:05of treatment services in the United
14:07States is so poor that very few
14:08of them are getting treatment,
14:10and very few of those are getting
14:12evidence based therapies.
14:13If we talk about service delivery,
14:15it's not just the total amount
14:17of services for children that is.
14:19That is a challenge in the United States.
14:22It's also the services that are
14:25available depending upon factors
14:26that it really shouldn't matter,
14:28like race or where you live.
14:30This is looking at the percentage
14:32of individuals who have received
14:34mental health services in the
14:36past year amongst adolescents
14:38over the last five years or so.
14:40As of 2019,
14:40and you can see that the likelihood that
14:42you're getting treatment for a mental
14:45illness depends tremendously upon race.
14:46Now the reason for these disparities
14:48in care are very complicated.
14:51Right,
14:51they include factors having to do with
14:53the individual communities involved,
14:55but they also have factors to
14:57do with access for a number of
14:59different reasons as well as the
15:00degree to which those treatments
15:02are tailored for and accessible
15:04to the the communities involved.
15:05So we need to do a better job of
15:08ensuring that people get services,
15:09and although it's harder to quantify,
15:11there is some evidence as well that
15:13the quality of care once you do
15:15receive services varies depending
15:17on factors like race and ethnicity
15:18and where you live as well.
15:22Another burden, another challenge
15:23that we face in mental health research
15:26is alleviating the worst outcomes
15:27of our illnesses, whether it be.
15:31Death or or chronic disability.
15:34One of those outcomes is
15:35illustrated here suicide deaths.
15:37This is a curve of crude suicide
15:39rates amongst youth in the
15:41United States from 1999 to 2020,
15:43and why you can see some little bit of
15:46hope saying that curve for 15 to 19 years.
15:49We're in the last few years,
15:50the curve has flattened a little bit.
15:52You can see that inexorably
15:54over the last 20 years,
15:55those rates have been going up.
15:57The situation is even more concerning
15:59when you look at this graph.
16:02Which was the first time I saw it.
16:04I was shocked this is children aged 5 to 9.
16:07Now you noticed of course they
16:09have a very low base rate of
16:12suicidal of death by suicide.
16:14But the fact that over the course
16:16of the past three years the rate
16:19has what more than tripled.
16:20And it's it's astounding and we have to
16:23acknowledge at least I have to acknowledge.
16:25Maybe you have more knowledge than
16:27I know nothing about suicidality
16:28and suicide in ages 5 to 9.
16:30And if you look at the field we know very,
16:32very little.
16:32And although and part of that is
16:34because it's so hard to study
16:35because the rates are so low,
16:37well they may not be so low anymore.
16:38And and and this is a population we
16:40need to start paying attention to another.
16:43Concerning trend is the rise in
16:45suicidality amongst black youth.
16:47This is showing 15 to 19,
16:48but the curves are are equally
16:51concerning with younger ages as well.
16:53Also in the last four to five years
16:55we've seen a substantial increase
16:57in suicide rates amongst black youth
16:59that also we can't quite explain.
17:03Black adults are relatively
17:05protected against suicide.
17:06They have lower suicide rates
17:08than white or other ethnicities,
17:10but the rates among black youth
17:11over the last several years have
17:13been rising so high that they now
17:15rival the rates amongst white youth.
17:16And we are quite concerned that through
17:18the course of the pandemic they may
17:20have actually surpassed rates of white youth.
17:22So suicide is a major burden that
17:26we face another burden that we
17:28face is the rising challenges of
17:31a more complex world.
17:33And one of those challenges
17:35it's use of social media.
17:36There's a lot of hand wringing and
17:39consternation about the mental
17:40health effects of social media,
17:42often expressed on social media,
17:45but also other forms of media.
17:47And we have to recognize that there's good
17:50reasons to be concerned about it nationally.
17:53We see tremendous adoption of social
17:55media and technologies with more and
17:58more time being spent on these devices,
18:00and there is some evidence that
18:02there are clear harms to be
18:04associated with social media.
18:06On the other hand,
18:07there are also evidence of some benefits,
18:09such as increased social
18:10connectedness that can be protective,
18:12so this is something that we know we have
18:14to study and that actually Congress has,
18:16or the President is proposing to
18:18give us additional funds to study,
18:19and we'll see how that works out over time.
18:22Finally, of course, we have to acknowledge
18:24that the COVID-19 pandemic has created
18:26created a whole new set of challenges
18:29for the mental health research field,
18:31and that's perhaps especially
18:32true for youth mental health.
18:34This is a chart of hospital admissions
18:36for US youth diagnosed with COVID-19.
18:39You can see the big Omicron
18:41peak in January of this year.
18:44The of course, as you know,
18:46the burden of COVID-19,
18:48especially in children,
18:49is not necessarily about
18:50those who've been infected,
18:51but about the population.
18:52Large we saw that early on in the
18:55pandemic where we saw increases in
18:57the proportion of visits to emergency
19:00rooms to child emergency rooms that
19:02were for mental health reasons.
19:04That's the lower graph,
19:05although in the upper graph you can see
19:07the number the total number of visits to
19:09ER's for mental health reasons didn't drop.
19:12So what was happening there in
19:13the early course of the pandemic?
19:14Well, an early course of the pandemic.
19:16You didn't take your kid to
19:17the ER unless they were really,
19:19really sick.
19:20So the fact that that we saw.
19:23Basically,
19:23steady rates of ER visits for
19:26mental health reasons suggested
19:27that there was at least an increase
19:30in accuity of mental illness in in
19:32the early phases of the pandemic.
19:34Of course we know across the population
19:36they were increases in the rates.
19:38This data is from adults of
19:40individuals reporting anxiety,
19:42depression, substance use, suicidality,
19:44et cetera.
19:46And the data on pediatric mental
19:48health usage has been a little bit
19:51more equivocal as the pandemic has worn on.
19:53This is a graph from a recent
19:56CDC publication and the Morbidity
19:58Mortality Weekly report showing
19:59essentially a return to pre pandemic
20:02levels of ER visits for mental
20:04health reasons across the country.
20:08With some notable increases
20:09in specific disorders,
20:11the top graph is increasing rates
20:13of visits for eating disorders,
20:15the dark blue, by the way,
20:16is females and the dotted line is
20:18males and then on the bottom you
20:21see the same for tick disorders.
20:23So is this the tip of the iceberg?
20:26Is this representing greater acuity,
20:30or is this representing essentially
20:32some mild or some modest?
20:34Let's say increases in demand
20:36for specific diagnosis.
20:38We're not really sure.
20:40We do know,
20:41though,
20:42that much of what we expected from
20:44the in terms of mental health effects
20:47of the pandemic is what we saw.
20:49We expected from surveys and studies
20:51of previous disasters and epidemics
20:53that we would see increases in the
20:55rates of mental health symptomatology
20:57and mental health utilization
20:58in the context of the trauma.
21:01In this case, the the COVID pandemic itself,
21:04and we're seeing that if you
21:05look on the bottom right,
21:06you can see this is again in adults.
21:08The rates of adults.
21:10Expressing depressive symptoms
21:11that meet mild,
21:12moderate, moderately, severe,
21:13or severe criteria are all so
21:15across the spectrum of severity.
21:18We're seeing greater depression in
21:20the US population, at least in adults,
21:22but on the on the the left graph.
21:25What you're seeing is that those
21:27symptoms self reported symptoms
21:29go up and down with the COVID
21:31cases as the pandemic wears on,
21:33and that's also what we expect
21:35that is most people exposed to
21:37trauma will have some level of
21:39symptomatology that symptomatology.
21:40Will be across the severity spectrum.
21:42Most of those people will get better
21:45as the disaster or epidemic wanes,
21:47but of course a significant
21:49minority of individuals will have
21:51chronic or and or severe symptoms,
21:53often requiring professional assistance.
21:55We kind of knew beforehand what the risks
21:58for poor outcomes from such events might be.
22:01The nature and severity of the exposure.
22:03So communities that have been hit harder.
22:05Children who've lost a parent.
22:06These are the individuals that
22:08you'd expect to have the highest
22:10likelihood of severity or chronic.
22:12In their in their mental health,
22:14mental illness.
22:15Response to the pandemic,
22:17but also individual differences play a role.
22:19History of trauma or mental illness.
22:21Ongoing stressors, financial strain,
22:23occupational strain,
22:25substance use or abuse.
22:26Being female or being non white.
22:28Also raise your risk and I don't know about
22:30that last one being an individual difference,
22:33I think that's more of a
22:34community based difference.
22:35Again in terms of #1 exposure to trauma and
22:39#2 access to services and then finally.
22:42Environmental factors,
22:43especially around social supports,
22:44raise your risk of chronicity
22:46or severity in the context.
22:48And all of these things have
22:50been seen in the pandemic,
22:51not necessarily in all populations,
22:53but as research comes out.
22:54What we're seeing is indeed
22:56the same kind of thing.
22:57The risk of severe or chronic outcomes
23:00depends upon many of these factors.
23:02Let's talk a few about a few of these of
23:05the impacts on children in particular.
23:07This is again data from the
23:10CDC showing an increase.
23:12In what they're calling adverse health
23:15behaviors in the context of school closures,
23:19or rather shift to virtual
23:20or hybrid schooling.
23:22We can see in the dark bars are the rates
23:24at which children are or parents I should
23:26say are reporting in their children.
23:28Decreased physical activity,
23:30time spent outside time,
23:32friend with friends in person.
23:35Decreased time with friends for
23:36non educational purposes and
23:38then worsen mental health.
23:39All of those things are increased in
23:42children whose school is either virtually
23:44only or some form of hybrid learning.
23:47So we know that school closures in
23:49the context of the pandemic have
23:52had adverse effects on various
23:54health and mental health outcomes.
23:57Some of those include externalizing symptoms,
23:59like fighting and arguing,
24:01disobedience, etcetera.
24:02Survey after survey has suggested
24:04increases in the rates of these
24:07kinds of behaviors in children,
24:09since the beginning of the COVID pandemic.
24:10This data was from mid to late 2020,
24:14published in 2021,
24:15also published around the same time was
24:17an examination of the factors that
24:20might have protected against some
24:22of these externalizing outcomes,
24:24and what you saw from that paper,
24:25although there's a lot of details
24:27that I won't have the time to go into.
24:28Is that in orange?
24:30Establishing and maintaining family
24:32routines despite the disruptions
24:34in work and school schedules
24:36was relatively protected both
24:38against externalizing symptoms and
24:40against child depressive symptoms,
24:42and interestingly enough,
24:43also protective against maternal
24:45depressive symptoms as well.
24:47So all these factors would suggest that
24:49the pandemic has had large effects on
24:51the well being of our of our children,
24:54as well as the perhaps more modest effects,
24:57although still unknown.
24:58In terms of severe mental illness outcomes,
25:02and then of course, as I alluded to before,
25:04the COVID-19 has cost.
25:06What is it now?
25:07A million Americans,
25:08their their lives and some very
25:11large proportion of them were
25:12parents of of young children,
25:14and in June 2021 that's,
25:16you know,
25:17hundreds of thousands of deaths ago,
25:19over 140,000 children had already lost a
25:21parent in the United States and of course,
25:24that number is even larger.
25:25If you think about the global population.
25:29If there is a silver lining to the pandemic
25:32from youth mental health perspective,
25:33it has been the tremendous energy and
25:36an awareness that has been raised
25:39about mental health in children.
25:41Whether it's the US Surgeon General,
25:42putting out an advisory of youth
25:45mental health crisis which you all
25:47know has been going on in the United
25:49States for years if not decades.
25:51But or the the fact that the President
25:53for at least the first time that I'm
25:55aware of a President spoke about mental
25:57health as being a national priority.
25:59In the state of the Union address
26:02this year and unveiled a so-called
26:04unity agenda to address mental
26:06health with significant components
26:07focused on youth mental health.
26:10So with that note,
26:12I think perhaps a slightly optimistic note.
26:14We can transition from thinking
26:16about the challenges that we face to
26:18thinking about the opportunities I'm
26:20going to talk about opportunities in
26:22three of the areas that I discussed
26:24before responding to COVID-19 suicide
26:27prevention and health disparities.
26:29Some of you who know me know me.
26:30I'm a diet in the wool neuroscientist.
26:32I think there are tremendous
26:34opportunities in neuroscience.
26:35Whether we're talking about genetics
26:38or computation or neural circuits.
26:40For drug development,
26:41there's lots of opportunity there.
26:42I'm not going to talk about it at all,
26:43but if you have questions or
26:45comments about that,
26:46I'm happy to entertain you
26:47for hours with enthusiasm.
26:49But I'm going to stick to these three
26:51topics because I think they're a
26:52little bit more timely right now.
26:54So let's talk about responding to COVID-19.
26:56What has NIMH done?
26:57You know NIH is in a curious role in
27:00the context of the pandemic, right?
27:02So we are a research organization.
27:03I told you that already.
27:04Our primary function is to support
27:06the work of you all all around
27:08the globe trying to come up with.
27:10Answers to questions that we have,
27:13but in the context of a of a public
27:15health emergency we take on another
27:17role which is also to try to promulgate
27:20evidence based approaches to dealing
27:22with a public health emergency.
27:24And so we spent quite a lot of effort,
27:26especially in the first six months or so.
27:28The pandemic developing resources
27:30and trying to put them out about
27:33what we already knew about coping.
27:35So some of what I told you about
27:37already right? The risk factors.
27:38The fact that we are all going to experience,
27:40and I know from personal experience.
27:41Certainly did adverse mental health
27:44consequences of the pandemic.
27:47That our children will and and and also
27:49that there are evidence based solutions.
27:52Actually,
27:52as you know mostly common sense
27:54but also evidence based solutions
27:56for reducing your risk such as
27:58maintaining social connectivity such
28:00as maintaining physical health,
28:02maintaining routines and importantly
28:04supporting financial and and other
28:07levels of security in the population.
28:10I must have left it out,
28:12but one of the interesting indicators
28:14from early on from 2020 that I saw.
28:17Was that the rate at which
28:18individuals declare symptoms of
28:20depression or anxiety is reduced in
28:23those individuals who have received
28:25food assistance compared to those
28:26who have not from the same community.
28:29So we knew what to do,
28:30and we tried to get people to do it,
28:32and I think to a certain
28:33extent we've been successful.
28:35And I I can't say that, and I am.
28:37H gets the credit for any of it,
28:38but you know, the fact that we as a
28:40society did increase our food assistance.
28:42We did put a moratorium on evictions.
28:45We did provide financial support.
28:48Uh, although perhaps mostly indirectly,
28:50to individuals who who lost their jobs,
28:53et cetera.
28:54I think that all played a role in minimizing,
28:57maybe not minimizing,
28:58but in decreasing the mental
29:00health impacts of the pandemic.
29:02But another impact of the pandemic
29:04has been on our researchers as well,
29:07and so NIH also put out a efforts to
29:10make sure that our scientists knew
29:12that they would be at least attempts
29:15to help make sure that they could see
29:18themselves through the pandemic as well.
29:20And then we put out also calls.
29:22These are old.
29:23Don't bother jotting down those
29:24numbers for research that we knew
29:26we would need eventually into
29:27the impacts of the pandemic,
29:29and in efforts to mitigate them.
29:31One of those calls that we put
29:33out was actually a part of a trans
29:35NIH initiative on the social,
29:36behavioral and economic impacts
29:38of the pandemic,
29:39and this initiative in particular was
29:43focused on underserved populations
29:45and frontline workers.
29:47So we we had a working group of 60
29:50different people from really across
29:52the NIH led by myself and three
29:55other institute directors from all
29:58of all of whom were interested in
30:01trying to understand beyond the
30:02health impact of the pandemic.
30:04Initially we funded 52 supplements
30:05and then some 20 more grants.
30:07After that,
30:08all aimed at trying to look at not
30:10just not the health impacts of the pandemic,
30:13but the other impacts,
30:15and in particularly interactions
30:16along the way. So a major theme.
30:18Behind this approach is to try to understand,
30:21for example,
30:21when you enact a mitigation measure
30:23that is aimed at reducing the
30:26health impact of the pandemic.
30:27What are the effects of that mitigation
30:30measure on economics on mental
30:31health and on behavioral approaches?
30:35This,
30:35this initiative had two different
30:37streams to it.
30:381A Data science initiative that
30:39seeks to look at the data available
30:41to try to break this down,
30:43and one of the studies that was
30:45funded through that data science
30:46initiative is really interesting.
30:48One looking at.
30:48On a county by county level,
30:50across the United States,
30:51what's the effect of the mitigation
30:53measures that were enacted in that
30:55county on mental health and then
30:57compare it to other counties that did
30:59different things at different times?
31:00So I think that will be really
31:02interesting and informative in
31:04terms of helping policymakers know
31:07what are the potential benefits
31:08and harms of the measures
31:10that one enacts in the context of a pandemic.
31:13The second stream was on intervention
31:15research trying to essentially mostly
31:18focus on implementation of interventions
31:20that we know that can be useful.
31:22In the context of disasters and traumas in
31:25this particular context of the pandemic,
31:28some of the interesting ones there are,
31:30as you might imagine,
31:32focused on remote care delivery methods like
31:36smartphones and and the Internet to deliver.
31:40Interventions to try to increase
31:42resilience in the context of the pandemic.
31:45One other thing that we did is try
31:47to use existing resources to be
31:49able to answer important questions,
31:51and some of you may have been
31:52involved in this.
31:53Of course,
31:54you're all aware of the adolescent brain
31:56and cognitive development study which
31:57is studying 12,000 children from age 9
32:00to age 20 with serial brain scans and
32:04lots of in-depth behavioral assessments,
32:06including assessments of social media
32:09used by the way and with the idea that we
32:12want to study children in their development.
32:15Through the course of greatest
32:17risk of emergence of substance use
32:19disorders and mental illnesses,
32:20and this is,
32:21as you know,
32:21a multi institute collaboration led by night,
32:24of which NIH has a strong role and
32:26immediately as the pandemic opened,
32:28we gave them a supplement to institute
32:31surveys and measures of their
32:33exposure to the pandemic so that
32:35we could study in a in a in a group
32:37that where we had baseline data.
32:39The effects of the pandemic,
32:40at least in adolescence.
32:43The domains covered in the BCD night
32:45COVID-19 questionnaire include
32:46all kinds of social determinants
32:47of health that would be relevant
32:49in the context of the pandemic,
32:51from family situation to schooling to
32:53routine relationships, you name it,
32:55and the idea is that we can measure
32:57these in children and in their parents
32:59and look for correlations with the
33:01mental health impact of the pandemic,
33:03and we hope that this will be reached
33:06data set which will yield not just
33:09findings and not just information
33:11but also some policy recommendations
33:13for the next pandemic.
33:15And I'll point out that the ABC D will
33:17be releasing this COVID-19 actually
33:20started releasing this COVID-19
33:22supplemental data in January 2021.
33:25As you know,
33:25all data from ABC has made public
33:27just as soon as possible,
33:29even before the investigators
33:30themselves had a chance,
33:32have had a chance to publish on it,
33:33and I encourage those of you with
33:35interest in these areas to consider
33:37studying this data, and frankly,
33:38to apply of trust for grants
33:40for secondary analysis.
33:41To do that data because we know it's not.
33:44Three to have coders sit in
33:45front of a terminal.
33:46In fact, it's very expensive.
33:49I'll point out one other one,
33:50which which I think also will maybe be
33:53giving us some really interesting data.
33:56Another NIH wide initiative that
33:58NIMH was involved in is evaluating
34:01the safe to return to school.
34:03Now this project was under the edges
34:05of of a larger program called RADAX,
34:07which was an effort to
34:09develop testing for COVID-19,
34:11which was remarkably successful if any
34:13of you have used a home test kit is,
34:16I think a 95% chance.
34:17It was one that was developed.
34:18Under the RAD X umbrella.
34:21Paid for by your tax dollars.
34:22Thank you very much.
34:25And so the a component of that
34:27though what went into trying
34:29to figure out how to use these
34:30tests in real world settings?
34:32And one of those real world
34:33settings that we found we thought
34:34would be important was how to
34:36use them to keep schools open.
34:37And so this study looks at that.
34:39There are four of those eight
34:40projects that were funded,
34:42though we'll include mental
34:43health assessments so we may get
34:45additional data about school,
34:46the effects of school closures,
34:48and keeping schools open and hybrid.
34:49Learning,
34:50etcetera from those data sets
34:52as they become available.
34:53Now there are ongoing areas of
34:55interest gaps in our portfolio that
34:57we are trying to fill and I'm very
35:00happy to say that Congress gave $20
35:03million extra to the NIH budget this year.
35:05A bigger increase than other
35:07institutes automatically got
35:09for the first time in memory of
35:11and specifically to address the
35:13mental health impacts of COVID.
35:16And so we put out a number of calls,
35:18and these are some of the grants that
35:20we funded with some of those calls,
35:22whether they be school based depression.
35:23Prevention longitudinal studies of
35:25art constructs and adolescents.
35:27Suicidality school based suicide prevention.
35:30School effects of school disruptions
35:32on mental health.
35:33So some of these that one last
35:34one is a notice.
35:35So we have a lot of grants in this area.
35:37We have an interest in launch more
35:38grants and I encourage you to look
35:40at and stay attuned to our notices
35:42in this area and I'll point out
35:44one that's actually not on here.
35:47As soon as Congress gave us that $20
35:50million extra and the President has
35:52now proposed 25 million more next year,
35:55we put out an emergency announcement for
35:58applications in the area of COVID health,
36:01mental COVID,
36:01mental health impacts and encourage
36:03you to look at that notice.
36:04It gives you a good idea of what we
36:06think are the important priorities.
36:07Of course, you may think better,
36:09and so you may have something else,
36:11but I encourage you to look at that
36:12and consider there are the first
36:14application deadline already passed,
36:15but there are two more applications
36:17in in the coming fiscal year.
36:18Application deadlines in coming fiscal year.
36:22So that's our response to COVID-19.
36:25And next I'll talk to you about
36:28suicide prevention.
36:29Our efforts in suicide prevention
36:31have been really quite focused,
36:33and so that means,
36:34although we have conducted a lot of
36:36research in youth and up till now,
36:37it's really been focused on adults
36:39because most suicide deaths are
36:41in adults and we were trying to
36:42figure out ways that we could bend
36:44that suicide prevent that suicide
36:45curve. And I didn't show you the adult curve,
36:48but you know that in 2019 it does look
36:50like that curve at least flattened and
36:51may have turned around a little bit.
36:53Our research aimed at doing that was
36:56focused on how can we identify individuals
36:58at risk and one of the most promising
37:01areas is in access to healthcare.
37:0330% of people who die by suicide were
37:05seen by a healthcare provider in the
37:07preceding seven days, seven days,
37:1050% in the preceding month.
37:13Of course, nearly 90% in the preceding year.
37:15So healthcare represents an opportunity
37:17to identify people at risk and
37:19intervene and study after study
37:21has shown this works and adults,
37:22we can reduce.
37:24Suicide attempts by universal screening
37:26and a simple referral package.
37:28In addition to usual care,
37:31you can reduce suicide attempts over
37:32the next year by 30%.
37:34So imagine if we could do
37:35that in the 30% of people,
37:37that would be a 10% drop
37:38in suicides immediately,
37:39and in fact we think that the
37:41fact that there is now universal
37:42screening in many ER's around the
37:44country is one of the contributing
37:45reasons to bending that curve.
37:47We also need to provide more
37:49effective interventions.
37:50Suicide screening works in kids.
37:52You know that there are a
37:53number of different measures.
37:53This one we're very proud of.
37:55The SQ because it was developed in
37:57house at the NIH and has been tested
37:59in a variety of different settings and
38:01a variety of different populations,
38:03both minority and majority populations,
38:06and so it's a really wonderful instrument,
38:09and I encourage people to use it.
38:10There's certainly other ones.
38:12A computerized adaptive screeners being
38:14studied by the Edge Stardust Group,
38:16which is the follow up to that
38:17adult ER study.
38:18But now trying to do the
38:19same thing in children,
38:20showing that you can identify 80%
38:22of youth who will attempt suicide.
38:25In the next 30 next 90 days,
38:28by asking them put by by universally
38:31giving this Screener to everyone
38:33coming to an emergency room,
38:35and now they're testing interventions
38:36to see if they can reduce
38:38rates in those who identify.
38:39There are other promising areas of risk,
38:41identification,
38:42and adolescence,
38:42and this one you can track
38:45trajectories for risk for suicide
38:47using ecological momentary
38:48assessments delivered to smartphones,
38:50and we have another.
38:51A number of research initiatives
38:53aimed at youth suicide prevention.
38:55I'll point out that there are
38:57several on here that are focused
38:59specifically on Black Youth and
39:01other underrepresented groups,
39:02and the reason for that of course,
39:04is that data that I showed you
39:06before that we're starting to see
39:07alarming increases in black youth.
39:09One of the things that I mentioned
39:11that we really haven't figured out is
39:13how we can study suicidal behavior in
39:16very young children younger than age 9 or 10,
39:18and that's something that we need to work on,
39:20and we know we need to work on as well,
39:22and that's a focus of an.
39:26Actually,
39:26it's not even on here.
39:27It may have closed already,
39:28an initiative that we put out to try
39:30to look at these early risk factors.
39:33Here we go. So we did try to hold
39:34a workshop to try to ask what we
39:36know and what we don't know in this
39:38area and I was really pleased to
39:40have a discussion with Jane Pearson.
39:41Is my suicide prevention research guru
39:43at NIMH and a special assistant to
39:45me on that topic. And Rachel Levine.
39:47Really outstanding assistant Secretary
39:49for Health that many of you may know,
39:51and the three of us talked about
39:53what we know and what we don't know
39:55about risk trajectories for youth.
39:57But more importantly,
39:57the experts talked about it too and
39:59helped inform the content of future
40:01or it will help inform the content.
40:03Future research calls.
40:04Finally, I'll talk about health
40:06disparities for a few minutes.
40:08This is an area, as I mentioned,
40:09to some of you before that I
40:11think we've underinvested in.
40:12Of course,
40:12one of the outcomes of that underinvestment,
40:14and maybe this curve right here
40:15that I showed you before the rise
40:17in rates among black youth suicide.
40:19But the fact of the matter is there
40:20been disparities and suicide rates,
40:22by ethnicity, for a long time.
40:24One of the ones that we've been
40:26most focused on at NIH for a number
40:28of years is the tremendously high
40:30rates of suicide deaths amongst
40:32American Indian and Alaska native.
40:36Both adults and youth we have had a program.
40:39As some of you may be aware,
40:41that involve involves research
40:43hubs to attempt to address the
40:46issue of suicidality in Alaska.
40:48In American Indian, Alaska Native youth,
40:51three different hubs were funded.
40:53They they study both a rural
40:54and urban populations.
40:55Both populations that are intermixed
40:57with the general US population and
41:00populations are on reservations,
41:01and we look forward to the
41:02outcomes from those.
41:03Fine, those studies soon.
41:04We have another a number of other initiatives
41:07in the health disparities area as well,
41:10and in addition to the things that
41:12I'm showing you on this slide,
41:13what I'm really most proud about is
41:15our work that transcends different
41:17areas of biomedical research.
41:20We are now participating in an NIH
41:22wide effort that just recently
41:23received approval to move forward
41:25on a common fund program.
41:27That's the the dollars to the NIH
41:30director directs him or herself.
41:31Common Fund program that really
41:34looks at health disparities.
41:35From a structural intervention lens,
41:37what can we do in communities that
41:40will really change the origins
41:41of health disparities?
41:43And it's a very innovative program,
41:45at least from the NIH perspective of
41:47many of you who work with communities.
41:48Been doing this sort of thing for a
41:50while to try to expand our ability
41:53to tackle structural problems that
41:56lead to health disparities from
41:58a really trans disease angle.
42:04We have also been asked by
42:06Congress specifically to address
42:08youth mental health disparities.
42:10We have established a strategic framework
42:11with the goal of addressing and reducing
42:14youth mental health disparities by 20-30.
42:16With three areas of focus,
42:18expanding research opportunities,
42:19expanding stakeholder engagement
42:20and growing the mental health
42:23disparities research workforce,
42:24we're in the final stages
42:26of writing this report.
42:27It will be submitted to Congress,
42:28hopefully actually next week.
42:31I just returned today.
42:33The final draft.
42:34So I look forward to you having the
42:36opportunity to review that report and
42:39get some ideas about things that you
42:41can do to help move the field forward.
42:43So I'll just mention that we are
42:46actually working with the White House
42:48and HHS on the mental health strategy
42:51trying to figure out what the research
42:54components of that strategy are,
42:55of course includes,
42:56as the President has announced $5
43:00million in next year's budget.
43:01If passed by Congress to support.
43:03Studies in the social media
43:04impact on mental health.
43:05It also the president's budget includes
43:07$5 million for innovative approaches
43:09to mental health care delivery.
43:11Recognizing that we need to
43:12have near term research.
43:14If we're going to have near term
43:15results for mental healthcare,
43:17we also want to enhance our support
43:19for early career scientists and
43:20use that as a tool to increase
43:22the diversity of our workforce.
43:23I recognize that the COVID-19 is.
43:25This graph suggests it has had outsized
43:27impacts on people early in their careers.
43:30We have supported extensions and
43:32continue to support extensions.
43:34To training and career development
43:35grants were necessary as well as
43:38administrative supplements for
43:39COVID-19 impacted NIH research.
43:41We put out a notice,
43:42in particular to talk about the kinds
43:44of research that we think are most
43:46important to support with those supplements.
43:47Again,
43:48I encourage you to look at that
43:49and then discuss with your program
43:51staff if your own project has
43:53been affected by COVID-19,
43:54and then I'll close with this,
43:56which is another slide with lots of links
43:58to initiatives that are all aimed at
44:00trying to improve workforce diversity.
44:02Many of them,
44:02but not all of them are about training,
44:04but we recognize it's not
44:05just about the so called.
44:07Pipeline,
44:07it's really about trying to create
44:10an environment that is open
44:12to an inclusive of researchers
44:14from a diverse backgrounds,
44:16and so I encourage you to look
44:17at those programs as well.
44:19With that,
44:19I'll stop and open it up for questions.
44:29Thank you so much Doctor Gordon,
44:30and just in the spirit of
44:32this being the Cohen lecture,
44:33I believe Phyllis Cohen.
44:34Gladstone is on the line Phyllis,
44:36could I call on you to make
44:38any initial comments or
44:39reflections on the presentation?
44:48You're muted if you're talking.
44:51I would be so. And I'll just reiterate.
44:55While we maybe we find her that
44:57you can ask me questions about
44:58anything that I talked about or
44:59didn't talk about. It's fine.
45:01Maybe just Phyllis unmuting.
45:02I'll open it up to the
45:04audience for any questions.
45:09Hi Doctor Gordon, great talk.
45:11My name is April. I'm a PhD student
45:13in Ellen Hoffman's lab and I have
45:16a two part question.
45:19Are there any studies or data that
45:21you can speak on about the mental
45:24health challenges of LGBTQ youth,
45:26both during COVID and regarding a
45:30suicide prevention or suicidality?
45:34Yes, there are. Let's start there.
45:37But actually my first thank you
45:38for asking the first question.
45:40It's unusual to have a trainee do
45:41it and I'm really appreciate that.
45:42I like to hear from trainees.
45:45We know from some data
45:47there's not a lot of it,
45:48but like the Trevor Project,
45:50for example, has accumulated a number
45:52of data showing that LGBT youth
45:53have been impacted by the pandemic.
45:55It's hard to know if it's worse
45:57or better because it's not really
45:59well tightly controlled controlled
46:00groups than in general youth.
46:02And of course,
46:03we know that suicide rates are very high,
46:05particularly amongst trans youth,
46:06but amongst LGBTQ plus youth in general,
46:09so that's that's a very,
46:12very short answer to what is a larger,
46:14more complex question.
46:15We have some equities and research
46:18in this area.
46:19A lot of our research in this area has
46:21been focused on suicide prevention,
46:24also on HIV prevention and the
46:26intersection between mental
46:27health and HIV prevention in a
46:29sexual and gender minority youth,
46:31sexual, gender,
46:32minority,
46:33youth and sexual gender minority
46:35individuals are now recognized by the
46:37NIH as a health disparity population.
46:39So everything I said about health
46:41disparities and also for that
46:43matter of workforce diversity,
46:44we want to and make sure to include.
46:45Just those communities in that study.
46:50Thanks. Great and I see a question on zoom
46:55Michelle Hampson if you'd like to unmute.
46:59Thank you so much for taking
47:01the time to come and present.
47:03I actually want to raise one
47:05thing which is a concern of mine,
47:07which is how the current clinical trial
47:11protocols are affecting early stage research.
47:15Can you hear me? Yeah, OK, great.
47:19So I think you know traditionally
47:23late stage clinical trials were the
47:25only thing that was called a clinical
47:28trial and what was decided is good.
47:30Clinical trial practice was developed
47:33to perfect late stage clinical research
47:37and some of those practices which are
47:39very great for late stage clinical
47:42research are absolutely horrible when
47:44leveraged onto early stage research,
47:47and unfortunately that's what's
47:49happening now.
47:50It feels like is there some technical issue?
47:53Just hearing you twice
47:54but we can hear you OK.
47:57So I keep going. Or should I wait
47:59to know what it is keep going.
48:01OK so I just wanted to express
48:03how concerned I am about that.
48:05I think registering what you're
48:07going to do on clinicaltrials.gov
48:08is just across the board.
48:09A positive thing,
48:10I think that's great for late
48:12and early stage research.
48:14However, some of the other ideas like
48:15the idea that you have to have a very
48:18fixed protocol and everything you do.
48:19Everything you look at has
48:21to be very well powered,
48:23is absolutely deadly for early
48:24stage research because early stage
48:26research you are taking something that
48:27nobody has done before and you're
48:29tweaking it and playing with it.
48:31And seeing how to make it work and if
48:33every time you make a tiny change you
48:34have to run a full powered clinical trial.
48:37You're not going to be able to look at much.
48:38You're not going to be able to figure
48:40out what works and that's the problem
48:42that we who do early stage intervention
48:44human intervention research are are
48:47struggling with at the moment and
48:49I'm just wondering if there's any
48:51awareness at NIH in general and NIH
48:53specifically about this issue.
48:55Well, I appreciate you raising it,
48:56and for those of you don't know
48:58that this issue is even more acute
49:00in what we might call basic science
49:02research and engages human beings,
49:04which is now almost universally being
49:07considered clinical trial as well.
49:09So I don't know how easy this is to do,
49:12but on the basic science side,
49:14they've gotten around this by
49:16essentially naming it something
49:17different at best clinical trial,
49:19but I forget what that stands for.
49:21Behavioral something, something and and,
49:24and in that setting they've been able
49:26to have a little bit more flexibility
49:29as the protocols are moving forward.
49:32To tell you the truth, it's not us that
49:34care about the rigidity of the protocols,
49:36although it may seem that way,
49:40and universities and more importantly.
49:43Irbs may consider it as important to
49:46maintain that rigidity for early stage.
49:49As for late stage clinical trials,
49:51so I don't mean to take the blame away
49:53from us, but as far as we're concerned,
49:55you can amend that.
49:57Clinicaltrials.gov protocol,
49:58as often as you want,
50:00you can trash it and create a new one,
50:02and you have to post the results saying,
50:04we, you know we did three people and it
50:06didn't work, but that would be fine with us.
50:09You can amend it all you want.
50:11You can change the protocol as
50:13much as you want.
50:14But as long as you reported out,
50:17that's essentially our requirement.
50:19But IRB's may not feel the same way.
50:21And and in the interactions
50:23between RB's and NIH,
50:25it also may not appear the same way.
50:27So I hear your frustration.
50:29Are we aware of this problem?
50:31Yes,
50:31I discovered in 2016 when I
50:34arrived it and I am H that this
50:37was a done deal already and and.
50:39And about six months later
50:41as it was announced,
50:42began hearing from all of my
50:43colleagues and I have many of them.
50:45And neuroscience,
50:46who do human behavioral studies that
50:48they are now going to have to hear this?
50:51Believe me,
50:52it was your your concerns
50:54were shared by many,
50:56but it is beyond too late for that now.
50:58So what I would say is that working
51:02with the administration in here at
51:04Yale to and the RB in particular to
51:06recognize the differences between a
51:08protocol that should not be amended
51:10to ensure the safety of the research.
51:12And I should say,
51:13not just Arabs but data safety
51:14monitoring boards as well.
51:15If you have those.
51:16And those that are early enough
51:18where it makes sense to amend it
51:20from time to time is helpful.
51:22Now I can't.
51:23I can't ignore the fact that that
51:25is a tremendous administrative
51:26burden at times to have to do that,
51:28but that's probably the best
51:29that we can do at this point.
51:31I would encourage you to make
51:33these problems known,
51:34not that they're unknown,
51:36but to Mike Lauer,
51:38who is at the office of Extramural
51:40research at NIH,
51:40as well as to Larry Tabak,
51:42the interim director.
51:44These are people that will.
51:46And it's useful for them
51:48to hear about this stuff,
51:49because all that I can say about
51:51how disruptive this stuff that is
51:54to investigators is less impactful
51:56than if a lot of investigators
51:59were continuing to to declare it.
52:01But I have to tell you,
52:03I have had no success in this area.
52:06Well, I'm I'm really glad to hear that.
52:07There's awareness and.
52:11I think to me the heart of the problem
52:13is partially the power focus as well.
52:15Putting people in these trials
52:17where you have to report,
52:20you know whether you're hitting
52:21targets every three months.
52:22When you're doing early stage clinical
52:24research and something weird has
52:25come up and you want to spend time to
52:27figure out what it is and you have to
52:29just move forward and keep recruiting
52:31people and do whatever you can.
52:32It's it's incredible waste,
52:34so I think that's that's a
52:36discussion that's worth having.
52:37If you're talking about NIMH
52:39with your NIH program officer.
52:41And if you feel like they're not
52:45understanding the the different
52:47focus that you have in your work
52:49compared to a more traditional
52:51or late stage clinical trial,
52:53let me know and I'll go over with them.
52:55Great, thank you.
52:58I should be looking over
52:59there right now here.
53:02Thank you Doctor Gordon.
53:03I know that you were really limited in
53:05time as to what you could talk about,
53:06but I wanted to follow up with
53:08Michelle's question moving
53:09even earlier in the research
53:12timeline to Preclinical Research.
53:14Could you spend the last minute or
53:16so telling us what NMHC's as you
53:20know how Preclinical Research will
53:22move the field forward?
53:25Well boy, I can't do that in a minute.
53:27I could do it in 10 hours, maybe no.
53:29I think there's some real let me let me
53:31focus on the the longer term since you
53:33you you asked me to Preclinical Research,
53:36I think it's crucial that we continue
53:38to focus on basic neuroscience
53:41on understanding brain behavior,
53:43relationships on mapping genetics
53:45and molecular biology onto those
53:48bringing brain behavior relationships
53:50in order to create the transformative
53:52treatments in the future.
53:53We're talking about long,
53:54long term payoff.
53:55Right, and there's been a lot
53:57of argument in actually even in
53:59the popular Press of late about
54:00our relative investments in near
54:02term versus long term research,
54:04which is frankly something close
54:06to 5050 right now by my definition.
54:08But by Fuller Tories definition,
54:09we're like 1090,
54:10I think I'm righter than he is,
54:12but I'll let everyone judge
54:14on themselves by themselves.
54:15But in any case, the you know,
54:17the the the argument goes that
54:19we haven't seen any benefit from
54:21basic science research.
54:22But if you look at what basic science
54:24research is in the mental health research.
54:26Field how old is it?
54:28I mean, yeah.
54:28OK,
54:29so Hodgkin Huxley is quite old already,
54:31but if with a focus on the
54:32neuroscience of mental illness
54:33per se or on mental illness,
54:35relative symptoms,
54:36we're talking thirty 4050 years.
54:38So how long did it take cancer to pay
54:41off from basic science investigations
54:43of cell biology and cell cycle
54:45biology to novel cancer therapeutics?
54:47Probably about 50 years.
54:49Have you asked historians?
54:50Well, we're starting to see the
54:52payoff from early investigations,
54:54so right?
54:54One of the earliest things that animation.
54:56Tested in was neurotransmitters and
54:58in novel neurotransmitters like
55:00neurosteroids and now we have brexanolone.
55:02And yeah it took 50 years to get
55:05brexanolone brexanolone from the
55:06part where we started looking
55:08at neurosteroid anesthetics and
55:09asking what their role is in mood
55:10and other complex behaviors.
55:11But now we have a new drug and I'm
55:13not saying we're going to have
55:14new drugs a year after year after
55:16year that come out in or biology.
55:17But I am saying that if we stop
55:19now we are really stupid, right?
55:21So we need to continue those investments.
55:23I could be more specific about
55:25what sort of near on the horizon.
55:26That that that's that's a good
55:28starting place.
55:30I like that you highlighted a treatment
55:32for postpartum depression with your
55:33father and your final comments,
55:35so I'll just pass
55:36it over to my Co chair
55:37for a final comments reflections.
55:40Doctor Gordon, thank you so much.
55:42Your last comment about Brickset alone
55:43make makes me think, and also Amanda,
55:46that someone a big scientist
55:47was asked something like this.
55:49What does big bricks and alone
55:50in 50 years and they said, well,
55:51what good is a baby, right?
55:53Babies take a long time to
55:55develop, but you know,
55:55we say, what does a baby and
55:58and I wanted to end on
55:59a personal note. Unfortunately,
56:00Phyllis Cohen is muted and Full disclosure,
56:03I'm Donald Cohen son-in-law.
56:04So Phyllis is my mother-in-law and
56:06I just want to say on behalf of
56:08the family, how honored we are.
56:10We're here in the Donald Cohen
56:12auditorium and you really, we're very
56:14grateful for all that you're doing,
56:15and we're very honored that
56:16you're our Donald Cohen speaker,
56:19and I think that the last, last,
56:20last, last word goes to my boss
56:21and our chair, Linda Mays.
56:24So, Doctor
56:25Gordon, we're just so grateful to have you.
56:26And please don't let this be your
56:28only visit to the Child Study Center.
56:31We're very glad that it's your first,
56:32but thank you for all your
56:34support for children and families.
56:35Well, thanks for having me.
56:36And thanks for all the work you do.
56:38And for coming here and
56:39asking great questions.