Tuesday, May 27, 2008

More on SPECT scans and Daniel Amen

I thought I would provide a quick run-down of some of the response to my Wired article on functional neuroimaging. Predictably, most of the comments revolved around Daniel Amen, who has presumably seen a major uptick in book and nutraceutical sales, and new appointments for SPECT scans. Any publicity is good publicity.

The neurologist and author Robert Burton emailed me a link to his excellent article in Salon, entitled “Brain scam: Why is PBS airing Dr. Daniel Amen’s self-produced infomercial for the prevention of Alzheimer's disease?” It is absolutely required reading.

Ginger Campbell, an ER physician and medical podcaster, contacted me about this brief discussion thread her blog, Brain Science Podcast

Dr. Charles Parker has defended Amen at length, which is not surprising, considering that he was once chief psychiatrist at the Amen Clinic in Virginia and that he currently has what he calls an “Active SPECT Image Evaluation Practice.” Dr. Parker posted three consecutive long entries on his blog, as well as a couple of comments on the Wired website. I would classify his postings as shotgun rants, taking aim at everything that gets in the way of selling more SPECT scans—including what he calls “silly statistical banter,” the FDA, and DSM-4. For Parker, scientists who insist on careful statistical evaluation of new treatments are missing the point, because, as he poetically concludes in one of his postings:

“but the real numbers
are with the smiling faces of patients who do improve
the satisfaction of knowing you got it after years of difficulties when others didn't
long after all the previous timid placebo hopes have been repeatedly dashed, and everyone is running on cold, frozen reality, with no hint of hope fueling the tank.
That real number is true satisfaction.”

File this under: Wow.


soulful sepulcher said...
This comment has been removed by the author.
Michelle said...

I met Dr. Amen at a lecture he gave and then participated in his brain study of injured and uninjured brains. I learned a lot about the damage that can occur even from normal children's bangs to the head - the kind that happen to most kids who engage in sports.

If you are interested in the brain and how it works, I highly recommend reading ""My Stroke of Insight"" by Dr. Jill Bolte Taylor. It's on the NY Times Bestseller list and it's a wonderful book. Dr. Taylor's talk at TED dot com is also AMAZING! Oprah interviewed Dr. Taylor and you can check that out on Oprah.com. And Time Magazine named Dr. T one of the 100 Most Influential people in the world. Having read her book, I can see why all the attention.

Dr. Amen's book is brain science and it's great at that. Dr. Taylor is a Harvard Brain Scientist, but what she writes about is the science and much more. She really cracks the code to understand how our brains (right and left hemispheres) work and she explains how we can get into our right brain and be happier and more joyful. Aside from any of the science, My Stroke of Insight is also just a great story.

Anonymous said...

Dr. Carlat wrote: "The neurologist and author Robert Burton emailed me a link to his excellent article in Salon, entitled “Brain scam: Why is PBS airing Dr. Daniel Amen’s self-produced infomercial for the prevention of Alzheimer's disease?” It is absolutely required reading."
While pointy-headed professionals debate these endlessly fascinating abstractions, those PBS specials are reaching a population that the medical field has FAILED miserably. I know, because I am receiving their e-mails and phone calls.

Thee are people who, in the past, would have never connected "brian issues" and their lifelong struggles. Often despite years (even decades) in therapy!

They are even discovering--are you ready for this?--that the brain is an physical organ that affects everything we think, do or feel. They'd never thought of that!

It is a wonderful thing to witness. Because finally, these people stand a chance of receiving real help. And they don't need a brain scan to do it. They just need a competent mental health professional.

Ah, but all the hand-wringing and tomato-throwing is so much more stimulating, isn't it?

I suggest all of the cynics and naysayers get out of your self-medicating bubbles and do some volunteer work in the mental health community. It might give you a dose of much-needed reality--and compassion.

Anonymous said...

Dr. Carlat,

What a cheap shot on Dr. Parker. You just have no idea what you're missing. No idea.

You are ostensibly covering a field where medically trained professionals (psychiatrists) almost NEVER remember that the brain is connected to the body.

For physicians like Parker, Amen, and others, the scan is one tool. But they have many others that most psychiatrists miss, too--like the importance of measuring thyroid function, treating allergies, regulating sleep, improving diet, getting exercise, and addressing metabolic issues.

Geez, most psychiatrists don't even take blood pressure readings! They don't even seem to know that the brain is Central Control for a host of bodily functions. They're practicing Cartesian claptrap.

You are just picking on the wrong people and reflecting your own biases. This is not serving humanity, which I assume is your goal.

Andrew Kinsella said...

Two years ago at age 47, I was diagnosed with adult ADHD. The diagnosis was undoubtedly correct,as it led to treatment that resolved all my attention, stress and irritability problems. Not only that but treatment was only required for 20 months.

I had the option of having a SPECT in Australia, with no connection to Amen's clinic, and it actually matched exactly the parts of the brain which Amen's questionnaire predicted. That diagnosis allowed much better targeting of medication with real benefit- as i found out when I cut down one of the meds due to temporary side effect issues.

Now I am a family physician myself- so I do know how to make accurate observations and keep proper records.

Gina Pera is dead right on this.Your comments are a cheap shot, and I will bet you haven't even done Daniel Amen the courtesy of reading his work or questioning him personally to gain a direct understanding of his clearly groundbreaking work.

While I am all for independent opinion, I like to hear opinions that are informed by an open minded and thorough reading of the ground the author intends addressing.

Dr Andrew Kinsella

P Dwyer said...

I agree completely with Dr. Carlat on this one. I read one of Dr. Amen's books and his claims about SPECT just don't stand up as science, for the same reason that psychiatry acknowledges that there are no physical tests for mental illnesses: there is tremendous overlap between the images of normal and abnormal brains, and it isn't possible to tell whether any apparent differences are causes of (or even caused by) patients' mental problems.

And I have read that Dr. Amen frequently refers to scans AFTER he's otherwise assessed patients, pointing out to them how the scans support his diagnoses. While patients take this as physical "proof" of their condition, it really isn't; the scan is interpreted post hoc, using other diagnostic information to inform the scan interpretation. If the scans really did reveal specific conditions, Dr. Amen could make those diagnoses blind; but like the rest of psychiatry, he clearly can't.

But the scans probably DO help some people. As Stephanie commented, "SPECT as a 'Placebo effect' is more accurate." Irving Kirsch's the emperor's New Drugs persuasively argues that the placebo effect is the entire basis of SSRI's effectiveness. Kirsch broadly defines placebo as the effect of meaning. Having a trusted physician describe how the images of your brain explain your problems and how treatment will help you - that's powerful. But it's also misleading and holds the field back from exploring what actually is and is not true.