Tuesday, December 19, 2017


What a psychiatrist learned from 87000 brain scans

Questions have been raised about the ethics of selling SPECT scans on the basis of unproven claims: neuroscience professor Martha Farah calls such use "profitable but unproven" and says "Tens of thousands of individuals, many of them children, have been exposed to the radiation of two SPECT scans and paid thousands of dollars out of pocket (because insurers will not pay) against the advice of many experts".  Professor of psychology Irving Kirsch has said of Amen's theory: "Before you start promulgating this and marketing it and profiting from it, you should ethically be bound to demonstrate it scientifically in a peer-reviewed, respected journal" as otherwise "you're just going down the path of being a snake oil salesman".  In a 2011 paper the neuroscientist Anjan Chatterjee discussed example cases that were found on the Amen Clinic's website including a couple with marital difficulties and a child with impulsive aggression. The paper noted that the examples "violate the standard of care" because a normal clinical diagnosis would have been sufficient and that there "was no reason to obtain functional neuroimaging for diagnostic purposes in these cases."  Most patients do not realise that the SPECT scans rely on unproven claims.

An initial session at one of Amen's clinics costs about $3,500.  As reported by the Washington Post in 2012, officials at major psychiatric and neuroscience associations and research centers see Amen's claims for the use of SPECT as "no more than myth and poppycock, buffaloing an unsuspecting public."…

In 2012, The Washington Post Magazine ran a cover story titled "Daniel Amen is the most popular psychiatrist in America. To most researchers and scientists, that's a very bad thing." The Washington Post detailed Amen's lack of acceptance among the scientific community and his monetary conflict of interest.  Journalist Sanjiv Bhattacharya wrote that Amen's critics likened him "to a self-help guru rather than a scientist, on account of all the books, DVDs and nutritional supplements which he hawks so shamelessly on infomercials" and that Amen was "the most controversial psychiatrist in America [who] may also be the most commercially successful."  Amen stated he felt the accolades went hand-in-hand and that "One reason why they hate me is because I make money. [...] our biggest referral sources are our patients. If I'm defrauding them how would I stay in business for decades?"

In 2008, Tufts professor and author Daniel Carlat published an article on Amen's use of SPECT imaging. After visiting Amen's clinics, Carlat called Amen's interpretations of the scans "spectacularly meaningless."

Amen is a Distinguished Fellow of the American Psychiatric Association.  He has also been an assistant clinical professor of psychiatry and human behavior in the University of California, Irvine, College of Medicine.

Amen is the author of more than 30 books with combined sales of about one million copies. Five of his books have been New York Times bestsellers.  In 2015, Amen's The Daniel Plan received the Christian Book of the Year Award.




    Founder of Amen Clinics
    Double Board-Certified Psychiatrist
    Ten-time New York Times Best-Selling Author
    Distinguished Fellow of the American Psychiatric Association

    “By almost any measure, Dr. Amen is the most popular psychiatrist in America.” — Washington Post

    Board Certified, American Board of Psychiatry and Neurology

    General Psychiatry, 1988
    Child Psychiatry, 1988

    Medical Licenses

    California, 1983
    Washington and Virginia, 2003
    Arizona and New York, 2009
    Georgia, 2012

    Radioactive Material License for Nuclear Brain Imaging

    California, 1985
    Washington, 2003
    Virginia, 2004

    Dr. Amen has helped millions of people change their brains and lives through his health clinics, best-selling books, products and public television programs.

    Dr. Amen is one of America’s leading psychiatrists and brain health experts. He has authored or coauthored 70 professional articles and more than 30 books, including New York Times mega-bestseller Change Your Brain, Change Your Life. He has appeared on numerous television shows including Dr. Phil, Larry King, Dr. Oz, The Doctors, and The View.

    His breakthrough public television programs on brain and mental health have made him well loved by millions of viewers seeking guidance on memory, attention, other cognitive functions, emotional issues, behavior, and more.

    The Washington Post has called Dr. Amen “America’s most popular psychiatrist” because of his wildly popular clinics which have over 4,000 patient visits a month and has the world’s largest database of functional brain scans relating to behavior, totaling over 130,000 scans on patients from 111 countries.

    Dr. Amen has appeared in movies, including After the Last Round and The Crash Reel and was a consultant for the movie Concussion, starring Will Smith. He has also appeared on the Emmy-winning show The Truth About Drinking.

    His work has been featured in Newsweek, Time, Huffington Post, ABC World News, 20/20, BBC, London Telegraph, Parade Magazine, New York Times, New York Times Magazine, Washington Post, LA Times, Men’s Health, Bottom Line and Cosmopolitan.


  2. Daniel Amen loves SPECT scans (Single Photon Emission Computed Tomography). And well he should. They have brought him fame and fortune. They have rewarded him with a chain of Amen Clinics, a presence on PBS, lucrative speaking engagements, a $4.8 million mansion overlooking the Pacific Ocean, and a line of products including books, videos and diet supplements (“nutraceuticals”). He grossed $20 million last year. Amen is a psychiatrist who charges patients $3,500 to take pretty colored SPECT pictures of their brains as an aid to the diagnosis and treatment of conditions including brain trauma, attention-deficit hyperactivity disorder (ADHD), addictions, anxiety, depression, dementia, and obesity. He even does SPECT scans as a part of marriage counseling and for general brain health checkups.

    SPECT imaging uses an injected radioisotope to measure blood flow in different areas of the brain. Amen is exposing patients to radiation and charging them big bucks because his personal experience has convinced him SPECT is useful. So far, he has failed to convince the rest of the scientific medical community...

    It’s not just me. Amen has a lot of other critics. Psychiatrist Daniel Carlat wrote “Brain Scans as Mind Readers? Don’t Believe the Hype” in Wired Magazine, describing his own evaluation by Dr. Amen. Amen told Carlat his scans showed too little activity, a pattern of angst, and a predisposition to depression (that part was a slam dunk, since in taking a medical history Amen had already elicited the information that Carlat had had a short bout with depression). He recommended a multivitamin, gingko, less snowboarding, and more tennis. An expert at UCLA later reviewed the same scans and explained that the findings are meaningless because they haven’t been validated by controlled studies to determine their diagnostic specificity. Carlat likens Amen’s spiel to the cold readings of palm readers...

    Anecdotes. He starts with an anecdote about his nephew, who had attacked a little girl for no apparent reason. Amen did a SPECT scan and found a large arachnoid cyst; after surgery, the violent behavior stopped. This is a touching story, but anecdotes are not evidence. Cysts and other brain abnormalities are frequent incidental findings on brain imaging and arachnoid cysts are often asymptomatic even when large. Even if the child’s violent behavior was due to the cyst, a SPECT scan was not necessary to find it. An MRI would have found it, with better anatomical detail and no need for radiation exposure.

    He asks,

    How could a child psychiatrist know what was going on in Andrew’s brain unless he or she actually looked at how it functioned?… psychiatry remains the only medical specialty that rarely looks at the organ it treats.

    He suggests that if the brains of recent mentally ill mass murderers had been looked at, their crimes might have been prevented. That might be a persuasive argument if “looking at the brain” actually corresponded to understanding what the neurons were doing or had any predictive value. It doesn’t.


  3. Although brain scans as part of a clinical psychiatric workup might be playing in prime time on some TV infomercials, brain imaging experts say we're not quite there yet.

    As editor Dr. Robert Freedman notes in last month's American Journal of Psychiatry, after a string of letters on the subject: “Commercialization of a diagnostic test, even if the underlying procedure such as brain imaging or DNA analysis is approved for human use, strongly indicates to physicians and families that the test adds significant new information to guide clinical judgment. We have published this exchange of letters as part of our responsibility to readers to point out when a procedure may lack sufficient evidence to justify its widespread clinical use."

    The procedure in question is SPECT (single photon emission computed tomography). At issue: the use of SPECT scans as part of a psychiatric diagnostic workup by some clinics. They cast themselves as “early adopters"1 in the vanguard of developing clinical applications for an emerging technology. Their critics say it's premature, pointing out the risks of exposing patients, particularly children, to radiation, and to treatments based on shaky interpretations of scans – possibly in lieu of clinically sound treatments. Moreover, more powerful, less invasive technologies have often been supplanting SPECT in psychiatric research over the past decade.