There’s flailing around a bit to help a unique patient, and then there’s opening a string of franchises across the US.

“Doing something can have health and safety consequences, doing nothing can have health and safety consequences. What is a reasonable approach to balancing the possibilities between risks/consequences of the two”

I tend to think along the lines of….
Do nothing unless doing something is science-based.
But I see you agree:

“To be clear, when I said “a reasonable approach”, I had in my mind the need for the use of plausible therapies (with a well understood risk profile) in conditions with real (rather than speculative) health consequences that may not have a well documented or well researched successful treatment”

I guess my concern is that the general public take-home message is (incorrectly) going to be that there is no evidence from these scans supporting a neurological basis for these conditions, rather than the more specific fact that the evidence does not support using these scans for individual diagnostic purposes. And to be honest, given the cost and risk involved, I still think the basic DSM diagnosis would be preferable even if these scans were diagnostically relevant. At best, these scans might be useful for research purposes to get a better idea of which diagnostic criteria are the most relevant. To that extent, I think that Dr. Amen is doing far more harm than good, both by peddling invalid diagnostic testing and by the way that his quackery gets far more publicity than real functional neuroimaging research (really cool functional neuroimaging research, too).

” until benevolent robots and artificial intelligence can take over.”

I’m just back from Washington, DC. I didn’t find any benevolent robots but plenty of artificial intelligence.

Those who identify strongly with a particular political ideology are often no different than those who embrace a particular confessional; they have outsourced their judgment. And who can blame them? Thinking is just too much work and besides American Idol will be on in twenty minutes.

I listened to a lecture series by Peter Navarro, an economist at University of California, Irving. Very interesting, for a lot of reasons – makes the news a lot more sensible when they talk about monetary and fiscal policy. He had an economic reason for the political parties being essentially the same – every time they move in one direction, they gain some voters and lose others. To get the kinds of numbers they need, both need to become similar. It’s a sad truth about democracy – it’s the least bad system. Enlightened dictatorship is the best, but the “enlightenment” part is too dependent on who the dictator is, and there’s zero guarantee they’ll be good for the majority. Look at China – currently they tremendous central planning (really one could almost argue the Communist Party is essentially a new incarnation of the Emperors of old) and fantastic economic success because of it. The economy and development can be strongly directed, vaccines can be rigorously promoted (probably mandatory in some cases) and you can make things like acupuncture illegal if you wanted to. So in this case, Deng Xiaoping and his successors did a fantastic job – benevolent dictatorship. However, Chairman Mao – terrible dictatorship; the Great Leap Forward starved millions to zero benefit and the Cultural Revolution gutted the country of scholars, knowledge and civil discourse.

That’s why I want an interim rule by technocratic decree through committees of scientists, until benevolent robots and artificial intelligence can take over. The only sensible solution.

“who divide the political spectrum into four rather than two groups.”

I am reminded of the only bumper sticker I would have ever agreed to put on my car (other than a Darwin fish). It read in large letters DEMOCRAT on the left half and REPUBLICAN on the right. In smaller lettering underneath it said “same sh|t, different piles”.

Those who identify strongly with a particular political ideology are often no different than those who embrace a particular confessional; they have outsourced their judgment. And who can blame them? Thinking is just too much work and besides American Idol will be on in twenty minutes.

I do think something should be done about Amen getting his infomercials on PBS (and PBS not doing anything about asserting some kind of control over local stations)

They can’t. The affiliates aren’t O&O’s (“owned and operated,” in the jargon). PBS distributes (i.e., sells) a portion of the affilates’ programming. Let’s take an example from radio: NPR got WBEZ to produce “Wait, Wait Don’t Tell Me” explicitly in order to compete with Michael Feldman’s “Whad’ya Know,” which is (currently) distributed by PRI. Would you want NPR to be telling affiliates that they had to pick one or the other or couldn’t air “Whad’ya Know” live?

To be clear, when I said “a reasonable approach”, I had in my mind the need for the use of plausible therapies (with a well understood risk profile) in conditions with real (rather than speculative) health consequences that may not have a well documented or well researched successful treatment. This would be more in the line of responsible off-label prescribing for things like migraines or rare under researched conditions – NOT speculative trial and error with any random therapy that strikes someones imagination for random findings that have no evidence of accuracy of anything.

And by the way – shame on those “friends” of yours. I get so fed up with people’s romanticized idea of mental illness as something that can be cured with a different diet, a lot of love, a spiritual epiphany or more self-discipline. Some people really do not get it and I have no idea how to deal with those folks.

Amen, windriven (pun intended). This isn’t exactly innovation, more like experimentation, and perhaps self delusion. If studies are being performed in a hospital setting, a competent audit committee should be constraining his enthusiasm, as we have well defined standards of care, as well as utilization criteria. But then medical staffs now days are largely hospital employees, and hospitals want increased utilization of their expensive technology. I also expect he is well lawyered up.

@richard

I prefer turkey,never tried ostrich. For what its worth, I agree with you.

I hate PBS. I used to love them for their educational programming. While they still have some good programs, I can’t support them anymore because of the quack infomercials they allow during their pledge drives. They claim to be an educational network and are supported by taxpayers, but their affiliates put out medical misinformation and they don’t do anything to curtail it. They are really just another part of the television wasteland they claim to be so far above. I think Big Bird should be roasted and served for Thanksgiving dinner. All ranting aside, I hope the SBM crew will write more articles highlighting how PBS has betrayed the public’s trust.

You might enjoy Science Left Behind by Alex Berezow and Hank Campbell, who divide the political spectrum into four rather than two groups. On the right are Republicans and Libertarians. On the left are Democrats and Progressives (I’m not positive on the terms, read the book!). Progressives are the left’s answer to creationists, ignoring or selectively quoting science when it suits them and advocating for strong social controls. It is here that the sins of the left, like PBS, are most apparent, adopting similar rhetoric and strategies about science as creationists, but with different goals.

It’s a very good, very eye-opening book, and you might even be able to read the ideas for free (Berezow and Campbell apparently based the book on a blog, which is quite apparent).

Three cheers to you for grabbing hold of your child’s care, especially in such difficult circumstances.

“I don’t know the “reasonable approach” MTR, or if the practice of medicine should be “strictly algorithmic”, windriven,”

I don’t either but it is something that, I think, needs to be addressed. Innovation happens in many ways and medicine is still a science defined largely by what isn’t well understood. But there are ethical constraints that apply to medicine that don’t apply to physics or metallurgy.

Lowering the cost of care seems to advocate for generally algorithmic practice. Innovation seems to argue for a less restrictive approach.

I don’t pretend to know the right balance. But I do know that much of the quackery discussed in these pages falls far outside what any rational person would consider appropriate.

That published study by Dr. Amen reinforces my point. It studied the effects of a kitchen-sink mixture of diet supplements in athletes with brain injury; it was open-label rather than placebo-controlled. It used SPECT as an additional measure of outcome along with conventional outcome measures. It did not show that SPECT added anything useful to the assessment of outcomes.

He has published a lot of things in peer-reviewed journals, but they are not good science and do not support what he is doing in his clinics.