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SPECT Scans at the Amen Clinic – A New Phrenology?

Phrenology was a 19th century pseudoscience that claimed to associate brain areas with specific personality traits. It was based on palpating bumps on the skull and was totally bogus. New brain imaging procedures are giving us real insights into brain function in health and disease. They are still blunt instruments, and it is easy and tempting to over-interpret what we are seeing. In his book The New Phrenology William Uttal warns that “the excitement of these new research tools can lead to a neuroreductionist wild goose chase” and that we must be careful not to succumb to new versions of the old phrenology.

The Amen Clinics, founded by Daniel G. Amen, MD, offer SPECT (single photon emission computed tomography) scans to help diagnose and manage conditions such as attention deficit disorders (ADD), mood disorders, anxiety and panic disorders, autistic spectrum disorders, obsessive compulsive disorder (OCD), substance abuse, toxic exposure, brain trauma, memory problems, temper problems, and relationship and marital struggles.

The scans generate colored pictures of the brain that show “areas of your brain that work well, areas that work too hard, and areas that do not work enough.” They do not actually provide a diagnosis, but “must be placed in the context of a person’s life, including their personal history and mental state.” “The goal of treatment is to balance brain function, such as calm the overactive areas and enhance the underactive ones.”

SPECT depicts blood flow or chemical reactions in different areas of the brain. It is invasive and potentially harmful: it requires the injection of a radioactive tracer. Areas of low blood flow show up as apparent “holes” on colored pictures of the brain, giving a moth-eaten appearance. Amen says that when patients improve clinically, the appearance of their follow-up scan typically improves. Patients using marijuana had areas of low activity in the temporal lobes compared to patients not using the drug. Dr. Amen says he can literally show his patients “this is what your brain looks like on drugs.”

In a typical patient with attention deficit disorder, obsessive thinking, anger outbursts, and depression, Amen found demonstrable defects on the initial scan which were visibly improved after three years of clomipramine therapy. He says that this kind of graphic demonstration can help persuade patients that their problem is physical or physiological and might be helped with medication or other treatments. I’m not convinced. Doctors regularly diagnose and treat depression on the basis of clinical symptoms, and both doctors and patients can recognize symptomatic improvement. Do SPECT scans really add anything significant to this process?

Insurance companies consider SPECT scans for diagnosis of psychiatric disorders to be a research tool, an experimental procedure not yet ready for prime time. In my opinion, Amen has jumped the gun by using SPECT scanning clinically before research has validated his methods. He thinks he is helping patients; but without proper controlled studies, he can’t really know for sure. The FDA would never have approved a new medication on the basis of the kind of evidence Amen is going by. We don’t know (1) whether the scans really improve accuracy of diagnosis, (2) whether the defects we see represent causes or results of the illness, (3) what the progressive changes from scan to scan really mean, (4) whether seeing a picture of their brain actually improves patients’ understanding of their disease, (5) whether it improves their compliance with treatment, or (6) whether Amen’s whole process actually improves patient-oriented outcome compared to optimal treatment without scans. Amen is convinced his methods work, because his patients improve, and because they give him grateful feedback and reinforcement. He may be right, or he may be wrong. Quacks all have patients who improve and give them reinforcement too, even for the most nonsensical remedies that can only act as placebos.

The charge is $3250 up front, and most insurance companies will not provide reimbursement because they consider it experimental. There is a 10% discount for testing additional family members. The testing procedure takes four days. The Amen Clinic’s informed consent form is misleading: it does not divulge that the American Psychiatric Association has spoken out against SPECT scanning for these purposes and has warned of potential harm – especially to children, who are more susceptible to the effects of radiation.

Desperate patients will grasp at any straw. There is an argument for offering unproven treatments as a last resort that “might” help. There are also arguments for limiting treatment to closely monitored research settings until the truth is known. There is no excuse for misrepresenting an unproven treatment as a treatment that has been proven effective. And there is no excuse for concealing essential information from patients, or for creating false hopes by implying a promise of more than they can really deliver.

In 2005 I wrote an article for Quackwatch critiquing the Amen Clinic. Amen and his lawyers protested. Dr. Stephen Barrett and I posed specific questions and they attempted to answer them, but we didn’t find their answers satisfactory. Their answers and my comments can be seen at this link.

In one of his books Amen suggests that “Mother Teresa and Mahatma Gandhi had optimal brain function” whereas “Adolph Hitler and other brutal dictators had faulty brain wiring.” The fact that he can make these historical diagnoses without SPECT scans argues against the need for SPECT scanning in his patients. I saw a TV documentary where a teenager was being shown his scan results and was told one area showed that he had difficulty controlling impulses. Why would you need a scan to tell that?

Amen’s website has lots of testimonials from satisfied patients; but he doesn’t tell you about the patients who were dissatisfied, who felt their money was wasted. In one case “nothing that was written or diagnosed actually came from the SPECT image, but from a history taken orally from the family.” A relative of a patient sent me the glossy Amen Clinic brochure that is being handed out at her son’s school. The sender was particularly amused by a set of brain pictures of an “overfocused wife” and an “underfocused husband.” Yes, Amen is using SPECT scans for marital counseling!

Some of the treatments he offers are even more disturbing. Once the pretty pictures have guided him to a diagnosis, Amen recommends a number of questionable treatments, some of which have been tested and found not to work, and many of which are not recommended by science-based medical doctors – such as Eye Movement Desensitization and Reprocessing (EMDR), hyperbaric oxygen therapy, and oral GABA, which is not likely to help with any problems in the brain since it can’t get there: it doesn’t even cross the blood-brain barrier. For “temporal lobe issues” he prescribes phosphatidyl serine, gingko biloba, vitamin E, and ibuprofen. He has his own line of vitamins and diet supplements which are available for purchase on his website. He also sells books and videos, lectures, and has developed his ideas into a big business.

It’s nice to have pretty pictures, and I’m sure they do serve as a visual aid to help doctors engage their patients in appropriate treatment programs. But do they really need those pictures, or is it just something “nice to have” like those ultrasound pictures of fetuses taken with no medical indication, just because parents want to “see” their unborn child? Can Amen really justify what he is doing? Desperate patients are being sold hope at these clinics, at a high price, at a small but real risk, and without any scientific evidence that SPECT improves patient outcome over those who receive optimum treatment without SPECT.

When William Withering wrote his book on foxglove in 1785, he described all his failures along with his successes, and he humbly suggested that “if” his observations were confirmed by others, foxglove “might” become a useful part of standard medical practice. That was the voice of a critical thinker and a true scientist.

There is no suggestion of that kind of caution on Amen’s website. He seems very certain he is right – but lots of people have been equally certain of other things that turned out to be wrong. Humans are very good at fooling themselves, and the only corrective is the scientific method properly applied.

Dr. Amen was recently in the news for advocating SPECT scans for all the presidential candidates. I don’t think I need to explain why that’s a very bad idea.

Posted in: Medical Ethics, Neuroscience/Mental Health, Science and Medicine

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34 thoughts on “SPECT Scans at the Amen Clinic – A New Phrenology?

  1. Calli Arcale says:

    He’s using these for marital counseling??? WTF???

    As someone with ADD, I’ve always been interested in research on the topic. So far, I’ve read that there may be some correlation between ADD and certain differences in activity certain regions of the brain. This is not enough to diagnose anything, especially since not all ADD patients in the study were found to even have this result on a scan. Was it coincidence? If not, what does it mean? Is it part of the ADD, or just an unrelated brain abnormality that happens to occur more frequently in ADD patients? (Some genetic traits just happen to occur together a lot of the time. Blacks are more likely to have sickle cell anemia, for instance, but this has nothing to do with the genes which encode the color of their skin. It just runs in their bloodlines, selected for because of the high rate of malaria in subsaharan Africa.)

    This is dangerous woo indeed if he’s using it to diagnose marital issues, though. We don’t understand the brain and mind anywhere near well enough for that. We can just about tell which parts of the brain are involved in things like speech processing, but marital troubles? That’s absurd. 21st Century phrenology indeed.

    One of the Discworld books (by Terry Pratchett) had a throwaway joke character called Zorgo. He was a retrophrenologist, and for a fee, would strike the patients’ head in very specific locations with just the right hammers to produce just the right bumps to correct various deficits in a patient’s personality. ;-)

  2. Zetetic says:

    There’s a story that Mark Twain once visited a prominent phrenologist in France who was unaware of Twain’s works and reputation. The phrenologist’s evaluation of Twain was that he totally lacked a sense of humor!

  3. daedalus2u says:

    This is quite interesting. I completely agree with you that Amen is a quack.

    Blood flow in the brain is extremely important and is closely coupled to brain activity, mostly because that blood flow is acutely regulated by nitric oxide and nitric oxide is the major factor that also acutely regulates brain function (but this is mostly not appreciated). Oxygenated hemoglobin is the sink for NO, and it is release of NO that causes the vasodilation that acutely increases the local blood flow (which is what produces the fMRI BOLD signal).

    I think that essentially the same information on blood flow (but with a lot better resolution, spatial and temporal) can be obtained using MRI which produces no ionizing radiation exposure. The fMRI BOLD signal measures blood flow second by second to a much higher resolution.

    The “marital problem” diagnosis they mention on their website was for a man who worked in a furniture shop and had large exposure to solvents. That should have been suspected from personality changes in a psychiatric work-up. An MRI looking for a tumor would be (I think) a more plausible diagnostic approach than this non-descript blood flow measurement.

    Virtually all MRIs of individuals with the problems Dr. Amen discusses will show abnormalities, usually what is seen are what are called white matter hyperintensities. These are essentially universally seen under conditions of hypoxia, ischemia or reduced blood flow. What they are is reduced diffusion of protons as revealed by diffusion in MRI. Essentially the orientation of the proton nuclei is “tagged” depending on where they are spatially, then the “tagging” is measured a short time later to see how far those protons have moved.

    The physiology behind the mechanism that causes the white matter hyperintensities is not understood. I think a large part of it is due to movement of “cargo” in axons, things carried by ATP powered motors which transport things from the cell body out the axons to the tippy end. Things such as mitochondria and receptors are synthesized in the cell body where the DNA and cellular machinery for protein synthesis is. Then they are transported out the axons. White matter is just about only axons. Gray matter is gray because of the cell bodies that have more stuff that absorbs light, the nuclei and mitochondria.

    I think that low ATP is what leads to white matter hyperintensities, and that this low ATP is due to natural regulation of the ATP setpoint due to low NO levels. I discuss this in my blog on the physiology behind the resolution of autism symptoms with fevers. Fever therapy (giving patients malaria) was used (successfully) to treat many neurological diseases which are characterized by white matter hyperintensities. I discuss the details of white matter hyperintensities and how fever therapy resolved them.

    http://daedalus2u.blogspot.com/2008/01/resolution-of-asd-symptoms-with-fever.html

    Fever therapy was the standard of care for decades. Any type of neuroinflammation, ischemia, ischemic preconditioning, or blood flow insufficiency is going to lead to low ATP and white matter hyperintensities. This is a problem of good regulation around a bad setpoint. The ATP regulation physiology is working correctly, it just has a bad setpoint because NO levels are too low. Fever therapy was a way to increase that NO acutely (via expression of iNOS), which overcame the hysteresis and allowed normal regulation to resume.

  4. Joe says:

    @Zetetic,

    I wonder if phrenology still exists, except in high-tech forms such as SPECT. I have thought that Twain was able to ridicule it out of existence. If so, we need another Twain to tackle sCAM; since nothing else seems able to stomp it out.

  5. In this story is a good example of a special “source reason” to doubt a claim: whenever the claim is made by someone who has a financial interest in the reader believing it, and who also has named the business after himself, then IMHO there is a synergy of plummeting prior probability. (OK, let’s hear it: “Amen, Brother!”) Only half-joking.

    On a more scholarly note: a few years ago I wondered if “cranial osteopathy” might have been wrought from phrenology. The timing was right (late 19th-early 20th century for C.O., just as phrenology was being debunked, but that would have been clear only to critical thinkers) and the simplistic quackery of it would have been typical (hmmm, if the shape of the skull is the problem, why not just change it?). In an effort to make the connection, I squandered a few bucks on The Cranial Bowl, by the “founder” of C.O., osteopath William Sutherland. (copyright 1939, somehow personally signed by both Sutherland and his wife, Adah Strand Sutherland).

    In the foreward Sutherland writes that “the idea originated” in 1899, while he was “viewing the disarticulated bones of a skull belonging to Doctor Andrew Taylor Still,” the founder of osteopathy. At that Eureka Moment, goosebumps must have covered Sutherland like flies on the products of a colon cleanse! Alas, nowhere in the book is the slightest hint that phrenology per se influenced Sutherland.

  6. BlazingDragon says:

    When I had a SPECT (for Hashimoto’s encephalopathy), I was told to sit very quietly in a room for an hour after getting the radiolabeled tracer. Bright lights and “mental activity” (like reading) were not allowed. Does this SPECT routine try to correct for this?

    It sounds pretty crazy to get yourself irradiated with gamma when the purpose is not clear and the error bars are probably larger than the “effect” being tested for…

  7. Harriet Hall says:

    I googled for “Amen Clinics” today and my Quackwatch article “A Skeptical View of SPECT Scans and Dr. Daniel Amen” was the third on the list.

    This is really encouraging – people who are Googling to find out about the clinics at least will have a chance to see that not everyone agrees.

  8. daedalus2u says:

    The answer they give in their FAQs are quite telling.

    Concern: Some physicians say, “I don’t need a scan for diagnosis, I can tell clinically”

    Response: often, well-trained physicians can tell clinically. But that is not when you order a SPECT scan. You order scans when you are confused or the picture is complicated.

    When the physician is “confused”, perhaps that is a time to find a physician with better training.

    15. Do I need a referral from my doctor?

    No, you don’t need a referral. If you would like to investigate your need for SPECT imaging, you may contact the clinic directly. Our intake coordinators discuss your situation with you and if deemed necessary a full evaluation with scans will be performed. All new intakes are reviewed by a staff professional for medical necessity.

    Any test is only useful for a differential diagnosis, and a differential diagnosis is only useful for differential treatment. I notice they say “staff professional”, and not physician.

  9. MargaritaE says:

    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.

  10. Harriet Hall says:

    MargaritaE,

    I’m afraid you didn’t understand what I wrote. Amen has done some real science – he has several studies listed in PubMed. But what he is doing in his clinic is pseudoscience. He even uses treatments that science has tested and found not to work. In his publications and his public appearances he makes many claims that are not supported by science.

    As for Taylor, she may understand a lot about science, but when she talks about “getting into our right brain” and about her personal subjective experience, she departs science and enters another realm. Most problematically, she resurrects an oversimplified right-brain/left-brain dichotomy that modern neuroscience has rejected.

    I can agree that Taylor’s is a “great story” but that’s all it is: a story.

  11. getreal says:

    I just encountered Dr Amen’s work and I find the criticism of it surprising. The fact that insurance companies consider SPECT a “reseach” tool is just a way for them to get out of paying for it.

    My adopted son was exposed to cocaine, heroin, and alcohol ineutero. He is currently diagnosed with ADD but not a specific kind as Dr Amen describes.

    The neurologists and psychiatrists we have seen cannot give me diagnostic answers and treatment strategies that I would accept from the local mechanic working on my car.

    Well… it sounds like this … so well try this med and if it doesn’t get better will try another one if the side effects aren’t too bad. This is utterly ridiculous. Dr Amen’s work is the first approach I’ve seen that attempts to identify a real diagnostic tool for brain issues.

    If someone has an abnormal heart rhythm it is diagnosed by analyzing the electrical activity and the recommending the treatment best suited to correcting it.

    If Dr Amen’s work shows specific improvement in a persons SPECT scan, mental performance and overall well being from treatment based on a diagnostic SPECT scan why is this invalid?

    Sounds a lot better than the “hunt and peck” approach I’ve seen.

  12. Harriet Hall says:

    Any quack can show improvement in his patients’ symptoms. Science requires controlled studies to show whether the improvement is actually due to the treatment. Dr. Amen is aggressively marketing his methods to the public before doing the necessary controlled studies to show that his scans really contribute to improved outcomes. He has anecdotes and pretty pictures, but he doesn’t have proper scientific evidence. Anecdotal evidence from dissatisfied patients suggests that his patients might do just as well without the scans.

  13. David Gorski says:

    Let me explain to you why I feel that you should be tortured and murdered.

    Should I fall and decide to set aside my devotion to Catholic personal and social morality, then you and your kind would be my first target.

    Threats such as this are unacceptable on this blog. Be aware that we have your IP address.

  14. Wallace Sampson says:

    BlazingDragonon 08 Apr 2008 at 6:57 pm
    When I had a SPECT (for Hashimoto’s encephalopathy), I was told to sit very quietly in a room for an hour after getting the radiolabeled tracer. Bright lights and “mental activity” (like reading) were not allowed. Does this SPECT routine try to correct for this?
    It sounds pretty crazy to get yourself irradiated with gamma when the purpose is not clear and the error bars are probably larger than the “effect” being tested for…

    SPECT and fMRI scans detect metabolic activity and blood flow, respectively (I think.) They are closely correlated.
    A classic error reported in Natl. Acad. of Sciences 9 years ago reported that acupuncture at the lateral foot point (eye point) caused fMRI activity in the occipital cortex, with the conclusion that acup. could treat eye disorders (more work is needed…)
    One’s first thought should have been, so what? fMRI only shows the focus of attention – calculation, emotion, memory search, visual/auditory/other sensory attention.
    When one examined the actual MRI photos of the above report one saw that some of the changes at time of acup. needle insertion were of increased activity, while others were of decreased activity – only the timing was similar.
    Conclusion: Some subjects shifted attention from visual to tactile (needle prick), others vise-versa. That’s all, and one could not conclude any change would relate to either visual improvement or change in an eye disease, anyway. The analysis of this is in SRAM. Fall/Winter 1998 Volume 2 ~ Number 2
    Evaluation of a Study on the Possible Validity of Acupoints
    A SPECT radiologist will tell one that thinking, attention, etc. do change SPECT pictures. I think (check it out) diseases changes – tumors, infections, MS plaques, etc, are likely of a higher magnitude than functional changes.
    WS

  15. JackB says:

    Dr. Hall’s medical experience seems out of date. For example, EMDR, which she says is an unproven treatment that Dr. Amen uses and recommends, is now reimbursed by most insurance companies. But as a retired family practioner, she would not really be up-to-date in psychology and psychiatry. Because Dr. Amen’s work is not reimbursed yet and is considered experimental does not mean it is true or not true. As much as we want the FDA to protect us, many people also complain it is too slow in approving new effective treatments and insurance companies don’t want to pay because they are expensive. So financial interest cuts both ways. To me, it is extremely unfortunate that the FDA does not test new treatments itself unless some pharmaceutical company pays $100 million for this type of work. So we patients are left wondering – does this work or not? Dr. Hall certainly can’t say he is quack. And Dr. Amen cannot prove he is not. We are all losers in this process where our regulators don’t really do what they could do – help us find out what works.

  16. Harriet Hall says:

    EMDR may be reimbursed by insurance companies, but all the evidence indicates that the eye movements are nothing but a gimmick to persuade patients to cooperate with conventional psychological treatment. What Dr. Amen does also amounts to a gimmick to get patients to cooperate with conventional treatment. And then he offers unconventional treatments too. And charges thousands of dollars.

    The FDA has nothing to do with approving what Dr. Amen does.

    If he told patients what he was doing was experimental, I would have no problem with him – especially if he enrolled them in studies that would answer some of our questions. What I object to is his making claims that go way beyond the evidence. Now he is even claiming he can prevent Alzheimer’s!! I also object to the unproven diet supplements, hyperbaric oxygen, etc. And I particularly object to offering a medication to treat the brain when we know it doesn’t even cross the blood-brain barrier. If that isn’t quackery, it sure sounds a lot like it.

    You say I am not up to date in psychology and psychiatry. Maybe not. I read a lot, but maybe I have missed something. Perhaps you can bring me up to date and tell us what new developments in those fields would support what Amen is doing.

  17. weing says:

    “To me, it is extremely unfortunate that the FDA does not test new treatments itself unless some pharmaceutical company pays $100 million for this type of work.”

    I think the pharmaceutical companies would love it if that is all it would cost them. The last time I checked, the price was about 10 times what you quote.

  18. JackB says:

    Dr. Hall – I am happy to bring you more up-to-date. Your statement that all EMDR does is make patients more compliant with therapy may in fact prove that it is effective i.e. if psychologist can be more effective while using EMDR – then great! I would think you would celebrate this. Also, EMDR is not limited to eye movement, but can be done with simple hand stimulating devices. In terms of brain scans, if you refer to the no less than the National Insitute of Mental Health current brochure which is available on-line it states

    “Brain-imaging studies are helping scientists learn what happens in the brain of a person with bipolar disorder.14, 15 Newer brain-imaging tools, such as functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), allow researchers to take pictures of the living brain at work. These tools help scientists study the brain’s structure and activity.”

    It quotes and footnotes studes from 1997 (more than 12 years ago) to this effect. Sorry you missed those too.

    While Dr. Amen may be overstating his case, I think you are overstating your expertise and holding yourself out as an expert and trying to dissaude people from using these tools. I agree with your comments that these treatments are experimental. Were not all treatments once experimental? I don’t agree that this implies they are dangerous as people might get from your comment “experimental”. I think you should revise your comments on him. It is completely fair to say he is experimental in that he is unproven. It is fair he is promoter and probably overcharging and benefiting personally too much. It may also be he is sincere, and onto something that could help a lot of people and perhaps some day more scientists will back up his work. I think this is much more fair and balanced view for the skeptical doctor to take. I am not associated with him, I have never seen him, I am just an educated person trying to find the truth.

  19. Harriet Hall says:

    EMDR “works” just as well as any placebo, even when the eye movements are eliminated. It does not work better than placebo. I’m happy when any patient is persuaded to accept effective psychotherapy, but I can’t condone lying to them about how eye movements and other voodoo have some physiologic effect.

    The brochure you cite has no relevance to what Dr. Amen is doing. I did not “miss” the literature on the value of SPECT scans. They are clearly valuable in research and for certain specific indications. The literature does NOT support using SPECT scans for diagnosis and treatment the way Amen uses them.

    My main objection to his “experimental” treatments is not that they are dangerous (although they do involve radiation). I object that he is presenting unproven treatments as if they were firmly grounded in scientific evidence.

    He may be very sincere, but he is not a good scientist. He has a hypothesis, and instead of working to test that hypothesis, he has made the leap to treating patients and establishing a commercial empire.

  20. LindaRosaRN says:

    “Brain Overclaim Syndrome”

    This appears to be some of Amen’s problem. Here’s a most interesting paper on this annoying “disorder.”

    “Brain Overclaim Syndrome and Criminal Responsibility: A Diagnostic Note” by Stephen J. Morse
    OHIO STATE JOURNAL OF CRIMINAL LAW
    http://moritzlaw.osu.edu/osjcl/Articles/Volume3_2/Symposium/Morse-PDF-04-05-06.pdf

    Abstract

    This brief diagnostic note identifies a cognitive pathology, “Brain Overclaim Syndrome [BOS],” that often afflicts those inflamed by the fascinating new discoveries in the neurosciences. It begins by suggesting how one should think about the relation of neuroscience (or any other material explanation of human behavior) to criminal responsibility, distinguishing between internal and external critiques based on neuroscience. It then describes the signs and symptoms of BOS, the essential feature of which is to make claims about the implications of neuroscience for criminal responsibility that cannot be conceptually or empirically sustained. It then applies the diagnostic lens of BOS to the claims in Roper v. Simmons. Finally, the article recommends Cognitive Jurotherapy [CJ] as the therapy of choice for BOS

  21. JackB says:

    Dr. Hall, Your comments continue to make little sense. I see no real support for your argument that EMDR only works as well as a placebo. If so, why do insurance companies pay for a placebo equivalent? If I told you that something “just enhances heart surgery” surely you would be interested. The idea that you are trying to discredit Dr. Amen by saying he used “even more disturbing” treatments such as EMDR – which is widely used by the way and has helped many people I know – shows a real bias on your part. EMDR is hardly “more disturbing”. This shows a real bias on your part against newer treatments, psychology and psychiatry. I agree with your general point that his SPECT scans may not be necessary. Certainly, is many cases you may only learn what you already know. But what if in some cases you learn something you don’t know. How much is saving a person from misery and getting them on the right medication worth? Obviously not very much by your standards. Would you rather do too much or too little in terms of diagnosis? Dr. Amen says he has enough evidence himself to find that in some cases he can learn something and help patients. He has invited others to replicate and test his work. Certainly any SPECT researcher could do this and publish on these topics but so far they have not. So this places us all in a delicate situation. Clearly Dr. Amen does not have $100 million or $1 billion to prove this to the FDA and the FDA has been late in many treatments. It is not reasonable to expect that he does. So as citizens, patients, and health care people, what is right in such a situation? I think the morality is more complicated than you admit. I believe you should say that his work is unconfirmed by others and may or may not help. Buyer beware. You are paying a lot and may or may not get benefit. I believe this is a much fairer view than calling castigating him and saying he is “disturbing” by using EMDR and other innuendo. Since you show up when you google Dr. Amen I believe you have a very important obligation to be fair. The quotes you have about unhappy patients can be gotten from the patients of any doctor. No doctor satisfies all patients all the time. I think you are excluding the realistic potential that this may help and be worthwhile for some patients but that patients are spending a lot of money and may or may not be helped. By excluding this potential and balanced view, you may very well be dissuading people who could be helped and therefore doing harm. I think is sum you are violating your oath to first do no harm. Why not be fair and let the patient, knowing that this may not be helpful and is expensive, decide for themselves.

  22. Harriet Hall says:

    As for your continued support of EMDR, you apparently are willing to accept poor quality evidence and promote the use of placebos. The authors of this blog have higher standards. We think good science-based medicine is important; that’s why we founded the blog.

    “How much is saving a person from misery and getting them on the right medication worth?”

    It’s worth a great deal, but Dr. Amen has not demonstrated that his SPECT scans contribute to that.

    “you are violating your oath to first do no harm.”

    WTF? Informing the public about overblown claims is hardly a violation of the medical oath.

    “Why not be fair and let the patient, knowing that this may not be helpful and is expensive, decide for themselves.”

    That happens to be exactly my point. I’m glad you agree with me. Dr. Amen does not tell his patients “this may not be helpful.” He makes them think he is using proven procedures that WILL help.

  23. JackB says:

    EMDR is NOT a placebo. It has been effective for many people – including people I now, and it is reimbursed. There are no placebos that are reimbursed. You are simply incapable of admitting to possible error or being fair and balanced.

    You are also fouled mouthed. WTF is expected from a barely educated teenager.

    I can see you are unqualified as a psychologist or psychiatrist, you are NOT qualified to be writing this column, and you are a bitter and nasty fouled mouthed woman.

    You are falsely self-righteous.

  24. Harriet Hall says:

    JackB,
    You are very free with your opinions, but you haven’t offered a shred of evidence to support your claims for EMDR or for Dr. Amen.

  25. daedalus2u says:

    Jack, EMDR can only be a placebo. If it has therapeutic effects, those effects are not mediated through pharmacology or surgery, so it is a placebo. Many things have effects mediated though placebo effects, stress reduction for example. Psychotherapy has therapeutic effects mediated through placebo effects too. Psychotherapy it a placebo that is reimbursed. It is reimbursed because it is effective, not because it is a non-placebo.

    EMDR is a pretty harmless and cheap placebo. It didn’t work for me, psychotherapy did (which is much more expensive). Using SPECT scans as a placebo is of a whole different category. Much more expensive and invasive and with significant radiation exposure. Doing things which produce radiation exposure that are placebos is (to me) unconscionable.

    As far as Dr Hall’s language is concerned, the appropriateness of language depends on the setting. This is her blog and her blog post. Her use of language on her own blog is always appropriate because she sets the standard.

  26. JackB says:

    Here is an article on EMDR with MANY scientific references showing it is not a placebo.

    http://en.wikipedia.org/wiki/EMDR

    End of story about EMDR.

    Psychotherapy is not a placebo. The reader above who thinks that is way out of touch with medicine.

    Dr. Amen’s techniques are not proven by others, but they may in fact work. You have no evidence that they do not work. I do not need to prove that his techniques work to show your comment is wrong. I only need to show that you have no evidence against him to say that you may be getting patients who could be helped not to go – and that would be a shame for those patients who could be helped. Those patients who could have been helped and do not go after reading your article have been harmed. Therefore, until YOU have evidence it does not work, your opinion should leave open the potential it does work. Otherwise, you are being both biased and potentially harmful.

  27. daedalus2u says:

    Jack, can you give me the definition of the term “placebo” that you are using?

    I consider a placebo to be a treatment that is not pharmacologically or physically active (i.e. physiological active drugs or surgery) that produces a perceived therapeutic result.

    With that definition, psychotherapy is a placebo. That is not to minimize or denigrate the effectiveness of psychotherapy. It simply labels it as a treatment with effects not mediate through pharmacology or surgery.

  28. Harriet Hall says:

    JackB,
    The wikipedia (!) reference you cited includes some criticism of EMDR and has a link to this article by a psychologist that explains my reservations and critiques the quality of the evidence supporting EMDR:
    http://www.quackwatch.org/01QuackeryRelatedTopics/emdr.html

    By the standards of “evidence-based” medicine, there is “evidence” that EMDR works, but by the standards of science-based medicine its efficacy has not been established. The underlying rationale is improbable and it has been shown that the eye movements themselves can be dispensed with. I have no doubt that the associated psychotherapy is helpful, but the eye movements are clearly nothing but a gimmick.

    Of course I have no “evidence” that Amen’s SPECT scan system “doesn’t” work. It is up to the claimant to prove that it DOES work. I always leave open the possibility that unproven claims might be later proven. I have tried to tell you, I have no objection to patients’ trying Amen’s system as long as they understand it is experimental. My objection is to his representing his methods as supported by solid science when they are not. I said this before and you seem not to have understood what I meant. Please try again.

  29. JackB says:

    You said “I had not offered a shred of evidence for EMDR”. In two minutes, I came up with a wikipedia article with 82 references. Many are from peer reviewed journals. The one you select from the 82 is written by another “self appointed” referee on another “quackwatch” while many other articles are in peer reviewed Journals. Further, again, EMDR is paid for by insurance companies. Now you say “peered reviewed articles” and “payment by insurance companies” is not enough for you.

    Personally, I know many people helped by EMDR after 9/11 and no, it no longer requires eye movements, yes, it can be done with small hand-held devices. It “only” “makes psychotherapy more effective. As if that was not enough – again I would think you would celebrate. Despite, all this, you call it “disturbing” and more strikes against your target Dr. Amen.

    If this is your standard – a self-appointed referee, over many peer reviewed articles as well as insurance payment, then we must wonder about your judgment in anything you write.

  30. Harriet Hall says:

    JackB,
    EMDR is EYE MOVEMENT desensitization and reprocessing. You yourself admit that the eye movements are not necessary. That alone discredits it as EMdr. That’s like saying acupuncture is effective but it doesn’t matter if you use needles. It appears to be the psychotherapy that is effective, not the gimmicks to get patients involved.

    Regular readers of this blog understand that a long list of positive published studies may not mean much, depending on their quality and design. There are plenty of positive studies of homeopathy, acupuncture, etc. but a reasoned review of ALL the evidence, the consistency with other scientific knowledge, and the prior plausibility, leads us to reject them.

    And of course, the fact that an insurance company pays for something is irrelevant. It is not scientific evidence for its efficacy.

    “If this is your standard – a self-appointed referee, over many peer reviewed articles as well as insurance payment, then we must wonder about your judgment in anything you write.”

    Yes, this is the standard of this whole blog. Not exactly “self-appointed referees” but scientific thinkers who apply rigorous standards of science, reasoning, and common sense to evaluate the published data. I’m sorry you’re not able to understand our thinking.

  31. daedalus2u says:

    Actually Jack, that is always the standard for a scientist and skeptic. Each individual has to look at and evaluate the data and conclusions for themselves. If you don’t, or can’t, then you are not a scientist (in that field).

    If you don’t know enough to evaluate a paper, i.e. to be a “self-appointed referee”, then you have no business trying to draw conclusions from it. You have to understand it before you can draw conclusions from it.

  32. JackB says:

    Harriet,

    You continue to astound me with your “logic”. The fact that EMDR can be done without eye movement but can be done with simpler equipment,does not in any way invalidate it. The simpler equipment is an advance in the field – making the treatment more available and more efficient. You clearly have failed basic logic and are so against progress that if something becomes simpler – well then it is invalid. Again – if all it does is make therapy more effective – than you should celebrate. And yes, insurance payment does correlate validation. Insurance companies do not pay for placebos. They do not want to pay for unproven techniques or placebos or unnecessary procedures. They have panels of scientists in the field – unlike the two of you – who review the balance of evidence to make a decision. Unlike you two, they have to put their money where their mouth is. You are entitled to believe EMDR does not work – and you also entitled to believe that gravity does not exist or has not been proven – but please don’t jump out any windows because in your opinion there are not enough papers to support it.

  33. Harriet Hall says:

    JackB,
    Do you think the evidence for EMDR is as solid as the evidence for gravity? I don’t.

    Why do they continue to call it EMDR when it has been established that it has nothing to do with EM?

    How do you know that the other non-EM procedures that work just as well are not also just placebos?

    I strongly disagree with your claim that insurance companies are trustworthy arbiters of scientific truth. If the associated psychotherapy is effective, they might be fooled into thinking the EMDR is an essential component when it is not. Their reviewers may support “evidence-based” medicine without any deep understanding of true science-based medicine – the subject of this blog.

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