FW: interesting Amen criticism

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-----Original Message-----From: Flowers, Jill [mailto:jill.flowers@...]Sent: Sunday, February 19, 2006 1:29 PMjccamp@...Subject: interesting Amen criticism

Saturday, May 21, 2005

Dr. Amen and SPECT

The activities of Dr. Amen have raised the suspicions of some people, and - as usual - Dr. Harriet Hall has responded with some excellent comments. Her response comes after these introductory links and comments:

His websites

http://www.amenclinic.com/ac/default.asp

http://www.brainplace.com/bp/default.asp

His SPECT brain imaging

http://www.brainplace.com/ac/whyspect.asp

The American Psychiatric Association and the American Academy of Pediatrics recommend that clinical use of neuron-imaging for psychiatric conditions be delayed until studies yield evidence in support of practical clinical applications.

APA: Practice Guideline for the Psychiatric Evaluation of Adults

AAP: Clinical practice guideline: diagnosis and evaluation of the child with attention-deficit/hyperactivity disorder.

_______________________________________________

Response by Dr. Harriet Hall, MD:

I had not previously heard of Dr. Amen, but I have just finished reviewing the websites, the video, and PubMed, and I am NOT impressed. SPECT is an experimental procedure that may eventually teach us a great deal about how the brain functions in health and disease, but it is premature to use it for diagnosis and for guidance of treatment. In my opinion, Dr. Amen's claims are unfounded and his approach unethical. SPECT is an invasive procedure requiring injection of a radioactive material, with additional radiation exposure from the scanner. The findings have not been validated as useful in diagnosis, and as far as I can see, all he is accomplishing is using a "picture" to help re-inforce what we already know - that the brain is the organ that determines behavior and psychology. He claims to be able to direct therapy based on scan results, and there is no research to support that claim, only anecdotal evidence and testimonials. It is unconscionable to charge patients thousands of dollars for an unproven technique and to give them the impression that it can accomplish more than it really can.

Unanswered questions: do patients treated in his clinic do better than patients treated by a competent not-SPECT-using clinic? Are the SPECT findings consistent enough that blinded observers could agree on the diagnosis from the scan alone? Have different treatments actually been compared as to their effect on the scans? Is it possible that Dr. Amen's judgment has been affected by common psychological pitfalls such as confirmation bias? Why did he leap into clinical applications, writing for the public, appearing on TV and the lecture circuit with information that the rest of the medical profession considers preliminary? Why has he not published his findings in a reputable, peer-reviewed journal? (A pubmed search for "Amen" and "SPECT" brought up only 7 items, all of which would be classified as preliminary studies and none of which supplies adequate evidence to support using SPECT scans as he is doing in his clinic.)

I noticed two other things on his website that I found very worrisome: the reference to "soul" (a metaphysical rather than a scientific concept) and the use of EMDR as a therapeutic technique.

For a critique of EMDR, see:

http://www.quackwatch.org/01QuackeryRelatedTopics/emdr.html.

I would not personally submit to a SPECT scan in Dr. Amen's clinic even if it were free. In my opinion, with the present state of knowledge, the potential harm outweighs any potential benefit.

Pictures of "your brain on drugs" may impress some people, but I am far more impressed by specific psychometric test results and clinical consequences than by nonspecific pictures of "holes" in the brain.

Harriet Hall, M.D.