When a psychiatrist diagnoses you with anxiety, depression, an eating disorder or a learning disability\u2014or even a serious pathology like schizophrenia\u2014they don\u2019t typically look at your brain. Dr. Daniel Amen thinks they should.<\/p>\n
You have probably seen Dr. Amen before. Television loves him\u2014especially PBS, but also Dr. Phil, The View, The Doctors. He has authored countless books, and if you pause the end credits and squint, you might see his name as a consultant on that Will Smith movie Concussion. Here, there and everywhere, he is preaching for SPECT scans to look at the brain, and his sayings sound like marketing slogans. \u201cHow do you know unless you look?\u201d \u201cPsychiatry is the only medical specialty that never looks at the organ it treats.\u201d \u201cMy colleagues are flying blind.\u201d \u201cChange your brain, change your life.\u201d He is so enamoured of his brain scans that he told The Telegraph<\/a> that any boy that dated one of his daughters for more than four months was required to submit his brain for examination. Despite some apparent neurological flaws, two of them ended up marrying into the family.<\/p>\n In 2012, The Washington Post<\/a> reported that Amen had recently spoken at a symposium of the American Psychiatric Association, telling attendees that \u201cit will soon be malpractice to not use imaging in complicated cases.\u201d The following year, his stance was much more radical<\/a>. \u201cI\u2019m saying 98% of my colleagues are performing malpractice,\u201d he said to a journalist.<\/p>\n So, who\u2019s right? The lone psychiatrist claiming he uses tomorrow\u2019s revolutionary diagnostics tool today? Or the many expert associations unconvinced by his use of brain imaging for unvalidated conditions?<\/p>\n InSPECTing the brain<\/p>\n Dr. Daniel Gregory Amen\u2019s credentials look unimpeachable though spiritually skewed, which will play a role later. He earned a biology degree from a Pentecostal school then called Southern California College and received a medical degree from the evangelical Oral Roberts University. He became board certified in both general and child psychiatry, and his many active medical licenses show no complaint or disciplinary action. When a psychiatrist who denounced Amen\u2019s brain scans for Wired magazine<\/a> went through Amen\u2019s protocol at his clinic, he wrote that he found him to be \u201can excellent psychiatrist.\u201d As is usually the case, Amen\u2019s basic advice is well-trodden ground and universally accepted: eat your vegetables, get enough sleep, and avoid recreational drugs, cigarettes, alcohol, and hobbies that put your brain at risk.<\/p>\n The cornerstone of Amen\u2019s practice\u2014and what sets him apart from almost all other psychiatrists\u2014is his reliance on SPECT scans to inform his diagnoses. SPECT stands for \u201csingle-photon emission computed tomography\u201d and dates back to 1963, around the time that other imaging technologies like CT and MRI scans were being developed. To carry out a SPECT scan of the brain, a radioactive molecule is injected and it makes its way to the brain. A special camera that rotates around the head picks up the gamma radiation the molecule emits, and the scanner\u2019s computer is able to create a three-dimensional image that provides information about brain activity.<\/p>\n SPECT is a functional type of imaging, not a structural one. The psychiatrist who wrote for Wired, Dr. Daniel Carlat, employed a good analogy. A structural scan, like an MRI scan of your brain after a concussion, shows you the layout of the house. A functional scan, like a SPECT scan, reveals where people congregate during a party in that house. It\u2019s a heat map. SPECT scans have genuine medical applications: they are ordered by cardiologists; they can rule out tumours; and they can be used if a patient is suspected of having dementia. But using them routinely to diagnose common psychiatric conditions by mapping blood flow to the brain? That\u2019s where Dr. Amen and his field differ.<\/p>\n Amen says he has done almost 300,000 SPECT scans<\/a> on people from 155 countries. You go and see him at one of his many clinics in the U.S. He does a scan of your brain at rest and another one, on a separate day, when concentrating. The data is analyzed and he combines this imaging with the standard psychiatric interview to arrive at a diagnosis. His diagnostic portfolio deviates from the manual of psychiatry, the Diagnostic and Statistical Manual of Mental Disorders or DSM. Amen\u2019s brain scans have revealed, he says, six types of anxiety and depression (two disorders he has combined into a single category), as well as seven types of ADHD and five types of obesity. He has given them names, like \u201ctemporal lobe anxiety and depression\u201d and \u201cring of fire ADD.\u201d He also uses these scans to treat<\/a> hormonal imbalances, body dysmorphia, and marital difficulties.<\/p>\n The problem? There\u2019s no randomized, blinded trial of his scans, and this important fact does not seem to bother him.<\/p>\n Demanding a paradigm shift<\/p>\n When Dr. Amen was recently interviewed on The Checkup with Doctor Mike, he went with the intent to plug his latest book. Dr. Mike Varshavski, however, wanted to confront him about the lack of robust evidence for the use of SPECT scans in neuropsychiatry. \u201cAre we gonna talk about the book at all or\u2026 not?\u201d Amen asked<\/a> an hour and a half into the interview. \u201cWe\u2019re not gonna talk about the book,\u201d he continued, half-asking, half-answering his own question. \u201cIt doesn\u2019t feel fun or fair,\u201d he said of Varshavski\u2019s questions.<\/p>\n There does not seem to be a single, rigorous, double-blind, randomized clinical trial of SPECT scans for the types of conditions Dr. Amen uses them for. It\u2019s one thing to learn from speaking to a patient that she\u2019s feeling depressed and to look at her brain scan and say, \u201cAh, yes, I see the depression here;\u201d it\u2019s another to be given a scan of an anonymized patient\u2019s brain and be asked, \u201cWhat\u2019s the diagnosis, doc?\u201d Likewise, Dr. Amen\u2019s patients might improve because of the scan and the treatment plan that follows from the scan; but would they also improve if given a sham scan\u2014no radiation\u2014and a standard treatment plan? If you\u2019re not testing for this specifically, you can\u2019t know.<\/p>\n When Dr. Mike asked<\/a> Amen what\u2019s stopping the two of them from conducting this exact type of trial, Amen was silent, shook his head, and finally admitted, \u201cI\u2019m all for it.\u201d Except he\u2019s not. Many years ago, the Brain Imaging Council of the Society of Nuclear Medicine made a similar offer to Dr. Amen: to send him a blinded set of SPECT scans in order to see how accurate his diagnoses were. The offer was declined<\/a>. Amen retorted<\/a> that the Society never \u201cformally\u201d approached him and that the proposed plan would be \u201ca charade.\u201d Fifteen years later, Amen is asked<\/a> by Dr. Mike at the end of his interview if Amen wants to try to disprove his method to show how robust it is? Amen replies that, at this point in his career, the answer is no. Amen\u2019s contrarianism is practically genetic: he says<\/a> his father\u2019s two favourite expressions were \u201cbullshit!\u201d and \u201cno!\u201d.<\/p>\n As I watched the two-hour interview, I kept waiting for one person\u2019s name to be dropped. It happened at the halfway mark. \u201cDid you ever read Thomas Kuhn\u2019s book?\u201d Amen asks<\/a> Varshavski. This is the indirect Galileo gambit<\/a>: using Kuhn to get to Galileo, asking people to glorify you because you\u2019re going against the grain. Kuhn described how scientific revolutions happen\u2014Pasteur\u2019s germ theory of disease or Dalton\u2019s idea that matter is made of atoms\u2014but the vast majority of science is not revolutionary; it is incremental. When I covered the researcher who, at the beginning of the pandemic, thought jade-nephrite amulets<\/a> could prevent us getting sick and who had self-published a whole paper on his Theory of Everything, I interviewed Naomi Oreskes, Ph.D., a historian of science, who told me that you don\u2019t get a paradigm shift because you want it. \u201cYou get one when the scientific community deems it necessary,\u201d she specified, when an anomaly can\u2019t be resolved despite multiple attempts by the field as a whole. Then and only then does the theory have to change. These events are rare.<\/p>\n It\u2019s a common trait of peddlers of pseudoscience that they perceive their rejection of the mainstream as bold, revolutionary, and necessarily right. \u201cThey laugh at me now,\u201d is the refrain, \u201cbut soon they will accept my new theory as self-evident.\u201d Without robust evidence, your theory is just, well, a hypothesis. Amen\u2019s use of SPECT scans for neuropsychiatry is not accepted by a large number of professional organizations according to reporting done by Neely Tucker for The Washington Post<\/a>: the long list includes the American Psychiatric Association, the National Institute of Mental Health, and the Society of Nuclear Medicine and Molecular Imaging.<\/p>\n Amen cites the Canadian Association of Nuclear Medicine in his defense<\/a>, claiming that their SPECT guidelines<\/a>\u00a0look as if he himself wrote them. First, Theodore Henderson, a proponent<\/a> of SPECT for neuropsychiatry, was on the committee. Second, while the guidelines cite \u201ca substantial body of research literature,\u201d they also state that it\u2019s highly unlikely we will find a \u201cneuroimaging fingerprint\u201d for any pure psychiatric disorder, contradicting Amen. Third, the association told Dr. Mike that it considers that their guidelines require \u201cfurther rigorous review and validation through an independent, expert-led editorial and peer-review process.\u201d Overall, a very weak argument on Amen\u2019s part.<\/p>\n Amen is contradicted a lot by actual scientific evidence throughout his appearance on Dr. Mike\u2019s podcast, highlighted by the many on-screen fact checks added in post-production. Combined with what he has said elsewhere, there is a lot of pseudoscience in his field of gravity. He claims<\/a> that Lyme disease is a \u201cmajor cause\u201d of psychiatric problems; this is patently false<\/a>, especially given that the U.S. saw roughly 30,000 yearly cases of the disease in the last decade in a population of over 300 million. He uses hyperbaric oxygen chambers for indications<\/a> they have not been approved for. And the dietary supplements<\/a> he sells\u2014chiefly a multivitamin, a probiotic, and an omega-3 fatty acid\u2014are not the science-backed, health-changing secrets he markets them as. Yet another reminder that dietary supplements are unregulated<\/a> in the United States and poorly regulated elsewhere, and it\u2019s not rare for them to be contaminated or adulterated. He repeats that he wants to use the least toxic, most effective treatment, which leads him to supplements, but what does he think psychiatrists look for? The most toxic, least effective pills?<\/p>\n The contradictions don\u2019t end there. Amen has stated<\/a> that, in medical school, the three fields he was interested in were family medicine, pediatrics, and psychiatry, the three lowest reimbursed and lowest paying fields. \u201cBecause it wasn\u2019t about the money,\u201d he explained.<\/p>\n Except that I have rarely seen someone monetize their unorthodox pursuit to the degree that he has.<\/p>\n More money than God<\/p>\n When pricing enters the equation, Amen replies that people can benefit from his work for free by taking the quiz on his website. That\u2019s not entirely true.<\/p>\n I filled out his Brain Health Assessment quiz<\/a> and I gamed the system by giving optimal answers to every question. Of course, to get the results, I had to give him an email address\u2014this is how all of these health quizzes work, signing you up for a mailing list. I was told via email that I have a \u201ctype 1 brain,\u201d which apparently means I\u2019m reliable, calm, and prefer structure. My brain fit score is 100\u2026 out of 100. And yet, there is a big button at the bottom of the email that states \u201cBOOST MY SCORE.\u201d The way to do it? Buy three supplements, change my diet, join a program called BRAINFITLIFE 5.0, and get a SPECT scan at one of Amen\u2019s clinics. And this email was only the first of many courting my dollar. You see, in Dr. Amen\u2019s commercial world, perfection does not exist.<\/p>\n Amen owns 11 clinics<\/a> and an initial visit will cost you, according to various reports, between US$ 3,000 and 4,000. His online bookstore lists 44 books<\/a> that range in price from US$ 7.99 to a US$ 95.96 bundle. He created Amen University<\/a>, which sells online courses and certifications that sell for up to US$ 6,000, and you can book him for an in-person talk. He owns a line of supplements, BrainMD<\/a> (95 items), and also sells a US$ 2,000 infrared light cap<\/a> for your brain and a music program<\/a> that claims to lower your blood pressure and improve your sleep. He has partnered with an online coaching program called GrowthDay<\/a> (US$ 50 a month) for which he appears to receive kickbacks. He sells practical resources for parents and teachers (LoveAndLogic<\/a>), a suite of 43 products that all come with a price tag.<\/p>\n Amen has a few trademarks<\/a> under his name (e.g. Brain Fit 4 Life\u2122 and Change Your Brain, Change Your Life\u2122), and he has been closely associated with 12 companies<\/a>, including his clinics, a publishing branch, a management company, a property rental, and a fundraising foundation<\/a> that claims to give \u201cscholarships\u201d that are revealed to be free brain scans and treatment plans at one of his clinics. The Washington Post reports that he lives in a US$ 4.8-million mansion overlooking the Pacific Ocean.<\/p>\n Everywhere you look, Amen is selling something. Given his deep Christian beliefs, I wonder how he squares this with the words of his messiah: \u201cIf you want to be perfect, go, sell your possessions and give to the poor, and you will have treasure in heaven. Then come, follow me.\u201d When confronted with his instinct for commercialization, Amen has replied that it\u2019s not illegal; that \u201cno margin, no mission;\u201d that his parents were already rich, so he doesn\u2019t need the money; that his companies have nowhere near the capital that the pharmaceutical industry possesses; and that \u201cexcuse me, but I thought this was America<\/a>!\u201d His 1999 book, Change Your Brain, Change Your Life, doubled<\/a> his business, and his first PBS outing doubled it again.<\/p>\n The bottom line is that Dr. Amen is making money hand over fist selling a type of brain scan that has not been shown to be good enough to be used in the psychiatry clinic. When a group of patients with one psychiatric disorder and another without the disorder have their SPECT scans compared in a research setting, what often happens is that, on average, the two groups can be distinguished. But visually, they are two somewhat overlapping circles<\/a>. People with the disorder can have a normal scan, and people without it can have an abnormal one. Findings in groups cannot be applied<\/a> to the individual.<\/p>\n Moreover, diseases can share features. Difficulty concentrating, for example, is not limited to a single psychiatric condition. If it were to show up on a scan, which condition triggered it? Studies of \u201cpeople with illness X\u201d versus \u201chealthy controls\u201d cannot answer the main challenge psychiatrists face: which of these three disorders does my patient have?<\/p>\n At best, the use of brain imaging for psychiatric conditions is not ready for primetime; at worst, it\u2019s the sciency equivalent of the Tarot or a new kind of phrenology. It\u2019s neuro-palmistry.<\/p>\n The risks and downsides of Amen\u2019s SPECT scans are many: from significant (and often) out-of-pocket spendings to the false reassurance of a clean or misleading scan, to what cancer specialists refer to in their field as \u201cincidentalomas.\u201d They are things that look like tumours on a test but that are revealed, after much anxiety and more invasive testing, to be nothing. Basically, a false positive.<\/p>\n Additionally, in the case of SPECT scans, you are exposing yourself to radiation. You will, on average, absorb a total dose of 1.4 rem<\/a> from those two initial scans, comparable to a CT scan<\/a>, which itself delivers more radiation to your body than a simple X-ray.<\/p>\n Amen claims that seeing your brain is a great compliance tool for his treatment plan. Taken further, the argument is that even if the scan doesn\u2019t provide good diagnostics information, seeing it will motivate you to change your life\u2014a placebo effect, to put a name on it. Are the price tag and radiation exposure worth the potential placebo effect, especially when the treatment plan will include unproven dietary supplements?<\/p>\n Joining Trump\u2019s coalition of quacks<\/p>\n Amen\u2019s questionable trailblazing has inspired other clinics to offer SPECT scans for neuropsychiatric conditions, but it\u2019s fair to say that Amen\u2019s own clinics remain at the top of the food chain, with an alleged 10,000+ patients per month<\/a>.<\/p>\n Given the embrace of Trump\u2019s White House for fringe alternatives and outright pseudoscience, is it any wonder that Daniel Amen is now working with the newly established White House Faith Office on a National Brain Health Revolution Initiative<\/a>? It may end up looking like an expansion of The Daniel Plan<\/a>, a nutrition plan he devised with Dr. Mehmet Oz and Dr. Mark Hyman for the Saddleback megachurch in California he attends and for which multiple books were released.<\/p>\n Putting aside its undeserved fearmongering of certain ingredients, like artificial sweeteners and MSG, The Daniel Plan makes a lot of sense. Half a plate of non-starchy vegetables, with the rest of the plate divided into lean proteins and either whole grains or starchy vegetables. A fruit that won\u2019t raise your blood sugar too much is on the side, next to a glass of water. But given the White House\u2019s recent adoption of the inverted food pyramid, will there be room for devotional nutrition?<\/p>\n Because, of course, the secret sauce in the Daniel Plan is faith<\/a>. In his 2002 book, Amen wrote that he was led by God<\/a> to pursue SPECT scans in his field. He has since accused his peers of flying blind by diagnosing without imagery. As the old proverb goes, in the land of the blind, the one-eyed man is king. But if that eye looks at the world through a green-tinted lens, all it will see will be green.<\/p>\n Dr. Amen, it seems, wants to bring back eminence-based medicine. He isn\u2019t looking at all the evidence; he is looking at his evidence. It may be good enough for him, but it\u2019s not good enough for the entire field of psychiatry, and it shouldn\u2019t be good enough for you. Amen!<\/p>\n Take-home message:
– Celebrity doctor Daniel Amen wants psychiatrists to use SPECT scans of the brain to help diagnose and treat psychiatric conditions.
– This application of SPECT scans has never been validated with a rigorous clinical trial, and Dr. Amen is not interested in conducting one.
– Dr. Amen\u2019s treatment options include universal health recommendations combined with a fair amount of pseudoscience, like dietary supplements and illegitimate uses of hyperbaric oxygen chambers.<\/p>\n