When a psychiatrist diagnoses you with anxiety, depression, an eating disorder or a learning disability鈥攐r even a serious pathology like schizophrenia鈥攖hey don鈥檛 typically look at your brain. Dr. Daniel Amen thinks they should.
You have probably seen Dr. Amen before. Television loves him鈥攅specially 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. 鈥淗ow do you know unless you look?鈥� 鈥淧sychiatry is the only medical specialty that never looks at the organ it treats.鈥� 鈥淢y colleagues are flying blind.鈥� 鈥淐hange your brain, change your life.鈥� He is so enamoured of his brain scans that he told 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.
In 2012, reported that Amen had recently spoken at a symposium of the American Psychiatric Association, telling attendees that 鈥渋t will soon be malpractice to not use imaging in complicated cases.鈥� The following year, his stance was . 鈥淚鈥檓 saying 98% of my colleagues are performing malpractice,鈥� he said to a journalist.
So, who鈥檚 right? The lone psychiatrist claiming he uses tomorrow鈥檚 revolutionary diagnostics tool today? Or the many expert associations unconvinced by his use of brain imaging for unvalidated conditions?
InSPECTing the brain
Dr. Daniel Gregory Amen鈥檚 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鈥檚 brain scans for went through Amen鈥檚 protocol at his clinic, he wrote that he found him to be 鈥渁n excellent psychiatrist.鈥� As is usually the case, Amen鈥檚 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.
The cornerstone of Amen鈥檚 practice鈥攁nd what sets him apart from almost all other psychiatrists鈥攊s his reliance on SPECT scans to inform his diagnoses. SPECT stands for 鈥渟ingle-photon emission computed tomography鈥� 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鈥檚 computer is able to create a three-dimensional image that provides information about brain activity.
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鈥檚 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鈥檚 where Dr. Amen and his field differ.
Amen says he has done 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鈥檚 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 鈥渢emporal lobe anxiety and depression鈥� and 鈥渞ing of fire ADD.鈥� He also uses these scans to hormonal imbalances, body dysmorphia, and marital difficulties.
The problem? There鈥檚 no randomized, blinded trial of his scans, and this important fact does not seem to bother him.
Demanding a paradigm shift
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. 鈥淎re we gonna talk about the book at all or鈥� not?鈥� Amen an hour and a half into the interview. 鈥淲e鈥檙e not gonna talk about the book,鈥� he continued, half-asking, half-answering his own question. 鈥淚t doesn鈥檛 feel fun or fair,鈥� he said of Varshavski鈥檚 questions.
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鈥檚 one thing to learn from speaking to a patient that she鈥檚 feeling depressed and to look at her brain scan and say, 鈥淎h, yes, I see the depression here;鈥� it鈥檚 another to be given a scan of an anonymized patient鈥檚 brain and be asked, 鈥淲hat鈥檚 the diagnosis, doc?鈥� Likewise, Dr. Amen鈥檚 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鈥攏o radiation鈥攁nd a standard treatment plan? If you鈥檙e not testing for this specifically, you can鈥檛 know.
When Dr. Mike Amen what鈥檚 stopping the two of them from conducting this exact type of trial, Amen was silent, shook his head, and finally admitted, 鈥淚鈥檓 all for it.鈥� Except he鈥檚 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 . Amen that the Society never 鈥渇ormally鈥� approached him and that the proposed plan would be 鈥渁 charade.鈥� Fifteen years later, Amen is 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鈥檚 contrarianism is practically genetic: he his father鈥檚 two favourite expressions were 鈥渂ullshit!鈥� and 鈥渘o!鈥�.
As I watched the two-hour interview, I kept waiting for one person鈥檚 name to be dropped. It happened at the halfway mark. 鈥淒id you ever read Thomas Kuhn鈥檚 book?鈥� Amen Varshavski. This is the indirect : using Kuhn to get to Galileo, asking people to glorify you because you鈥檙e going against the grain. Kuhn described how scientific revolutions happen鈥擯asteur鈥檚 germ theory of disease or Dalton鈥檚 idea that matter is made of atoms鈥攂ut 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 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鈥檛 get a paradigm shift because you want it. 鈥淵ou get one when the scientific community deems it necessary,鈥� she specified, when an anomaly can鈥檛 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.
It鈥檚 a common trait of peddlers of pseudoscience that they perceive their rejection of the mainstream as bold, revolutionary, and necessarily right. 鈥淭hey laugh at me now,鈥� is the refrain, 鈥渂ut soon they will accept my new theory as self-evident.鈥� Without robust evidence, your theory is just, well, a hypothesis. Amen鈥檚 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 long list includes the American Psychiatric Association, the National Institute of Mental Health, and the Society of Nuclear Medicine and Molecular Imaging.
Amen cites the Canadian Association of Nuclear Medicine , claiming that their 聽look as if he himself wrote them. First, Theodore Henderson, a of SPECT for neuropsychiatry, was on the committee. Second, while the guidelines cite 鈥渁 substantial body of research literature,鈥� they also state that it鈥檚 highly unlikely we will find a 鈥渘euroimaging fingerprint鈥� for any pure psychiatric disorder, contradicting Amen. Third, the association told Dr. Mike that it considers that their guidelines require 鈥渇urther rigorous review and validation through an independent, expert-led editorial and peer-review process.鈥� Overall, a very weak argument on Amen鈥檚 part.
Amen is contradicted a lot by actual scientific evidence throughout his appearance on Dr. Mike鈥檚 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 that Lyme disease is a 鈥渕ajor cause鈥� of psychiatric problems; this is , 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 they have not been approved for. And the he sells鈥攃hiefly a multivitamin, a probiotic, and an omega-3 fatty acid鈥攁re not the science-backed, health-changing secrets he markets them as. Yet another reminder that dietary supplements are unregulated in the United States and poorly regulated elsewhere, and it鈥檚 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?
The contradictions don鈥檛 end there. Amen has 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. 鈥淏ecause it wasn鈥檛 about the money,鈥� he explained.
Except that I have rarely seen someone monetize their unorthodox pursuit to the degree that he has.
More money than God
When pricing enters the equation, Amen replies that people can benefit from his work for free by taking the quiz on his website. That鈥檚 not entirely true.
I filled out his 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鈥攖his is how all of these health quizzes work, signing you up for a mailing list. I was told via email that I have a 鈥渢ype 1 brain,鈥� which apparently means I鈥檓 reliable, calm, and prefer structure. My brain fit score is 100鈥� out of 100. And yet, there is a big button at the bottom of the email that states 鈥淏OOST MY SCORE.鈥� 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鈥檚 clinics. And this email was only the first of many courting my dollar. You see, in Dr. Amen鈥檚 commercial world, perfection does not exist.
Amen owns and an initial visit will cost you, according to various reports, between US$ 3,000 and 4,000. His online bookstore lists that range in price from US$ 7.99 to a US$ 95.96 bundle. He created , 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, (95 items), and also sells a US$ 2,000 for your brain and a that claims to lower your blood pressure and improve your sleep. He has partnered with an online coaching program called (US$ 50 a month) for which he appears to receive kickbacks. He sells practical resources for parents and teachers (), a suite of 43 products that all come with a price tag.
Amen has a few under his name (e.g. Brain Fit 4 Life鈩� and Change Your Brain, Change Your Life鈩�), and he has been closely associated with , including his clinics, a publishing branch, a management company, a property rental, and a fundraising that claims to give 鈥渟cholarships鈥� 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.
Everywhere you look, Amen is selling something. Given his deep Christian beliefs, I wonder how he squares this with the words of his messiah: 鈥淚f 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.鈥� When confronted with his instinct for commercialization, Amen has replied that it鈥檚 not illegal; that 鈥渘o margin, no mission;鈥� that his parents were already rich, so he doesn鈥檛 need the money; that his companies have nowhere near the capital that the pharmaceutical industry possesses; and that 鈥渆xcuse me, but !鈥� His 1999 book, Change Your Brain, Change Your Life, his business, and his first PBS outing doubled it again.
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 . People with the disorder can have a normal scan, and people without it can have an abnormal one. Findings in groups to the individual.
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 鈥減eople with illness X鈥� versus 鈥渉ealthy controls鈥� cannot answer the main challenge psychiatrists face: which of these three disorders does my patient have?
At best, the use of brain imaging for psychiatric conditions is not ready for primetime; at worst, it鈥檚 the sciency equivalent of the Tarot or a new kind of phrenology. It鈥檚 neuro-palmistry.
The risks and downsides of Amen鈥檚 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 鈥渋ncidentalomas.鈥� 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.
Additionally, in the case of SPECT scans, you are exposing yourself to radiation. You will, on average, absorb a total dose of from those two initial scans, comparable to a , which itself delivers more radiation to your body than a simple X-ray.
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鈥檛 provide good diagnostics information, seeing it will motivate you to change your life鈥攁 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?
Joining Trump鈥檚 coalition of quacks
Amen鈥檚 questionable trailblazing has inspired other clinics to offer SPECT scans for neuropsychiatric conditions, but it鈥檚 fair to say that Amen鈥檚 own clinics remain at the top of the food chain, with an alleged .
Given the embrace of Trump鈥檚 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 ? It may end up looking like an expansion of , 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.
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鈥檛 raise your blood sugar too much is on the side, next to a glass of water. But given the White House鈥檚 recent adoption of the inverted food pyramid, will there be room for devotional nutrition?
Because, of course, the secret sauce in the Daniel Plan is . In his 2002 book, Amen wrote that 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.
Dr. Amen, it seems, wants to bring back eminence-based medicine. He isn鈥檛 looking at all the evidence; he is looking at his evidence. It may be good enough for him, but it鈥檚 not good enough for the entire field of psychiatry, and it shouldn鈥檛 be good enough for you. Amen!
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鈥檚 treatment options include universal health recommendations combined with a fair amount of pseudoscience, like dietary supplements and illegitimate uses of hyperbaric oxygen chambers.
