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Tuesday, 30 December 2008 10:46

Visionary or Voodoo? - Page 3

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To be sure, Amen has acquired a small, but growing, crowd of supporters and colleagues in psychiatry, psychology, and nuclear medicine--he says more than 1,000 professionals refer to him--who consider him a trailblazer and believe SPECT scans will revolutionize the practice of psychotherapy. "I think he's a real pioneer, making an enormous contribution to the field of psychiatry and helping to change the paradigm of how people think about the brain and psychiatric symptoms," says Joseph Wu, professor of psychiatry and clinical director of the brain imaging center at the University of California, Irvine. "Daniel Amen introduced me to a whole new universe of subcortical brain structures that we in nuclear medicine had only looked at casually before. He helped me realize that SPECT can be very useful for evaluating complex, difficult cases in which comorbidities are present," notes Dan Pavel, professor of radiology and nuclear medicine at the University of Illinois. "I came away from Amen's clinic convinced there is a place for SPECT in clinical psychiatry," writes AD/HD expert Edward M. Hallowell, coauthor with John J. Ratey of the bestselling Delivered from Distraction: Getting the Most Out of Life with Attention Deficit Disorder. "It is obviously helpful to be able to look at the brain before you try to treat it. Perhaps SPECT will prove to be the most practical way for psychiatrists to do that."

But utter the name Daniel Amen to some of the leading members of the psychiatry and neuroscience research community and the reaction ranges from dismissal to derision and denunciation. "He's made a mountain of money doing scans [a two-scan evaluation at one of Amen's clinics costs $3,250, which also includes, a history, physician evaluation, and follow-up visit], but never, to my knowledge, published any data, or provided one shred of evidence that an independent investigator would be able to reproduce," says George Bush, psychiatry professor at Harvard Medical School and psychiatric neuroimaging researcher at the Martinos Center for Biomedical Imaging. "Amen is extremely successful, has many franchises and is a wickedly good salesman, but what he's doing isn't supported by scientific evidence. Where's his data? What does he know that all the other practitioners and researchers don't know?" asks Helen Mayberg, psychiatry and neurology professor and brain-imaging researcher at Emory University. In fact, so exercised is much of psychiatric officialdom by Amen's approach that, last January, the American Psychiatric Association's nine-member Council on Children, Adolescents and Their Families felt moved to issue an independent position paper opposing the use of SPECT in the clinical practice of child and adolescent psychiatry.

It seems strange that a person so disarming and apparently eager to please, who's clearly distressed by the uproar he's caused and seems like the last person who'd mount a Rambo challenge against entrenched power, would arouse such hostility. Or that his cause--the incorporation into psychotherapeutic and psychiatric practice of SPECT scans, a technology that's been around for decades--should be so contentious. So what is it about Daniel Amen and his mission to get therapists to use brain imaging, and SPECT in particular, as an aid to diagnosis and treatment that makes him such a lightning rod?

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