explains how behaviour such as anxiety, anger or impulsiveness could be related to the way specific areas in your brain work.
For the past 15 years he has been using [SPECT (photon emission computerised tomography)] scanning technology to assess brain activity in people with ‘psychological’ problems.
What these scans have shown is that often these problems are not actually psychological, but are biological – some area of the patient’s brain isn’t functioning well, but is instead under or over-active, he says.
Certainly, the idea that brain scans can tell us what is ‘really’ happening in our minds is a highly seductive one. However, Amen is not what I would view as the most reliable of sources.
Burne refers to the
neuroscientist and psychiatrist Daniel G. Amen, who is professor of psychiatry-and human behaviour at the University of California, Irvine
the title “assistant clinical professor” is the name for an untenured volunteer faculty member, of which the U.C. Irvine School of Medicine has more than 1,000. Amen is not affiliated with the university’s Brain Imaging Center; all of his studies on SPECT scanning have been privately performed at his proprietary Amen Clinics.
This type of position is clearly – while a perfectly respectable position to hold – very different from a full professorship at UCal.
We do like to see these things accurately reported, but this would not be a big issue if Amen’s use of SPECT was backed up by strong evidence. Sadly, however, there are serious concerns. As Harriet Hill argues:
The key question in evaluating a diagnostic test is whether or not its findings are useful in determining what treatment the patient should have. SPECT is a research tool useful for exploring how the brain functions, but the findings are nonspecific, and uses related to treatment of emotional or behavioral problems should be considered experimental. Dr. Amen has vast clinical experience and says he has performed and interpreted more than 35,000 scans. However, I do not believe he has demonstrated that specific scan patterns reliably reflect specific clinical problems and how they should be treated. Even when he is able to show a correlation between a diagnosis and an area of low perfusion (blood flow), he has not shown what this really means and how it could aid clinical treatment. Is low perfusion an indication of the primary pathology or perhaps just a secondary brain response to the symptoms? His published research comprises “preliminary studies,” and most psychiatrists believe it is premature to use SPECT clinically.
Burne’s article compares SPECT scans of brains supposedly affected by various drugs (caffeine, nicotine, alcohol and cannabis) with a “normal”, “healthy” brain. We should first note that Amen explicitly argues that
it took us almost 3,000 people screening to find about 90 healthy brains…if your brain is struggling, welcome to normal. Normal is not healthy.
If so few brains are ‘normal’, then many deviations from ‘normality’ could be due to a huge number of factors: it is not clear from Burne’s article how it was determined that the ‘problems’ found were caused by the drugs used. One can certainly not conclude, for example, that because a patient “admitted to smoking two packs of cigarettes a day and drinking three pots of coffee”, the ‘abnormalities’ in their SPECT scan are caused by one or both drugs. It is not clear from Burne’s article how Amen has reached his lifestyle recommendations – for example, “no more than three cups of coffee a day” is perfectly sensible advice, but I do not see how it can be derived from Amen’s research on SPECT scans.
Adding problematic claim to problematic claim, the Mail article argues that one scan
should come as a shock to those who want to downgrade cannabis from a class B to a class C drug. Like other recreational drugs, cannabis squeezes down blood flow, leading to brain cell damage and death…those who want drug classifications loosened should also look closely at these scans.
Clearly, drug use can damage one’s health. However, I do not see good evidence that Amen’s use of SPECT scans is the best way of measuring this. As Hall argues:
Pictures showing that “this is your brain on drugs” may impress some people, but I am far more impressed by quantifiable data (such as tests of mental performance) and clinical consequences (such as improved behavior) than by nonspecific pictures of “holes” in the brain.
Even if the damage a drug does to the brains of users is to be used as a reason to impose particular legal penalties on those caught with the drug, SPECT scans are not the best evidence re how cannabis does or does not affect the mental functioning of its users.
We would also note that – while Amen’s use of SPECT scans in this area is novel and, we would argue, not based on strong enough evidence to justify its clinical use in this context – his recommendations regarding drug and alcohol use are pretty conventional. Not smoking tobacco – or stopping, if you do smoke – is good health advice: there is excellent evidence that smoking is harmful. Likewise, moderating one’s intake of alcohol and caffeine is a sensible move, and it seems likely that avoiding drugs such as cannabis is advisable if you want to avoid health risks.
Hall responds to Amen’s work by asking
What does the scan tell us that would change how we treat a patient?
That is very relevant in this context: we see a novel test which lacks a strong evidence base being used in order to ‘justify’ very mainstream advice. Admittedly, ‘smoking is bad, as shown by a large body of published, good quality research’ may be a clumsy headline, but it would offer much stronger evidence as to why smoking is a bad idea than pictures of ‘your brain on tobacco’.
We would also argue that – while lifestyle modifications such as stopping smoking are very much positive things – this type of scanning technique is not necessarily benign. To see ‘holes in your brain’ or how one’s brain is ‘abnormal’ can, of course, be distressing: the Mail article refers to how one patient “burst into tears” on seeing his SPECT scan. There are also, of course, very real risks involved in drug use, and it is important that individuals and policy-makers are informed about these risks and encouraged to take appropriate action: overblown ‘this is your brain on drugs’ articles are therefore unhelpful. Amen’s approach is expensive, too: in 2008, an Amen Clinic Evaluation cost $3,300
The price includes two Spect scans and a series of clinical interviews…recommendations about lifestyle changes, supplements, and medications — a prescription for a “better brain.
For treating certain conditions ‘diagnosed’ through this process, Amen advocates
a potpourri of unproven treatments, such as antioxidants and proprietary nutraceuticals.
Once again, this carries a financial cost and – when supplements contain active ingredients – they also carry certain risks.
Daniel G. Amen is clearly a controversial figure and his research is – at best – preliminary and contestable. Jerome Burne’s article fails to make this clear: instead, Amen is presented as an authority figure, and his SPECT scans are presented as strong evidence of the damage done by various drugs. Such poor-quality science reporting is unfortunate, and is not a helpful contribution to the important debates around drug use, drug policy and mental health.