Scientifically Unfounded Claims in Diagnosing and Treating Patients

To the Editor: We greatly appreciated the thoughtful book review by Andrew F. Leuchter, M.D. (1), published in the May 2009 issue of the Journal, on Daniel Amen's Healing the Hardware of the Soul: Enhance Your Brain to Improve Your Work, Love, and Spiritual Life (2). Dr. Amen claims that numerous psychiatric illnesses can be diagnosed and treatments prescribed based on resting single photon emission computerized tomography (SPECT) images. Dr. Leuchter correctly points out the absence of empirical data to support the claims of Dr. Amen. Several years ago, following conversations with Dr. Amen on how to address such concerns, the Brain Imaging Council of the Society of Nuclear Medicine offered Dr. Amen the opportunity to submit his analyses of a blinded set of SPECT scans (to have been prepared by the Brain Imaging Council) to determine how effective his technique is at correctly diagnosing subjects. Although this proposed study could have provided support for his approach, the offer was declined. Nevertheless, for more than two decades, Dr. Amen has persisted in using scientifically unfounded claims to diagnose and treat patients (over 45,000 by his own count).

There are several dangers to patients that can accrue from this approach: 1) patients (including children) are administered a radioactive isotope without sound clinical rationale; 2) patients pursue treatments contingent upon an interpretation of a SPECT image that lacks empirical support; and 3) based on a presumed diagnosis provided by Dr. Amen's clinics, patients are guided toward treatment that may detract them from clinically sound treatments.

Just as serious is the danger to our field. It is likely that, within the next decade, Dr. Amen's claims will be realized in that psychiatrists will enjoy the ability to diagnose and prescribe treatments based, in part, upon neuroimaging findings. Unfortunately, if previously led astray by unsupported claims, patients and their doctors may be less inclined to utilize scientifically proven approaches once these are shown in the peer-reviewed literature to be effective.

It is therefore incumbent upon all of us to monitor and regulate our field. We encourage physicians to remain vigilant of unproven approaches practiced by our peers and to immediately report these trespasses to their state medical boards.