Top critical review
104 people found this helpful
Well written but not trustworthy
on July 30, 2011
I really enjoyed reading Dr Amen's book, he has a charismatic and uplifting style of writing and unique approaches to ADHD diagnosis and treatment. I purchased this book specifically because I was I was intrigued by the idea of using brain scans (SPECT) to have an objective explanation of the physical manifestations of ADHD in the brain and the biology underlying ADHD symptoms. Most books on ADHD have only a cursory explanation of the biological nature of ADHD and tend to focus instead on the symptomology as reported by those with ADHD. Having been diagnosed with ADHD and in light of questions of the validity of the condition, I was attracted to this physical evidence for ADHD being a true biological phenomena as it would help refute doubts about the existence of the condition.
As much as I enjoyed the book, I started to become suspicious when Dr. Amen began to explain his quest for acceptance among his peers in the medical community. He writes at length of the troubles he had in getting support for using SPECT scans to diagnose ADHD. Specifically, he writes about how so many experts in his field do not view SPECT as a valid tool for diagnosis and treatment of ADHD, and he goes on to use anecdotal evidence of when he used SPECT to successfully treat numerous cases of ADHD. Throughout the first half of the book Dr. Amen alludes to the idea that he has this amazingly effective tool for diagnosing and treating ADHD, and everyone else is simply failing to appreciate its' value. He suggests that he has the best methods for diagnosing and treating ADHD and that other experts in the field are failing to provide optimal care due to their closed-mindedness. This type of language from health professionals is suspicious because it is frequently used by quacks; those who assert that their unproven methods are the true best ways for dealing with a particular condition, and that the medical consensus and standard of care are models for suboptimal care.
AETNA on SPECT for ADHD: "Functional neuroimaging such as PET and SPECT has been used to study patients with attention deficit/hyperactivity disorder (ADHD). Although some studies have shown differences in brain structure or function comparing children with and without ADHD, these findings do not differentiate reliably between children with and without this disorder (i.e., although group means may differ significantly, the overlap in findings among children with and without ADHD results in high rates of false-positives and false-negatives). As a result, SPECT should not be used as a screening or diagnostic tool for children with ADHD. The American Academy of Pediatrics' Practice Guideline on "Diagnosis and Evaluation of the Child with Attention-Deficit/Hyperactivity Disorder" does not recommend neuroimaging studies in the diagnosis of ADHD. An evidence review by McGough and Barkley (2004) stated that there are insufficient scientific data to justify use of laboratory assessment measures, including neuropsychological tests and brain imaging, in diagnosing adult ADHD."
This is of particular importance because SPECT scans are the crux of Dr. Amen's treatment, and the main component of what differentiates his approach to ADHD from that of other psychiatrists. SPECT scans for ADHD are not covered by the vast majority of insurance plans, and according to quackwatch.org, "The Amen Clinics charge $3,250 for a "comprehensive evaluation," which included the patient's history, two SPECT scans (concentration scan and baseline scan), a physician consultation, and a 30-minute treatment follow-up appointment. Follow-up scans after treatment are $795 each." Dr. Amen is charging exorbitant rates for treatment centered on use of an expensive diagnostic tool with no good evidence to support improvements in patient outcomes. Furthermore, unwarranted SPECT scans expose patients to unnecessary doses of radiation.
I have only read this book by Dr. Amen but my understanding is that he (unnecessarily) advocates the use of SPECT in most of his books. From a review of Dr. Amen's "Healing the Hardware of the Soul," Andrew Leuchtner M.D. notes that For each of the vignettes Dr. Amen presents, many psychiatrists would have chosen treatments similar to those he used when confronted with the particular symptoms he describes, based solely upon clinical judgment. There is no systematic analysis of the 45,000 imaging studies to demonstrate how Dr. Amen's approach is superior to treatment-as-usual by a psychiatrist. Thus, there is also no evidence presented to justify exposing patients to the radiation of a SPECT scan and to support the considerable expense to patients, families, and their insurers."
Drs. Bryon Adinoff, M.D., and Michael Devous, Ph.D. responded with praise to the Leuchtner review, and added: "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)."
Dr. Amen has frequently responded to criticisms of his research methods and use of anecdotal evidence, but has seldom provided the data acquired from his experiments for peer-review (the gold standard in medical research). These criticisms go back many years, and year after year he has failed to provide data for review, the one thing that could legitimize his methods for treatment and diagnosis. In addition to his advocacy for unproven uses of neuroimaging, he advises people to use many nutritional supplements with little or no proven value. Therefore as promising as many of the ideas he presents may seem, at this point in time they just may be too good to be true. Dr. Amen has had ample time to prove his legitimacy and his failure to do so raises suspicion about his methods.
I rate this book a two out of five because Dr. Amen does have a very enjoyable style of writing that is fun to read, he is charismatic and I have no doubt that he has excellent rapport with his patients, however for many reasons I do not consider him a reliably trustworthy source of medical advice. Certainly much of the advice presented in the book is valid, but it is frustrating to read a book where you must frequently check if his advice is supported by evidence. Dr. Amen is prone to jumping to conclusions and promoting unproven treatments.
I suggest that anyone considering buying this book (or any of Amen's work) do research on the author. Consider reading Dr. Amen's response to criticism on Quackwatch, where his use of SPECT is critiqued and he presents his rebuttal to the critique. You can see the argument from both sides and decide for yourself, at [...].
Leuchter AF: Healing the hardware of the soul: enhance your brain to improve your work, love, and spiritual life, by Daniel Amen (book review). Am J Psychiatry 2009; 166:625
Adinoff, Bryon, Devous, Michael
Scientifically Unfounded Claims in Diagnosing and Treating Patients
Am J Psychiatry 2010 167: 598
A Skeptical View of SPECT Scans and Dr. Daniel Amen
Dr. Daniel Amen's Response to Criticism on Quackwatch
AETNA Clinical Policy Bulletin: Single Photon Emission Computed Tomography (SPECT)
All accessed 07/30/2011