When believing is seeing

By Greg Freiherr, Editor, gfreiherr@cmp.com

Scientific tools should be used only for objective clinical inquiry, but they are not. And the threat to the medical imaging community is palpable.

During an HBO special called "Smalltown Ecstasy," television cameras entered the office of neuropsychiatrist Daniel G. Amen in Fairfield, CA. There, a teenager with a history of drug use underwent a brain scan to demonstrate the effects of the drugs. During the consultation, Dr. Amen compared the cratered 3D SPECT image of the young man's brain to that of a "healthy" one.

"Do you see these cavities?" he asked the boy. "What this tells me is that you have less access to your temporal lobes, which control memory, mood stability, temper control, motivation."

The patient could recover, Dr. Amen said, if he stopped abusing drugs.

"As it is," he said, "your brain looks like you're 45 years old."

That stopped me cold. I'm 47. Is my brain really worse off than this kid's? Piqued, I took a closer look at Dr. Amen. On his Web site I found an extraordinary collection of conclusions regarding the power of gamma cameras: that SPECT can be used to visualize aggression, anxiety, attention deficit disorder, depression, even PMS.

The most troubled PMS patients, according to Dr. Amen, may require lithium or anticonvulsant medications. Others, who exhibit such symptoms as nagging and "cognitive inflexibility" usually respond to Zoloft, Paxil, or Prozac, he said.

The medical community may not share these views, Dr. Amen admitted on the Web. That has not stopped him, however, from using SPECT to document behavioral problems.

"We can show patients and their families the physical 'brain' evidence of problems, helping them to be more accepting and compliant with treatment," he said.

How should the imaging community respond when imaging is used for persuasion rather than for clinical inquiry? Should manufacturers sell imaging systems to any and all physicians, providing them the opportunity to brandish their own novel interpretations?

We'll need these answers soon. Enhanced imaging technologies are taking medical science into uncharted areas at precisely the time more and more nonradiologists are gaining access to these technologies.

On his Web site, Dr. Amen says that seeing is believing. But I wonder whether, for some people, it is the other way around.