3 ms·

This isn’t entirely news to people in the field doing research, but it’s important information to keep in mind when anyone starts pushing fMRI (or SPECT) scans

by Aurornis 11mo ago

This isn’t entirely news to people in the field doing research, but it’s important information to keep in mind when anyone starts pushing fMRI (or SPECT) scans into popular media discussions about neurology or psychiatry. There have been some high profile influencer doctors pushing brain imaging scans as diagnostic tools for years. Dr. Amen is one of the worst offenders with his clinics that charge thousands of dollars for SPECT scans (not the same as the fMRI in this paper but with similar interpretation issues) on patients. Insurance won’t cover them because there’s no scientific basis for using them in diagnosing or treating ADHD or chronic pain, but his clinics will push them on patients. Seeing an image of their brain with some colors overlayed and having someone confidently read it like tea leaves is highly convincing to people who want answers. Dr. Amen has made the rounds on Dr. Phil and other outlets, as well as amassing millions of followers on social media.

kspacewalk2 11mo ago
Dr. Mike, a rare YouTube doctor who is not peddling supplements and wares, and thus seems to be at the forefront of medical critical thinking on the platform, interviewed Dr. Amen recently[0]. I haven't finished the interview yet, but having watched some others, generally the approach is to let the interviewee make their grandiose claims, agree with whatever vague generalities and truisms they use in their rhetoric (yes it's true, doctors don't spend enough time explaining things to patients!), and then lay into them on the actual science and evidence. [0] https://www.youtube.com/watch?v=J-SHgZ1XPXs https://www.youtube.com/watch?v=J-SHgZ1XPXs
- patmorgan23 11mo ago
  Dr. Mike did an incredible job in that interview. He gave Dr. Amen all the rope to hang himself with his own words. When you're hawking a diagnosis method and you're not interested in building up the foundation of evidence for it by doing a double blinded, randomized controlled study. And that the results of said study would change how your treating patients it's pretty clear who the snake oil salesman is
  - flatline 11mo ago
    I also thought the rest of the interview was really worthwhile - they talked a lot about real problems in the medical industry from different perspectives. What a great and critical discussion from Dr. Mike. If Amen had conceded the point they could have moved on. There could be real findings to be had there, and some may even match his conclusions, but many likely will not, and the whole thing could also be pure fiction. We should want better answers to these questions. It's unfortunate to watch someone as seemingly intelligent and well-informed as Amen come across as shilling snake oil, and/or just being hung up on his ego, at the end of it all. Scientific literacy is so critical, because it's easy to cloak pseudoscience behind high-tech smokescreens.
  - jama211 11mo ago
    Unfortunately I worry about the rebound effect, where even though the entire interview was debunking his claims this could still on average increase amen’s popularity.
    - Aurornis 11mo ago
      I worry about the same effect. Debunking style conversations produce the opposite effect in viewers who instinctively take the side of anyone who appears to be trying to help and reactively take the opposite position of anyone who appears to be attacking. So many will watch this video and come away siding with Dr. Amen, feeling like they're doing the right thing to disregard the mean man on the other side who is questioning everything. The alternative medicine and pseudoscience communities thrive on "but what if it works" or "they're just trying to help" attitudes, which snake oil sellers capitalize on.
      - jama211 11mo ago
        Yes, well put!
  - rkagerer 11mo ago
    I'm no expert in medicine, but I watched that entire video and your analogy about performance and rope doesn't fit well with how it came across to me. I actually thought the interviewer was a little disingenuous. He said things like "We're on the same team" and "I'm not trying to trap you", then proceeded to lob his guest with criticisms from the other team and questions aimed to maneuver him into a contradiction. There's nothing inherently wrong with that, but if you're going to do it, be forthright you're engaging in a debate. Earlier in the interview he could have put his cards on the table and plainly stated "Myself and others in the medical community are skeptical of the efficacy of imaging on outcomes, and a rigorous, double-blind study would lend dramatic support for us to adopt what you're touting." Then they could have had the conversation he was clearly after, focused on that issue. Instead it felt like I was watching for ages as he took a winding route to get there, then the interview cut off abruptly when they finally really did. The overlays applied in editing while helpful and fair in some cases, at other times came across as one-sided. It's a shame we can't see a follow-up where the interviewee has an opportunity to respond (or squirm) in light of them. For the record I would very much love to see additional research and gold-standard, double-blind studies. In the meantime I'll treat this as "Hey, we've got this interesting thing we can measure, we're seeing some good results in our practice" without over-emphasizing the confidence in this one diagnostic. I did find the bit interesting about how having a gauge you can viscerally see impacted patients' engagement in care. Both agreed on the potential usefulness of that aspect, and conceded the difference in profiles between patients coming to Dr. Amen vs. ordinary front-line family physicians.
- kafkaesque 11mo ago
  [flagged]
  - yomismoaqui 11mo ago
    I have been treated by very good doctors that smoke. And also... https://en.wikipedia.org/wiki/Ad_hominem https://en.wikipedia.org/wiki/Ad_hominem
    - kafkaesque 11mo ago
      I'm not sure why you are drawing a parallel to a good doctor that smokes. I never said "Doctor Mike" is a bad doctor. I have no idea if he is a good or bad doctor. Further, an ad hominem is when a person attacks someone's character without any base. I wrote specifically about him not being at the forefront and questioning his values, as displayed by his actions during the pandemic. His actions were literally not in line with Covid guidelines. Those are guidelines that were formulated by hundreds (thousands?) of doctors, all of whom sought to be at the forefront of medical science during a pandemic. As another user said, MRI scans not corresponding to brain activity is not really news, and in at least the part of the US I live in, MRI scans are not so easily recommended, especially since they're not covered by health insurance. Dr. Amen should be called out, of course, but it doesn't mean a doctor is at the forefront for doing so.
      - dpark 11mo ago
        > I'm not sure why you are drawing a parallel to a good doctor that smokes. Presumably because it is very analogous. You are essentially saying Dr. Mike shouldn’t be trusted because he made a bad decision. That is extremely similar to saying you shouldn’t trust a doctor’s advice because they happen to smoke. > Further, an ad hominem is when a person attacks someone's character without any base. No. An ad hominem is when the person is attacked rather than the argument. A terrible person can still make a perfectly sound argument. Calling them terrible doesn’t change the argument, even if it is emotionally satisfying. > I wrote specifically about him not being at the forefront and questioning his values, as displayed by his actions during the pandemic. You’re attacking his actions and not his recommendations. Ad hominem.
badlibrarian 11mo ago
I thought I was being clever by coining the term "non-invasive phrenology" but it appears people are already using it non-ironically.
- telotortium 11mo ago
  In many ways old-school bump measurement is actually less invasive
- fluidcruft 11mo ago
  ("wallet biopsy" is another fun term if you haven't encountered it)
  - kridsdale3 11mo ago
    Cashectomy.
- caycep 11mo ago
  I saw Parvizi say this in a talk back in 2019!
suyash 11mo ago
Dr. Amen is more of a marketing/sales guy than a medical expert.
ashleyn 11mo ago
Back in 2009 I remember reading about how dead salmon apparently turns up brain activity in fMRI without proper statistical methods. fMRI studies are something frequently invoked unscientifically and out of context. https://www.wired.com/2009/09/fmrisalmon/ https://www.wired.com/2009/09/fmrisalmon/
- caycep 11mo ago
  I think technically there's some statistical correction you apply to the voxels to avoid this. But yea...most hypotheses from fMRI are considered hypotheses until there's some other modality, i.e. electrical recordings, etc that confirm it. i.e. the well regarded studies, i.e. Kanwisher and the visual processing areas, have follow up studies on primates and surgical volunteers w/ actual electrical activity correlating w/ visual stimuli etc
api 11mo ago
Pop science guru-ing is a giant flashing red sign for me. I am never even a little surprised when the latest “sense maker” or pop science guru comes out as a complete loon or is consumed by some kind of scandal. Influencers in general are always suspect. The things that get you an audience fast are trolling or tabloid-ish tactics like conspiracism. There are good ones but you have to be discerning.
caycep 11mo ago
I saw a clinical report of his on a patient, he puts a graphic in their report of their "brain scan" but it's basically a vector graphic of the brain w/ a multicolor MS Paint gradient...
saidnooneever 11mo ago
thanks for this comment. it was really insightful thank you.
mNovak 11mo ago
>> Seeing an image of their brain with some colors overlayed ... is highly convincing Indeed, there's been quite a few studies [1] that find just including any old image of a brain with stuff highlighted will cause a paper to be perceived as more scientifically credible. [1] https://pubmed.ncbi.nlm.nih.gov/17803985/ https://pubmed.ncbi.nlm.nih.gov/17803985/

kspacewalk2 11mo ago

Dr. Mike, a rare YouTube doctor who is not peddling supplements and wares, and thus seems to be at the forefront of medical critical thinking on the platform, interviewed Dr. Amen recently[0]. I haven't finished the interview yet, but having watched some others, generally the approach is to let the interviewee make their grandiose claims, agree with whatever vague generalities and truisms they use in their rhetoric (yes it's true, doctors don't spend enough time explaining things to patients!), and then lay into them on the actual science and evidence. [0] https://www.youtube.com/watch?v=J-SHgZ1XPXs https://www.youtube.com/watch?v=J-SHgZ1XPXs

patmorgan23 11mo ago
Dr. Mike did an incredible job in that interview. He gave Dr. Amen all the rope to hang himself with his own words. When you're hawking a diagnosis method and you're not interested in building up the foundation of evidence for it by doing a double blinded, randomized controlled study. And that the results of said study would change how your treating patients it's pretty clear who the snake oil salesman is
- flatline 11mo ago
  I also thought the rest of the interview was really worthwhile - they talked a lot about real problems in the medical industry from different perspectives. What a great and critical discussion from Dr. Mike. If Amen had conceded the point they could have moved on. There could be real findings to be had there, and some may even match his conclusions, but many likely will not, and the whole thing could also be pure fiction. We should want better answers to these questions. It's unfortunate to watch someone as seemingly intelligent and well-informed as Amen come across as shilling snake oil, and/or just being hung up on his ego, at the end of it all. Scientific literacy is so critical, because it's easy to cloak pseudoscience behind high-tech smokescreens.
- jama211 11mo ago
  Unfortunately I worry about the rebound effect, where even though the entire interview was debunking his claims this could still on average increase amen’s popularity.
  - Aurornis 11mo ago
    I worry about the same effect. Debunking style conversations produce the opposite effect in viewers who instinctively take the side of anyone who appears to be trying to help and reactively take the opposite position of anyone who appears to be attacking. So many will watch this video and come away siding with Dr. Amen, feeling like they're doing the right thing to disregard the mean man on the other side who is questioning everything. The alternative medicine and pseudoscience communities thrive on "but what if it works" or "they're just trying to help" attitudes, which snake oil sellers capitalize on.
    - jama211 11mo ago
      Yes, well put!
- rkagerer 11mo ago
  I'm no expert in medicine, but I watched that entire video and your analogy about performance and rope doesn't fit well with how it came across to me. I actually thought the interviewer was a little disingenuous. He said things like "We're on the same team" and "I'm not trying to trap you", then proceeded to lob his guest with criticisms from the other team and questions aimed to maneuver him into a contradiction. There's nothing inherently wrong with that, but if you're going to do it, be forthright you're engaging in a debate. Earlier in the interview he could have put his cards on the table and plainly stated "Myself and others in the medical community are skeptical of the efficacy of imaging on outcomes, and a rigorous, double-blind study would lend dramatic support for us to adopt what you're touting." Then they could have had the conversation he was clearly after, focused on that issue. Instead it felt like I was watching for ages as he took a winding route to get there, then the interview cut off abruptly when they finally really did. The overlays applied in editing while helpful and fair in some cases, at other times came across as one-sided. It's a shame we can't see a follow-up where the interviewee has an opportunity to respond (or squirm) in light of them. For the record I would very much love to see additional research and gold-standard, double-blind studies. In the meantime I'll treat this as "Hey, we've got this interesting thing we can measure, we're seeing some good results in our practice" without over-emphasizing the confidence in this one diagnostic. I did find the bit interesting about how having a gauge you can viscerally see impacted patients' engagement in care. Both agreed on the potential usefulness of that aspect, and conceded the difference in profiles between patients coming to Dr. Amen vs. ordinary front-line family physicians.
kafkaesque 11mo ago
[flagged]
- yomismoaqui 11mo ago
  I have been treated by very good doctors that smoke. And also... https://en.wikipedia.org/wiki/Ad_hominem https://en.wikipedia.org/wiki/Ad_hominem
  - kafkaesque 11mo ago
    I'm not sure why you are drawing a parallel to a good doctor that smokes. I never said "Doctor Mike" is a bad doctor. I have no idea if he is a good or bad doctor. Further, an ad hominem is when a person attacks someone's character without any base. I wrote specifically about him not being at the forefront and questioning his values, as displayed by his actions during the pandemic. His actions were literally not in line with Covid guidelines. Those are guidelines that were formulated by hundreds (thousands?) of doctors, all of whom sought to be at the forefront of medical science during a pandemic. As another user said, MRI scans not corresponding to brain activity is not really news, and in at least the part of the US I live in, MRI scans are not so easily recommended, especially since they're not covered by health insurance. Dr. Amen should be called out, of course, but it doesn't mean a doctor is at the forefront for doing so.
    - dpark 11mo ago
      > I'm not sure why you are drawing a parallel to a good doctor that smokes. Presumably because it is very analogous. You are essentially saying Dr. Mike shouldn’t be trusted because he made a bad decision. That is extremely similar to saying you shouldn’t trust a doctor’s advice because they happen to smoke. > Further, an ad hominem is when a person attacks someone's character without any base. No. An ad hominem is when the person is attacked rather than the argument. A terrible person can still make a perfectly sound argument. Calling them terrible doesn’t change the argument, even if it is emotionally satisfying. > I wrote specifically about him not being at the forefront and questioning his values, as displayed by his actions during the pandemic. You’re attacking his actions and not his recommendations. Ad hominem.

badlibrarian 11mo ago

I thought I was being clever by coining the term "non-invasive phrenology" but it appears people are already using it non-ironically.

telotortium 11mo ago
In many ways old-school bump measurement is actually less invasive
fluidcruft 11mo ago
("wallet biopsy" is another fun term if you haven't encountered it)
- kridsdale3 11mo ago
  Cashectomy.
caycep 11mo ago
I saw Parvizi say this in a talk back in 2019!

suyash 11mo ago

Dr. Amen is more of a marketing/sales guy than a medical expert.

ashleyn 11mo ago

Back in 2009 I remember reading about how dead salmon apparently turns up brain activity in fMRI without proper statistical methods. fMRI studies are something frequently invoked unscientifically and out of context. https://www.wired.com/2009/09/fmrisalmon/ https://www.wired.com/2009/09/fmrisalmon/

caycep 11mo ago
I think technically there's some statistical correction you apply to the voxels to avoid this. But yea...most hypotheses from fMRI are considered hypotheses until there's some other modality, i.e. electrical recordings, etc that confirm it. i.e. the well regarded studies, i.e. Kanwisher and the visual processing areas, have follow up studies on primates and surgical volunteers w/ actual electrical activity correlating w/ visual stimuli etc

api 11mo ago

Pop science guru-ing is a giant flashing red sign for me. I am never even a little surprised when the latest “sense maker” or pop science guru comes out as a complete loon or is consumed by some kind of scandal. Influencers in general are always suspect. The things that get you an audience fast are trolling or tabloid-ish tactics like conspiracism. There are good ones but you have to be discerning.

caycep 11mo ago

I saw a clinical report of his on a patient, he puts a graphic in their report of their "brain scan" but it's basically a vector graphic of the brain w/ a multicolor MS Paint gradient...

saidnooneever 11mo ago

thanks for this comment. it was really insightful thank you.

mNovak 11mo ago

>> Seeing an image of their brain with some colors overlayed ... is highly convincing Indeed, there's been quite a few studies [1] that find just including any old image of a brain with stuff highlighted will cause a paper to be perceived as more scientifically credible. [1] https://pubmed.ncbi.nlm.nih.gov/17803985/ https://pubmed.ncbi.nlm.nih.gov/17803985/