All Amen is doing is selling modern snake oil. SPECT imaging is a very basic and poor representation of how the brain works and it can only be used diagnostically when paired with many other imaging techniques like structural and functional MRI, PET, and EEG (and even then it only gives clues). Any of these imaging techniques by themselves are not capable of painting the full picture of a patient’s status. For instance in epilepsy, the physicians use all of these tests together and review them all in a meeting for each possible surgery patient to figure out where their seizures may be starting. In the case of epilepsy, the cause of the abnormal activity is fairly well understood (i.e. electrical storms in the brain), but Amen claims to be able to diagnose “brain trauma, underachievement, school failure, depression, obsessive compulsive disorders, anxiety, aggressiveness, cognitive decline, and brain toxicity from drugs or alcohol”, but that is totally not true.

Let’s take depression as an example. I work with a lab who’s main mission is to determine a diagnostic biomarker for depression. They have been working for 15-20 years on this problem and have only recently discovered some possible neural ‘biomarkers’ that may point to whether a person will get better from an anti-depressant, therapy, or a combination of both. And if you ask them, they’ll tell you we essentially know nothing about how these things actually work in the brain.

That’s right. We honestly don’t know how the brain works at this point and are just beginning to sort of understand it. We have gained many clues in the past century, but the full picture is far, far from being understood. Brain imaging is one useful way to get these clues, but it is very limited in it’s scope. Each different type of brain imaging gives us a view of a different facet of the brain at work. Techniques like fMRI, SPECT, and PET imaging all give us one part of the picture, but honestly all of these techniques are very abstracted from the true level at which the brain works: the level of neurons, neurons firing, at the temporal resolution of milliseconds. In other words, the activity in our brains is constantly changing to give rise to the thoughts we have and behaviors we display. These changes in brain state happen on the order of milliseconds and can only be summed on the orders of seconds, minutes, hours, and days. The sums of these millisecond by millisecond changes that happen in the brain both form and constrain our current and future behaviors and personality. SPECT and PET imaging can at most tell us where glucose or another molecule is being used in the brain on the order of MINUTES! fMRI is only now (in the past couple years) able to tell us where the fresh, oxygenated blood is going from our heart and lungs in our brain on the order of 1 second. That doesn’t mean that these human brain imaging techniques don’t tell us anything, but rather that they only tell us part of the story. They are also basically the only way for us to see into the living, functioning brain of a normal, healthy human being. Without these techniques we’d have to only rely on studies of what happens when the brain is damaged or animal studies to understand what behaviors different parts of human brain are involved in computing.

Daniel Amen should have his MD licensure stripped for this clear, fraudulent use of a neuroimaging technique that takes advantage of those that are not scientifically savvy. There is no way on earth that his ‘approach’ helps anyone beyond a placebo effect, where just from going to get brain scans and see him, helps the patient believe they are better or understand something. Here are some other articles that further cover his fraudulence:

http://www.thedailybeast.com/…/can-daniel-amen-read…

Dr. Amen’s Love Affair with SPECT Scans

I’ve seen him on various TV channels selling his snake oil, but he is doing nothing more than defrauding people and making them trust science less. If you hear any of your friends talking about this please tell them to steer clear and to tell their friends the same.

Cory Inman, Ph.D. is a Postdoctoral Fellow at Emory University in the Department of Neurosurgery. He studies the dynamics of neural processing in the brain with fMRI and intracranial EEG. The thoughts and opinions shared here are his only and do not necessarily reflect the views of his employer.

I know I fell of the face of the blogosphere for a while, but I’m trying to slowly but surely make come back. In the past year I’ve filled my plate nice and full and some things that I enjoyed fell off. You know just had to go finish the Ph.D. and start a new postdoctoral fellowship in the mean time. Either way, if you’re new around here welcome, and if you’ve been here before, stick around, I have some good intuitive curiosities coming your way.

Thanks!

Cory

Everyone. This is science. This is the why we do science. This is the joy of science. We do it both to understand how the universe works and how we work, but there is a much more human element that is missed way too often. We do science for moments like this. These moments of revelation are what keep us going through the hard slough of trying to decipher the universe or the brain. I hope that science is portrayed with this human more often. I am happy to hear that there is a documentary about the discovery of the Higgs Boson that aimed at capturing both the science and the human element of working to discover the Higgs called ‘Particle Fever’. It is playing in theaters now. Hear about the documentary in this Science Friday podcast:http://www.sciencefriday.com/segment/03/07/2014/-particle-fever-captures-the-excitement-of-the-higgs-discovery.html. Honor the scientists that do the science, not just the scientific discovery!

Though the article title is a bit over the top (you surprise me sometimes NPR), here are 2 great articles on something that is always on the mind of neuroimagers (and should always be).

“Some members of the public may appreciate the inferential leaps behind a neuroimage, but the details get pretty complicated pretty quickly, and popular science coverage rarely even hints at this complexity.

Instead, it could be that neuroimages – and neuroscience in general – are a battleground for warring intuitions. On the one hand, there’s a tendency towards reductionism that leads people to find concrete, spatially meaningful renderings of brain activity irresistibly real and objective in a way that beliefs and emotions and the other contents of mental life are not. On the other hand, we resist the idea that mental life is nothing more than a series of spatiotemporally localized physical events.”

For a great basic explanation of what PET and fMRI can show us see this NPR article:
http://www.npr.org/blogs/13.7/2012/12/07/166733094/brain-scans-dont-catch-the-brain-in-action?sc=tw&cc=share

Finally, remember that even though these technologies and techniques have their limitations, they are still useful. To put it in a way I heard at a Society for Neuroscience talk last week, ‘…Brain images and models are never perfect and shouldn’t expect to be so at this stage of exploration…they are like maps of the world from the 1600s. Although the 1600s maps are not as detailed and fine grained as google maps are today those maps still provided useful information about the world at that time. They allowed for small steps along a continued search for the True ‘map’ of the world. We need to see neuroimaging through both the lens of past and future, but we should not forsake the entire brain imaging endeavor now because the information we’ll be able to get in the future will be more accurate and closer to the Truth.’ – Martijn van den Heuvel

Of course that analogy only flies if the neuroimaging work is being done scientifically, obeying all of the guidelines that any scientific endeavor is required to follow…

Post thoughts below for continued conversation…

1. Get anxious about having good thoughts as you fall asleep because you might forget them if you let yourself go to sleep without writing them down.

2. Watched the moon or sun chase their car when they were a kid.

3. Counted the rotations on a ceiling fan. Maintaining isolated vision on one fan blade. Seeing how long you can maintain your vision on one blade at a time.

4. Listen to the wax and wane of crowds as they give a long clap (for the outdoorsy people out there the wax and wane of the insects in the woods).

5. Listen to the volume at a party go up and down as people compensate for the volume of others and then realize nearly at the same time that it’s getting loud. Then it suddenly gets quieter. (And maybe your suddenly the only one who’s talking loud).

6. Stick your tongue out or do something else that is odd with your face when you’re focusing on something.

7. Left to go do something then forgot what you left to go do.

8. Wondered what you’d look like when you’re X years older than you are now. (i.e. When I was 7 or 8, I distinctly remember thinking I was going to have red hair for some reason when I was 16; perhaps because I had lots of freckles)

9. Not getting dressed unless you have to.

10. You have to move something continuously when your focused and thinking (Why do people need to do that??? I really want to know if there is some sort of cognitive benefit to moving while thinking)

11. Worried about what other people think about you, only to realize that if they think about themselves as much as you think about yourself they probably don’t have the time to think about you too. (This is both comforting and concerning…)

That’s just a few that I’ve come across, but I’d also like to hear what things you thought only you thought. Please leave them in comments below…

I believe this is a fundamental issue with the world today (and in the past). Many who are so convinced of their beliefs that they leave no room for doubt. This lesson is not only pertinent to religious beliefs, but ALL beliefs that matter to us (politics, science, ethics, morality, etc.). I also find it interesting that science is built to actively combat doubtless conviction. It seems that many religions for that matter are also built to do the same, but those trusted with interpreting the fundamental writings of the religions (i.e. have the power) preach a version in which you MUST have conviction (not faith/doubt) or else. Politics suffer from the same issue, but it is even less structured and the interpretation is adversely effected by the 24 hour news cycle and the endless search for ratings (i.e. profit).

I gave a talk last month for the 50 year anniversary of the Psychology department at Emory. The writer quoted me a couple times near the end. It’s cool to be quoted. Enjoy!

Where have all of the Leonardo DaVinci’s and Archimedes gone?  Several writers have suggested that the enlightenment of all ( or most) has reduced the need and prevalence of polymaths. With the enlightenment there has been a push towards specialization and mastery of one’s skills.  Though I think this isaccurate, I don’t think it has to be the case. I think we can strive for mastery of everything that we are interested in and eventually do. I imagine this was DaVinci’s motivation. I’d like to think that the polymaths of old pursued their interests because they were intrinsically motivated to do so, they had the resources, and the talent.  In my opinion, we are currently meeting a zenith in the arc of knowledge distribution such that polymaths will become more and more prevalent again because of the ubiquity of knowledge that the internet provides. The ability to access almost any knowledge at any moment allows for people to pursue their interests in a much more efficient and broad way. Thus the resources are there for anyone who has the motivation and talents to become a jack of all trades and master a few along the way. I’ve always been inclined to learning all sorts of new skills. When I really enjoy a particular skill, I first try to figure out a path towards mastery, then I try to figure out how to get paid to work towards mastery. I am still learning new skills I enjoy and have yet to fully master most of my skills, but the pursuit is what makes it satisfying and fun.

Ready here for more interesting writings on the subject:

http://www.moreintelligentlife.com/content/edward-carr/last-days-polymath

http://www.dubage.com/API/ThePolymath/1.1/ThePolymath0701plo.html

Do you find yourself drawn all sorts of directions?  You don’t have to stick with the straight and narrow path. Most of us now have the ability pursue anything that tickles our fancy. Let me know what your interests are and which one’s you are working to master. Also, as always, let me know what you think…this writing thing is something I’m working on mastering

–Curious Cory

Miracles do not necessarily require divine intervention, but are rather “something that is impossible from an old understanding of reality and possible from a new one”
-Charles Eisenstein

Miracles are traditionally defined as an extraordinary event manifesting divine intervention in human affairs (Merriam-Webster). I heard a seemingly more appropriate definition of a miracle today:

Something that is impossible from an old understanding of reality and possible from a new one (Charles Eisenstein). Science is the best way for humans to progress in our understanding of reality from old to new. The very act of doing science is an attempt progress in our understanding of reality. Discoveries that are on the bleeding edge of science is what I would consider miracles. In my scientific and academic career thus far I’ve been fortunate enough to bare witness to miracles by this definition.

Essentially all medical and technological developments in our current boom of progress could be considered miraculous at the time of their release and use in the world. The miraculous development in our understanding of reality that I’ve been fortunate to experience is deep brain stimulation (DBS). Deep brain stimulation is used to alter the brain’s activity in movement and mood disorders. First developed for movement disorders like Parkinson’s disease and dystonia, when placed in a certain part of the brain, DBS has been shown to almost instantly relieve tremor or dystonic symptoms. If you haven’t seen an example of this miracle in movement disorders watch this video. As you can see, once the DBS is applied their tremors almost completely stop or are drastically alleviated. My miraculous experiences is with DBS for treatment-resistant depression (TRD).

Unlike DBS for movement disorders, it is more difficult to gauge when DBS for depression has worked. Until recently we have mainly relied on the patient’s subjective behavioral report of their feeling. As you’d suspect there are many issues with subjective report that aren’t specific to DBS for depression, but rather affect any study of behavior. None the less, I’ve had the experience of seeing patients sad or emotionally flat one moment and relieved, happy, and slightly overwhelmed the next. So far I’ve seen 11 or so patients. I see them once before surgery, during the surgery (some stimulation to test for the best stimulation site), when the stimulation is turned on indefinitely for the first time, and 6 months after the stimulation was first turned on. I’m in a unique position because I get to see the patients at distant enough time intervals to see a difference (MDs and other staff working with the patients see them every week or so). The difference DBS makes immediately and over time is a miracle. Most of the patients I’ve had the pleasure of working with have gotten so much better that they are nearly unrecognizable from their first visit. The immediate effects of DBS we see during the surgery and 1 month after surgery likely fit what most think of as a miracle (i.e. a specific event or instance). Patients report “feeling lighter, calmer”, “more connected”, “feeling warm, flushed”, “feeling aroused”, “more awake, aware, and reactive”, “feeling relieved”. It is one of the most incredible things I’ve ever seen. The evolution of my interactions with these patients is just as amazing. We go from quiet, flat interactions before receiving DBS to free flowing, jovial conversation during DBS. Even though I didn’t invent and am not one of the MDs implementing the treatment, seeing these patients progress and knowing that I’m the MDs team is by far one of the most satisfying feeling’s I’ve ever felt.

So, it’s a miracle, but not in the divine intervention, should have never been possible kind of way. DBS is currently considered a miracle because is part of the ‘new understanding of reality’ that technology, medicine, and incredibly brave people has made possible. DBS for depression came after the demonstrations of DBS working in movement disorders, but there wasn’t a particularly great reason for it to work. It very well might not have worked or even made the depression worse. Some confidence that it might work came from evidence that a certain part of the brain (Broadman’s area 25 or the subgenual cingulate) was consistently overactive in depression. Working with Andres Lozano, Helen Mayberg thought that DBS might alter area 25s activity. With development of the technique for placement of the electrodes in area 25, the success rates are great for a new medical treatment.

Given that DBS for depression very well might not have worked, it took another component of most traditional miracles, faith. The neurologist, surgeon, and most of all first patients had to have immense faith that DBS for depression would work. It still takes an enormous amount of faith from everyone involved that the DBS will work because of how dire the situation can be for these patients that have been depressed for 5 to 10 to 50 years! The miracle of DBS is one of the newest pieces of our understanding of reality. Our team of scientists are now trying to understand how and why DBS works for these various disorders. As we gain that knowledge it will further our present understanding of reality and make DBS a little less miraculous or magical for the world as a whole. Importantly, if your life has ever been saved, restored, or drastically improved by technology or medicine, it is a miracle, regardless of ‘OUR understanding of reality’, because in that case it has changed ‘YOUR understanding of reality’.

For a view into our work with DBS in depression watch this: http://www.youtube.com/watch?v=Lq5rIILcVgA

For a great talk on uses of DBS with helpful examples see: http://www.ted.com/talks/andres_lozano_parkinson_s_depression_and_the_switch_that_might_turn_them_off.html