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Carlat and Amen: Naysayers and the SPECT process have some fallout

Posted Sep 16 2008 4:51am

SPECT in the news: Naysayers huddle together and build a straw man - so let's see what you think about terms like "mind reader" and "hype."

And do take a look at Carlat's brain [from his blog] and draw your own conclusions: Spectscans

Then several other functional brain study modalities [e.g. qEEG] are all lumped in with a hyperbolic flourish with Amen and SPECT. Is Carlat saying that no functional neuroimaging works when the literature is filled with peer reviewed SPECT and PET reports, and much excellent progress with qEEG?

Come on...

Dr Daniel Carlat, author of The Carlat Report, recently visited Amen's office in Newport Beach to write a piece for Wired on SPECT brain scans and neuroimaging.

Carlat and Amen portray the meeting in different ways in their respective blogs. Take a look for yourself at Amen's blog account of the meeting, and then this blog piece by Carlat.

I am sending the links here for you to see, and to take a look at a comment I left over there as well, siding, for the most part, with Amen.

It is interesting to see how the naysayers grumble about statistics, including Rubin from UCLA, but have no clinical experience with *actually using the scans,* or even *learning how to use scans* clinically. It doesn't matter what your academic position is - if you don't know how to use the information, how to assess the findings, then why comment?

Carlat's Wired piece sounds a bit like People Magazine. Gossip, banter, - he said, she said - incredible.

Amen's response in his blog to this silly *statistical banter* [reported by Carlat in his blog] is perfect: We [Amen, Parker, and others who actually do this work] treat one person at a time. The complexity of the brain, the nuances of the brain function material, and evidence from the history and clinical exam... you just can't cookie cut it, and break out one piece, one comment.

Then dig into more of Carlat in his blog: his whole message, his appearance at the APA in DC - much massive hype and over the top showmanship. He could be the poster boy for public gossip about psych meds - implying that all docs are brain dead, just going for pens and trinkets. Glad we have some smart people like him to tell us what to do.

Yes, the public may think that docs are drooling over pens, but having myself "detailed" in offices for pharmaceutical companies for >12 years, I can tell you with considerable certainty from real experience, the medical population needs and wants more information. They are not stupid. All of this discussion about the validity of SPECT is a debate about more information - and the validity of that new information.

-And he and Rubin use old models: DSM-IV - "Depression" - phenotypic diagnosis to evaluate functional models. Apples and oranges... Phenotype is connected to endophenotype, but let's differentiate what we're talking about - they are not the same thing guys. Appearances often don't directly connect with brain function - that's the point!

Looks like he wants to be the "objective" gate keeper. Keep to your own limited gates, Dr Carlat, I won't be visiting your emotionally laden confusion.

Readers: Please review these matters in the discussion - see what you think about this "dialog" [read "copy" or "personal PR"] and drop a comment here so we can get on this subject!

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