Dr. Daniel Amen, a psychiatrist recently endorsed by Secretary of Health and Human Services nominee Robert F. Kennedy Jr., faced intense questioning about his controversial use of SPECT brain scans in psychiatric practice during a recent interview with Doctor Mike.
The exchange highlighted a fundamental tension in modern psychiatry: the gap between innovative clinical approaches and the rigorous scientific validation required for widespread medical adoption.
Dr. Amen, who founded the nationwide Amen Clinics network, has built his practice around SPECT (Single Photon Emission Computed Tomography) imaging, a nuclear medicine study that examines blood flow and activity in the brain. He claims to have reviewed nearly 300,000 scans from patients across 155 countries, making him perhaps the most experienced practitioner in applying this technology to psychiatric conditions. His approach stands in stark contrast to standard psychiatric practice, which relies on symptom-based diagnoses without brain imaging.
“Psychiatry is the only medical specialty that never looks at the organ it treats,” Dr. Amen argued, criticizing the field’s reliance on the DSM (Diagnostic and Statistical Manual of Mental Disorders) for making diagnoses based solely on symptom clusters. He believes this approach has left psychiatry stagnant, with outcomes no better than they were in the 1950s despite decades of pharmaceutical development.
However, Doctor Mike pressed Dr. Amen on a critical weakness: the absence of randomized controlled trials demonstrating SPECT’s effectiveness in psychiatric treatment. When asked directly whether such studies exist, Dr. Amen cited research on distinguishing PTSD from traumatic brain injury and mentioned a 1992 study on bipolar teenagers that showed reduced hospital stays for scanned patients.
Yet he acknowledged never conducting a study where patients were randomized to receive treatment with or without SPECT guidance, which is the gold standard for proving medical efficacy.
“Do you not feel that it’s an issue that there is no randomized controlled data?” Doctor Mike asked repeatedly throughout the conversation. The question became increasingly pointed as Dr. Amen defended his methods based on clinical experience and patient outcomes from his own clinics, rather than independent, blinded research.
The absence of such validation is significant because major medical organizations, including the American Psychiatric Association and the American Academy of Neurology, do not endorse using SPECT scans for routine psychiatric diagnosis. Doctor Mike emphasized that departing from established guidelines requires compelling scientific evidence—evidence that Dr. Amen has not produced in over three decades of practice.
Dr. Amen countered that imaging changes his clinical approach 79% of the time and improves patient compliance by allowing people to see their brain health visualized. He also noted that SPECT is covered by insurance in Canada and cited procedure guidelines from the Canadian Association of Nuclear Medicine supporting its use for various conditions including head trauma, seizures, and psychiatric indications.
Yet when Doctor Mike proposed designing a randomized controlled trial together, one that could potentially validate SPECT for widespread use, Dr. Amen’s response was revealing. Asked whether he would abandon the method if such a study showed it wasn’t useful, he replied: “Absolutely not.” His reasoning: he wouldn’t discard 35 years of experience based on a single study, regardless of its findings.
This position raises troubling questions about scientific methodology. Dr. Amen simultaneously criticizes the psychiatric establishment for not adopting his approach while refusing to subject that approach to the very standard of evidence that would convince skeptics. He dismissed the need for such validation at this stage of his career, stating he feels “really confident” in his interpretations based on his extensive experience.
The interview also touched on Dr. Amen’s supplement company, BrainMD, which sells products he frequently recommends to patients. While he disclosed this conflict of interest openly, the arrangement mirrors the pharmaceutical industry practices he criticizes, creating products and protocols without the rigorous independent testing required of prescription medications.
Perhaps most concerning was Dr. Amen’s characterization of standard psychiatric practice as “flying blind” and “complete crap.” Such language not only undermines confidence in conventional mental healthcare but may discourage patients from seeking help from providers who don’t offer expensive SPECT scans.
Doctor Mike highlighted this danger, noting that many patients lack access to specialized imaging and might feel they’re receiving inferior care as a result.