Amen clinics

[deleted1100659]

I had not heard of this till today, where a patient with worsening anxiety and her mother were convinced they needed holistic healing methods..They do things like IV vitamin replacement therapy and charge patients 4,000 for MRIs essentially...Ironically it was started by an actual psychiatrist (though a very controversial one to say the least) and now he has a chain of these.

I have not found an effective way to reason with people who are convinced these alternative therapies are the magical answer. Apparently they even have a lyme disease psychiatrist....

any one else run into this mess?

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[WisNeuro]

Yeah, this snakeoil salesman has been around for quite some time. We know him well because he also "treats" mTBI and such in his establishments. These clinics throw a bunch of meaningless brain scans and pseudojargon at people and tell them what they want to hear. Then they direct the patient to the company store where they can buy all of the Amen branded and affiliated products to treat whetever made up diagnosis they were told they had.

 

[deleted1100659]

Yeah, this snakeoil salesman has been around for quite some time. We know him well because he also "treats" mTBI and such in his establishments. These clinics throw a bunch of meaningless brain scans and pseudojargon at people and tell them what they want to hear. Then they direct the patient to the company store where they can buy all of the Amen branded and affiliated products to treat whetever made up diagnosis they were told they had.

Heard of him today; cant believe he actually has a panel of psychiatrists that work at these clinics...unreal.

Of the court the patient's mother got snippy when I told her it sounded pretty ludicrous but i guess what can you do...

 

[calvnandhobbs68]

Yeah Amen clinic is pretty notorious. It's a brand just like Dr. Oz is a brand. A lot of it is "look at this pretty scan of your brain, now we're going to do some unproven super expensive treatment or the exact same treatment you would have gotten anyway".

https://www.washingtonpost.com/lifestyle/magazine/daniel-amen-is-the-most-popular-psychiatrist-in-america-to-most-researchers-and-scientists-thats-a-very-bad-thing/2012/08/07/467ed52c-c540-11e1-8c16-5080b717c13e_story.html

Brain Scans as Mind Readers? Don't Believe the Hype

Photo: Corbis, Illustration: Satian Pengsathapon “So here’s your brain,” the doctor says, as the center of my mental life pirouettes before me, rendered in electric blues and reds. Daniel Amen, MD, manipulates the screen image with a few taps on his keyboard. “It looks good, pretty symmetrical...

www.wired.com

Head Case: Why Has PBS Promoted Controversial Shrink Dr. Daniel Amen?

Leading neurologists charge that Dr. Daniel Amen peddles questionable brain imaging technology, dubious supplements and false hopes.

observer.com

 

[Merovinge]

I actually read a job posting for one of his clinics in my area, they certainly phrase it to sound very attractive to psychiatrists. To be fair, it is a very attractive job if peddling pseudoscience and making easy money is one's jam.

I kind of enjoy speaking to people who are engaging these types of services. In contrast to say chiropractors, people expect you as a psychiatrist to be able to discuss brain pseudoscience and tend to value your opinion if you do a decent job with the conversation. I really got after the baited promise of science to know all in fixing or psychiatric woes, compare this to the promise of flying cars and how we have automated parking assistance and this being a similar gap to what is being peddled and what actually exists in 2022. I actually find about 3/4 of the patients/families feel relieved to discuss this topic with a doctor who actually knows the current state of science, a lot have some idea it's a scam but were desperate and want someone to non-judgmentally understand that.

 

[WisNeuro]

I actually read a job posting for one of his clinics in my area, they certainly phrase it to sound very attractive to psychiatrists. To be fair, it is a very attractive job if peddling pseudoscience and making easy money is one's jam.

I kind of enjoy speaking to people who are engaging these types of services. In contrast to say chiropractors, people expect you as a psychiatrist to be able to discuss brain pseudoscience and tend to value your opinion if you do a decent job with the conversation. I really got after the baited promise of science to know all in fixing or psychiatric woes, compare this to the promise of flying cars and how we have automated parking assistance and this being a similar gap to what is being peddled and what actually exists in 2022. I actually find about 3/4 of the patients/families feel relieved to discuss this topic with a doctor who actually knows the current state of science, a lot have some idea it's a scam but were desperate and want someone to non-judgmentally understand that.

One of their people contacted me for a partnership, as they moved into an area south of us. He stopped trying to recruit me after I sent him a list of some of their claims and asked for the supporting literature in legitimate peer-reviewed journals

 

[PikminOC]

People who go there get snippy as they just spent a ton of money there. Then they get mad that you don't think the scans are the best things ever. Then they get mad about paying you copays.

 

[WisNeuro]

People who go there get snippy as they just spent a ton of money there. Then they get mad that you don't think the scans are the best things ever. Then they get mad about paying you copays.

But, like, the Amen clinic cured their Chronic Lyme's and Electromagnetic Sensitivity. And all it took was a 10k PET scan, some $200 bags of saline with B12, and a monthly supply of Amen branded multivitamins for $150 a pop. What have you done for them lately.

 

[nexus73]

Pysch clinic selling 70% evidence-based treatment, 25% woo woo vitamins and supplements, and 5% $4000 PET scans (and the last 30% is EXPENSIVE). The trick is they aren't 100% snake oil and unnecessary PET scans...because that's when you get caught. If you can keep the evidence-based care a significant portion you can charge a premium for the extra stuff even though it's likely not doing anything and still maybe sleep at night. The last thing you'd want to do is short people evidence-based treatment and only use the snake oil, because that can get you sued.

Some motivational speakers are like this as well. Give a lot of great tips about setting goals, holding yourself accountable, sticking to a schedule, getting regular exercise etc etc, but all stuff that's actually useful. Then they sell you a 150$ magnet bracelet.

The biggest problem is people who don't have the money go to places like this. If Jeff Bezos wants to get Vitamin C infusions for his anxiety, who cares, but if someone is short their rent money it's no good in my book.

 

[comp1]

I guess it's not harmful other than to your wallet. It's just really expensive supportive psychotherapy...

 

[clozareal]

I had not heard of this till today, where a patient with worsening anxiety and her mother were convinced they needed holistic healing methods..They do things like IV vitamin replacement therapy and charge patients 4,000 for MRIs essentially...Ironically it was started by an actual psychiatrist (though a very controversial one to say the least) and now he has a chain of these.

I have not found an effective way to reason with people who are convinced these alternative therapies are the magical answer. Apparently they even have a lyme disease psychiatrist....

any one else run into this mess?

I've had several patients come to me from the Amen Clinics, who've received SPECT diagnoses of ADHD, toxic mold syndrome, etc. These patients usually don't stick around for long when I don't offer them unneeded laboratory tests or imaging to monitor for their symptoms or when I don't offer them IV ozone.

Why are they coming to you if they already have a psychiatrist that can offer them what they want?

 

[singasongofjoy]

I had a couple of folks from there when I was rotating through a sleep disorder clinic and tbh they both seemed kinda culty-level into it. Seemed like some top level naval-gazing in that N=2- both brought reams of printouts and relished trying to explain them at length to me. Both were out pretty quickly when they realized CBT-I involved actual effort / behavior change and not just more scans and woo-woo. Real shame on that front; one was so very clearly a typical teenager with ****e sleep hygiene and clear mismatch between parent expectations and his own motivation/interest which fatigue got him out of. But sure, spending equivalent of my salary on AMEN clinic is a more logical approach and will also "cure" the kid into being gung-ho about being an overachiever aspiring to med school.

 

[WisNeuro]

Pysch clinic selling 70% evidence-based treatment, 25% woo woo vitamins and supplements, and 5% $4000 PET scans (and the last 30% is EXPENSIVE). The trick is they aren't 100% snake oil and unnecessary PET scans...because that's when you get caught. If you can keep the evidence-based care a significant portion you can charge a premium for the extra stuff even though it's likely not doing anything and still maybe sleep at night. The last thing you'd want to do is short people evidence-based treatment and only use the snake oil, because that can get you sued.

Some motivational speakers are like this as well. Give a lot of great tips about setting goals, holding yourself accountable, sticking to a schedule, getting regular exercise etc etc, but all stuff that's actually useful. Then they sell you a 150$ magnet bracelet.

The biggest problem is people who don't have the money go to places like this. If Jeff Bezos wants to get Vitamin C infusions for his anxiety, who cares, but if someone is short their rent money it's no good in my book.

I've seen a few handfuls of these reports. And yeah, they add in the stuff that works for everyone, eat more of a Mediterranean diet, sleep well, exercise, etc. And then they add the expensive snakeoil on to the back of that. And, I **** you not, the last report I read from there recommended books by Jordan Peterson. I don't know when Amen jumped in the incel nation hype train, or what that has to do with "brain health." But, I guess hucksters stick together?

 

[alina_s]

A family brought in a whole binder of “personalized” recommendations after going to the Amen clinic, and it was worthless. Not at all personalized, or even specific to the diagnosis- things like eat your vegetables, exercise reduces stress. At least it was a legitimate diagnosis. The last time I looked at the Amen web site, it had rotating 3-D brain images purporting to diagnose things like “relationship toxicity.”

 

[PikminOC]

I have seen patients who were suicidal going there. And there were no notes about the suicidality at all.

 

[deleted1100659]

I've had several patients come to me from the Amen Clinics, who've received SPECT diagnoses of ADHD, toxic mold syndrome, etc. These patients usually don't stick around for long when I don't offer them unneeded laboratory tests or imaging to monitor for their symptoms or when I don't offer them IV ozone.

Why are they coming to you if they already have a psychiatrist that can offer them what they want?

its always the difficult patients too that pursue the amen clinics, the ones that are convinced that alternative medicines are the cure. A patient said "things made in a lab are not natural and harmful, where as herbal medicine comes from nature and things made in nature are safe". My counter "Would you rub poison ivy that you found in nature, on your face?". They usually have no counter to that one.

Did you guys see, they're generous enough to offer online classes, and at discounted rates? And a convienent link to their online store to fulfill the "meds" you need for your diagnosis..

its frustrating at times but it is what it is.

 

[hallowmann]

... The last time I looked at the Amen web site, it had rotating 3-D brain images purporting to diagnose things like “relationship toxicity.”

Bwahaha, I definitely know some people with "relationship toxicity" and mood lability. But admittedly I didn't need 3D brain imaging to diagnose that.

 

[PikminOC]

Pysch clinic selling 70% evidence-based treatment, 25% woo woo vitamins and supplements, and 5% $4000 PET scans (and the last 30% is EXPENSIVE). The trick is they aren't 100% snake oil and unnecessary PET scans...because that's when you get caught. If you can keep the evidence-based care a significant portion you can charge a premium for the extra stuff even though it's likely not doing anything and still maybe sleep at night. The last thing you'd want to do is short people evidence-based treatment and only use the snake oil, because that can get you sued.

Some motivational speakers are like this as well. Give a lot of great tips about setting goals, holding yourself accountable, sticking to a schedule, getting regular exercise etc etc, but all stuff that's actually useful. Then they sell you a 150$ magnet bracelet.

The biggest problem is people who don't have the money go to places like this. If Jeff Bezos wants to get Vitamin C infusions for his anxiety, who cares, but if someone is short their rent money it's no good in my book.

I don't see 70 percent evidence based treatment. They start with the pet scan. That's already 0 percent.

 

[WisNeuro]

I don't see 70 percent evidence based treatment. They start with the pet scan. That's already 0 percent.

Every report I've seen includes things about diet, sleep, and exercise, so there is the evidence based part. Then they just have to tie these things in to some BS about it will help with their hypometabolism in the anterior cingulate gyrus and they're good to go.

 

[nexus73]

I don't see 70 percent evidence based treatment. They start with the pet scan. That's already 0 percent.

maybe I'm being too generous

 

[PikminOC]

Every report I've seen includes things about diet, sleep, and exercise, so there is the evidence based part. Then they just have to tie these things in to some BS about it will help with their hypometabolism in the anterior cingulate gyrus and they're good to go.

So 20 percent. They expose everyone to useless radiation.

 

[WisNeuro]

Eh what's a little FDG-18 here or there?

 

[FlowRate]

Pysch clinic selling 70% evidence-based treatment, 25% woo woo vitamins and supplements, and 5% $4000 PET scans (and the last 30% is EXPENSIVE). The trick is they aren't 100% snake oil and unnecessary PET scans...because that's when you get caught. If you can keep the evidence-based care a significant portion you can charge a premium for the extra stuff even though it's likely not doing anything and still maybe sleep at night. The last thing you'd want to do is short people evidence-based treatment and only use the snake oil, because that can get you sued.

One of my patients started down the path of pursuing "MeRT". What's mert? 70% rTMS, 30% frequent qEEGs ($$$$$) and EKG's ($$) for no apparent reason and with known lack of insurance coverage. The people who started MeRT were real savvy and managed to convince (IIRC) the VA system to allow them to register a trial with veterans. Nothing published yet but that way they can call it "military research based" on their marketing materials.

Similarly, these folks start with the qEEG and EKG.

 

[NickNaylor]

The target audience for the Amen Clinics are people that are stupified by technological sophistication irrespective of the clinical utility or actual accuracy of those things. Since I work in a TRD clinic, I've come across numerous patients that have been "diagnosed" at the Amen Clinics and bring very well-presented imaging and diagnostic reports that sound believable if you have no understanding of the state of neurobiology and psychiatric diagnosis. I tell them that there is very little clinical utility in much of what they do, very little is evidence-based other than their own "evidence," and I do not rely on their reports whatsoever for diagnostic assessment or treatment recommendations.

This has generally not made me many friends among these patients.

 

[PsyDr]

Someone looked at psychiatry and said, "The rate limiting step for this profession is face to face contact. Let's avoid that.".

 

[Liquid8]

Have had a few patients enquire about PET and SPECT scans, they’ve inevitably stumbled across Dr Amen in their online travels.

Usually we just end up having a chat about clinical indications for investigations, noting that the majority of psychiatric diagnoses are clinical and contrast this with some other physical conditions eg. ordering brain scans to exclude a tumour if someone has focal neurological signs. Often they’re relieved at not having to spend thousands on unnecessary investigations.

 

[birchswing]

Tell me this about Amen, though: Does he do any of the worst parts of psychiatry (long term benzo use, etc.)?

Also, why do people from his clinics keep coming to you all? Is it too expensive to keep seeing the people at his clinics?

 

[splik]

Daniel Amen as his name suggests, is an evangelical christian who went to a (now defunct) evangelical medical school and preaches the gospel of SPECT scans. I never see psychiatrists talking about this aspect of his work, but even NPR has reflected on how he has more in common with the televangelists (and PBS gave him a pulpit from which to proselytize) than he does with conventional psychiatry. He trained in nuclear medicine when SPECT/PET imaging was holding out promise of revolutionizing psychiatry. The reality of course was more sobering, and the decade that follows, held out to be "the decade of the brain", failed to bear out its promise to revolutionize the treatment of mental illness. Amen, as early as the late 1980s, saw differently, and believed this then new technology could be brought to the masses and transform the practice of psychiatry. Interestingly, its more so in recent years that his clinics have really started booming.

If nothing else, Amen is a shrewd businessman, and believed to be the most successful psychiatrist in America. In addition to his clinics and expert witness work and going on the lecture circuit, he also has a line of nutriceuticals, sells courses on Amen Univeristy, and has written numerous books, some of which are NYT bestsellers. He also has amassed a celebrity following, and counts Miley Cyrus amongst his patients.

 

[WisNeuro]

Tell me this about Amen, though: Does he do any of the worst parts of psychiatry (long term benzo use, etc.)?

Also, why do people from his clinics keep coming to you all? Is it too expensive to keep seeing the people at his clinics?

The expense is one of the issues. Some of these patients are not well off, but desperate, and get taken in by the claims. As much of this is cash pay, they cannot afford to keep shoveling thousands of dollars buying the smakeoil in perpetuity.

As for your first question, we could have another debate whether or not taking financial advantage of desperate people is better or worse than prescribing a maintenance benzo TID.

 

[Stagg737]

My counter "Would you rub poison ivy that you found in nature, on your face?". They usually have no counter to that one.

My counter is similar, but I bring up that arsenic and cyanide are "natural" and then ask the patient if they would ever consider taking those. Their answer is usually pretty indicative of where the rest of the appointment will go...

 

[deleted1100659]

"Dr. Amen can tell the exact amount of serotonin deficiency in my brain". Ok cool. Then what, he puts you on an SSRI and it increases? You know, kinda like I did without the $5,000 fee.

Im wondering if this patient will come back and see me after amens clinic. A testament to how many people believe psuedoscience is apparently his clinic is booked over two months out.

Oh and i forgot this gem: when the patient went to the ER for a panic attack, an NP in the ER is the one who recommended him. She also told the patient that she probably has diabetes based upon a random blood sugar rating, yet I had already done an a1c on her and it was completely normal. Sounds so ridiculous that even I doubt my own story, lol

 

[WisNeuro]

"Dr. Amen can tell the exact amount of serotonin deficiency in my brain". Ok cool. Then what, he puts you on an SSRI and it increases? You know, kinda like I did without the $5,000 fee.

Im wondering if this patient will come back and see me after amens clinic. A testament to how many people believe psuedoscience is apparently his clinic is booked over two months out.

Oh and i forgot this gem: when the patient went to the ER for a panic attack, an NP in the ER is the one who recommended him. She also told the patient that she probably has diabetes based upon a random blood sugar rating, yet I had already done an a1c on her and it was completely normal. Sounds so ridiculous that even I doubt my own story, lol

Only $5000?!? How'd the patient get a 50% off deal?

 

[FlowRate]

There's a psychiatrist in town who's "triple-board certified" in various integrative/holistic pursuits. She offers all the usual pharmacogenomics, urine metabolites, etc. testing and supplements. Looks like she's raised her fees since last year. She charges new patients $1500 for up to 2 hours of f2f time with her and 1 hour of documentation/intake with office staff. $550 for follow-ups. Which are called 45 minute but I would bet are 30 min f2f with her. Her website says she is no longer accepting new patients.

 

[Merovinge]

There's a psychiatrist in town who's "triple-board certified" in various integrative/holistic pursuits. She offers all the usual pharmacogenomics, urine metabolites, etc. testing and supplements. Looks like she's raised her fees since last year. She charges new patients $1500 for up to 2 hours of f2f time with her and 1 hour of documentation/intake with office staff. $550 for follow-ups. Which are called 45 minute but I would bet are 30 min f2f with her. Her website says she is no longer accepting new patients.

I poke fun at, and am also particularly bothered by, these people when they do this under the guise of having an MD/DO and practicing EBM, but this is clearly just a result of A) market economy for healthcare and B) the limitations of modern medicine in treating psychiatric disorders. If SSRIs worked as well as ECT the Amens and shamans would be hard-pressed to light their cigars with $100 bills.

 

[birchswing]

<Not a doctor.>

I do have insulin resistance, and I just wanted to point out that A1Cs got way too much praise and is not that great of a test. If someone has florid diabetes, it will show it, yes. (Can you use florid for diabetes?) But it sometimes misses people who are not well with insulin resistance and type 2 diabetes who are at risk for cardiovascular complications.

When the WHO adopted A1C as a biomarker for diabetes, the incidence of diabetes fell and the mortality of it rose.

Because it sometimes misses diabetes.

My A1C is always in the low to mid 5s. But I were to eat certain foods, my blood sugar can go up to 220. And it can crash down to the 70s. Normal people don't have their glucose go above 180 even when challenged with high glucose consumption, though, by OGTT definition, and by looking at actual population data it's really more 120-140 as a maximum after meals. Yet my A1C remained perfectly normal.

I have never had an A1C at 6 or above, and the WHO guideline was to diagnose at 6.5%.

People with insulin resistance have red blood cells with shorter life spans and as a result you're going to inherently have a bias toward lower A1C values. Not to mention high glycemic excursions are damaging to endothelial cells--as is the constant state of hyperinsulinemia.

The OGTT is now the gold-standard again with the WHO, but you really can find out just about as much with a home meter which have become increasingly accurate.

I had to convince my doctor to do a fasting insulin test to show him how bad my insulin resistance was because I was testing fasting and after meals and knew I had a problem, yet my A1Cs were good and it was all he was interested in. Yet the boom and bust glycemic excursions are not good for the body regardless of the A1C, and knowing your numbers can help you realize which foods cause that pattern.

Fasting insulin is a very good predictor of the development of diabetes and presence of insulin resistance, and he was surprised at my results.

Edit: I forgot to quote. This was for @DrAmazingishere

I do agree though what you said about the end results being the same after the imaging. It was probably 20 years ago I was introduced to Dr. Amen through some TV program, and I can recall the same thing, in which he diagnosed ADHD with the aid of SPECT imaging and the end result was giving medication, the same as it would have been without the imaging.

 

[deleted1100659]

<Not a doctor.>

I do have insulin resistance, and I just wanted to point out that A1Cs got way too much praise and is not that great of a test. If someone has florid diabetes, it will show it, yes. (Can you use florid for diabetes?) But it sometimes misses people who are not well with insulin resistance and type 2 diabetes who are at risk for cardiovascular complications.

When the WHO adopted A1C as a biomarker for diabetes, the incidence of diabetes fell and the mortality of it rose.

Because it sometimes misses diabetes.

My A1C is always in the low to mid 5s. But I were to eat certain foods, my blood sugar can go up to 220. And it can crash down to the 70s. Normal people don't have their glucose go above 180 even when challenged with high glucose consumption, though, by OGTT definition, and by looking at actual population data it's really more 120-140 as a maximum after meals. Yet my A1C remained perfectly normal.

I have never had an A1C at 6 or above, and the WHO guideline was to diagnose at 6.5%.

People with insulin resistance have red blood cells with shorter life spans and as a result you're going to inherently have a bias toward lower A1C values. Not to mention high glycemic excursions are damaging to endothelial cells--as is the constant state of hyperinsulinemia.

The OGTT is now the gold-standard again with the WHO, but you really can find out just about as much with a home meter which have become increasingly accurate.

I had to convince my doctor to do a fasting insulin test to show him how bad my insulin resistance was because I was testing fasting and after meals and knew I had a problem, yet my A1Cs were good and it was all he was interested in. Yet the boom and bust glycemic excursions are not good for the body regardless of the A1C, and knowing your numbers can help you realize which foods cause that pattern.

Fasting insulin is a very good predictor of the development of diabetes and presence of insulin resistance, and he was surprised at my results.

Edit: I forgot to quote. This was for @DrAmazingishere

I do agree though what you said about the end results being the same after the imaging. It was probably 20 years ago I was introduced to Dr. Amen through some TV program, and I can recall the same thing, in which he diagnosed ADHD with the aid of SPECT imaging and the end result was giving medication, the same as it would have been without the imaging.

one random blood sugar is not as useful as an a1c which gives a better timeline/average. Fasting glucose can be useful when done correctly but a patient going to the ER and getting a POC glucose without any form of fasting/context thats its elevated generally isnt useful info. There are many physiological reasons blood sugar can be elevated as well

But it is a great test because people with diabetes often don't record their blood sugar at home consistently/check consistently so this gives somewhat of an average at least

 

[birchswing]

one random blood sugar is not as useful as an a1c which gives a better timeline/average. Fasting glucose can be useful when done correctly but a patient going to the ER and getting a POC glucose without any form of fasting/context thats its elevated generally isnt useful info. There are many physiological reasons blood sugar can be elevated as well

But it is a great test because people with diabetes often don't record their blood sugar at home consistently/check consistently so this gives somewhat of an average at least

I agree with all that. if you can't get access to serial data, it is a good test in that regard. I think at one point it was overpromised in its reach.

I suppose there are all sorts of people with diabetes and the group I belong to online has a self-selecting bias in that they are part of the group, but they love knowing their numbers. But I hadn't thought of the case of people who might not be eager to check. There is a CGM you can prescribe as a diagnostic (the Freestyle Libre) for 14 days. The patient just wears a patch where the data is recorded for 14 days and doesn't see the data (different from the regular Freestyle Libre patient use where they do see their data and get alerts). But I personally found the results of the Freestyle Libre to be flaky and went back to finger sticks.

 

[WisNeuro]

I agree with all that. if you can't get access to serial data, it is a good test in that regard. I think at one point it was overpromised in its reach.

I suppose there are all sorts of people with diabetes and the group I belong to online has a self-selecting bias in that they are part of the group, but they love knowing their numbers. But I hadn't thought of the case of people who might not be eager to check. There is a CGM you can prescribe as a diagnostic (the Freestyle Libre) for 14 days. The patient just wears a patch where the data is recorded for 14 days and doesn't see the data (different from the regular Freestyle Libre patient use where they do see their data and get alerts). But I personally found the results of the Freestyle Libre to be flaky and went back to finger sticks.

In my modal pt group (60+) very high percentage with diabetes. When I inquire about recent numbers as part of my clinical interview, maybe 1 in 10 is checking at any meaningful interval.

 

[Monocles]

Had an inpatient a couple of months back on a cocktail of these boutique supplements. Home meds ran out and of course it is non-formulary... I offered to replace them with a 5 cent multivitamin. Family was not happy.

 

[calvnandhobbs68]

Had an inpatient a couple of months back on a cocktail of these boutique supplements. Home meds ran out and of course it is non-formulary... I offered to replace them with a 5 cent multivitamin. Family was not happy.

Uh how could some peasant multivitamin be boosting my levels as well as Neurovite Plus? What are you some hack?

 

[whopper]

On occasion I get a patient who went to Amen, and I just point blank tell them Amen's reputation is garbage.

Every single patient I've seen whose done the PET scan never had anything from it that suggested they got better because of it. E.g. "I was depressed, and the PET scan showed I was depressed. They gave me Citalopram and a few weeks better I got better."

I tell them, 1-the diagnosis didn't need a PET scan, 2-Citalopram as a choice didn't need a PET scan either.

That this guy has a PBS show just goes to show you that even media with higher standards like PBS still get some garbage here and there. While I worked at U of Cincinnati Steve Strakowski was the chair, and one of the leading psychiatrists involved with use of brain imaging in the field. I never saw it but a friend of mine told me if you mentioned AMEN to Dr. Strakowski you'd see his face turn sour.

It wasn't AMEN but I had a patient with treatment-resistant depression that was convinced by a quack she had a type of metabolic disorder that was proven to not even exist. My first day I was puzzled because the name of this disorder wasn't even showing up in any legitimate medical sources.

I've had a few out-there cases. E.g. an autoimmune encephalitis that was confirmed with anti-NMDA antibodies, successfully treated with prednisone, severe ADHD looking like Bipolar Disorder (the guy didn't sleep for weeks, looked manic and a stimulant calmed him down, and he was able to sleep. It wasn't my patient but a colleague of mine had a patient that would involuntarily punch himself in the face every few minutes. He was seen by some of the leading doctors in the field who couldn't figure it out (Paul Keck, Henry Nasrallah...) and was successfully treated with ECT. So when I hear these weird types of cases I try to have an open mind and have seen some weird things sometimes help people that were treatment-resistant.

I did the homework and there was no good data this disorder even existed. Further the quack that pushed the theory pushed supplements that only he sold. I told her, "if this guy's theory is correct obviously it didn't get you better. You tried the supplement. This disorder has been proven to not exist but even if it did this other doc's treatment is a supplement that didn't work and you still embrace this diagnosis." I don't even remember the name of the BS diagnosis she was given but she wouldn't drop her belief in it. She eventually stopped seeing me.

 

[Mad Jack]

A family brought in a whole binder of “personalized” recommendations after going to the Amen clinic, and it was worthless. Not at all personalized, or even specific to the diagnosis- things like eat your vegetables, exercise reduces stress. At least it was a legitimate diagnosis. The last time I looked at the Amen web site, it had rotating 3-D brain images purporting to diagnose things like “relationship toxicity.

This sort of thing should be criminal. People like this being allowed to practice is a detriment to the field and outright theft that preys upon vulnerable populations

 

[birchswing]

I don't know if my views on this are welcome . . . but if someone doesn't have a very serious mental disorder, and they go to something that is more holistic like this versus a traditional practice, I'm not sure that I necessarily think they would come out worse. I am not comparing what they do to the best of care of traditional medicine but more what you may encounter from standard of care of medicine, which seems quite variable, and averages out to a grade of C.

As an analogy, there was an inflection point in history in which it was probably safer to go to a Christian Scientist practitioner than it was to a medical doctor who might bleed you to death in service of trying to cure you of something. You can see a decline in Christian Science that is inversely proportionate to the rise of the efficacy of medicine. Essentially, at one point in history you probably were safer not seeing a doctor.

I've often thought about this with ex-Scientologists. I've watched a lot of YouTube videos with them, and they all have very valid complaints (well, actually some of them are kind of petty—the proximate reasons for leaving in particular are always petty, but the larger complaints quite valid). But the one thing I come back to is: they are disciplined, they're not drug addled, they seem extraordinarily organized and clear headed, and they seem like hard workers. Sort of like ex-military to an extent. Now of course there are the casualties, the children who died in Scientology for lack of medical care, etc. But of the ones who went in because they were lost in Hollywood—they seem to have been able to have become disciplined and at least not gone down paths a lot of people do. It was a racket, but at least maybe a protection from something else.

I look at my history in psychiatry and think I would have been better off in my early years if I had come across some holistic voodoo rather than some of the more "creative," to use a euphemism, prescribing practices that can happen in traditional psychiatry. I know very little about Amen except some stuff I probably heard 20 years ago, but I get the sense they probably wouldn't be pushing hard tranquilizers out like it's candy. With my experience, the very first doctor I saw, a CAP, was very pro-benzo and was not only agnostic about therapy but actively against it saying it was a waste of time. At that point in history, I don't think benzodiazepines were considered voodoo first line treatment. I think that was standard of care--maybe for my age it was unusual. I'm not sure. But in that particular instance, I do feel like those people who were bled out by doctors of early modern medicine. I would have been better off with some placebo new-age something or another.

Is it really that different showing people 3D images of their brains that have no clinical significance to when the doctor told me that taking this medicine was analogous to a diabetic taking insulin? Whether it's a 3D image or a catchy analogy like that, both heuristics are canards . . . but where does each lead. That's the important part.

It's hard for me to get really down on someone like Amen unless I see evidence of absolute harm versus chicanery. I always thought the same with Dr. Oz. I never liked him that much. But how many ways could he tell people to get off the sofa and get the spoon out of their mouth. Sure he made a lot of stuff up, but what other TV show were they going to watch. No one listened to Michele Obama about exercise and diet. He had to do something odd to get people's attention. I don't think anybody didn't exercise or eat better because of him. Absolute harm has become my measure for politicians and other figures. Maybe there is with Amen, but the 3D images . . . I don't know. There's a lot of waste in medicine. Speaking of the entire opposite, I just saw this regarding a brain scan that *should* have been done as it relates to psychiatry (kind of totally off topic, but just happened to read it recently):

https://www.washingtonpost.com/health/2022/02/12/medical-mystery-mental-facility-ct-scan/

 

[Sushirolls]

These days I'm having a hard time faulting the Amen folks and others like them.

Our whole society wants this. They've always wanted this when you look at history. People intentionally pushed to get marijuana legalized as a medicine. It too, is almost like its own cult how folks cling to it and believe it to be the panacea cure. Soon hallucinogens will be another panacea.

My local area NDs are everywhere. I'm starting to be more surprised when I see people have an MD/DO/PA/ARNP as their primary. The crap NDs come up with in their infusion suites. I bet more NDs have hyperbaric chambers then board certified physicians in hyperbaric medicine. The hormone panels and how folks cling to that as explanation of their symptoms based upon what their ND ordered.

People who are financially broke, or on medicaid will go out of their way to pay cash for stupid interventions. Yet, they stiff their real doctors, or balk at copays or complain about insurance.

Every month the more articles I see about different states crumbling under scope of expansion by every other field, and even those within my own state. These expansions, it beckons the question of why? Why do we even bother with licensure? Why do we even bother state licensing boards? May as well just open the gates and let people get what they want. As a society we are legislatively tearing down infrastructure of a quality, experienced, evidenced based health system. I see/feel the weight of this daily/weekly - its like entropy. One example recently was the swing to limit opioids in chronic pain, and those effected pushed back hard enough that the MEq dosing may be undone? I've not followed closely but the point is people will get what they want.

Release the Kraken. "A fool and his money are soon parted."

*The above may also just be a snap shot of my getting jaded. I'll still march forward as trained, but witnessing the entropy is sorrowful.

 

[Mad Jack]

These days I'm having a hard time faulting the Amen folks and others like them.

Our whole society wants this. They've always wanted this when you look at history. People intentionally pushed to get marijuana legalized as a medicine. It too, is almost like its own cult how folks cling to it and believe it to be the panacea cure. Soon hallucinogens will be another panacea.

My local area NDs are everywhere. I'm starting to be more surprised when I see people have an MD/DO/PA/ARNP as their primary. The crap NDs come up with in their infusion suites. I bet more NDs have hyperbaric chambers then board certified physicians in hyperbaric medicine. The hormone panels and how folks cling to that as explanation of their symptoms based upon what their ND ordered.

People who are financially broke, or on medicaid will go out of their way to pay cash for stupid interventions. Yet, they stiff their real doctors, or balk at copays or complain about insurance.

Every month the more articles I see about different states crumbling under scope of expansion by every other field, and even those within my own state. These expansions, it beckons the question of why? Why do we even bother with licensure? Why do we even bother state licensing boards? May as well just open the gates and let people get what they want. As a society we are legislatively tearing down infrastructure of a quality, experienced, evidenced based health system. I see/feel the weight of this daily/weekly - its like entropy. One example recently was the swing to limit opioids in chronic pain, and those effected pushed back hard enough that the MEq dosing may be undone? I've not followed closely but the point is people will get what they want.

Release the Kraken. "A fool and his money are soon parted."

*The above may also just be a snap shot of my getting jaded. I'll still march forward as trained, but witnessing the entropy is sorrowful.

Except it isn't harmless. Each SPECT image is associated with approximately a 0.07% lifetime cancer risk. They boast about doing 200,000 unnecessary scans, but statistically they've caused 140 cases of cancer.

 

[birchswing]

These days I'm having a hard time faulting the Amen folks and others like them.

Our whole society wants this. They've always wanted this when you look at history. People intentionally pushed to get marijuana legalized as a medicine. It too, is almost like its own cult how folks cling to it and believe it to be the panacea cure. Soon hallucinogens will be another panacea.

My local area NDs are everywhere. I'm starting to be more surprised when I see people have an MD/DO/PA/ARNP as their primary. The crap NDs come up with in their infusion suites. I bet more NDs have hyperbaric chambers then board certified physicians in hyperbaric medicine. The hormone panels and how folks cling to that as explanation of their symptoms based upon what their ND ordered.

People who are financially broke, or on medicaid will go out of their way to pay cash for stupid interventions. Yet, they stiff their real doctors, or balk at copays or complain about insurance.

Every month the more articles I see about different states crumbling under scope of expansion by every other field, and even those within my own state. These expansions, it beckons the question of why? Why do we even bother with licensure? Why do we even bother state licensing boards? May as well just open the gates and let people get what they want. As a society we are legislatively tearing down infrastructure of a quality, experienced, evidenced based health system. I see/feel the weight of this daily/weekly - its like entropy. One example recently was the swing to limit opioids in chronic pain, and those effected pushed back hard enough that the MEq dosing may be undone? I've not followed closely but the point is people will get what they want.

Release the Kraken. "A fool and his money are soon parted."

*The above may also just be a snap shot of my getting jaded. I'll still march forward as trained, but witnessing the entropy is sorrowful.

I follow pharmacy forums a bit, and I think those opioid changes were guidelines by the CDC, not enforceable rules. From what I gathered, there are a lot of institutional restrictions already in place that would have to be changed before there is an actual change. I think this is probably more up to states and insurance companies. The CDC puts out a lot of position papers that people don't ever pay attention to because they're not related to headline grabbing news like the opioid epidemic, and they seem to have little impact. (And you can see with COVID, a headline grabbing issue, states have done whatever they've wanted regardless of CDC guidance except where the federal government is able to act like schoolbuses but not classrooms, for example, but even that I think is not enforced by the CDC itself.)

 

[futureapppsy2]

I guess it's not harmful other than to your wallet. It's just really expensive supportive psychotherapy...

The completely unnecessary and medically unjustified radiation exposure crosses the line to “harmful” (and I think one could make a decent argument for malpractice).

My counter is similar, but I bring up that arsenic and cyanide are "natural" and then ask the patient if they would ever consider taking those. Their answer is usually pretty indicative of where the rest of the appointment will go...

Abestos is another natural substance to mention. People seriously underestimate how great nature is at killing things.

 

[Liquid8]

It wasn't AMEN but I had a patient with treatment-resistant depression that was convinced by a quack she had a type of metabolic disorder that was proven to not even exist. My first day I was puzzled because the name of this disorder wasn't even showing up in any legitimate medical sources.

I've had a few out-there cases. E.g. an autoimmune encephalitis that was confirmed with anti-NMDA antibodies, successfully treated with prednisone, severe ADHD looking like Bipolar Disorder (the guy didn't sleep for weeks, looked manic and a stimulant calmed him down, and he was able to sleep. It wasn't my patient but a colleague of mine had a patient that would involuntarily punch himself in the face every few minutes. He was seen by some of the leading doctors in the field who couldn't figure it out (Paul Keck, Henry Nasrallah...) and was successfully treated with ECT. So when I hear these weird types of cases I try to have an open mind and have seen some weird things sometimes help people that were treatment-resistant.

I did the homework and there was no good data this disorder even existed. Further the quack that pushed the theory pushed supplements that only he sold. I told her, "if this guy's theory is correct obviously it didn't get you better. You tried the supplement. This disorder has been proven to not exist but even if it did this other doc's treatment is a supplement that didn't work and you still embrace this diagnosis." I don't even remember the name of the BS diagnosis she was given but she wouldn't drop her belief in it. She eventually stopped seeing me.

I wonder if it was pyrrole disease or pyroluria. Can remember receiving one referral for depression/anxiety with this diagnosis attached, and it stood out because I'd never ever heard of it before and couldn't find anything about it on standard references. This referral also many alarm bells ringing because the patient (in their 20s) was wanting to get on the disability pension, had been to see another doctor and been unhappy with their "biobalance" approach (again, something I'd never heard of) and was on 8 different supplements. More than half the referral was an explanatory document about the disorder and some pseudoscience garbage about methylation, copper and zinc.

Later on I found out that pyroluria was a condition theorised by a single doctor, and when his experimental research couldn't be replicated he basically started his own journal about said condition.