Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Wednesday, July 17, 2013


In case you didn't get to read this article in the Times, on Monday, the FDA "approved the first brain wave test to help diagnose attention deficit hyperactivity disorder in children."

The way it works is that they hook up the kid to a device called a NEBA, "Neuropsychiatric EEG-Based Assessment Aid", and 15 or 20 minutes later, it interprets the EEG to determine if it's consistent with ADHD.

What the NEBA people didn't tell the FDA is the way it really works. You hook up the kid to the NEBA, and 15-20 minutes later, if the kid is still sitting there, he doesn't have ADHD.

Okay, I'm joking. And I don't mean to be glib about ADHD, which is a source of tremendous suffering. But a device like this does make you consider the whole concept of "lab tests" for psychiatric illnesses.

One common complaint about Psychiatry is that it's not "scientific" enough, because there are no lab tests to clearly delineate disease, unlike something more "medical", such as diabetes. In a recent post, Learning From Diabetes, I addressed this point from the angle of, Diabetes isn't really that scientific, either. And in my first week of medical school, we were taught that, "No lab test is 100% dependable." That's a reasonable point-that science always has its limits in medicine, and clinical correlation, based on clinician experience, is a necessary entity.

But I think there's something deeper going on here. NEBA may well be scientifically sound. And it is exciting to imagine being able to draw some blood to diagnose OCD, or to differentiate Schizophrenia from Bipolar. But science for the sake of science doesn't always make sense. (And science for the sake of industry always does make sense, but isn't always desirable.)

What I'm trying to say is, it isn't cool to overlook the painfully obvious just so you can say you're scientific. And especially where there is money to be made, the temptation is very great to do just that.