The Checkup with Doctor Mike - Are These Brain Scans Too Good To Be True? | Dr. Daniel Amen

Episode Date: December 14, 2025

Comment from the Canadian Association of Nuclear Medicine, December 12th 2025 “At this time, CANM considers that the guidelines require further rigorous review and validation through an independent, expert-led editorial and peer-review process. Until such a process has been completed, CANM believes it would be premature to adopt, endorse, or formally comment on the recommendations contained therein.”I'll teach you how to become the media's go-to expert in your field. Enroll in The Professional's Media Academy now: https://www.professionalsmediaacademy.com/Dr. Daniel Amen's new book "Change Your Brain, Change Your Pain" is available here: https://www.amazon.com/Change-Your-Brain-Pain-Emotional/dp/0063426706/ref=pd_lpo_d_sccl_3/147-0559025-3543367?pd_rd_w=m70zn&content-id=amzn1.sym.4c8c52db-06f8-4e42-8e56-912796f2ea6c&pf_rd_p=4c8c52db-06f8-4e42-8e56-912796f2ea6c&pf_rd_r=AZTK0E7M2BPBN9KC9V93&pd_rd_wg=Y0Z5p&pd_rd_r=5178d844-a424-4242-a1a0-688f454f89de&pd_rd_i=0063426706&psc=100:00 Intro01:55 Origins07:42 Lifestyle Changes vs. Pharmaceuticals vs. Therapy12:38 Does imagining change treatment?18:48 Overprescription26:08 How Your Thoughts Affect Your Pain30:32 Over-testing / CTE34:28 His Supplement Company44:35 Patient Compliance54:06 Kim Kardashian’s Brain Scan1:02:48 Randomized Control Data1:37:10 Shaming Psychiatrists1:47:23 Would You Give It Up?Help us continue the fight against medical misinformation and change the world through charity by becoming a Doctor Mike Resident on Patreon where every month I donate 100% of the proceeds to the charity, organization, or cause of your choice! Residents get access to bonus content, and many other perks for just $10 a month. Become a Resident today: https://www.patreon.com/doctormikeLet’s connect:IG: https://go.doctormikemedia.com/instagram/DMinstagramTwitter: https://go.doctormikemedia.com/twitter/DMTwitterFB: https://go.doctormikemedia.com/facebook/DMFacebookTikTok: https://go.doctormikemedia.com/tiktok/DMTikTokReddit: https://go.doctormikemedia.com/reddit/DMRedditContact Email: [e-mail] Producer: Doctor MikeProduction Director and Editor: Dan OwensManaging Editor and Producer: Sam BowersEditor and Designer: Caroline WeigumEditor: Juan Carlos Zuniga* Select photos/videos provided by Getty Images *** The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional **

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Don't you want to try and disprove your method in order to prove how strong it is? So at this point in my career, no. A spec scan takes 3D images of the brain, looking at blood flow and activity. Dr. Ayman says the images can be a powerful tool to diagnose underlying problems. I have more experience in this than anybody probably in the history of the world. Do you not feel that it's an issue that there is no randomized control data? You know, I went and got a brain scan by this guy. called Daniel Amman.

How do you know what is actually going on in that person's brain without looking by asking them questions by doing some validating crap, Mike. It's complete crap. Today's guest is Dr. Daniel Aman, a physician with double board certifications in psychiatry and child and adolescent psychiatry. He's a multiple New York Times bestselling author and has just published a new book called Change Your Brain, Change Your Pain. He is also the founder of Aeman.

clinics, a nationwide network of offices that rely heavily on spec scans, a unique functional imaging approach that Dr. Aiman claims is capable of identifying psychiatric diagnoses within the brain, which allows him to create better treatment plans for his patients, which often includes supplements he sells through his other company, BrainMD. As you'll hear him say, he's reviewed hundreds of thousands of these scans, which he's used to improve the lives of countless patients over his decades-long career. Given that major health organizations have come out against using spec in this way, I needed to ask what research he was using to guide his protocols. Because if you're going to go against the APA, the AAN, you have to have some pretty compelling data, right?

Let's talk historically how you got into this space because I don't see a lot of folks, at least on the internet talking about neurology, psychiatry, and how these two fields come together. Is this a unique field? I'm not certainly exposed to it as a primary care doctor, so I'm curious how you found your interest in that. So when I was 18, Vietnam was going on, and I became an infantry medic, and that's where my love of medicine was born. But about a year into it, I realized I didn't like being shot at. So I got retrained as an x-ray technician. And that was pivotal for me because our professors used to say, how do you know unless you look? And then 1979, I'm a second year medical student, someone I love tries to kill herself. And I took her to see a wonderful psychiatrist. And I came to

realize if he helped her, which he did, it wouldn't just help her that it would help me. It would help her children, it would help her grandchildren, is they would be shaped by someone who is happier and more stable. So, 46 years ago, I fell in love with psychiatry, loved it every day since. The only medical specialty that never looks at the organ it treats. Think about that. Is that true? That is absolutely true that they still make diagnoses based on symptom clusters, the DSM, that has no neuroscience in it. They make diagnoses, based on symptom clusters with no biological data, exactly like they did with Abraham Lincoln in 1841.

So think about that. Yeah, why is that? Because it's the paradigm that feeds the pharmaceutical industry. It doesn't feed outcomes, because our outcomes are not better than they were in the 1950s, the year I was born. How are you, where is the, like in terms of more people being sick, or people not being helped. More people being sick.

And if you are sick, your ability to get better, right? Imipramine was released in the 1950s. We don't have antidepressants that are more effective. Now, we have ones with fewer side effects, but not more efficacy. Thorazine was released in the 1950s. Ritalin was released in the 1950s. Why?

Why? And so I asked the question. And when I was growing up, my dad had two favorite phrases. Bullshit was his first one. Everything was bullshit. And no. Bullshit, no. And so when I'm like, well, why aren't we looking? They go, well, it's the future. And I'm like, bullshit. No, we should do it now. There's technology now. And in 1991, I went to a lecture on the imaging study we do at Amen Clinics. They have 11 clinics around the country. It's called Brain Spec-Spect imaging. Spect is a nuclear medicine study that looks at blood flow and activity.

It looks at how your brain works. How's that different from functional MRI? So functional MRI is harder. You have to catch that difference in, brain activity, spec actually gives you a look at how the brain works over time. So it looks at about a two-minute snapshot of brain activity, but it happens to be very consistent over your lifetime, unless you do things to change your brain. And so now we have almost 300,000 scans. We've done on people from 155 countries. And literally, it changed everything in my life.

life from the time I go to bed because what I realize, most psychiatric illnesses are not mental health issues, they're brain health issues. Get your brain healthy and your mind will follow. How is that, what's the difference between mental versus brain? So if you think of it as mental health. So number one, no one wants to be called mental, right? Because it shames you. It's stigmatizing and it's sort of about you when it's brain health well everybody wants it and if it's mental health okay diagnoses symptom clusters let's do this medicine or that medicine right as a family doctor you treat more psychiatric patients than most psychiatrists it's like almost half of the patients that come see you are stressed they're not sleeping they're angry

or depressed. Especially my pain patients. And the tools you have in a limited office visit is medicine. And yeah, it's like, okay, symptom clusters, medicine or therapy, and then I'll see you back, where if it's brain health, you have to lose weight. because I published three studies on 33,000 people that show as your weight goes up, the size and function of your brain goes down, should scare the fat off anyone. You have to get your diabetes under control.

You need to go to bed. Alcohol is not a health food, and marijuana is not innocuous. So what you begin, every patient, this is not true if it's sort of a mental health issue. If it's a brand health issue, you have to ask yourself, whatever you're doing, today is a good or bad for your brain? So it's a completely different paradigm and a completely different discussion. I'm trying to think of how I go about seeing a patient that perhaps has a psychiatric concern or maybe even doesn't and doesn't realize that they have a psychiatric situation going on. Obviously doing the symptom clusters, the checklists, the PHQ9s, all of these

gad sevens that they fill out. And then you're right. It's either therapy. or medication, a combination of medication, and then see you later, especially with our broken health care system. It's near impossible for anyone with not the greatest insurance or paying cash to even get therapy, let alone quality therapy. So I see that happening. But the idea of weight loss and getting their diabetes under control, to me as a family medicine doctor, especially as a DO who thinks very holistically, that is almost always included in my mental health portfolio. Is it just because I'm automatically thinking about mental health as brain health? No, it's because you're rare. That very few family doctors go, you're depressed,

could be from the inflammation you're carrying, creating from the extra weight and the ultra-processed food. It's you're depressed. That means you need an SSRI. And, you know, the serotonin hypothesis for depression. It's not well supported. Oh, for sure. And we've gone back and forth on, is it receptor modulation? But you see, I don't think depression should be an illness. I think depression is like chest pain. Nobody gets a diagnosis of chest pain. Why? That's in my ICD 10 diagnosis. Well, yes, but nobody gets, no thoughtful cardiologist goes, that's your problem. You have chest pain. It's a symptom. Depression is a symptom that has many different causes. And there are certain brain patterns that respond to SSRIs, especially if you

have increased activity in an area of the brain called the subgenial cingulogiris. So yes, SSRIs work for that. But what if you have low activity in that part of the brain? SSRIs can make you violent or and they're black box warnings on SSRIs. They're black box warnings on every psychiatric drug because depression can happen from a head injury, like you had a whiplash injury, so you never even really thought you had a head injury. It could come from toxic exposure like lead or heavy metal or mold. It could come because your brain works too hard from Lyme disease

or not hard enough. And so the standard, your pHQ 9 is elevated. So here's an antidepressant plus therapy or one or the other. And I'm like, well, why are you depressed? And that's not the question people really ask. I'm curious about the chicken or the egg scenario with the weight and poor diet. I have patients that I believe that there's a component of their weight, their diet, their choices in life,

are impacting their feelings leading to the symptom of depression. Because technically I don't diagnose someone with depression. I diagnose them with major depressive disorder or dyshthymia, some kind of more DSM appropriate diagnosis. So how do I know is this a symptom or a sign of them having major depressive disorder leading to unhealthy eating? Or is it the other way around that the unhealthy eating is causing those symptoms? Well, I would think we should look at their brain

before we go about changing it. And then I think a really good detailed history will give you a good idea. Now, if you can't get a scan, look at their ACE score. And I don't know if you do that routinely. But I published a study last year on 7,500 patients looking at adverse childhood experiences.

So on a scale of 0 to 10, how many bad things happen to you as a child? So if you have increased trauma, you have increased activity in your limbic or emotional brain or when we talk about the pain book in the suffering pathway of the brain. So you're more likely to eat simple carbohydrate foods because that raises serotonin.

If you can get an insulin response, then it raises tryptophan in the brain and serotonin and you feel happy. Now, you don't feel happy, really. You feel happy for the moment. You feel happy for the moment. Until the next thing. Right.

I want my patience to feel good now and later versus now. Without the negative effects of overeating. Without the negative effects. So in these scenarios, when let's say they have elevated ACE scores and as a result, they're having worse lifestyle changes, how does the imaging, getting the imaging improve that level of treatment because let's say I have a patient who has a high A score who's consuming a lot of foods. We would be discussing the consumption of those foods as part of their metabolic workup, knowing that there's an added benefit to their mental health state, but it would be primarily

focused from a metabolic standpoint. So what is the imaging add to it? So many different things. The first thing it adds is compliance because people see their brain, they begin to have a relationship with their brain, and they want it to be better. Okay. So it's the reason- It's showing them a bad EKG when they're having chest pain. And or high liver function tests, and they're drinking too much. Right. In 66% of the time, if you show them an abnormal lab test, they want to do something to make it better. But now, so when I did my first scan was 1991. I scanned my mom the week before and her brain was beautiful and mine wasn't and I developed a concept I called brain envy Freud was wrong penis envies not the cause of anybody's

problem brain envy right that's the organ where size really does matter you want a healthier brain And I just wanted my brain to be better. So that leads to a cascades of decisions if you go, is this good for my brain or bad for it? So that's the first thing that I fell in love with imaging compliance and it decreases stigma. And it gives you as a physician targets to go after. Is the brain overactive? so I need to calm it down. And from a medicine standpoint, SSRIs or anti-convulsant medications, calm it down.

But if it's low in activity to start and you calm it down, you've just disinhibited that person, which can be problematic. Well, butrine is a common option. But how would you know where to start? Well, based on symptoms and what they're experiencing. Based on symptoms. But what other. specialty in medicine

acts without imaging. I don't know if that's a valuable question, though. Because not every specialty is going to have equivalent need for imaging. For example, for me to make a diagnosis of a UTI, I don't need any imaging or any lab tests. But you need lab tests. You don't. It's a clinical diagnosis. So if someone has symptoms, dysuria, superpubic pain on a physical exam, perhaps CVA tenderness. I can make that diagnosis. I technically don't need

the tests. There are in moments where it's valuable to get a test, if you're concerned about a kidney stone, if you're worried about someone who has a high risk UTI, like someone in pregnancy, so you need to get a urine culture to confirm sensitivity. So there are, there's a lot of these specifics. But I'm interested in your reasoning, the compliance, the stigma. I think those are really the roadmap. And the roadmap of treating to some outcome. So now I'm curious about the compliance portion of that. Not every patient's going to have access to imaging, simply because of the nature of our health care system. It sucks. A lot of people can't afford even basic medications. The other day I prescribed clendomycin for a patient, and their insurance denied it because I sent

capsules, not tablets, just some ridiculous notion, which is typical for our system. So when I think about our system and who I treat, especially in the community health center, I think about those people who can get imaging and then the worry that it instills in them as if I'm treating them badly because they will view our podcast or they'll hear a new story about the need for imaging and that we're functioning basically as we're blind. And then those people feel like they can't get care for me or their psychiatrist. Do you worry about that outcome? So from the beginning of the time I've done imaging. And that's why I write. That's why online you can take our brain health assessment, know what, based on our work, what type of brain you have. You have a balanced brain, spontaneous brain. That's my ADD group, a persistent brain, my OCD group, sensitive or cautious brain. So these symptoms tend to go with,

these patterns. So I think people can benefit from my work for free, right, and go to the library and get, change your brain, change your pain, or change your brain, change your life, or any of the 40 books I've written, or they can listen to our podcast. And so there's so many people, everywhere I go, people go, your work changed my life. And they never got a scan. But I would argue, but I would argue psychiatry is broken and we need to be viewed as a real medical specialty with imaging because if you don't look, you don't know. So, for example, one of the big lessons is mild traumatic brain injury is a major cause of psychiatric problems and nobody knows it. because psychiatrists don't look at the brain or family doctors don't look at the brain and this person who's having problems with domestic violence or this person who's been

incarcerated three times or this person that is homeless and no one's thinking did that car accident damage their brain so are psychiatrists who are not using brain imaging by functioning without looking, are they doing a disservice to their patients? I think they're flying blind and they're missing so much that could be gotten from imaging. Is your brain hurt? Is it toxic? Is it overactive? Is it underactive? Like, I'm a psychiatrist. Why do I care about Lyme disease? Because it's a major cause of psychiatric problems. yeah, I think as a profession, we can do so much better. And that's why in medical school psychiatry has sort of looked down on, it's like, really?

Well, it's looked down upon because it's the lowest reimbursed field out of all of the specialties? No, I don't think so. I think it's looked down on. Family medicine, pediatrics, and psychiatry are the lowest ranked fields. And those were the three I was interested in when I was a medical student because it wasn't about the money. It was about where I could do the most good. Sure. Well, we definitely need the most help in those specialties.

Because I think a good primary care system is the backbone. I don't know if you agree. Absolutely. A good health care system. No, you should have a wonderful family medicine doctor. But, you know, most people use the emergency room. Or urging care, there's no continuity. Right.

Just a relationship. And I trained in the early 80s before managed care took over medicine. and I'm so grateful that I did because in the early 90s psychiatrists became the prescriber and they just ruined the profession. Like for me I was taught to do family therapy and group therapy and individual therapy

and medicine was just sort of a part of what I did and I wouldn't be happy if I was the prescriber. Probably in the same way that I can relate to that in being a family medicine doctor, there are a subset of family doctors who have trained to be referologists who, oh, you have high blood pressure? Here's a cardiology referral. Oh, you have UTI. Here's heurology. You don't need to do that. I constantly have to remind my residents that 90% of all medical ailments can be handled by a primary care doctor. And there are subsets that are complex that require specialist intervention procedures. We don't do colonoscopies

as a simple one surgeries. So there's a lot we can handle, and I think there needs to be improvement across all these fields, especially in the area of education. So much how you're talking about the prescriber, I'm talking about the referer in that. No, I love that.

It's the first time I heard that term. And it's like, no, that's not why we went to medical school. Correct. We had to take all of those rotations. Exactly. And we forget them because it's easy to just refer. It also shifts the legal concern.

oh, well, I sent you to the cardiologist. They made the decision. It takes the decision-making pressure off me. So I don't like that in terms of practicing medicine that way. So I agree with you in that regard. You mentioned some of these brain classifications that you do to see if someone has a ADHD-type brain. You know, we have all of these validated PhD-9s, GAD-7s, Vanderbilt, M-chats. These are questionnaires we give to patients.

Sometimes we give them to parents, to teachers. Do you not like those ways that we use? We give them to our patients, but depression is clearly not one thing. Anxiety disorders are clearly not one thing. Now, you get a high GAD 7. So what do you do with that? Do you give them a benz-o that's addictive, that increases their risk of dementia? I mean, that's out of standard care.

You don't, but that's out of standard care. 27% of all doctor visits, someone's getting a benz-o. This is insane. That's not what the agencies recommend, right? If we were to go on to the APA or any of these organizations, they wouldn't say that that's standard. I mean, hopefully you teach them diaphragmatic breathing. You give them things like phyonyne, maybe from a medicine standpoint, propranol.

But that's not what we're seeing. I mean, now we're even introducing allergy medication for people who have anxiety. Yeah, the anihistamines would also increase the risk of dementia. Yeah, for sure, overuse a lot of it. But I mean, every medication has some sort of trade-off. Right, but teaching someone not to believe every stupid thing they think and teaching them diaphragmatic breathing, no side effects, no increased risk, a dimension probably decrease the risk.

It sounds like you're a fan of therapy, of cognitive behavioral therapy. Are you? Absolutely. Okay. And I think family doctors, if they just learn some of the basic principles, right? Oh, let's, I talk about killing the ants, the automatic negative thoughts that steal your happiness whenever you feel sad, mad, nervous, or out of control, write down what you're thinking. And just ask yourself whether or not it's true.

And in the book, part of the doom loop is an invasion of ants, these automatic negative thoughts. And there's nowhere in school where we teach. kids not to believe every stupid thing they think. I was 28 years old in my psychiatric residency when one of our professors said, you have teacher patients not to believe every stupid thing they think. And I'm like, but I believe every stupid thing I think. Revolutionary idea. Right. It's like, but that's such an important concept. You know, if patients came in knowing how to manage their minds, they're going to have a lot less back pain. They're going to have a lot less neck pain

because negative thinking goes to more tension, which then leads to more pain. Yeah, we talk about that a lot on the channel. Are you familiar with Dr. Sarno's work? Love Dr. Sarno's work. I talk about him in the new book because what he basically says is chronic pain is repressed rage.

But he doesn't do a great job of helping people get rid of the rage. And so in the book, Pollyanna actually meets Hannibal Lecter because you have to have a mechanism to get in touch and express the rage in an appropriate way while you're directing your mind to what's right rather than what's wrong. Yeah, I think he was ahead of his time to some degree and people will point out flaws of he had this theory of increased muscle spasms due to decreased blood flow. to a specific area, and when that was somewhat disproven or questionable, they threw out all his theories. And I feel like, as someone who's practiced medicine for over a decade, I've seen his theories play out, not just from, I see this happening with my patient, but direct intervention in handling anxiety, stress, childhood traumas, just discussion of those issues leading to elbow

pain going away. So I believe that there's definitely a variable there. Sometimes it's hard to get patients on board, though. I've had patients get very offended at me when I say, Hey, what's going on in your life emotionally? What is your upbringing like? And I'll say, why the hell are you asking me this? And I explain, they say, well, you're one of these asshole doctors that just wants to blame it on me. And I said, no, no, no, quite the opposite. I'm explaining that you have an internal regulator that basically dials up volume when you're stressed,

as it's supposed to as part of its survival mechanism, and then down regulates it when they're having a good time. because you just told me that your pain is only there when you're working, but now when you're having fun with your friends. But it's still sometimes hard to get by it. What's your strategy on getting that buy in? People say, oh, well, you think it's all in my head. Well, absolutely. But it's in your brain, which is in your head. That if you've had pain for more than a couple of weeks, that now has a signature in your brain. And if we don't get your brain healthy, the pain's going to stick around. And one of the reasons I wrote, change your brain, change your pain. I'm 71, is I just got tired of being in pain all the time. It was my back. It was my knee.

It was my neck. It was my hip. And I'm like, what is going on? So Red Sarno's work started looking at the scans of our patients in chronic pain, and I'm like, oh, pain gets stuck in your brain. And the one study that just completely blew my mind was 80% of people, my age, have abnormal backs who have no pain. Oh, yeah, that's, who have no pain. Why try and talk patients out of MRIs for their spines just because? and what I have found that when people go get them after I teach them this, their abnormal neck doesn't freak them out so they automatically go get surgery. They go, oh, 70% of people my age have abnormal necks who have no pain.

So it means your body can figure out how to heal around the arthritis in your neck or the crushed disc in your neck. And that's so freeing to me. And it's like if I calm my brain down, my pain's going to be less. And now I'm in no pain at all, which I dearly love. Because it doesn't freak me out if I wake up and my neck is sore. Sure. What do you say to patients? Because I've had this end up even with the patient finally complaint against me.

I have a whole video on the channel about it. where I was trying to discourage the patient from getting an MRI for low back pain that I believed not to be from a spinal cause based on my physical exam, the history of present illness. And I felt like there was an emotional component. I introduced it. I asked how they feel about that. They said, I still want the MRI.

I said, I'm happy to order the MRI. But I'm just explaining that if we find something on this MRI, we're likely to end up chasing it when it's not the cause. And she didn't like that answer. So I'm curious how you go about avoiding unnecessary images. in those cases? Well, you know, I'm a huge fan of informed consent. It's, this is, you know, do we agree on what the problem is? So back pain. Okay, you have back pain. Here are the things we can do. And here are the pros and cons of those things. What do you want to do? You decide.

And if I've done a good job of connecting with them, generally they'll choose what my recommendation is, but not always. And as long as it's not irrational, I feel like I work for my patients. I don't work for the insurance companies. I work for my patients. And generally, that works out for me. And I think works out for my patient because if they do, something that, you know, I don't think I would have done it. And it doesn't work. They trust me because they feel like I'm their partner. So you're saying perhaps I didn't form a good doctor

patient alliance with this patient. So alliance is so important. I mean, I don't know because I wasn't there and you probably were as kind and empathetic and listening as you could have been. you know one of the things I learn is and I guess I'm free associating you have to ask patients 10 times whether or not they've ever had a brain injury it's shocking to me so I start imaging like oh have you ever had a brain injury you can see the damage to the left front and to their anterior temporal poles it's sign of traumatic brain injury they go no I'm like well are you Sure. Have you ever fallen out of a tree, fell off a fence, dove into a shallow pool, had a concussion playing sports, been in a car accident? No, no, no, no, no, no. Oh, it's always no, no, no. Oh,

I fell out of a second story window when I was seven. Do you think that counts? Or I fell out of a moving vehicle going 30 miles an hour. Do you think that counts? And I just think it's one of the major causes of psychiatric problems. So when you have a patient that you come across with a history of falling out of a window when there's seven, how do you alter your approach to treating that patient? Well, we go repair the brain injury, right? If you don't do that, then they're going to be living with chronic, whatever, depression, irritability. Not surgically. No, I put them out a hyperbaric chamber.

So I did the big NFL study when the NFL was sort of lying. It had a problem with traumatic brain injury and football, right? Everybody knows CTE. And they have the wrong thoughts on CTE, which we could talk about. But in 1999, Brent Boyd was offensive guard for the Minnesota Vikings came to see me, clearly had traumatic brain injury on scans. And by then, I'd already been scanning people for eight years. He filed a workers' comp claim.

The NFL said he was faking. and called me a quack and just completely dismissed it. Well, in 2007, Anthony Davis, the Hall of Fame running back from USC, came to see me, his brain at 54, looked like he was 94, but five months later, he's dramatically better. And we partnered with the NFL Players Association in Los Angeles, published the first largest study on 100 active and retired NFL players. there's high levels of damage, but 80% of our players got better.

We put them on a really good multiple vitamin, high-dose, high-quality fish oil, and a brain supplement that works in six different ways. 80% of our players got better. Their imaging was better. And for those that didn't, we put them in a hyperbaric chamber, and that improved our outcomes even more. So I'm really excited. So the idea is, okay, boxing, football, soccer, rugby, horseback riding.

They're brain damaging sports. But you can get better if you put the brain in a healing environment. So we specifically target repairing those parts of the brain. And I don't know a supplement company, so I'm a huge fan. but I'm also a huge fan of hyperbaric oxygen therapy. Published a study on soldiers who had blast injuries, showed significant improvement after the first session, and then much more after the 40th session.

You mentioned you're the owner of the supplement company. How do you protect yourself from the conflict of interest that can happen in scenarios like that? You know, I write about the research. I love what we do. I'm so proud of what we do. So, for example, we make happy saffron. 28 randomized controlled trials, 30 milligrams of saffron,

equally effective to antidepressants. So I think my job is just, one, tell people I own a supplement company. So clear disclosure. People know it. and then write about the science behind the ingredients we have. And so I always say no brand violations that we only want high-quality things that have efficacy. And I love that.

So it's not a secret, right? Brain MD by Dr. Daniel Lehman. And people go, oh, but he makes money. Well, I'm like, no margin, no mission. it's like that's not illegal right all doctors get paid for what they do um but i love it and after we made happy saffron with saffron zinc and curcumans there's a brand new meta-analysis on 192 studies on 17,000 patients saffron effective is an antidepressant but when you add zinc and curcumin now this is true if you add it to saffron or lexaphron

Pro. If you add zinc and curcumans, they actually work much better. So I was very happy that I figured that out before. For the conflict of interest portion, people always, I get this sent to me, you're a pharmacill, you prescribe medications, therefore whatever you're recommending is not good. And we hear even Secretary Kennedy of HHS now say similar things. Basically, people bad mouth pharma because they're for profit do you think that's unfair absolutely um i mean there are the reasons to bad mouth pharma like but we absolutely need pharmaceuticals and for the right brain they're incredibly effective and if the companies didn't make money they wouldn't be in business And I'm a huge fan of medicine and prescribe them when I think it's appropriate.

And I'm a huge fan of supplements. And why? Why did I get interested in supplements? When I started imaging, I realized some of the medications I was prescribing were not good for the brain. And you remember in medical school, they go first do no harm and use the least toxic, most effective treatment. And so if omega-3 fatty acids, head-to-head against Prozac, were more effective in a study from New Zealand, well, why wouldn't I start with that? Well, it depends how severe the person's symptoms are.

If someone is having radiation, you don't want to start with omega-3s. Well, nothing works by itself, right? If you look at the studies, there's not much that works by itself for the most. severely depressed people. And I would argue it's because often it's not only the depression, but it's the head injury that's complicating it or it's the infection. Yeah. You mentioned that's why I got interested in it. Yeah, you mentioned there are some reasons to be critical of pharma. What are those? Well, I think that they market them nonstop. And, And so they almost creating the market for it.

How is that different than your supplement line? That's a good question. Supplement companies like mine don't have nearly the money that pharma has. Well, the Global Wellness Institute estimates that the wellness industry is a $2 trillion a year industry in the United States. and big pharma is 700 billion? That would shock, shock me, right? Because I own a supplement company knowing our budget as opposed to Eli Lilly's budget. It's like we're not even talking the same thing.

Or even the very large supplement company. So I just don't know the statistics. Yeah, well, let's take the numbers out of it because that needs to be fact check. but let's say for those who want to advertise a supplement. Like if I want to start my own supplement company, we have 14 million subscribers, very healthy YouTube channel, very active audience. If I wanted to start a supplement company, it wouldn't take much. I have to get someone to give me the ingredients to create the label, send it out.

But pharma has to go through trials. The FDA has to approve it. They have to spend a lot of money. Don't you think it's easier to create a supplement than it is, to create a pharmaceutical? Yeah, no, I think absolutely you're correct. And there are a lot of bad actors in the supplement world. So finding somebody you trust is important.

What's a bad actor in the supplement space? Well, somebody who doesn't test the ingredient, someone who you don't feel confident. What it says on the label is actually in the bottle. So how does an average person to decide that? I think they have to find brands they trust. Consumer reports, does analysis, does independent testing. There are other companies that do that.

Yeah, like consumer labs, consumer reports have done a lot of these trials, and they go to the local pharmacies. They take things that are top selling, and they find 70% of them don't have accurate ingredient lists. Shouldn't that worry people about the supplement industry? It should. And I think they should be cautious, careful. And again, I'm trying to figure out what practical advice to give them there.

So how can they be cautious, careful? They can't test what's in there, which is why I think the FDA tests. No, but they go to a place like consumer labs and go which are companies that are reliable, consistent. I think that's my best advice. before I had my supplement company, I would do that and recommend certain brands for my patients. And if, let's say, the FDA currently doesn't look at supplements, right? But they look at the pharma industry to make sure everything is standardized, validated, efficacy rates are tested.

Even if pharma markets a medication for a use that it wasn't initially approved for, they get in trouble, right? They get huge funds. The FDC, the Federal Trade Commission, if you're marketing a supplement inappropriately, they'll send you a letter, they'll find you, they'll put you out of business. Yeah, you have to be somewhat careful, because I looked into this, into starting a supplement line. If you don't say that something clearly cures something and you just say balanced brain or healthy energy levels and you don't clearly.

clearly say that it does that, you can get by making all sorts of claims. And historically, people have destroyed their livers with some of these supplements, the hydroxycutt scandal of years ago. So there's all these sort of, it's like kind of the wild west out there when it comes to the supplement. Yeah, but I read one study. Your chances of dying from a supplement are like 60,000 times less than dying from a medicine.

Now, it doesn't mean. that you shouldn't be thoughtful and careful on what you put in your body. You absolutely should be. But when we look at pharma and the level of death from pharmaceuticals, it's not even the same league with supplements. So death is the way you judge the safety of these medications?

Well, it would be one way. well sure but the idea that 70% of them don't have the thing in them that's pretty problematic too imagine the pharmaceutical industry turned out that when we tested their medications they didn't have what was in there their insulin was only present 70% of the time that would be a big deal you know i can only speak for brain MD and i'm very proud yeah do you think the FDA should be out there randomly sampling and testing to make sure that these supplement companies have what's written on the label? I think it's a good idea to police whatever people put in their bodies. Yeah, I'm always for that, just because right now it's against such a wild west. Even consumer

reports published recently a study of heavy metals inside protein powders and how people can be inadvertently trying to be healthy, but perhaps getting, especially if they're taking mega doses, you know, some of these body builders, scoop, scoop, scoop, scoop. And before you know it, you can get a serious problem developing there. And some of the brands are very legitimate, very popular brands that you see selling quite well. So I'm always trying to figure out what's a safe recommendation that I can give universally to my patients. I'm curious, we never kind of settled on our question about the compliance issue. That you mentioned that getting these imaging tests is valuable for compliance. And I was talking about how we could potentially scare people away

from seeking health care, from a mental health care, specifically, from a provider who doesn't do imaging. Do you have any fear that you might be discouraging patients from getting good quality medical care or mental health care just because they're not doing imaging? Well, I guess, you know, the question I have is do you really get good quality brain health, mental health care if you have no idea what's going on in the organ that you're treating? I don't think so. I mean, I wanted to write a book. once called Flying Blind and the rain of the American mind. Wow. Dark.

And I'm sort of sad. I didn't write it. I actually had a book deal for that book. And I'm like, it's just too negative. But what is happening in American society today where 57% of teenage girls report being persistently sad? Or that it has been, It has increased significantly in the young since the year 2000. That with all this sadness, the use of antidepressant medication has skyrocketed. In 2021, there were 337 million prescriptions written for antidepressants. And we're not teaching people how to love and care for their brains or manage their minds. And I think if we imaged that people would care about their brain a lot more,

they would just eat better, think better and do a better job of taking care of themselves. So I think we're in, I call it a whole four crisis. We haven't talked about this. Don't hate me. God, it's so frustrating. I'm working with the White House on a national brain health revolution initiative, specifically with the White House Faith Office,

because they believe that brain and mental health are sacred human rights. And I have people that just love me and support my work there. And as I explain it, It's we're in this whole four crisis. We're in a physical health crisis. I think you and I would agree with that.

Chronic health conditions, all time high. Of people overweight or obese, 50% diabetic or pre-diabetic. 90% of our health care dollars are spent on chronic preventable illnesses. We have these epidemics of anxiety, depression, autism, ADHD addiction. Before the pandemic, and then everything got worse. loneliness, 58%, so biological, psychological, social, spiritual,

where 58% of young people report a lack of meaning and purpose. But I believe the answer to these epidemics is not to see them as separate disorders, but as different expressions of the same unhealthy lifestyle that have exactly the same cure, which is getting your body, brain, mind, relationships, and spirit, healthy all at the same time. Yeah, you're looking at it more holistically.

Right. I did a program with Pastor Rick Warren called The Daniel Plan. It actually came out of a prayer. I went to my church. I just finished writing, change your brain, change your body. It's 2010. Went to my church on a Sunday morning. I was so happy and walked by hundreds of donuts for sale for charity.

and it just pissed me off. I'm just like, I'm going to church to get my soul fed. These people are trying to kill me. And I prayed God would use me to change the culture of food at church. And two weeks later, Rick Warren, who is our generation's bestselling author, he wrote The Purpose Driven Life, sold 50 million copies. He called me up. He said, I'm fat.

My church is fat. Will you help me? We created this program called the Daniel Plan that ended, up being done in thousands of churches around the world and like how do you get people healthy you get them healthy where they live whether in their community and their churches in their businesses and their schools and that's part of this sort of national brain health revolution yeah these uh mental health this mental health crisis that we're facing we have as you said teenage girls experiencing high level of sadness, the amount of SSRI and antidepressant

prescriptions are going up and up. You think this is partially due or maybe majority due to the fact that psychiatrists are wringing their brains? I think that as a specialty, we have gone to be the prescriber rather than the healer, that antidepressants don't cure. anything. They suppress symptoms. I think, um, do they say that it cures it? It's not psychiatry's fault. I've never heard a psychiatrist say that antidepressant's cure depression. You don't hear that. Yeah. That it cures, anything. Right. Right. I heard once John Paul DeGioria speak. He, uh, founded Paul Mitchell, the famous shampoo company. He said, you never want to be in the order business. You always want to be in the reorder business. You always want to be in the reorder.

order business. And once you start these medications, people don't stop them. Well, the goal is not to use them indefinitely. I think the correct indication is to create a bridge to get people over their life. And how many of your patients, once you start them, stop them? Almost all. I have a rule that if we're starting an antidepressant, we're creating a date that both me and the patient are comfortable with, where we're doing reevaluations, whether or not they feel that they're in a safe place to come off, given their circumstances. Because being in a community health center, I'm working with people who are disadvantaged, who are taking care of multiple children on their own, family members in prison. And as a result, sometimes they need the antidepressant.

They don't have the capacity to get scans, to get a hyperbaric chamber. It just, it's not feasible. There's the perfect model, and then there's the realistic model by which a lot of family medicine doctors have to practice by. We're talking about two different things. Yes, I think in this situation, but most people who start stay on them. Most people who start don't have Dr. Mike that go, we're going to start this, and then we're going to reevaluate it and work on getting you off of it. That's not been my experience. I agree with you. I think there's a lot of reasons to that from what I've seen in the medical

community. A big part of it is the consumerization of it. We blame pharma for marketing these medications when I have seen patients say that I'm not getting rid of this. This helps me and I need this and I can't function without it. And if you're not prescribing it to me, you're evil. And perhaps they are right in some instances. So I don't want to discredit what they're experiencing. But in some instances where I feel that we should be having that discussion, some patients aren't open to that. Well, and ultimately, I think my job is informed consent like we talked about before. But head-to-head against antidepressants, exercise is equally effective.

Head-to-head against-again, there's a lot of caveats that you need to be made there. Head-to-head. But learning how not to believe every stupid thing you think is equally effective. Sure. and omega-3 fatty acids and saffron. And so I'm thinking, let me at least go the, because a lot of patients who come to see me, they don't want to take medicine.

They're like anything I want to do. Which is why I think our worlds are so different. You're having this pre-selected, highly motivated treatment preferred specific group come to you versus I essentially function in the wild. and you're working in a zoo for lack of a better example with domesticated animals. I was an army psychiatrist for seven years.

For sure. But I mean in your clinic. And here, those patients aren't super excited about a specific approach. Yeah, no, the people come see me are excited about it. Which is a huge advantage. Do you see that that's a huge advantage?

But then a lot of them, grandma's pan for them to come see us. And they're not super excited. And we have to get them excited. And the imaging really helps that. Well, let's talk about the imaging because Kim Kardashian recently got some imaging done and you found some results on her.

Tell me about that. She had sleepy frontal lobes. What does that mean? So spec is a study of relative blood flow. It looks at activity. Actually, 49% of the tracer is taken up in the mitochondria in the brain. And she had less activity in the front third

of her brain, which means it's going to go with things like forethought and judgment and impulse control and focus. She wanted to be better. She's in law school and get ready to take her boards or the bar, getting ready to take the bar and wanted to function better. And I had previously seen Kendall, who had post-COVID anxiety, and Chloe, who had a traumatic brain injury. She's in a bad car accident. And they got benefit from my work. So I saw Kim, and it just blew up because the little clip they played was her and I talking, showing her brain with lower activity in the front part, which is not good for her. And once you find that there's this low activity what is your recommendation in those scenarios is fix it is improve it and so you can do it with

medicine you can do it with supplements you could put them in a hyperbaric chamber and see if that does it there's neurofeedback that you can do there are also some stimulating um treatments you know things like TMS. So my job is to give her the options. I think we went with stimulating supplements and see how that works. And the cool thing is you can look at it again and go, well, is that working. If you were to interview Kim and hear all these struggles that she's having, taking the bar, issues with impulse control, would you have been able to come to that same diagnosis without the imaging? Well, I would have been able to guess at it, but I wouldn't be able to know. Well, there's a difference between guessing and asking validated questionnaires.

So I had this discussion, actually, with the head of the National Institute of drug abuse. And she goes, but the brain has language. And it's like, no, you can't see low blood flow from just talking to somebody that that's just an insane position in my mind it's like well how would you really know if you didn't look and it's like oh well I can tell because you had these symptoms it's like no you can't it's like that's a leap in logic that just isn't correct because that's like that's like That's what most psychiatrists believe now. Oh, you have six of these nine symptoms. You're depressed.

That means your limbic brain is too active. I'm going to give you something to calm it down. Well, SSRIs wouldn't have black box warnings if it worked like that all the time. And it's just not my experience, even a little bit, is I can get 100 people that are depressed. and we're going to find seven or eight different patterns. In fact, I wrote a book on ADD, Healing ADD, C and Heal the Seven Types. I'm like, it's not one thing. Why is Rital and Controversial when it can take the right kids from C's D's and F, stays, and B's,

but make other kids suicidal, right? I mean, why is Rital and Controversial? because it works dramatically well for some kids and it disrupts other kids or adults. You said that based on your questionnaire, you would still have questions that needed to be answered that you could get answered by this imaging protocol. Does your treatment then change?

79% of the time. I published a study on this where we took 107 cases, gave them to board-certified Skyer, took out the imaging and we got here's the history here's the mental status exam here are the answers to the questionnaires what's the diagnosis and what would you do and then we added imaging and we go in what percentage would it change eight times out of 10 from their protocol it changed their guidance change their guidance why is the imaging so controversial like even when you came in you said that people hate you now is it

because of the imaging? Well, some people love me. You have a lot of people who love you. I have a lot of people who love me. But if I'm right, and I think I am, that means 40,000 psychiatrists and actually hundreds of thousands, family medicine doctors, nurse practitioners,

OB-GYN doctors, internists, right, everybody and their mother prescribes psychiatric drugs. 85% of psychiatric drugs were prescribed by non-psychiatric physicians are flying blind. And when you say that, they don't say thank you to that. It's like, we need a new paradigm. And we need a paradigm based on imaging, because what imaging will do is completely reshape how we diagnose and treat people. Why don't, like, if we're flying blind, why don't we include this image?

Why doesn't every family medicine doctor, why does the American Psychiatric Association, American Academy of Neurology, why are they against this imaging? Well, not everybody's against imaging. That's really important. Society for Nuclear Image Medicine. Do you ever read Thomas Cune's book, The Structure of Scientific Revolution? It's such a good book. It was written in 1962 because when I first started imaging, there was.

It was all-day seminars at the American Psychiatric Association on brain spec imaging in child and adolescent psychiatry. All-day seminars. And I went, I loved it. In 1993, I taught in it. And then they go, oh, you shouldn't use this. We're like, well, why? Remember, I told you my dad, bullshit, no. I'm like, bullshit, no. Why? I'm a better doctor. Because I use this. And it doesn't fit the paradigm. It does not fit. The DSM paradigm is we make diagnoses based on symptom clusters with no biological data. This is the paradigm. But if it works, why wouldn't they want it? Okay. So Cune talks about six stages of

scientific revolution. Normal science. So you're just going along doing what everybody else does. Stage two, somebody notices is there is a problem. I prescribe Prozac. Some people get better. Some people want to kill themselves. Okay, we have a problem. Three, the status quo sees there as a problem.

But they make small incremental changes to protect itself and the money. And so how many versions of the DSM are there? Well, there's six of it. Even though it's DSM-5, there was three and three are. But it's the same as DSM3. It's really not different at all. Stage four, somebody comes up with a new paradigm,

detailed histories, imaging, natural ways to heal the brain in an integrative or functional medicine approach. We haven't talked about that yet. Stage five, is the most consistent of all the stages, the rejection. it's like no you're crazy this is how we do it the brain has language you don't need imaging you know in science we're trying to always come up with the validated solution to our

problems and when i read people who are smarter than me who understand this feel like the society of nuclear medicine i don't fully understand what they're talking about if i can't argue the nuances with them i can't argue the nuances with you but their statement as an organization that is set out to seek the best for their patients, perhaps imperfectly at times, say that this imaging is not validated enough to be used. And it's not that they're against imaging. They're just saying that the imaging is not validated or can be used repetitively across a diverse group of patients. So it's not that they're anti-looking at the brain. They're anti this specific method because they feel that it doesn't have enough evidence. But you know, the Canadian Association of

nuclear medicine wrote procedure guidelines on spec, as if I wrote them, that spec is indicated for head trauma, for seizures, for dementia, for stroke, for addiction, for toxic exposure, for neuropsychiatric indications. So it really depends who you read, right? Well, I'm reading the largest agencies that represent neurologists, psychiatrists. It's like me saying something fully against the American Academy Family Physicians without evidence to say why I'm disagreeing with them. Well, I have 90 studies

that I have published and I have the world's largest database and I actually don't know what the point of us argument about it is I have more experience in this than anybody probably in the history of the world and if you don't look, you don't know. And some people go

oh no, we should just continue to do what we're doing which is a disaster. in our society, and I'm like, no, I don't believe that. We need to do better. And if you don't look, you don't know. Logically, what you're saying makes sense. And I think evolution-wise, scientifically, all these organizations will agree with you that we need to move in that space. But do we have the randomized control data to be able to back these things up? Well, give me an example, and I'll tell you what the research.

search is. Let me ask you a specific question. Is there randomized control data on spec scans and their efficacy in a specific mental health condition? Yes. Which one? Well, which one do you want to talk about? Anyone. I mean, if you go on PubMed. Well, can you name one right now? You're the leading expert. So I'm a family medicine. I don't know. One of the most important things to do is distinguishing post-traumatic stress disorder from traumatic brain injury. And because they often present with similar symptoms, but the treatments are actually opposed to each other. PTSD generally you want to calm the brain down, traumatic brain injury, you have to repair and stimulate it. I published two studies on 21,000 people.

showing we can separate these groups with high levels of accuracy. In 2016, Discover Magazine listed our research is one of the top 100 stories in science. We could also talk about Alzheimer's disease. But that's not a randomized controlled study. I'm sorry? That's not a randomized controlled study. We're talking imaging. Yeah.

This is not a pharmaceutical intervention where we're going to do a randomized... Well, the goal of doing the image. imaging is to create more customizable treatments, as you said. And if you have customizable treatments, your outcomes should be better. That's the randomized controlled study. And our outcomes are better. We published a study on 500 outcomes. Randomized controlled data is really important.

Wouldn't you say to develop a causal relationship? I'm sorry. Say this again. Randomized controlled trials are very important to creation, causal, interventions to say that this isn't just a correlation. This is a causative pathway. You need the randomized control data to remove outliers, to create a generalized group, to have them double blinded, to not know which one's getting intervention, which one's not, because it's great that you're helping people. And I am so for that you're helping people, and I want more of that. Now I'm

trying to think, as a family medicine doctor, how can we generalize what you're doing so that I can do it too. But in order for me to do it, I need to know it works from a randomized controlled study. Why don't we have that? So, design it for me. Because you're going to randomize, you got imaging, you didn't. So automatically it's not blinded. Well, you can get sham imaging. Okay. you've been doing this since 1991, so I'm trying to look at you as the expert. Do you not feel that it's an issue that there is no randomized control data? Like you're asking me to design the trial right now.

We have data that goes, you get better and you don't. So what's the difference in depression of people who got better and those who didn't? where are you sourcing those patients from well from our clinics so all your patients are getting the spec you're not separating into groups of here we're treating patients who didn't get spec well no not everybody gets scanned at our clinics but for the research you're pointing out like you have this study that shows 84% of your patients improved but we're not comparing them against a group of people who didn't get spec no but nobody is that I know of has outcomes like that. But do you think that's enough for me to start doing spec in my clinic?

I think if you started doing spec in your clinic, it would revolutionize your practice. And you're saying that as someone who's passionate about it or that there's proof of that? No, I'm saying it as someone who has taught people around the world to do imaging and they become passionate about it. Yeah, so we talked about the patient selection of it all earlier, how if you have patients who are highly motivated, it can bias your outcomes. Like we do Journal Club in my family medicine residency. And part of it is, is there a bias from the patients? Is there a selection bias of who you're selecting? And when you have your clinic, people who love you, is there a chance that you could be introducing bias by only looking at the people who love you, support you, and want

your treatment? Well, I mean, we do have a more motivated group for sure. We have a group, yeah, I think it's a more motivated group for sure. And what outcome do you think that has on the outcomes that you study? So we actually did this study this week on compliance because we do a formal outcome study on everybody we see. I mean, I don't know if you know many clinics that do that, but the people who are very compliant get better way faster

and much bigger numbers. So we ask everybody about their compliance. And compliance is just huge. I think you would agree with me. Yeah, for sure. And it's great that you're doing the reassessment because I feel like that's missed a lot of the time. Well, very few clinics actually focus on outcomes.

And for us, it's research, but it's also quality control. Sure. And if you're not compliant at all, your outcomes are not very good. That's for sure. But also mental health patients or patients who have issues with their mental health, they tend to have lower compliance, not because they're, bad people or saying something negative about them. They're going through something. No, it's because their brains aren't healthy. So, I mean, yes, they're going through something, but in large part

because their brains are not healthy. I mean, we might agree, maybe not, that if you're depressed, something's going on in the organ of how you feel, which is your brain. Sure. And like you're such a proponent of CBT, we say depression can be a chemical imbalance. Well, CBT actually alters the chemicals in your brains, right? Yes. That's psychological treatments like EMDR or CBT. DBT, whatever alphabet soup we want to put, but they all help with changing the chemical composition. Right. But you're still advocating, at least what I'm hearing, is you're still advocating for not looking before you go about changing? I, because I don't want this to feel like a gotcha, because what I'm trying to do is...

It doesn't feel like a gotcha. It feels like a good conversation. I really want to learn from what you're doing because I want to be a better doctor, genuinely. Like my goal, why I still practice medicine is because I want to deliver the best care for my patients. And if what you're doing is great, we need to get that message out there to the world as fast as possible because otherwise people are suffering. So in order to make the generalization that everyone should get a speck skin before... But that's not what I said. But if I get you to be a better doctor, just start thinking of mental health as brain health.

Is this person actively working for their brain's health? You can do that in your practice. Without speck skin. going to be a day when spec or fMRI or quantitative EEG or pet is going to be covered by insurance and you're going to be able to use it but what you can do today is you can go if we improve the health of your brain your anxiety is going to be less and it starts with one question i teach all of my patients whatever you're going to do today is it good for your brain or bad for it. Is it good for your brain or bad for it? And that will begin to spark a revolution

in their life. Now, if you have somebody that's not getting better, you should advocate for them to be imaged because to continue to fly blind is not anybody's interest. So for my patients who have such bad major depressive disorder that they can't groom themselves they have trouble taking a shower the solution is asking them if what they're doing is good or bad for their brain you think that's enough motivation to help this individual no it's all of it see now i feel like you're twisting my words to create conflict please tell me uh how do i like if somebody because you're saying the one question somebody is that bad you should be advocating to look at their brain because you don't know if they're living in a mold filled home

that is damaging their brain right i mean we check everyone's brains everybody should be asking themselves that question is what i'm doing today good for my brain or bad for it but do you spend any time is a family doctor asking about mold no is this good for your brain or bad for it going through their habits or just teaching them to love and care through. I don't. I don't. And I'll tell you why I don't. A, we don't have enough time with our patients. So that's a little bit of a cop out. But at the same time. Yeah, because that's a really easy question. That's like, in the seven-minute visit,

you can take 30 seconds to ask them that question. You'd be surprised. But you don't have it in your head yet because we were never taught that mental health is brain health. I do ask that question without asking the question. is my second point. I ask questions that don't directly ask about the brain, but ultimately point to me behaviors that they have that put their brain at risk. So I ask about smoking, I ask about alcohol, I ask about diet, I asked about intimate partner violence, I ask a PHQ2 screening question. So while I may not be saying the question as specifically as you are,

I am figuring out the mental health state of the brain. But not the brain health state of the brain. See, that is the distinction that if we get anything. What is that distinction? Because I'm having trouble understanding that. It's not mental health. It's brain health. The distinction is one is loose.

Mental health, that's very loose. is PHQ 9, GAD 7 stuff, or is your brain healthy? And if you want to keep your brain healthier, rescue it, you have to prevent or treat the 11 major risk factors. So I told you, so the big three ways I want to transform psychiatry, imaging, if you don't look, you really don't know, natural ways to heal the brain, in an integrative or functional medicine model.

And that's why our model not only works to decrease depression, it helps to prevent Alzheimer's disease. And I think you prevent Alzheimer's disease by prevent or treating these 11 risk factors. And the acronym I talk about is bright minds. Like B is for blood flow. Low blood flow is the number one brain imaging predictor of Alzheimer's. disease as is sleep and then all sorts of things in between so you said that when a patient is that

severely depressed they should get a spec skin is that true for all patients that are that severely depressed that they have trouble shower and getting up out of bed absolutely because how do you know why they're that way well uh the issue that uh i believe no no answer the question how do you know what is actually going on in that person's brain without looking? By asking them questions? By doing validating question? That's complete crap, Mike. It's complete crap that you know what's going on in that person's brain.

You're guessing, now, maybe it's an educated guess, but don't tell me you know because you completely don't. Well, here's my defense of why I feel like it's better than just a slightly educated guess. because when you look at randomized controlled trials for people who get either therapy or antidepressants or sometimes both, we see the improvements. So while it looks on paper like a guess, we see the outcomes hold up validated across research. I've been doing this for 45 years.

You're guessing. And maybe you can point to some studies that say, oh. Are you saying there's no studies that show therapy, CBT has evidence based on? You're completely mixing lots of different concepts. This patient, you don't know because you didn't look. Now, are there studies on big populations, and most of the severely depressed, like you're talking about, there's not one single thing that works for them. They need a combination of things that...

I didn't say that they wouldn't. I just said that there could be a combination. But you don't know what's causing it. And I think imaging holds such a key here, which is why I'm trying to figure out how to get it to the masses on a level that is scalable. So I'm trying to figure out how we get there. How do we get spec across the APA, the A&? How do we get everyone? Well, I think the Canadian model, I mean, it's covered by insurance in Canada.

I think that is a really great model, that there's a lot of research that when you really understand it, put it together that imaging plus clinical evaluation, we have better outcomes. And that's why they wrote the paper. I didn't write it. I'm not an author on it. But we don't have that. I just, we just, we do have imaging and head trauma, imaging and depression. But I'm not asking for imaging. In order to universally recommend the treatment, you need randomized. It's not a treatment. It's not a It's an assessment. I know, the assessment leading to the treatment, which changes ultimately the treatment because it's customizable.

In order to verify this, we need to be able to test it with a randomized, double-blinded, controlled study. And in 30-plus years of doing this, you're okay with not one study being done? So I've published a lot, like I published on. NFL players. And I published on, here's the pattern for it. Here's the pattern that after treatment. I haven't done a study where, okay, everybody gets scanned, but we only use the scans and half the people and see, I think that's the study you're thinking about it. Well, let me ask it to you in a different way that takes us out of the equation. If a pharmaceutical company came out and said,

we have this medication. It works. We never tested it against any other placebo. No randomized controlled data, but everyone who takes it loves it. Would you buy into that pharmaceutical? Or would you say, I need to see the data? You always have to see the data. Where is the data with spec scans? It's 15,000 abstracts on spec on PubMed.gov today. But again, we're talking about the need for the randomized control data to be able to take bias out of the equation. You said you have a more motivated patient population. These are all issues that can make actually spec not helpful for people and perhaps a spending of money that is not

valuable given how constricted our health care spending is already or needs to be. So you're arguing we should just continue to fly blind. No, I argue. But see, do you think I am advocating for flying blind? Can I tell you what I'm advocating for? Then you tell me if you agree with my notion. I think we should test spec to see if we can improve and no longer fly blind. And if it's not spec, perhaps it's something else. You don't think that's reasonable of me to say that? No, I think more studies. One study?

I think that would only help. Yeah, I agree too. and I'm curious, why do you think they haven't been done? I don't know. The first study that was presented in 1992 at the American Psychiatric Association is they took 100 bipolar teenagers. 50 of them were scanned on the day of admission.

50 of them were never scanned. They looked at the average length of stay. For the kids who were never scanned, it was 44 days. Now, this was, and you could actually keep people in psychiatric hospitals. For the kids who were scanned, it was 15 days, was an average cost savings of $15,000 per hospital stay. Is that the kind of study you're thinking about? No, but it's getting there. That's a great preliminary piece of research that I think we can build upon, because I think we would agree that there's a hierarchy of evidence.

for recommendation, for deciding between causation and correlation? You agree with that? Yeah. So to me, unless we have that randomization where we take two groups, ideally match them as best as we can, randomize them so they don't know what they're getting, blind them, test the outcomes based on the treatments being more customizable in the spec category, and then if we see this drastic improvement,

everyone changes their mind. AAN, APA's recommending it, we're all getting it done. Yeah, see, I don't, I'm, that would be great if that happened. You don't want to make a push for that on this podcast? I'm not sure this podcast is going to get this to where we need to go. Why not? That would surprise me. But this is so valuable.

I feel like spec can help so many people based on the way you're presenting it. I think it can too. But you know, so if you, if we present randomized controlled data to the AAN, APA, we publish it in the Lancet, together, let's say. We can change the practice in the United States. Isn't that something you would want? Absolutely. So what's stopping us from doing it? I'm all for it.

Okay. At least you're for it. That's really exciting. Because when we think about. people who are critics of spec, I want to prove them wrong, right? Because I want to help people and I'm on your side and I want to figure out how to get this done correctly. But if we're trying to do scientific research, it shouldn't be done in a way where Secretary Kennedy said, we're going to prove that this causes this. Scientific research starts with asking a hypothetical,

asking a question, creating a hypothesis, disproving yourself, proving the null hypothesis, not just agreeing with yourself or seeking to agree with yourself. Do you agree with that? I'm not always thinking. You want to set out to disprove yourself if you're doing research. Because ultimately, if you can't disprove yourself, that makes your information stronger. And look, there are some instances where correlation can be strong enough, where you actually don't need a randomized controlled trial?

How do you do a randomized controlled trial on you have Alzheimer's or you don't? I mean, they have autopsy confirmed data that Alzheimer's disease, which has been described in the literature for 35 years. So you need better data than that to say spec can help in the diagnosis of Alzheimer's disease? I need SPECT to differentiate itself from the standard of care as exists today for it to be found valuable and widespread recommendation. And I would argue for... Because SPECT is expensive. Speck has radiation.

It can fuel misdiagnosis. So I also don't want to overdo it with spec. So I'm trying to find the reasonable middle ground. Oh, yeah. Is that on, I don't, correct me if I, please disagree with me. I, yeah. You're arguing for the status quo until someone can show you a randomized controlled trial for a specific diagnosis, um, although I gave you the one with,

bipolar disorder um yeah i'm just thinking flying blinds not the answer i agree i don't think we and i didn't you didn't bring this up and probably you don't know the american psychiatric association last year named me a thought leader and but i'm not i'm not attacking you here this isn't i'm not anti your work i'm trying to figure out how to get your work to more people i'm literally i'm we're on the same team helping patients yeah and hopefully bringing psychiatry into the 21st century rather than making diagnoses just based on symptom I agree and I think I'm just trying to do it without doing it prematurely because with any medical intervention there could be drawbacks think we did it prematurely I think but you don't have one randomized controlled

trial. Well, we're not, we're not thinking about it in exactly the same way. How are you thinking about it? If I get a scan, on the day of admission, it cuts hospital days 67%. That's pretty exciting. And what I saw as a clinician is it changed what I did eight times out of 10. Not only did it increase compliance and decrease. stigma, it made me more effective because I had a roadbound. I think that's great. But again, how do we get that out there?

Because I'll give you an example. So for my patients who are over the age of 40, I can do the ASCVD risk score, which is their 10-year risk score of having a stroke or heart attack. Now I plug in some numbers into this calculator and I get a percentage. This percent, based off this percentage, I can decide course of action for patient. And the reason why I'm comfortable using the score calculators is because it's validated across diverse patient population, randomized controlled studies done on it, seeing what the actual outcomes are from doing this risk score calculator, as well as the interventions that follow.

There are some people who make their own risk score calculators in the cardiovascular world, and they choose their own numbers to plug into their calculator. Here's why I don't agree with it, because it's not validated across a diverse group of patients. Do you see why I don't like their calculator as opposed to the 10-year ASCBD calculator? But some of them will come and show that their calculator helps 84% of their patients. Now, using their anecdote of helping their patients, should I then just throw away my other calculator and say, patients, I'm going to use this new calculator now because this person said this about their clinic. or should there be a level of skepticism, like your father said, and said, BS, no, let's test it.

Or should we just accept it? Well, I think you should test it, which is why we do outcomes on all of our patients. No, is that going to randomize, is that going to go with your patients? No, but your patients will be better if you added imaging. But are we going to talk about the book at all? Well, I mean, this is a premise of your book, no? Imaging is not the premise of my book. Is not in your book?

It's in the book, but it's not the premise of the book. We're not going to talk about the book. What do you mean? We talked about pain. We talked about the cycle of pain, how your brain has this blueprint that it starts cycling between that we're on board with.

We talked about Dr. Sarno's work. Do you feel like I'm being unfair? If you think so, please tell me. Yes. How so? Because you're like going on the same thing over and over again. Yeah, no, it doesn't feel fun or fair. But I love talking about our work.

And it's interesting to me. Often I've been criticized. And very few people go. so you've seen more scans than anyone in the history of the world what have you learned and as opposed to well you didn't do this and you didn't do that and you should have done this and don't you think it'd be better if you did that as opposed to so what did you learn from nearly 300,000 scans are you saying I said that no that it just doesn't feel like it right i mean i can only tell you my experience it feels like but don't you think i should be a

skeptic on behalf of my patients i think you should be curious i'm so am behalf of your patients that if you could help them have a better brain they would have a better life and that things like Alzheimer's disease. So I wrote a book in 2005 called Preventing Alzheimer's Disease and got no end of grief. It's like that's giving people false hope. And last year, the Lancet came out with an article that said 50% of Alzheimer's is preventable. And what were the tips that you gave in that book? So it was bright minds. You want to keep your brain healthy or rescue it. You have to prevent or treat these 11 risk factors that if you're pre-diabetic that's an emergency because diabetes if you have diabetes you have all 11 risk factors just that one so it's going back

to really creating this revolution in brain health getting people to love and care for their brain and if i was a family medicine doctor i would be thinking as mental health as brain health like the need for treating patients with pre-diabetes uh i frequently struggle actually in finding motivation uh from my patients when they do flag on their labs having a hemoglobin a1c in that level of saying hey this is when it's reversible because once technically maybe there's some outliers. Once you become a diabetic, you're a diabetic for life, at least in terms of your risk factors. Weight loss, extreme weight loss can seemingly control it because we've seen those who have bariatric surgery not need medications anymore, even though they were diagnosed

with type 2 diabetes. But in the majority of cases, the time when it's reversible is the pre-diabetic stage. So I struggle in helping my patients get motivation there. So which of these 11 recommendations in the Alzheimer's book, do you think that we're lacking in the primary care space so we can encourage doctors to do it? I think it's, so much of these bad things that happened to your parents

that we can prevent if we work together to be very serious about it. It's one of the beautiful parts about imaging. On my podcast, We had Julius Randall recently, three-time NBA All-Star. He's depressed, smoking way too much pot, about to get divorced. And he saw his scan, and he's like, oh, no, I don't like that. Immediately stopped smoking pot.

And a year later, his life's completely different. because the images created an idea in his head that if he didn't do the right thing, it was going to get worse, and he would be worse. And if he did the right thing, it could be better. One of the reasons I fell in love with imaging. It's creating the hope, and hope is tomorrow can be better, I have a role in it, it's creating that sense of agency in your patients. And if they don't ever get a scan, you could show them the images. If we don't do the right thing, your brain is headed

this way. But if you do the right things, it can be better, which is why my first big book, change your brain, change your life, I think work because it was a book of strategies and hope. Get you and your crew to the big shows with Go Transit. Go connects to all the main concert venues like TD Coliseum in Hamilton and Scotia Bank Arena in Toronto. And Go makes it affordable with special e-ticket fares. A one-day weekend pass offers unlimited travel across the network on any weekend day or holiday for just $10. And a weekday group pass offers the same weekday travel flight. from $30 for two people and up to $60 for five.

Buy yours at go-transit.com slash tickets. Yeah, because using that motivational tool as a behavior modification tool could be quite valuable. Like I actually am not against finding unique ways of trying to motivate my patients because ultimately, if I had to say my biggest struggle outside of our health care system, is finding motivation in my patients who are perhaps depressed or maybe don't even have a formal diagnosis, but have issues with life that are ongoing, that aren't easily resolvable, custody battles, divorces, et cetera.

So my only concern with using the imaging as the compliance benefit is that if you were just using it in that way, I see the benefit, but then when you're criticizing the rest of the psychiatric community, it's almost impacting our ability to practice medicine because we're not doing the imaging. Do you see what I'm saying with that? Yeah, but I can't not say what I believe the truth is because then the field will never change. But why can't you just say the tool is beneficial?

I'm sorry? Why can't you just say this is beneficial? This is how I motivate my patients. But when you say we're flying blind, you're creating this distinction for patients that are saying, we don't see Dr. Aiman and we see Dr. Mike, we're going to get subpar blind care. Why would we ever do that?

Why would anyone want to go see a doctor that's flying blind? It's a good question. But do you see how it sets up the dichotomy for patients where they have to make this terrible decision and they're already not in a good mental health space? So I'm curious, can we use it as a compliance booster

but not necessarily shame the rest of psychiatry? And instead... So how do we move forward if we don't say that what we're doing is flawed. We need to... Well, first of all, you could say what we're doing is flawed.

But I think it's not fair to say you have the solution until we have the randomized controlled data. Yeah. You could say you're working towards that solution. Because I have outcomes on thousands of patients. I mean, I published the outcomes

on the first 500. And this is what I believe, that if you don't look, you don't really know. And it's not based on 40 cases that we've seen. It's based. You keep saying these criticisms and defending them that I'm not saying. I'm not saying that you have a limited number of cases. I'm not saying anything negative about you. I'm just saying that the randomized control data that I need for universal recommendation is missing.

And I feel like that's important. I mean, the critics of spec say, depending if you have a cup of coffee, certain parts of the brain imaging will change. It's the same way. They're very consistent over time. There's a study from UCLA, Ishmael Mena, that over three weeks, there's less than 3% variability. Plus, in our clinic, we do two.

We do one at rest, one when you concentrate. And so we have 100,000 rest concentration scans, and your pattern is going to be your pattern, unless you get drunk. It does change during the time of your cycle, which is very interesting. If you never believed in PMS scans during different times of the cycle, we'll convince you it can be a real thing. Yeah, no, they're very consistent over time.

Well, given the fact that certain things interfere with them, couldn't that make it weaker? Like, for example, when I prescribe a patient to get a HIV screening test, right? I know the sensitivity and specificity is to a level that I'm comfortable giving this test to someone who has no symptoms. But in these scenarios, what is the sensitivity of a spec scan on the same person, weeks apart, across a diverse group of people,

and does it hold up? We don't know that yet. Well, Mena said it was less than 3%. Well, in that study, but I'm saying the randomized controlled data is missing to be able to diversify it. Again, I'm not talking about the initial research being found. I think the research are you doing so important

because you need foundational research. The first doctor that said, wash your hands in between the morgue and delivering patients was viewed as someone who's making stuff up and see something on that. died in poverty, crazy. In the insane asylum or something.

So Ignis Semmelweis. But we need to be able to test whether or not these things are valuable. And I'm, I don't understand why you're not leading the charge for that as the number one proponent. I've published more research than almost anybody on. But there's a difference between publishing outcome data. Outcomes, how it changes clinical practice. I published on ADD multiple times of a new study coming out on bipolar disorder.

We've published on traumatic brain injury. I published review papers. There's a lot of published research on it. We haven't done your study. But you keep saying it's my study. Or the one that you keep talking about over and over again in the last hour or so. Well, if you're trying to find out something.

We've published a lot. I mean, it's very important for people to understand in my book, the end of mental illness, there are 1,084 references. Because if I'm going to make this big idea, paradigm shift, stop calling it mental illness, start calling these things what they really are, their brain health issues, that I have to be able to back that up. and talk about a lot of the research on spec for a wide variety of conditions. But even though I can tell you the pattern for OCD, I can tell you the pattern for autism,

it doesn't say what your brain who has OCD looks like. And if you don't, because if all the patterns were 80 percent, sensitive and specific, and we have ADHD data that's way higher than that, but not everybody has that pattern. That's why you look, not because spec can say, oh, you have this or that diagnosis. You and I can say you have this or that diagnosis. What you and I can do, can never be able to do, is to go, this is your brain pattern, and that's how I need to do. target the treatment to you, not your cluster of symptoms. We can change the threshold in the imaging to make it appear different.

So? What does that mean? I mean, yes, I can make your scan look terrible by changing the threshold. Well, that's what I'm saying. But why would I do that? I mean, I make how we render the image. What would we make a threshold for what is pre-diabetes? We take a diverse set of people that is generalizable to the individual, and because we have this randomized controlled data, validated data, we can then say above 5.6, you're entering pre-diabetes, above 6.5, you're getting diabetes.

But with these thresholds, do we have validated thresholds to say this is where you should set your imaging parameters? We do. Yeah. With normal. We have normal. So average is 72%. So spec is a study of relative blood flow. What that means is we take the coldest spot in the brain, make that zero. The hottest spot in the brain, make that 100. And we scale everything between these two poles. And the average, most parts of the brain outside the cerebellum, is 72. And so two standard deviation, standard deviation is six, two standard deviations, 84, so above 84%, we think that's increased activity in the brain, below 60%. We actually use 55 for safety, two standard deviations or more below. Those are the thresholds.

That's how we set it, again, very consistent with the data from. UCLA. I have an idea for that randomized controlled study that you mentioned that I could design. What about taking people, randomizing them into two groups, scanning actually both groups with spec, but for one group, not using the spec data to guide treatment. Yeah, that's what we talked about earlier. So you're not treating, you're not treating off of that, But you're still randomized, doctors still don't know, I mean the patients still don't know which group they're in, and then going treatment-wise, and then seeing their outcomes from a clinical perspective, seeing how they're doing through patient surveys, and then also looking

back at their spec, redoing their spec and seeing if there's a change. Isn't that a great study that could truly perhaps prove that spec can be generalizable to the general public? Yes, no, I think that's a great idea. And then we'd probably need three or four independent of Aeman Clinic sites to do that as well. I think it's an important question to ask if we do that randomized controlled study that we've just talked about. And it turns out that it's not useful. Would you give it up? Absolutely not.

Why? because how am I going to know if your symptoms are a result of your brain working too hard or not hard enough if it's toxic or traumatic? So you're just asking me to give up, you know, 35 years of experience showing how imaging changes what I do or guides what I do based on a study of 50 people. Now, I suspect the study will be... Why'd you underpower my studies so quickly? Well, there's 300 people, right?

I'm not giving up imaging because if you don't look or you don't know. I mean, there's this thing called face validity that it makes... I mean, there's just so many advantages to imaging that... that probably if there were 50 studies done like that, 40 of them would come out positive and maybe 10 wouldn't. Why? You've been around research long enough to go, whatever the person thinks is going to happen, they'll set it up to make it happen. that maybe you have way more confidence in research than I do. But one statistician told me that 16 out of 17 statistics lie,

depending on what people think. You saw it, Dr. McCarrie just come out recently with the hormone study. And he goes, when you actually read the study, they made that huge recommendation that kept HRT from women for, what, 20 years, that it was actually based on flawed data. So I'm not giving up the idea that imaging is useful. Can we use it better? Absolutely.

And we're using AI tools in studying all of our patients' data. because they allow us to study anonymized data. So in my mind, no, I wouldn't give it up. But there's ways to use it better. I'm certain. You said like 16 out of 17 research articles are flawed. Does that apply to your research? No, no, 16 out of 17 statistics lie.

Oh. So you can- Is that true about your research as well? No. Why? because we want it to be reproducible. But the rest of the scientific community doesn't? I'm just asking why your assumption is that this randomized controlled study would be flawed, but yours aren't.

You said I didn't have any randomized controlled trials. I didn't say your randomized controlled trial. I said your trials. I just don't know why there's such a negative push to the scientific field. like we're now discounting data because you're saying data is always flawed. But you use data. So you don't believe that?

Really? I mean, after all the time you've been a doctor. Well, what's the question? When you read the studies. Let's just take the one, Dr. McCarrie, who's the commissioner of the FDA, decided that when he actually went and looked at the data, it actually said the opposite

of what the press release came out. and said, which then hurt millions of women. The medications that were used in that trial were appropriate for what that trial was trying to achieve, and what we were trying to extrapolate for it was not what the study was trying to achieve. In addition, the way that the study patient selected, which carries a tremendous impact on the study, they tried to pick people without menopausal symptoms, hot, flat, all of these things, because they were worried that if people saw their hot flashes improve,

they would know, and it would no longer be a blinded study. So there are criticisms of the research, and there's always criticisms of the research. Always. But my concern is that when you're ready to write off the research that disagrees with you, you're part of the problem that you just said, that if you, you're just seeking to agree with yourself how the scientific community says that you just said they do that they try and get research that agrees with them don't you want to try and disprove your method in order to prove how strong it is so at this point in my career no why is that if i looked at your scan i feel really confident

that it tells me how healthy your brain is, if it's overactive, if it's underactive, compared to not just our normal group, but our hundreds of thousands of scans. And for you to just sit here and go, but don't you want to prove yourself wrong? It's like, no. That's a scientific method.

when you fail to prove yourself wrong, that strengthens your own. But we're pretty early on. Is this helpful or not helpful? Yeah. No, I find it incredibly helpful. What if you scan my brain? But I'm just like what's, I'm just asking myself, what's the point?

Right? It just seems like we're arguing to argue as opposed to learn. anything new. If you scan my brain and it shows low brain activity, perhaps holes, sleepy, frontal lobe, but I'm crushing it. I love life. I'm happy. I'm excelling at sports. Podcasts is going well. What does that mean? Well, it means you have low frontal lobe activity and you're compensating for it and you're not suffering. And so Alzheimer's disease actually starts in the brain 20 years before you have any symptoms. Frontal temporal lobe dementia starts in the brain way before you have symptoms. So what it means, in my mind, based on my experience, is your brain

vulnerable, and it's probably not good for you. So you may be crushing it, but are you going to be crushing it 20 years from now, or would it be better for you to get it as healthy as it could be so you could continue to crush it and you end up not being a burden to your children? That's a really good question. And I think the way we figure that out is by doing the research to figure out if that intervention will get me there. So I think we should look at your brain. I have a clinic here in New York. And the radiation is about the same as a head CT,

ordered millions of times every year in the United States. There was a recent report that CTs are raising a risk of cancer by double digits. So got to be careful about that. But go ahead, sorry. Ordered millions of times every year in the United States. I think it would be interesting. And then you could decide if it was valuable for you. Yeah, my hesitation is, so why I tell patients who, residents, rather,

that want to reflexively check thyroid levels in my patients that are not having symptoms, like part of their screening, basically. a healthy person comes in, and my resident automatically checks off checking thyroid. And I said, well, why? They said, well, I want to check and make sure it's optimized. So my question to them is, let's say a patient comes in, and their T4 is marginally low. Are you going to treat that patient who's comfortable and then give them thyroid hormone, leading them to have palpitations and discomfort?

So, like, every time I'm ordering a test, I'm trying to think, what if, how is this going to change my practice of care. And if you're saying that if I have these findings on the spec scan and I'm feeling great now, there's a chance I won't feel great later, I would want to know how sure of that you are based on randomized validated data. I think that's pretty reasonable to ask. No? I think it's also reasonable to ask is what's your experience.

is it as healthy as it could be? And I actually disagree with you. I think people should know their important numbers every year. Like you should know your BMI. You should know what your thyroid is doing. You should know your testosterone levels. But there's such natural fluctuations of these numbers that are outside of your control

that will lead you to premature, perhaps unnecessary treatment. So many times. So many times. So if you're hanging with a testosterone level of 250, which is not uncommon today. Okay. You think? What time of day did you test them?

Probably morning. Because a lot of these clinics that do it, don't do it in the morning in order to prescribe testosterone for their patients. Which is bad. Very bad. You know, too high. your libido goes up and your empathy goes down and you get divorced. Well, I think about also the medical problems that come along with that.

It's like, so I'm just, you know, I often say, how do you know unless you look? Well, thank you so much for your time. Thank you for your work. Everyone can check out the book. Pre-orders until December 9th. December 9th. And then that's when it publishes. Congratulations on another.

I know this is going to be in New York Times bestseller. So wishing you the best of luck for that. Thank you, doctor. Huge thanks to Dr. Ayman for coming. to New York for this interview. I really hope further research will ultimately get us to a better understanding of functional imaging because I'd love to use it to help my patients, but we have to take things one step at a time. If you like this interview, you might also like my conversation with psychiatrist, Dr. David Bender, who dove in deep with me on the various psychiatric conditions

of characters like The Joker, all sorts of video games and movies that we discussed. It was a really cool conversation. If you want to help us out, I'd be so grateful if you can leave us a comment, perhaps your thoughts on this episode. And if you could give us a five-star review, it's the best way to help us find new listeners. And as always, stay happy and healthy.