Brain imaging for neurological disorders is an exciting, fast-moving and very promising area of research. This segment (and a companion piece aired the day before on autism) reports on clinical application of MRIs and EEGs by a well qualified neurologist.
Dr. Fernando Miranda’s clinical work puts him at the forefront of treatment for ADHD and other neurological conditions. But his work is also in some ways ahead of the research, which is inconclusive and still in early stages. He also operates a clinic that sells this service, creating a conflict of interest.
The segment’s serious flaw is its failure to put Dr. Miranda’s work in the context of the research, which has been done for over a decade, funded by government agencies and published in top medical journals. The segment dwells on anecdotes suggesting benefit without really exploring the underlying questions: Does the science justify the treatment Miranda giving? What are his results aside from the anecdotal? What have other researchers and clinicians–those who do not operate for-profit clinics offering the service–found when using similar techniques? What are the objections of well-informed dissenters?
The use of a single brief quote "for" and one "against" doesn’t illuminate any of the underlying issues.
Having said all that, the report is commendable in two ways:
The question that dogs this piece is why the producers would choose to ignore all the important research being done in the field. One fears it’s to make the story appear more edgy, more of a breakthough, more of an exclusive. If so, it does not serve viewers well.
The segment does not report the costs of the diagnostic procedures or recommended treatments. It also does not report whether these costs are usually covered by insurance.
The segment does not make an attempt to quantify the benefits of diagnosis or subsequent treatment. It provides only anecdotes illustrating benefit.
The segment does not discuss the potential harms of a misdiagnosis using the new technique, or of providing inappropriate treatment based on the diagnosis. It does not mention the harm of potentially wasted money.
It also does not mention the vulnerability of children with renal conditions getting contrast MRIs.
Although there is considerable ongoing research into brain activity/structure and ADHD (and other neurological disorders), the segment does not refer to it. The only evidence cited is anecdotal.
The story does not exaggerate the symptoms or severity of ADHD, language processing or similar neurological disorders. The segment does a good job giving the number of children affected and converting that number to per average classroom.
The segment draws on the practitioner, two independent neurologists (one for and one against), and two parent/guardians and their children. No research is drawn on.
The segment fails to acknowledge Miranda’s conflict of interest: As operator of a clinic that sells this form of diagnosis and treatment, he is conflcted in a way that the report should have acknowledged.
The segment does not sketch the usual treatments for ADHD and learning disorders or provide information about their effectiveness.
It also fails to mention alternative approaches for diagnosing ADHD. What are current best practices? What should a parent expect?
While the MRIs and EEGs used to diagnose children who may have ADHD are widely available, the segment does not make clear how many providers are trained to use it. A parent would not know where to find a clinician other than Dr. Miranda.
The segment makes clear that brain imaging and quantitative EEG are not often used in a clincial setting to diagnose ADHD.
There appears to be no press release associated with this broadcast.