Neuroimaging - notes of caution

Doctor Thomas Insel points out that although neuroimaging is a tremendously exciting technique, there are no examples of findings affecting clinical practice or diagnosis.

There is a huge amount of excitement around neuroimaging. It has in a way taken us into an era where the brain is no longer a black box. What an exciting time it is to be able to say, 'How is the human brain working at a systems level?', and seeing the networks and seeing how people with depression or schizophrenia or dementia are different than those without. Even now, with these longitudinal studies, seeing changes in the brain over time and how they emerge for people who are at risk for Alzheimer’s disease or people who develop schizophrenia, we’re just beginning to see this. So a huge amount of potential here. I am excited about it but I think there has to be some caution. We’ve had 19 thousand imaging papers since 1991. Currently about 4 papers a day on average are being published in neuroimaging, and I can’t point to a single paper that’s affected practice; that’s changed the way we diagnose or treat depression, schizophrenia, autism, bipolar disorder, or any anxiety disorder. That’s a problem because I would give you a very different story for cancer, heart disease and some neurological illnesses where actually neuroimaging has turned out to be extremely important. But at this point in 2008, it’s more promise than actual deliverance. We don’t yet have the ability to use neuroimaging in the way we need to, which is to affect practice either because it gives us earlier diagnosis or it helps us to select a treatment.