questions have been raised about the ethics of selling spect scans on the basis of unproven claims: neuroscience professor martha farah calls such use "profitable but unproven" and says: "tens of thousands of individuals, many of them children, have been exposed to the radiation of two spect scans and paid thousands of dollars out of pocket (because insurers will not pay) against the advice of many experts". professor of psychology irving kirsch has said of amen's theory: "before you start promulgating this and marketing it and profiting from it, you should ethically be bound to demonstrate it scientifically in a peer-reviewed, respected journal" as otherwise "you're just going down the path of being a snake oil salesman". in a 2011 paper the neuroscientist anjan chatterjee discussed example cases that were found on the amen clinic's website including a couple with marital difficulties and a child with impulsive aggression. the paper noted that the examples "violate the standard of care" because a normal clinical diagnosis would have been sufficient and that there "was no reason to obtain functional neuroimaging for diagnostic purposes in these cases." most patients do not realize that the spect scans rely on unproven claims.