Posted by Adam on May 19, 2000, at 23:49:32
In reply to Editorial Concern, Too, posted by boBB on May 18, 2000, at 18:33:42
I don't think there's anything contradictory about what I have said. I have merely stated
that when one peruses the literature on ECT, especially the publications from the last
decade or so, you see virtually no evidence in support of claims that ECT does permanent
harm to the brain. I have seen, rather rarely, and not much recently, articles in respected
journals suggesting (especially in the case of geriatric patients and some individuals who
may be at risk for siezures) that there can be prolonged, unwanted effects.I have just wondered, of those who have experienced persistant adverse effects due to ECT,
are these people just rare cases, indicating, at most, that perhaps better screening of
candidates for ECT should be developed, or are these people are a sort of "canary in a
coal mine," whose relative sensitivity gives the more tolerant the first sign of danger.
The danger may be subtle, and normally escapes detection.This is just speculation, of course. At any rate, it's not easy in science to always say
that two opposing views or claims are necessarily contradictory, even when they appear
to be on the surface. If alternate claims both appear credible, it probably just means
that more research needs to be done, and the differing conclusions result from the way the
investigators approached the subject. Often what one finds in science is that the question
is a lot more complicated than you first thought, and the answers may take a lot of hard
work to find.I'm not as cynical about science as bob is, though there are egos and idiocy to be had in
abundance in the field, just like any human endeavor. I do believe, though, that modern
psychiatry does need to find a balance between rather sweeping claims of safety and
efficacy (this goes for drugs, psychotherapy, you name it), and the rather alarmist claims
of a vocal minority, that many or our current psychiatric interventions are unacceptably
dangerous and are pushed on us by scheming capitalists. I think there may be real dangers
for some people, for any given treatment. Those who support psychiatry often minimize
the claims of adversity to the point that the victims and their concerned physicians are
accused of dissemblance. Those who don't give their support can sometimes blow isolated
cases out of all realistic proportion.I think the uncomfortable truth is likely to be that for treatment X, the odds are in your
favor that it will be safe for you. Unfortunately, if you are the one-in-large-number-N
who shouldn't use said therapy, not only is there no good way to screen for your
vulnerability, no one of any use to you may believe you when you complain of adverse effects.Statistics gives us a valuable set of tools, but I think maybe sometimes they are misapplied
in clinical research. Or maybe I should say, the tools we really need in addition to the
statistical analyses of heterogeneous populations are only just begining to show tangible
promise. When you think about it, the jump from the animal model of a drug trial, for
instance, to clinical studies doesn't involve any radical changes in analytical tools, even
though the expected polymorphisms in the group to be studied "in the real world" could be
orders of magnitude more frequent than what one finds in the lab. There's a big difference
between getting statistical data from a colony of Sprague-Dawley rats, which are highly
inbred and thus about as genetically alike as you can hope for without being total
Frankensteins, and, say, a group of 100 caucasian males, between the ages of 18 and 45,
non-smokers, with no known illnesses besides (your disease here).I imagine genomics, and the subsequent correlation between genetic differences and various
diseases will provide us with another piece of the puzzle. Hopefully with this information
we will be able to get a clearer picture of how these differences interact with environment
to yeild the observed syndrome. Then we'll do a better job of screening candidates for
various treatments. In defense of all that preceded such advances, that vital information
just wasn't available before, so we had to make do.What I find rather disturbing and unscientific about the attitudes taken by many practicing
or researching in the field of psychiatry (we'll call them the authorities on the subject, or
the credible ones), is that they seem to often react to the likes of Dr. Breggan and Dr.
McMullen with a response that is in polar opposition. No, ECT does not cause brain damage.
No, people don't commit suicide because they are taking an antidepressant. Why not respond
with something like "There may be many explanations for the symptoms described. We, as of
yet, have no statistically significant evidence to support contrary claims, but we must
remain open to the possibility that for some individuals, certain unacceptable risks may
exist, and as of yet, we do not know how to positively identify such rare individuals.
Given the cost-benefit analysis, we feel that (treatment) is safe for the vast majority
of the poulation, but that patients should still be closely monitored." It's wrong to go
around saying "Prozac KILLS! Lily is run by Nazis!" but it might be equally wrong to say
"Any such claim that (treatment) caused X is patently absurd." I don't see how we could
have enough information to make such a definitive statement.I suspect the lack of a moderate public stance on many of these issues has more to do with
politics and economics than science (which means we shouldn't impugn science, just those
who don't practice it with due dilligence or exaggerate pseudoscientifically). The trick
is figuring out how to approach various treatments safely and sanely without exposing
ourselves to unnecessary danger, or denying ourselves a useful treatment. I'd wonder, myself,
if the story with ECT is this: "For most people, it's quite safe. For some, it's not. We
have no idea if you fall into the former or the latter, just that the odds are in your
favor." I don't want to be in the latter catagory, and yet, I don't want to be suicidally
depressed either. ECT helped me in many ways. Did it hurt me? Can anyone say for certain
one way or the other? Are any of my fears and supicions valid? It's an uncomfortable and
unahppy position to be in, to not have any real answers, just "schools of thought." It's all
cost-benefit analysis at this point, just playing the numbers. And I don't like that. I also
know I have no real alternative approaches at this point. Nothing better to work with.> I have a question of purely editorial concern. It seemed your post offered two conflicting assessments of the available, peer reviewed literature regarding ECT.
>
> You wrote:
> > Nearly every major journal in psychiatry has published at least a couple of review articles on it, and ALL OF THEM (emphasis added), not for want of looking, claim unequivocably that there is no credible evidence in support of permanent harm from ECT.
>
> > I do find myself being afraid of THE FEW REPORTS, PUBLISHED (emphasis added) in peer-reviewed journals, that suggest ECT is not so benign.
>
> Maybe I damaged my memory some other way, like falling off my skateboard while improperly acting like a teenager, and comparing your two apparently contradictory assessments does require that I remember the one while I read the other. Are you saying that peer reviewed suggestions "that ECT is not so benign" do not undermine unequivocable claims that there is "no credible evidence in support of permanent harm from ECT"? If so, I guess your assessment is consistent, at least with itself.
>
> I understand that reports from people who awake from anesthetized ECT experiences with broken bones, or reports of long-lasting post-ECT memory loss do not carry water, scientifically, unless they are verified and published in peer reviewed literature. The question remains, however, whether informed consent implies only information published in peer reviewed publications, or whether it also implies access to case record of malpractic litigation, summaries of practitioners' records in adverse cases and access to reports compiled by public health agencies and other governmental bodies.
>
> The discussion of informed consent can also include discussion of the potentially prejudicial role of an authority figure who is supplying the information. If the clinical caregiver stands to gain from collection of Medicaid payments with little oversight concerning the efficacy of the treatment, which often seems to be the case, at least in the administration of ECT, we might want to consider whether the caregiver themself can be relied upon as a fair arbitrer of what information is sufficient to qualify the consent of the ECT subject. My perception of informed consent is that it refers to information provided to the subject of a therapy, who then consents, rather than information shared by scientists who then consent to allow or require a particular therapy.
>
> Anyway, I agree that waking from anesthesia ROCKs. (but that is a subjective, un-peer-reviewed assessment). AND, my sister had pretty good luck dressing up cats, but I have experienced ferocious resistance attempting to put pajamas on feline subjects.
poster:Adam
thread:33082
URL: http://www.dr-bob.org/babble/20000517/msgs/34082.html