Doctor’s financial stake in shock therapy

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Doctor’s financial stake in shock therapy

When medical students learn about shock therapy, they turn to the only textbook on the subject: Electroconvulsive Therapy, published by Oxford University Press.

Richard Abrams, a professor of psychiatry at the Chicago Medical School, writes that shock therapy is proven safe and effective for depression and other problems, even in children and the elderly.

He advises that shock should be considered as the first treatment given, not as the last resort.

He concludes with an attack on doctors who criticize shock treatment and attaches a form to have patients sign when they consent to shock therapy.

But Abrams doesn’t tell the medical students one thing: He owns Somatics Inc., one of the nation’s two shock machine manufacturers.

He didn’t tell his publisher, either.

“Wow,” says Joan Bossert, executive editor of Oxford University Press. “I did not know that.” She would have had him disclose that in the book’s preface, she says.

“I really wish he’d told us, but it doesn’t take away from his expertise,” she says.

Neither did Abrams disclose his financial interest in the academic journal Psychiatric Clinics in September 1994, when he wrote an upbeat article on shock titled, “The Treatment That Will Not Die.”

In some recent articles, Abrams disclosed that he’s a “director” of Somatics. But readers weren’t told that he is also president and owns the company with shock researcher Conrad Swartz, a University of South Carolina psychiatry professor.

Abrams says it’s ridiculous to think his ownership of a shock machine company may create a conflict of interest.

“Most advances in medical instruments and technology have come from practicing physicians putting (their) knowledge to work in building better equipment,” he says.

He says he thought Oxford University Press knew he owned Somatics. “The association is very well-known in the community,” he says.

In a 1991 deposition, Abrams said Somatics provided half his income.

Abrams and Swartz started Somatics Inc., in Lake Bluff, Ill., in 1985. Somatics makes about half the USA’s shock machines; MECTA Corp. of Lake Oswego, Ore., makes the rest.

Abrams wouldn’t reveal company revenues or profits, but the Somatics Thymatron shock machine is used in about 500 hospitals nationwide and costs approximately $10,000.

“It’s a very small industry,” Swartz says. “The sales of these machines don’t compare with the sales of any one drug.”

Swartz says Somatics’ profits are comparable to having an additional psychiatry practice. (The average psychiatrist made $131,300 in 1993.)

Swartz writes extensively on shock therapy, too, and also rarely discloses his Somatics ties.

For example, when a doctor wrote in Convulsive Therapy, a medical journal, that doctors could save money using sports mouth guards during shock treatment, Swartz wrote a letter attacking the idea. He did not disclose that Somatics sells specially designed mouth guards for $23 a dozen.

Abrams and Swartz should “absolutely, without a doubt, disclose their ownership in all their publications,” says Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania.

They also should disclose it to patients on informed consent forms before shock treatment, Caplan says.

“True informed consent is not what the doctor thinks you should know, it’s what a reasonable patient might want to know,” he says.

Swartz calls this absurd.

“It’s a nonissue. Every doctor who does ECT makes money, just as every doctor who prescribes drugs does,” he says. “Patients know . . . and don’t particularly care.”

Swartz says Somatics was founded because MECTA wasn’t listening to psychiatrists who do shock therapy.

“I’m now able to improve machines. Who else can best advance ECT? Someone like me, who knows what they’re doing,” says Swartz, who has a Ph.D. in engineering as well as a medical degree.

For his part, Abrams is the most quoted shock therapy researcher.

The American Psychiatric Association’s 1990 task force report on how to practice shock therapy cites him more than any other expert.

His 340-page textbook is often the sole source of information about shock therapy in general medical books and articles read by doctors and patients.

Abrams’ textbook never mentions Somatics by name.

But he describes new shock machine innovations found only on Somatics machines.

For example, his textbook reports that a charge “delivered over four to eight seconds will optimize the risk-benefit ratio for ECT and provide maximal clinical efficacy with minimal cognitive consequences.”

Only one machine gives a four to eight second charge: the Somatics Thymatron DGx.

And Abrams sells it.

By Dennis Cauchon, USA TODAY

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