By SANDRA G. BOODMAN
The Washington Post
September 24 1996, Page Z14

ECT Experts’ Ties to Shock Machine Industry

Among the small fraternity of electroshock experts, psychiatrist Richard Abrams is widely regarded as one of the most prominent.

Abrams, 59, who retired recently as a professor at the University of Health Sciences/Chicago Medical School, is the author of psychiatry’s standard textbook on ECT. He is a member of the editorial board of several psychiatric journals. The American Psychiatric Association’s 1990 task force report on ECT is studded with references to more than 60 articles he has authored. Abrams, whose interest in ECT dates back to his residency in 1960s, has served on the elite committee that planned the National Institutes of Health’s 1985 consensus conference on ECT. In addition he has long been a sought-after expert defense witness on behalf of doctors or hospitals sued by patients who allege that ECT damaged their brains.

What is less well known is that Abrams owns Somatics, one of the world’s largest ECT machine companies. Based in Lake Bluff, Ill., Somatics manufactures at least half of the ECT machines sold worldwide, Abrams said. Most of the rest are made by MECTA, a privately held company in Lake Oswego, Ore.

Yet Abrams’s 340-page textbook never mentions his financial interest in Somatics, the company he founded in 1983 with Conrad Melton Swartz, 49, a professor of psychiatry at East Carolina University in Greenville, N.C. Neither does the 1994 instruction manual for the device written by Abrams and Swartz, the company’s sole owners and directors, which contains extensive biographical information.

Financial ties between device manufacturers, drug companies and biotech firms “are a growing reality of health care and a growing problem,” said Arthur L. Caplan, director of the Center for Bioethics at the University of Pennsylvania School of Medicine.

For doctors “the questions that such financial conflicts of interest generate are, do patients get adequate full disclosure of options or are you skewing how you present the facts because you have a financial stake in the treatment and you personally profit from it every time it’s used?” Caplan asked.

“It’s especially disturbing with ECT because it’s so controversial” and public mistrust of the treatment is so great, he added.

Abrams said his publisher at Oxford University Press knew about his ownership of Somatics. “No one ever suggested I list it,” said Abrams. “Why should it be?” Abrams said he has disclosed his directorship of Somatics after several medical journals began requiring information about potential conflicts of interest. Caplan said that a growing number of medical journals are requiring disclosure of payments greater than $1,000.

Abrams said he sees “no specific conflict” between his role as an ECT expert and his ownership of a company that makes shock machines. He said he has not decided whether to list his ownership in the third edition of his book, which is due out next year.

Abrams declined to say how much he has earned from Somatics. Approximately 1,250 machines, priced at nearly $10,000, have been sold to hospitals worldwide, he said. Between 150 and 200 machines are sold annually, according to Abrams. Somatics also sells reusable mouthguards for $29, which are designed to minimize the risks of chipped teeth or a lacerated tongue.

Swartz, 49, declined to be interviewed. Last year USA Today reported that he considered his financial interest in Somatics to be “a non-issue.” Swartz is quoted as saying that the company was founded to provide better machines and to “advance ECT.”

“Psychiatrists don’t make much money and by practicing ECT they can bring their income almost up to the level of the family practitioner or internist,” Swartz is quoted as saying. Swartz also said that the profits from Somatics are comparable to having an additional psychiatry practice. (Last year psychiatrists earned an average of $132,000, according to the American Medical Association.)

Abrams and Swartz are not the only ECT experts with financial ties to the industry.

Max Fink, 73, a professor of psychiatry at the State University of New York at Stony Brook, whose passionate advocacy is widely credited with reviving interest in ECT, receives royalties from two videos he made a decade ago. Fink is one of six ECT experts who served on the APA’s 1990 ECT task force, which drafted guidelines for the treatment.

In 1986 he made two videos about ECT, one for patients and their families, the other for hospital staff. Each sells for $350 and is used by hospitals that administer ECT. Fink said that Somatics paid him $18,000 for the rights to the videotapes; he said he receives 8 percent of the royalties. He declined to disclose how much money he has earned from the videos.

Duke University’s Richard D. Weiner, 51, chairman of the APA task force on ECT, appears on a MECTA videotape. Weiner said he served as a consultant to the company about 10 years ago but has not “received any money directly” for his services. Instead MECTA deposited between $3,000 and $5,000 in a university account that Weiner controls which, according to a Duke spokesman, is earmarked for “research support and other educational functions.”

Harold A. Sackeim, director of ECT research at New York’s Columbia-Presbyterian Hospital, is also a member of the APA task force on ECT. Sackeim, who has consulted for both MECTA and Somatics, says he has not accepted cash payments from the manufacturers because he does not want to be perceived as “benefiting personally” from ECT. Instead both companies have made payments to his lab. Sackeim estimates that his lab has received about $1,000 from Somatics and “several tens of thousands of dollars” from MECTA.

Ethicist Caplan said that he believes such donations raise fewer ethical questions than do direct payments to a doctor or an equity interest in a company. Even so, he said, it is up to physicians who receive such payments to disclose this to the public an d especially to prospective patients.

“There needs to be full disclosure in writing and the information needs to be repeated over and over again,” Caplan said. “Doctors need to give patients the opportunity to ask questions if they want, not to make those decisions for them by saying they won ‘t be interested.”

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