December 17, 1999
MedscapeWire
"Unscientific" Surgeon General's Report Misrepresents Research, Minimizes Risks of Electroshock, Say Advocates

"Unscientific" Surgeon General's Report Misrepresents Research, Minimizes Risks of Electroshock, Say Advocates. Surgeon General David Satcher's Report on Mental Health, released December 13, is said to be a rigorously science-based document, yet at its center was a political struggle between patients who have been harmed by mental health treatment and doctors with a vested interest in promoting it.

Representatives of the New York City«based Committee for Truth in Psychiatry (CTIP), an organization made up entirely of former electroconvulsive therapy (ECT) patients, saw a draft of the ECT section (Chapter 4, "Treatment of Mood Disorders") and were outraged that the treatment was called "safe and effective." All members of the group have permanent and often severe memory loss due to ECT, and many suffer permanent cognitive effects they say indicate ECT causes brain damage.

CTIP Director Linda Andre and concerned patient advocates from the National Mental Health Association and the National Mental Health Consumers Self-Help Clearinghouse called a meeting at National Institute of Mental Health (NIMH) with the head of the ECT panel. Andre asked to work with the panel in redrafting the ECT section, and her request was supported by hundreds of petitions from ex-patients and concerned citizens around the country. Instead, NIMH redrafted the ECT section in secret. The result, say advocates, is somewhat improved in that it acknowledges and warns of the risk of permanent memory loss. But it downplays what is known about the nature and frequency of that and other serious risks, and ignores much of the scientific literature in favor of a few, very recent, and highly selective articles, many done by persons who profit from it. A frequently referenced author ď ECT promoter Matthew Rudorfer ď was himself a drafter of the report.

Truthful information about ECT would have added a sobering note to the "Let's all get treatment" tone of the report, which is why patients were not allowed input into the ECT section, says Ms. Andre. "Anyone who believes the Surgeon General's report is a scientific document has no idea of the political struggle that went into it," she adds, a struggle which nobody won.

Countering claims that the report is "the best available science," advocates point out:

There are 15 citations to articles by men with known financial ties to ECT machine companies.

There is no evidence for the report's claim that "most patients return to full functioning following successful ECT" and that permanent severe memory impairment is "the exception rather than the rule."

The Surgeon General claims that ECT does not cause brain damage, but cites no studies earlier than 1985. The major brain imaging studies documenting brain damage from ECT were done prior to 1985.

The Surgeon General claims, without any evidence, that modern ECT uses "one-third" less electricity that previously. That claim has been disproved by a published study which was ignored by the panel.

The report falsely states that "advances in treatment technique over the past generation have enabled a reduction of adverse cognitive effects." One of the studies cited does not make that claim. The other was done by a doctor who admits to receiving "tens of thousands of dollars" from ECT machine company Mecta.

The report claims that ECT cannot permanently harm the ability to learn and remember. Neuropsychological studies documenting permanently compromised abilities as a result of ECT were made available to the ECT panel.

"The overarching message of the report is that there is no downside to mental health treatment," says the CTIP Director. "When it comes to ECT, that's just a big lie."