Prof Peter Kinderman: Should ECT be judged by the standards of homeopathy?

This blog was originally published on 7th September 2020 on the Psychology Today website as: https://www.psychologytoday.com/us/blog/our-turbulent-minds/202009/should-ect-be-judged-the-standards-homeopathy

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Extraordinarily, we now live in a world in which the best evidence [https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/ect] that the Royal College of Psychiatrists has been able to muster for the real-world effectiveness of ECT exactly parallels the claims for homeopathy. 

ECT is defended energetically by traditional psychiatrists, and many claims are made, but systematic reviews of the available evidence conclude that there is no reliable evidence [https://connect.springerpub.com/content/sgrehpp/early/2020/04/02/ehpp-d-19-00014] that ECT helps lift depression significantly after the end of the treatment (although there is some evidence for a significant placebo effect and the induction of a convulsion through the passage of electricity through the brain may lead to a temporary dissociative and euphoric state [https://connect.springerpub.com/content/sgrehpp/early/2020/04/02/ehpp-d-19-00014]).

This leads to a problem – for a profession and those professionals who would like to believe in the effectiveness of the procedure. It appears, as an outsider, that ECT holds a special place. In general, psychiatry tends [https://academic.oup.com/shm/article-abstract/32/2/395/4833896] to defend the effectiveness of any particular class of drugs in vogue at any particular time (before realising the harms done, changing the narrative, and then defending the new status quo). Despite the claims to be practicing evidence based medicine, there seems to be more effort expended in defending practices than developing more effective and humane alternatives. 

We could speculate that this may be because psychiatry needs to defend its place as a subspecialty of medicine (and therefore requires the use of conventional diagnosis and medical, physical, treatments), perhaps because it is felt that there must always be a back-stop, a treatment which has the twin benefits of drama and (it is claimed) “miraculous” effects [https://theconversation.com/electroconvulsive-therapy-does-work-and-it-can-be-miraculous-76381] or perhaps guilds merely tend to defend their members. 

But in any event, ECT requires defending. And ECT needs to demonstrate its effectiveness… in the regrettable absence of any real evidence. 

In 2013 a different group of people were lobbying for the effectiveness of their practices. The UK Parliament was debating the management of ‘long term conditions’ and specifically which forms of care should be commissioned by the NHS. The Health Select Committee held hearings and invited submissions from interested parties.

One of the organisations supplying evidence [https://publications.parliament.uk/pa/cm201415/cmselect/cmhealth/401/401vw60.htm] was the Society of Homeopaths. Part of their evidence included the claim that 68% of people receiving homeopathic treatments were reported that their problems were “better” or “much better”. 

This is quite a claim, given the widespread view in the medical profession that homeopathy is little more than an expensive placebo. 

It turns out that this evidence was gathered in a study [https://www.liebertpub.com/doi/abs/10.1089/acm.2005.11.793] in which the clinicians (the homeopaths) rated their subjective judgments as to whether they believed their patients (who had received the homeopathy treatment) were; “much better”, “better”, “slightly better”, “no change”, “slightly worse”, “worse”, or “much worse”. The authors reported that 65.8% of children were reported as “better” or “much better” (it seems that the exact figure slipped a little in reporting). To be clear; these were not the judgments of the patients as to whether their treatment had helped. These were the judgments of the clinicians.

The Society of Homeopaths were unconvincing. Their ‘evidence’ did not feature in the Select Committee’s report [https://publications.parliament.uk/pa/cm201415/cmselect/cmhealth/401/40102.htm] and, a few months later, the Chair of the Select Committee, Dr Sarah Wollaston (a practicing GP as well as MP) tweeted; “It’s homeopathy awareness week. Will @rpharms issue clear advice that there is no evidence that homeopathy is anything other than a placebo” [https://twitter.com/sarahwollaston/status/610072583669682176].

In other words – and I agree – it simply isn’t good enough to base healthcare decisions on the subjective opinion of the treating clinicians. There are significant vested interests that could give rise to unconscious bias. And there are risks of artefacts; if treatment continues until, whether causally related or not, the patient reports an improvement, mathematics tells us that the outcome is likely to be “improved” if clinicians report back when treatment ends. 

The scientific methodology applied to healthcare is intended to address these issues… and I agree with Sarah Wollaston and the Royal Pharmaceutical Society “no effect beyond placebo” [https://twitter.com/rpharms/status/610082078743523328].

Interestingly, the Royal College of Psychiatrists recently revised their guidance [https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/ect] on ECT. In their leaflet for the public, they also claimed that “around 68% of patients were “much-improved” or “very much improved” following ECT. 

The data for the supposed effectiveness of the controversial treatment comes from a database compiled by members of the Royal College of Psychiatrists’ ECT Accreditation Service (ECTAS). Their members routinely collect and compile key information on the use of ECT, and publish [https://www.rcpsych.ac.uk/docs/default-source/improving-care/ccqi/quality-networks/electro-convulsive-therapy-clinics-(ectas)/ectas-dataset-report-2016-17.pdf] the findings.

The methodology used in compiling these reports relies on ‘CGI’, or ‘clinical global impression’, scores. Here, a clinician rates their subjective judgments as to whether they believe their patients (in this case, people who had received ECT) were; “very much improved”, “much improved”, “minimally improved”, “no change”, “minimally worse”, “much worse”, or “very much worse”. The Royal College of Psychiatrists reported that 68% of people receiving ECT were judged by their clinicians as “much-improved” or “very much improved”.

In other words, the evidence for the effectiveness of ECT is functionally equivalent to the effectiveness of homeopathy. In both cases, the proponents of the treatment rely on the subjective judgments of the prescribing clinicians to evaluate outcomes, and, remarkably, on almost identical scales, with the same outcome – that homeopaths believe that homeopathy has resulted in 68% of their patients recovering and psychiatrists believe that ECT has resulted in 68% of their patients recovering. 

When homeopaths present evidence such as this, quite rightly, senior doctors are scornful, pointing out that “there is no evidence that homeopathy is anything other than a placebo” [https://twitter.com/sarahwollaston/status/610072583669682176].

Despite the professional packaging and the protective carapace of a Royal College, the evidence for the effectiveness of ECT remains decidedly dubious.  

6 Responses to Prof Peter Kinderman: Should ECT be judged by the standards of homeopathy?

  1. Orli 11/01/2021 at 11:02 pm #

    It doesn’t need much to understand this message, a great reasoning ! May I please take the opportunity to suggest that “health professionals, psychiatrist” to do themselves a favour and to volunteer for some ECT testing? Then they may revise their opinions, for sure something will change. May Psychiatry dissappear from Earth! So much harm they have done and they are doing! Hitler and his associates, many of them psychiatrist kill millions before they were stop, how many more have to “dye” before psychiatry is stopped? Thank you

  2. Rosemary Knowles 12/01/2021 at 10:45 am #

    I greatly respect Peter Kinderman since I first read him in “The Sedaed Society” book. Quite apart from comparing psychiatry and homeopathy, can we now assume after reviews and numerous books and conferences that Pharmaceutical companies are a very untrustworthy and dubious breed, Prof. Gotzsche whom I also respect, labels them corrupt and criminal. Yet, here we are in the midst of a pandemic being asked to trust ourselves to a hastily and possibly inept vaccine – and by Pfizer of all people. Once again unique individuals, with differing genetic make-up, differing immunity or auto-immunity, differing side-effects to similar drugs, differing ethnicity and family histories – I could go on – are being subjected to a same vaccine to a very new and still mutating virus. Having lost a baby after a Gamma globulin vaccine meant to protect me and her, I have become an anti-vaxxer for myself. Surely we have to wait at least a year before we can judge this vaccine “safe” and not another horrifying epidemic like anti-depressants were.

  3. Sarah Ruddock 12/01/2021 at 6:00 pm #

    I had a lucky escape!

    In 1996 I was so exhausted that I could not get my words out. It had been a difficult week: my late father had been leaning on me heavily because he had difficulties at work and my now ex-husband was in the throes of setting up a new business. I had also tried to cook a ridiculous Keith Floyd beef casserole, which genuinely took three days, in order to try to impress a friend of my husband of less than one year. That was the sort of thing that young brides did in those days.

    I was admitted to the Nightingale Hospital, North London under the care of a psychiatrist by the name of Jeremy Pfeffer who had rooms on Harley Street. He told my husband and me that I was extremely ill and needed to be treated with a cocktail of hideous chemicals. We were newly qualified accountants in our very early thirties and had yet to realise that not all doctors are on the side of the angels and that Harley Street is home to many small businesses popular with foreigners and the rich and vain. We were also unaware that private hospitals habitually pay money to doctors referring patients to them and that drugs companies have very large marketing departments. We did notice that the canteen of the Nightingale Hospital was a soup kitchen for Harley Street doctors.

    Years later we sat in a bar very close to Pfeffer’s rooms and listened to young doctors discussing ways of making more money out of their patients. We also learned that private doctors are unregulated by their peers in the way that general practitioners are and that general practitioners do not tend to question the wisdom of consultants openly.

    My poor ex-husband wanted what he was told was the best for me and therefore took out a loan to pay this “doctor”. The drugs were powerful sedatives, they took me down and down and down until the good doctor was able to tell me that I was depressed and so had manic depression which required treatment with different hideous chemicals. I was turned into a drooling zombie with a Parkinsonian gait. Three NHS doctors said that there was something odd about my treatment, but did nothing. Time passed and I learned from other patients how to fill in a questionnaire which was occasionally handed out so as to be discharged. The last words I remember Pfeffer uttering were “Had I known how depressed you were, I would have tried ECT”. But he had prescribed the drugs which caused the depression. Talk about job creation! Not once did he ask about the events that had caused me to be so exhausted or about my childhood or education or financial situation or whether I had been abused at work.

    After 11 years of this treatment, during which Pfeffer wrote letters to my GP saying things like “she is slightly better so I will tweak her drugs in this way” or “she is slightly worse so I will tweak her drugs in that way” my husband left me. I do not blame him: he did not want or need a zombie for a wife. I was lucky in that I knew an osteopath who saw this treatment for the nonsense that it was and weaned me off the drugs. That process ended in 2009, 13 years after the exhausting week. Those drugs are addictive.

    I have not been on medication since then. Pfeffer’s treatment meant that I have not had a career or children and that I lost my husband and home, but I feel lucky because he did not prescribe ECT for me.

    Quite apart from the fact that there is no genuine evidence that ECT does any good, it is surely a barbaric practice? I have had the privilege of meeting Dr Sue Cunliffe whose brain has been damaged by it.

    • Orli 12/01/2021 at 8:03 pm #

      Sarah, I am sorry of what has happened in your life. But at the same time I am very happy you are now out of this! there are so many out there with no light in the dark. Some they will not be able to come out of this not for their fault ! You are now someone very valuable in society, someone that can help to see the blind… you will find another partner in your life …. and you will enjoy very happy moments… it does not matter how old you are! at least the remorse of unwilling “helping” the psychiatrist will never be with you. So many families and friends are ignorant in the matter, sometimes they do not want to hear, sometimes they are just ignorant! The system in the NHS with psychiatry is very special. They use their junior psychiatrist as ” giving responsibility in their training” next how are they going to admit their wrong doing later on? so many years for the wrong study …. it is easy just to deny it all…..
      And by the way you have an Angel …..” I was lucky in that I knew an osteopath who saw this treatment for the nonsense”… not everyone has one! Best of luck in your life you must be very proud of yourself! nevertheless be careful

  4. Rosemary Knowles 13/01/2021 at 2:33 pm #

    Sarah – glad you recovered finally. I have a daughter who is an osteopath, but she totally opposed me when I began campaigning against psych. drugs which I could so clearly see were harming and destroying her brother. 4 years on he is fine in his mind but still trying to restore everything he lost. His experience with antidepressants tore our family apart, but I hope that one day they will believe what I learnt was true and will even give me some credit. Till then we should be wary of vaccinations, as the trailer to the website VAXXED states that the MMR vaccine is the cause of autism in chidren, and by 2032 they calculate that 80% of males in the USA will have autism. Robert Kennedy Junior also campaigns against Gardasil 9, the vaccine given to young boys in our state schools, against the HPV virus. In Denmark they set up 5 clinics specially to treat the harmed victims of it. My grandson has had his first jab – do I have to spend my old age researching and campaigniing against all these harmful “interventions” by drug companies? Please cepuk.org. focus on vaccines now as they become the greaterst harms in our so-called Health System.

  5. Sarah Ruddock 15/01/2021 at 3:46 pm #

    Orli, thanks for your message. Yes, I am very happy to be out of the psychiatrist’s clutches too. I am very grateful to all the journalists who drew attention to strange “medical” treatment and all the psychologists and others who wrote books explaining logical sadness, stress, exhaustion etc. and how unscientific and illogical it is to suggest that those suffering from such malaises could be cured with chemicals.

    You are correct: family and friends (even scientific ones) believe the out of date medical model because they think that all medical doctors are necessarily demi-gods to be revered unquestioningly or because it was what they were taught at university as recently as the 1980’s. Also bad textbooks lead to misinformed doctors.

    I am lucky enough to be related to some medical doctors so know that they are flesh and blood and slow to admit their mistakes. (I know that they will not mind me saying so for the sake of progress!) Also, my great grandfather was a headmaster, so I am blessed with an enquiring mind….. Do you mind if I ask what you mean by ‘They used their junior psychiatrists as “giving responsibility in their training”’ please?
    Thanks again.

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