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.  

11 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 3:43 pm #

    Rosemary – thank you – it took a while – drugs which numb the brain make it difficult for people to read as well as vulnerable to exploitation, but luckily I am blessed with an enquiring mind!

    Sorry to hear about your family. The mind-numbing drugs and outdated unscientific treatment according to the medical model did not do wonders for mine either.

    I am afraid I do not subscribe to your anti-vaccination theory. I do not eschew necessary medication or vaccination. The current vaccination programme is a vital element in bringing the pandemic to an end. The “anti-vaxxers” believe fake news.

    My understanding is that the story about the MMR vaccination came from a deluded, eccentric doctor/conspiracy theorist/hoaxer who managed to get a scientifically and statistically flawed paper published in The Lancet. I think that there was also a financial element to the scandal. I believe that the man concerned was struck off and/or prosecuted and fled abroad.

    Forgive me but psychiatry is the study and treatment of mental illness/disorder whereas autism is a developmental disorder. “CEP exists to communicate evidence of the potentially harmful effects of psychiatric drugs to the people and institutions in the UK that can make a difference.” It seems that you are seeking to divert the discussion rather a long way from CEP’s purpose and the dangers of ECT. Take care.

    • Rosemary Knowles 26/02/2021 at 12:25 pm #

      Hi Sarah, that came as a surprise as I had only just, seconds earlier, been trying to research auto-immune diseases in relation to vaccines. This was ‘cos I live in block of flats full of elderly people who are all getting vaccinated against Covid. I wanted to explain to them out of courtesy why I was not – 1. because I dont trust Big Pharma, as you aready know and my reasons why; 2. because I was informed in around 2013 that I had an autoimmuine disease, when I saw a Registrar who told me I was to have a “serious operation” – I had been led to believe for months that it was diverticular disease which was treated with repeated doses of anti-biotics till I had a pristine bowel – no infections at all – BUT I had one third of my large bowel removed, and an ovary which had adhered to it, plus my appendix for good measure. Ghastly experience. Also 3. 50 years ago I was given Gamma Globulin jab when just pregnant and with a toddler with German Meases. i FELT ABSOLUTELY FINE FOR ABOUT 4 MONTHS. Then waters broke one night and carted off by ambulance to maternity hospital for total bedrest indefinitely. My mother stayed to help out but three generations of family were severely “inconvenienced”. After 4 weeks of becoming a headcase, my baby was delivered feet-first – lived in an incubator and un-touched by her mother but beautiful despite all the tubes she was attached to – and died on second day. I still cry over that ordeal. Today with Covid 19 we cannot access our surgery to talk to anyone – usually you hang onto a line where you start off being number 49 in a slow queue. It is frustrating to the point of not wanting to go anywhere for medical intervention. I told my fellow residents that herd immunity did not mean we had to be like sheep – .we are unique humans, not clones either.

  6. 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.

  7. Orli 23/02/2021 at 10:23 pm #

    Sorry Sarah that has taken me so long to reply.
    I am in a very difficult situation and I am trying my best but it does not seem enough. Everyday is predicted to be mostly unpredictable and I cannot describe here what is going on at this moment in our lives because no one would believe it!
    My comment is that they use the training psychiatrist to write the patients reports that are subjective to their point of view, observations on the patients are not real, They adapt what they see to comply with their ‘ invented diagnose ‘ to fit a “mental illness” to be able to prescribe drugs, otherwise patients cannot be legally treated, specially if they are detained.
    By making them author s of the reports they become complice of their doing, after is harder to admit the wrong doing, mistakes or errors… they do not reason even presenting the evidence in front to their eyes.
    Students in psychiatry are not taught the other side of the story. When they become psychiatrist is usually very hard to accept what they are part off. In reality some of them are brainwashed. Others just deny reality!

  8. Sarah Ruddock 26/02/2021 at 6:05 pm #

    Thank you for your reply Orli. Maybe I would believe what is going on because I have experienced hospitals for various reasons and life in a mental health ward! I could not believe what went on there!

    It seems to me that private doctors over treat because the more appointments they can make, the more money they earn and NHS doctors over treat because they are afraid of being sued. It is not possible to scientifically diagnose mental illness in the same way as physical illnesses are diagnosed by blood tests etc. Psychiatrists seek to make patients’ behaviour fit the highly dubious classifications/labels available to them so that they have something to treat. If there is no label, then it is much more difficult for them to justify their kind of treatment – drugs which either sedate or stimulate. These labels were discussed and agreed on by a group of people who say that they are bullshit.

    Historically, psychiatrists were paid less than other doctors and they thought it would add to their credibility if they were able to prescribe drugs to ‘cure’ patients. The marketing departments of the drug companies “encouraged” psychiatrists to do this. As Sami Timimi says, there is a Mafia-like collaboration between the pharmaceutical industry and much of academic psychiatry and the mental health industry commodifies distress.

    It seems that in a mental health ward, the various staff – junior doctors, nurses, health care assistants, occupational therapists, physiotherapists – all write reports which back up the view of the consultant, however unscientific, unethical and factually incorrect that view may be. An extract from a current job advert for the Birmingham and Solihull Mental Health Foundation Trust states that “The post holder is responsible for ensuring accurate and timely written records are kept…” but this does not occur. They have conversations with people and then write reports which bely those conversations and echo the consultant’s theory. These people are duplicitous, arrogant, ignorant, poorly educated and slow to admit that they are wrong. In my case the hospital notes actually say “We are satisfied that the patient suffers from a mental disorder because it says this in her GP records”!!! The name of the “disorder” had been put there by a private psychiatrist who had done his best to make as many appointments with me as he possibly could: to this end, he attached a label to me even though my “symptoms” did not match the description of the symptoms leading to that particular label on his own website and wrote to my GP after each of those numerous appointments. Three GP’s said that the treatment was odd, but did nothing about it. GP’s do not question or criticize consultants.

    My hospital notes also say “Birth and infancy uneventful. She is said to have had a good childhood”. In fact, my mother dropped me down the stairs when I was a baby, my arm was broken in bizarre circumstances when I was out for a walk with my parents aged 6, a couple of years later my parents put me in a rubber dinghy and let me float out to sea, my father used to shout so much that my friends would not come to play because they were terrified of him, he hit me across the back of my head and my mother whipped me. I can only assume that the truth did not fit the label which had been chosen for me, so the hospital staff decided to write something else instead!

    I witnessed groups of staff wait outside patients’ doors ready to hold them down and administer depot antipsychotic injections. One of the staff then had to rush to the canteen to gulp down some tablets down herself! The “garden” was a few square metres of concrete occupied by smokers. The only hot drink available was caffeinated coffee which rendered being deprived of one’s liberty even more annoying. Staff made hurtful comments about patients’ appearance. At the management meeting at which I was discharged, the chairman said it was difficult to tell which was Cagney and which was Lacey, the consultant or me. A couple of weeks after I left, there was murder on a neighbouring ward.

    You are right, people are very reluctant to criticize a system of which they are a part and which pays them a salary and so keeps a roof over their heads, and psychiatry is the Cinderella end of the medical profession. Its misdiagnoses and assumed remedies do not wipe away mental pain and suffering, nor do they do anything to address the causes of pain and suffering, rather they provide shelter for abusers and are disempowering cruel and oppressive. The drugs which psychiatrists prescribe disable people mentally and deprive them and their families and friends and the economy of their lives.

  9. Rosemary Knowles 27/02/2021 at 10:53 am #

    Dear Sarah – what a traumatic childhood you had and subsequent abuse you endured in mental health institutions. Have you read Prof. Peter Gotzsche’s book “Deadly Medicines and Organised Crime” – so honest and informative and uncompromising. Also, more accessible – “CRACKED” by Dr. James Davies who conducted the PHE Review which cepuk.org reports on. Although these comment strips focus on flawed and harmful psychiatry, it is really the Pharmaceutical companies which are the main devils.Yesterday’s Guardian had an article on the world’s largest consultancy firm – McKinsey, who were paid £14,000 a day to create a permanent replacement for Public Health England, defining its “vision, purpose and narrative.” It goes on to say that McKinsey agreed to pay nearly £426m to settle a lawsuit brought by 49 US states over its role in helping drug makers sell more prescription painkillers – even as the country faced a nationwide opioid overdose epidemic. It advised Oxycontin maker, Purdue Pharma, on how to turbocharge sales of the drug in 2013 by encouraging doctors to move patients to more potent versions of the drug. You told me to take care – this is not social media – we must question everything and everybody and take care of an experimental vaccine rolled out to the world by the likes of Pfizer. Governments are not highly moral institutions and need to be held to account too.

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