Shock Therapy...IT'S BACK - Electroconvulsive Therapy

Written by SANDRA G. BOODMAN The Washington Post

In a series of studies in the 1970s and 1980s Squire, a memory expert who has spent years studying ECT, compared more than 100 patients who underwent ECT with those who never had the treatment. He found that memories from the days shortly before, during and after shock treatments were probably lost forever. In addition, some patients demonstrated memory problems for events up to six months before ECT and as long as six months after treatment ended.

After six months, however, Squire said that ECT patients "perform as well on new learning tests and on remote memory tests as they performed before treatment" and as well as a control group of patients who never had ECT.

The widespread perception that ECT has permanently impaired memory is "an easy way to explain impairment," Squire said in interview. When patients are pressured to have ECT, he said, "outrage . . . combined with a sense of loss or low sense of self-esteem " could account for such a belief, even if there is no empirical evidence to support it.

Some psychiatrists are skeptical of Squire's hypothesis. They question the ability of standard tests to detect subtle memory problems and point to their own clinical experiences with patients.

Daniel B. Fisher, a psychiatrist and director of a community mental health center near Boston, has "grave reservations" about ECT's effects on memory and says he has never recommended it to a patient.

"The variability is still there, the unpredictability and uncertainty about the nature of the side effects," said Fisher, who has a doctorate in neurochemistry and worked as a neuroscientist at the National Institute of Mental Health before he went to medical school. "You see these people who can perform routine functions [after ECT] but have lost some of the more complex skills." Among them, he said, is a woman he treated who coped adequately with everyday life but no longer remembered how to play the piano.

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."