Andrew D. Krystal, MD, director of Duke's Sleep Disorder Center, an associate of Weiner's who is frequently cited in pro-ECT journals received $150,036 in funding from the NIMH in fiscal year 1998 to conduct research on improving ECT's effectiveness.

"In this issue of The Journal, Sackeim et al report the results of a multicenter, randomized controlled trial that addressed the important clinical problem of preventing relapse following a course of ECT," writes Glass.

Harold A. Sackeim, Ph.D., is chief of the department of biological psychiatry at the New York Psychiatric Institute, where he directs the ECT research program and co-directs the Late Life Depression Research Clinic. The ECT machines Sackeim used in the research Glass cites above were donated by MECTA, Corporation, one of two US companies that manufacture these devices. MECTA reputation is less than stellar. In 1989, the MECTA, Model D machine was used to give ECT to Imogene Rohovit. As a result, she sustained permanent brain damage and could no longer work. The Iowa nurse and her family successfully sued METCA for an undisclosed amount.

Electroconvulsive Therapy authored by Richard Abrams, MD, a professor of psychiatry at the Chicago Medical School, is the primary reference used by ECT practitioners. Abrams, a member of the editorial board of Convulsive Therapy, has authored numerous articles and books, and lectured extensively on the subject of ECT. Glass does not mention this highly esteemed ECT expert by name, however, APA's 1990 task force report relies heavily on Abrams' ECT expertise. Abrams also rarely mentions his interest in ECT goes beyond his practice, writings and lectures.

"Somatics, Inc. was founded in 1983 by two internationally recognized ECT experts and professors of psychiatry for the purpose of manufacturing and distributing the Thymatron? brief-pulse electroconvulsive therapy instrument," reads a statement on the company's Web site. Missing from the site are the names of the two psychiatrists -- Abrams, and Conrad Swartz, MD, Ph.D., a professor at the University of South Carolina, an ECT practitioner, who writes extensively about ECT, and also designs ECT machines and other related devices.

For years, Abrams failed to disclose his financial interest in the company. He did not disclose it in his pro-ECT article, "The Treatment That Will not Die," published in the academic journal Psychiatric Clinics. When journalist David Cauchon interviewed an editor at Oxford University Press, the publisher of his book, she claimed Abrams had never disclosed his financial interest in Somatics. Cauchon reveals this information in his article "Doctor's Financial Stake in Shock Therapy" published in USA Today, December 6, 1995. (A financial disclosure is now included.)

"Abrams says it's ridiculous to think his ownership of a shock machine company may create a conflict of interest," wrote Cauchon. In the article, Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, chides Abrams and Swartz for failing to disclose their financial interest in Somatics, when they lecture or write about ECT. Caplan told Cauchon Abrams and Swartz should "absolutely, without a doubt, disclose their ownership in all their publications," and also on informed consent forms.

Psychiatrists find insurance programs, including federal programs such as Medicare and Medicaid, are willing to pay for less costly shock treatments than for psychotherapy sessions.

"With the insurance companies there isn't a limit [for ECT] like there is for psychotherapy," Gary Litovitz told Sandra Boodman in an interview for her article, "Electric Shock...It's Back" published in The Washington Post, September 24, 1996. "That's because it's a concrete treatment they can get their hands around. We have not run into a situation where a managed care company cut us off prematurely," stated the medical director of Dominion Hospital, a private 100-bed psychiatric facility in Falls Church, Virginia.

"The number of shock treatments in Ontario's community hospitals has more than doubled in the last ten years, Ministry of Health statistics now show," writes Maria Bohuslawsky in The Ottawa Citizen, March 19, 2001. She reports that 40 percent of the 2,087 people who received shock treatment from 1996-1997, were older people -- a growing trend. Bohuslawsky writes that those on both sides of the ECT issue agree that "the trend is partly due to a push for shorter hospital stays: As a short-term treatment, electroshock works faster than antidepressant drugs."

The People Factor

"Neither congressional hearings nor other government proceedings have ever heard from shock survivors and other opponents of shock in representative numbers," states the National Council on Disability in From Privileges to Rights: People labeled With Psychiatric Disabilities Speak for Themselves, a 2000 report the federal agency prepared for the president and Congress. "More often, the proponents of shock have either authored the reports or had major involvement in writing them, often without disclosing conflicts of interest (such as financial involvement with the manufacturers of shock machines), while opponents of shock treatment have been excluded from the process."

"Dr. Glass says it's time for ECT to come out of the shadows," asserts Lawrence. "I've got news for him -- it's out, but not always in the positive light he seems to want. Every day I hear from new people who now consider themselves survivors of ECT. When these patients try and talk to their doctors about their complaints, they are simply ignored or met with scorn. That's what is in the shadows, and it's because the industry refuses to recognize their experiences."

ECT critics raise legitimate concerns which Glass omits from his editorial. The absence of such information, which practitioners and the public have a right to know, casts a dark shadow on Glass's editorial and the Journal of the American Medical Association's credibility.

next: Email from Dr. Carl Littlejohns