No, that was definitely NOT Mike's point. I was particularly appalled by Mike's statement that "ECT is pure behavior therapy: 'Mr. Smith, we understand that you are unhappy. We will continue to induce seizures until you feel better.' After a few seizures, Mr. Smith endorses positive change on the Beck Depression Inventory. The psychiatrist stops inducing seizures. ECT is a punishment condition."
ECT has been extensively studied for many years and the idea that it is a "punishment condition" has been thoroughly debunked.
This is false. It has not been debunked. The expectation bias that existed back in the snake pit days is the same one used today: "We will induce seizures until the patient changes for the better". These changes are manifested on the Hamilton or Beck or some other self-report measure. If I want the seizures to stop, I endorse positive change on the measure. Its a very simple mechanism of change that has nothing to do with depression. The investigators and supporters of ECT have the burden of proof to partial out this explanation and prove the punishment condition is not valid. This is difficult or impossible to do because of all the limits on constructing blinded conditions that I presented before.
The most obvious objection to that idea is the the fact that modern ECT uses general anesthesia. The patient wakes up and doesn't know whether or not the ECT has been administered.
This is false. The patients are not asked to indicate which condition they were in. Since the obvious intent of the
anesthesia etc is to create a placebo, why don't the researchers just ask? I can only think the reason is because they are afraid of the answers. They may discover the placebo did not work and ECT patients were aware that seizures produce side effects (memory loss, extended lethargy etc) that were different than anesthesia. On our research floor, the ECT patients hang out with the patients receiving alternate treatments and they all talked to each other about the treatment.
The research question is: "How does the patient's understanding of the treatment condition influence ratings
on the dependent measures". You could even design a study in which all the patients receive a sham treatment and you examine the difference associated with believing your in the treatment condition vs believing your in the placebo condition. The research hypothesis is obviously that subjects will endorse change consistent with their beliefs. If I believe I was receiving ECT and I would prefer not to continue receiving seizures, I will probably indicate that I am happier now than I was the last time I received the BDI.
The general point is that every human in a research study thinks about which treatment or placebo they are receiving and
makes dependent measure ratings consistent with their beliefs. I can't believe anyone thinks this is a radical idea. All the investigators have to do is study it. Why is it not studied? Besides, if it was such a punishment, a painful shock should be even more effective than a seizure. Its not. And "eyes open" ECT (much scarier) should be more effective than ECT done under anesthesia. It's not. And bilateral ECT, with it's severe retrograde amnesia, should be less efffective than unilateral ECT with its negligible retrograde amnesia. It's not.
The expectation bias exists for all these conditions. If a patient feels they are receiving seizures and they don't
like seizures, they will endorse positive change on the dependent measures in order to avoid more seizures. This is a classic punishment condition. It doesn't have to be related to pain dosage. The patients just endorse enough change to make it stop. Again, why don't the researchers just ask patients about their expectations? Mike's diatribe sounds more like a humanistic harangue than an informed opinion.
Name-calling is not an argument.
And while we're on the topic, would Mike be as critical of "talk therapies" than of biological therapies? Talk therapies are, of course, subject to most of the same criticisms that he levels at biological therapies. But that discussion gets even more interesting since one can argue that talk therapies ARE a placebo and that its practitioners are the "institutionalized dispensers of placebos" ) per Marvin Gross in "The Psychological Society." And once said, is that a bad thing?
I was critical of all psychotherapies on similar grounds. I don't think you read all the comments from other posts. The main difference is that the talk therapies are even worse. Since everyone in psychotherapy outcome studies accepts that placebo conditions are impossible to construct, they don't even ponder the consequences any longer.
Placebo effects are real, powerful, and have a clear biological basis.
There is no evidence placebos have a biological basis. They represent cognition working full time to produce expected changes on self-report or other-report dependent measures.
My argument is that all the positive dependent measure changes, the effect sizes from all these studies, are the result of expectation bias. It is the duty of the investigators to partial this out and prove that the treatments are effective. If this can't be done, then no one should claim that the treatments have empirical support.
The other beef I have is that until recently, the drug companies were never required to publish their negative
findings. Publishing negative findings reduces the drug company stock values and all the operatives in the companies have major stock options. Most people do not know that publication of negative findings reduces the personal income of hundreds of drug company executives. Thank the FDA for clinicaltrails.gov. I am very interested in seeing the results of meta-analyses after all the studies are available. Anyone got any bets for the change in effect size? Mike Williams --- You are currently subscribed to tips as: [email protected]. To unsubscribe click here: http://fsulist.frostburg.edu/u?id=13090.68da6e6e5325aa33287ff385b70df5d5&n=T&l=tips&o=12863 or send a blank email to leave-12863-13090.68da6e6e5325aa33287ff385b70df...@fsulist.frostburg.edu
