Talk:Electroconvulsive therapy/Archive 1

Controversy
From the article:
 * Controversy also stems from the fact that many leading proponents of the treatment hold financial interests in the companies which manufacture ECT equipment.

Really? Evidence please. The Anome 23:56, 16 Mar 2004 (UTC)

Here some evidence. The following was discovered in the U.S. Federal Trial, Akkerman verse MECTA, 2006. Duke University, is a private University located in Durham NC, USA. owns a patent on a widely used MECTA ECT machine. Duke Hospital has profited from shocking thousands patients. Duke profits every time their machine is sold in the U.S. and Internationally. MECTA arguably sells more shock machines than any other ECT manufacture in the world. Duke employees have participated in studies with the NIH that have helped establish ECT's widely accepted safety and efficacy. Other Duke and MECTA consultant hold positions that are high-ranking members of the American Physiatrist Association and the U.S. National Institute of Mental Health. Both these organizations help establish ECT's standard of care in and are proponents of ECT wide acceptance in the U.S. This is my first post, so if I have placed my post in the wrong place, please let me know where I can comment on the controversy. April 11, 2006 Rizza


 * I would have thought that most of the leading proponents would be psychiatrists who have personally observed the benefits of administering ECT and that most psychiatrists wouldn't even know who manufactures ECT machines. It is not as though ECT machine manufacture is a huge industry.  Each psychiatric unit would have one that they keep for maybe 10 years before they update them.  Since there has been no response to the above comment I have removed this sentence. --CloudSurfer 19:58, 12 Sep 2004 (UTC)


 * Today, the administration of electroshock brings an estimated $3 billion annually into psychiatric industry coffers in the U.S. alone. Reason enough? Terryeo 12:59, 6 April 2006 (UTC)


 * Stuff like this always annoys me. Basically, what this kind of argument insinuates is that psychiatrists (and anyone else involved with ECT) would just be sitting at home staring at the wall, if they weren't doing ECT. The other problem is it insinuates that most people in the field are greedy and only care about money. Now, I'm not a psychiatrist, but from what I've heard about it, if you want to be rich, there's far easier ways. I really don't think that greedy people with no scruples are flocking to the psychiatric field. Shanebratt 00:16, 16 May 2006 (UTC)

-

Actually, the leading proponents are psychiatrists who earn a hefty fee every time they flick that switch. On our local psych ward, the machine was manufactured by an outfit called Somatoform, but I have no information on that company. -- EFS


 * It is also used in countries without a per-session fee, so I'm not sure if you are correct about this assertion. JFW | T@lk  20:42, 15 August 2005 (UTC)

Good point - I'm sure it varies world-wide. In British Columbia, however, a physician bills the Medical Services Plan for each electroshock. And North America is experiencing a resurgence in electroshock. -- EFS


 * In the Ontario city where I'm a psychiatry resident almost all the psychiatrists are salaried. As a result though they all refer patients for ECT and all believe in it's effectiveness they all prefer not to be the one to carry out the procedure since it involves arriving in the hospital at a fairly early hour and the work itself it somewhat boring and repetitive (check vitals, flick switch, observe convulsions, record info, repeat) djheart 06:11, 2 December 2005 (UTC)


 * Maybe they don't like doing one of these things:


 * The patient is injected with an anesthetic to block out pain and a muscle relaxant to shut down muscular activity and prevent spinal fractures.
 * A rubber gag is placed in the mouth to keep teeth from breaking or patients from biting their tongues.
 * Electrodes are placed on the temples bilaterally (from one side of the brain to the other) or unilaterally (front to back on one side of the brain).
 * Between 180 and 480 volts of electricity are sent searing through the brain. Terryeo 12:59, 6 April 2006 (UTC)

Sounds boring, all right. Too bad they don't stick around for the fun afterwards, like having family members have to explain to the patient where she lives, or her husband's name, or why she's in the hospital, etc. time after time after time. Psychiatrists sicken me. The whole field needs to be turned upside down. Francesca Allan of MindFreedomBC 03:27, 3 December 2005 (UTC)


 * The attending psychiatrist for the patient is around afterwards for the follow-up, frequently however the psychiatrist performing the ECT is not the same as the one following the patient on the wards since as I said before psychiatrists usually take turns doing the ECT and will do it for all the patients scheduled for the morning. djheart 01:48, 5 December 2005 (UTC)

Same around here. Different psychiatrists act as the shock doctor week to week. However, they are paid for their "services" by the Medical Services Plan. As for the initial terror and confusion experienced by the patient upon awakening, that is mostly missed by the treating psychiatrist who typically sees the patient on the ward later that day. Francesca Allan of MindFreedomBC 06:18, 5 December 2005 (UTC)

-

WHO DELETED MY LINK TO AN EXCELLENT REFERENCE,DR. PETER BREGGIN'S PAPER ON ELECTROSHOCK? AND WHY? -- EFS

EFS, I don't think shouting will get you anywhere and the rationale has been explained (withdrawn Ft. Jack Hackett 12:55, 19 November 2005 (UTC)).. --81.179.80.131 15:40, 17 November 2005 (UTC)

Where has the rationale been explained? I'm curious as to what the rationale could be for deleting references that pro-psychiatry editors happen not to like. Francesca Allan of MindFreedomBC 16:19, 17 November 2005 (UTC)

Excerpts from one of Breggin's books on his web-site appear to state something to the effect that in whoever thinks ECT helped him/her this is automatically an expression of iatrogenic denial and helplessness (he does endorse the fact that many ppl think they benefited from ECT). Also, that serious risks associated with a certain treatment preclude its use. If all of this was true, scientific research, rational thought and all of medicine and surgery are folly and should be abolished, because they are not viable methods to gain knowledge and potentially put ppl in harms way respectively. Tell this to your surgeon when he has you in theater for trauma-surgery (<--- potentially life-threatening in itself), god forbid. Consider the ad-hoc-ness of the first statement: such an expression _cannot_ be argued against. It is a way of trying to _immuninse_ an argument against criticism. See Karl Popper's works for in-depth discussion of this. However, I have not yet read the article nor the book in full. But as the excerpts appear hand-picked by the author they may very well be representative. Ft. Jack Hackett 13:44, 19 November 2005 (UTC) PS: BTW, I didn't delete the reference. Oh, and EFS, please stop using all-caps: its irritating.


 * So you don't like one of Breggin's books (which apparently you haven't even read except for an excerpt posted on his website) and therefore we can't have a link to his excellent and relevant article posted here. Please explain this IN A WAY THAT MAKES SENSE, please, and stop being a wiki-bully.  Francesca Allan of MindFreedomBC 03:46, 2 December 2005 (UTC)


 * By the way, you're misquoting and misunderstanding Breggin above. Try not to sneer at what you don't understand.  It's unbecoming. Francesca Allan of MindFreedomBC 03:48, 2 December 2005 (UTC)


 * You're out of line, Ft. Jack Hackett, and I've asked an admin to come over and take a look. Francesca Allan of MindFreedomBC 03:57, 2 December 2005 (UTC)


 * I can't believe your arrogance. You haven't even read the article but you decided it doesn't rate and so you made a substitution.  The Breggin article is now back in.  Please stop and take a moment to consider your actions before destroying other people's work.  THANK YOU.  Francesca Allan of MindFreedomBC 04:24, 2 December 2005 (UTC)


 * Hi, Francesca. Just to get the facts straight: I have _never_ edited the actual article on ECT. That means as well that I _never_ have taken out the link to any of Breggin's works/websites. I, for one, would even _agree_ to have his works/websites linked to in the ECT article, because I believe in representing _all_ sides on potentially controversial topics. And, believe me, Francesca, I know, that ECT is a really very controversial topic, and should not be considered lightly. I have to stress that the above lines were just to give my personal opinion (POV) on Breggin's works. This I did in the hope to maybe explain why someone should have taken out the link to his works, which I, as you _and_ I rightly point out, I haven't even read. (Still, I am convinced, that I do not need to read all his work to be entitled to have a personal opinion about it). And, again: I have _no_ doubt that a link to his works would be just and even helpful. I just thought, I'd mention this, because sometimes we are too quick at having a fixed opinion about a situation without getting the facts correct first. Take care, and all the best for the festive season and the New Year... Ft. Jack Hackett 23:22, 29 December 2005 (UTC)

Overall, this is a very excellent article, but two sentances in it struck me as widely exaggerated, if not completely inaccurate. As far as I know, neither of these are true, so I felt compelled to stick them here. I'd like to see some evidence (I'm next in line behind The Anome) before they go back in the article.


 * "...and may remain mentally dull and listless for hours, days, or even weeks afterwards - see side effects below."


 * "Repeated administration of ECT produces dramatic long term changes in personality and mood, along with increasingly diminished memory function." Defenestration 10:03, 20 Mar 2004 (UTC)


 * Here's some evidence for those things:


 * "CREATIVITY AND LIFE DESTROYED Ernest Hemingway 1899-1961 Nobel Prize-winning author Ernest Hemingway allowed himself to be talked into receiving 20 electroshock treatments. The result devastated him. As he told a friend, “Well, what is the sense of ruining my head and erasing my memory, which is my capital, and putting me out of business? It was a brilliant cure but we lost the patient....” Indeed we did. He committed suicide shortly afterwards." Terryeo 13:05, 6 April 2006 (UTC)


 * Maybe you can find some evidence here: Retraumatizing the Victim or here: Case Reports: Restraint Deaths & Abuse (I think most cases of psychiatric "treatment" could be subsituted by early recognition (e. g. by some kind of auditing) of the precursors of so called insanity). --Riddick 23:33, 29 Sep 2004 (UTC)

Kwertii, I'm sorry, but I can't agree with some of these changes. There is a small subset of previous patients that now speak out against ECT, as you mention, and appropriately, the article mentions them (in several places). However, their view that ECT does nothing but kill brain cells is not taken seriously within the medical community; ECT has been studied for years, and although they still don't understand exactly how it works, there is absolutely no evidence of brain damage or neuron death. I strongly feel that, while they should be mentioned in the article, it simply has no place in the first paragraph. I understand your concern about representing the other side fairly, but first and foremost we should be representing the truth. Defenestration 07:07, 1 Apr 2004 (UTC)


 * ''"Opponents claim that ECT's only mechanism of action is through causing the death of brain cells."


 * For all the reasons mentioned above, I have decided to remove this sentence. I didn't agree with many of Kwertii's changes, but this was the worst of them. The rest, I can live with. For now, at least. Defenestration 06:27, 6 Apr 2004 (UTC)


 * I could think of a conditioning-like effect, because some opponents of death penalty by electrical current (electrocution) claim, that low-level operation centres (remember: according to Church of Scientology N2O anaesthesia does not shut down the whole brain function; remember: at least one anaesthesist in F.Rep.Germ uses local anaesthesia together with full anaesthesia during belly surgery) in the brain are triggered by the current, so that the brain feels fear, which could explain the calm behaviour afterwards (after they (nearly) feared to death)). --Riddick 23:33, 29 Sep 2004 (UTC)


 * I have seen alltogether two completely black cars in front of the entrance of two different psychiatric facilities; one of those cars was loaded with a cadaver box (of course death might be caused by suicide, too; of course somebody might have called those cadaver-care-people wrongfully (but it was not me)). --Riddick 23:33, 29 Sep 2004 (UTC)


 * I would like to know, why psychiatrists do not look as close as possible for the cause of the "insane" behaviour; the Church of Scientology tries to propagate such procedures since 1950 without any real success (as far as I know; I wonder why that is). --Riddick 23:33, 29 Sep 2004 (UTC)

I have a relative who had ECT about a year ago. He didn't have any issues with receiving it, and had no problems afterwards. Defenestration commented on 20 Mar 2004 about two lines about ECT that said that people who received it remained in a dull and listless state for a long time after receiving ECT. He also commented on the line about ECT changing personality and mood, and the effects on long term memory. Based on what my relative said, neither of those were true, at least for him. He was groggy from the anestetic for a few hours afterwards, but didn't have any problems with dullness or listlessness after the stuff wore off. He said some of his memories around that times that he had ECT aren't very good, but that ECT hasn't really done any damage to the memory.


 * JesseG 03:23, 17 Jun 2004 (UTC)

-

JesseG, with respect, the fact that you know of ONE person who wasn't harmed isn't much reassurance. I know of HUNDREDS of people who were harmed. -- EFS

I think that the "controversy links" if they are to exist at all, should include some links to sites that argue in favor of, or are at least neutral about, the use of ECT as a medical treatment. I can't help but notice that every single link in this section currently points to an anti-ECT site. How is something a controversy if there is only one side arguing?

-Rusty 18 Feb 2005

There is PLENTY of evidence of long-term impairment (including cell death) from electroshock but psychiatry disregards it. I posted a link to a great article on the subject but one of those NPOVers deleted it because it didn't fit with THEIR POV. -- EFS

-

WOULD WHICHEVER PRO-PSYCHIATRY CAMPAIGNER IS CHANGING MY EDITS WITHOUT DISCUSSION PLEASE DISCUSS THEM IN THIS SECTION FIRST? WP IS SUPPOSED TO BE NPOV. THUS, REFERRING TO "RATHER VOCAL FORMER PSYCHIATRIC PATIENTS" HAS NO PLACE IN THIS ARTICLE. THERE IS A LARGE MOVEMENT AGAINST ELECTROSHOCK AND OTHER PSYCHIATRIC ASSAULT. IF YOU CONTINUE TO TRY TO MINIMIZE OUR POINT OF VIEW, I WILL GET MORE AND MORE FORCEFUL ABOUT MINIMIZING YOURS. -- EFS

-

Removed the following: "The Church of Scientology's Dianetics claims that ECT does not treat the cause of the disorder but suppresses natural reactions to certain influences by creating further disorders (this view should be treated with caution as it seems to lack scientific background.)" Scientology's theories on psychiatric treatment have no place in an article on actual psychiatric treatment. Otherwise, we might as well put "Scientology thinks this is bullshit," in every psychiatric article. 208.210.144.246 05:37, 24 December 2005 (UTC)

-- There is no such thing as an "artificial seizure." The writer means to refer to a medically-induced seizure, but an iatrogenic seizure is no more "artificial" than any other seizure. -- Nicolas Martin, American Iatrogenic Association

Historical Usage
Frank, Leonard R. (June 2006). Electroshock Quotationary. Retrieved July 23, 2006, from The Coalition for the Abolition of Electroshock in Texas Web site: http://www.endofshock.com (Wolfdeck 05:48, 24 July 2006 (UTC)Wolfdeck) I am proposing that the above reference be cited at the end of the 1st paragraph where it states (citation needed). This book (pdf) is the definitive statement on the subject matter, although he has written another - this one speaks in everyone's voice, i.e. a quotationary. PROBLEM: I have no idea how to do the citation. I thought that I could just add it to the reference section (alphabetical order) and maybe the #s would change automatically AND then I could add the #? If I do this and it doesn't happen then I have messed up your page. Not my intention! I could stick his name in there, like (Frank, June 2006). Only I can't remember if this is how it is done in the Humanities, which is where Electroshock belongs, i.e. NOT in the hard sciences, e.g. medicine - as there is NO objective science backing the procedure up, not a single little bit :-) (Wolfdeck 15:49, 24 July 2006 (UTC)Wolfdeck)

Do we actually know that it was used as a form of punishment? I know some patients have written that it was but do we know that the treatment team at the time used it with that intent. It is more likely that they saw the disturbed behaviour and then decided to treat that with one of the few treatments they had available before the general use of antipsychotic and antidepressant medications. We have to be careful here about the attribution of these sort of things as they are not NPOV unless they can be justified. --CloudSurfer 20:16, 12 Sep 2004 (UTC)


 * I think it was supposedly used as a punishment for people with Sluggishly progressing schizophrenia in the USSR. This was a disease of political prisoners --MacRusgail 02:41, 11 July 2005 (UTC)

On the contrary, I'm in British Columbia and it is used as punishment. Many psych patients are threatened with it. It's also used as effective coercion: take this drug or we'll have to shock you. -- EFS

You surely are aware that what you're saying is not a statement about ECT itself but rather about a health care individual trying a mean way to cajole a patient into having ECT. BTW have you considered that during cardiac defib a much stronger current is applied to an equally non-regenerating tissue: the human heart. And naturally you wouldn't argue that someone has suggested a feasible better treatment for pulseless VT/VF along the lines of "hey let's wait and see, this is just an expression of environmental influence on the patient so let's not interfere with it." There are patients that are depressed to the point of not being able to get themselves to the toilet and not eating anymore. Depression can be an extremely disabling illness. And I find it quite cynical to push for ECT to become abolished if it in _some_ cases it is the last resort (well-researched) treatment option. And I can assure you that there are patinets who are thankful they were lifted out of life-threatening illness by this treatment. The problem of course being that you resort to evasive/unbacked/ad hoc statements like "you know one who benefited? I know hundreds who didn't.". However, ECT should of course not be taken lightly, and it of course is a somewhat "crude" treatment. But for want of a better researched, comparably efficient and less harmful _last-resort_ treatment for otherwise treatment-refractory severe depression we should be glad ECT is available. --Ft. Jack Hackett 12:42, 19 November 2005 (UTC)

Actually, what I'm saying is that psychiatric patients have their rights violated all the time and being threatened with electroshock is just one example from thousands. Depression is not at all like a heart attack so your cardiac defib analogy just doesn't apply. Patients are lied to about the risks of electroshock and, despite your claims, it is not merely a treatment of last resort -- many psychiatrists push ongoing maintenance electroshock. Why are you saying my claims are "evasive/unbacked/ad hoc"? I've survived electroshock and can speak to its effects. We do have treatment for depression that is more efficient and less harmful but psychiatry isn't interested in it. Francesca Allan of MindFreedomBC 03:21, 3 December 2005 (UTC)


 * Here's a history of the development of Electroshock. History of Electroshock Terryeo 13:15, 6 April 2006 (UTC)

Recent changes and future improvements
I have changed the controversy section to say there is for the most part consensus amongst psychiatrists about ECT. This is certainly my experience from Australia but I truly don't know what psychiatrists in the rest of the world think. The APA position in the US would seem to confirm what I have written but I don't have practical experience of that. I do know that many people who have not had direct contact with the clinical use of ECT see it as barbaric and that includes psychology students and graduates who have not worked in psychiatric hospitals. Please feel free to alter that section but I would ask that you internationalise it with any differences. E.g. "While in some parts of the world there is for the most part consensus amongst psychiatrists about the benefits of ECT, in XXX psychiatrists are in general against its use."

This article has a few references but does not then go on to list them at the bottom. The reader is left with some names and dates and no idea of how to verify or expand on what is said. If anyone has these citations, could they please put them in. --CloudSurfer 17:15, 22 Sep 2004 (UTC)

The section on "Effectiveness" seems to have been copied verbatim from the Surgeon General's report to which the article provides a link at the end... --jcm787s@smsu.edu

The fact that mainstream psychiatry is all for electroshock isn't very helpful to the debate. BTW, I have had DIRECT contact with electroshock and can tell you first-hand that it is devastating. -- EFS

Involuntary ECT
In case of catatonia it should be possible to "force feed" (e. g. by those slimy fatty fluids, glucosis and isotonic (NaCl) water infusions (my father had them after his belly did not heal after some surgery)). Does anybody know, why refusing to eat is considered to be an exculpation for ECT? --Riddick 10:14, 30 Sep 2004 (UTC)


 * In catatonia and in severe depression a refusal or inability to take fluids and food requires a relative level of intensive care for a psychiatric hospital. Intravenous treatment is very difficult in a ward of disturbed people. Anyone receiving intravenous, or nasogastric treatment is liable to have their tubes interfered with unless they are treated specially in an individual room. This is usually possible but does require the facilities and the staff resources. The problem then becomes how to treat the person. Experience has shown that ECT works better than medication in these severe and very uncommon problems. That is why it is used. Your use of the word "exculpation" suggests that you believe that ECT is essentially harmful and that its use could evoke blame. All treatments have risks and complications. ECT, in the consensus opinions which are provided in the links, at times presents an equal risk and at other times presents a lower risk than other treatments. No treatment is perfect but doctors try to pick the least harmful and most effective treatment for a specific condition. A core element of the Hippocratic oath is, "In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing ..." and this part of the the oath has been paraphrased into the Latin phrase "Primum non nocere" (first do no harm) which, despite not being in the oath is still an oft repeated phrase that governs the ethics and actions of doctors worldwide. Over the centuries these treatments change and I have no doubt that one day better treatments than ECT will emerge. At present however, ECT remains the most effective treatment for catatonia and severe depression and that is why it continues to be used seventy years after its invention despite the availability of a raft of antidepressants. By comparison, psychosurgery has all but disappeared to be replaced by effective antipsychotics. --CloudSurfer 01:27, 1 Oct 2004 (UTC)


 * Since 1991 I wonder why patients, who refuse to move, are not moved into a intensive care unit. But the leading M.D just allowed a short-term transfer for implementing a central veneous access point (afterwards he was quite satisfied with the work of his colleagues; he just complained about missing stitches where the hose entered the body). But I gave it up to ask (them)... --Riddick 10:14, 1 Oct 2004 (UTC)
 * Catatonia is a very uncommon condition. In my years of working in the field I have seen it once, but then I haven't spent a lot of time working in the psychiatric hospitals where people with this disorder are admitted. Because the patient is largely unresponsive it is usually impossible to obtain informed consent for any procedure. Added to that is the great difficulty in treating this condition. ECT is believed to have a role in catatonia but I wonder if a trial has been done comparing ECT with clozapine (the most effective antipsychotic medication). The problem in doing trials with rare conditions is recruiting enough subjects to obtain statiscally valid results. Such a study would probably have to be multi-centre and even then may take several years to collect the numbers. To make it double blind all the patients would then have to be given tablets and referred off to ECT. Those in the tablet trial would get the active drug and dummy ECT and those in the ECT trial would get a placebo and real ECT. The treating doctors would then rate their progress and switch non responders after a set time to the alternate group. Perhaps this study has been done but I am not aware of it. --CloudSurfer 17:51, 1 Oct 2004 (UTC)
 * By the way: In F.Rep.Germ the Hippocratic oath was substituted by another oath (e. g.: in order to reflect the new pregnancy abortion law), that still says something like "The M.D shall care for the health of the patient first". But there is hear-say about M.D.s who believe that psychiatric treatment should create a "rehabilitation pressure" on the patient, and that this pressure results in a certain suicide rate, that should not be below a certain rate, which sounds quite cruel and like a third justice system (i. e.: 1. criminal, 2. civil, 3. medical) to me... --Riddick 10:14, 1 Oct 2004 (UTC)
 * [N.B.: This is, however, factually wrong. Doctors in Germany are not sworn in under an oath. There is a thing called the "Approbationsordnung für Ärzte" based on another set of laws the "Bundesärzteordnung", which is by no means an oath (would be a pretty long one to recite as well at that ;-)) but rather something like a legal act. And of course we would all be grateful to see a link to a published case or an independent source giving us a more in-depth run-down of an alledged principle in German psychiatry that systematically drives its patients into suicide. This smacks of conspiracy theory IMHO and sure is a great help in an effort to stop stigmata and misconceptions about mental health from propagating. --Ft. Jack Hackett 20:37, 19 November 2005 (UTC)]
 * I cannot find the source... :-(( It was hear-say anyway... But I am quite sure, that it said, that the doctors compare their suicide-rates, where a lower rate means, that the rehab-pressure (Rehabilitations-Druck) was not high enough. The same(?) paper said, that a doctor said on a party (in GERM lang) "I wish somebody cripples me, so that I will have my private nurse for the rest of my life." On another paper the author describes the iatric opinion about ECT/lobotomy/euthansia in 1945 in GERM (on find "Euthanasie"; in that paragraph the author says, that the doctors called ECT "the little leukotomy"). I cannot see any improvement in their concepts (it seems like the psychiatrists mistreat me in order to please my family and social environment). --213.54.75.173 20:11, 1 February 2006 (UTC)
 * Yes, the Hippocratic oath is an old one and has been changed over the years. The concept of doing no harm remains critical and believed by the vast majority of doctors as being a guiding principle. Psychiatric treatment can put pressure on people but psychiatrists and others working in the field try to prevent that leading to bad consequences. Without some pressure, either internal or external, change will not occur. --CloudSurfer 17:51, 1 Oct 2004 (UTC)

-

CloudSurfer, you are woefully misinformed. Electroshock is gaining in popularity throughout North America and so is psychosurgery. Lobotomies are being done again at the Vancouver General Hospital. The case that I know of involved a patient who suffered from debilitating obsessive-compulsive disorder. After his lobotomy, he had a whole new set of problems to contend with PLUS the original obsessive-compulsive disorder.

Electroshock does "work" in the short-term if by "work" you mean "has an effect." So does smoking crack but that's hardly justification to force people to smoke crack. The effects are indeed short-term: the brain takes about four weeks to recover from a closed head injury. With that recovery, the initial euphoria from electroshock is lost. It is for this reason that many psychiatrists recommend "maintenance ECT" which is usually once a month and continues indefinitely.

Psychiatry, and all of medicine, is great at ignoring the people who are affected the most. There are very good books written by electroshock survivors and you might want to check them out. Wendy Funk writes of her devastating brain damage post-electroshock. She had to teach herself to read and write again. She had to be reintroduced to her children.

I, myself, am almost 12 months after electroshock and I still have trouble finding my way around my home town (I have lived here since 1974). If anybody wants to find out the truth about electroshock, they need only to speak to an electroshock survivor.

The Coalition Against Psychiatric Assault is calling for a complete ban on electroshock (whether by consent or otherwise) and I support them 100% in this goal. There was also recently a very large civil judgment awarded in the USA to an electroshock survivor.

I am appalled at your wilful ignorance of human rights violations in psychiatry. The so-called "mentally ill" are the last sector of our society to be awaiting our human rights. -- EFS

-

CloudSurfer writes: "Experience has shown that ECT works better than medication in these severe and very uncommon problems. That is why it is used. Your use of the word "exculpation" suggests that you believe that ECT is essentially harmful and that its use could evoke blame."

Contrary to your statement here, CloudSurfer, electrock is quite common and is not saved for "severe and very uncommon problems." It is not a treatment of last resort; rather, it is one weapon in an arsenal which includes talking therapy and drug therapy. The preponderance of evidence confirms that electoshock is indeed harmful and, beyond that, common sense would tell you that electroshock would have to be harmful. To suggest otherwise is to deny the obvious. The use of electroshock does indeed evoke blame and we will see more lawsuits in this regard, including MINE. -- EFS

-

CloudSurfer also writes: "By comparison, psychosurgery has all but disappeared to be replaced by effective antipsychotics."

Please see my comment re psychsurgery above. Furthermore, there is no such thing as an "antipsychotic." What these drugs, including the newer "atypical antipsychotics," are is actually major tranquillizers. They depress the central nervous system and thus lessen psychosis, as well as the ability to think clearly and many other critical functions. So-called antipsychotics were used by the Soviets to torture dissidents. Patients on excessive levels of them are literally subhuman: they stare, they drool, they are utterly unable to function. These drugs are often used in psychiatric wards for patient "management" because patients drugged to their eyeballs are much easier to handle.

Antipsychotics are implicated in tardive dyskinesia, a devastating and permanent condition (also referred to as Parkinsonian syndrome, because the symptoms are similar) that often drives patients to suicide from the stigma of this affliction alone. The scientific evidence on TD rates vary: it is AT LEAST 10% but could be high as 40%. The newer antipsychotics, the so called atypicals, MAY be safer in this regard but they have not been in use long enough to safely make that determination. The word tardive refers to the fact that this condition may come on at any time (weeks, months, years, decades) after the use of antipsychotics. -- EFS

Antipsychiatry view
I have edited a recent entry by User:Riddick and I hope I have rendered his meaning. With the paragraph below I am afraid I just don't understand what he is trying to say. I have removed it to the talk pages so that it might be rendered into clear English before being reinserted into the controversy section.


 * According to Antipsychiatry ECT is used to suppress certain individual, non-criminal, a little bit uncommon properties of the patients (examples for such cases: Retraumatizing the Victim, Case Reports: Restraint Deaths & Abuse).

--CloudSurfer 23:57, 11 Oct 2004 (UTC)


 * Thank you for your effort on correcting my texts.
 * I have a little problem with your rendered text: The trailing "according to CCHR" looks a little bit funny to me due to the "which" after the comma. Maybe we should point out, that the Scientology Church established CCHR in order to fight human rights crimes?
 * My English is possibly too bad... I do not even see, what is wrong with my text about Antipsychiatry. I wanted to express,
 * that there is an organization, that is called Antipsychiatry
 * that they believe, that there is no real psychiatric illness in most cases (e. g. Mr. Alan Turing) or )
 * that they believe, that psychiatrists mostly (at least in 1950) want/wanted to suppress behaviour, that freightens them or that is uncommon
 * and that they believe, that psychiatrists often treat behaviour, that can be seen as completely healthy and legally allowed.
 * I would be glad, if you could produce a comprehensible sentence.
 * Do not hesitate, please, to ask me further questions. :-))

--Riddick 01:08, 12 Oct 2004 (UTC)

How do these look now?


 * The Church of Scientology's Dianetics claims that ECT does not treat the cause of the disorder but suppresses natural reactions to certain influences by creating further disorders. The CCHR, an institution set up by Scientology, also claims that the real nature of psychiatry is that of human rights abuse.


 * Antipsychiatry believes that, for the most part, there are no real mental illnesses and that ECT is used to suppress certain behaviors which, although perhaps uncommon, are still within the normal range. (See: Retraumatizing the victim and Case reports: restraint deaths & abuse for examples of such cases.)

I have reworded the first paragraph which is still in the text as the original. The second paragraph is a rewording based on what you have written above. If you put them in yourself don't forget to take out the colons at the beginning of each paragraph. --CloudSurfer 02:04, 12 Oct 2004 (UTC)

I like both paragraphs and I copied them to the article (and I remembered to remove the colons)... Thank you. --Riddick 02:49, 12 Oct 2004 (UTC)

I remembered, that the "consent" might be questionable under the influence of psychotropic substances (again according to CCHR). E. g. there was a case in F.Rep.Germ where a patient in the beginning did not like a certain treatment (castration) and after some months of treatment by psychiatrists he agreed. Do you think we should mention that? If yes: I would be glad, if you could find an apropriate wording. --Riddick 02:49, 12 Oct 2004 (UTC)


 * We are talking about ECT not castration (thank heavens). I actually think that is better going into the article about informed consent, which I haven't really looked at. See what you think. There could then be a reference such as:
 * Some question the effects of drugs on the ability to give informed consent.
 * But I do think this should be further explained in the informed consent article, preferably with a reference. --CloudSurfer 03:19, 12 Oct 2004 (UTC)

I would only like to say that the use of ECT in cases of severe cases can be useful and not just for behavioral control but behavioral support if the patient is agreeable to the process. I have a patient who has experienced severe situations that is neither normal nor healthy by anyones standards and this patient is undregoing ECT with the hopes that it will help so no matter who argues to the contrary I am in hopes that this is a success. (Coco1) -

It's important that you understand that scientologists are but one subset of the anti-electroshock movement. It's a common slur of mainstream psychiatry to call any anti-electroshock activists scientologists. The only reason scientologists are linked in the public's mind to this issue is because their church has a lot of money and publicly speaks out. But please keep in mind that anti-electroshock does NOT equal scientologist. -- EFS

Clarification required on the separation of treatment.
The last sentence in the second last paragraph in the overview reads:


 * Studies have shown that each fit must be separated by a day at least.

...or what? Is the treatment ineffective? Does it result in some sort of damage? Does the sky fall? What happens if fits are not separated by at least a day? The reader is left expecting more, but unfortunately the sentence unexpectedly ends.

--PJF (talk) 08:31, 19 Feb 2005 (UTC)

Cites needed
I removed this sentence from the article:
 * Even though ECT is "safe", passing the current through the 'non-dominant' hemisphere is "safer" &mdash; unless of course, one happens to be an artist, musician, or other professional who depends upon the right hemisphere for creativity. 

This appears to be highly POV, unless evidence can be supplied to back it up. Cites, please? -- The Anome 08:45, May 20, 2005 (UTC) - WHO DELETED MY LINK TO AN EXCELLENT REFERENCE,DR. PETER BREGGIN'S PAPER ON ELECTROSHOCK? AND WHY? -- EFS

EFS, I don't think shouting will get you anywhere and the rationale has been explained (withdrawn, see above Ft. Jack Hackett 14:43, 19 November 2005 (UTC)).. --81.179.80.131 15:40, 17 November 2005 (UTC)

I don't recall seeing any explanation of why Dr. Peter Breggin's article on electroshock was deleted. Could you give the explanation again, please? Francesca Allan of MindFreedomBC 01:57, 19 November 2005 (UTC)

Sorry, it has in fact not been explained, you're absolutely right, see my notes above though. However I think in the controversy section quoting of his site is quite adequate. Also, this wikipedia article seems fairly balanced and very informative to me as it stands, minus perhaps the "...because of its brain damaging effects.". There would really have to be scientific evidence for such physical brain damage claims to be included here. Although, mentioning that there are groups that perceive ECT as brain damaging is quite in order IMHO. Ft. Jack Hackett 14:43, 19 November 2005 (UTC)


 * So what you're saying is that the Breggin article can't stay because you don't like it. The Breggin article specifically deals with the brain damaging effects of electroshock so what's the problem?  Francesca Allan of MindFreedomBC 03:39, 2 December 2005 (UTC)


 * Who are you to decide whether or not a reference can stay in? It's a great article.  It's very informative and raises troubling questions about electroshock and this wikipedia article is about electroshock.  Please clarify your position or back down.  Francesca Allan of MindFreedomBC 03:43, 2 December 2005 (UTC)

Requiem for a dream
HI!

I just thought, that Requiem for a dream does not need to be mentioned, since ETC is not so apparent there (only administered at the very end, and the long-term effects are not visible). When cleaning up the article, I think this example can be taken out. "One flew over the cuckoo's nest" and "The bell jar" are the most prominent examples, and they well deserve to be noted. Just an idea - didn't want to edit the article, in case you people object. Please write "oppose" or "in favor" below. --Msoos 10:40, 12 October 2005 (UTC)


 * In favor --Msoos 10:40, 12 October 2005 (UTC)

A wild paragraph
I removed the following, not necessarily because it is wrong but because it is speculative enough to warrant scrupulous sourcing:

Relationship of ECT to Religious Practices for Inducing Ecstatic Seizures ''The efficacy of ECT for treatment of severe depression have led some to speculate that the seizures observed in some forms of ecstatic religious practice, e.g. among the Holy Ghost, Slain in the Spirit, Shakers, Pentecostals, Shamanic, and Kundalini Yoga practitioners, are serving a similar function in relieving symptoms of depression. Those who support this view theorize that the evolution of such seizure-inducing practices, which is widespread among the world's religions, may have been selected for by an accidental process but remain as cultural traditions due to the emotional benefit the practitioners feel they receive. Some feel that candidates for ECT might benefit from participating in such religious practices if they have a prior religious predisposition.''

While it sounds interesting and probably factual, it is unsourced and fairly speculative. Comments? JFW | T@lk  10:24, 21 October 2005 (UTC)

Patients' views
withdrawn. etc.org does not allow posting of this here... sorry Ft. Jack Hackett 16:11, 22 November 2005 (UTC)

CITE
There is a big problem here. It's called WP:CITE. The article contains numerous Harvard-style pointers at references but.... there are no references at the end of the article. This is serious. We can't expect every reader to go to the PubMed site and dig for hours to find the correct material. I've added the original Cerletti paper (1938) as a starter, but someone really needs to find the Surgeon General's original article and copy whatever references are mentioned into this article. JFW | T@lk  19:40, 5 December 2005 (UTC)

JDWolff, please.
The problem of psychiatry lacking "informed consent" is self-evident from mental health legislation. Patients are offered the choice of treatment. If they refuse, they're deemed incompetent and consent is dispensed with. In British Columbia, this is called "deemed consent" and what it means in plain English is "no consent." Similar problems exist across Canada and I'm quite sure it's true in many states of the USA. Could you please explain why you tolerate such a double wiki-standard? Anything remotely anti-psychiatry has to be backed up (and even then pro-psychiatrists complain about the validity of the references) but psychiatrists are allowed to blather on about any highly improbable information they care to without fear of contradiction. I was under the impression that we were getting along quite nicely, JDW, so please don't let me down. Please endeavour to hold both sides to the same standard. Anything less is highly POV. Francesca Allan of MindFreedomBC 02:00, 6 December 2005 (UTC)

As for the UBC research, Dr. Christina Kaloff presented this within the last few weeks. I don't know if it's available on the internet yet. Francesca Allan of MindFreedomBC 02:03, 6 December 2005 (UTC)


 * I'm not letting you down. I'm just mindful of our verifiability policy. The statements on bypassing consent can be reintroduced without rewording if it gets a source. Possibly you could contact Dr Kaloff's secretary and request where it will be published. JFW | T@lk  02:33, 6 December 2005 (UTC)

I'll see what I can get from UBC. As for the other matter (bypassing consent), what about citing the relevant legislation? It's clear enough that consent is not required. Francesca Allan of MindFreedomBC 04:06, 6 December 2005 (UTC)


 * You may actually have better sources than me on this subject. I'm speaking from experience in The Netherlands, where legislation is very much against forced treatment. Are you aware of any comparative studies between the laws of various jurisdictions in regard to involuntary treatment? JFW | T@lk  05:16, 6 December 2005 (UTC)

I seem to remember reading something about this some time ago. I'll see if I can find it again. As for your country being against forced treatment ... Hooray, Netherlands! Francesca Allan of MindFreedomBC 15:01, 6 December 2005 (UTC)


 * Francesca, in Ontario and Quebec ECT can only be given if either the patient or a substitute decision maker consents to it since it is not an emergency procedure. I'm not sure about the legislation in BC but I'd be quite surprised that it would be much different from the legislation here where the only situation where treatment can be given without such consent (again from patient or SDM) is in emergency situations (e.g. sedation of a patient suffering from psychosis who is acting violently) djheart 05:43, 6 December 2005 (UTC)

Well, I am familiar with the legislation in BC and it's quite different than what you describe above. Consent (either by the patient or a substitute decision maker) is not required. BC's Representation Agreement Act (which allows for people to nominate their substitute decision maker) specifically excludes any medical decisions which would fall under the Mental Health Act. Francesca Allan of MindFreedomBC 14:58, 6 December 2005 (UTC)

Another problem is psychiatrists ignoring mental health legislation secure in the knowledge that the average mental patient has very limited avenues of redress. That happens in BC a lot. Francesca Allan of MindFreedomBC 15:01, 6 December 2005 (UTC)


 * But should Wikipedia turn into a battlefield because of the situation in BC? Honestly, I'm warmly in favour of representing the issue of forced treatment accurately, but not if this leads to problems of balance. I'm unfamiliar with the legal status in the US and Canada, but the Netherlands have fairly strict rules for prolonged involuntary confinement in closed units and involuntary treatment. In the UK, the basic requirements for involuntary treatment appear to be less strict, although I have not worked in psychiatry here. JFW | T@lk  15:42, 6 December 2005 (UTC)

No, of course not but BC is not particularly unusual. You seem to have backed off your position on the Netherlands a little bit. Above you said legislation was very much against forced treatment but here you are saying there are fairly strict rules for prolonged confinement and involuntary treatment. Francesca Allan of MindFreedomBC 07:34, 7 December 2005 (UTC)


 * I meant strict from the point-of-view of the psychiatrists, i.e. the patient had to satisfy specific criteria and a judge came to the unit to meet with the doctors and the patient. JFW | T@lk  22:50, 7 December 2005 (UTC)

Rsabbatini
You made the following edit summary: "Controversy - removed spamlink, CCHR is a front for the Church of Scientology, so it is not NPOV."

I'm curious. Although I am no fan of the Church of Scientology, I'm wondering about your logic here. Why is CCHR POV? NAMI, by way of comparision, is a front for Big Pharma but I'm sure you'll happily allow references to NAMI. Just wondering about the double standard. Please explain, if you can. Francesca Allan of MindFreedomBC 04:04, 13 December 2005 (UTC)

Comment
What kind of torture is this? I know a woman who is having this procedure. She has no idea why she agreed to this, no idea if it is effevtive {she dosn't think so}, no idea how long she will be subjected to this crime. Her doctors give her very little info as they believe she won't understand. When we first met 2 years ago she was bright, bubbly, and vivacious. Now she's broccoli. This is a sick procedure and so are the people who perform it. "Faces Off" —Preceding unsigned comment added by 65.147.117.234 (talk • contribs)

One presumes from your comments that you feel the proceedure is unwarrented, but has the person concerned not got a mental illness ? Might not the mental health illness in itself be the cause of the changes you observe ? If ECT is being used, were other treatments tried first (most psychiatrists would prefer the simpler task of writing out a presdription for a drug and letting the patient self-administer their treatment), if so were they not effective ? For the patient to have "no idea why she agreed to this" she needs disagree that she has a mental illness, no idea if drugs previously used, no idea if she felt better on any previous drugs given. I suspect ECT was not given to a person who was completely well for no reason... David Ruben Talk 00:09, 21 January 2006 (UTC)

Information Re: Based Edits to this page
Hiya, this is Thor from the Counter Vandalism Unit of Wikipedia. I have reverted yet ANOTHER anonymous edit by an IP user on the section of this page where NPOV is disputed. The report made is now being listed with my superiors and I will make sure than any anonymous edits to this page which breach NPOV standards, will be reverted without further recourse to the editor. Please make sure your edits to this page conform to NPOV. Thanks Thor Malmjursson 00:44, 21 January 2006 (UTC)   Wikipedia CVU - Talk to Thor

The annon user has reverted yet again - I now count x6 reverts within the last 24hrs. Several (revert) edit comments have asked that they discuss in the talk page prior further re-insertion of what is stated to be POV. This talk page already has past discussion about ECT & side-effects, so this is unilat action by the annon user. The annon user is re-editing at a faster rate and with a huge number of references (at least these are now being stated) that I suspect no practicing doctor has the time to wade through. The original version gave considered opinions that there is no credible evidence of harm (National Institue for Health), so the quoting of large numbers of anecdotal reports is hardly fair (pretty much every patient forcibly committed to a psychiatric ward and assessed as needing forced treatment by tablet or injection also claims unfair & unecessary treatment and that they are unwell as a result of the medication which they would like stopped). David Ruben Talk 02:59, 21 January 2006 (UTC)

Interesting, the anon user might be making POV-looking edits, but they seem to be referenced, which is rather interesting and unique. I'll see if I can leave a message to the anonymous user, and get them to discuss. Kim Bruning 03:55, 21 January 2006 (UTC)

To annon user User:209.122.225.245, you stated in your message to User:Tmalmjursson that you are new to wikipedia, so welcome ! We try to assume good faith by all editors and hope we don't bite the newcomers. So appologies if you failled to understand the revertion by several people of your edits and why your x6 reverts yesterday then caused you to be blocked under the Three revert rule. You clearly have detailled knowledge of this subject & the background medical literature and thus hopefully can contribute some well informed edits to this article. We all undergo a learning curve on joining wikipedia and hopefully don't get involved in disputes, content disputes, edit-wars etc - or at least not too often :-) So please discuss why the current discussion on side-effects of ECT is insufficient and the type of edits you wish to use. I'm sure that many will disagree with your views, but as I indicate on your talk page, WP is not about other editors imposing their idea of "truth" upon you, but rather reaching a consensus on the POVs that go to make up an article's overall NPOV in a general enclyclopedia (with some constraints on article size too) David Ruben Talk 02:18, 22 January 2006 (UTC)
 * I have tried to place some thoughts on my understanding of wikipedia's attitudes and policies on your talk page. I hope you take these in a welcoming positive manner, to help you understand the reasoning behind the editors you encountered yesterday.
 * Wikipedia is about writing a general encyclopedia, so there are restrictions on article length & number of references. Also NPOV is not about absolute truth, but fairly describing the majority & significant minority views. Your previous edits were seen as POV by others (whether or not you agree with them) especially as you also deleted out paragraphs written from a the majority view you disagree with.
 * You are welcome to disagree with anyone but where agreement can not be found about different POVs, then discussion within an article's talk page should be held to try and reach a consensus on further edits. Your ignorance as a newcomer of how to determine this page's past history & discussion meant of course that you were unaware that your edits prompted a request to engage in discussion for a consensus and hence the reverts applied to your edits. We got increasingly irritated at your failure to engage as I suspect you obviously got increasing irritated at revertions you failled to understand...
 * So please do not be upset if you find a majority disagree with you however 'valid' your feel your own assessment is :-)
 * The major medical consensus is that ECT is acceptable. Of course even within the majority view there is debate as to the appropriateness of past or current selection of patients, mental conditions, methodology and of course consent.  Even if one disagrees with any of these aspects, the majority medical & legal POV is still (rightly or wrongly) one that is positive towards ECT.
 * You will see above in this talk page that there has been considerble previous discussion about the ECT article. Now, as a newcomer, I appreciate you will not have been aware how to view the Page History or this talk page and so continued to edit in ignorance of various editors' attempts to engage in discussion.

Regarding citations
The citations thus far reviewed are a mixed bag. There are some interesting studies that indicate some possible long term anatomical effects. There are anecdotal reports, public testimony, and case reports. The most controversial assertions are not well supported.
 * that the ECT machine industry monopolized funding - citation is court testimony
 * every long term study has confirmed permanent memory loss - 3 citations, one unavailable, the second is here, and the third is a name/date. This statement seems to be original research.
 * that at least one-third of ECT patients experience permanent memory loss - see text. This does not distinguish between retrograde memory loss which is acknowledged to be a common complication in the original text, and the implication of anterograde memory loss which tests have proven does not get permanently impaired.
 * ECT causes permanent neuropsychological deficits - citation is a fda docket
 * ECT causes a >30 point IQ loss - citations are 2 public testimonies and a book by an ect patient.
 * that Anesthesia and muscle-paralyzing drugs increase the risks of the procedure and thus its mortality rate - of the 3 citations, one is not available, and the other 2 are name/dates.

In essence, the most controversial assertions are very sparsely supported. P.S. It is not customary for the other editors to have to vet sources. It is customary to do your own searches and provide links. -- John DO | Speak your mind   07:39, 22 January 2006 (UTC)


 * All material that does not satisfy WP:CITE may be removed. If you can't find a source, how are others supposed to? JFW | T@lk  08:27, 22 January 2006 (UTC)

Furthermore, these do not look like primary sources. These look like a wholesale copying of citations from other people's articles. Unless we are to believe that the anonymous user has personally referenced 10+ pre 1950 journals? -- John DO | Speak your mind   21:21, 22 January 2006 (UTC)

In the absence of any response from the anon, I will be reverting the changes while incorporating the supported assertions.
 * Patients have issues with informed consent
 * Data suggests ECT may cause anatomical changes in the brain of uncertain significance
 * Memory loss should be clarified. Patients report regrade loss, which clinicians acknowledge.

-- John DO | Speak your mind   21:33, 22 January 2006 (UTC)

Anon has a good point regarding one thing. The original article was poorly cited, rife with name/date citations.-- John DO | Speak your mind   22:08, 22 January 2006 (UTC)

Some more comments on those sources listed in the disputed "side effects" part of the article. The article does mention "changes in nuclear volume" in the cortex, but also notes that "there was no loss of neurons in the cortex". This makes it very difficult to suggest permanent damage, and the authors don't, so far as I can make out. The article is also more than 30 years old, and ideally a more recent study - one which uses the vastly more effective imaging options medicine has now - would be found. This paper (a) only looks at schizophrenic patients, who are a subset of those who get ECT, and (b) actually concludes that treatment is *not* responsible for the brain changes it notes, but rather the underlying disease process: "This study shows that lateral cerebral ventricular enlargement is associated with chronic schizophrenia; it suggests that this is not a result of treatment." That's consistent with what is known about the neuroanatomy of schizophrenia - there's more on that in Wikipedia. Nmg20 23:35, 26 April 2006 (UTC)
 * Colon EJ, Notermans SLH. A long-term study of the effects of electro-convulsions on the structure of the cerebral cortex. Acta Neuropathologica (Berlin)1975; 32: 21-25
 * Weinberger DR, Torrey EF, Neophytides AN et al. "Lateral cerebral ventricular enlargement in chronic schizophrenia". Archives of General Psychiatry 1979 36: 735–739.

More. This paper does find an association with frontal lobe atrophy and ECT. Criticisms would be that (1) it's 25 years old and (2) it's a retrospective review of scans, and so can't prove causation - the frontal lobe changes could be a symptom of severe depression or other mental illness rather than caused by the ECT. So it would not be true to say this paper shows ECT causes these changes - but the side effects section of the article doesn't say that, so it's fine. This paper has nothing to do with brain atrophy or lesions, and it's outright misleading to say it does. The method involved neuropsychological testing of cognitive function with the Bender-Gestalt, WAIS, and Benton instruments. The cases (i.e. those who'd had ECT) performed significantly worse on all three tests - until degree of psychosis was controlled for, when only the Bender-Gestalt test was any different. That's equivocal. Regardless, this would be more accurately included as slight evidence for worse cognitive functioning of patients who've had ECT, not as evidence for actual brain damage as currently. This study doesn't look at ECT directly - it uses it as the most reliable indicator of disease severity ("a proxy of illness severity over time"). I quote: "As the total number of ECT treatments, total duration of hospitalisation and total number of admissions were highly inter-correlated, we elected to use the total number of ECT treatments as the measure of cumulative illness severity, aware that a significant association of ECT with cortical tissue reductions may have alternative interpretations." In addition, their conclusion is (TRD = treatment-resistant depression): "Thus, reduced hippocampal grey matter density in TRD seemed to be unrelated to the cumulative severity (or cumulative ECT received) or duration of illness." In other words: they do not conclude that ECT was responsible for brain atrophy. To quote again: "We did not find volumetric change, in contrast to other studies (e.g. Sheline et al, 1999), but rather evidence of change in tissue composition, which appeared to be unrelated to illness severity (or to ECT)." I'll go remove this one from the list of supporting references now.
 * Calloway SP, Dolan RJ, Jacoby RJ, Levy R (1981). "ECT and cerebral atrophy. A computed tomographic study.". Acta Psychiatrica Scandinavica 64: 442–445.
 * Templer RI, Ruff CF, Armstrong G. "Cognitive functioning and degree of psychosis in schizophrenics given many electroconvulsive treatments". British Journal of Psychiatry 1973 123: 441–443.
 * Shah PJ, Glabus MF, Goodwin GM, Embeier KP (2002). "Chronic, treatment-resistant depression and right fronto-striatal atrophy". British Journal of Psychiatry 180: 434–440.

More to follow as I have time. Nmg20 23:50, 1 May 2006 (UTC)

The latest batch. I've only found the abstract of this (as it appears on Pubmed - it's linked from the references section of the main page), but: It doesn't find any evidence of brain damage - just "significant post-ECT T2 increases in the right and left thalamus" which may be responsible for memory impairment. The mechanism? "These findings are consistent with a post-ECT increase in brain water content (perhaps secondary to a breakdown of the blood-brain barrier)". Although, in a pilot of six patients, results will always be weak until repeated, I suppose it could be described as an abnormality.
 * Diehl DJ, Keshavan MS, Kanal E, et al (1994 (November)). "Post-ECT increases in T2 relaxation times and their relationship to cognitive side effects: a pilot study". Psychiatry Res 54 (2).

This is a study of rats given kainic acid and shocks to induce seizures and measure mRNA expression to look at PAF-stimulated signal transduction pathways. ECT is mentioned not once in the whole paper - understandably - and the study makes no attempt to assess brain lesions/abnormalities/etc. In the rats. I am going to remove this one from the list, but will leave it in the references for now - although really it has no place there either.
 * Marcheselli et al. "Sustained induction of prostaglandin endoperoxidase synthase-2 by seizures in hippocampus". J Biol Chem 1996 271: 24794–24799.

This is another paper that observes that the ventricles are enlarged in schizophrenia. It isn't about ECT, and this is a well-known finding in patients with schizophrenia whether they've had ECT or not; in addition they make up a minority of those who have ECT. As a final nail in the coffin, the paper notes in its abstract: "In a second large series of schizophrenic patients studied with magnetic resonance imaging at the University of Iowa, Iowa City, earlier findings of decreased frontal, cerebral, and cranial size were not replicated." - i.e., no structural abnormalities. I will remove this one from the list of supporting papers as well, and as for Marcheselli & Bazan, it probably shouldn't stay in the references.
 * Andreasen et al (1990). "MRI of the brain in schizophrenia". Archives of General Psychiatry 47: 35–41.

Hallelujah! A paper which does what it's claimed to: "Patients with a past history of treatment by electroconvulsive therapy showed more sulcal widening in the parietal and occipital areas than those not so treated."
 * Dolan et al (1986). "The cerebral appearance in depressed patients". Psychological Medicine 16: 775–779.

This is dubious - it deals only with ECT-induced delirium and only with elderly patients. While it did find abnormalities in these patients, it is very difficult to generalise from that to therapeutic uses of ECT - which aren't designed to induce delirium and aren't always in elderly patients.
 * Figiel G, Coffey E, et al (1990). "Brain MRI findings in ECT-induced delirium". Journal of Neuropsych and Clin Sci 2: 53–58.

That's the lot. I have grave doubts about the validity of using this selection of papers to support the idea that ECT causes brain abnormalities - many of the papers simply didn't do that anyway, many are decades old and predate modern (NB: not "so-called" modern) practice, many are pilots, many are interested in other things, and in among them is not one trial comparing pre-ECT MRIs to post-ECT MRIs in the same patient. That means none of these studies can prove anything. They are well aware of that - but the use they're being put to isn't.

Nmg20 20:50, 2 May 2006 (UTC)

double standard here
There is clearly a double standard here. The original text does not meet Wikipedia quality standards; it is copied, word for word, from the Surgeon General's Report, a highly POV souce (I would like to post the criticism of the Report from major national organizations and news media, which would require typing them in since I have no scanner and cannot find links, but this is a very important point.) Is that allowable, or is it plagiarism? Which leads to the second problem. There were only THREE citations for the whole article before I came along, which means nearly all references were not cited! Yet no one complained, no one said they needed references, and there are still NO references for any of these cites. Does that not violate quality standards? I understand why the copier of this article could not provide references, because they were only copying the Report word for word and did not have the references, but that does not mean that they don't have to provide them! Meanwhile, while I have provided detailed citations, they have all been deleted, with commentary that is extremely inaccurate and biased IN FAVOR OF ECT, for instance, a peer reviewed article is said, without any foundation or evidence, to be "from an anti ECT Group" which is ridiculous! It is not. In short, any kind of sloppy article involving possible plagiarism or at least word for word copying without quotes, and without ANY citations, is acceptableas long as it is favorable to ECT; however, anything thought, without any reason or evidence (and by WHOM?) to be anti-ECT (Whatever that means) doesn't need to have any citations at all!

No matter what your opinion on ECT (which should not enter into this) you should be able to see that there is a double standard here and an article that does not meet quality standards.

Either EVERY cite must be referenced or else deleted, or it must be permissible to cite without ANY references (which the majority of the article is).

The commentary on my references follows the same pattern, with articles in peer reviewed journals that have stood the test of time and been cited countless times being dismissed as not "real articles" apparently simply because someone thinks they aren't favorable enough to ECT.

Also, just because a source is not available online does not make it a "worthless" source. Someone called the FDA docket on ECT this. This docket predates the agency's putting its records online, and it is not online, but it is a public access document that anyone can read in hard copy. Please, by what standard are the FDA---every bit as much part of the government as the SG or NIMH---findings worthless? Only, apparently, by the standards that someone here thinks---without bothering to read it---that it's not sufficiently adulatory about ECT.

Again, the same standard must apply to everyone and every article. No edits and no article should be subjected to some kind of de facto sniff test by someone who obviously has an agenda to promote ECT. And why is this person in charge of this page, anyway?

I may not be the most computer literate person but I do know the literature on ECT.

The issue of financial conflict is critical. There are many ways to verify that authors have financial conflicts of interest which is absolutely material to evaluating their work. I have suggested three. Some, but very few, authors disclose their financial conflict (Abrams, cited here without any discussion of his ownership of a shock machine company, is one) but none disclose it within their articles themselves.

The vast majority of the cites which appear here without references (almost all that I did not put up) are by financially conflicted authors, and there is proof of that. 13 of 17 references in the ECT section of the SG Report (which was simply copied here word for word) are to financially conflicted authors. Why does Rudorfer appear so many times, who is he, some famous researcher? Not at all. He was the editor of this section of the SG report, and cited to himself more than anyone else on earth because he could. I realize you people did not know that. But now that you do, how could anyone call the Report a NPOV document that should be cited here word for word with claims of neutrality?

Does anyone here disagree that financial conflicts of interestare important for readers to know and for the authors of this article to tell them? &mdash;The preceding unsigned comment was added by 209.122.225.79 (talk • contribs).
 * As is apparent here, I had already agreed that the article was deficient in citations and that it must be remedied. In fact, it was the last post before your message here and cleanup and citation needed tags had already been placed in the article. Find a good source for the financial conflict and it goes in, but the language has to be NPOV. And you should try to assume good faith, the reasons for the criticism of individual sources were given. And I assume you are speaking of me when you said someone who obviously has an agenda to promote ECT. And why is this person in charge of this page, anyway? . This kind of attitude is counterproductive and may constitute a personal attack which will significantly reduce your credibility here. No one here has any nefarious agenda. I am not a psychiatrist and do not use ECT, nor am I affiliated with any ECT company. I, like the other editors, am only interested in making this article accurate and NPOV. Frankly a number of your sources (video depositions, court testimonies, patient books) are not good citation sources to support medical claims in a scientific article. The documentation that I could find regarding the FDA docket revealed a conclusion that regulations regarding ECT machines would not be changed. This is not a reputable source to support allegations of permanent neurological deficit caused by ECT. And despite your allegations The commentary on my references follows the same pattern, with articles in peer reviewed journals that have stood the test of time and been cited countless times being dismissed as not "real articles" apparently simply because someone thinks they aren't favorable enough to ECT, the majority of your citations were deemed legitimate. Only 3 of your articles in peer reviewed journals  were questioned as "not real articles", and the reasons were given, generally for lack of pubmed citation. And it is the responsibility of every editor including yourself to do a "sniff test" if someone starts doing massive edits of articles and includes information that is controversial and contrary to accepted knowledge. Frankly, the amount of effort that was expended to vette your sources was unusual, something you don't seem to appreciate. That effort should have been done by the editor inserting the sources. Typically articles are reverted until new additions are vetted. However, I do thank you for providing those sources, but I am troubled by your accusatory tone, and your instant reversion of the article despite good faith efforts to incorporate information from your sources.-- John  DO | Speak your mind  03:08, 24 January 2006 (UTC)
 * P.S. please sign your posts, it helps us figure out who is saying what.-- John DO | Speak your mind  02:14, 24 January 2006 (UTC)
 * You found the discussion tab? Hurrah! :-) Kim Bruning 02:06, 24 January 2006 (UTC)

While it is encouraging that you are finally discussing matters, it is also troubling that despite repeated entreaties to discuss this matter, you reverted the material prior to engaging us in discussion. -- John DO | Speak your mind  03:27, 24 January 2006 (UTC)

Editors,"vets", POV
Once again, I am new to all this. So please be patient. I am coming in and seeing so many inaccuries in the article, it was all I could do not to change it all at once!

Instead I took the one section that had been copied (or plagiarized, because there are no quotes) from the SG report, a very biased (pro-shock) POV document. There lies the problem, for some reason this article starts with a very strong POV, which no one is acknowledging because after all, they didn't write it, just copied it.

I don't understand how one person "edits" this, I thought we all did. Apparently there is someone who is a doctor who volunteered? Was chosen? to have final say over this article? How does that happen?

I am assuming he wasn't chosen because of expertise in ECT.

What is meant by "vet"? Is there a rule that this one person, the editor, has to read every reference? And does he get to judge them all by himself (highly problematic, in my opinion?)

Clearly this person is not the owner of a shock machine company---but I have been involved with ECT long enough to know that even rank and file doctors react very strongly to anything but the APA's party line on ECT. It is as if when you examine ECT closely, you are holding the entire enterprise of psychiatry up to scrutiny, and any "criticism" of ECT will bring it all down. This is not rational, but I've seen it enough to know it's common.

In any case, Dr. Editor, if there is a rule that you have to read every reference, it is not the case that any of mine are inaccessible to you. They are accessible to anyone. You can get them at a medical library; or in the case of the FDA, at the FDA; or in the case of court hearings or legislative testimony, by ordering the transcripts.

Thanks for clarification and your patience.

Doogs (anon)


 * Please take the time to read the talk page and the discussions above. It should be readily apparent that 4 editors (,, , and ) have reverted your edits, and 2 were involved in checking your sources. Your allegation that one person "was chosen? to have final say" is inaccurate to say the least. No one is final arbiter of content. We are supposed to reach a consensus as to content according to the policies of verifiability, no original research,and neutral point of view, something that you have not done as of yet. Again, you should try to assume good faith rather than allege conspiracy. And you should refrain from characterizing other editors' actions as irrational. I am not a psychiatrist and have little stake in their legitimacy. We are all editors who are interested in creating a good article. Again, it is my contention that a number of your sources (FDA dockets, court hearings, legislative testimony, a book by a patient) are inappropriate as citations supporting specific side-effects. -- John  DO | Speak your mind  07:02, 24 January 2006 (UTC)

I appreciate the information, but I have read this whole section and it doesn't answer my questions. How did you four get to be the ones who have final say over this page? Were you self chosen or is there a process one must go through to become an editor of a page? Did you choose this page or was it assigned to you? Also, what is meant by "vet" and is this just your practice or mandatory Wikipedia policy? From what you say, I think it means that all editors must personally read all sources. But of course, except for my references, you couldn't have done that, because there were no references provided, only cites. So I'm confused. Doogs
 * Anyone can edit any page as long as they reach consensus with the other people who have decided to edit that page. "Vetting" is the process of determining accuracy of sources according to wikipedia policy:verifiability. -- John DO | Speak your mind  21:25, 25 January 2006 (UTC)

How is it that you four (and only you four?) get to ban people from Wikipedia? Anyone can make changes, but not anyone can ban, as far as I can see. &mdash;The preceding unsigned comment was added by 209.122.225.37 (talk • contribs).
 * Admins can ban. I am not an admin, I can't speak for the others. You are mistaken in your assumptions.-- John DO | Speak your mind  05:17, 26 January 2006 (UTC)

Thanks for the clarification. So one of you is an admin(istrator), not the other three? And did you mean you are editors in the same sense that I am?

Who put that tag up there, and is it something that any of us can do? Because as I think we all agree, there are serious problems in POV and missing refs in all sections, not just the ones most recently edited.

Doogs

The best available evidence
Perhaps I should take this a little slower, a piece at a time.

Every single "fact" we know or think we know about ECT is influenced by the research or lack of it. In the case of ECT, it is more the latter case.

There are some very critical aspects of ECT that simply have never been researched, and some that have been very inadequately researched, and this all relates directly to the financial conflicts of a few key men who have a lock on the research money.

(In my edit I did not say that these financial conflicts cause the lack of research, for instance, the dearth of long term studies; I said, quite accurately, that the time period when there have been no studies correlates with the time period when research money has been in the hands of men who work for the shock machine companies. This is not a POV statement, but a factual one.)

So, what do you tell patients, or the world in this Wikipedia, when formal research data simply isn't there? You tell them the data isn't there, and because these are such important things to know, you use the best available evidence that exists.

Take IQ. It is extremely important for patients and families to know whether ECT can permanently lower IQ. This has not been studied. However, what you can say, and what I did say, was that former patients have reported extreme (30+ points) loss of IQ, and that they did not only just say this, but they backed it up with neuropsychological testing, and that the some of the results of this neuropsychological testing have been submitted to the FDA, where they can be viewed by anyone by going in and reading the docket.

Is this "too anecdotal"? I cited testimonies given at formal public hearings, transcripts of which are available to anyone. I did not cite someone going on a talk show and saying, Oh, ECT lowered my IQ. In fact, I could have cited to Philpot on this point, because approximately 40% of ECT patients in their study reported that ECT lowered their intelligence; however, those patients did not, as far as we know, have formal IQ testing done, which the others did.

Until there is a study done, which in my opinion will not be done until (unlikely) someone wrests the available research money away from those who've had it locked up for 20 years, this is the best evidence we have, and it is important to cite to it.

Interestingly, there are two studies which incidently (as part of studying something else) mention IQ and claim to have tested it, but the scores of the patients were never reported, only means of the whole group, which makes it impossible to see whatever individual differences there were. However, it is possible to tell in one of these that pre ECT there was a patient who scored 127, and afterwards the highest score was around 100.

I think it is very important to keep the IQ part in, and use the best available cites that exist.

One is a "patient book", but remember, the APA does highly regard and recommend "patient books" in its ECT guidelines---as long as they are adulatory of ECT! They do not discredit books written by former patients or say they are unreliable sources. And this one was published by Random House, so one must assume author credibility.


 * Anecdotal does not refer to whether the patients were sworn in. Anecdotal refers to lack of bias control and controls. Patient reports do not demonstrate causality. Until there is research done that demonstrates causality between ECT and loss of IQ, that does not belong in a scholarly article. If you want to say that patients have reported IQ loss but this has not been proven by studies, that seems acceptable. Whether the APA recommends "patient books" is immaterial. We are not going to use pro-ECT patient books to support causality regarding "lack of side-effects" either. Neither use demonstrates causality. Looking at the book's contents, it contains anecdote and some research. The research within can be cited independently and the anecdote does not demonstrate causality. -- John  DO | Speak your mind  07:08, 24 January 2006 (UTC)

Therefore, anything we include should have been published in the records, reportage, research, or studies of other reputable sources. (Wikipedia verifiability policy)

All of my sources meet this critera. The FDA, New York State legislature, Vermont legislature, California courts, etc. are reputable sources, and these are their records, reports, etc.

Doogs
 * Read the policy in its entirety especially as regarding science and medicine articles. -- John DO | Speak your mind  05:14, 26 January 2006 (UTC)

FDA
I think it is important to add the FDA's official position to this article. I understand the FDA website is difficult to navigate.

FDA classifies the ECT machine, and therefore ECT, as Class III, high risk. This is the category for devices that have not been proven safe, meaning the benefits have not been shown to outweigh risks and there is unreasonable risk of injury or harm. (You can look up the meaning of Class III on their site.)

The change that they might have made, were pressured by the shock industry to make, and did not make, was to change the classification to Class II. This would have put ECT in the same category as a massage chair, just think about that! That is what the APA wanted.

The ECT docket, 40 volumes all of which I have read, contain the evidence that went into their making the decision to maintain the device in Class III.

In 1979 (I will get the cite from CFR when I edit the article) the FDA stated that the risks of ECT include brain damage and memory loss, and it has never retracted that statement.

Any objection to including the FDA classification in the article?

Doogs


 * The FDA's refusal to change from Class III to Class II is certainly notable and I have no objection to the inclusion of that decision. But citing the docket as evidence of causality of specific side effects is not in accords with verifiability policy. The evidence presented would consist of either research or anecdote. Research submitted to the FDA can be cited independently of the docket. Anecdote is not notable except as anecdote. I object to your edit because you have made several leaps in causality. You can't say "X causes Y" in a scientific article without demonstrating causality through research with controls. If the research is lacking, fine, you can say that. But case reports, testimony, depositions, are all anecdote and do not demonstrate causality. So far, your sources contain indications of 1) anatomical changes of uncertain significance with some causal relationship to ECT, 2) that patients have significant concerns about informed consent, 3) that the FDA refused to downgrade ECT machines, 4) that memory loss is a significant factor, patients report significant retrograde memory loss. I have no objections to inclusion of these supported statements. -- John DO | Speak your mind  07:20, 24 January 2006 (UTC)

As I said, Johnny, I did not say the patient reports were reports of causation, I said that patients reported drastically lowered ECT and backed it up with scientific testing.

The problem is that those with the ability ($) to do research are financially conflicted. That fact does not prove or show that there is no causality, it shows that something besides science is going on here. With ECT, it is impossible---and unscientific--to say, Because there is no research there is no evidence.

"Refused" is a strange and POV word to use to describe the FDA's decision. For your information, "anecdotal" does not mean what you say. It simply means unpublished. By that standard, my sources are not anecdotal.

Doogs


 * Unless you have research proving causality, you cannot state X caused Y. Anecdotal reports are not definitive as different types of bias cannot be filtered. Why is refused a POV word? You say the APA requested or pressured the FDA to change the classification. The FDA did not do so. In other words, they refused to do so. I am puzzled. Perhaps you can choose a different word? And the term anecdotal has several meanings depending on context. We are speaking of anecdotal evidence. So, FYI while the greek roots of the word anecdote does indeed mean unpublished, its well-established and uniform use in the context of scientific experimentation, logical analysis, and statistics, and law means testimonials or reports. So, indeed your sources are anecdotal evidence. The semantics don't matter. If you would rather refer to them as testimonials or reports, that's fine. That does not change the fact that reports or testimonials do not demonstrate causality.-- John DO | Speak your mind  07:50, 24 January 2006 (UTC)

"FDA classifies the ECT machine, and therefore ECT, as Class III, high risk. This is the category for devices that have not been proven safe, meaning the benefits have not been shown to outweigh risks and there is unreasonable risk of injury or harm. (You can look up the meaning of Class III on their site.)"

While the FDA's explanation of Class III devices mentions "a potential, unreasonable risk of illness or injury" as one possible reason for a Class III designation, it hardly says that Class III devices are those for which the benefits have not been shown to outweight the risk. That distinction seems to be entirely your own invention. One could hardly say that a pacemaker's benefits do not outweight the associated risks, but a pacemaker is a Class III device. To paraphrase my understanding of the designation, it seems to me that Class III devices are merely those whose malfunction or misuse presents the highest risk to human life or health. It seems intuitively obvious to me that ECT--whatever the benefits expected and whatever can be done to minimise the risks--has an extremely low tolerance for malfunction or misuse. And as such, it seems reasonable that it would be designated Class III regardless of the preponderance of benefits vs. risks in cases involving no malfunction or misuse. 70.137.149.55 08:09, 25 January 2006 (UTC)
 * A very good point that I did not catch. -- John DO | Speak your mind  08:41, 25 January 2006 (UTC)

No, you are wrong. Class III is exactly what I said. That wording is in the definition of Class III. Classification is a risk/benefit calculation. Now, I do not know where exactly that is on the internet, because I find the FDA site very confusing, and my information is all in hard copy. However, it seems to me you could make a phone call to the FDA and confirm that what I say is accurate. Class III has nothing to do with "tolerance for malfunction or misuse", or "misuse".

For your information, all implanted devices, such as pacemakers, are Class III. It is in the definiton of Class III that it includes all implanted devices.

FDA rules are what they are and not subject to your interpretation. They are clear and verifiable.

Doogs
 * I found the regulation. The exact text follows:

Class III - Premarket Approval Class III is the most stringent regulatory category for devices. Class III devices are those for which insufficient information exists to assure safety and effectiveness solely through general or special controls.Class III devices are usually those that support or sustain human life, are of substantial importance in preventing impairment of human health, or which present a potential, unreasonable risk of illness or injury. Premarket approval is the required process of scientific review to ensure the safety and effectiveness of Class III devices. Not all Class III devices require an approved premarket approval application to be marketed. Class III devices which are equivalent to devices legally marketed before May 28, 1976 may be marketed through the premarket notification [510(k)] process until FDA has published a requirement for manufacturers of that generic type of device to submit premarket approval data. Class III devices which require an approved premarket approval application to be marketed are those: 1.regulated as new drugs prior to May 28, 1976, also called transitional devices. 2.devices found not substantially equivalent to devices marketed prior to May 28, 1976. 3.Class III preamendment devices which, by regulation in 21 CFR, require a premarket approval application. Examples of Class III devices which require a premarket approval include replacement heart valves, silicone gel-filled breast implants, and implanted cerebella stimulators. Class III devices which can be marketed with a premarket notification 510(k) are those: postamendment (i.e., introduced to the U.S. market after May 28, 1976) Class III devices which are substantially equivalent to preamendment (i.e., introduced to the U.S. market before May 28, 1976) Class III devices and for which the regulation calling for the premarket approval application has not been published in 21 CFR. Examples of Class III devices which currently require a premarket notification include implantable pacemaker pulse generators and endosseous implants.


 * Nowhere does it say "not proven safe"-- John DO | Speak your mind  20:39, 25 January 2006 (UTC)


 * You said FDA classifies the ECT machine, and therefore ECT, as Class III, high risk. This is the category for devices that have not been proven safe, meaning the benefits have not been shown to outweigh risks and there is unreasonable risk of injury or harm. This is in fact completely inaccurate. You completely ignored the word potential which was clearly in the regulations. ECT devices present a potential, unreasonable risk of illness or injury. That does not mean they are "unsafe". And the Class III definition does not say "all implatable devices" are Class III. It gives some examples. To quote you "FDA rules are what they are and not subject to your interpretation. They are clear and verifiable."-- John DO | Speak your mind  21:12, 25 January 2006 (UTC)
 * I think the FDA's classification of ECT devices as Class III is appropriate for inclusion in the article, but that means little other than it can cause potential harm, which is hardly surprising. POV editorializing like "This is the category for devices that have not been proven safe, meaning the benefits have not been shown to outweigh risks" is inappropriate.-- John DO | Speak your mind  21:20, 25 January 2006 (UTC)

Johnny, FDA does not "approve" devices or make judgments on safety. It assesses devices, and does so on a risk/benefit basis. Class I means no risk, Class II means low risk, Class III high risk. If you are able to access to proposed rulemaking on ECT (if it is not online it can be gotten in hard copy) you will see exactly what I mean. There is a section on risks, a section on benefits, and then the calculation. Actually, you could look at any proposed classification or reclassification, not just ECT, to see how this works. I think this would make it clearer for you. The very definition of Class III is that benefits have not been proven to outweigh risks..) —Preceding unsigned comment added by 209.122.225.37 (talk • contribs)
 * The regulations are online and I have clearly linked them. They are CLEARLY reproduced above. The U.S. Food and Drug Administration (FDA) regulates medical devices to assure their safety and effectiveness... . The FDA clearly has to "makes judgments on safety" to regulate medical devices. Again if you want to say the FDA did not grant a motion to reclassify as Class II, that is proven.-- John DO | Speak your mind  06:32, 26 January 2006 (UTC)

Why do you assume bad faith or error on my part? Is it because you have already made up your mind as to what you believe on ECT, and anything else threatens you? I am quite surprised, actually, at the degree of mistrust, and the bad faith you presume, and at several logical fallacies in your reasoning, like trying to figure out what the FDA says based on what it "seems to you" it must have said, and putting words in my mouth rather than quoting what I actually said (I did not ever use the word unsafe, you did.) What I said is accurate: ECT devices have never been proven safe. For that, they would have to go through the above mentioned premarket approval process, which ECT devices have never done. (That process means that there have to be studies done and submitted by the manufacturers on the safety of the device. No ECT manufacturer has ever done any studies.) —Preceding unsigned comment added by 209.122.225.37 (talk • contribs)
 * Because repeated assertions by you have been mistaken. Because you started your discussion by making blanket wholesale accusations of bias on the part of the other editors. Because you have made repeated reversions of the article without discussion . Because you have have given I already posted that I cannot get onto the talk page. Would someone please post how to do this? as an excuse to not discuss matters but have been able to post on User:Talk pages  and use advanced wikitemplate tags. . Because you accuse other editors of "logical fallacies" and of "trying to figure out what the FDA says based on what it "seems to you"" despite the fact that links were provided to the direct regulation and reproduced here. Because IPs you posted wi

th are associated with blatant vandalism of articles. However, you are right in that you did not say "unsafe", you said "This is the category for devices that have not been proven safe" which ignores the word "potential" in the regulation to suit your POV. Do you see why this behavior could be inspiring of less than total trust? -- John DO | Speak your mind  06:32, 26 January 2006 (UTC)

Allow me to quote from fda.gov's information on Premarket Approval Applications (emphasis mine)
 * The Medical Device Amendments of 1976 to the Federal Food, Drug, and Cosmetic Act (the act) established three regulatory classes for medical devices. The three classes are based on the degree of control necessary to assure that the various types of devices are safe and effective. The most regulated devices are in Class III. The amendments define a Class III device as one that supports or sustains human life or is of substantial importance in preventing impairment of human health or presents a potential, unreasonable risk of illness or injury . Insufficient information exists on a Class III device so that performance standards (Class II) or general controls (Class I) cannot provide reasonable assurance that the device is safe and effective for its intended use. Under Section 515 of the act, all devices placed into Class III are subject to premarket approval requirements. Premarket approval by FDA is the required process of scientific review to ensure the safety and effectiveness of Class III devices.


 * An approved Premarket Approval Application (PMA) -- like an approved New Drug Application (NDA) -- is, in effect, a private license granted to the applicant for marketing a particular medical device. A Class III device that fails to meet PMA requirements is considered to be adulterated under Section 501(f) of the act and cannot be marketed.

One need not "assume bad faith or error on [your] part" to surmise that you are in error. You are, straightforwardly, presenting falsehoods as if they were authoritative facts. While this doesn't necessarily mean that you are acting in bad faith, it does at least cast significant doubt on your motives. FDA approval is required before a Class III device can be marketed in the US. (ECT machines are exempted from this requirement, true, because they were marketed in the US prior to the 1976 amendments establishing the current rule.) If you have a source that establishes that Class III devices are precisely those for which the "benefits have not been proven to outweigh the risks", please provide it. That definition directly contradicts the definitions and explanations available on fda.gov, which provide "a potential, unreasonable risk of illness or injury" as a clear reason why ECT devices might be placed in Class III. And again, I would point to the pacemaker as a device for which the benefits have certainly been shown to outweigh the risks but which is designated Class III. If indeed the descriptor of a Class III device is that the benefits do not outweigh the risks, is there an explicit exception for implanted devices? Could you provide a concrete source for that explicit exception?

It is true that no ECT device manufacturer has submitted to the PMA process, though this is hardly surprising since it is a very costly process that the FDA has not yet required for ECT devices. There is, however, a good deal of academic literature extant on ECT. It is not as if no studies on its safety or efficacy have ever been undertaken by anyone. If you wish to dispute that safety or efficacy, I would suggest you appeal to these studies rather than circumstantially claiming that the procedure is unsafe or ineffective based on the unwillingness of ECT device manufacturers to voluntarily undergo the costly PMA process in the absence of any legal requirement that they do so. 63.200.51.118 07:27, 26 January 2006 (UTC)

Hi again. I am absolutely certain that my information on the FDA is correct. You are going through a learning curve, so please refrain from accusing me of posting false information while you are going through it.

And please refrain from speculating on my motives, which constitutes a personal attack on me---a Wiki nono. You seem to understand the difference between pre amendment and post amendment Class III devices. ECT devices are preamendment (pre-1976) which is the reason why there have been no PMA calls yet. However, there was a 515(i)---please look that up before yelling at me---which required the manufacturers, legally, to provide all available safety and efficacy information. They provided nothing, in violation of the law.

It is the manufacturers who have the legal responsibility to prove their devices safe, not the users.

I'll accept your apology for speculation on my motives if you offer it.

Doogs

"I am absolutely certain that my information on the FDA is correct." Then you are absolutely certain about things which range from patently false to merely unsupported by the sources you have provided. I invite you, once again, to produce sources backing up the following claims you have already made about the FDA:
 * The definition of a Class III device is that its benefits do not outweigh its risks.
 * The FDA is not responsible for approving medical devices.
 * There is an explicit regulation placing all implanted devices in Class III regardless of their benefits and risks.

I have not speculated on your motives beyond pointing out that they are in doubt owing to your obvious willingness to claim as true things that are verifiably untrue and your repeated refusal to support these claims with anything beyond (to paraphrase) "Trust me; I know what I'm talking about." It is hardly a personal attack to draw reasoned conclusions about your frame of mind based on your behavior. I am tempted to speculate more explicitly on your motives based on the emotional language you have consistently used in your edits to both the main article and the talk page, but I would rather not foul the air any further. Suffice it to say I am not interested in offering an apology.

As for the legal status of ECT devices, I would refer you to Section 882.5940 of Title 21, the current FDA regulation on ECT devices, which reads in part, "(c) Date PMA or notice of completion of a PDP is required. No effective date has been established of the requirement for premarket approval."

The FDA did indeed call for information from the device manufacturers pursuant to 515(i), and indeed none was provided. These events are unfortunate for all concerned and perhaps worthy of inclusion in the article, but it is overstating the case to call the manufacturers' inaction a violation of law, and would especially be overstating the case to imply that this inaction is proof that ECT is unsafe or ineffective. I would point out that it was well within the FDA's power to subsequently require a PMA, but they chose not to do so. If there is negligence here, the FDA is a willing contributor to that negligence. 70.137.166.217 03:25, 30 January 2006 (UTC) (Addendum: I've just created an account as even I am getting confused by my multiple IPs N6 06:43, 30 January 2006 (UTC))

Hi again---what "emotional language?"

You continue to misread and misunderstand. All three statements above are true and factual. Once again, because I am unable to navigate the FDA's website, I suggest a phone call to FDA. As far as the risks v/ benefits and that's how FDA decides, I suggested you look at any proposed classification or final rule for a medical device. It need not be a shock machine. That will show you the formula the FDA uses to make its determination. Have you done this? Looking at a few of them would be good, and would help you to understand the procedure that is followed for all devices.

Yes, in fact the failure to submit a 515(i) is a violation of the law. Once again, someone at the FDA can explain this to you.

Please, do not draw a conclusion that something is false just because you cannot find it with the click of a computer button. You may have to go beyond that.

As far as the implanted devices, I did not say "regulation". It is contained in the definition of Class III that it includes implanted devices.

Where that is online, I cannot begin to tell you.

It is also not correct that FDA "Chose" not to call for PMAs. It does not have that option. There must, eventually, be PMAs for all pre amendment devices that stay in Class III. That is what the law says.

If you are having trouble understanding all this and live in the US, perhaps your Congressperson can help you get clarification.

Once again, please refrain from speculating on my motives based on the fact that you are having trouble understanding this. It is complex, that's for sure.

Doogs

It is your responsibility to provide sources (online sources or publicly available offline sources) for the claims you make. Saying "call the FDA" is not the same as providing a source. Please familiarize yourself with No original research and Verifiability.

Yet again, you have claimed a verifiably false statement as true: "It is also not correct that FDA 'Chose' not to call for PMAs. It does not have that option." From the same fda.gov PMA info page I quoted above:


 * A preamendments device is one that was in commercial distribution before May 28, 1976, the enactment date of the Medical Device Amendments. Manufacturers of Class III preamendments devices are not required to submit a PMA until 30 months after the promulgation of a final classification regulation or until 90 days after the publication of a final regulation requiring the submission of a PMA, whichever period is later. FDA may allow more than 90 days after promulgation of a final rule for submission of a PMA.

Note in bold that the FDA has the authority to "[publish] a final regulation requiring the submission of a PMA".

As for implanted devices, from the letter sent by the FDA pursuant to 515(i) in 1998:


 * Class III are devices for which insufficient information exists to assure that general controls (Class I) and special controls (Class II) provide reasonable assurance of safety and effectiveness, and if the devices are those represented to be life sustaining or life supporting, or for use which is of substantial importance in preventing impairment of human health or present potential unreasonable risk of illness or injury. Generally, implanted devices have been placed in Class III unless a lower class can be justified by sufficient information to promulgate special controls or a performance standard. New devices after 1976 and transitional devices considered drugs prior to 1976 are classified into Class III by statute.

Note, once again, that Class III devices are those (subject to certain restrictions) for which "general [...] and special controls" are insufficient to ensure safety and efficacy. Those restrictions are that the device must be life sustaining/supporting OR be responsible for preventing impairment of health OR present the potential for unreasonable risk. Nowhere among the sources I have seen or the sources you have provided is it said that Class III devices (which don't fall into the life or health sustaining/supporting categories) always present an unreasonable risk or that there are no controls sufficient to ensure safety and efficacy.

Note also the specific mention that exceptions to the general trend of placing implanted devices in Class III can be made. An "Implanted peripheral nerve stimulator for pain relief" is a specific example of a Class II implanted device. The claim that all implanted devices are in Class III is categorically false.

Also, from the same letter:


 * The Food and Drug Administration (FDA) is continuing its implementation of the provisions of the Safe Medical Devices Act of 1990 (SMDA) which address preamendments devices classified in Class III. FDA is now seeking information from you to determine if down classification, from Class III to Class II or Class I, is appropriate for certain of these devices. When requested under Section 515(i) of the Food, Drug and Cosmetic Act (the Act) all manufacturers may be called to submit a summary of, and a citation to, updated safety and effectiveness data, including any adverse information, to the FDA.


 * Based upon a review of this information, FDA will then initiate a reclassification action for the device or call for premarket approval applications (PMA's) for the device. A list of these devices, and the deadlines for submission of updated safety and effectiveness information, were published in the Federal Register on August 14, 1995 (copy enclosed). FDA records indicate that you manufacture/market one of these devices and are required to submit the summary described above.

When I say that it is "overstating the case" to call failure to submit information pursuant to a 515(i) request from the FDA a violation of law, I mean that there are no apparent legal penalties associated with failure to submit such information. The FDA alludes to no penalty beyond (at its option) refusing to reclassify the device into a lower class and/or calling for a PMA. N6 02:34, 31 January 2006 (UTC)

I am glad you're learning, and hardly attacked me personally in your last! Now, look up controls, so you understand what that means. There are no controls that can make the ECT device safe.

Verifiable does not mean that it needs to be easy for you personally or that it needs to be over the internet. Verifiable facts are those that can be checked. All of mine can be verified by the FDA. Offline is OK.

Doogs

Calling the FDA is original research. It is your responsibility to prove the verifiability of your claims by providing explicit references to reputable published sources. Please familiarize yourself with Verifiability before making any further claims about what does and does not constitute verification of a claim with respect to Wikipedia. If you would like to establish the technical meaning of "controls", feel free to provide an explicit reference to a reputable published source. If you would like to establish that the FDA considers that there are no controls sufficient to ensure the safety of a Class III device, feel free to provide an explicit reference to a published source. Continuing to make nonobvious and/or controversial claims without providing explicit references will continue to get us nowhere.

Making observations about your behavior and reasoning logically about your motives based on that behavior is not a personal attack. The level of condescension with which you continue wording your contributions to this discussion, on the other hand, is distinctly uncivil. N6 03:27, 1 February 2006 (UTC)

After some more digging, I begin to understand that the only real difference between Class II and Class III is that the FDA feels Class III devices need to go through the PMA process to be proven safe and effective via general and special controls (where Class II devices can be judged safe and effective via general and special controls without the necessity of a PMA). To emphasize the most salient portion of the FDA's definition, "Class III devices are those for which insufficient information exists to assure safety and effectiveness solely through general or special controls." So, while it is true that the FDA has not officially judged that general and special controls are sufficient to ensure the safety of ECT machines--as they have left them in Class III and no PMA has been called for and decided upon--it is not true that the FDA has judged that general and special controls are insufficient to ensure their safety and efficacy. Per the sources I have cited above, it is within the FDA's power to call for a PMA in order that they might reach a final decision on that question, but instead they have (thus far) chosen to allow the continued use of the machines without calling for a PMA. I do not claim this means that the FDA judges the machines safe and effective, but it certainly does indicate they are currently willing to allow that judgment to go unmade while the machines remain in use. N6 04:12, 1 February 2006 (UTC)

You are correct except for the one sentence it is not true that the FDA has judged that general and special controls are insufficient to ensure their safety and efficacy. If controls could make the device safer, it would be in Class II. Also there is more to Class II than controls, there are performance standards, etc. By definition, if controls and standards could ---not ensure safety, but lower risk--- that is Class II. That is its definition.

By the way, I am heartened to see ads for drugs and devices which now tell the public they are "FDA-cleared" rather than "FDA-approved". The FDA only regulates, not approves.

There is a whole long story involving intense lobbying by the APA behind the "willingness" you infer on the part of FDA. They were browbeaten and pressured to death.

Doogs

You are mistaken about the definition of Class II. All nonequivalent post-amendments Class III devices in use are approved as safe and effective under general and special controls. The difference between these devices and those in Class II is that the Class III devices have gone through the PMA process to prove to the FDA's satisfaction that they are safe and effective under general and special controls. A device is only placed in Class II if the FDA is satisfied, in the absence of a PMA application, that the device is safe and effective. A Class III designation for a nonequivalent device merely indicates that the FDA requires more information to make a decision.

I do not know whether the FDA's failure to call for a PMA on ECT machines is due to outside pressure. If you have sources to back this up, I would be happy to read them. N6 21:34, 4 February 2006 (UTC)

Hi again---

You are still not quite there. You are wrong about the difference between II and III. If a device could be made safe by general and special controls, it would be in Class II by definition. It would not be in Class III. And you are wrong about the PMA process because you're not getting the difference between pre and post amendments devices. A post amendment device must have gone through PMA, but there are quite a number of pre amendments devices such as the ECT machine which have not. So, your "merely" is your speculation but is not correct.

The source for the pressure on the FDA to avoid a PMA is in Docket #82P-0316, along with various articles that have commented on the ECT device over the years. You can certainly read it, but you must do so in person at the FDA offices.


 * "If a device could be made safe by general and special controls, it would be in Class II by definition. It would not be in Class III."


 * Categorically false. I have explained this with references already. To reiterate, every approved post-amendments device, regardless of class, has been ajudicated safe and effective given some set of controls. Please provide an explicit reference if you wish to dispute this rather than saying it is wrong without justification. Class III devices are those that the FDA feels require a PMA to verify their safety and efficacy (or which are equivalent to pre-existing Class III devices). Allow me to quote again from fda.gov's Device Classes page: "Premarket approval is the required process of scientific review to ensure the safety and effectiveness of Class III devices." If a successful PMA "ensure[s] the safety and effectiveness" of a Class III devices, how can it be said that there are no controls sufficient to do just that?


 * I do not see how I am "wrong about the PMA process". I am not confused in the way you suggest about the difference between pre- and post-amendments devices; I am well aware that not all pre-amendments devices have actually gone through PMA (ECT machines included). Note the word "non-equivalent" earlier in my paragraph. I was talking specifically about non-equivalent post-amendments devices; I apologize if the wording was unclear. N6 23:09, 23 February 2006 (UTC)

I hope this helps you: Kessler DA, Pape SM, Sundwall DN. The federal regulation of medical devices. New England Journal of Medicine Vol. 317 No. 6, 357-466. You said To reiterate, every approved post-amendments device, regardless of class, has been ajudicated safe and effective given some set of controls. No, not true. Once again, assessment of medical devices unlike drugs is based on risk/benefit assessment, not safety and efficacy per se. Some post amendment devices are in Class III, which means no controls can assure reasonable safety and efficacy.

A quote from the above article, written by the former FDA Commissioner:. "Unlike the regulation of new drugs, in which standards of safety and effectives are applied uniformly, the regulation of devices is based primarily on risk."

A "successful PMA" is simply a license to market a device, not an assurance of safety and efficacy. PMAs can be and are granted for Class III devices.

Once again, FDA does not assure safety and efficacy or approve devices. A lot of your confusion must be because you're not understanding the difference between regulation of drugs and regulation of devices.


 * The quote you provide from the NEJM does not state that approved medical devices are not judged to be safe or effective; it merely implies that the safety and efficacy standards for medical devices do not have the same uniformity as those for drugs, and perhaps (as you have suggested) that there is a more explicit risk vs. benefit calculation for devices. Any drug or medical device comes with associated risks. I do not know the particular standards the FDA applies to drugs, but the standard is certainly not 0% risk and 100% efficacy, as no drug can possibly satisfy that standard. As with medical devices, there must be some degree of accepted risk and some accepted chance that a given drug will be ineffective.


 * In any case, the quote directly from the FDA's literature that I have already provided, "Premarket approval is the required process of scientific review to ensure the safety and effectiveness of Class III devices," places a rather large burden of proof on anybody wishing to claim that a PMA provides no assurance of safety or effectiveness. Why does the FDA say in black and white that a PMA ensures safety and effectiveness if it does not? N6 22:23, 26 February 2006 (UTC) Forget it. I'm tired of arguing in circles and I'm tired of being doggedly condescended to. N6 08:31, 27 February 2006 (UTC)

about Good Faith
I am going to take a breather and try to assume good faith. Let me summarize how this all looks to the rest of us. TO THE ANONYMOUS EDITOR "DOOG" This is recapped here for a reason. Our discussions have become increasingly acrimonious. In the light of the above please put yourself in our shoes and see if you might react in a similar way. We are desperately trying to see things from your perspective. Obviously you feel strongly about this issue, ECT. And we applaud that. But just because people disagree with you does not mean that we are "not rational" or have "logical fallacies in our reasoning" or that we "have already made up our minds as to what we believe on ECT, and anything else threatens us"
 * An anonymous editor appears and makes huge edits with a strong POV and no sources without discussion to an article that hasn't seen significant changes since early december.
 * This is reverted with an appeal for sources and discussion
 * Despite repeated entreaties for discussion, anonymous editor engages in an edit war and no discussion with 3 editors and an admin, severely violating the 3 Reverts per day rule by making 5 reverts between 19:26, 20 January 2006 and 02:09, 21 January 2006 a period of less than 7 hours.
 * Anonymous editor starts adding sources, still with no discussion, and reverts an admin's edit engaging in a 6th revert in 24 hours.
 * Anonymous editor is thanked for providing sources. Anon's edits are kept for over 36 hours, the only edits were to assist the anon in formatting his sources ,
 * Anonymous editor is asked to discuss things again
 * Editors work to provide links for anon's sources, work that traditionally should have been done by anon.
 * The article is reverted at 22:03, 22 January 2006 to a more NPOV version which also incorporates portions of the anonymous editor's content. The edit summary is rv to more NPOV version while adding the supported statements. see Talk . A Cleanup tag is in this edit because it is felt the rest of the article should be better sourced. A message is left saying Anon has a good point regarding one thing. The original article was poorly cited, rife with name/date citations.
 * Despite messages to discuss before reverting and edit summaries asking for the same consideration, anon again unilaterally reverts to his edit leaving a long message in the article saying he can't get to the talk page but commenting on messages on the talk page.
 * His first post did not explain the 7 unexplained reversions but made a blanket accusation of "double standard" against other editors.
 * Meanwhile IP used by anon engages in a variety of WP:Vandalism.
 * Discussions ensue as above.

Please keep in mind that since we have refrained from editing the article in over 2 days, leaving your version despite the fact that we feel it is entirely too biased. And all our prior changes were accompanied with an invitation to talk. We are discussing it with you. You felt the same way about the old version but you reverted 7 times without a single word of discussion with us.

Please read Five pillars and the links therein, especially the parts about Verifiability in science and medicine articles and Neutral point of view. Reading this essay should also help explain why it may not be good to start out editing things that you care deeply about.

I extend an invitation. Welcome to Wikipedia. Get an account, especially if you share an IP with a vandal. Log in. Contribute. Start out small and be prepared to defend your changes. Try not to take things personally. And don't make personal attacks. Help us improve this article. It may not end up saying what you want it to say. But we should be able to make it say something true and something in a neutral point of view.-- John DO | Speak your mind  10:04, 26 January 2006 (UTC) Withdrawn. I am obviously wasting time.-- John DO | Speak your mind  00:33, 27 January 2006 (UTC)

Dear Johnny, Bad faith means assuming that I did not post in the discussion area because I wanted to be in a "war" with you, and not because, as I repeatedly stated, I was having difficulty navigating this site.

Not one person, including you, posted instructions which would have helped me get on here earlier than I did.

And if the above is not a personal attack, I have difficulty imagining what one would be.

Please respect that people enter into Wikipedia not to "vandalize" or assault or attack you, but out of genuine desire to share knowledge that other people do not have. Please respect that I am one of those people, having studied this subject for more than two decades. It is not all about you. You do not know everything. You cannot learn in a couple days hhat was taken me more than 20 years, no matter how good you are with computers (as I have repeatedly stated, not all valuable knowledge is online) and many links you can post.

Have you made that phone call to the FDA yet? I appreciate that you want to learn about this subject. Put your energy into that. I am happy to answer your questions. Why not try posing questions, instead of posting litany of my supposed bad deeds? I feel like I am in a courtroom and you are a hostile lawyer. This is entirely inappropriate.

Oh, and another thing. What time zone are you in? At least one of us is staying up much too late with this stuff.

Doogs


 * Doogs, you are editing on the assumption that unless you are told to, you don't need to adhere to policy. This is a bit odd, if I may say. You can't tell a policeman that when you've gone through a red light. We have Policies and guidelines. Non-adherence to policy makes any editor a candidate for exclusion from the Wikipedia community. Consistently failing WP:CITE, WP:V and potentially WP:NPOV have in the past been grounds for banning. Reverting more than 3 times a day is also a bannable offense.


 * With your "Have you made that phone call to the FDA yet?" you are being unjustly patronising. Lecturing DocJohnny about time zones is also a bit on the chummy side. JFW | T@lk  16:30, 26 January 2006 (UTC)


 * raises hand I was busy trying to get some navigation info to you. Note that probably several of the editors of this page are likely tenured scientists or whatnot, so assume they're at least as competent as you are ;-) . People, just because Doog doesn't understand wikipedia (or nettiquette :-P ), doesn't mean he has no understanding of the subject area. Not everyone is a wikipedian. Be patient and teach him! At least, my patience hasn't run out yet. Give it a week eh? :-) Go work on the article, and see what pops up. Doog, try discussing problems you have with the article on the talk page first. Apparently some things are a tad controversial. It happens! Kim Bruning 03:31, 27 January 2006 (UTC)

Oh, going throught the list above: please note that Doogs is editing from a dynamic IP pool. I am unsurprised that someone else would be assigned one of those IPs on a different day, and use that to vandalise. It happens all the time. Kim Bruning 20:03, 28 January 2006 (UTC)

UTC, what is a dynamic IP pool, and are you accusing me of vandalizing? Can you explain your comment for the non-geeks here? What is the difference between vandalizing and editing?I mean, if my edit read "UTC is a stinkbucket", that would be vandalism. But editing text based on verifiable references and citations, and editing out text that doesn't meet those standards; staying on topic and demonstrating considerable expertise, even if it's expertise that upsets some peoplevandalism?

Doogs


 * A dynamic IP pool is where multiple people share a common pool of internet addresses. Sometimes there's some bad apples in such a pool who decide to also err... edit... wikipedia. I'm fairly sure you're not vandalising. It might help to create a login, however. (Top right corner). Up to you if you want to do that though. :-) Kim Bruning 20:55, 28 January 2006 (UTC)

Well, someone made a mistake, cause I'm not in any pool. Nor have I ever vandalized. I hope that's the end of that. Again, an apology would be nice from Thor or whoever accused me of that, but I won't hold my breath. Anyway, this isn't supposed to be all about me!

Anonym edits from Andy.we
Sorry i have forgotten my password. will correct this later. I just looked for some pmids, its a lot of work and i think it is not worth doing it. Greetings Andy.we -- 62.180.225.190 16:56, 26 January 2006 (UTC)

Stay cool
Wikipedia guidelines are just guidelines. If we're dealing with an editor who doesn't know them, explain them first. Or just skip the guidelines and use common sense. :-P

Ignorance is an absolute defence around here, as long as people edit articles in good faith.

Yes it does take some extra long breath and so, but well, some good has come of this already.

So I'm advocating patience. If no progress whatsoever is made in a weeks time from now, drop me a line, and we'll have to block. But it looks like some progress has been made. Or am I just imagining? :-) Kim Bruning 18:59, 26 January 2006 (UTC)


 * When a user edits a page there is a comment under the edit box "Content must not violate any copyright and must be verifiable. You agree to license your contributions under the GFDL." Just as much as content has to be GFDL compliant, it has to be verifiable. Repeated ignorance of policy despite several reminders is not excusable. And WP:CIVIL is common sense. JFW | T@lk  21:05, 26 January 2006 (UTC)

Hello! I only read a part of this discussion and it seems to me a difficult controvercy at least because of its length: I can not go through every argument, and I realy do not understand every argument. So please assume good faith when I tell you the following. According to medical standards in Germany (and I think also in the USA) today, ECT is recommended in cases of severe depression. It is not recommended in cases of schizophrenia except the rare cases of Katatonia. For both statements I can give you sources. First: ECT in schizophrenia has only a very limited effect: Second: ECT is recomanded in affective disorders: It is true that patients suffer sometimes cognitive disturbances (amnesia), wich can last for days until weeks. Severe Amnesia lasting longer than weeks is rare and the reason unclear. If the method is used according to modern standards (unilateral application to the non-dominant hemisphere in anesthesia and muscle relaxation) structural alterations of the brain cannot be detected. The most problematic aspect of ECT is, that the therapeutic effect is good but not long-lasting. Too many patients suffer recidives within 6 months. I personally have no experience with ECT. I do not remember a case of involuntary ECT in Germany in the last years. Sincerely Yours -- Andy.we 22:10, 26 January 2006 (UTC)
 * Tharyan, P. and Adams C.E.: Electroconvulsive therapy for schizophrenia The Cochrane library. Issue 4. Update Software, Oxford 2002.  (also:  actualisation for the year 2005)
 * Geddes, J. and Butler, R.: Depressive Disorders. in: BMJ Publishing Group (ed.): Clinical evidence. Mental health. The international source of the best available evidence for mental health care, pp. 6176. Thanet Press, Margate, Kent 2002.
 * Klecha, D. et al.: Zur Behandlung depressiver Störungen mit modernen Verfahren der Elektrokonvulsionstherapie. Fortschr. Neurolg. Psychiatr. 70 (2002) 353-367.
 * American Psychiatric Association: The practice of Electroconvulsive Therapy: Recommendations for Treatment, Training und Privileging: A Task Force Report of the American Psychiatric Association.2nd Ed. Washington DC 2002.
 * Berger, M. (ed.): Psychische Erkrankungen. Klinik und Therapie. Urban und Fischer. München 2004. ISBN 3-437-22480-8

The comments about ECT use in Germany are a reminder that it is important to say which country you are talking about (which isn't always done in the article) as practice and policy differs regarding ECT so much from country to country. Also, of course, it is important to distinguish between what the guidelines say and what happens in real life (not always the same); and between what is illegal or banned and what is simply not done anymore. For example, has ECT really been banned in Slovenia or is it just not used any more?

Here in the UK we still have a relatively high rate of ECT use although it has been declining fairly steadily for at least 35 years, and about 20 per cent of ECT patients are given it without their consent, which again is probably relatively high. The vast majority of patients are given bilateral, not unilateral ECT. I am not sure what the figures are for the USA are but a survey of New York hospitals in the late 1990s found that about 75 per cent of patients received bilateral.

The guidelines in the UK say ECT should only be used for depression, but a few patients still receive it for others things, schizophrenia for example. In some countries, though, ECT is still used more commonly for schizophrenia. In Hungary, for example, more than half of ECT patients are being treated for schizophrenia.

In many countries people are still receiving unmodified ECT. Not all these countries are less economically developed countries; for example some psychiatrists in Japan and Turkey still give their patients unmodified ECT. Staug73 14:01, 27 January 2006 (UTC)

Dianetics
I recently reverted 2 edits related to Scientology. Dianetics has no specific relevance to ECT. Please see Scientology and psychiatry, which is linked off of Psychiatry already. N6 01:06, 1 February 2006 (UTC)


 * OK. I had only tried to make it more NPOV and placed in the paragraph that started off talking about anti-psychiatry (which seems appropriate for any scientology viewpoint), but deletion of the reference is fine by me. David Ruben Talk 01:11, 1 February 2006 (UTC)

I personally don't think it's POV not to specifically mention Scientology here. There are probably numerous groups who have general opinions on the field of psychiatry, but it would be kind of ridiculous to say "Foo group thinks Bar about all psychology" for every such group in every psychiatric article. The reference to Antipsychiatry should, I think, be quite sufficient. N6 01:50, 1 February 2006 (UTC)

To clarify, I don't think Antipsychiatry particularly needs to be mentioned either, unless the movement has specific opinions on ECT as separate from other psychiatric treatments. It is unclear from the wording in the article whether this is the case. N6 02:08, 1 February 2006 (UTC)

In my opinion Dianetics has a good tradition and per se few side effects and a quite good founding. In contrast to Dianetic the psychiatry has just strange theories, that are sometimes even founded by iatrogenic damage (e. g. one of my psychiatresses told me, that I have a depression due to the long-term use of an anti-psychotic-agent, although the paper in the pill-pack did not say anything about depression...). So Dianetics is a nice alternative to psyche-bullshit (even the costs seem to be acceptable; I had hundrets of hours of psycho analysis and I am (still) disabled (today)). Furthermore as a citizen of F.Rep.GERM I am concerned, that somewhen the US people say, that the GERMs tricked them into severe torture brutish practices (there might be some historical findings); and I have heard that dumb accusation too often (e. g. from my former swiss colleagues, who reapetedly told me (e. g. three time in the same "phone-meeting", which I had to abate once, because it was too silly for my taste) that "the GERMs" are responsible for bad quaility in his paging network). --213.54.75.173 14:37, 1 February 2006 (UTC)


 * If you have been helped, then good :-) any form of support/therapy/psychology that helps people either manage better or cope with problem more effectively is to be welcomed, but single anecdotes don't consitute proof of action verses natural resolution over time/good luck/placebo effect. However Dianetics is a minority viewpoint. I would be the 1st to admit psychiatry is far from perfect in its understanding, assessment of patients, application of best treatment or careful monitoring & ongoing support for patients. For the majority of those who have just very mild disorders it probably makes little difference what treatment option is used, as the absolute effects of success or failure in treament are of relatively little importance. However scientology's general complete rejection of psychiatry, however extreme the apparent psychosis, makes the majority of medical opinion see dianetics as potentially dangerous.  This is really a debate over the psychiatric & psychologial (scientology) models and I'm sure is fully debated/edited in the relevant articles. This article though is about ECT, what it is, methodology of application, history, selection of patients - discussion of Dianetics is inappropriate to this article, as would discussion on counselling for mild psychological distress, choice of SSRIs for depression, etc etc. David Ruben Talk 17:42, 1 February 2006 (UTC)


 * Hmm... OK... I can't say, that Dianetics helped me, because it was inapplicable in my case (according to a GERM Dianetics Centre), because I have been treated intensely psychiatrically (~4 months) and possibly even with ECT... The Dianetics-idea just feels better (I am aware, that I do not always know the truth)... :-) --213.54.75.173 19:38, 1 February 2006 (UTC)


 * Does anyone want to say something about "Who spread ECT in U.S.A?" or "Are we sure, that we really want it?"? --213.54.75.173 19:38, 1 February 2006 (UTC)

The former question is of historical interest and may be revelant to the article. The second question almost automatically becomes WP:NPOV and WP:NOR unless this has been addressed in this form as some sort of a bird-eye's view. JFW | T@lk  22:04, 1 February 2006 (UTC)

It is important to realize that human beings are organisms composed of cells which are composed of particles which follow immutable rules. There is a cause for every illness, even if that cause is not yet known. Psychiatry is still a young science. We don't know everything about how the brain works and how to treat problems with it, but that's no reason to discard it in favor of something that is *not a science*. Psychiatry is all about treating neurophysical causes for disorders. Psychology is where you treat the symptoms. Science is more reliable than science fiction. User:rdbrady 5:00, 30 March 2006

Phew!
The problem with this article is that it started out so POV that it is now difficult to tidy up in such a way that it flows and reads easily. It should have started off the other way around, by describing the current situation as it exists - today - in the real world. Then us old fogies could have added the history to explain how the present situation came about. Then, those young whippersnappers, with minds free and unencumbered by the dogmas of yester year (and who maybe critical of the present methods etc.), can spend their time referring to sources that point to the future direction that this treatment modality might take. That, would then be the time to start looking for errors, omissions, woolly thinking, et cetera, et cetera, et cetera. --Aspro 18:31, 18 February 2006 (UTC)

Current Usage
I am removing this section:


 * The FDA regulates devices based on their risk to benefit ratio, and Class III are the highest-risk devices. Class III devices pose a potential unreasonable risk of injury or illness when used as directed by the manufacturer. A Class III device such as the ECT machine is one in which benefits have not been shown to outweigh risks. The risks of ECT, according to the FDA, include brain damage and memory loss. (Federal Register, 1978).

Firstly, this doesn't really belong here. I would recommend adding a suitably-edited version to Medical devices, which already has space for the three FDA device classes. Secondly, it is somewhat misleading. The section beginning and ending "Class III devices pose a potential unreasonable risk [...] not been shown to outweigh the risks." is only true because we are talking about pre-amendments devices that have not yet been through premarket approval. N6 00:10, 24 February 2006 (UTC)

I disagree. We've had extensive discussion of this topic, and it is entirely relevant to the issue of usage of ECT and risks of ECT. There is nothing misleading about that sentence on class III; and it has nothing to do with being a preamendments device. The definition of Class III applies to any device, pre or post.

Once again, what the government's highest authority on medical devices has to say about ECT is entirely relevant to the article, which consumers will read for information about ECT. Doogs


 * I agree that this information is relevant to the topic. I do not agree that it needs to be provided directly in the article. My edit to the current usage section included a link to the medical devices article, which is where I think this information belongs. A detailed description of Class III devices in general does not belong in an article about a particular Class III device. Providing one is akin to providing a large section of text from every wikilink in every article. Certainly some information about Class III would be valuable for those that do not wish to read about the class in depth at Medical devices, but a brief explanatory note (as I provided when I made my edit) would suffice.


 * As to the accuracy of your wording: You have provided a description of Class III as it applies to pre-amendments devices which have not yet been granted a PMA that is inaccurate for post-amendments devices and pre-amendments devices that have had a PMA. Your wording is accurate with respect to ECT machines, but not with respect to Class III devices in general. After a PMA is granted, the benefits of a device have been shown to outweigh the risks; that is the very purpose of the PMA process. N6 22:36, 26 February 2006 (UTC)

If that were true, there would have been no Class III devices since 1976. Of course there are. Quite simply, FDA allows devices to be used in which risks may outweigh benefits, as long as, if they were invented post-1976, they have gone through the PMA process. Doogs


 * I moved this section to its own sub-section under Side Effects and Complications -- it didn't really belong in the Current Usage section, and the "risks/benefits" nature of the content is more appropriate under the Side Effects and Complications heading. It think it also flows much better now.  --Scot &rarr;Talk 13:52, 4 March 2006 (UTC)

Informed Consent
I've removed the phrase "(though not always adhered to)" as no citation was ever given. I've also reorganized the material in the section to make it more readable and (hopefully) less POV. Lastly, I've removed the section: "In most cases of depression, the benefit-to-risk ratio will favor the use of medication and/or psychotherapy as the preferred course of action (Depression Guideline Panel, 1993). In cases where medication has not succeeded or is fraught with unusual risk, or else where the potential benefits of ECT are great, such as in delusional depression, the balance of potential benefits to risks may tilt in favor of ECT."

for several reasons:


 * it doesn't have anything to do with informed consent
 * it has been covered elsewhere in the article
 * it borders on giving medical advice, which Wikipedia should not be doing. --Scot &rarr;Talk 14:40, 4 March 2006 (UTC)

Cultural Depictions section
I created a new section for this, as it was diluting the "Controversy" section. I added a note about the ECT depicted in "One Flew Over The Cuckoo's Nest" being unmodified. I also moved the excellent Hemmingway quote to be after his name in the "Famous People" section. --Scot &rarr;Talk 15:26, 4 March 2006 (UTC)

Cleaning up the Side Effects section
This section is a real mess -- I'm going to start digging into it. My procedure will be thus: This may take a while. Scot &rarr;Talk 05:14, 21 March 2006 (UTC)
 * Based on the excellent vetting work done previously by several contributors, plus any further vetting work I'll need to do myself, remove any references which do not meet standards of acceptability.
 * Clean up the references by putting them all in the Cite.php style, which will make the section at least readable.
 * Remove any statements which end up unreferenced, or which are inappropropriate for the section for whatever other reason.
 * Do a flow and readability edit on the text.
 * See what we have left.

BTW -- a personal disclaimer -- just FYI, I'm currently transitioning from the username Spark Plug to the username ScotG. But you can call me Scot. :) Scot &rarr;Talk 05:16, 21 March 2006 (UTC)

'Electroshock' changed to 'ECT' where appropriate
I changed the text to say ECT instead of electroshock for the following reasons:
 * 'electroshock'
 * Is Ambiguous on wether it's about using electricity to induce a state of shock or just using an electric shock.
 * Does not describe the intents and purposes of the practitioners.
 * Is not the mainstream term of use.

-Sinus 12:13, 27 March 2006 (UTC)

Reordering, annotations
Is there a protocol regarding the latest edit (19:30, 28 April 2006 151.201.158.242 (→External links - Reordered links, annotated CCHR link)?

It seems to me that "reordering the links" involved moving the CCHR to the head of the list and "annotated CCHR link" involved removing the link to scientology - which strikes me as deliberately misleading. The organisation is run by the Scientologists, and it seems to me that link is an important one to make in an article about a hotly disputed area of psychiatric practice given that the CCHR have called psychiatrists "Professional Rapists, Pervert [sic] and Pedophiles" (see CCHR for the reference).

I think this should be reverted. Nmg20 23:10, 1 May 2006 (UTC)

Please ignore. Misread the revert. Nmg20 21:07, 2 May 2006 (UTC)

I think that the claim that Sackeim "works for" an ECT instrument manufacturer is questionable, though it may be that some of his research is funded this way. There are more recent recviews that could be used, see Lisanby SH, Morales O, Payne N, Kwon E, Fitzsimons L, Luber B, Nobler MS, Sackeim HA. New developments in electroconvulsive therapy and magnetic seizure therapy. CNS Spectr. 2003 8:529-36. PMID:12894034 Gleng 19:08, 13 May 2006 (UTC)

Edits by Kwertii
Kwertii - may I suggest that some of your recent set of edits (the four on 13th May 2006) undo what I, for one, thought was an excellent set of edits by Gleng in terms of making the article more NPOV.

There are two bits which I'd take issue with:

"While many psychiatrists believe that properly administered ECT is a safe and effective treatment for certain conditions, a vocal minority of pyschiatrists, former patients, antipsychiatry activists, and others strongly criticize the procedure as extremely harmful to patients' subsequent mental state."


 * Many people besides psychiatrists believe ECT is a safe and effective treatment for certain conditions - specifically, an awful lot of people with mental illness and their carers do. It is wrong to suggest, as this sentence does, that it's only psychiatrists who back it.
 * It's certainly true that the vocal minority you mention do criticise it - but that's implicit in the fact that it's controversial, which is stated in the first sentence of the article. Mentioning this vocal minority in the introduction to an article, before the history, nature, and purpose of ECT have been mentioned, is unnecessary - this belongs in the "Controversy" section, IMHO.

"When it was still in common use, the ECT procedure was sometimes abused by unethical mental health professionals as a means of punishing and controlling unruly or uncooperative patients."


 * Can this claim be sourced? If not, I suggest Gleng's "and in some cases it is alleged that it was also used for disciplining unruly psychiatric inpatients" is both more accurate and more NPOV.

Thanks, Nmg20 00:48, 14 May 2006 (UTC) Started to check refs on PubMed. removed Weiner 1986, Ann N Y Acad Sci is not peer reviewed. Next few I couldn't find, seem to be miscitations but have left them for now.Gleng 08:44, 18 May 2006 (UTC)

Latest revision by Siney2
Siney2 claims in the description of his recent edit (18th May 2006) that the part removed is untrue, and therefore that the patients depicted in One Flew Over the Cuckoo's Nest receive ECT with muscle relaxants. To anyone who has seen someone having ECT with muscle relaxants, it's clear that the ECT in the film is unmodified, and this is supported by countless websites:

http://www.bipolarworld.net/Treatments/Treatments/tr8.htm "The old method of performing ECT - without muscle relaxants or drugs to induce sleep - is what is responsible for the unfavorable reputation given to ECT. A great deal of anti-ECT sentiment was generated by its unfavorable depiction in the 1975 movie One Flew Over the Cuckoo's Nest"

http://www.healthyplace.com/communities/depression/treatment/ect/index.asp "When we think of ECT many of us recall the terrifying image of Jack Nicholson in “One Flew Over the Cuckoo’s Nest”. This is not an accurate portrayal of the present day application of ECT. Certainly, before the development of effective muscle relaxants, it was not unusual for patients to suffer broken bones as a result of these electrically induced seizures."

http://www.tmcrew.org/stopshock/post.htm "There is little dispute that ECT administered before the late 1960s, commonly referred to as "unmodified," was different from later treatment." (Ken Kesey wrote his book in 1962 and was in Menlo Park before 1960)

If Siney2 can find a credible source supporting his claim, I'd like to see it. Otherwise I propose to revert his edit in a day or so. Nmg20 19:28, 18 May 2006 (UTC)

"Advice" and boundaries of article
I've deleted the section on use with other medications. There are two issues here, first it is unreferenced, second it seems to be offering specific medical advice. I think it's best avoidedGleng 11:14, 20 May 2006 (UTC)

References in the controversy section
I've put in proper references, and cleaned these up as follows:
 * Barker & Baker 1959. Corrected the spelling of the first author's name.
 * Novello 1974. Removed - this is an article on psychiatric referral, not on ECT, and while I've been unable to trace it online or in the KCL archives, I find it so unlikely that Novello was genuinely making claims about anaesthesia and mortality in ECT in an article which had nothing directly to do with treatment that I've removed it.
 * Impastato 1957. Added link to the study referenced.
 * Corselis and Meyer, 1954. Removed this. I assume it is meant to be "KOHLER W, MEYER F, BLENDINGER G. [Convulsive therapy and spontaneous epileptic seizures.] Nervenarzt. 1954 Jun 20;25(6):225-32. German." - regardless, there are several Meyers on Pubmed writing about ECT in 1954 (there are no "Corselis"es anywhere), but the reference as it stands is wrong. Were I able to get hold of the article and read German I would decide if it merited correction - but I can't and I'm not quite there, so I'm removing it until someone who's read it can confirm it does what it's meant to here.
 * Madow, 1956. The full reference is "MADOW L. Brain changes in electroshock therapy. Am J Psychiatry. 1956 Oct;113(4):337-47." The abstract is available online http://ajp.psychiatryonline.org/cgi/content/abstract/113/4/337, and this series of four postmortem studies of patients who died during ECT found that only one of four died of cerebral causes.
 * Maclay 1953. The full reference is "Maclay WS. Death due to treatment. Proc R Soc Med. 1953 Jan;46(1):13-20." I have no way of confirming it's what it says it is, but it remains.
 * Matthew and Constan 1964. There are three papers from this year which this could be, titled "PHARMACOGENETICS IN PRE-ECT MEDICATION.", "COMPLICATIONS FOLLOWING ECT OVER A THREE-YEAR PERIOD IN A STATE INSTITUTION.", and "RUPTURE OF ABDOMINAL VISCUS: A SURGICAL COMPLICATION FOLLOWING ELECTROSHOCK THERAPY." Predictably, none are available online, so I have removed the reference for now. I would of course be happy for whoever included it originally to confirm which paper they meant and include the full reference - all three are on pubmed searching for "matthew constan".
 * Barker and Barker 1959. Removed. This is another mis-spelling of the first paper in this list, so I have left it in there on the basis that the same paper should probably only appear once in a list, ideally spelt properly.
 * Hartelius 1957. The full reference is "CLEMEDSON CJ, HARTELIUS H, HOLMBERG G. The effect of high explosive blast on the cerebral vascular permeability. Acta Pathol Microbiol Scand. 1957;40(2):89-95." The title suggests this is about vascular permeability and not about brain injury - but I've left it in under duress. I would like to remove it at some point unless someone can confirm quoting the article that it finds an association or reports on a patient who suffered brain injury.
 * Heilbrun 1946 (and similar). There are both Heilbrun s and Heilbrunn s on Pubmed - neither have anything available from the 1940s. These have stayed in despite being sixty years old.
 * Mckegney & Panzetta 1963. The full ref is "MCKEGNEY FP, PANZETTA AF. AN UNUSUAL FATAL OUTCOME OF ELECTRO-CONVULSIVE THERAPY. Am J Psychiatry. 1963 Oct;120:398-400." While it's clear from that that even then death was unusual, it's far from clear that it was a cerebral death.

In short, the quality of citing of these early sources is the issue, not the sources themselves (necessarily). I suspect that someone has looked for "ECT" and "death" and has listed everything, leaving those attempting to defend the procedure to do the actual work of finding the proper references and critically assessing them. I will resist as strongly as possible, therefore, any attempt to list further papers without evidence they have been read and understood, and without proper referencing. Nmg20 22:03, 22 May 2006 (UTC)


 * It's Corsellis with 2 "l"s. He was a British neuropathologist and did indeed publish an article about ECT in 1954. Staug73 15:46, 26 May 2006 (UTC)

Thanks, Staug73. Now that we know the proper(ly spelt) reference, if you can dig up a Pubmed ID, I'll happily put it back where I took it out. Nmg20 18:22, 26 May 2006 (UTC)


 * The pubmedid is 13175001. But it is already in the bibliography to the article, although with a small spelling mistake in the title (it should be convulsant, not convulsive). The Journal of Mental Science, by the way, is what the British Journal of Psychiatry used to be called.Staug73 21:44, 26 May 2006 (UTC)

I have deleted the following section

"The objectivity and scientific integrity of this Surgeon General's Report have been widely criticized: see for instance http://www.ctvip.org/surgeongeneral.html

Criticisms of the ECT section in particular include the limiting of references to only a few writings of financially conflicted researchers, one of whom was cited fourteen times out of a total of seventeen references, and the fact that the editor of this section, Matthew Rudorfer (a known advocate of ECT) cited to himself twelve times."

The linked article doesn't appear to criticise either the objectivity or scientific integrity of the SG report. I can't see any V RS support for the subsequent allegationGleng 08:27, 25 May 2006 (UTC)

Hi folks: The reference to Hartelius which was changed to a collaborative article with others is wrong. The correct reference is to the cat study of which Hartelius is the sole author. Can we please correct this? Thanks. Doogs

The correct reference is Hartelius H. Cerebral changes following electrically induced convulsions. Acta Psychiatrica Neurologica Scandinavica 1952; 77 (supp): 1-128. If you recall, I was the one who added all the references to the early literature. I've got all the original articles right here in my office, so it is no sweat to look things up. It must be a lot harder on Medline or Pubmed! Doogs 209.122.225.96 17:27, 22 June 2006 (UTC)

Is that the one I had down as "CLEMEDSON CJ, HARTELIUS H, HOLMBERG G."? I'll get it changed if so - thanks for the correction. And yup, I imagine it was harder on Pubmed - but a necessary evil! Nmg20 07:19, 23 June 2006 (UTC)

Yes, that one. Also, in another section, someone referenced the wrong Janis article. It is a different one from 1951---he published three that year. When I get back to the office I will correct it.