Dr McCall responds to my letter but does not answer it. I get very tired of explaining to ECT proponents that the Committee for Truth in Psychiatry is not an ‘anti-ECT’ group, but no matter how many times and in how many contexts I do so, that false statement continues to be made. More about CTIP later, since I cannot leave Dr McCall's claims unrefuted. But much more important are the still unaddressed concerns about the methodology and validity of the McCall et al study.
My point about building assumptions about the longevity of ECT's adverse effects into the research design by including persons who had recently had ECT was not addressed.
Nor was any evidence presented to show that the rating scales chosen by McCall et al are relevant to the types of deficits reported by former ECT patients and illustrated so well in the SURE report. (Nor has there been evidence, which I requested privately from the author, to show that the study participants, who for some reason scored so poorly on both the MMSE and the IADL prior to this course of treatment, are representative of ECT patients as a whole.)
McCall's point that ex-patients and only ex-patients define what quality of life is and by what standard it should be measured is exactly my own: no ECT survivor or ex-patient ever has or ever would define ‘quality of life’ or ‘functioning’ in the terms Dr McCall uses. He says, ‘It is a violation of the concept for anyone to define a patient's QOL for them’, yet that's exactly what he has done. Had he asked patients themselves, an approach taken by the Rose et al group, he would have set off in a productive direction instead of down a blind alley.
His attempt to selectively redefine the work of Rose et al as research on ‘satisfaction’, not relevant to work on quality of life, is without foundation, as a reading of the actual study will show. It was he who brought up the work ongoing in Britain as relevant, by his reference in his first sentence to the National Institute for Clinical Excellence guidelines which came out concurrently with, and used some of the same evidence base as, the report of the Rose group at the SURE.
There is a wide literature on non-financial conflicts of interest, best described as ‘an individual occupying dual roles which should not be performed simultaneously’ (Reference FavaFava, 2001). Those include treatment researcher and editor of a journal promoting the treatment under study.
If you yourself read what CTIP says, and not what others say about us, you will begin to wonder where the ‘anti-ECT’ claim comes from. We are an international organisation made up entirely of persons who have received ECT. We represent the spectrum of outcomes, from persons who feel ECT is beneficial and have had it more than once, to persons whose lives were ruined by it. None of us was truthfully informed of the risks of ECT before consenting to it, and no one liked being lied to. Our organisation exists for one purpose only: to advocate truthful informed consent for prospective ECT patients. Thus, it makes no sense to say that ‘any information that supports the use of ECT threatens the position of CTIP’.
Whether you are of the opinion that being in favour of truthful and informed consent somehow makes you anti-ECT depends on whether you believe that patients have the right to full disclosure of ECT's risks – and the right to make a decision for themselves based on that information – or whether you believe that ECT's risks are such that full disclosure would result in patients en bloc deciding to forego the treatment. That Dr McCall and colleagues are in the latter camp speaks much more eloquently than their article as to what they really believe about ECT's effects on quality of life.
CTIP, founded in 1984, has never received funding of any kind.
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