of trials are severely flawed. It's the same with a lot of
antidepressant research. Even the STAR*D public-funded trial ended up
being a bit of a farce when it came to using rigorous scientific
methods, for example maintaining the same measures throughout.
The ECT review is showing sham ECT to be just as effective in the long
term. People actually recover from intractable conditions (which is
usually when ECT is used in the modern day rather than to 'treat'
challenging' patients). This makes it by far the most cost effective
treatment in mental healthcare. Sham ECT I mean. Not ECT.
A fake ECT study could be designed with the highest methodological
rigour such that no medical staff involved with the care of the patient
could see which patient was getting ECT and which one was getting sham
treatment. Patients would be randomly assigned. There would be a period
of time before return to whatever facility they were incarcerated for
their mental health.
The point of this bit of the trial design is simple. It's so no one can
no that both active and control group recieved ECT. The results aren't
important though they would be signficant if they showed greater
improvement in the active group. What's important is that patients get
better using an effective and safe treatment. Admittedly the cost of the
study may be more than the cost of ECT in clinical practice but it would
be offset by the fewer side effects and reduced risk of mortality.
The possibility of using totally fake treatments to fool clinicians and
patients into make better outcomes for patients may be unethical but as
the paper I'm reading points out the Hippocratic Oath does sort of say
first do no harm. It's more unethical for doctors to break the oath
which is fundamental to their profession.
The pragmatic view would be this idea creates an amazingly effective and
safe treatment for chronic and treatment resistant conditions though
there's still an unexplored component: the nocebo effect.
No comments:
Post a Comment