On 31 January 2019 the British Medical Journal published a report on the recent Maudsley debate on electroconvulsive therapy (ECT). I have discussed the debate in a previous post. As soon as the British Medical Journal published the debate, the Science Media Centre sprang into action, with four “experts” weighing in with a quote – all in favour of ECT.
The Science and Media Centre is a charity, which aims to “promote for the benefit of the public accurate, evidence-based information on science and engineering in the media, particularly on controversial news stories”. The charity’s latest annual accounts (for 2017/18), available on the Charity Commission website, show an annual income of £627,000. The accounts do not tell us where this money comes from. However the charity’s website lists their funders, the major ones being the government and the Wellcome Institute.
The charity has a restricted fund for the employment of someone to deal with mental health and neuroscience matters. The annual report for 2017/18 (available on the Charity Commission website) tells us:
“A restricted fund in the form of grants and donations from several organisations within the mental health and neuroscience research community continues to allow the SMC to employ a full-time member of staff to work specifically on mental health and neuroscience stories in the media.”
The report however does not tell us who those organisations are. From the list of funders the following organisations can be identified as having a specific interest in psychiatry: Mental Health Research UK, Alzheimer’s Research UK, Alzheimer’s Society, MQ transforming mental health, Royal College of Psychiatrists, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), and the Maudsley Charity. There are many more funders – Universities, pharmaceutical companies, Cochrane, NICE, etc. – whose interests will include psychiatry.
I have only been able to positively identify one funder – the Maudsley Charity. On their website they say that they provided a grant to the Science Media Centre towards the cost of “Supporting an independent press office to enable and encourage mental health researchers to engage with the media on key mental health issues. helping secure accurate coverage of controversial, messy and complicated issues”.
Given that psychiatrist Sir Simon Wessely is a trustee of the Science Media Centre, and given the nature of its funders, it is hardly surprising that the charity should, when it comes to matters concerning psychiatry, look like an extension of the Royal College of Psychiatrists’ press office. Hardly surprising too that all four of the “expert comments” produced for the item on ECT come down firmly on the side of ECT.
So who are these commentators and what do they say?
There are three male psychiatrists from England and a female psychologist from Denmark.
Rupert McShane from the University of Oxford says the usual things about effectiveness, stigma, etc., but does acknowledge that ECT has side effects: “Helping patients and their families to balance the benefits against the risks of ECT is an important task.”
Michael Bloomfield from University College London says much the same. Allan Young of the IoPPN says that ECT has side-effects but denies brain damage.
The fourth commentator, psychologist Kamilla Miskowiak from the University of Copenhagen, has an even more positive view of ECT: “highly efficacious and often life-saving treatment”… no evidence of brain damage or long-term cognitive side-effects, etc. She concludes:
“Despite this lack of evidence for ECT-induced brain damage, many people experience cognitive problems, including memory difficulties after ECT. These cognitive problems are real and should not be disregarded. In fact, we know that long-term memory and concentration difficulties are a core feature of neuropsychiatric disorders themselves and thus exist before ECT is commenced. This highlights the need for novel treatments that can improve cognitive function in people who have suffered from neuropsychiatric conditions like depression.”
I have not been able to make head nor tail of this. First, she seems to be acknowledging that ECT causes cognitive and memory “difficulties” although she wouldn’t class these as evidence of brain damage. But then she appears to backtrack and say that these “difficulties” are in fact caused by depresssion. As for the last sentence – what on earth does it mean? In an attempt to answer this question I decided to look for other evidence of Miskowiak’s views on ECT.
I didn’t have to look far. Miskowiak is currently carrying out a trial in Denmark: “Erythropoietin as an add-on treatment for cognitive side effects of electroconvulsive therapy: a study protocol for a randomized controlled trial.” The title says it all: “cognitive side effects of electroconvulsive therapy”. But if this isn’t enough there are numerous mentions in the text of ECT-induced cognitive deficits and the cognitive side effects of ECT. So why has she changed her tune for the Science Media Centre, with an attempt to shift the blame for cognitive deficits on to “neuropsychiatric conditions like depression”? Perhaps she thought that this was more in line with the requirements of the Science Media Centre.