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The Body Electric's New LookWhy shock therapy deserves its mini-revival.

By Barron H. Lerner
Posted Thursday, Jan. 3, 2008, at 7:38 AM ET

(Continued from page 1)

Also influential was a 1974 New Yorker article by renowned medical writer Berton Roueche, who claimed that ECT caused permanent memory loss. Because the woman featured in Roueche's essay was not a representative case, her story exaggerated the importance of a real, but limited, side effect. The anti-ECT sentiment culminated in the passage of a 1976 California law that actually tried to prevent physicians from prescribing it—a rare instance of direct legal interference with medical practice.

Meanwhile, what did the data about ECT actually show? Research from the mid-20th century was more susceptible to bias than more recent work, but hundreds of studies from a wide variety of institutions claimed it was effective. Shorter and Healy also argue that proponents of ECT were always concerned about the treatment's real side effects. By the 1950s, the use of better anesthetics and muscle relaxants helped control the seizures and made the procedure less violent. Other improvements sought to minimize memory loss. But the persistently suspect characterizations of ECT meant that many patients with mental illnesses who were unresponsive to drugs never received the treatment. As a result, some worsened and some died. This surely represents a lot of potentially avoidable pain and suffering. The backlash against ECT, Shorter and Healy make clear, somehow led to a collective denial about what it could accomplish.

This selective reading of scientific data has been the downfall of many treatments besides ECT. In the 1930s, researchers published studies suggesting that removal of a portion of the breast plus radiation was as effective for treating breast cancer as disfiguring radical mastectomy, which necessitated removal of the breast, local lymph nodes, and both chest wall muscles on the affected side. Yet especially in the United States, where surgeons monopolized control of the disease, these data were ignored for decades. After women began demanding less extensive operations in the 1970s, additional studies validated the earlier findings.

In other instances, the reverse has occurred: therapies not justified by the data have achieved wide popularity. One example was hormone replacement therapy, which became popular when gynecologist Robert Wilson characterized menopause as an estrogen-deficiency disease in his 1966 book Feminine Forever. Ingesting synthetic estrogen, Wilson argued, would make women feel younger and also prevent osteoporotic fractures and heart disease. Although some critics questioned HRT from the outset, its harms became apparent only in the last few years, with the publication of definitive long-term studies. For decades, the combination of Wilson's salesmanship, drug company advertising, and the pathologizing of a normal stage of life led to the widespread adoption of a treatment not supported by the science.

These historical examples of science misused or ignored helped to usher in the now-powerful movement known as evidence-based medicine, which argues that treatments must be evaluated by the most sophisticated biostatistical and epidemiological tools. At the forefront is the randomized controlled trial, which eliminates many of the biases seen in older studies. And evidence-based medicine has come to the world of electroconvulsive therapy. Beginning in the 1980s, a series of expert task forces reviewed the existing data and concluded that in certain cases of mental illness, ECT is not only an acceptable, but a highly advantageous treatment. Its use is again on the rise, helping to alleviate the symptoms of certain patients with severe psychiatric diseases.

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Barron H. Lerner, Angelica Berrie-Arnold P. Gold Foundation associate professor of medicine and public health at Columbia University Medical Center, is the author, most recently, of When Illness Goes Public: Celebrity Patients and How We Look at Medicine.
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