Marketing Electro Convulsive Therapy

The Last Psychiatrist Weblog has an interesting observation on the press releases that essentially spin and market ECT in the wake of some new study.

Of course, our opinion of ECT is much harsher than the dear doctors', but the insider's insight is worth taking notes on.

A recent study in the Journal of Clinical Psychiatry, the largest of its kind, finds that prior treatment failure with antidepressants did not predict lower success rates with ECT. Phew.

Well, if that was all there was, it would be a pretty pointless study. And certainly not worthy of press releases. You have to read them, to see how the authors spin the study:

They therefore conclude that given appropriate indications for ECT, "antidepressant medication resistance should not sway the clinician from providing this modality."

Read it again. Just because you failed antidepressants, it doesn't mean you shouldn't try ECT. Huh? I thought that was specifically when you were supposed to use ECT?

"The implication of our study," lead investigator Dr. Keith G. Rasmussen told Reuters Health, "is that even if a depressed patient has not responded to one or more antidepressant medication trials, ECT still has acute success rates as high as for patients who have not had a medication trial before ECT."

That's some might nice sleight of hand. Look how he phrases his comparison: "...ECT still has success rates as high as for those who have not taken meds." See? He's making your baseline clinical experience be all those patients you've put on ECT who have never been on meds, and saying that ECT in the medication resistant will be just as good.

That's the important part, read it again.

He is trying to implant in you the belief that there exists an entire group of patients for whom you used ECT first line, before antidepressants.

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It's a product positioning strategy, Marketing 101. You cannot take on a market leader head on, even if your product is "better" because, as the adage goes, "first beats best." Royal Crown cola can't take on Coca Cola. In order to succeed, you need to position your product as an alternative to the market leader. How? By admitting there is a market leader.

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Antidepressants occupy the "first line" position in the customer's (i.e. doctor's) mind. ECT can't compete directly with them. But Rasmussen positions ECT as an alternative to antidepressants, one of equivalent value. He doesn't say ECT is better than antidepressants-- a point which then becomes a debate-- he says there's no relationship to antidepressants. It's an alternative to antidepressants, equal. Go ahead and try, you have nothing to lose, they're all the same.