Psychiatry does need more randomised controlled trials

Abstract

Edited by Kiriakos Xenitidis and Colin Campbell Contents ▪ Psychiatry does need more randomised controlled trials

‘A landmark in psychiatric progress’? The role of evidence in the rise and fall of insulin coma therapy

“…The other paper frequently referred to as a 'landmark' in the decline of insulin coma therapy (Burns, 2019) is the report of a randomized controlled trial carried out by Brian Ackner and colleagues at the Maudsley, Bethlem and Cane Hill Hospitals in London and Surrey and published in 1957. The study compared insulin coma therapy with a barbiturate-induced coma using random allocation and was one of the first randomized controlled trials in psychiatry (Ackner et al, 1957).…”

“…The consensus view is that insulin coma therapy, like other ineffective treatments, was discarded with the advent of modern research techniques and a new understanding of what constitutes proper and reliable evidence. Most authors credit the randomized controlled trials, published in the late 1950s, with having disproved the idea that insulin coma therapy was effective (Burns, 2019;James, 1992), especially the trial that compared it with a barbiturate-induced coma and found no difference in outcome (Ackner, Harris and Oldham, 1957). For some, it marks the start of the movement towards 'evidence based medicine' because it was the first therapy to be rejected on the basis of randomized controlled trials (Andrews, Briggs, Porter, Tucker and Waddington, 1997;Burns, 2019).…”

“…Most authors credit the randomized controlled trials, published in the late 1950s, with having disproved the idea that insulin coma therapy was effective (Burns, 2019;James, 1992), especially the trial that compared it with a barbiturate-induced coma and found no difference in outcome (Ackner, Harris and Oldham, 1957). For some, it marks the start of the movement towards 'evidence based medicine' because it was the first therapy to be rejected on the basis of randomized controlled trials (Andrews, Briggs, Porter, Tucker and Waddington, 1997;Burns, 2019). Others have described how insulin coma therapy was, in its time, seen as an efficacious and scientific treatment for mental illness (Doroshow, 2007), suggesting that today's view of evidence and what qualifies as 'scientific' is quite different from that of the recent past.…”