I was able to get a copy of a Task Force report from 1977. The Task Force was assembled to propose regulations for conducting psychosurgery in the state. There had been some controversy in the early 1970s when Vernon Mark and colleagues received a grant to set up a psychosurgery clinic at Mass General Hospital (Harvard) to investigate violence and brain function. They linked violence with the race riots of the time and their racist rhetoric and proposal to screen and conduct psychosurgery on the brains of "violent" individuals ignited a strong response from advocacy groups and advocates. Vernon Mark and colleagues lost their grant funding but continued to perform psychosurgery on patients with mental illness. It was estimated that at least 30 patients per year received psychosurgery but the number was really incalculable because there were few regulations and surgeons in private practice were also conducting these surgeries. This post deals with this report.
First two pages of the report.
A couple of short videos of me starting to read the document. I talk about the Task Force Chairman, Dr. Alan Stone. I am trying to figure out if he is a "good guy" or a "bad guy." He was a psychiatrist and lawyer / professor at Harvard University.
My notes on the task force report.
In 1977 Massachusetts had a taskforce led by Alan Stone review regulations and practices for psychosurgery in the state.
The task force broke into majority and minority opinions. Their disagreements were so irreconcilable they drafted a majority and minority report. The biggest point of contention was whether there should be an outside doctor appointed to approve psychosurgeries for every case in the state. The minority group vehemently disagreed with this stating there was no precedent in other areas of medical practice and that it would destabilize the doctor / patient relationship.
For the most part the majority group saw psychosurgery as experimental, with little evidence, and they make the recommendations for regulations because that’s what they were asked to do (not because they agree with the use psychosurgery). Their feeling was that there was so little evidence for benefits of psychosurgery in the literature and in practice that it should ALWAYS be deemed investigative / experimental. In doing so, then every hospital conducting psychosurgery would have to follow human subjects review protocols. The regulations proposed by the majority cover the requirements for hospitals doing psychosurgery. Because the majority called it experimental the regulations set forth by the majority say there has to be a two tiered review process before conducting any psychosurgery. The staff qualifications must be reported to the dept of mental health. The patient’s history needs to be submitted to the dept. of mental health. Get baseline behavioral information on the patient (because it is designated as experimental). Informed consent. Basically Alan Stone created an argument that psychosurgery is not just a “procedure” it is experimental and falls under the same requirements / regulations as research studies. The majority proposed regulations included the appointment of a physician to exercise the right make the decision about a psychosurgery.
The minority report has a different tone. They state they agree with many of the conditions in the majority report they feel humane and scientific research can best proceed using the standard guidelines for medical investigation and human studies. They strongly disagreed with the notion of appointing an outside physician to have control over clinical decisions (i.e., psychosurgery) for a patient. They said the decisions about clinical care should remain between the physician and patient. Many of the other regulations were similar with regard to informed consent and hospital regulations. The tone of the minority report seemed to support the use of psychosurgery and leaving control in the hands of the doctors.
Final regulations left me with a few thoughts.
vi.Richard F. Thompson
ii.Shervert Frazier,Jr. M.D.
iii.Bernard Levy, M.D.
iv.David J. Myerson, M.D.
v.Leon N. Shapiro, M.D.
vi.William H. Sweet, M.D.
**2008 article by alan stone brings up the fact that the mass dept of mental health and all the other MDs on the task force rejected having an outside appointed doctor to review the case. This became the standard in other states and the 2008 article provides a compelling argument for protection of patients by having an outside doctor reviewing the process.