Revox, Xerox, Redux: Thomas Leer & Robert Rental

Punk was never a parasite gnawing at the inner fabric of society or even the music establishment, but it did lay some unexpected eggs on its welcoming host. The anti-establishment DIY ethos of making noncommercial music, and then pressing and distributing your own records clearly emerged with post-punk and electronic music...

After all, most punk bands were signed by majors, their commercial appeal to young people was obvious and blindly exploited by major labels. Its easy to overlook how swiftly punk came and went - all under a Labour government, well before Maggie Thatcher was elected as Prime Minister. Rather, it was a peculiarly British revolution from the lo-fi British electronic pioneers, Thomas Leer, Robert Rental, the Normal, who initiated this crucial DIY sea-change in UK (and world) music.



Daniel Miller (aka the Normal) went on to develop his label Mute into the important artist stable it remains today, starting with Depeche Mode. And his first single Warm Leatherette and TVOD are well-known. His JG Ballard Crash inspired Warm Leatherette has been covered by the likes of Grace Jones as well as Trent Razor, Geordie White and Pete Murphy. 

Although I knew Daniel Miller at that time, the evolution of Mute is well-documented. Rather I wanted to talk about two friends of mine at that time: Thomas Leer (born Wishart) and Robert Rental (born Donnachie). Thomas and Robert came from the same Scottish hometown of Port Glasgow and in the mid 70s they moved to London together, with their respective partners (and sisters) Liz and Hilary Farrow (I recall Robert and Hilary also had a least one, possibly two children then) .All of Tom's home-made experiments were 'tested' on the world by Liz, who worked at the original Virgin Records store in Oxford Street - where she regularly played cassettes of his prolific outputs to those perusing the singles-section in the shop basement.

Necessity is the Mother of Invention

In 1978 Thomas Leer pressed 650 copies of his double A side Private Plane and International on his own Oblique records - possibly a nod to the Oblique Strategies of Peter Schmidt and Brian Eno - 100 worthwhile dilemmas - used by Eno in recording sessions to overcome artistic blocks or to seek inspiration - an online version is here - be inspired!

Robert Rental similarly pressed 650 of his double A side single ACC and Paralysis on his own alliteratively consistent Regular records. When they rapidly sold out, both singles were re-released by 'Company' in somewhat different sleeves (slightly less DIY)

Private Plane/International were recorded in Tom's small Finsbury Park flat in 3 days using a TEAC A3440 4-track recorder and an ALICE mixing board. "The only FX used were a Watkins Copicat tape echo unit, Electo Harmonix DrQ filter, an old Roland drum machine and a Stylophone 350S. The process was simply a case of laying the tracks down one at a time, applying FX as I went along, and then mixing them all down onto a REVOX A77 mastering machine" They then moved everything across the Thames to Robert's Battersea flat to record ACC/Paralysis.

The DIY nature is evident above in my original time-jaundiced copies of the 45s: the xeroxed covers, even some felt tip colouring on Robert's (by him), John Bull printing on the white labels, handwritten cut-out details, even Robert's home address (where their album 'the Bridge' was recorded - see below).

 

Tom's single made a big impact - being made NME single of the week by Tony Parsons (now social commentator and author of Man & Boy), which normally assured fame and fortune in those days. The two 45s have a special feel that I believe have stood the test of time partly ‘because’ of the way they were recorded – at home on 4-track, in the same room where Liz was sleeping (hence Tom's vocals are delivered so softly), guitar, rhythm from a cheap drum machine and a bubbling bass that sounds too fast (in the style of Neu on Fur Immer or Hallo Gallo) and finally, Rolf Harris stylophone lead melodies! Without doubt, this 45 would be on my desert Island disc selection. Robert's two songs, by contrast, were less immediately accessible and at the time, overshadowed by his friends release; however, to my ear, Robert's ACC/Paralysis have matured more with age - on ACC sounding like a 'tired and emotional' Barry White on acid or on Paralysis like a terribly sad Tim Buckley being played at 16 RPM.

I heard Private Plane by Thomas Leer which he did all by himself, all the playing and writing, everything. That was the big turning point for me because it introduced me to a whole new form of music...Leer had all these drum machines and loops and totally different instrumentation, and this whole new world opened up, listening to his experimentation with atmospheres. I realised then that I didn`t have to make songs that sounded like everybody else...People would buy a stylophone and a small tape player and put out a record they had made in their bedroom. That was really inspiring.- Matt Johnson,The The

I don`t have to go into a studio, the fact that Thomas Leer made his record at home with a Revox and on mostly hired equipment, I thought was marvellous and I like his record a lot. In fact it`s one of my favourite records at the moment.– John Foxx, Ultravox

The Bridge: "I thought the idea of the song was dead"

Following their successful singles, Thomas and Robert produced 'The Bridge' for Industrial Records (Throbbing Gristle's label). One month after Margaret Thatcher was first elected as UK Prime Minister, and just as Joy Division released Unknown Pleasures, Tom and Rob spent two weeks (18 June to 2nd July 1979) recording the album using TG's 8-track recorder holed-up at Robert's high rise council flat (identified above). In the same vein as David Bowie's Low, released the previous year, the Bridge consists of two discreet sides - one with regular song structures, the other more fluid  instrumental pieces.


Thomas said "Robert wanted songs and I wanted to do a pure ambient album...the idea of the song was dead and the future belonged to instrumental music. Voices could be used, but not in a structured way" - which I suppose is what he had been doing even in his poppier songs - the lyrics are largely indecipherable and add a melodic line for the listener.

As an example of the structured minimal electro pop of side one, here is Day Breaks, Night Heals - a dirty, grungy Kraftwerk as filtered through a more apologetic British mentality. The distinctive sound is of the Wasp synthesizer made by the British Electronic Dream Plant with its monophonic touch-sensitive keyboard, dual oscillators, it could be run on batteries, had a built in speaker, and connected to other Wasps or its sister sequencer -the Spider. It was the first affordable synthesiser to use digital technology- I bought mine over 30 years ago and it still works!

Although repetition is a major force in music it was never used in this way before - Terry Riley
From side 2, here is Interferon , which is a paradigmatic example of a looping technique pioneered by Brian Eno on Discreet Music. Althoiugh it was used earlier by people like Terry Riley, who referred to it as the 'Time Lag Accumulator' -listen to his Ecstasy  from 1968; and then more explicitly by Eno's collaborator Robert Fripp (formerly of King Crimson), who referred to it as Frippertronics. Fripp introduced this to Eno on their album No Pussyfooting (listen to Heavenly Music Corporation).

Interferon uses a mixture of tape loops and synthesiser sounds played backward to develop a dense though dark orchestral sound - closer to the experimentation of Riley than the quietness of Eno. As noted on The Bridge sleeve (see below), you can actually hear interfering electrical items click (a fridge or other domestic device) echoing away infinitely during Interferon. At other points on side 2, you can hear their soft Scottish voices chatting in the background, coughing, attempting repeatedly to light cigarettes, excerpts of the TV - all encompassed in a womb of hypnotic loops - side 2 as a whole contains some of my favourite electronic insrumental pieces - music made in life - truly ambient!

This simple looping technique is described here (with Eno's Discreet Music in the background). It consists of two Revox tape machines linked together with one recording input and then the tape being fed and played through the second machine; the output of Revox 2 is then fed back via leads to Revox 1 and an infinite echo loop occurs with gradual decay. This technique could not be simpler or more analogue - as the length of the delay echo is purely dependent upon the distance between the two Revox machines.

The back cover of The Bridge shows the dominating presence of the tape-loop decks
Robert (left) and Thomas (right)

Robert Rental and the Normal live

Robert did play live a few times with Daniel Miller (as Robert Rental and the Normal) during a typically perverse Rough Trade tour in which they were support act for Stiff Little Fingers in 1979.

Fortunately one gig was recorded and released as a single-sided LP by Rough Trade: Live at the West Runton Pavilion - a smallish venue on the North Norfolk coast (which now no longer exists but did host everyone from Chuck Berry to T-Rex, Sex Pistols, the Clash and Joy Division). Some great footage of Robert and Daniel playing live to the somewhat bemused would-be-punk audience also exists (see below)

Before setting off on the tour Robert and Daniel played a single night at the Cryptic One Club under Trinity Church, Bishops Bridge Road, Paddington, along with Metabolist, Cabaret Voltaire and Throbbing Gristle. This was one of many great nights organised in unusual venues by the gig promoters 'Final Solution' - or Colin Faver (who worked in Small Wonder Records in Walthamstow, London) and Kevin Millins - who deserve credit for the role they played. Colin subsequently became a DJ on the rave scene. By the way Colin, if you ever read this, you still have my copy of the 1st Annual Report by Throbbing Gristle (on cassette) - 30 years is a long loan!

NME journalist, and now culture commentator, Paul Morley's description of the Cryptic Club evening resonates closely with my memories:

A youth club under a church. A cramped cellar, lots of arches. The "stage" is 15 feet deep and six feet wide. Twenty at most of the audience can see it. A few more can see part of it. In a corner lager is being sold for 50 pence a can. The writing on the wall doesn't say "a culture never falls to pieces, it just gives birth", but that's only 'cos I'd forgotten my chalk.It was hot, crowded, murky, NOISY now and then, silent but mostly decadent. Paul Morley

Also Cosey Fanni Tutti of Throbbing Gristle recalled that night:

"It was an electric night, very alive and thumping energy from  wall to wall and from roof to well below ground. A great shift and a great surge forward happened that night.... Suffice  it to say it was special in MANY many ways to all the people who attended" - Cosey 

Cryptic One Club 11th November 1978 (the remainder of my Ticket stub)

Later

Robert produced a solo demo cassette of Wasp-based instrumentals 'Mental Detentions' in 1979 (with titles A1, A2 etc B1, B2...an example is loaded here), but only released one more musical offering - the propitious Double Heart for Mute Records, then retired from music to spend time with his family. Very sadly, Robert died of lung cancer in 2000 (aged just 48)

Thomas was always a musical chameleon and I vividly recall certain new albums making a strong impression on him (the forboding contents of PIL's Metal Box, Peter Hammil's A Black Box, Joy Division's Unknown Pleasures to name a few) and then these following through into his musical experiments. After The Bridge, he signed for Cherry Red and released a funky well-acclaimed album called Contradictions. He later signed for Arista, for whom he produced the Fairlight-heavy 'The Scale of Ten', which contains two wonderfully subversive Eastern-flavoured pop-tunes about heroin

International (a completely new song about the mundane life of an international heroin-trader)

Came in on flight 83, making a drop here for the company, seems to be travelling light, a secret compartment holds the Chinese white.

He lives his life on the move, making connections in cold hotel rooms, but in a far away place, poppies are harvested in the morning haze

...carrying across the world and selling it to boys and girls, delivered from the company, packaged by international

and Chasing the Dragon (about using Heroin for the first time)

lay your money down, a bigger price you have to pay for what you are about.. to try...clear a space, strike a light, I need to satisfy, watch the crystals come to life and feel your senses die...and fly

I had not mentioned Thomas' use of words until now - largely because his voice was often so subtle that the words were indecipherable (he once said to me that he didn't try to create linear stories usually, but used phrases for their sound and atmosphere more than anything else)

International (top) and Chasing the Dragon (bottom)

"You can hardly separate music from technology" Trevor Horn

Thomas went on to form ACT with Claudia Brücken (formerly of Propaganda who had produced hits in the mid 80s - here they oddly but nicely cover Throbbing Gristle's Discipline). ACT released a few singles and an album for the ZTT label with famed producer Trevor Horn, who co-owned ZTT - coincidentally with Paul Morley (quoted above). Here is ACT with Snobbery and Decay - in receipt of the full Trevor Horn 'wall-of-sound' production treatment (that many benefited from including ABC,  Frankie Goes to Hollywood,  and the Pet Shop Boys)

Following this, Thomas more or less retired from the music industry for many years until a few sporadic releases more recently on small labels - largely low budget productions inspired by modern offerings from bands such as Future Sound of London. Tom's latest offering From Sci Fi to Barfly is available only on the web as far as I can determine but here are a couple of beautiful tracks: Blood of a Poet and Paths of Least Resistance

I am still astonished that no major artist has covered the perfect pop songs that lurk behind the lo-fi production of Thomas Leer's Private Plane and International (or many of his later songs).

My strongest personal recollection of Thomas and Robert is how charming and inspiring they were and our rehearsing together in a short-lived attempt to form a band (provisionally called Acid)consisting of Robert, Thomas, Liz, Matt Johnson and myself ...but that's another story...

Rhythm of Cruelty: Rod Pearce & Fetish Records

Today many create their future memories online. Those of us with a pre-digital existence, however, sometimes have to retrospectively recreate the known unknowns of our past from Googled fragments...but with this facility comes the possibility of discovering unwanted news. One such experience befell me recently - I was thinking about an old friend - Rod Pearce - from the late 70s/early 80s - so I Googled him and innocuously tucked away in one sentence on a webpage, my Google search revealed that Rod had been murdered and in dreadful circumstances in 1997 almost 15 years to the day.

Rod was the mogul behind Fetish records - a small, but extremely important independent record label releasing industrial-electro music in the late 70s and early 80s. During that period, people realised that to produce music, you didnt need to deal with large conglomerate record companies. And in that dawn of DIY music and production, Rod's Fetish Records was a one-man organisation - certainly far harder to operate than it would be in this digital age. I searched for links to Rod and his Fetish legacy, but was astonished to find so little - not even a Wikipedia page for the Fetish record label! This small personal tribute to Rod and Fetish may hopefully introduce a few to what might otherwise be the shamefully overlooked work of Rod and the Fetish catalogue.

Rod started Fetish Records in 1978 with the (re)release of the seminal industrial/electronic Second Annual Report by Throbbing Gristle. The initial pressing of only 785 copies on TG's own Industrial Records had sold out rapidly through word of mouth as reviewers intriguingly grasped at familiar comparables: Faust, John Cage...or my favourite a "Syphilitic Tangerine Dream".  Sandy Robertson, in Sounds said "If the Clash are the sound of the Westway, then TG are the sound of Tesco (with a run down battery)". Prophetic perhaps given that TG were labelled the 'Wreckers of Society ' by Tory MP Nicholas Fairbairn. Despite the ineffable quality of 2nd Annual Report, we are reliably informed by Genesis P Orridge that copies were purchased by Peter Gabriel, Frank Zappa and ...Elton John amongst others (Wreckers of Civilisation: Simon Ford).

As the original copies flew off the shelves, Rod stepped in and with the blessing of TG, pressed 2000 copies of this desired item with the different and now classic TG flash symbol cover shown below - Fetish was born
....producing some of the most unique music from 1978 to 1984, before folding as a business in 1986. The Fetish catalogue is not to everyones taste - it was true then and true today - some of it pushes the boundaries of what constitutes music (hear the late 70s audience response to TG and the DJ barracking the audience in response when TG finish playing). I will not try to describe much of the 'music' here because I just dont burst with adjectives, most defies description and you should listen for yourself.

The Fetish Catalogue

Aside from TG, the Fetish stable included several UK artists strongly associated with developing a more rhythmic industrial sound, including: from Sheffield Stephen Mallinder (of Cabaret Voltaire), the disjointed jazz edge of ClockDVA and London-based dark funk rhythms of 23 Skidoo. Rod complemented the dark and somewhat bleak edge of the UK outfits with several New York artists. These included New Jersey group the Bongos, whose cover of T. Rex's "Mambo Sun" reached #22 in the Billboard Dance Chart. Other New York artists included the gloriously sharp funk of the Bush Tetras and the female duo Snatch (Patti Palladin and Judy Nylon) who had friends in high places. Snatch's contributions for Fetish were produced by the Velvet Underground's John Cale. Snatch also recorded a wonderful single with Brian Eno which in 1978 reached #54 in the charts. This 'Judy' is also the Judy in Brian Eno's Back In Judy's Jungle and perhaps most crucially, Nylon is described as a kind of muse for Eno's venture into ambient music - according to his own liner notes for Discreet Music. Fetish also had releases from other New Yorkers 8-Eyed Spy, featuring one of John Peel's favourite New Yorker artists Lydia Lunch. Added to this from the West Coast came Z'ev, whose percusive work using industrial materials has no parallel. I am not sure it was by design, but in retrospect, the common Fetish denominator is the strong rhythmic aspects (aside perhaps from TG and even they had their rhythmic days)

 

Many, if not all of the above artists are now seen to have been highly influential (explcitly or implicitly) on the later music scene. To take just one example, the following is a BBC review of the re-release of 23 Skidoo's Fetish debut Seven Songs: 

Seven Songs is still as rare as hen's teeth in one sense - as an album which actually lives up to the claim of having been 'hugely influential'. These eight tracks trailblazed much of what we take for granted now: a cut'n'paste sample culture audibly eating itself; white boys playing global funk rhythms; liberal application of metallic white noise and industrial ambience; sophisticated media-savvy imagery and political consciousness - it's all here.

Fetish Artwork and Neville Brody

Aside from the extraordinary Fetish music, the label was closely aligned with the brilliant immediately recognisable artwork of Neville Brody more famous for being artwork director for the pioneering high quality fashion/music magazine The Face and later for the men's magazine Arena. Brody's album covers for Fetish were pre-computer design and so, all hand-crafted elements were pasted together from paper cut-outs, film overlays or PMT [photo-mechanical transfer] prints, with type provided by a professional typesetter.) Some of the Fetish sleeves used three-dimensional work that was then photographed, such as the wooden carvings or plaster hands on the 23 Skidoo sleeves.

          Seven Songs by 23 Skidoo, FM 2008, 1982.         Thirst by Clock DVA, FR2002, 1981

In his book The Graphic Language of Neville Brody: vol. 1, Brody highlights the approach of Fetish and how it differed from mainstream record labels not just in music but all the way through to cover design:

"The musicians on Fetish were also totally open to the idea of me working under my own steam; there has been such a shift in this respect—most groups now take a much bigger hand in design which does not necessarily make for a better cover"
The Graphic Language of Neville Brody, 1988.

The Last Testament

Jon Savage former journalist on electronic/avant garde music for the music paper Sounds, wrote the sleeve notes for The Last Testament (1983), the final Fetish release and much of what he says captures the energy and innovation of Fetish:

I’D IMAGINE IT TO BE SYMPTOMATIC that the word Fetish should have changed in the middle to late 70s, from being a slogan on an obscure Mail Art T Shirt to becoming the tradename of an internationally renowned record label—Maida Vale’s own ‘Home of the Hits’—but that’s showbiz.

IN THIS PULSATING SCENE, Fetish represented an opportune, if haphazard, meeting of New York, Sheffield, and Hackney. All of these spots have been glamourised to a greater or lesser degree, so you would have thought that this brand name was onto a winner. It is, however, an undoubted sign of human perversity that Fetish’s greatest success was to occur at the point when mogul Rod Pearce was shutting up shop: in early 1982, 23 Skidoo’s ‘Seven Songs’, produced by noted noisemakers Genesis P-Orridge and Peter Christopherson, became NUMBER 1 in the indie charts. Phew! Luckily, insufficient interest combined with too much time spent promoting the Bongos meant that this incredible success was nipped in the bud: disheartened at rock ‘n’ roll’s indifference, Pearcey announced that Fetish was to cease operating. People in polytechnics wept.

1980! 1981! THOSE WERE THE DAYS! Those heady days of idealism are over. The fragile dividing line between art and commerce which Fetish represented has now shattered: Rod Pearce and Perry Haines are now prostituting themselves with King, Genesis P-Orridge and Peter Christopherson with Psychic TV, Adi Newton with DVA, and Neville Brody with the Face. I too, am deeply implicated, having sold my soul similarly to PTV and the Face. How worlds change! Isn’t life tough?

In his rather self- and other-admonishing manner, Savage highlights how Rod - in a total reversal of what he had been doing - along with Perry Haines (onetime founder of i-D magazine), surprisingly went on to manage the successful popstars King - who had a massive hit with Love & Pride.

A train trip to Northampton

It was our mutual links with members of TG that fostered my relationship with Rod. For a couple of years from 1979 onwards, we went to some eye/ear-opening/splitting evenings, watching what for some, is far removed from conventional notions of music. I want to relate one specific evening that has stuck in my mind - a trip by train to the Northampton Guildhall on 26th May 1979 to see Throbbing Gristle. TG were being supported by local Northampton band Bauhaus (of Bela Lugosi's Dead fame - so effectively used in the opening of Tony Scott's movie The Hunger) - though more correctly known as Bauhaus1919 at that time. 

        

                              Northampton Guildhall where the gig took place 26 May 1979

Thirty-three years later, I cannot recall much detail (strangely, I was trying to recall if Rod smoked... and I couldn't!) What is life... if not a series of apparently trivial half-remembered events that sometime later may gain resonance. Nonetheless, I do remember the palpable excitement (both of us teenagers) that I felt travelling for the first time out of London (on unreliable British Rail from Euston) to see a band. On the journey I recall us chatting about Rod's fledgling record label and our anticipation of seeing TG. It is difficult to convey, but at that time TG events - not gigs - were highly unpredictable; often accompanied by violence, confrontation and disorientation in equal measure (not just from the audience, but also on the part of TG). Bear in mind that TG had emerged from a performance arts and not a music background - musical entertainment of an audience was low, if at all, on their agenda. I vividly recall our being in the wonderful Guildhall venue - perfect for this kind of event, both of us worrying about time ticking-on and how we would get home - the one blessing was that TG always played for exactly 1 hour (as a timing device turned off their instruments after 60 mins) - so we knew when we could leave to catch the train and made it home after our venture into the wilderness known as Northampton. On the positive mnestic side of the internet, someone has actually uploaded a rough YouTube clip from the Guildhall on that night of TG and their infamous Hamburger Lady 

Hamburger Lady at Northampton Guildhall 26 May 1979

Fetish Finale (Fetish Night - the end of Industrial Music?)

At some point, Rod and I lost contact as our lives diverged - mine away from music and into University/academia and Rod's away from Fetish and into managing King. The big hurrah for Fetish, however, occurred at the Fetish Night, The Lyceum, London 8th February 1981 with Z'EV, NON, Clock DVA, Cabaret Voltaire and Throbbing Gristle (being their last London gig shortly before Psychic TV emerged)

Although Rod decided that Fetish was finished, the artists continued with several appearing the following year at The Final Academy, Ritzy Cinema, London September 1982, which featured the first live readings in London by William Burroughs along with Brion Gysin, 23 Skidoo, Cabaret Voltaire and the debut performance of Genesis P Orridge's Psychic TV.

 

Rod's murder

Finally, I want to say something concering the circumstances of Rod's murder. The following is extracted from a press report of the events.

Rod had moved to Mexico and planned to start a firm running motorbike tours. In May 1997, friends in the UK received a call from his Rod's friends in Mexico to say his body had been discovered on a beach. A friend who identified the body said that he had been virtually decapitated. He was aged just 39, hacked to death with a machete.  

The Mexican authorities initially claimed Rod had been killed in a motorcycle accident.  Suspicious, some of his friends flew to Mexico to investigate further only to be confronted by a wall of bureaucracy. Suddenly, however, witnesses were found. One saw Rod arguing with two men and a woman while another spotted the three in a 4-by-4 vehicle, similar to one owned by the brother of Rod's girlfriend.

It was claimed one of the men was carrying a machete - and that the girl shouted "kill him".

Determined, Rod's friends finally forced the prosecution of his ex-girlfriend, Jemima Alaves Dobles, who was charged with murder and spent three years in jail before being cleared by the court. 

The statements also sealed the death of two witnesses, including the one who reported seeing the machete. They were shot with a .38 and their two bodies were dumped at the site where Rod was found. It was thought they were Rod's killers - silenced as part of a cover up.

PostScript
Recently I was contacted by one of the friends (Rod Buchnan) who investigated Rod's murder. I am grateful to Rod B for sending me this scan of an artricle 'Burying the truth' - that he wrote and was published in the Times newspaper (below). Rod also plans to write a book about the episode...but as he said to me ...."trouble is that there are holes in the truth as we see it and there is certainly no happy ending"

 

CBT: You Spin me Round

Although we failed to show a statistically significant effect of the intervention we cannot rule out a beneficial effect of the cognitive therapy on transition rate (although it could be argued that the sample size required to show such an effect, and the small effect sizes reported here, would make such an endeavour unfeasible in practical terms and unwarranted in clinical terms).

We regularly hear scientists complain about the truth gap that exists between their research findings and how science journalists portray those findings ...but what about that void that sometimes opens up between the findings of scientists and their own conclusions?

A case in point is a paper by Morrison et al (2012) published 'open access' recently in the British Medical Journal. The paper examines the use of Cognitive Therapy in individuals at High-Risk for developing psychosis. High-risk is a particularly contentious and hot topic in the context of DSM-V proposals for early intervention and CBT for psychosis is a similarly contentious topic.

This paper strangely brought to my mind the 80s group Dead or Alive, their one-hit wonder 'You Spin me Round' and the physical transformation of their singer Pete Burns...perhaps you will see why

Figure 1. Still spinning - Pete Burns from the 1980s group Dead or Alive -
before and after a CBT makeover

What did Morrison and the 13 co-authors do?

They conducted a multisite single-blind randomised controlled trial of Cognitive Therapy in 288 individuals thought to be at high-risk for psychosis (aged between 14 and 35). Participants were randomly assigned to either Cognitive Therapy sessions over six months (plus monitoring of mental state i.e. provision of warm, empathic, and non-judgmental face-to-face contact and supportive listening) or monitoring of mental state only.

Results

• Overall, the prevalence of transition to psychosis was lower than expected (23/288; 8%), but crucially, no significant difference in transition rates emerged between the CT and control group

• Distress from psychotic symptoms did not differ

• but symptom severity was significantly reduced in the CT group (P=0.018)

A few thoughts about the study

1) Transition rates Cognitive Therapy has no impact on transition rates
The low rate misses 29 individuals who were excluded at a second baseline assessment because they were deemed to have developed psychosis. The authors say...

This was a cautious manoeuvre to eliminate the possibility that such individuals were under-reporting at baseline and were, therefore, appropriately excluded on the basis of psychosis at first baseline assessment. … The inclusion of these 29 would have given an overall transition rate of 18%, which is similar to that found in the recent cohort studies

2) Reducing Symptoms The authors' claim that CT reduced symptom ratings is itself also questionable. The interaction between group and time did not reach significant and so it could be reasonably argued that CT had no greater impact than the control condition across time.

Moreover, as the authors themselves note, any effect "...would become of borderline significance if we were to adjust for multiple testing using a Bonferroni correction (there being three primary outcomes)."  This is interesting because the primary outcome of the EDIE study protocol is transition and nothing is mentioned about symptom reduction as a primary outcome.


Who is spinning - Media, journal or authors?

Despite the authors not being able to make any claims about CT positively affecting transition rates (which we have seen should be more than doubled), the lack of difference between CT and monitoring alone, the unreliable change in symptom scores, the lack of any medication analysis (in fact all patients were unmedicated as an entry requirement) - they conclude the following

"On the basis of low transition rates, high responsiveness to simple interventions such as monitoring, a specific effect of cognitive therapy on the severity of psychotic symptoms, and the toxicity associated with antipsychotic drugs, we would suggest that antipsychotics are not delivered as a first line treatment to people meeting the criteria for being in an at risk mental state"

So the article in the UK Guardian entitled Drugs not best option for people at risk of psychosis, study warns is not simply misunderstanding by a journalist, but what looks like author spinning. Indeed, as far as I am aware, no direct comparison between CBT and medication has ever been published!

Focusing on different angle, The BMJ press release itself is headlined Cognitive therapy helps reduce severity of distress among psychotic patients - even though the paper (and the press release itself!) clearly states:

Cognitive therapy did not significantly affect distress related to these psychotic experiences...nor levels of depression, social anxiety, or satisfaction with life...

But the confusion arises because the authors also proppose that

...it is clear that both groups improved significantly in terms of psychotic experiences, distress, anxiety, and depression...

How authors may conclude the efficacy of any intervention (CT or monitoring) is beyond me when they have no control group as such! Who knows what would have happened with no intervention at all?

So, this paper gave me a 'mind-pop' for the 80s band Dead or Alive, their hit 'You Spin me Round' and the wonderfully eccentric self-transforming Pete Burns. In fact, this tune has been reinvented many times by Pete Burns and others (e.g. Marilyn Manson) and like Cognitive Therapy, will no doubt continue to reinvent itself
        ...perhaps some papers remind you of pop tunes or musicans although I wouldnt be surprised to be in a minority of one! 

References
Morrison AP, Stewart SL, French P, Bentall RP, Birchwood M, Byrne R, Davies LM, Fowler D, Gumley AI, Jones PB, Lewis SW, Murray GK, Patterson P, Dunn G. Early detection and intervention evaluation for people at risk of psychosis: multisite randomised controlled trial. British Medical Journal, 344 



Worlds fastest fMRI trip

There is no such thing as pure pleasure; some anxiety always goes with it ~ Publius (Ovid)ius Naso (43 BC – AD 17)

The neuroscience writer Mo Costandi recently asked me for a comment on an article he was writing about the fMRI psilocybin (Magic Mushroom) study by Carhart-Harris and colleagues (2012). Naturally, this research generated a great deal of press attention - mostly concerning psilocybin as a potential treatment for depression - even though no data were presented on that topic.

Anyway, what did Carhart-Harris et al do in their pioneering study? Using fMRI (Arterial Spin Labelling [ASL] and BOLD) they compared brain activity in 15 individuals following a placebo (10-mL saline) and after psilocybin (2 mg in 10-mL saline). And they reported:

"...surprisingly, only decreases in cerebral blood flow and BOLD signal were seen, and these were maximal in hub regions, such as the thalamus and anterior and posterior cingulate cortex(ACC and PCC). Decreased activity in the ACC/medial prefrontal cortex (mPFC) was a consistent finding and the magnitude of this decrease predicted the intensity of the subjective effects."

Fig 1. Significant deactivation of mPFC and PCC following psilocybin

  

Looking at the pattern of results, I raised the possibility of anxiety being a confound for this profile of brain deactivation. The pattern of reduced mPFC, PCC activity has strong parallels with patterns seen in clinically anxious individuals and healthy individuals under threat. For example, Zhao et al (2007) examined the responses of clinically anxious and healthy individuals when listening to threat-related words (alternating with emotionally neutral words). Clinically anxious individuals showed mPFC, PCC deactivation and the healthy control group even more so.

Fig 2. Zhao et al: significant deactivation of MPFC & PCC

Anticipatory anxiety is also a potential confound here as the psilocybin scan always occurred after the placebo control scan - so, participants could predict that the second scan would be the trip. Several imaging studies of normal healthy individuals experiencing transient anticipatory anxiety have also reported similar deactivations to those reported by Carhart-Harris and colleagues. For example, Simpson et al (2001) found that normal subjects anticipating uncertain pain intensity (finger shock) display decreased mPFC blood flow.

Does psilocybin study itself provide information about participant anxiety? Some data appear not in the paper itself, but in the supplementary materials, where two relevant questions are posed:

• I feared losing control of my mind increased from 3.3 to 18.0% (ASL) & 3.1 to 14.6 % (BOLD)
• I felt afraid increased from 5.8 to 13.7% (ASL) & from 6.5 to 20.4% (BOLD)

So, psilocybin increased ratings for fear of losing mind by 4-5 times; and for I felt afraid doubled or nearly tripled in percentage terms.

Lack of a significant effect does not equal lack of an effect that is significant - Ratings for I felt afraid failed to reach significance - unfortunately sufficient information is not available to derive effect sizes and therefore any issue of power (given the small sample size n=15). Nevertheless in the earlier mock fMRI psilocybin study of Carhart-Harris et al (2011), they did report enough anxiety details to derive Cohen's d, which was greater than 1 - a large effect - again non-significant only because of the low power of the study (n=9).

Fig 3. Subjective intensity ratings (10=extremely intense effect) maximising in <60 secs

The world's fastest trip in a scanner? The psilocybin was administered intravenously, with a very rapid onset (see Fig 3). As the authors themselves remarked, finding deactivation was surprising -especially as others report increased activation following the oral ingestion of psilocybin (see Vollenweider & Kometer 2010), which is much slower acting (and was scanned one-hour later). Although Carhart-Harris et als participants had previously tripped (which is an issue itself, but left aside here), their history would not prepare them for zero to tripping in seconds!

An intravenously administered dose of psilocybin, an anticipated trip that maximises in seconds and left alone in an fMRI scanner ~ anxiety-provoking? It seems quite likely that people experienced anticipatory anxiety and anxiety during the scan itself. And most importantly, both types of anxiety are associated with the functional imaging profile documented by Carhart-Harris et al. Nobody denies the effect of psilocybin on the brain, the how much is 'trip' and how much is 'trip anxiety'.

References

A video of Carhart-Harris talking about the work

Carhart-Harris RL, Williams TM, Sessa B, Tyacke RJ, Rich AS, Feilding A, Nutt DJ (2012) Neural correlates of the psychedelic state as determined by fMRI studies with psilocybin. Proc Natl Acad Sci. 109:2138-2143


Carhart-Harris RL; Williams TM; Sessa B; Tyacke RJ; Rich AS; Feilding A; Nutt DJ. (2011). The administration of psilocybin to healthy, hallucinogen-experienced volunteers in a mock-functional magnetic resonance imaging environment: a preliminary investigation of tolerability. J Psychopharmacol. 25:1562-1567

Simpson JR Jr, Drevets WC, Snyder AZ, Gusnard DA, Raichle ME (2001): Emotion-induced changes in human medial prefrontal cortex: II. During anticipatory anxiety. Proc Natl Acad Sci 98:688–693.


Vollenweider FX and Kometer M (2010) The neurobiology of psychedelic drugs: implications for the treatment of mood disorders. Nat Rev Neurosci 11: 642–651Nat Rev Neurosci 11: 642–651

Zhao, X.H., Wang, P.J., Li, C.B., Hu, Z.-H., Xi, Q., Wu,W.-Y., Tang, X.-W., (2007). Altered default mode network activity in patients with anxiety disorders: an fMRI study. Eur. J. Radiol. 63, 373–378.

Whats Your Poison - LSD vs Alcohol

"A single dose of LSD, in the context of various alcoholism treatment programs, is associated with a decrease in alcohol misuse"

This was the remarkable conclusion from a meta-analysis just published by Krebs & Johansen (of the Norwegian University of Science and Technology in Trondheim). Their paper forms part of an intriguing renewed interest in using psychedelic drugs as therapeutic agents and is the first attempt to draw some conclusions from the wider literature through the use of meta-analysis.

Unsurprisingly, the study has received wide media attention with headlines such as LSD 'helps alcoholics to give up drinking' and claims by some, such as Professor David Nutt that:

"Overall there is a big effect, show me another treatment with results as good; we've missed a trick here…This is probably as good as anything we've got [for treating alcoholism]."

Administering LSD to alcoholics was quite popular during the late 50s until the early 70s -as partly evidenced by Krebs & Johansen locating over 4000 relevant articles in their litearture trawl. At one point, Alcoholics Anonymous founder - William Griffith Wilson - advocated dispensing LSD at AA meetings (prior to changes in LSD legality).

The Watchmen or just early members of an AA group?

So, what did Krebs & Johansen do in their analysis? After screening their 4000+ records, they whittled their meta-analysis down to just 6 randomised controlled trials.

• the 6 LSD groups consisted of 325 individuals who received single oral doses of LSD ranging from approx 210 mcg (3 mcg/kg) to 800 mcg, with a median dose of 500 mcg
• the 6 'Control' groups consisted of 211 indviduals receiving low-dose LSD (25 mcg or 50 mcg), d-amphetamine (60 mg), ephedrine sulphate (60 mg), or non-drug control conditions (TAU or sit and write for 3 hours)

Krebs & Johansen evaluated 'outcome' as the number of alcoholics who showed 'improvement' and so, for each study they calculated an odds-ratio. Overall, the odds-ratio was 1.96, indicating that compared to 'controls', those in the LSD condition were almost twice as likely to show lowered alcohol misuse. Those few studies that followed-up patients showed that any improvement was temporary.

Given the potentially huge ramifications of their conclusions, it is worth considering the Krebs & Johansen paper in more detail - so here are a few reasons why we may want to reign in the rhetoric:

1. None the 6 studies in the meta-analysis actually documented a significant impact of LSD on alcohol misuse. Pooling data from the 6 studies, however, revealed a highly significant effect (p=.0003). As the authors note, a lack of significant effects for individual studies may reflect the use of small samples and their lack of power to detect differences. Despite this, 2 of the 6 studies with seemingly quite large samples (Ludwig n=176, Pahnke n=117) still reported nonsignificant effects of LSD on alcohol misuse. The lack of effects for individual studies may well explain precisely why the practice of LSD as a therapy for alcoholism was terminated – i.e because it did not produce any noticeable effect in a single study!
2. The question now is whether a large-scale trial is warranted (to overcome the assumed low power of past studies)? Meta-analyses can produce significant effects despite most or even all individual studies being nonsignificant; and several high profile cases have appeared in other treatment literatures (e.g. streptokinase: Lau et al 1992). Crucially, when those treatments have subsequently been evaluated in definitive large trials, they have failed to reach significance. Egger and colleagues have written extensively on the unreliability of conclusions in meta-analyses where small numbers of nonsignificant trials are pooled to produce significant effects (Egger & Davey Smith. 1995) for a recent example, see Rerkasem K, Rothwell PM (2010).
3. When examining small numbers of randomised control trials with marginal effects, one particular issue is publication bias. Given the lack of significant effects in these 6 published trials, it seems feasible that other nonsignificant studies never even reached the publication stage (but languish in file drawers of researchers). Consistent with this notion, we would expect small trials to produce greater variability in the outcomes with some reporting large effects and others reporting small (negative) effects – this does not appear to be the case here – the studies were strikingly homogeneous. Unfortunately bias was not addressed in the paper

4. As the 6 studies themselves date back to 1966-1970, it has not been possible to track-down all of the original papers. Nonetheless, I draw attention to one study in the analysis (Smart et al 1966). Although Krebs & Johansen claim they excluded serious mental health problems with "contraindication for treatment with LSD" such as schizophrenia, the Smart et al study tests alcoholics with schizophrenia, organic brain syndrome, epilepsy, OCD and borderline IQ. It is difficult to know what to make of analyses of the effects of LSD in such groups and it would be useful to know if the groups in the remaining studies had similar compositions.
5. Crucially, I note an important data error in the meta-analysis. For the Ludwig et al (1969) study, Krebs & Johansen report an OR of 1.88; however, this does not correspond to the data of 88/132 and 31/44 reported (see their Figure above). This is a particular concern not just because there are only 6 studies, but because the Ludwig study contains the largest weighting in the whole meta-analysis!
6. Two studies (Hollister et al., 1969; Tomsovic and Edwards, 1970) had poor retention rates specifcially for the controls - with retention rates of 64% and 73% for controls vs. 81% and 92% for LSD. Crucially, these two studies produced the largest Odds-Ratios in favour of LSD (OR =2.27 and 2.25 respectively). Referring to these studies, Krebs & Johansen state that the "...authors of both of these trials expressed that missing participants had probably relapsed to problem alcohol use, consistent with the strategy of considering missing participants as unimproved."  In other words, Krebs & Johansen assumed that drop-outs reflected 'alcohol misuse'; and since drops outs were high for controls in these two studies, we have the largest effects!

These are only some of the issues - we could also discuss the strange control groups, which clearly are not 'controls' in our normal understanding (e.g. treatment as usual and so on), the inability of the designs to disentangle the effects of LSD from the therapy provided, or the somewhat opaque outcome measures.

Summary
While this is an intriguing re-analysis of old data, I don't think anyone should be placing any orders on the basis of this meta-analysis. The number of studies is small; given the negative findings for all individual studies, it seems quite likely that further unpublished studies exist (with even more negative results); the analysis appears to contain a potentially influential error; at least one other study contains individuals who would seem unsuitable for analysis; and far more controls were assumed to relapse simply because they dropped out of the study. So, with only 6 studies in the meta-analysis, it would seem prudent to think very carefully before offering LSD as a treatment for alcoholism just yet.

References

Egger & Davey Smith. (1995) Misleading meta-­analysis. Lessons from “an effective, safe, simple” intervention that wasn't. British Medical Journal;310:752­4

Krebs, T. S. & Johansen, P-O. (2012 in press). Lysergic acid diethylamide (LSD) for alcoholism: meta-analysis of randomized controlled trials Journal of Psychopharmacology

Rerkasem K, & Rothwell PM. (2010) Meta-analysis of small randomized controlled trials in surgery may be unreliable. British Journal of Surgery; 97: 466–469.

Smart RG, Storm T, Baker EF & Solursh L (1966) A controlled study of lysergide in the treatment of alcoholism. 1. The effects on drinking behavior. Q J Stud Alcohol 27: 469–482