Rees, William Linford Llewelyn

   (1914–)

   Pioneer of controlled drug trials in psychiatry, Rees was born in rural Wales, the son of a family of teachers (he said that he entered medicine "to avoid becoming a teacher"), and received his medical degree from the Welsh National School of Medicine in 1938. After serving as a house officer at the Worcester asylum in Powick, he came down to London in 1940 to do a Diploma in Psychological Medicine at the Maudsley Hospital (which had already moved to its wartime location at Mill Hill). In 1947, he left the Maudsley, where he had become a staff psychiatrist, for several mental-hospital posts in Wales, returning to London in 1954 as a consultant physician to the now combined Bethlem Royal Hospital and Maudsley Hospital. In 1966, he became professor of psychiatry at St. Bartholomew’s Hospital ("Barts").

   It was, however, when Rees was in South Wales running outpatient clinics that he and Carl Lambert carried out several important trials. In 1950, Rees reported at the First World Congress on Psychiatry in Paris a study of insulin coma therapy, electroconvulsive therapy, and leukotomy (lobotomy) in the treatment of schizophrenia, compared to a randomized group of historic controls (patients admitted to hospital before these treatments were available). He found insulin coma therapy most effective of all.

   Then, Rees and Carl Lambert carried out a controlled trial of chlorpromazine in anxiety states. Designed as a crossover study (one half of the patients took chlorpromazine, another half took the dummy tablets, then unknowingly switched halfway through), it did not employ the standard later technique of randomized parallel groups. "It didn’t take me long to get a hundred anxiety states," Rees later said. "Colleagues in London were flabbergasted but it was different there because I had an unlimited supply of patients." He presented the findings in 1955 at a conference in Paris that Jean Delay, Pierre Deniker, and Pierre Pichot had organized on chlorpromazine, then published them the same year in the Journal of Mental Science. He found that the drug was only of marginal utility in anxiety "because people with executive or responsible positions had their anxiety relieved but it also eroded their enthusiasm and motivation," Rees said in a later interview (with David Healy). Rees and collaborators went on to do a long series of controlled trials on various psychiatric drugs, with the further refinement that the patients were usually randomized to the treatment group or the control group. This technique of randomized control trials (RCTs) became the gold standard for clinical trials in psychopharmacology.*