Irving Kirsch is a soft-spoken researcher who accidentally stumbled upon one of the biggest and most costly errors in modern medicine. His cautious yet relentless search for the truth has made him persona non grata to much of the psychiatric profession and pharmaceutical industry, and a hero to the rest of us.
His findings, documented in his book The Emperor's New Drugs as well as in dozens of published papers and book chapters, has generated a lot of controversy, including a 5-page cover story in Newsweek and a segment on 60 Minutes.
His conclusion: antidepressant drugs, including blockbusters like Prozac and Paxil, don't work. They're no better than placebo, meaning the only reason people feel and get better when they take those drugs is because they believe they will.
When you look at the evidence collected and analyzed and curated by Kirsch, it's hard to disagree.
I wanted to talk with him about this topic, and also about placebos in general.
I mean, think about it: how cool is it that our brains can generate healing responses through the power of belief? Western medicine knows all about the placebo effect, but until very recently dealt with it only as a nuisance that made it hard and expensive to do “real” scientific research.
Even more significant than Kirsch's research debunking antidepressants, I believe, is his groundbreaking work on the mind-body connection represented by the placebo effect. Through his efforts, we're started to understand both the limits and the dazzling potential of placebo medicine.
In our conversation, we covered:
- what qualities make for a more or less effective placebo drug (pill vs capsule, red vs blue, etc)
- how “voodoo death” related to placebos
- where the placebo effect is strongest and weakest
- using “open label” placebos to treat irritable bowel syndrome
- placebos and hypnosis
- using placebos without deception – the next research frontier
- the importance of a positive physician/patient relationship in influencing clinical outcomes (and why HMO-mandated 10-minute office visits may border on malpractice – my words, not his)
- how to balance the power of placebo with the principle of autonomy and realistic expectation setting
- how a drug gets approved by the US Food and Drug Administration (FDA) – if this process doesn't outrage you, you own a pharmaceutical company!
- why Kirsch started studying antidepressants (it wasn't to debunk them!)
- the difference between statistical and clinical significance
- what he discovered from a Freedom of Information Act filing with the FDA about all the studies that aren't published
- what works better for depression than drugs (acupuncture makes the list!)
- why antidepressants are dangerous
- the poverty of the entire “brain imbalance” theory of depression (and, in my opinion, by extension, the entire psychiatric model of mental illness)
- his current research directions
- and much more…
Enjoy, add your voice to the conversation via the comment box below, and please share – that's how we spread our message and spread our roots.
The Emperor's New Drugs – on amazon
Kirsch's “Emperor's New Drugs” course on Ruzuku (if you don't need CME credit, it's basically a really entertaining 50-minute lecture for free; the CME credits cost $15)
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