The Emperor’s New Drugs
The book is a fine example of a new kind of popular science spreading over now in the USA and in GB: written by well known researchers in clear, common sense text, accessible for everybody interested, but useful also for the scientific community because of the citation of the relevant literature, and of a large bibliography and and an apparatus of notes.
Kirsch gives an overview of his research concerning the effects of antidepressants, a field he had explored in the last decades. Originally as a research psychologist he was interesting in mental sets mediating quick behavioral responses to external stimuli. These cognitive-emotional sets have great survival value for the human animal, and their forerunner mechanisms can be found in higher levels of the evolutionary system of animals. In humans these sets have simple inherited and conditioned bases (e.g. appraisal and its role in eliciting emotions) but also shortcuts in complex cognitive, conceptional structures developed through socialization and life experiences. These complex reactions work in the form of expectancies, the topic of research for Kirsch.
Kirsch could prove that expectancies and the automatizes bound to them play a key role in the placebo phenomenon, known in medicine and used in the pharmacological trials in order to separate real effects from psychological reactions, which manifest themselves very often in the clinical settings. His attention was focused on the phenomenon of active placebo, a term related to the common observation that if patients feel some bodily or mental changes after ingerting inert substances or undergoing therapeutical procedures, they are prone to attribute a higher rate of beneficial change in their troubles (cc 10 %), even if treatment does not influence their illness or complaint. Since the meta-analyses show that antidepressants have a 10 % advantage to placebo, Kirsch had pointed out, that the much ballyhood mind altering drugs are in reality expensive and often harmful (because of their side effects) placebos.
This issue led Kirsch and many others who made similar critical analyses to highlight the marketing interests of the pharmacological industry and its manipulation of drug trial date. Kirsch succeeded to get access to the FDA’s files (on the basis of Freedom of Information Act) and found, that the industry used in its advertisements only researches which had showed better clinical results and suppressed the other trials whose conclusions supported the importance of the placebo factor.
This book is the history of Kirsch’s way to his theory of placebo and to the deconstruction of the – as he calls – the antidepressant myth. He is describing the most interesting clinical investigations and researches until he can cancel the slogan of the „Prozac nation”, the „listening to Prozac” philosophy, suggesting that this listening leads to hearing placebo.
The criticism of the chemical imbalance theory of depression and the wide diagnostic category of depression and the often irreal extension of indications of antidepressants are very important. But in the reviewer’ eyes the larges merits of the book is the new explanation and interpretation of the placebo.
There is an interesting concomitant of the phenomenon, the nocebo, well described in the book, and placebo and nocebo, taken together provide us with an interesting scientific picture of medication, healing, expectations and responses of patients. Beside conditioning, medical settings, specific suggestions and the non-specific effects of doctor-patient relationship and communication contribute maximum effects of therapies, including the full placebo reaction and counteracting nocebo influences.
This thesis has very important consequences to medicine and health services as well as for futher psychological and clinical research concerning the placebo issue. Placebo can mean a renewal for psychotherapy theories and practices. The general public can get some insight, why alternative medicine and traditional ways of healing can gain so much influence int he modern world,: because they reach high levels of placebo effects through adequate communication and indoctrination of their followers and users.
Kirsch’s book is an excellent job and can be recommended for both general public and or stakeholders of health services, patients and their families.
Béla Buda, M.D.,Ph.D., psychiatrist
Irving Kirsch: The Emperor’s New Drugs. Exploding the Antidepressant Myth.
2009. The Bodley Head, London, 226 pp. ISBN 978-1-847—92083-6
Overview at the Publisher's page:
The Emperor's New Drugs: Exploding the Antidepressant Myth
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