1 The Sherlock Holmes of Antidepressants
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Many people tortured by pain really did rise.Their agony really did recede.John Haygarth couldn’t understand was how.Everything he had learned in his medical training suggested that the claim that pain was a disembodied energy that could just be expelled into the air was nonsense.But here were the patients, telling him it worked.Only a fool, it seemed, would doubt the power of the tractor now.So John decided to conduct an experiment.At the Bath General Hospital, he took a plain long piece of wood and disguised it inside some old metal.And so, on the seventh of January 1799, with five distinguished doctors there as witnesses, he ran the wand over them.John wrote to a friend of his, a distinguished doctor in Bristol, to ask him to try the same experiment.But within four minutes of the wand being waved over him, he raised his hand several inches.They continued to treat him with the wand over the next few days, and before long he could touch the mantelpiece.Within eight days of treatment with the wand, he could touch a wooden board that was fully a foot above the mantelpiece.It happened with patient after patient.Could there be some special property in a stick they hadn’t known before?They tried to vary the experiment by wrapping an old bone in metal.It worked just the same.They tried wrapping an old tobacco pipe in metal.With the same success, he noted drily.After the initial miracle, they became crippled again.There is a huge argument among scientists, and no consensus.And then I became angry.He seemed to be kicking away the pillars on which I had built a story about my own depression.He was threatening what I knew about myself.His name was Professor Irving Kirsch, and by the time I went to see him in Massachusetts, he was associate director of a leading program at Harvard Medical School.Irving believed the huge body of scientific research that had been published, and he could see the positive effects with his own eyes when his patients walked back through the door feeling better.But Irving was also one of the leading experts in the world in a field of science that began right back in Bath when John Haygarth first waved his false wand.At that time, the English doctor had realized that when you give a patient a medical treatment, you are really giving her two things.You are giving her a drug, which will usually have a chemical effect on her body in some way.As amazing as it seems, Haygarth realized, the story you tell is often just as important as the drug.How do we know this?This came to be known as the placebo effect, and in the two centuries since, the scientific evidence for it has become enormous.Scientists like Irving Kirsch have shown remarkable effects from placebos.For example, a placebo can make an inflamed jaw go back to normal.A placebo can cure3 a stomach ulcer.If you expect it to work, for many of us it will work.Scientists kept stumbling across this effect for years and being baffled by it.So, because he didn’t know what else to do, he tried an experiment.He told the soldiers he was giving them morphine, when in fact he was giving them nothing but a saltwater drip with no painkiller in it at all.The patients reacted just as if they had been given morphine.He knew this for a simple reason.If you want to sell a drug to the public, you have to go through a rigorous process.Then the scientists compare these groups.You are allowed to sell the drug to the public only if it does significantly better than the placebo.Guy explained that he was curious to investigate something.Whenever you take a drug, there’s always some placebo effect, on top of the effects of the chemicals.With powerful drugs, it’s always assumed to be a minor element.Irving and Guy both knew that if they started exploring this, they’d certainly find that most of the effect was chemical, but it would be intellectually interesting to look at the more minor placebo effect, too.So they started with a pretty simple plan.There’s an easy way to separate out how much of the effect of any drug you take is caused by the chemicals it contains and how much is caused by your belief in them.The investigators have to carry out one particular kind of scientific study.They split the people taking part into three groups.Imagine, he explains, that you are investigating a new remedy for colds. You give people either a placebo or a drug.Over time, everyone gets better.The success rate seems amazing.You need the third group to test the rate that people will simply get better on their own, without any help.So Irving and Guy started to compare the results for antidepressants from these three groups, in every study that had ever been published.To find out the chemical effects of the drug, you do two things.First, you subtract all the people who would have just gotten better anyway.Then you subtract all the people who got better when they were given a sugar pill.What’s left is the real effect of the drug.But when they added up the figures from all the publicly available scientific studies on antidepressants, what they found baffled them.The numbers showed that 25 percent of the effects of antidepressants were due to natural recovery, 50 percent6 were due to the story you had been told about them, and only 25 percent to the actual chemicals.That surprised the hell out of me, Irving told me in the front room of his home in Cambridge, Massachusetts.Guy was sure, he told me later, there’s got to be something wrong with this data, and so they kept going over it, again and again, for months.