If Only We Could Sell Placebos

Big takedown of depression and mental illness in some books reviewed here.

Here’s what a casual reader will take away from this article:

Psychiatric drugs were first used in the 50s as tranquilizers to combat the unpredictable high-energy behavior of patients in mental hospitals. Subsequent research revealed that the drugs had an effect on brain chemistry and, prodded by Big Pharma, everyone concluded that brain chemistry must have been the problem all along. In reality, the patients were just stoned.

Fast forward to today and we have an unholy collusion between psychiatrists, who need the drugs to run a profitable business, and Big Pharma, who sells them. The research is all biased because studies that validate the Golden Hypothesis are cherry picked. Those that dissent are shuttered away, never to be read, save for by one redoubtable psychiatrist who threw the book at the FDA and got the data.

Bottom line?

Putting all this together, writes Kirsch, leads to the conclusion that the relatively small difference between drugs and placebos might not be a real drug effect at all. Instead, it might be an enhanced placebo effect, produced by the fact that some patients have broken [the] blind and have come to realize whether they were given drug or placebo. If this is the case, then there is no real antidepressant drug effect at all. Rather than comparing placebo to drug, we have been comparing “regular” placebos to “extra-strength” placebos.

Ok. This kind of article terrifies me. The evidence, the conspiracy theory, the baddest boogeyman of them all. It’s all here. How can skepticism possibly survive this attack?

The most bizarre effect of this kind of publicity is to reduce the effectiveness of psychiatric drugs. If these books convince everyone that everything is a placebo, the placebo effect goes away.

And, presumably, mental health deteriorates. Is there such a thing as a virtuous lie?

As Robin Hanson asks:

when exactly is it important to emphasize truth, relative to other belief functions?

A better question: is it even possible for a society to collectively self-deceive given ANY level of reward?

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