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GLOBAL ADVANCES IN HEALTH AND MEDICINE editorial: perspectives on the placebo effect The Placebo Effect: A Conversation With Dr Irving Kirsch 安慰剂效果:与 Irving Kirsch 博士的谈话 El efecto placebo: una conversación con el doctor Irving Kirsch William Scott, United States Author Affiliation William Scott is the media and legislative liaison for Christian Science in Washington State. Correspondence William Scott washington@ compub.org Citation Glob Adv Health Med. 2012;1(5):8-9. Key Words Placebo, antidepressants, depression, psychiatry, pharmaceuticals “ Explosive” was the word 60 Minutes reporter Leslie Stahl used to describe the scientific conclusions of Dr Irving Kirsch, MD, in the episode titled “Treating Depression: Is There a Placebo Effect?,” which aired February 19, 2012. Dr Kirsch, the associate director of the Program in Placebo Studies and the Therapeutic Encounter hosted at the Beth Israel Deaconess Medical Center of Harvard Medical School, Boston, stated that any benefit from antidepressants is from the patient’s belief in the drug and not from the drug’s chemical composition. 1   Given the legions of patients spending a com- bined billions of dollars each year on antidepressants, Dr Kirsch’s research and the 60 Minutes interview have caused patients and members of the medical community to reconsider the treatment of depression. (The episode also cautioned, “If you’re already on these powerful drugs, you shouldn’t stop taking them on your own.”) In May 2012, Dr Kirsch was a featured speaker at the International Research Congress on Integrative Medicine and Health (IRCIMH) in Portland, Oregon. More than 1000 attendees, physicians, and scientists from 23 countries heard Dr Kirsch share his findings that antidepressants, when used in cases of mild to mod- erate depression, have no statistically measurable effect. I have always been interested in the mental nature of health, so I attended Dr Kirsch’s presentation in Portland and met with him the next morning to discuss his work.   Mr Scott: In your conference presentation, you men- tioned that the 60 Minutes episode made you a hero to some and a villain to others.   Dr Kirsch: The drug companies have not been hostile to our findings, and medicine overall seems open to what we’ve found. I work at Beth Israel Deaconess Medical Center Hospital in Boston, and they have been very supportive, but those who have been trained to prescribe antidepressants don’t seem very happy. A large part of their education and practices is based on drug-based treatments and the perceived benefits of antidepressants.  Mr Scott: I’m very interested in your work because the founder of Christian Science, Mary Baker Eddy, studied the placebo effect in the 1870s and came to similar 8 Volume 1, Number 5 • November 2012 • www.gahmj.com conclusions. She wrote about layers of the placebo effect or the faith placed on drugs. For any one drug today, these layers might include the clinical scientists devel- oping the drug, the US Food and Drug Administration approving it, the commercials promoting it, the physi- cians prescribing it. These represent placebo layers that promote the mental acceptance of the drug’s effective- ness experienced by patients. Can you share more about the science behind placebos?   Dr Kirsch:  Emotions, expectancies, and behavioral conditioning like that of Pavlov’s dog have long been known to affect the body. This is the basis of the pla- cebo effect. Timothy Walsh has done a meta-analy- sis on the effects of placebo and drugs over time. He showed that as public awareness of antidepressants increased, the response to drugs and placebos for depression also increased. 1  This shows how beliefs about the effectiveness of a drug can change the effect of prescribing it.  Mr Scott: Would you say your placebo studies are in tandem with those of Italy’s Dr Benedetti, or does each of you focus in different areas of placebo research?  Dr Kirsch: I’d say our work is supportive. We have built on each other’s findings. Mr Scott: Since your interview with 60 Minutes aired, have you noticed a general shift in thought regarding antidepressants?   Dr Kirsch: Change comes slowly. I have received doz- ens of emails from people asking me to help them get off their dependency of antidepressants since the 60 Minutes episode. Unfortunately, I don’t know enough psychiatrists who are willing to work toward easing them off the drugs.   Mr Scott: What do you feel should be done for the mil- lions who now feel dependent on antidepressants?   Dr Kirsch: In the United Kingdom, there is an organiza- tion called NICE (The National Institute for Health and Clinical Excellence) that has written new public health guidelines that discourage prescribing antidepressants except in severe cases. Unfortunately, there is no simi- lar organization in the United States.  Editorial