In the April edition of Cerebrum, a neuropsychology-themed periodical, Floyd E. Bloom wrote a brilliant piece on Irving Kirsch’s “The Emperor’s New Drugs.” In Bloom’s “review,” he presents a relatively brief case against the author’s claim that the apparent effectiveness of anti-depressant drugs can be entirely accounted for by the placebo effect. When a counter-argument as convincing and fact-based as Bloom’s can be made in a few short paragraphs, one has to wonder how such a book gained popularity at all. The answer to this, in short, seems to be pop psychology.
Kirsch’s book is a perfect example of the dangers of writing about scientific matters with the average person in mind. At first, an attempt to make complicated psychiatric research accessible to the general population may seem admirable. After all, the results of such research are generally published in scientific journals that go unread by many of the people who are impacted by the findings. In theory, a way to make this information easily comprehensible sounds fantastic, but without an unbiased party to do the translating, the efforts do more harm than good.
Arguments about the effectiveness of a drug relies on an in-depth understanding of at least three things: the condition which the drug is meant to treat, the research done to test the drug and the statistics used to evaluate the research. While authors of pop psychology literature may claim to give a crash course in these subjects, there are two reasons why this inevitably fails.
First, no crash course can make up for the intensive schooling required to genuinely understand scientific research. Second, it’s incredibly easy for the author to trick his readers into thinking he’s given them all the facts, when he’s only given them the facts needed to make his own argument look plausible.
Bloom debunks many of Kirsch’s claims with results from research that Kirsch failed to mention in his book, leaving his readers none the wiser. Kirsch’s approach works because readers rarely notice what isn’t there. They simply assume they’ve been supplied with all the research there is or all the research that matters.
After citing statistic after statistic, it quickly becomes clear that this topic is over the head of anyone unfamiliar with the methods used to analyze the relevant data. At the most basic level, if you’re not well acquainted with the phrase “statistically significant” and don’t know how to interpret a p-value, it’s not likely you can create a well-informed opinion on this topic.
Kirsch preys on this fact, feeding his opinion to naïve readers, who’ve been fooled into thinking this was a subject simple enough to grasp into 240 pages.
That is perhaps the true crime here: convincing readers that an issue so complex, an issue people devote their lives to understanding, can actually be conquered in a few hours’ worth of reading.
What’s worse is that many people make decisions based on books like this. Certainly more than one frustrated patient has read Kirsch’s book and decided to trust the text over a doctor, flushing his medication down the toilet. Scenarios like this strain the relationship between patient and doctor and, at worst, send the patient into withdrawal.
Arguments of effectiveness aside, there’s little to be said against the fact that abruptly stopping any medication can have serious, if not fatal, consequences.
Unfortunately, not much of a case can be made against Kirsch’s right to write books like “The Emperor’s New Drugs.” Instead, it’s important that authors such as Bloom call out errors when they see them and let both sides of the issue be seen.
Furthermore, readers must understand that this subject matter is incredibly complicated, and no single person or book should have the power to completely sway their beliefs.
If understanding the issue at hand is truly what you want, then read the research (and not just some of it), or take a class — you’ll be much better off.