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article in the American Psychological Association’s Prevention & Treatment, “The Emperor’s New Drugs,” University of Connecticut psychology professor Irving Kirsch found that eighty percent of the effect of antidepressants, as measured in clinical trials, could be attributed to the placebo effect. (Kirsch, et al, 2002) Kirsch had to invoke the Freedom of Information Act in 2001 to get information on the clinical trials of the top antidepressants: these data were not forthcoming from the Food and Drug Administration. The data show that in more than half of the clinical trials for the six leading antidepressants, the drugs did not outperform placebo, sugar pills. And Kirsch noted in a Discovery Health Channel interview that “the difference between the response of the drugs and the response of placebo was less than two points on average on this clinical scale that goes from fifty to sixty points. That’s a very small difference. That difference clinically is meaningless.”

Another interesting fact about the effectiveness of antidepressants is that they have performed better and better in clinical trials over the years, suggesting that their placebo effects are in part due to savvy marketing. The more the miracle of antidepressants was touted in the media and in advertisements, the more effective they became. Beliefs are contagious! We now live in a culture where people believe that antidepressants work, and so they do.

A California interior designer, Janis Schonfeld, who took part in a clinical trial to test the efficacy of Effexor in 1997, was just as “stunned” as Perez when she found out that she had been on a placebo. Not only had the pills relieved her of the depression that had plagued her for thirty years, the brain scans she received throughout the study found that the activity of her prefrontal cortex was greatly enhanced. (Leuchter, et al, 2002) Her improvements were not “all in her head.” When the mind changes, it absolutely affects your biology. Schonfeld also experienced nausea, a common Effexor side effect. She is typical of patients who improve with placebo treatment and then find out they were not on the real drug—she was convinced the doctors had made a mistake in the labeling for she “knew” she was on the drug. She insisted that the researchers double-check their records to make absolutely sure she wasn’t on the drug.

Nocebos: The Power of Negative Beliefs

While many in the medical profession are aware of the placebo effect, few have considered its implications for self-healing. If positive thinking can pull you out of depression and heal a damaged knee, consider what negative thinking can do in your life. When the mind, through positive suggestion improves health, it is referred to as the placebo effect. Conversely, when the same mind is engaged in negative suggestions that can damage health the negative effects are referred to as the nocebo effect.

In medicine, the nocebo effect can be as powerful as the placebo effect, a fact you should keep in mind every time you step into a doctor’s office. By their words and their demeanor, physicians can convey hope-deflating messages to their patients, messages that are, I believe, completely unwarranted. Albert Mason, for example, thinks his inability to project optimism to his patients hampered his efforts with his ichthyosis patients. Another example is the potential power of the statement: “You have six months to live.” If you choose to believe your doctor’s message, you are not likely to have much more time on this Earth.

I have cited the Discovery Health Channel’s 2003 program “Placebo: Mind Over Medicine” in this chapter because it is a good compendium of some of medicine’s most interesting cases. One of its more poignant segments featured a Nashville physician, Clifton Meador, who has been reflecting on the potential power of the nocebo effect for 30 years. In 1974 Meador had a patient, Sam Londe, a retired shoe salesman suffering from cancer of the esophagus, a condition that was at the time considered 100 percent fatal. Londe was treated for that cancer,