Future HHS secretary RFK Jr. sets my teeth on edge when he starts talking. Also, what did he do to the made-in-heaven match of Ryan Lizza and digital mistress Olivia Nuzzi? How can one man be so destructive? And I think he's wrong about vaccines and autism.
However, people are grudgingly admitting that he's got a point here and there. Dr. Leana Wen, who writes on health policy for the Washington Post opinion page, has said his views on water fluoridation and raw milk are not as crazy as you might think. That's as generous as the healthcare establishment has gotten.
But one recent remark or promise or plan of Kennedy's led to explosive outrage on Bluesky (it takes a lot to outrage Bluesky, really): Kennedy's apparent approach to addiction rehab.
I’m going to create these wellness farms where they can go to get off of illegal drugs, off of opiates, but also legal drugs, other psychiatric drugs, if they want to, to get off of SSRIs, to get off of benzos, to get off of Adderall, and to spend time as much time as they need—three or four years if they need it—to learn to get reparented, to reconnect with communities.
He suggested that these wellness farms would raise organic vegetables, thus leading to various headlines along the lines of RFK Jr. Says He'll Send People Taking Adderall to Labor Camps. That's probably not an entirely fair characterization of the proposal (if it’s a proposal and not just a stray remark).
So I wonder whether wellness farms would also strike Dr. Wen as not as crazy as you might think. Treatment facilities for alcohol or opiates aren’t a new idea. But the idea of treatment facilities to get people off psychiatric medications such as Adderall and SSRI compounds such as Celexa, Lexapro, Paxil, Zoloft, and Trintellix does seem fairly new. And that’s what really threw Bluesky for a loop: the idea that he was going to wean people forcibly (in labor camps) from the psychiatric meds they rely on.
I'm sure there are people in treatment right now for Adderall abuse. And whether or not there’s a well-defined condition picked out by the phrase "Attention Deficit Hyperactivity Disorder," and whether or not Adderall is an effective treatment for that alleged condition, Adderall’s a widely-abused drug, a classic narcotic: straightforward speed, and of course addictive. Almost anyone under 40 probably knows someone who could’ve benefitted from addiction treatment for Adderall abuse. That a doctor prescribed your amphetamines doesn’t make them not amphetamines.
But I doubt there are a lot of people are in treatment facilities for addiction to Selective Serotonin Reuptake Inhibitors. When one asks, Google AI swears that SSRIs aren’t addictive. Then it lists withdrawal symptoms, including anxiety, nausea, dizziness, sleepiness, chills, sweating, muscle aches, "sensations that feel like jolts or zaps of electricity," cognitive problems, hallucinations, and tremors. So you're not addicted, you'll be pleased to know. But still you might need a wellness farm to manage your withdrawal.
Kennedy's lumping together of "drugs of abuse" and psychiatric medications also isn’t as crazy as you, or indeed Dr. Wen, might think. It's remarkably hard to get a clear picture, for reasons that might end up being disturbing, but evidence for the effectiveness of SSRIs is remarkably thin, considering that millions of people have been on them for decades. People who defend the effectiveness of these drugs point to studies that indicate that they’re slightly better than placebos, which is a little, but only a little, preferable to nothing.
And it’s possible that the effectiveness of SSRIs, such as it is, may be entirely due to the placebo effect as enhanced by side effects. For remarkably, side effects can enhance the placebo effect, and do it in more than one way. So, to begin with, in clinical studies where some subjects receive an actual medication that’s alleged to have anti-depressant effects and other receive an inert placebo such as a sugar pill, many of the people taking the medication will detect the side effects (for example, weight gain and loss of sexual desire) and hence be aware that they’re not in the placebo group. This, studies demonstrate, enhances the placebo effect and that, in turn, produces data that apparently show the medication to be... slightly more effective than an inert placebo.
But outside the context of clinical studies, the same effect has been proven: "active" placebos, or placebos with side effects, are substantially more effective than inert placebos. That the medication is having dramatic effects on you, even if these don’t appear to be directly relevant to your condition, assures you that you’re taking a powerful drug. That you feel very different may lead you to think that your psychological condition is changing, even if no physiological changes have occurred that are directly relevant to your psychological condition.
And this, as far as we know, is the case. When drug companies, and most psychologists, claimed that depression was a "chemical imbalance," and that SSRIs addressed this imbalance, they were engaged in fantasy, not research. They have no idea what the physical mechanism is, and I’m suggesting that the effect of anti-depressant medications may be accounted for entirely by the enhanced or active placebo effect.
But this begins to turn into an amazing conceptual dead end and medical disaster: the worse the side effects, the stronger the placebo effect. Pretty soon, we might be prescribing drugs with very bad side effects, whose clinical efficacy is due entirely to the severity of those side effects. To make them more effective, we'd have to make them more destructive. I wonder whether it has actually happened.
If people know they're not in the placebo group in a study, the placebo effect is enhanced. It’s also the case that if you know you’re on a placebo, the placebo effect is reduced (though not eliminated). This suggests that even if anti-depressants aren’t effective, if they engage no physiological mechanism to reduce depression, that should be concealed, in order to keep the (enhanced) placebo effect intact.
Together, these factors suggest that to have the most effective anti-depressant drugs, we should manufacture compounds with maximum side effects while concealing their ineffectiveness for the target condition. We might need wellness or decency farms at that point not only for people addicted to psychiatric medications but for drug companies and doctors. Also, maybe wellness farms can reparent Ryan Lizza and Olivia Nuzzi, who’ve been through so much. Not as crazy as you might think!
—Follow Crispin Sartwell on X: @CrispinSartwell