Certainly something I've noticed before, is that people who push psychedelics as a cure for mental illness are invariably way more interested in psychedelics than in mental illness. It's honestly really garbage behaviour to thrust questionable medical treatments on some highly vulnerable people for the sake of pushing for a completely unrelated political goal (ie the legalisation of drugs for recreational purposes).
If you think drugs should be legalised so that you can get high more easily, have the balls to make that argument. Don't make ill people into your puppets.
Great piece. One thing that I think of every time I read one of these pro-psychedelic pieces is "how much differently would this research be if the drugs were legal?" I suspect that psychedelics (and canibis before them) get so much positive press with the idea being "if it's medicine they HAVE to make it legal". I am curious if it will end up as transparent as canibis was - since recreational canibis passed in Canada basically nobody even pretends to think of it as primarily medicine after YEARS of it being framed as such - should a country journalists and academics actually care about (sorry Portugal) legalize it.
Ha! Totally true re medicinal marijuana. Perhaps this is just restating your point, but I think there's a sort of contrarianism to this - it seems it's not enough to say "the people who banned the drugs were wrong because the drugs are fun"; you have to say "the people who banned the drugs were wrong because the drugs are the next big medical breakthrough!!". It's like an overcorrection - stating the point in its most extreme, attention-grabbing version rather than its most defensible one.
Reminds me of when people say "music lessons are good because they boost your kids' IQ!". Can't they be good because learning music is good in and of itself?
(I think this is orthogonal to whether psychedelics actually improve mental health and whether music lessons actually improve IQ - I just think the above is a common rhetorical tendency).
It's like the propaganda about "Cigarettes are bad because second-hand-smoke causes cancer," where what people really object to is the obnoxious smell. They feel they need a medical reason to object to smoking.
I think this is way too cynical. As someone who has had very meaningful experiences on psychedelics and believes they can help humanity, what you're saying trivializes those experiences as merely me "getting high." The reality is that humans carry a lot of pain, and I strongly intuited from my own experimentation that these compounds could be very helpful for helping humanity deal with its pain, that our pain has its roots in collective traumas and dysfunctions that psychedelics can help to reveal (though so do many other forms of deep searching and healing).
I recognize that's a very debatable proposition, but I hold it sincerely.
Yes, there's a spiritual aspect to that belief, but it's not outside of scientific investigation either. My donating to MAPS at the time (this was 20 years ago) and keeping up on the science was not because I looked forward to making it easier to get high. It could already "get high" if I wanted: the drugs were easy to obtain. What I wanted was to access high quality psychedelic-assisted therapy to help me with my trauma. I have found partial relief through my own stumbling experimentation (alongside some new troubles, as well, to be fair).
Overall, your article was thoughtful and useful, but I think you're overly cynical about the motivations of researchers. It's hard to appreciate the profundity of the experiences, and personal healing, sometimes brought about by these substances, if you've not experienced it yourself (which is far from a recommendation, by the way: I'm not an evangelist). There is no shortage of folks who get into this because their struggles with depression, trauma, or feeling spiritually adrift are helped dramatically by their own psychedelic experimentation. These experiences can be deeply meaningful and personal, and while science might find these experiences don't generalize in a helpful way, I believe we have to be overly skeptical if we assume most of these folks are delusional about having been helped. The passion people have to share this with others should be something we have great sympathy and appreciation for, even if we appropriately need to remind those researchers to temper that passion with scientific principles.
Maybe it is true for many people, maybe even for the fiercest defenders of medicinal marijuana, but (thought I neither used it and nor think there is any valid reason to forbid adults from using it) I would be satisfied in letting well enough alone if patients had easy access to medicinal marijuana in Brazil.
A few things could have be added to this. Firstly formal research into psychedelics as a treatment for mental health goes back at least to the 1960s. As I understand it research was similarly ‘promising’ but was stymied by the moral panic that has hampered research into many drugs that have been banned because they are used recreationally. Exploring the political context of research into psychedelics would have been useful because it has shaped the way some of the researchers have presented their work. For instance the California project around MDMA touted the drug as a possible treatment for PTSD and made a great deal of its possible efficacy for helping US veterans because advocates believed that the US political right was less likely to oppose something that could ‘help our vets’. The point being that the sort of PR campaign you suggest surrounds psychedelics could be attributed at least in part to the perceived need to counter political squeamishness around recreational drugs. Commercial conflicts of interest? Absolutely possible, but are they more common in psychedelic research than other areas of pharma? You tell me. Lastly there does seem to be a degree of evangelism around psychedelics. This doesn’t surprise me. Growing up, my acquaintances who took psychedelics tended to call them life changing. It was a pretty consistent message. I didn’t encounter the same evangelism around other recreational drugs. Sure, CAMRA evangelises for good beer, and thank goodness because it’s now much much better than it was in the 80s, but I’ve never met anyone who has told me that cannabis or amphetamines or cocaine or smack changed their lives for the better in the same way. There’s a fairly consistent theme around psychedelics through much of recorded history that places the experiences in the spiritual realm. Perhaps, just perhaps, it’s linked to our development of the capacity to experience the spiritual. More research needed doubtless. The point is that I have seen very little written about researchers on psychedelics that has been particularly surprising. We know SSRIs benefits over placebos are quite marginal ( the placebo effect in mental health is considerable and worth embracing of itself) and frankly anything that could help people in a society where mental health seems to be a growing problem is worth encouraging. Are psychedelics the messiah or just a very naughty boy? Who knows. But pharma has long had the inherent conflicts of interest arising from its commercial imperatives, I’m not sure whether you’re arguing the conflicts around psychedelics are greater than the norm but if you are I didn’t feel you successfully established that.
I'm not sure whether the conflicts are greater than other areas - I'm not sure how you would quantify that! But I've been critical of all sorts of areas of science before for their conflicts, and the fact that this is a common problem doesn't make it right.
And I totally agree that the "life-changing" nature of psychedelics is part of the appeal (I say that in the post). But until recently--until that NYMag podcast and a few other articles and tweets here and there--it seems like the pendulum was swinging very much in the pro-psychedelic direction, to the point that it was getting way beyond what the evidence can actually support. That's why I thought it would be useful to have an article like this.
Listening to various people from ICL they seem pretty excited by the research. That much seems understandable given that people invest emotionally and intellectually in the subjects they pursue. And I’d expect them to lobby for additional research. If all you’re saying is ‘hold your horses we need more research because studies to date have been quite small, that’s sensible and I’m not aware that people are arguing with that. But you seem to be saying that results thus far haven’t been sufficiently impressive to warrant the excitement. Is that really the case? I’m just intrigued. Most of what I’ve read by researchers seems enthusiastic but fairly level headed and pretty consistent.
Terrific essay! As a future topic, you might consider comparing the psychedelic literature to research on mindfulness-based therapies. They deal with similar challenges (impossible to do blinding, researcher exuberance, etc). But there's less of a commercial factor compared to psychedelics, and people like Richie Davidson show commendable restraint about how much the literature currently supports. (Other challenges show up -- consistency in the treatment protocols, etc.)
It’s an unwieldy literature. Worth covering though, if only to tell your readers there’s such a thing as a meta-meta-analysis. ;-) https://doi.org/10.1177/1745691620968771
One thing that has confounded me, though I guess there are some good reasons, is the miniscule trial designs. I know funding can be - or is the - issue. But when Compass Pathways came out with their psilocybin for depression study (Phase II trial), they essentially double the number of participants.
Here's to hoping to larger and better designed trials, to have some more data to say something serious about.
I guess another reason for this is the fact the drugs are (at least in the UK) highly illegal, so it’s probably hard to get them in large quantities. Not sure though.
That is very true. I heard last week that some researchers at Imperial College London are still waiting for approval for over 3 months. And that is the group that has been through the bureaucracy a lot of times, so I would think the issue is not on them not handing in the right paperwork :(
What a contrast to the psychedelics research community. Here are the world's leading meditation researchers publishing their own failure to replicate prior findings in a larger sample. They specifically chose to highlight the replication failures, even though they could have easily focused on the findings that did replicate (e.g., reduced amygdala reactivity). https://www.science.org/doi/10.1126/sciadv.abk3316
Appreciate your article, well said, though I wish you wouldn't list "(RIP)" after people's names when not referring to their actual death. Thanks for posting
This was my field, working with people in acute psychiatric emergencies at a state hospital for 40+ years. Psychiatrist Scott Alexander (Siskind) at Astral Codex Ten has a very good extended discussion of the subject and gives a tentative approval and explanation of mechanism for continued research. But even after a long look and practicing in San Fran, he does not recommend them. We actually have treatments for anxiety and depression that are far better than placebo. PTSD - mixed. But the side effects (weight gain and subjective feelings of dissociation in particular) are real, and those meds don't give you a buzz. Sorry, but it is part of the truth. Many people want buzz.
The bias of the researchers is very, very real. I no longer follow the literature, but as of five years ago I was still looking for the researcher who clearly wanted psychedelics to be useless and damaging but nonetheless thought there was something to them. The reading public needs to understand the difference between different trial phases and what level of knowledge they imply.
The New York Magazine's podcast "Cover Story" was indeed informative and chilling. I did sense it suffered from the opposite bias, that they wanted to find a scandal and abuse. They did find some, and pretty horrifying, frankly. But I wonder how the material would have been worked by a journalist not seeking scandal. The ignoring of negative results, of study participants who found themselves suicidal, for example, was evaded in discussion by conveniently defining what "counts" as still being in the study. That is just shameful.
I'd love for anything to work for people in such distress. I thought EMDR was voodoo when it came out and now think something like it may have merit, so I can change my mind. The research on psychedelics is still so cluttered with misleading crap that it is hard to find anything good in it.
"This isn’t like ivermectin or vitamin D for COVID-19, where you could make a pretty good bet that the proponents—who also got way ahead of the evidence in both cases—would end up with their hopes dashed (there never was a plausible rationale for how these drugs would work against a respiratory virus)."
Spoken like a true triple boosted toothless person with Myocarditis, Arthritis, Hepatitis, Cellulitis, Meningitis and strokes.
Great article. I have been around a lot of psychedelic use and my anecdotal observation is that it seems to exacerbate mental illness and social problems.
Medicating Normal is the untold story of what can happen when profit-driven medicine intersects with human beings in distress. This is MUCH more dangerous. How the drug companies torture the data to get approval for Xanax and SSRI.
Thanks and very good points. My main disagreement is with "we shouldn’t be so desperate for a breakthrough mental health treatment". SSRIs, for example, are in practice almost a "forever medicine". Addiction to SSRIs is pretty normal - in a way that there are extremely heavy withdrawal symptoms for those who want to stop. Easy and cheap to prescribe and start, difficult and stressful to quit. Insert: "How convenient for big pharma" meme. Forever medicine seems like both bad science and especially bad culture of mental health treatment. The fact that psychedelics could be a one time dose seems unfathomably superior to a forever medicine, and this convinces me enough to take the psychedelic risk. Never tried psychedelics. Clinical psychology student.
(Disclaimer - I do have a conflict of interest being proponent of legalization and co-founder of drug discovery company April19)
I think it's good to highlight the negatives of psychedelic research and bring some soberness to the hype. Specifically the abuse during therapy is something absolutely indefensible from any point of view. But regarding the scientist's conflict of interest and expectancy bias - I can't help to see that both you and Power Trip authors are not very familiar of the drug development field and pharma practices in general. The point is, there are very, very rotten things going on, large scale intentional manipulation of data, the regulators, the public opinion, politicians, doctors. Just look at the US opioid scandal. You might think how could anyone have gotten away with selling opioids legally en masse - and it happened anyway. I would recommend to read Bad Pharma by Ben Goldacre to have a sobering, scientifically referenced view on the state of the field. You might come to realize that yes, there is horrendous stuff being done on all levels - from early drug design to distribution. You might come to realize there is no such thing as an objective clinical trial without conflict of interest. And only then, having the full picture, I believe it would be fair to assess how much worse the methodological and reporting issues are with psychedelics compared to other drugs. Because in this article you realized the game is flawed but you put all the blame only on one player - which I believe is unfair.
I've just read "Empire of Pain", so I'm very familiar with the opioid scandal and the incredibly unethical marketing practices that contributed to it (to anyone reading this: I strongly recommend that book! I might write about it on here sometime). But you seem to think two (or indeed many) wrongs make a right, which is obviously not the right way to think about it. There are all sorts of ways to make trials more reliable and transparent (in design, methodology, statistics, reporting, etc), and if the psychedelics researchers want to set themselves apart from the bad stuff Big Pharma do, they should be jumping on all those methods ASAP.
I never said it was OK. Just that it would be fair to include a broader context of the drug development game, because doing all those right things you write about surely is not as easy as simply deciding to do them. Because at the very least, you also need to pay for them. It is crucial to understand that getting a drug through all clinical trials is TOUGH and a major reason for that is that Big Pharma likes it that way. Why? Because they are the only ones so filthy rich they can afford it.
Considering the case of Compass trial - results are not as expected in phase 2, massive drop in stock price, capital availability and investor interest tumbles - there is a real possibility that they won't be able to raise money for all other phase 2/3 trials needed, esp. if FDA asks for more phase 2 based on poor results. So Harris writes an optimistic piece, with the one wrong thing of cherry-picking the statistics so the results look good. So that the stock price doesn't plummet, so the investors keep up their hopes. **So that there is a chance to really find out if there is an added benefit in phase 3 trials.**
The thing is, Big Pharma pays for 10 trials, publishes the 3 positive ones and buries the evidence about the other 7 that failed. They pay scientists, regulators, politicians,... to tell the story they want. And I'm NOT saying it's OK to do that if they are doing it. But that people should understand the reasons why psychedelic companies cannot afford to pay extra for fancy study designs (administering 5 drugs, etc...) that will make their study results even more uncertain.
People should realize that their cries for more safety (made in good faith) have made it nearly impossible for most small, honest initiatives to enter the market and allowed Big Pharma to dominate the field. In case of psychedelics, this is ultra ridiculous. People say: "Look at the phase 2 trial, its improvement over SSRI is non-significant - we should definitely not approve it and give it to people under controlled conditions, we should keep people taking it in shady shacks under the supervision of pseudoshamans." Maybe instead of endless tightening of the safety regulations we should loosen them and focus more on explaining the science and risk to patients, who could make their own decision. Drug being approved doesn't mean anyone has to take it - at times I feel people forget that.
Thank you! These look great and I'm sorry I could only really focus on a few review articles for fear of making the post even more massively long than it already is. I might do a follow-up post on ketamine sometime soon - one "psychedelic" (I know there's debate over whether it counts as one) that I didn't cover at all in this post. If I do, I'll certainly include this stuff.
Certainly something I've noticed before, is that people who push psychedelics as a cure for mental illness are invariably way more interested in psychedelics than in mental illness. It's honestly really garbage behaviour to thrust questionable medical treatments on some highly vulnerable people for the sake of pushing for a completely unrelated political goal (ie the legalisation of drugs for recreational purposes).
If you think drugs should be legalised so that you can get high more easily, have the balls to make that argument. Don't make ill people into your puppets.
Great piece. One thing that I think of every time I read one of these pro-psychedelic pieces is "how much differently would this research be if the drugs were legal?" I suspect that psychedelics (and canibis before them) get so much positive press with the idea being "if it's medicine they HAVE to make it legal". I am curious if it will end up as transparent as canibis was - since recreational canibis passed in Canada basically nobody even pretends to think of it as primarily medicine after YEARS of it being framed as such - should a country journalists and academics actually care about (sorry Portugal) legalize it.
Ha! Totally true re medicinal marijuana. Perhaps this is just restating your point, but I think there's a sort of contrarianism to this - it seems it's not enough to say "the people who banned the drugs were wrong because the drugs are fun"; you have to say "the people who banned the drugs were wrong because the drugs are the next big medical breakthrough!!". It's like an overcorrection - stating the point in its most extreme, attention-grabbing version rather than its most defensible one.
Reminds me of when people say "music lessons are good because they boost your kids' IQ!". Can't they be good because learning music is good in and of itself?
(I think this is orthogonal to whether psychedelics actually improve mental health and whether music lessons actually improve IQ - I just think the above is a common rhetorical tendency).
It's like the propaganda about "Cigarettes are bad because second-hand-smoke causes cancer," where what people really object to is the obnoxious smell. They feel they need a medical reason to object to smoking.
I think this is way too cynical. As someone who has had very meaningful experiences on psychedelics and believes they can help humanity, what you're saying trivializes those experiences as merely me "getting high." The reality is that humans carry a lot of pain, and I strongly intuited from my own experimentation that these compounds could be very helpful for helping humanity deal with its pain, that our pain has its roots in collective traumas and dysfunctions that psychedelics can help to reveal (though so do many other forms of deep searching and healing).
I recognize that's a very debatable proposition, but I hold it sincerely.
Yes, there's a spiritual aspect to that belief, but it's not outside of scientific investigation either. My donating to MAPS at the time (this was 20 years ago) and keeping up on the science was not because I looked forward to making it easier to get high. It could already "get high" if I wanted: the drugs were easy to obtain. What I wanted was to access high quality psychedelic-assisted therapy to help me with my trauma. I have found partial relief through my own stumbling experimentation (alongside some new troubles, as well, to be fair).
Overall, your article was thoughtful and useful, but I think you're overly cynical about the motivations of researchers. It's hard to appreciate the profundity of the experiences, and personal healing, sometimes brought about by these substances, if you've not experienced it yourself (which is far from a recommendation, by the way: I'm not an evangelist). There is no shortage of folks who get into this because their struggles with depression, trauma, or feeling spiritually adrift are helped dramatically by their own psychedelic experimentation. These experiences can be deeply meaningful and personal, and while science might find these experiences don't generalize in a helpful way, I believe we have to be overly skeptical if we assume most of these folks are delusional about having been helped. The passion people have to share this with others should be something we have great sympathy and appreciation for, even if we appropriately need to remind those researchers to temper that passion with scientific principles.
Maybe it is true for many people, maybe even for the fiercest defenders of medicinal marijuana, but (thought I neither used it and nor think there is any valid reason to forbid adults from using it) I would be satisfied in letting well enough alone if patients had easy access to medicinal marijuana in Brazil.
A few things could have be added to this. Firstly formal research into psychedelics as a treatment for mental health goes back at least to the 1960s. As I understand it research was similarly ‘promising’ but was stymied by the moral panic that has hampered research into many drugs that have been banned because they are used recreationally. Exploring the political context of research into psychedelics would have been useful because it has shaped the way some of the researchers have presented their work. For instance the California project around MDMA touted the drug as a possible treatment for PTSD and made a great deal of its possible efficacy for helping US veterans because advocates believed that the US political right was less likely to oppose something that could ‘help our vets’. The point being that the sort of PR campaign you suggest surrounds psychedelics could be attributed at least in part to the perceived need to counter political squeamishness around recreational drugs. Commercial conflicts of interest? Absolutely possible, but are they more common in psychedelic research than other areas of pharma? You tell me. Lastly there does seem to be a degree of evangelism around psychedelics. This doesn’t surprise me. Growing up, my acquaintances who took psychedelics tended to call them life changing. It was a pretty consistent message. I didn’t encounter the same evangelism around other recreational drugs. Sure, CAMRA evangelises for good beer, and thank goodness because it’s now much much better than it was in the 80s, but I’ve never met anyone who has told me that cannabis or amphetamines or cocaine or smack changed their lives for the better in the same way. There’s a fairly consistent theme around psychedelics through much of recorded history that places the experiences in the spiritual realm. Perhaps, just perhaps, it’s linked to our development of the capacity to experience the spiritual. More research needed doubtless. The point is that I have seen very little written about researchers on psychedelics that has been particularly surprising. We know SSRIs benefits over placebos are quite marginal ( the placebo effect in mental health is considerable and worth embracing of itself) and frankly anything that could help people in a society where mental health seems to be a growing problem is worth encouraging. Are psychedelics the messiah or just a very naughty boy? Who knows. But pharma has long had the inherent conflicts of interest arising from its commercial imperatives, I’m not sure whether you’re arguing the conflicts around psychedelics are greater than the norm but if you are I didn’t feel you successfully established that.
I'm not sure whether the conflicts are greater than other areas - I'm not sure how you would quantify that! But I've been critical of all sorts of areas of science before for their conflicts, and the fact that this is a common problem doesn't make it right.
And I totally agree that the "life-changing" nature of psychedelics is part of the appeal (I say that in the post). But until recently--until that NYMag podcast and a few other articles and tweets here and there--it seems like the pendulum was swinging very much in the pro-psychedelic direction, to the point that it was getting way beyond what the evidence can actually support. That's why I thought it would be useful to have an article like this.
Listening to various people from ICL they seem pretty excited by the research. That much seems understandable given that people invest emotionally and intellectually in the subjects they pursue. And I’d expect them to lobby for additional research. If all you’re saying is ‘hold your horses we need more research because studies to date have been quite small, that’s sensible and I’m not aware that people are arguing with that. But you seem to be saying that results thus far haven’t been sufficiently impressive to warrant the excitement. Is that really the case? I’m just intrigued. Most of what I’ve read by researchers seems enthusiastic but fairly level headed and pretty consistent.
Terrific essay! As a future topic, you might consider comparing the psychedelic literature to research on mindfulness-based therapies. They deal with similar challenges (impossible to do blinding, researcher exuberance, etc). But there's less of a commercial factor compared to psychedelics, and people like Richie Davidson show commendable restraint about how much the literature currently supports. (Other challenges show up -- consistency in the treatment protocols, etc.)
Thank you! And that's a great tip - one does hear a lot about mindfulness but I've never looked into what the science is like.
It’s an unwieldy literature. Worth covering though, if only to tell your readers there’s such a thing as a meta-meta-analysis. ;-) https://doi.org/10.1177/1745691620968771
Great article Stuart!
One thing that has confounded me, though I guess there are some good reasons, is the miniscule trial designs. I know funding can be - or is the - issue. But when Compass Pathways came out with their psilocybin for depression study (Phase II trial), they essentially double the number of participants.
Here's to hoping to larger and better designed trials, to have some more data to say something serious about.
I guess another reason for this is the fact the drugs are (at least in the UK) highly illegal, so it’s probably hard to get them in large quantities. Not sure though.
That is very true. I heard last week that some researchers at Imperial College London are still waiting for approval for over 3 months. And that is the group that has been through the bureaucracy a lot of times, so I would think the issue is not on them not handing in the right paperwork :(
What a contrast to the psychedelics research community. Here are the world's leading meditation researchers publishing their own failure to replicate prior findings in a larger sample. They specifically chose to highlight the replication failures, even though they could have easily focused on the findings that did replicate (e.g., reduced amygdala reactivity). https://www.science.org/doi/10.1126/sciadv.abk3316
Proper integrity! Soooo nice to see it!
Appreciate your article, well said, though I wish you wouldn't list "(RIP)" after people's names when not referring to their actual death. Thanks for posting
Just my little joke…! 😬
This was my field, working with people in acute psychiatric emergencies at a state hospital for 40+ years. Psychiatrist Scott Alexander (Siskind) at Astral Codex Ten has a very good extended discussion of the subject and gives a tentative approval and explanation of mechanism for continued research. But even after a long look and practicing in San Fran, he does not recommend them. We actually have treatments for anxiety and depression that are far better than placebo. PTSD - mixed. But the side effects (weight gain and subjective feelings of dissociation in particular) are real, and those meds don't give you a buzz. Sorry, but it is part of the truth. Many people want buzz.
The bias of the researchers is very, very real. I no longer follow the literature, but as of five years ago I was still looking for the researcher who clearly wanted psychedelics to be useless and damaging but nonetheless thought there was something to them. The reading public needs to understand the difference between different trial phases and what level of knowledge they imply.
The New York Magazine's podcast "Cover Story" was indeed informative and chilling. I did sense it suffered from the opposite bias, that they wanted to find a scandal and abuse. They did find some, and pretty horrifying, frankly. But I wonder how the material would have been worked by a journalist not seeking scandal. The ignoring of negative results, of study participants who found themselves suicidal, for example, was evaded in discussion by conveniently defining what "counts" as still being in the study. That is just shameful.
I'd love for anything to work for people in such distress. I thought EMDR was voodoo when it came out and now think something like it may have merit, so I can change my mind. The research on psychedelics is still so cluttered with misleading crap that it is hard to find anything good in it.
"This isn’t like ivermectin or vitamin D for COVID-19, where you could make a pretty good bet that the proponents—who also got way ahead of the evidence in both cases—would end up with their hopes dashed (there never was a plausible rationale for how these drugs would work against a respiratory virus)."
Spoken like a true triple boosted toothless person with Myocarditis, Arthritis, Hepatitis, Cellulitis, Meningitis and strokes.
Great article. I have been around a lot of psychedelic use and my anecdotal observation is that it seems to exacerbate mental illness and social problems.
https://medicatingnormal.com/
Medicating Normal is the untold story of what can happen when profit-driven medicine intersects with human beings in distress. This is MUCH more dangerous. How the drug companies torture the data to get approval for Xanax and SSRI.
Thanks and very good points. My main disagreement is with "we shouldn’t be so desperate for a breakthrough mental health treatment". SSRIs, for example, are in practice almost a "forever medicine". Addiction to SSRIs is pretty normal - in a way that there are extremely heavy withdrawal symptoms for those who want to stop. Easy and cheap to prescribe and start, difficult and stressful to quit. Insert: "How convenient for big pharma" meme. Forever medicine seems like both bad science and especially bad culture of mental health treatment. The fact that psychedelics could be a one time dose seems unfathomably superior to a forever medicine, and this convinces me enough to take the psychedelic risk. Never tried psychedelics. Clinical psychology student.
Though it is worth noting regular old depression medication barely shows an effect over placebo. https://www.newscientist.com/article/mg25734220-100-fresh-ideas-about-the-causes-of-depression-are-bringing-new-treatments/
(Disclaimer - I do have a conflict of interest being proponent of legalization and co-founder of drug discovery company April19)
I think it's good to highlight the negatives of psychedelic research and bring some soberness to the hype. Specifically the abuse during therapy is something absolutely indefensible from any point of view. But regarding the scientist's conflict of interest and expectancy bias - I can't help to see that both you and Power Trip authors are not very familiar of the drug development field and pharma practices in general. The point is, there are very, very rotten things going on, large scale intentional manipulation of data, the regulators, the public opinion, politicians, doctors. Just look at the US opioid scandal. You might think how could anyone have gotten away with selling opioids legally en masse - and it happened anyway. I would recommend to read Bad Pharma by Ben Goldacre to have a sobering, scientifically referenced view on the state of the field. You might come to realize that yes, there is horrendous stuff being done on all levels - from early drug design to distribution. You might come to realize there is no such thing as an objective clinical trial without conflict of interest. And only then, having the full picture, I believe it would be fair to assess how much worse the methodological and reporting issues are with psychedelics compared to other drugs. Because in this article you realized the game is flawed but you put all the blame only on one player - which I believe is unfair.
I've just read "Empire of Pain", so I'm very familiar with the opioid scandal and the incredibly unethical marketing practices that contributed to it (to anyone reading this: I strongly recommend that book! I might write about it on here sometime). But you seem to think two (or indeed many) wrongs make a right, which is obviously not the right way to think about it. There are all sorts of ways to make trials more reliable and transparent (in design, methodology, statistics, reporting, etc), and if the psychedelics researchers want to set themselves apart from the bad stuff Big Pharma do, they should be jumping on all those methods ASAP.
I never said it was OK. Just that it would be fair to include a broader context of the drug development game, because doing all those right things you write about surely is not as easy as simply deciding to do them. Because at the very least, you also need to pay for them. It is crucial to understand that getting a drug through all clinical trials is TOUGH and a major reason for that is that Big Pharma likes it that way. Why? Because they are the only ones so filthy rich they can afford it.
Considering the case of Compass trial - results are not as expected in phase 2, massive drop in stock price, capital availability and investor interest tumbles - there is a real possibility that they won't be able to raise money for all other phase 2/3 trials needed, esp. if FDA asks for more phase 2 based on poor results. So Harris writes an optimistic piece, with the one wrong thing of cherry-picking the statistics so the results look good. So that the stock price doesn't plummet, so the investors keep up their hopes. **So that there is a chance to really find out if there is an added benefit in phase 3 trials.**
The thing is, Big Pharma pays for 10 trials, publishes the 3 positive ones and buries the evidence about the other 7 that failed. They pay scientists, regulators, politicians,... to tell the story they want. And I'm NOT saying it's OK to do that if they are doing it. But that people should understand the reasons why psychedelic companies cannot afford to pay extra for fancy study designs (administering 5 drugs, etc...) that will make their study results even more uncertain.
People should realize that their cries for more safety (made in good faith) have made it nearly impossible for most small, honest initiatives to enter the market and allowed Big Pharma to dominate the field. In case of psychedelics, this is ultra ridiculous. People say: "Look at the phase 2 trial, its improvement over SSRI is non-significant - we should definitely not approve it and give it to people under controlled conditions, we should keep people taking it in shady shacks under the supervision of pseudoshamans." Maybe instead of endless tightening of the safety regulations we should loosen them and focus more on explaining the science and risk to patients, who could make their own decision. Drug being approved doesn't mean anyone has to take it - at times I feel people forget that.
Thank you! These look great and I'm sorry I could only really focus on a few review articles for fear of making the post even more massively long than it already is. I might do a follow-up post on ketamine sometime soon - one "psychedelic" (I know there's debate over whether it counts as one) that I didn't cover at all in this post. If I do, I'll certainly include this stuff.