Apr 15, 2022·edited Apr 15, 2022Liked by Stuart Ritchie
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.
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.
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.)
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
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.
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.
Everything you need to know about psychedelics and mental illness
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.
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.
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.)
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
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.
Stuart. Much of this covered over a year ago in our first publication on this topic.
https://www.tandfonline.com/doi/abs/10.1080/17512433.2021.1933434
and then followed up here more recently.
https://journals.sagepub.com/doi/abs/10.1177/00048674221081763
See also:
https://newatlas.com/science/placebo-problem-blinding-modern-psychedelic-science/
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.
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/
"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.
(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.