4 ms·

I'm not a biologist, but a biologist friend of mine suggested that these results are specious because it is impossible to double-blind test the effects of psych

I'm not a biologist, but a biologist friend of mine suggested that these results are specious because it is impossible to double-blind test the effects of psychedelic drugs. Does such skepticism have any merit?

danharaj 7y ago
There is merit to that skepticism but if effect sizes are large enough then it doesn't matter. You don't need to double blind to figure out the impact of gunshots on cardiovascular health.
fredophile 7y ago
We also don't do double blind tests for surgeries. We must have an accepted process for determining if a particular type of surgery is effective for various conditions. Applying the same standard here would make sense.
- samatman 7y ago
  Although maybe we should. I would love to find this study again, so far, no luck: someone decided to test an 'active placebo' for ACL surgery, of making four incisions in the usual places, but not actually scraping away at the ligament. It was comparably effective as the actual surgery. This left me thinking that stimulating the immune system by causing trauma might be an underutilized medical technique.
chiefgeek 7y ago
The results are not specious. MAPS.org has excellent information about the progress of the trials for psilocybin and MDMA. It works and I speak from experience.
PragmaticPulp 7y ago
The trial can, and should, be double-blinded. With psychedelics, both the patient and observer know if they've received psychedelics vs. placebo. That's often used an excuse to perform studies without control groups, which is not a valid argument. There must always be a control group. That's one of the main flaws in this study. As for considering the studies specious: Not true. If the active group has considerably improved scores relative to the control group, then it doesn't really matter if they know they received true psychedelic drugs. In fact, some of the downstream effects might be due to psychedelics acting as a sort of super placebo. If someone tells you they're giving you psychedelics to study antidepressant effects and then you spend the next 12 hours tripping, you're going to feel that something profound has happened. Being primed to expect improvements in depression and anxiety combined with the extreme disorientation of a psychedelic might be enough to elicit the antidepressant response.
- pmoriarty 7y ago
  "With psychedelics, both the patient and observer know if they've received psychedelics vs. placebo." That's not necessarily true. With MDMA, which can arguably be considered a psychedelic, some people who were given a placebo during the research studies swore they got MDMA, and had very productive sessions. Some people also don't hallucinate even on psychedelics like LSD, which usually cause visual hallucinations, so even with those it's possible for placebos to be effective. Rick Doblin originally designed his MDMA studies to use a lower dose of MDMA as a placebo, but found that it actually tended to make people with PTSD worse than using an inactive placebo (because the small dose would be enough to bring up old trauma, but not large enough for the people to feel safe in dealing with it, so they re-buried the trauma after being re-traumatized with it, making them worse), so he gave the FDA the choice of using the active placebo and making subjects worse or using the inactive placebo and not making them worse but giving up the double-blind nature of the trial, and they chose the latter.
floatrock 7y ago
So the problem is something like it's pretty obvious when someone has taken a psychedelic and no one has figured out a good placebo that can honestly blind the observer. The counter-argument I've heard is well, should everything in medicine be subject to the double-blind gold standard? Or put another way, is there a class of experiments where the double-blind standard is not applicable to? Is it right to discount a class of experiments just because the proponents of the double-blind standard can't figure out a way to make the double-blind applicable? I'm a hacker not a doctor, but my instinct is "well, if the only tool you'll accept is a hammer, it's kinda up to you to make this thing look like a nail."

danharaj 7y ago

There is merit to that skepticism but if effect sizes are large enough then it doesn't matter. You don't need to double blind to figure out the impact of gunshots on cardiovascular health.

fredophile 7y ago

We also don't do double blind tests for surgeries. We must have an accepted process for determining if a particular type of surgery is effective for various conditions. Applying the same standard here would make sense.

samatman 7y ago
Although maybe we should. I would love to find this study again, so far, no luck: someone decided to test an 'active placebo' for ACL surgery, of making four incisions in the usual places, but not actually scraping away at the ligament. It was comparably effective as the actual surgery. This left me thinking that stimulating the immune system by causing trauma might be an underutilized medical technique.

chiefgeek 7y ago

The results are not specious. MAPS.org has excellent information about the progress of the trials for psilocybin and MDMA. It works and I speak from experience.

PragmaticPulp 7y ago

The trial can, and should, be double-blinded. With psychedelics, both the patient and observer know if they've received psychedelics vs. placebo. That's often used an excuse to perform studies without control groups, which is not a valid argument. There must always be a control group. That's one of the main flaws in this study. As for considering the studies specious: Not true. If the active group has considerably improved scores relative to the control group, then it doesn't really matter if they know they received true psychedelic drugs. In fact, some of the downstream effects might be due to psychedelics acting as a sort of super placebo. If someone tells you they're giving you psychedelics to study antidepressant effects and then you spend the next 12 hours tripping, you're going to feel that something profound has happened. Being primed to expect improvements in depression and anxiety combined with the extreme disorientation of a psychedelic might be enough to elicit the antidepressant response.

pmoriarty 7y ago
"With psychedelics, both the patient and observer know if they've received psychedelics vs. placebo." That's not necessarily true. With MDMA, which can arguably be considered a psychedelic, some people who were given a placebo during the research studies swore they got MDMA, and had very productive sessions. Some people also don't hallucinate even on psychedelics like LSD, which usually cause visual hallucinations, so even with those it's possible for placebos to be effective. Rick Doblin originally designed his MDMA studies to use a lower dose of MDMA as a placebo, but found that it actually tended to make people with PTSD worse than using an inactive placebo (because the small dose would be enough to bring up old trauma, but not large enough for the people to feel safe in dealing with it, so they re-buried the trauma after being re-traumatized with it, making them worse), so he gave the FDA the choice of using the active placebo and making subjects worse or using the inactive placebo and not making them worse but giving up the double-blind nature of the trial, and they chose the latter.

floatrock 7y ago

So the problem is something like it's pretty obvious when someone has taken a psychedelic and no one has figured out a good placebo that can honestly blind the observer. The counter-argument I've heard is well, should everything in medicine be subject to the double-blind gold standard? Or put another way, is there a class of experiments where the double-blind standard is not applicable to? Is it right to discount a class of experiments just because the proponents of the double-blind standard can't figure out a way to make the double-blind applicable? I'm a hacker not a doctor, but my instinct is "well, if the only tool you'll accept is a hammer, it's kinda up to you to make this thing look like a nail."