Opinion – Psychedelic Turn: Editorial condemns shoddy psychedelic science

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The specialized journal Psychological Medicine brings this Wednesday (19) an article against the vogue of studies of the so-called psychedelic renaissance. As it is at the root of the emergence of this blog two years ago, it is only fair to reproduce here the unusually acidic criticism.

The text is signed by Wayne D. Hall, from the National Research Center on Substance Use in Youth at the University of Queensland, in Brisbane (Australia), and by Keith Humphreys, from the Psychiatric and Behavioral Sciences area at Stanford University, in Palo. High (USA). Its central target is Robin Carhart-Harris (RCH) of the University of California at San Francisco.

Anyone interested in the therapeutic effects of consciousness-altering compounds has likely come across the name RCH in news reports or interviews. He is an assiduous figure in the coverage of this renaissance, as in this space.

RCH became a celebrity for his pioneering studies of psilocybin from so-called “magic” mushrooms for depression and imaging the brain under the influence of psychedelics while still at Imperial College London. He also publishes work with models that attempt to clarify the mechanism behind alleged psychic benefits, such as the concept of increased brain entropy (disorder) in minds afflicted with excessive rigidity.

Hall and Humphreys (H&H) justly highlight a paper from last April by the Imperial team on “demodulation” of brain networks as an explanation for the alleged rapid antidepressant effect. The measurements that would characterize this process came from brain scans of participants in another study, from a year ago, also criticized in the editorial.

Following the chronological order, first the criticisms of the 2021 work, published in the prestigious New England Journal of Medicine (NEJM). It compared psilocybin with the antidepressant escitalopram (Lexapro).

“As longtime readers and reviewers of the NEJM, familiar with its pattern of maintaining ‘a rigorous peer review and editing process’ that aims to prevent ‘exaggerated results from reaching physicians’, we wonder why the editors published an phase 2 with low power [59 participantes]short term [seis semanas]which did not support any clinical conclusions,” write H&H.

The final statement was taken from the NEJM article itself. The absence of statistical significance in the difference in correlation between the primary result (reduction in a depression scale) and escitalopram or psilocybin, it was recognized, did not allow inferring to assert the superiority of the psychedelic. The authors, however, highlighted another dozen measures that would supposedly reinforce the greater therapeutic benefit of psilocybin.

When reporting this article here, I used the title “Psychedelic draws with antidepressant and can win game on penalties”. A resource not to fail to record that the result was partially negative for RCH.

H&H also attack the second article, in the no less prestigious journal ” rel=”” target=””>Nature Medicine, also reported here. The Imperial group used images from the same sample of depressed patients, but compared with another depression scale, not the one in the NEJM study. Obviously, it was a more favorable scale for correlation.

Other methodological flaws were pointed out in this second work. Among the most scathing criticisms were those of Manoj Doss, from Johns Hopkins University, in Baltimore (USA). Accusations not moderated between Doss and Carhart-Harris gained the social networks, including.

“Critics of the study point out that other journals [do grupo] Nature have published papers explaining the flaws in this form of statistical inference and showing how it contributed to the failure to replicate the findings of many neuroimaging studies,” H&H notes.

“Despite these serious problems, this study appeared in a leading medical journal that has no history of accepting comparably limited work on other therapies.” To make matters worse, both articles received wide coverage in the lay press, given RCH’s fame.

“Only the best of these studies should be published in leading journals, and they should all be described to the public and press with meticulous acuity,” conclude H&H.

To improve psychedelic science, they advocate that public funds be devoted to clinical research on these promising substances. This is hardly the case today, with most funds coming from private philanthropic institutions or individuals.

Such is the strength of the stigma attached to them for their association with the counterculture and for having become enemy number 1 in the US War on Drugs in the 1970s. However, the prohibitionist flag could fall to the ground with the first phase 3 clinical trials with hundreds of patients, such as the one being completed to treat post-traumatic stress disorder with MDMA, and the likely FDA authorization for use in assisted psychotherapy.

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To learn more about the history and new developments of science in this area, including in Brazil, look for my book “Psiconautas – Travels with Brazilian Psychedelic Science”.

Be sure to also see the reports from the series “A Resurreição da Jurema”:

https://www1.folha.uol.com.br/ilustrissima/2022/07/reporter-conta-experiencia-de-inalar-dmt-psicodelico-em-teste-contra-depressao.shtml

https://www1.folha.uol.com.br/ilustrissima/2022/07/da-caatinga-ao-laboratorio-cientistas-investigam-efeito-antidepressivo-de-psicodelico.shtml

https://www1.folha.uol.com.br/ilustrissima/2022/07/cultos-com-alucinogeno-da-jurema-florescem-no-nordeste.shtml

It is worth remembering that psychedelics are still experimental therapies and certainly do not constitute a panacea for all mental disorders, nor should they be self-medicated. Talk to your therapist or doctor before venturing into the area.

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