"Psychedelic Zealots" w/ Dr. Tyler Black
Psymposia sits down with Dr. Tyler Black — an adolescent psychiatrist, suicidologist, and prolific debunker of misinformation — to discuss pseudoscience, a recent case study involving the administration of psilocybin to a woman with Alzheimer's disease, psychedelic zealotry, and his ketamine research.
00:00:00 Intro
00:04:18 Interest in psychedelics
00:06:05 Role of skepticism and replication in research
00:08:40 History of psychedelic research misconduct and "purple hat" therapy
00:09:45 Venture capital and "strip mall psychedelia"
00:15:10 Reviewing psilocybin for Alzheimer's patient case study
00:31:30 "Zealot" culture and framing harms as beneficial
00:43:08 Tokenizing veterans and vulnerable populations
00:48:00 Adolescent psychedelic research
00:51:02 Nuance, caution, and responsible research
Show Notes:
A pilot randomized trial of ketamine for suicidal ideation in a pediatric emergency department (Canadian Journal of Emergency Medicine)
Transcript
This transcript was generated automatically from YouTube's captions, then cleaned up by removing filler words, repeated words and background sounds. It may still contain errors.
[00:00] At double blind and in the psychedelic community at large, we generally don't like to use the word bad trip. The best thing that can happen is to think that you're going to die. It's unfalsifiable. You know, it reminds me of like no pain no gain or these types of statements, you know, like no pain no gain is actually pretty bad advice. We learned that there were actually researchers involved in this study that would refer people to other drugs after. The idea was that if people who were getting worse after the trial, it was because this healing process that was unfolding hadn't fully worked out. And so they were specifically referring people to, you know, help it move out. We just have to jiggle it out and help the process to complete. As you know, when you go to the conferences or you hear these people, these are true believers.
[00:48] They will never admit that psilocybin doesn't work. They will never admit that ketamine doesn't work. I've said this to them publicly. Like I said, I don't even know why you bother because any real scientist is going to look at everything you publish and say, "Wait for the replication. It's powerful pharmarmacology and it might have good uses, but it might, you know, have a lot of side effects too and you know, it's exciting as a pharmacologist to explore new things. We don't get a lot of new things in neuroscychiatry, but we have to do it with caution. Hey there, I'm Russell with Psymposia. Thanks for joining us today. We've got a special guest interview today.
[01:33] I'm here with Nishay, Mike, and James with the team and Dr. Tyler Black. Dr. Tyler Black is a psychiatrist with an expertise in child and adolescent psychology, suicidology and debunking misinformation online I think is one of the ways that we have been particularly turned on to his work. He's a great follow on Twitter, always kind of pushing back on misinformation. Tyler, thank you so much for being here with us. Can you give our audience a little bit of information on your background? Sure. Thanks for having me. It's a it's really a pleasure. So yeah, I'm a clinical assistant professor at the University of British Columbia. I've originally did my degree in pharmarmacology as an undergrad and then went into med school psychiatry, child adolescent psychiatry.
[02:20] And I've been practicing for almost 20 years now. I'm getting pretty old. And my primary clinical work was in child and adolescent psychiatry on the emergency side. So I would I worked in a tertiary care emergency hospital. And so we would get kids admitted for a host of psychiatric emergencies and I was the director of that unit for about 14 years. And then last couple of years I've had a little bit of time off. I went through a little bit of burnout and I've been kind of reconfiguring what I want to do and I'm starting to do some private work and also working for some local mental health teams in my area. But yeah, I really got onto Twitter as an extension of all the online sort of advocacy that I've been doing.
[03:06] I've been on the internet as long as there's been an internet and I have always been in that space of looking up the science on claims. you know, my first foray into it was MSG allergy and the sort of garbage science behind that and then sort of, you know, it's always been a thing. And, you know, my heroes being like Steve Nolla from Skeptics's Guide to the Universe and people who spend a lot of time debunking things and then Twitter, I was just tooling along. I was doing my thing on Twitter. I was a regular voice. And then the pandemic hit and all of a sudden people started saying that pandemic measures or sending kids home from school or the pandemic itself was going to cause a whole bunch of suicide in kids. and that was right in my wheelhouse. And then from that point on, I've recognized the importance of me really stepping up and combating misinformation because it was driving policy at the time.
[03:54] So that's how I sort of got here and I'm lucky to still be in the health the hell site. Twitter is an awful place to be, but it's where people are and so, you know, it's where I feel scientists have to be, too. Yeah, it's that kind of double-edged sword. One particular tweet that I think we've brought up from you on our show before was related to your commentary on like the MAGA world kind of accepting Ibagane as opposed to vaccines around the cardiotoxicity. I think that was one really interesting piece of commentary that you had made. U but we've seen some other tweets of yours in the past related to your psychedelic commentary. I guess to the topic at hand and what we discuss a lot through our publication. What's your general familiarity with the psychedelic world and are there any trends or misinformation or things you're particularly interested in or skeptical of within the psychedelic science space?
[04:50] Yeah, I mean so I'm a pharmacologist by training and I you know I love pharmarmacology. I have a textbook for pharmarmacology for children and adolescence. So, I love the idea of exploring a different system, a different pathway, you know, drug discovery through whether it's natural substances or synthesized substance. There is nothing about psilocybin or ketamine or anything that I consider to be bad on its own. But you know, and I have a comfort with ketamine. I you know because of my position at a tertiary center I was often in a position of delivering ECT and delivering conscious sedation to kids for ECT ECT and sometimes propall is used and other times ketamine is used and you know I've been generally skeptical of the claims because I've treated so many people who've used these substances and they don't seem like better people like I think about all of the serendipitous discoveries.
[05:50] We've had like epileptic people on anti-alyic medications and then we find out that it treats their bipolar disorder. Well, I've treated so many people who've had ketamine for a shoulder relocation or some procedure that they've had in the ER and they don't wake up saying, "Oh my god, my mood's so much better." So, I've been sort of like skeptical of it and you know, I don't dip my toes too much into it. You know, we're I live in Vancouver. There was a very famous case of a maps case that was quite unethical and shut down that maps study being done here in Vancouver. But then I was so interested in ketamine that I actually had just published we did a triple blinded randomized control trial of ketamine mazzelam and placebo in kids for suicidality. We didn't get the numbers that we wanted.
[06:36] So it really is just more of a study showing what we wish we had done better. We only got about five in each arm. So there's nothing we can say about efficacy. But I designed the trial as a skeptic. I designed it to impress me because I feel like most of the effect that we're seeing is because it's open blind, open label. It's being used in people with really really refractory conditions who are really desperate for help. And I feel like it's the perfect setup for expectancy to be driving most of the effect and the actual drug effect to be very small. So the more that we can do expectancy blinding and sort of triple blind or even quadruple blind placebo controls, I think we'll get a little bit closer to what the drug's actually doing. So that's my background in it. Yeah. Yeah. Thanks a lot for that. I just wanted to mention because a lot of that resonates with stuff that we've been paying attention to and in particular I was just thinking when you mentioned the point about how we know this doesn't happen organically to a lot of people who are just you know taking
[07:36] Ketamine outside of this medical context of excitement and everything else. And just many people within the field, many of the boosters will respond to that kind of a statement and say, you know, it's because they didn't have our special sauce added to the mix. Like a lot of people, there is a split, I would say, between the people in the ketamine field who do just kind of give it and walk away and don't have a lot of intervention. It's more of like a normal pharmaceutical intervention. And then there's the more therapy side, much of which is based on pseudoscientific kind of principles. But people on that side of the field will say the reason that people are not just taking MDMA or taking ketamine and getting better organically when they're outside of this context is because our context is what is adding to this these beneficial outcomes.
[08:29] But I think the answer to that is what you were just saying that there's a all of the mechanisms and heristics that cognitive biases that we know of that go into producing placebo effects are operative in these kinds of context when you have true believer researchers who are kind of at the reigns. Yeah, absolutely. And the truth is that like we've done this before. You know, I know that there's many people here that care a lot about the ethics involved in psychedelic assisted therapies and these types of things, but the 70s and the late 60s and early 70s were rife with psychotherapists dropping acid with their clients and all sorts of things and all these N of three studies that were being published. And it was fraught with what we often call in sort of skepticism on therapy purple hat therapy where you know the person says hey look at this purple hat it's why everybody's getting better but what they're actually doing is providing a whole bunch of non-specific benefits holding and time
[09:31] With and time caring and real belief and trust and you can call me anytime and all this other stuff and then they're saying and we wore a purple hat. In this case it's and we gave them ketamine. And then the second problem of that statement is the reason that venture capitalists and big business are getting into ketamine is not because there's an expensive therapeutic procedure to tie to it. They're hoping that they can just have something that people will use as a pill and walk away. Like they're not like this is not shaping in the direction of ketamine assisted psychotherapy. This is shaping in the direction of even if a study showed that ketamine assoc or a psychedelic associated psychotherapy caused benefit what would be sold is a McDonald's version of that where it's come to the clinic sniff your spado or take your hit of acid or whatever it is and then go home and you're cured.
[10:22] That's the direction that it's going to go even if the therapy is the most important part. Yeah. I've started referring to that as strip mall psychedelia like ketamine clinics pop up on billboards and in your local strip malls and the venture capitalists are flooding to this space you know everybody talks about big pharma and this is you know that tweet that I gave about the maja thing it's this ironic thing like everybody was making such a big deal about cardiac toxicity on on vaccines and yet I is a known and in Italy in the studies on ibeigane that have been done there have been deaths due to cardiotoxicity and yet it's this hyped amazing thing and it's going to be the same thing with quote unquote big pharma. I mean big psychedelic is here. Natural treatments and perceived natural treatments are about six or seven times the market of big pharma.
[11:13] And so the financial ties to even some of these studies are deeper than what we've even seen in you know my realm you know with psycho psychiatry and SSRIs and that type of thing. And the other direction that some of those venture capitalists are going beyond just you know the no therapy model is the AI therapy option as an alternative that you know you don't have to deal with the labor costs of humans providing actual therapy and instead kind of charting this future where they control the large language models and they're controlling the yeah the AI therapy that they want to give to people. So, it's had even considered that. That is very scary, very dystopian kind of threads that are [laughter] coming together and what they're kind of building out and envisioning here.
[12:00] One of the people we highlight in our report, the psychedelic syndicate, Steve Jervson, he's a SpaceX board member. His wife is a board member of the psychedelic science funders collaborative, which is one of the biggest funders of these trials in the space and of some of the nonprofits and advocacy groups in the psychedelic space. Steve Jervson has gone on record saying that's how he sees the future of psychedelic therapy is is AI therapists that'll do a better job than a regular humans and humans might be staffed without degrees who can be there as a stop gap if someone tries to like leave the room or something like that. That sounds like a venture capitalist dream. One of the things that you mentioned about the big pharma is psychedelics. That's something I think that's another tweet that we've seen from you in the past of this kind of misunderstanding that big pharma doesn't want psychedelics to happen or something like that or this myth that they're trying to prevent this from becoming a thing or else SSR what
[13:01] Are SSRI going to be worth or anything like that and that's a like dichotomy we've been struggling with in our coverage for a long time is people saying oh you must just be big pharma funded big pharma doesn't want this to happen all of these kind of sentiment And it's you know it's at the same time that you're reading about you know we there you know Eli Lily puts out a gene therapy that might you know cure a disease or they you know they found a new way to stop pancreatic cancer and it's this weird conspiracy belief about pharma that we don't want people to get better we want them to continue to be sick and it's the weirdest conspiracy ever because we continue to create new human beings every day like a true person who's looking at you could cure everybody and there'll be a new group of 60-year-olds next year.
[13:48] I mean, that's the way human beings work. And so, this idea that we have this incentive to keep people sick. The worry I have about psychedelic research and psychedelic use is almost everything you could say about SSRIs is true for psychedelics that we can see so far, except it's less studied. So, it looks like you need to continue to take them at some frequency. It looks like there are side effects that we need to be concerned about. It looks like some people can have a really hard time stopping them. Some people can have really bad experiences with them and get really really worse. At some point, I imagine if the FDA gets involved, there'll be a blackbox warning on on psychedelics. And yet we're doing this all before the science has shown the true benefit. And that's it's so ironic that, you know, we have SSRIs, which are boring.
[14:38] Most people who take SSRIs, I always tell my patients, expect to be bored. The first four weeks are boring. This the effects are often very subtle. And it's not until six or eight weeks that we can really ask, does it make you feel better? And it's just the opposite of what people are trying to sell, which is this one pill that you take and then instantly you're better. But then you read the fine details and it's like they're not planning on people just taking it once. They're planning on people taking it for a long time like micro doing strategies and ongoing dosing strategies and things like that. Absolutely. And regarding kind of the current research in psychedelics, I think one of the topics we wanted to transition into was a couple of specific recent pieces of research. Mike, I don't know if you had any you wanted to discuss up top. I know the most recent one was kind of regarding this N of one study with like elderly woman with Alzheimer's.
[15:30] You've got Brian Johnson tweeting about this, saying it's biblical and all of these people sort of hyping up this recent publication. How this came to me was our colleague NorMe just sent kind of this nondescript account. They just said like, "Can you believe it? This is like cures Alzheimer's, right?" And it's like, "Okay." So I looked at it and I'm like, "This is actually kind of interesting if I had this hunch, you know, that like okay, you know, it's a neuro Alzheimer's a neurodeenerative disorder. Maybe there's something there with neuroplasticity and all this stuff." So this tweet that we the tweet that has been sent to us by Normmy has this like AI infographic about like the timeline of how the psilocybin goes you know into this person with Alzheimer's the things that it changes and she comes out like better right so I kind of dug in to find the real paper which took a while actually once I finally got to the study link you know at first I was like this is this could be interesting you know but first thing is it's n equals one there was one person
[16:32] It's observational case study that they're very clear about and I kind of read papers like outside to in. So the first thing I do is I look at the abstract then I kind of look at the like funding declarations and the conflicts of interest look for the limitations. So some immediate green flags to me which is not typical for like psychedelic studies are that they're like obsessively stating the limitations like okay this is N of one. This is you know only one person this is just an observational study and so forth. Then I look at the conflict of interest. no conflicts of interest, no funding declaration whatsoever. Then I look at the ethical statement and it's a little bit weird. It says like no ethical statement needed or something like that. We can look at the paper, but it was like vaguely like I was like, "Okay, whatever. If you say so." And then when we kind of look into the, you know, actual paper, the first thing I kind of noticed after these flags was they're not actually measuring subjective effects at all, which is very common for psychedelic papers, right?
[17:28] Like normally they're trying to figure out depression changes and mds and all that but there was no subjective effects because this person wasn't really in a place to be commenting on their subjective effects due to the nature of the condition right so it's 100% objective so I'm like that's exciting you know we can actually see a paper that somebody's it's an observational study but they're actually not doing anything like they're giving five grams of enigma mushrooms to you octogenarian with Alzheimer's and then she falls asleep for like 19 hours and while she's asleep for these 19 hours, they're measuring like her heart rate and they're noticing distress. They're seeing that she's kind of, you know, her heart rate's going up, sweating, that kind of thing.
[18:14] I don't know if sweating is actually in the paper, but the paper is showing that there's like distressing signals. It's okay though, right? Like they're not intervening in any way. And then they're not but they're not really measuring anything else. So when you look into the paper, there's like this chart about like the things that have happened. And so one of the things was like she said she asked where somebody is like that was a result of this like after the 19 hours sleep she woke up and she asked where somebody was. And so this is like this huge improvement, right, from somebody that has Alzheimer's that isn't typically talking, I guess. And then they noticed that her inconcontinence has improved. So, she wasn't peeing herself as often apparently, but there's not a lot of like data in terms of like how often was it before and how often is it now? And then I started digging into the authors and like the institution that that provided the paper.
[19:07] And so, they say it's this medical department of an association of the crews of the enh the cross of the enh paulo, Brazil. So, I like dug in. I was like, what is this place? They're on the Brazilian registry as a church, a philosophical organization, church/filosophical organization in the Brazilian registry with no medical department associated, no reported revenue. And it was created one year ago. There's zero public footprint on this institution at all other than that registered church in this in the Brazilian registry. And so like I said, you know, I was going through this thing like, okay, this could be interesting. You know, it's a little bit different than most psychical papers. Now it's kind of getting weird.
[19:53] And then upon closer inspection, it seemed to me, and I said this in the group chat, that it looks like a caretaker gave permission to a madeup new age religious legal entity in Brazil to give a frail woman in her 80s a heroic dose of mushrooms. They observed acute but expected dangerous symptoms and then noticed that she peed herself less often and maybe talked a little bit more for a while. So then they gave her more and then we're supposed to take their word for it that she's just still doing better than before and then from here published it under neuropharmacology. Can I just pull up and read this acute phase real quick because you did a good job of breaking it down but I want to make sure we get the actual here. So it's this section here and it says the acute phase of the first section was characterized by clinically suspected hyperothermia, profuse sweating, profound silence.
[20:47] Yeah, it's like a sleeping right and a prolonged deep sleep like state. I My favorite is the next word, the next sentence though. Exact quantitative temperature measurements were not available. I They didn't even measure it. [laughter] They had a hand on the forehead. It's the easiest measurement in the world to get is temperature. It's like that to me that was like the biggest red flag was reading that exact quantitative measurements on temperature were not available. I did want to point out do and people recognize what they're describing there with sweating, sleeping, hyperothermia. Like they're reporting a near miss death of serotonin syndrome I suspect and they're purporting it as a success. I mean that that is classic serotonin syndrome that they're describing right there. a quick change in level of consciousness, hyper hyperothermia, and a change in sweating and autonomic abnormalities.
[21:42] That's I mean that's serotonin syndrome. That lady could have died and they're reporting their near miss as a success. It's quite something. That's this article on the day that I that it was released had 15,000 views already in Frontiers and like then I'm like this is so sad. Like what are the comment? Now I go into the Twitter comments and I'm like these people are just going to everyone's going to assume that okay we need to give psilocybin mushrooms to our demented you know parents that are like on their way out and maybe they can come back and chat with me again. And so then we looked at the tweets and I think James, you have that one. Yeah. Synergy. I go game with psilocybin. Like they're go they're shooting into this like really dangerous frame of thought.
[22:29] Yeah. Like you see these really desperate people saying synergy I gain with psilocybin and then asking Grock for its opinion on all of this. Yeah. I mean that's dystopian. But I mean five grams I don't know this particular strain but this sounds like quite a dose. and her reaction is exactly what we would expect for serotonin syndrome. This lady needed to be in an ER and actually getting her quantitative temperature measured and she was in some hospice somewhere almost dying and then they're reporting it as a success. It's the scariest report I've seen, especially the way it's being carried as from this one end of one report, there are going to be many people who want to use psilocybin in their demented grandmother or grandfather and that's really really sad.
[23:17] I was going to say I just feel like it's also odd that like a lot of the like things that they highlight happening happen 19 hours after administration. Like there's this line in here that is approximately 19 hours after administration, the patient spontaneously initiated autobiographical conversation lasting several hours. During the second session, the patient remained significantly more verbally expressive throughout the experience and described emotionally positive imagery involving surfing with her son on a peaceful island. I just feel like it's I don't know. Feels odd to me that it would be like 19 hours later and it doesn't seem like they dug into that at all. They just assumed that it was definitely psilocybin related. I don't know that just Well, and correct me if I'm wrong, Tyler.
[24:04] You're the doctor. I But like Alzheimer's is a First of all, they actually also didn't say that they confirmed Alzheimer's with this woman. They just said that there that she's dement has dementia and is like presumably, you know, an Alzheimer's case. But in this kind these kind of diseases are transient anyway. like they people come, you know, they talk and you know, if we're dealing with something akin to a delirium or they're feeling a little bit better or they were feeling worse before, like, you know, the big problem with this is there's no real clinical description aside from a few small sentences about what she was like before. or you would expect in a case report to have a lot more detail and you would certainly want some sort of imaging to make sure that this wasn't vascular dementia or some kind of mixed dementia or something else like how they knew it was Alzheimer's like even the establishment of Alzheimer's like what was the course of her dementia and how did it come about is missing from this it's not written like a case report at all
[25:04] Case reports contain important information but they usually contain enough information for you as a clinician to read it and understand the patient. I know the treatment and I know what happened. They're never evidence of anything. But this you don't even understand the patient very well. You just have a description of how much they're better. Yeah. So it's quite weird. Very weird case. Yeah. And just to make sure that we're like representing their conclusion correctly that they are concluding that residual functional capacity may persist in advanced Alzheimer's disease and can become transiently accessible following psilocybin induced modulation of largecale brain networks. Systemic investigation is warranted. So they're suggesting that all of the functionality that has kind of left within an Alzheimer's patient, like the degeneration of their disease is actually secretly there and potentially transiently accessible through psilocybin, which yeah, there's no reason to think that's the case.
[26:04] In fact, pretty much everything we know about the way that the brain is attacked in Alzheimer's disease is the loss of things that don't come back. You know, there's no like definitely, you know, and anyone who's worked with people with dementia knows that people have good weeks and bad weeks and good months and bad months and it's not a linear decline, but you know, you can do an autopsy on an Alzheimer's brain and this isn't just, you know, they weren't accessing their great brain. Their brain is being absolutely destroyed. Yeah. And it's really really sad to see this happen. and worse it, you know, like you said, this is an uncontrolled anecdote from a non-academic clinic. No scans whatsoever, no scales, not even measuring the fever, like how high did the fever get would be nice to know.
[26:50] And then probably serotonin syndrome reported as a success, you know, this was really dangerous what they did. And as a quick postcript, we wanted to make sure to come in and highlight this tweet a little bit more because we brought it up but didn't quite get to talk about it enough. So, I'm going to go ahead and throw it on screen. It's this Brian Johnson tweet here where he says that this study is biblical. A woman in her 80s, 10 years into Alzheimer's, hadn't spoken a full sentence in 5 years, takes one 5 g dose of psilocybin. She slept 19 hours and woke up and spoke for hours about her life. She recognized family and held real conversations, regained bladder control after 5 years, walked on her own and dressed herself. Gains held for weeks. Do they even actually say that she hadn't spoken a full sentence in five years in the study?
[27:39] We can look at the background in this. During the preceding 5 years, verbal output beca became predominantly monosyic. Predominantly monoselabic. That's like that's very different. That's very different. accompanied by severe reduction in spontaneous interaction, chronic urinary incontinence, executive dysfunction, impaired mobility, dysphasia, and marked dependent marketked dependence on activities of daily living. So, it also doesn't explicitly say that she wasn't able to walk on her own ever or dress herself ever. It just said that she had less ability to do such, right? Like it seems like what he's saying is this is a zero to one. like he she went from completely incapable, incapacitated to suddenly able to do all these new things, which is not how it's even presented in this case presentation.
[28:30] Yeah. As far as I can tell, I believe this is the only like real background information like maybe this the diagnosis of advanced Alzheimer's disease had been established approximately 10 years prior clinically but somewhere in there they said that yeah although the clinical course was considered most consistent with advanced Alzheimer's disease formal biioarker confirmation and advanced imaging were not available in the present real world setting. So they don't know you know. Yeah. Yeah. and that the vascular dementia is an alternative. That's what Tyler had mentioned. So, it's like I have a grandmother who, you know, at first I thought she had Alzheimer's, but then had the scans done it was vascular dementia. It was kind of triggered by a COVID infection.
[29:16] So, it's like that happens all the time that like something is assumed to be Alzheimer's and it's not actually. I think some of the boosters would say it's transdiagnostic, you know, like they would say it doesn't need to be Alzheimer's. It's good for it all. You know, all forms of dementia can be addressed with this neuroplasticity boosting substance. But I did also just want to emphasize like, you know, who Brian Johnson is because without the context, it's not as clear why this is being mobilized in the way that it is. And so, he is someone who's really been pushing this psilocybin for longevity and psychedelics broadly for longevity. And he's also mentioned like in the Shayla Loves Guardian article that also quoted me, he mentions that like part of his goal in this new influencer kind of mode that he's in is to in his words teach people to yearn for the sea of like believing in his vision of like transhumanist kind of longevity future.
[30:13] And so this is becoming like another rhetorical marketing chip for this broader Silicon Valley kind of like hype mission that these guys are on. Right. I want to note something else on there. Like he says that the effects persisted for weeks, but if I'm not mistaken, they gave her more. It wasn't like this one five gram dose did everything and for weeks later it was better. They did do two doses. So the second one was after a month using three grams and associated with greater verbal expressivity, improved facial mimicry, spontaneous humor, emotionally balanced autobiographical imagery, and increased agility while walking. The patient spontaneously stated, "It is pleasant to come here."
[31:01] I feel like this is the type of description that would be published, you know, with the MK Ultra funded, you know, you and Cameron, you know, psychic driving depattering, like they would describe people with in the same type of way after that research and with, you know, in retrospect, we realized like, oh, it's because they had this enthusiastic frame that they were filtering things through that they're seeing things in a very positive light. All right, cool. Let's go ahead and get back into it. you know the fact that there in that study the you know positives were kind of de facto attributed to the intervention of the psilocybin mushrooms that's very common for psychedelics and then the filter of people who are on the more booster side of the field is also to view negative symptoms adverse effects as you know signs that it's working essentially that I think that's what we saw here that it's you know instead of seeing it as this person could be having a potentially fatal reaction and responding appropriately.
[32:03] It's viewing that as the medicine is working. And that connects to a broader talking point in the field that views psychedelics in terms of the challenging trip. The adverse effects are actually how the process works. And so the talking point is bad trips are the best trips that you actually want to have this distressing difficult experience because it's going through that process that allows you to gain the insight. So we have a clip here queued up that we can run and then we can chat about it. At Double Blind and in the psychedelic community at large, we generally don't like to use the word bad trip because we like to demystify the notion that as long as you've prepared your set and setting properly that there is such a thing as a bad trip.
[32:49] Sure, trips can be challenging. Things that are uncomfortable can surface or emerge. But you know, psychedelics, the word psychedelic etmologically actually means mind manifesting. And you don't do a psychedelic to run away from what's inside of you. You do a psychedelic so you can work through it and process it and come out the other side. For more information, check out doubleblindmag.com. The best thing that can happen is to think that you're going to die. There's no such thing as a bad trip any more than there's a bad meal or a bad relationship or a bad day. It's the difficult ones that are often the best. Those are the ones that really teach you something. But I think even these bad trips, although they can be difficult, are beneficial and are a learning experience in the same way that a bad meal could be.
[33:35] You'd learn not to go to that restaurant. You know, if you are approaching life from a nonfearful perspective where your intention is to learn, then you can extract benefit from almost any experience. Tyler, is that a concept that you have experienced or heard in this space at all come up? Any thoughts about it? You know, it reminds me it's one of those folksy things that creates an unfalsifiability. Basically, if you had no bad trip and it worked for you, great. If you had a bad trip and it didn't work for you, that's what you need to go through. It basically creates everything to be a win for psychedelics. It's unfalsifiable, you know? It's it reminds me of like no pain no gain or these types of statements that there's like a truthiness behind it but the reality is like generally when you're working out if something hurts you should stop doing it you know like no pain no gain is actually pretty bad advice in the same way bad trips you know I don't have a ton of clinical experience using you know with patients who use therapeutics psilocybin sin but
[34:36] Boy do I have experience with bad trips these people end up seriously hurt in hospitals or extremely ly psychotic really really in distress in a way that prompts us to do really [laughter] really dire things. So So painting a bad trip in such a positive way is like to me it's like when I saw that that I was actually pretty disgusted by it. I really don't like that framing at all. And how does that come up in the broader research sphere nay? I know you've mentioned and reported on some of the places that's come up from like the South by Southwest and some of the places it's come up in the actual clinical data or lack thereof in the MAPS trials. Yeah. Well, so we had, you know, in 2024, some of us had presented to the FDA's advisory committee that was considering the MDMA assisted therapy, new drug application with concerns about the quality of the research based on working
[35:38] In the field for a long time, talking to whistleblowers both at the company and clinical trial participants, people who worked on the clinical trials. And as part of that, there was a lot of very concerning and contradictory discourse around the potential for MDMA to induce or kind of exacerbate experiences of suicidality. I when I was at the South by Southwest mention was I had this was back was it I think it was like March 2024 that that occurred where I heard Rick Doblin who was the founder of MAPS talking about the fact that increase increases in suicidality only occurred in the placebo group but then on a different stage at the same conference there was Amy Emerson who was the CEO at the time of MAPS PBC the pharmaceutical wing that was overseeing the trials And she said that they needed to teach the medical establishment that suicidality is just part of the process
[36:38] Of MDMA assisted therapy that it emerges as part of this you know healing journey that people can go on. And the FDA, we had reported to the FDA, shared with the FDA that there were accounts of increased suicidality in the MDMA dosing groups that were not reported to the FDA or publicly. And the after there was an investigation, the FDA also corroborated that there were they had found unreported adverse events. So, and I guess the last thing I wanted to mention about this is that even the way that the researchers who were working on the trials talked about the reporting of suicidality and what was required of them did not match what the protocol said. So they said at conferences and online speaking to the media that they only needed to report increases in suicidality above baseline, but the actual protocol said that that would be an adverse event of special interest, but that all suicidality at a
[37:40] Four or five on the Columbia scale that they were using needed to be reported, which is did not align with what they were saying. And part of what we had, you know, I had discovered in my kind of ethics research looking into this is that when you frame suicidality as a therapeutic transient mode that is leading to this healing journey, the researchers are not well equipped, like in this case with the supposed Alzheimer's case study, they're not equipped to see and respond to adverse events as potentially problematic because they have this framing. So, just I was curious if you have any thoughts on any of that. Yeah, I mean I always say like if you're a computer and you your automatic response to suicidality is everything will be okay, you'll be right 99.98% of the time.
[38:32] I mean, the way that suicide works in its absolute baseline rates is that you know 10 in 100,000 die of suicide. If you want to give someone 10 times the risk, let's make it 100 in 100,000. So you can be really wrong in your approach and get good feedback. The reason that you know this is so distressing you know hearing about that and also you know the way that they hid suicidality in that way but also things like addiction like people who had you know actually turned to ketamine recreationally afterwards and not reporting that as a side effect. But it just goes to this larger thing that if you're if you if you're not wellversed in the thing that you're sort of proclaiming to be a side effect, like in this case, you had the, you know, the Alzheimer's people were, you know, missing serotonin syndrome.
[39:18] The danger of suicidality is not that every time someone's suicidal, they're going to die. It's you're increasing the chance of that person dying, but the absolute risk is low. So, you know, I always try and remind people that, you know, if you have a study of 40 and they all did something that made them hundred times more likely to die by suicide, you're very unlikely to get a suicide in that study of 40. That's just the baseline rates of suicide. So, you could do something that was a hundred times worse than doing the other thing and you still wouldn't show a suicide in your group. So, this is why suicidality is such an important measure. And more importantly, that double framing of suicidality is part of the cure is is this unfalsifiable. There is no side effect.
[40:04] It's all effect, which is the talk of a zealot. That's not the talk of a scientist. Yeah, definitely. And I just wanted to chime in on that point you made about how sometimes, you know, people would turn to other drugs after, you know, MDMA, potentially going to ketamine. In our kind of research in the field, we had there were there there were actually we learned that there were actually researchers involved in the study that would refer people to other drugs after. And kind of the idea was that if people who were getting worse after the trial, it was because this healing process that was unfolding hadn't fully worked out. And so they were specifically referring people to, you know, help it move out. you just have to jiggle it out and help the process to complete by taking 5 Modo DMT, ketamine, psilocybin.
[40:56] And that model is the underground model that the trials were based on where it's not just about MDMA. It's this idea that we have all these different psychedelics that can help to dislodge this process that will kind of purify people by purging the trauma from their bodies. Yeah. Yeah. And it's really sad. It's not surprising. Like I've always taken the position that anything that comes out of maps is going to have to be replicated anyway. So I don't really care what maps says because as you know when you go to the conferences or you hear these people, these are true believers. They will never admit that psilocybin doesn't work. They will never admit that ketamine doesn't work. There's no value to their research. And I've said this to them publicly. Like I said, I don't even know why you bother because any real scientist is going to look at everything you publish and say, "Wait for the replication."
[41:48] Of course, that's not and the FDA, I think, rightly is aware of that, too, because the FDA was pretty trouncing in its rejection of MDMA for PTSD. I think it was like 10 to1 or something. So like I think the FDA is on to it as well. I mean, you'd think so, but there's a lot of intensive lobbying happening currently where, you know, some of the whistleblower accounts that we help to submit to the FDA that is are still not public are so concerning and are still not known to the public. And there's a lot of now people that work within the FDA who are kind of promoting the party line of this kind of hype boosterism rhetoric. And so we have a lot of questions and it's part of why we even kind of relaunched this podcast is like we don't necessarily trust that this is going to be look looked into as carefully as it deserves before it is open to the public.
[42:46] And so the public at least has a right to know that there are problems with the research that we should be cautious about some of the headline data and the kind of the talking points that we're seeing in the media. and that's in part from you talking firsthand as well to people who have been very harmed in some of these trials and have and to know that their stories are still not part of that public narrative. Yeah. Yeah. So, just on the topic of suicidality and like psychedelics is a cure for depression and like therefore you know suicidality suicidal thoughts and so forth. There's a lot of research going into obviously psychedelics as kind of a cure for this type of thinking and these kind of disorders and there's a particular paper that has gotten a lot of hype around it by Kubala at all I think is how you pronounce it and it's about inhaled fotin which is a patented GH001 is what they call it.
[43:40] The conflict of interest statement is as long as the paper. I'm exaggerating a little bit but it's you know a tie and Beckley and everybody there. And what they're saying is that it the inhaled UFO reduced depression severity by 15.5 points more than placebo with over half of patients achieving remission versus 0% in the placebo group. So in fact the placebo group got more depressed. So the and there's the blinding situation is kind of absurd here where I think it was like 90 plus% of the therapists guessed I mean if not 100% you know that they were on the buffo and then you know we're talking about placebo collapse like it's like double unblinding right functional unblinding where the those that knew that they weren't getting the treatment became more depressed.
[44:34] Not only that, but they were claiming that the theoret that the depression score improvement was beyond the theoretical maximum of a depressive of a anti-depressant. So, I mean, and then it was hyped up like crazy. You know, Robin Carheart Harris had this whole Twitter storm for days about people kind of like picking apart the study and, you know, all sorts of defense about this. But that's I think the issue here is that there's these scientific papers that are coming out that are like trying to corroborate the hype about how this is a cure. This is a cure for depression. This is better than any possible cure for depression even. Yeah. And one of the major points in this space is like marketing specifically veteran suicide but any kind of suicidality and depression and vulnerable people are the face of the advertising and marketing of this industry.
[45:29] And I think in a broad view, I was curious to just hear your thoughts on on when a new industry, especially a not particularly proven or like fully evidence-based industry, is using these kinds of populations as the face of their marketing. Yeah. I mean, a it's you know, my when I think of PTSD that happens in the military, I don't think about the type of PTSD that I generally see in my clinic, you know, with kids, you know, and some of that has to do with, you know, the actual in extent of the trauma, you know, there was there have been good studies showing that, you know, being in the military is increases suicide risk regardless of whether or not you're deployed. like you know you get sent or you don't get sent.
[46:18] After you're discharged, your risk of suicide increases and it's almost the to me it feels like it's a destabilization of going from the military environment to the civilian environment, the sort of cultural shift. But veterans are such a strong political wedge. It's great you have a VA in the United States that has the ability to conduct these really large investigations and things like that. So sometimes there's some great data that comes out of veteran studies, but it does feel a little bit like veterans are being used sort of as a token of serious suicidality or something and then the research the sorry the evidence bar just seems so much lower for psychedelics than it would be for any other intervention. And I you know part of that is the funding structure, part of that is the narrative.
[47:06] You certainly have an administration right now in the United States that's going to be a little bit more sympathetic and excited about psychedelics. Although I think their conservative streak might take over at some point. I don't know. But it's, you know, it's a frustrating thing to see politically vulnerable groups who are subjected to higher rates of homelessness, higher rates of work workforce integration problems. Just like with my patient population with kids, it's almost like they don't really care about the person. They care about the thing that they're talking about. Like the antivaxer doesn't really care about kids. They care about not getting vaccines. And in the same way, it feels like there's a bit of a tokenization of veterans to try and advance psychedelic research.
[47:52] And yeah, that's an intentional strategy as because we our psychoic syndicate report we analyzed a lot of plans from the funders that were kind of saying that explicitly. It was a not an accident that this was this group was chosen. And just as last point of the patient population you work with, I just want to mention that there is a huge coordinated push right now to you know get trials of psychedelics with adolescence out and really really targeting that population which I have a lot of concerns about given the science. The whole reason that I did this myself and my colleague Dr. Don we did this triple blinded trial of ketamine is because we were wanting to do the science after it was being used.
[48:39] I had heard of clinics in the United States giving ketamine and inhaled esetamine to adolescence. And so here I am trying to do play catch-up science to something that's already being done. And there's lots of reasons to think that we should be even more cautious with adolescence than we should be with adults because of the way that our brains change over time. So I'm generally pretty okay with an adult using cannabis. Like as long as they're not overusing it and using it as a crutch for everything in their life, I don't get pretty anti-cannabis. But I'm pretty, you know, hey, you shouldn't be doing that to kids because we have good evidence that for kids the psychosis risk is pretty high. And so we should actually be more cautious about approaching kids, not this is exciting, it works in adults, let's try it in kids, which is how we often do child nlescent psychiatry.
[49:35] Some new drug gets approved in adults and then some brave child adolescent psychiatrist tries it in kids before the evidence gets there. And I always try and point out like there are so many SSRIs that look great for adults or what we call great a lot of people may say the great but you know the effect sizes that we see for anti-depressants become minuscule for child and adolescence and there's only one or two drugs that are approved for depression in kids because of that. So treating adolescence as just a new population that's rife for work is kind of backwards. we really need to do good research on adolescence and you can do somewhat better research because they're supervised human beings. They have parents around them. So you can do better research. It just has to be done before the therapy.
[50:21] But I honestly feel very nihilistic about that. I think the cart has left the barn on that one. I don't think we're getting it back. Unfortunately, there's too many people excited about using ketamine and psilocybin. Yeah. Yeah, I just the way that the field has responded to us as kind of using this veteran suicide idea is a cudgel to scapegoat us and blame us for raising very reasonable questions that are grounded in the history of research on pseudocience and the risks of you know due confidence in novel interventions. It just doesn't signal that the field is in a great place to responsibly handle this move into more adolescent side research. So, I wish, you know, I wish people would understand the history of psychedelics more because this was a thing that already happened.
[51:10] We went through this before and it was it wasn't shut down because of this like horrible, you know, well, there was a little bit of a drugs or bad thing going with it, but it was also universities and employers firing their employees because of the awful things they were doing. you know, it was rife with abuse and to see this happen without a lot of guard rails, it's really scary in 2026. Yeah. Well, we really appreciate you coming on and kind of helping to extend advance this sort of side of the conversation because I do think that a lot of people want a more nuanced perspective on psychedelics. And as a parting line, I just I had been listening to your excellent interview with the White Hatter podcast on on on video games and you mentioned there this quote about it's not the it's not about the technology causing the harms, it's the it's how you use it.
[52:03] And I think the psychedelic field is the same is that there's not they're not inherently good or inherently harmful, but we have to pay attention to this the context of the research and the hype and this kind of state of capitalism. We know for sure it's powerful pharmarmacology and it might have good uses but it might you know have a lot of side effects too and you know it's exciting as a pharmarmacologist to explore new things. We don't get a lot of new things in neuroscychiatry but we have to do it with caution and we have to really respect that these are you know these are really life-changing drugs but that doesn't always mean good. Yeah. Thanks so much for sharing your expertise with us this whole time. Really appreciate it. One big push we've hoped to bring to the space is voices from outside the general like psychedelic millu into these conversations.
[52:56] Such a club. Like I'm hearing about all these things that you're hearing and I wish the public knew how much of a network it was. Like it's a group of in people that are pushing each other forward. It's very much like a Silicon Valley thing where it's a whole bunch of people telling each other what a good idea it is. Yeah, very much so. But if you were to listen to the conversations actually happening, you'd be like, "Whoa, do you really want to say that in public?" Yeah. Well, as we wrap here, is there anywhere that you would like people to go to find more of your work, follow you, support what you do? Yeah. I mean I would say like anyone in the psychedelic space you know we published our findings of our very small and not successful trial that we weren't able to get enough users for but we did learn a lot for example you know so if you look up black dome psychedel or ketamine triple blinded you'll find our study it was just published about it wasn't very long ago that it was just published it was just accepted but we hit a lot of snags that I think people you know when
[53:57] When I'm not a maps person and I'm not like super into it and I don't have all these things. Getting the nursing time to do it properly because people need to be observed. Making sure that the you're doing proper ascent and consent. So you have adolescents who need ascent because they can't consent. And then you need parents to also consent but we have kids that are mature minors that might be able to consent. Like there was a whole bunch of things we ran into. And a whole bunch of people when offered said no, I don't want to try this. and they were presenting with suicidal crisis and we said, you know, we're investigating a drug that might be used and there was a number of people that said no. So whenever I see research and it's like we recruited 12 people, I'm like, yeah, but you went through like 900 to do it [laughter] like that's, you know, so so it was a real like it was two and a half years of approaching lots of people in the emergency department with suicidality and we got a very low number.
[54:50] So, I it made me even more skeptical about some of the research that I'm seeing, knowing what goes on behind the scenes for this. Wow. Yeah. Thanks for sharing that. We can share in the show notes, too, right to our to the episodes. People can Absolutely. People can find me on Twitter. I'm still there. I don't recommend anyone join Twitter to find me. But if you want to reach out to me, it's either on Twitter or my email address is just dr.tatterblack@gmail.com. And I'm happy to take emails and questions and stuff like that. You're a bright spot in the hell site, even if it's a kind of depressing subject matter sometimes. [laughter] Yeah. Thank you. 100% less Nazi than you're used to on Twitter. Yeah, that's true. Thank you so much. It was really wonderful to meet and chat with you and hopefully we can stay in touch as things come up down the line and just stay in communication about some of this stuff.
[55:40] Yeah. Yeah. Thanks so much.
