Why do we need anyone criticizing claims about psychedelics as antidepressants?
Because all claims about treatments affecting human health and well-being should be subject to robust review. That review requires someone to facilitate criticism, locate qualified critics, and bring them into the discussion.
Authors want to be heard, praised, loved, paid handsomely, not criticized — even scientists.
That is why, as a counterbalance, scientific publications get peer reviewers involved to evaluate their claims.
Science journalism should be a key part of the independent, post-publication peer-review process. But how often have you seen journalists taking on that responsibility?
When it comes to psychedelics as treatments, the critics presumably, won’t be the only ones having a say. What they say can be disputed by the advocates of these drugs.
After all, there is an all too familiar situation across all of science, not just biomedicine or psychiatry: Initial claims about breakthroughs so often turn out exaggerated, premature, or simply false.
Ioannidis JP. Contradicted and initially stronger effects in highly cited clinical research. JAMA. 2005 Jul 13;294(2):218–28.
Having critics ready to point out that breakthrough findings might just not be what they seem can save time, resources, and maybe lives.
The critics come in with some advantage because of this strong past pattern of decline effects in science and biomedicine. Reliably critics have been met with resistance, often fierce because of what is at stake for advocates: prestige, reputation, and money.
Of course, critics, like advocates can prove biased or wrong, but it takes debate involving outsiders to decide that.
So, why do we have such wild enthusiasm and so little criticism of a recent RCT of psilocybin as an antidepressant in JAMA Psychiatry?
Or the past research cited to justify these studies?
Across peer-reviewed journals and the media we are witnessing an extraordinarily coordinated campaign for psychedelics as antidepressants that makes extraordinary claims:
The claim is that psychedelics administered in the context of relatively long term psychotherapy will have rapid, profound, and lasting effects on depression.
This campaign is funded and coordinated by advocates of the use of psychedelics for recreational and performance enhancers, not just as mental health treatments. The advocates include venture capitalists such as Tim Ferriss, one of the leading podcasters American entrepreneur, investor, author, and podcaster Tim Ferriss.
Where else do you see substances Pharma proposes as mental health treatment being discussed by leading psychiatrists as “expanding minds.” yet ‘advancing science’? Mental health professionals are letting their guard done, They are tolerating screaming conflicts of interest in a merging of the shouting of advertisements with the more, cautious, rigorous, skeptical talk of scientists.
I am not sure that is a good idea.
The unique claim for psychedelics as antidepressants is that they change the brain long-term, maybe permanently, yet they do absolutely no damage to the brain. Wherever have you seen such claims in psychiatry that did not have to be revised?
The claim is not being made that psychedelics can be shown to be effective antidepressants, but rather that psychedelics administered in the context of 8 months of psychotherapy can prove extraordinarily effective.
Skeptics who are accepted for their expertise in psychopharmacology may be hesitant to weigh in on matters requiring expertise in psychotherapy. They are concerned about being greeted with “Please don’t speak about things outside your expertise.”
Skeptics who are accepted for their expertise in psychotherapy may be hesitant to weigh in on matters requiring expertise in psychopharmacology for similar reasons.
Sure, experts in psychopharmacology may feel comfortable about combining evidence-based drug treatment with evidence-based psychotherapy, particularly when they have the advice of those who know more about psychotherapy research than they do. The assumption is that the effect might be not simply additive but interactive.
An analogous statement could be made for psychotherapy researchers needing to weigh in on combining evidence-based drug and therapy treatments.
So, who am I, the notorious CoyneoftheRealm, to try to stir the pot when so many others sniff the aroma and taste the success of a breakthrough treatment for depression?
Good question, but don’t ask me, I am biased.
Maybe you can decide that I can safely be ignored. All I can do in my defense is point out some serious flaws in the studies being discussed as clinical trials. I am trying to make the case as clearly and transparently as I can.
I don’t think any one person has all the expertise for a final word on whether psychedelics are great anti-depressants. We would seem to need breakthroughs, all the available antidepressants are not all that impressive.
There have been so many disappointments in past promising candidate drugs, that a lot of the smart money in Pharma has moved away from the search for new psychiatric drugs to cancer and cardiovascular disease.
Maybe I can make enough fuss so that experts with the full range of needed expertise step in and talk to each other. And I would be pleased if they showed me my skepticism was misplaced.