JAMES COYNE'S COLUMN

How Dare You Criticize Psychiatrists Who Praise Studies of Psychedelics As Antidepressants?

All claims about treatments affecting human health and well-being should be subject to robust review, especially extraordinary claims.

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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 entrepreneurinvestorauthor, 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.

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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.

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James Coynehttp://www.coyneoftherealm.com
James C. Coyne is Professor Emeritus of Psychology in Psychiatry at the University of Pennsylvania where he was Director of Behavioral Oncology at the Abramson Family Cancer Center and Senior Fellow, Leonard Davis Institute of Health Economics. He also was Professor of Health Psychology at the University of Groningen, the Netherlands, and has been on the faculties of University of Michigan School of Medicine and University of California, Berkeley. He received a BA in Psychology from Carnegie Mellon in 1969 and a Ph.D. in Clinical Psychology from Indiana University in 1975. Professor Coyne was the 2015 Carnegie Centenary Visiting Professor at the University of Stirling. He is the author of over 400 articles and chapters and has been designated one of the most influential psychologists of the second half of the twentieth century. His diverse interests have included clinical health psychology, mental health services research, and evaluation of depression screening and suicide prevention programs. As a blogger at Science-Based Medicine and Mind the Brain, Dr. Coyne is known for skeptical appraisals of advice gurus misleading consumers with hype and hokum. His activism with colleagues concerning undisclosed conflicts of interest has yielded dozens of corrections to published papers, a few retractions, and the Bill Silverman Prize from the Cochrane Collaboration.

1 COMMENT

  1. James, such an important article. I couldn’t agree more about the role of journalists in keeping these processes honest. The problem though often extends to the journalists, who cherry-pick data to support their publications viewpoints. Editors aren’t qualified to pick up on inaccurate scientific reporting, creating another break in the bullshit filter. You have to wonder how such a precise profession could have arrived at a process that is so easily skewed. There must be an alternative independent method of reviewing data that doesn’t allow for manipulation or misinterpretation? That’s where our focus should be right now. If Covid hasn’t taught us this lesson, we’ll never learn.

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JAMES COYNE, PHD

James C. Coyne is Professor Emeritus of Psychology in Psychiatry at University of Pennsylvania where he was Director of Behavioral Oncology at the Abramson Family Cancer Center and Senior Fellow, Leonard Davis Institute of Health Economics. He also was Professor of Health Psychology at University of Groningen, the Netherlands and has been on the faculties of University of Michigan School of Medicine and University of California, Berkeley. He received a BA in Psychology from Carnegie Mellon in 1969 and a PhD in Clinical Psychology from Indiana University in 1975.

Professor Coyne was the 2015 Carnegie Centenary Visiting Professor at the University of Stirling. He is the author of over 400 articles and chapters and has been designated one of the most influential psychologists of the second half of the twentieth century. His diverse interests have included clinical health psychology, mental health services research, and evaluation of depression screening and suicide prevention programs. As a blogger at Science-Based Medicine and Mind the Brain,

Dr. Coyne is known for skeptical appraisals of advice gurus misleading consumers with hype and hokum. His activism with colleagues concerning undisclosed conflicts of interest has yielded dozens of corrections to published papers, a few retractions, and the Bill Sliverman Prize from the Cochrane Collaboration.

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