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Yeah that’s exactly the problem but you can’t just be like “sorry fda, the data is very suspect because the subjects knew they were being treated or not but pass us anyway pretty plz”
Especially so when the drug in question is fairly controversial and (at least in the case of mdma) there are also other major problems with the trials that cause the whole thing to be suspect.
I frankly think all drugs should be decriminalized and if you want to fuck with psychedelics go for it (assuming you’ve researched the risks and ideally spoken to some kind of physician who knows you that you trust that can let you know if it’s a terrible idea, especially if you’re on a bunch of medication already). You’re going to do it anyway. There is some interesting neurological research to support their use.
But there’s also no getting around the fact that users anticipate a strong positive effect, see that positive effect, and that positive effect wears off relatively quickly (which may strengthen the idea that a placebo effect is at play). Further, aside from the posted study most of the lsd research supports it as an adjunct to psychotherapy, which is one of the places where mdma research was compromised.
The MAPS program for mdma clinical trials was appallingly bad to the point it seemed like it was designed to sabotage the effort: the most egregious example is two therapists who were a married couple were videotaped spooning and cuddling a client during an mdma session. That same client later accused one of the therapists of sexual assault in an incident outside of session. Outside of that there were independent reviews of videoed sessions that found several instances of therapists coaching clients, high on mdma, to report better outcomes. The issue here is that the MAPS program was made up of therapists who were dedicated to seeing MDMA (and other psychedelics) become legalized as clinical supports so their bias was visible and MAPS did not do nearly enough to train against this. Ideally therapists would have been impartial (and not sex pests)
That said one thing that is sometimes done here is “active placebo”, essentially microdosing. eg if they are testing the effects of 100um of lsd they may give the placebo group 10um (arbitrary numbers, I don’t know) to induce some kind of effect but not enough of one to create benefit. This was done in the Swiss studies on LSD for anxiety in cancer patients
Sorry, I haven't kept up with any studies. I gave up when everything in the US stayed Schedule I or got rekt under the Analogue Act, despite research from other countries showing promising results, which meant there would be no meaningful progress. It would just be more "drug war" nonsense.
I'm not familiar with the MDMA studies that you're referencing. I'd love a reference if you have one. Not doubting you or anything. Like I said: I just haven't kept up with it. If it's like you say, then that's wildly unethical. I can say from experience that MDMA makes people highly suggestible. I'm really not sure how you would design an ethical test environment, but I'm not a clinical psychologist. It surely isn't the only sober people in the room spooning and using overt suggestions though.
I agree that likely the only way to even begin to test some of these drugs, things like MDMA, LSD, mescaline, etc. Things that have obvious and profound effects that break the blind of testing is like you said: vary the dose. Easy to double blind something like blood pressure meds. You won't really notice if you're on the actual meds or not. You take a hit of X you will absolutely know you are on something. IDK. It takes a lot of people that are all a lot smarter than I am. It also takes the backing of the powers that be. Can it be done? Absolutely. Will it be done? I have my doubts. The drug war is very profitable for a lot of people.
Fair warning this article opens up with a still image from the therapy video. In the still image the patient is supposedly being restrained (by the person she was later cuddled and spooned and allegedly sexually assaulted by) but given the context it’s a bit creepy.
https://www.cbc.ca/news/canada/british-columbia/bc-mdma-therapy-videos-1.6400256
A longer form exploration is from what that article references (cover story by New York magazine). The link in the article is dead but it is still available:
https://www.psymposia.com/powertrip-2/
I can’t get the page to load on my phone so I don’t know which specific episode it is but there are a few. The general theme of the series is “there are people that think psychedelic assisted therapy is so important that they’re willing to overlook terrible things” and honestly the reality appears to be exactly that when it comes to MAPS. I don’t disagree with their mission at all but I very much disagree with rushing things immensely in a way that puts patients and the entire trial at risk because you are so desperate to see it through as soon as possible. The more I’ve read the more it appears they recruited only therapists primed for expectancy bias with little training to counter for this, not enough screening for risk, etc.
https://icer.org/wp-content/uploads/2024/03/PTSD_Draft-Report_For-Publication_03262024.pdf
_this was the first report that came out summarizing the MAPS (by then called lykos) trials and studies by an independent body. It’s lengthy but dives right into the issues. This came out a few months before the expected fda ruling
https://downloads.regulations.gov/FDA-2024-P-2148-0001/attachment_2.pdf
This is the citizens letter, given to the fda shortly after the above where a number of people outlined similar issues
https://www.nature.com/articles/s41591-023-02565-4
And the clinical trial itself, for reference
Thank you. I appreciate it. That you typed and linked all this on a phone is impressive, but I'm fucking old and I probably don't know how to phone XD.
I think what MAPS is doing is a worthy pursuit. I just think we need to have standards and competent medical professionals administering the studies. But here in
that's not possible (I know the linked study was carried out in Canada.) If these drugs are so illegal that they can't even be tested, then how are we supposed to test them? It just frustrates me to no end. I was born with severe clinical depression. It runs in my family. It's genetic. One of the most therapeutic things I can do is every year or so I tell everyone to fuck off and leave me alone, take a big hit of mushrooms, and just think about stuff... and things, and also stuff. Somehow that staves off the massive depression for a year or so. I haven't done a double-blind study. I just know that it's something I need to do every year or two so I don't destroy myself. For me it's just a survival mechanism.
I would love it if we could research things like this though. One dose every year or two. But of course we won't ever do that. We need you eating these pills every fucking day, and we need these pills to be extremely expensive. Your health and well-being is secondary to the bottom line. Selling cures is for chumps. We want you sick forever.
Therein lies the problem. I get it, we need novel treatments, and we need them yesterday. I work in the field and I have tons of people with treatment resistant mental health problems that I would love to cut loose to a novel treatment that actually works. It’s frustrating on both ends to just endlessly be stuck (though admittedly it’s worse for the person experiencing discord, obviously).
But that’s the real frustrating part of this. MAPS/lykos had a unique position to study this stuff and while they knew it was an uphill battle thanks to the legal status and perception of mdma they rushed, likely out of the perceived necessity of getting the treatment out to as many people as possible as soon as possible. I get that but you have to shove that fire down when you’re dealing with these kind of regulatory processes and do things meticulously. Because look where it got them. Now the perception is damaged a bit more and more importantly it will have to complete another stage 3 clinical trial which will take at least two more years to achieve approval. If the goal was to get approval asap this is obviously counter to that and likely pushes back other project timelines (lykos/maps is not just mdma but psychedelic assisted therapy research).