There’s a common argument that psychedelic trials are invalid because they’re not truly double blind.
But If psychedelics work in part because people know they have taken psychedelics, they still work. And in the first instance that’s the important thing.
“But what if the fact that it’s partly caused by unblinding means there are less dramatic ways we could get the result with less risky side effects”—well find them! No one is stopping you, and the possibility of one day verifying less risky mechanisms for treatment isn’t a good argument against approval now. By all means fund these trials, they could be immensely useful, but again this is not a reason to delay effective treatments now.
Moreover, there are reasons to be sceptical of the whole unblinding/blinding framework in antidepressants. Consider the ideal anti-depressant, you take it and your depression is instantly cured. Of course such a drug will have abysmal blinding rates! Like running a double-blind study of parachutes and worrying that people knew their parachute had triggered.
I think this is related to a larger dynamic. There is, I think, an assumption in psychiatry that the ideal anxiety/depression has subtle effects. This is partly out of a fear of creating new drugs of abuse. But if we take mental health seriously, we should be willing to risk, where appropriate, dramatic effects. Human welfare matters, deep and pathological unhappiness is one of the worst of all possible conditions, and it is worth taking risks to prevent it.
I strongly suspect, partly on the basis of having worked in an osteoarthritis clinic, that there is a pervasive tendency in medicine to place far too little weight on pain as a source of moral and clinical urgency in comparison to function. During COVID we used a scale to evaluate whether or not we could still see people for physiotherapy. Almost all of the items were about function rather than pain. I suspect the bias towards the subtle is deeply linked with insufficient concern about hedonic tone.
I largely agree with this, but pure placebo drugs stop working as soon as the novelty wears off. Medicine wants to rule out placebos for this reason, not because there are “less dramatic ways we could get the result with less risky side effects”.
This is a special post for quick takes by philosophybear. Only they can create top-level comments.
The issue is that there is no article for others to “want to comment on the article”, the body of the shortform article is empty and should stay that way.
Placebo and pain
There’s a common argument that psychedelic trials are invalid because they’re not truly double blind.
But If psychedelics work in part because people know they have taken psychedelics, they still work. And in the first instance that’s the important thing.
“But what if the fact that it’s partly caused by unblinding means there are less dramatic ways we could get the result with less risky side effects”—well find them! No one is stopping you, and the possibility of one day verifying less risky mechanisms for treatment isn’t a good argument against approval now. By all means fund these trials, they could be immensely useful, but again this is not a reason to delay effective treatments now.
Moreover, there are reasons to be sceptical of the whole unblinding/blinding framework in antidepressants. Consider the ideal anti-depressant, you take it and your depression is instantly cured. Of course such a drug will have abysmal blinding rates! Like running a double-blind study of parachutes and worrying that people knew their parachute had triggered.
I think this is related to a larger dynamic. There is, I think, an assumption in psychiatry that the ideal anxiety/depression has subtle effects. This is partly out of a fear of creating new drugs of abuse. But if we take mental health seriously, we should be willing to risk, where appropriate, dramatic effects. Human welfare matters, deep and pathological unhappiness is one of the worst of all possible conditions, and it is worth taking risks to prevent it.
I strongly suspect, partly on the basis of having worked in an osteoarthritis clinic, that there is a pervasive tendency in medicine to place far too little weight on pain as a source of moral and clinical urgency in comparison to function. During COVID we used a scale to evaluate whether or not we could still see people for physiotherapy. Almost all of the items were about function rather than pain. I suspect the bias towards the subtle is deeply linked with insufficient concern about hedonic tone.
I largely agree with this, but pure placebo drugs stop working as soon as the novelty wears off. Medicine wants to rule out placebos for this reason, not because there are “less dramatic ways we could get the result with less risky side effects”.
Apparently only I can create top level comments, so here’s a comment to comment on if you want to comment on the article.
What do you mean? You don’t seem to be rate-limited or have other posting/commenting restrictions applied to you.
The shortform hint says
The issue is that there is no article for others to “want to comment on the article”, the body of the shortform article is empty and should stay that way.
Thanks for the clarification on how this works