back to indexMatthew Johnson: Psychedelics | Lex Fridman Podcast #145
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The following is a conversation with Matthew Johnson,
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a professor of psychiatry and behavioral science
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at John Hopkins, and is one of the top scientists
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in the world conducting seminal research on psychedelics.
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This was one of the most eye opening
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and fascinating conversations I've ever had on this podcast.
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I'm sure I'll talk with Matt many more times.
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Quick mention of a sponsor followed by some thoughts
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related to the episode.
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Thank you to a new sponsor, Brave,
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a fast browser that feels like Chrome
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but has more privacy preserving features.
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Neuro, the maker of functional sugar free gum and mints
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that I use to give my brain a quick caffeine boost.
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I'm just now realizing how ironic the set of sponsors are.
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And Cash App, the app I use to send money to friends.
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Please check out these sponsors in the description
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to get a discount and support this podcast.
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As a side note, let me say that psychedelics
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is an area of study that is fascinating to me
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in that it gives hints that much of the magic
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of our experience arises from just a few
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chemical interactions in the brain
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and that the nature of that experience can be expanded
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through the tools of biology, chemistry, physics,
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neuroscience, and artificial intelligence.
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The fact that a world class scientist and researcher
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like Matt can apply rigor to our study
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of this mysterious and fascinating topic
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is exciting to me beyond words.
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As is the case with any of my colleagues
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who dare to venture out into the darkness
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of all that is unknown about the human mind
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with both an openness of first principle thinking
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and the rigor of the scientific method.
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If you enjoy this thing, subscribe on YouTube,
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review it with five stars on Apple Podcast,
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follow on Spotify, support on Patreon,
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or connect with me on Twitter at Lex Friedman.
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And now, here's my conversation with Matthew Johnson.
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Can you give an introduction to psychedelics,
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like a whirlwind overview?
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Maybe what are psychedelics
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and what are the kinds of psychedelics out there
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and in whatever way you find meaningful to categorize?
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Yeah, you can categorize them by their chemical structure.
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So, phenethylamines, tryptamines, ergolines,
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that is less of a meaningful way to classify them.
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I think that their pharmacological activity,
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their receptor activities are the best way.
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Well, let me start even broader than that
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because there I'm talking about the classic psychedelics.
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So, broadly speaking, when we say psychedelic,
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that refers to, for most people,
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a broad number of compounds
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that work in different pharmacological ways.
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So, it includes the so called classic psychedelics.
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That includes psilocybin and psilocin,
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which are in mushrooms, LSD, dimethyltryptamine or DMT,
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it's in ayahuasca, people can smoke it too,
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mescaline, which is in peyote in San Pedro, cactus.
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And those all work by hitting a certain
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subtype of serotonin receptor, the serotonin 2A receptor.
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They act as agonists at that receptor.
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Other compounds like PCP, ketamine, MDMA, ibogaine,
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they all are more broadly speaking called psychedelics,
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but they work by very different ways pharmacologically.
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And they have some different effects,
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including some subjective effects,
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even though there's enough of an overlap
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in the subjective effects that, you know,
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people informally refer to them as psychedelic.
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And I think what that overlap is, you know,
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compared to say, you know, caffeine and cocaine
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and, you know, Ambien, et cetera, other psychoactive drugs
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is that they have strong effects
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in altering one's sense of reality
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and including the sense of self.
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And I should throw in there that cannabis,
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more historically, like in the 70s,
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has been called a minor psychedelic.
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And I think with that latter definition,
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it does fit that definition,
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particularly if one doesn't have a tolerance.
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So you mentioned serotonin, so most of the effect
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comes from something around like the chemistry
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around neurotransmitters and so on.
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So it's chemical interactions in the brain,
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or is there other kinds of interactions
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that have this kind of perception
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and self awareness altering effects?
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Well, as far as we know, all of the psychedelics
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of all the different classes we've talked about,
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their major activity is caused by receptor level events.
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So either acting at the post receptor side of the synapse.
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So in other words, neurotransmission operates
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by, you know, one neuron releasing neurotransmitter
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into a synapse, a gap between the two neurons.
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And then the other neuron receives,
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it has receptors that receives,
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and then there can be an activation caused by that.
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So it's like a pitcher and a catcher.
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So all of the major psychedelics work
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by either acting as a pitcher,
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mimicking a pitcher or a catcher.
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So for example, the classic psychedelics,
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they fit into the same catcher's mitt
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on the post receptor, post synaptic receptor side
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as serotonin itself.
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But they do a slightly different thing to the cell,
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to the neuron than serotonin does.
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There's a different signaling pathway
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after that initial activation.
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Something like MDMA works at the presynaptic side,
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And basically it floods the synapse or the gap
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between the cells with a bunch of serotonin,
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the natural neurotransmitter.
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So it's like the pitcher in a baseball game
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all of a sudden just starts throwing balls
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like every second.
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Everything we're talking about is it often more natural,
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meaning found in the natural world.
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You mentioned cacti, cactus,
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or is it chemically manufactured,
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like artificially in the lab?
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So the classic psychedelics, there's...
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What are the classics?
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So using terminology that's not chemical terminology,
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not like the terminology you see in titles of papers,
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academic papers, but more sort of common parlance.
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Right, it would be good to kind of define their effects,
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like how they're different.
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And so it includes LSD, psilocybin,
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which is in mushrooms, mescaline, DMT.
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Which one is mescaline?
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Mescaline is in the different cacti.
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So the one most people will know is peyote,
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but it also shows up in San Pedro or Peruvian torch.
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And all of these classic psychedelics,
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they have, at the right dose,
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and typically they have very strong effects
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on one sense of reality and one sense of self.
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Some of the things that makes them different
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than other more broadly speaking psychedelics,
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like MDMA and others,
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is that they're, at least the major examples,
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there's some exotic ones that differ,
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but the ones I've talked about are extremely safe
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at the physiological level.
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Like LSD and psilocybin, there's no known lethal overdose,
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unless you have like really severe heart disease,
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because it modestly raises your blood pressure.
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So same person that might be hurt traveling snow
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or going up the stairs, that could have a cardiac event
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because they've taken one of these drugs.
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But for most people, someone could take a thousand times
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what the effective dose is,
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and it's not gonna cause any organ damage,
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affect the brainstem, make them stop breathing.
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So in that sense, they're freakishly safe at the physiolo...
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I would never call any compounds safe,
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because there's always a risk.
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They're freakishly safe at the physiological level.
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I mean, you can hardly find anything over the counter
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like that, I mean, aspirin's not like that.
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Caffeine is not like that.
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Most drugs, you take five, 10, 20, maybe it takes 100,
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but you get to some times the effective dose,
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and it's gonna kill you or cause some serious damage.
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And so that's something that's remarkable
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about most of these classic psychedelics.
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That's incredible, by the way,
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that you can go on a hell of a journey in the mind,
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like probably transformative,
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potentially in a deeply transformative way,
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and yet there's no dose
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that in most people would have a lethal effect.
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That's kind of fascinating.
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There's this duality between the mind and the body.
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It's like, it's the...
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Okay, sorry if I bring them up way too much,
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but David Goggins is like,
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the kind of things you go on in the long run,
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like the hell you might go through in your mind.
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Your mind can take a lot,
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and you can go through a lot with the mind,
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and the body will just be its own thing.
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You can go through hell,
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but after a good night's sleep, be back to normal,
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and the body's always there.
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So bringing it back to Goggins,
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it's like you can do that
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without even destroying your knee or whatever,
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or coming close and riding that line.
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So the unfortunate thing about the running,
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which he uses running to test the mind,
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so the aspect of running that is negative,
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in order to test the mind,
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you really have to push the body,
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take the body through a journey.
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I wish there was another way of doing that
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in the physical exercise space.
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I think there are exercises
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that are easier on the body than others,
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but running sure is a hell of an effective way to do it.
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And one of the ways that where it differs
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is that you're unlike exercise,
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you're essentially, most exercise,
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to really get to those intense levels,
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you really need to be persistent about it.
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I mean, it'll be intense if you're really out of shape,
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just jogging for five minutes,
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but to really get to those intense levels,
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you need to have the dedication.
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And so some of the other ways
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of altering subjective effects or states of consciousness,
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take that type of dedication.
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Psychedelics though, I mean, someone takes the right dose.
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They're strapped into the rollercoaster
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and something interesting is gonna happen.
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And I really like what you said about that distinction
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between the mind or the contrast between the mind effects
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and the body effects,
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because I think of this,
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I do research with all the drugs,
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caffeine, alcohol, methamphetamine, cocaine,
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alcohol, legal, illegal.
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Most of these drugs, thinking about say cocaine
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and methamphetamine, you can't give to a regular user,
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you can't safely give a dose where the regular cocaine user
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is gonna say, oh man, that's like,
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that's the strongest coke I've ever had, you know,
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because you get it past the ethics committee
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and you need approval.
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And I wouldn't wanna give someone something that's dangerous.
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So to go to those levels where they would say that,
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you would have to give something
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that's physiologically riskier, you know.
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Psilocybin or LSD, you can give a dose
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at the physiological level that is like very good chance
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it's gonna be the most intense psychological experience
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of that person's life and have zero chance
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for most people if you screen them of killing them.
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The big risk is behavioral toxicity,
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which is a fancy way of saying doing something stupid.
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I mean, you're really intoxicated,
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like if you wander into traffic or you fall from a height,
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just like plenty of people do on high doses of alcohol.
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And the other kind of unique thing
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about classic psychedelics is that they're not addictive,
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which is pretty much unheard of when it comes
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to so called drugs of abuse or drugs that people,
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at least at some frequency choose to take, you know,
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most of what we think of as drugs, you know,
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even caffeine, alcohol, cocaine, cannabis,
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most of these you can get into alcohol,
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you can get into a daily use pattern.
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And that's just extreme, so unheard of with psychedelics.
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Most people have taken these things on a daily basis,
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it's more of like they're building up the courage to do it
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and then they build up a tolerance or yeah,
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they're in college and they do it on a dare,
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can you take take acid seven days in a row
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and that type of thing rather than a self control issue
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where you have and say, oh God, I gotta stop taking this,
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I gotta stop drinking every night,
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I gotta cut down on the coke, whatever.
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So that's the classic psychedelics.
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What are the, what's a good term, modern psychedelics
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or more maybe psychedelics that are created in the lab?
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What else is there?
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Right, so MDMA is the big one.
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And I should say that with the classic psychedelics,
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that LSD is sort of, you can call it a semi synthetic
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because there's natural from both ergot
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and in certain seeds, morning glory seeds as one example,
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there's a very close,
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there are some very close chemical relatives of LSD.
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So LSD is close to what occurs in nature, but not quite.
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But then when we get into the other non classic psychedelics,
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probably the most prominent one is MDMA,
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people call it ecstasy, people call it Molly.
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And it is, it differs from classic psychedelics
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in a number of ways, it can be addictive, but not so.
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It's like, you can have cocaine on this end
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of the continuum and classic psychedelics here.
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Continuum of addiction.
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Continuum of addiction, you know,
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so it's certainly no cocaine.
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It's pretty rare for people to get into daily use patterns,
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but it's possible and they can get into more like,
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you know, using once a week pattern
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where they can find it hard to stop,
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but it's somewhere in between mostly towards the,
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to the classic psychedelic side in terms of
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like relatively little addiction potential.
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But it's also more physiologically dangerous.
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I think that the, certainly the therapeutic use,
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it's showing really promising effects for treating PTSD
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and the models that are used,
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I think those are extremely acceptable
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when it comes to the risk benefit ratio
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that you see all throughout medicine.
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But nonetheless, we do know that at a certain dose
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and a certain frequency that MDMA can cause longterm damage
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to the serotonin system in the brain.
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So it doesn't have that level of kind of freakish
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bodily safety that the classic psychedelics do.
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And it has more of a heart load, a cardiovascular,
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I don't mean kind of emotion, I mean, in this sense,
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although it is very emotional
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and that's something unique about its subjective effects,
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subjective effects, but it's more of a oppressor.
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And the terminology you use instead of
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like a freakish capacities,
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allowing you from a researcher perspective,
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but a personal perspective too,
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of taking a journey with some of these psychedelics
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that is the heroic dose, as they say.
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So like these are tools that allow you
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to take a serious mental journey, whatever that is.
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That's what you mean.
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And with MDMA, there's a little bit,
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it starts entering this territory
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where you gotta be careful about the risks
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to the body potentially.
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So yes, that in the sense that you can't kind of
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push the dose up as high as you safely as one can,
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if they're in the right setting, like in our research
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as they can with the classic psychedelics.
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But probably more importantly,
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just the nature of the effects with MDMA
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aren't the full on psychedelic.
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It's not the full journey.
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So it's sort of a psychedelic with rose colored glasses on.
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A psychedelic that's more of,
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it's been called more of a heart trip than a head trip.
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The nature of reality doesn't unravel
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as frequently as it does with classic psychedelics.
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But you're able to more directly sense your environment.
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So your perception system still works.
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It's not completely detached from reality with MDMA.
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That's true, relatively speaking.
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That said at most doses of classic psychedelics,
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you still have a tether to reality.
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Changes a little bit when you're talking about smoking DMT
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or smoking 5 methoxy DMT,
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which are some interesting examples
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we could talk more about.
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But with MDMA, for example,
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it's very rare to have what's called an ego loss experience
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or a sense of transcendental unity,
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where one really seemingly loses
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the psychological construct of the self.
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But MDMA, it's very common for people to have this,
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they still are perceiving themselves as a self,
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but it's common for them to have this warmth,
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this empathy for humanity
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and for their friends and loved ones.
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So it's more, and you see those effects
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under the classic psychedelics,
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but that's a subset of what the classic psychedelics do.
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So I see MDMA in terms of its subjective effects
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is if you think about Venn diagrams,
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it's sort of MDMA is all within the classic psychedelics.
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So everything that you see on a particular MDMA session,
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sometimes a psilocybin session looks just like that,
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but then sometimes it's completely different with psilocybin.
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It's a little more narrowed
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in terms of the variability with MDMA.
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Is there something general to say about what the psychedelics
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do to the human mind?
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You mentioned kind of an ego loss experience
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in the space of Venn diagrams.
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If we're to like draw a big circle,
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what can we say about that big circle?
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In terms of people's report of subjective experience,
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probably one of the most general things we can say
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is that it expands that range.
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So many people come out of these sessions
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saying that they didn't know it was possible
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to have an experience like that.
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So there's an emphasis on the subjective experience
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that is there words that people put to it
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that capture that experience
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or is it something that just has to be experienced?
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Yeah, people like...
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As a researcher, that's an interesting question
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because you have to kind of measure the effects of this
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and how do you convert that into numbers?
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That's the ultimate challenge.
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So is that possible to one, convert it into words
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and the second, convert the words into numbers somehow?
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So we do a lot of that with questionnaires,
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some of which are very psychometrically validated.
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So lots of numbers have been crunched on them.
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And there's always a limitation with questionnaires.
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I mean, subjective effects are subjective effects.
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Ultimately, it's what the person is reporting
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and that doesn't necessarily point towards a ground truth.
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So for example, if someone says
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that they felt like they touched another dimension
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or they felt like they sensed the reality of God
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or if they, I mean, just you name it,
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people's ontological views can sometimes shift.
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I think that's more about where they're coming from
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and I don't think it's the quintessential way
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in which they work.
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There's plenty of people that hold
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onto a completely naturalistic viewpoint
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and have profound and helpful experiences
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with these compounds.
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But the subjective effects can be so broad
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that for some people, it shifts their philosophical
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viewpoint more towards idealism,
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more towards thinking that the nature of reality
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might be more about consciousness than about material.
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That's a domain I'm very interested in.
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Right now, we have essentially zero to say about that
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in terms of validating those types of claims,
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but it's even interesting just to see
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what people say along those lines.
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So you're interested in saying like,
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can we more rigorously study this process of expansion?
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Like, what do we mean by this expansion
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of your sense of what is possible
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in the experiences in this world?
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Right, as much as what we can say about that
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through naturalistic psychology,
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especially as much as we can root it
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to solid psychological constructs
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and solid neuroscientific constructs.
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And I wonder what the impact is of the language
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that you bring to the table.
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So you mentioned about God or speaking of God,
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a lot of people are really into sort of
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theoretical physics these days at a very surface level
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and you can bring the language of physics, right?
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You can talk about quantum mechanics,
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you can talk about general relativity
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and curvature of space time and using just that language
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without a deep technical understanding of it
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to somehow start thinking like,
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sort of visualizing atoms in your head
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and somehow through that process
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because you have the language,
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using that language to kind of dissolve the ego,
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like realize like that we're just all little bits
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of physical objects that behave in mysterious ways.
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And so that has to do with the language.
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Like if you read a Sean Carroll book or something recently,
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it seems like it has a huge influence
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on the way you might experience,
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might perceive the world and might experience
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the alteration that psychedelics brings
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to your perception system.
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So I wonder like the language you bring to the table,
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how that affects the journey you go on with the psychedelics.
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I think very much so.
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And I think there's, I'm a little concerned
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some of the science is going a little too far
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in the direction of around the edges,
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speaking about it changing beliefs in this sense
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or that sense about particular, in particular domains.
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And I think what really what a lot of what's going on
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is what you just discussed.
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It's the priors coming into it.
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So if you've been reading a lot of physics,
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then you might bring up like space time
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and interpret the experience in that sense.
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I mean, it's not uncommon for people come out
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talking about visions of the,
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it's not the most typical thing,
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but it's come up in sessions I've guided,
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the Big Bang and this sort of nature of reality.
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I think probably that the best way to think
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about these experiences is that,
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and the best evidence,
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even though we're in our infancy and understanding it,
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they really tap into more general psychological mechanisms.
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I think one of the best arguments
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is they reduce the influence of our priors,
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of what we bring into all of the assumptions
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that we all that we're essentially,
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especially as adults, we're riding on top of heuristic
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after heuristic to get through life.
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And you need to do that.
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And that's a good thing.
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And that's extremely efficient
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and evolution has shaped that,
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but that comes at an expense.
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And it seems that these experiences
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will allow someone greater mental flexibility and openness.
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And so one can be both less influenced
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by their prior assumptions,
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but still nonetheless the nature of the experience
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can be influenced by what they've been exposed to
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And sometimes they can get it in a deeper way.
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Like maybe they've read,
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I mean, I had a philosophy professor one time
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as a participant in a high dose psilocybin study.
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And I remember him saying, my God,
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it's like Hegel's opposites defining each other.
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I've taught this thing for years and years and years.
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Like, I get it now.
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And so like that, you know,
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and even at the psychological, emotional level,
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like the cancer patients we worked with,
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you know, they told themselves a million times
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over this people trying to quit smoking,
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I need to quit smoking.
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Oh, I'm ruining my life with this cancer.
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I'm still healthy.
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I should be getting out.
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I'm letting this thing defeat me.
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It's like, yeah, you told yourself that in your head,
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but sometimes they had these experiences
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and they kind of feel it in their heart.
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Like they really get it.
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So in some sense that you bring some prize to the table,
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but psychedelics allow you to acknowledge them
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and then throw them away.
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So like one popular terminology around this
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in the engineering space is first principles thinking
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that Elon Musk, for example, espouses a lot.
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Let me ask a fun question
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before we return to a more serious discussion.
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With Elon Musk as an example,
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but it could be just engineers in general,
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do you think there's a use for psychedelics
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to take a journey of rigorous first principles thinking?
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So like throwing away,
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we're not talking about throwing away assumptions
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about the nature of reality in terms of like our philosophy
link |
of the way we live day to day life,
link |
but we're talking about like how to build a better rocket
link |
or how to build a better car
link |
or how to build a better social network
link |
or all those kinds of things, engineering questions.
link |
I absolutely think there's huge potential there.
link |
And there was some research in the late 60s, early 70s
link |
that were, it was very early and not very rigorous
link |
in terms of methodology, but it was consistent with the,
link |
I mean, there's just countless anecdotes of folks.
link |
I mean, people have argued that just,
link |
Silicon Valley was largely influenced
link |
by psychedelic experience.
link |
I remember the, I think the person that came up
link |
with the concept of freeware or shareware,
link |
it's like it kind of was generated out of
link |
or influenced by psychedelic experience.
link |
So to this, I think there's incredible potential there
link |
and we know really next,
link |
there's no rigorous research on that, but.
link |
Is there anecdotal stuff like with Steve Jobs?
link |
I think there's stories, right?
link |
In your exploration of that,
link |
is there something a little bit more than just stories?
link |
Is there like a little bit more of a solid data points,
link |
even if they're just experiential like anecdotes?
link |
Is there something that you draw inspiration from
link |
like in your intuition?
link |
Because we'll talk about,
link |
you're trying to construct studies
link |
that are more rigorous around these questions.
link |
But is there something you draw inspiration from,
link |
from the past, from the 80s and the 90s
link |
and Silicon Valley, that kind of space?
link |
Or is it just like you have a sense
link |
based on everything you've learned
link |
and these kind of loose stories
link |
that there's something worth digging at?
link |
I am influenced by the, gosh,
link |
the just incredible number of anecdotes surrounding these.
link |
Carey Mullis, he invented PCR.
link |
I mean, absolutely revolutionized biological sciences.
link |
He says he wouldn't have won the Nobel Prize for him.
link |
He said he wouldn't have come up with that
link |
had he not had psychedelic experiences.
link |
Now, he's an interesting character.
link |
People should read his autobiography
link |
because you could point to other things he was into.
link |
But I think that speaks to the casting your nets wide
link |
and this mental flex,
link |
more of these general mechanisms
link |
where sometimes if you cast your nets really wide
link |
and it's gonna depend on the person
link |
and their influences,
link |
but sometimes you come up with false positives.
link |
You connect the dots
link |
where maybe you shouldn't have connected those dots,
link |
but I think that can be constrained.
link |
And so much of our,
link |
not only our personal psychological suffering,
link |
but our limitations academically
link |
and in terms of technology
link |
are because of the self imposed limitations
link |
and heuristics, these entrenched ways of thinking.
link |
Like those examples throughout the history of science
link |
where someone has come up with the paradigm,
link |
Kuhn's paradigm shifts.
link |
It's like, here's something completely different.
link |
This doesn't make sense by any of the previous models.
link |
And like, we need more of those.
link |
And then you need the right balance between that
link |
because so many of the novel crazy ideas are just bunk
link |
and that's what science is about separating them
link |
from the valid paradigm shifting ideas.
link |
But we need more paradigm shifting ideas like in a big way.
link |
And I think we could,
link |
I think you could argue that we've,
link |
because of the structure of academia and science
link |
in modern times, it heavily biases against those.
link |
Right, there's all kinds of mechanisms in our human nature
link |
that resist paradigm shift quite sort of obviously.
link |
So, and psychedelics, there could be a lot of other tools
link |
but it seems like psychedelics could be one set of tools
link |
that encourage paradigm shifting thinking.
link |
So like the first principles kind of thinking.
link |
So it's a kind of, you're at the forefront of research here.
link |
There's just kind of anecdotal stories.
link |
There's early studies.
link |
There's a sense that we don't understand very much
link |
but there's a lot of depth here.
link |
How do we get from there to where Elon and I can regularly,
link |
like I wake up every morning, I have deep work sessions
link |
where it's well understood like what dose to take.
link |
Like if I want to explore something where it's all legal,
link |
where it's all understood and safe, all that kind of stuff.
link |
How do we get from where we are today to there?
link |
Not speaking in terms of legality in the sense like
link |
policy making all that like laws and stuff,
link |
meaning like how do we scientifically understand this stuff
link |
well enough to get to a place where I can just take it safely
link |
in order to expand my thinking,
link |
like this kind of first principles thinking,
link |
which I'm in my personal life currently doing.
link |
Like how do I revolutionize particular several things?
link |
Like it seems like the only tools I have right now
link |
is just, just, but my mind going, doing the first principles
link |
like, wait, wait, wait, okay.
link |
Why has this been done this way?
link |
Can we do it completely differently?
link |
It seems like I'm still tethered to the priors
link |
that I bring to the table
link |
and I keep trying to untether myself.
link |
Maybe there's tools that can systematically
link |
Yeah, well, we need experiments and that's tied to
link |
kind of the policy level stuff.
link |
And I should be clear,
link |
I would never encourage anyone to do anything illicitly.
link |
But yeah, in the future, we could see these compounds
link |
used for technical and scientific innovation.
link |
What we need are studies that are digging into that.
link |
Right now, most of what the funding,
link |
which is largely from philanthropy, not from the government,
link |
largely what it's for is treatment of mental disorders
link |
like addiction and depression, et cetera.
link |
But we need studies.
link |
One of the early initial stabs on this question decades ago
link |
was they took some architects and engineers
link |
and said, what problems have you been working on?
link |
Where have you been stuck for months
link |
like working on this damn thing
link |
and you're not getting anywhere,
link |
like your head's butting up against the wall.
link |
It's like, come in here, take,
link |
and I think it was 100 micrograms of LSD.
link |
So not a big session.
link |
And a little bit different model
link |
where they were actually working.
link |
It was a moderate enough dose
link |
where they could work on the problem during the session.
link |
I think probably, I'm an empiricist,
link |
so I'd like to see all the studies done.
link |
But the first thing I would do is like
link |
a really high dose session where you're not necessarily
link |
in front of your computer,
link |
which you can't really do on a really high dose.
link |
And then the work has been talked about,
link |
like you take a really high dose, you take a journey,
link |
and then the breakthroughs come
link |
from when you return from the journey
link |
and like integrate, quote unquote, that experience.
link |
I think that's where all the,
link |
again, we're babies at this point,
link |
but my gut tells me that it's the so called integration,
link |
We know that there's some different forms of neuroplasticity
link |
that are unfolding in the days following a psychedelics,
link |
at least in animals, probably going on humans.
link |
We don't know if that's related to the therapeutic effects.
link |
My gut tells me it is,
link |
although it's only part of the story,
link |
but we need big studies where we compare people,
link |
like let's get a hundred people like that,
link |
scientists that are working on a problem,
link |
and then randomize them too.
link |
And then I think you need even more credible,
link |
active controls or active placebo conditions
link |
to kind of tease this out.
link |
And then also in conjunction with that,
link |
and you can do this in the same study,
link |
you wanna combine that with more rigorous
link |
sort of experimental models
link |
where we actually give there a problem solving tasks
link |
that we know, for example, that you tend to do better on
link |
after you've gotten a good night's sleep versus not.
link |
And my sense is there's a relationship there.
link |
People go back to first principles,
link |
questioning those first principles they're operating under
link |
and getting away from their priors
link |
in terms of creative problem solving.
link |
And so I think wrap those things
link |
and you could speak a little more rigorously about those
link |
because ultimately, if everyone's bringing their own problem,
link |
that's more in the face valid side,
link |
but you can't dig in as much
link |
and get as much experimental power
link |
and speak to the mechanisms as you can
link |
with having everyone do the same sort of canned
link |
problem solving task.
link |
So we've been speaking about psychedelics generally.
link |
Is there one you find from the scientific perspective
link |
or maybe even philosophical perspective
link |
most fascinating to study?
link |
Therapeutically, I'm most interested in psilocybin and LSD
link |
and I think we need to do a lot more with LSD
link |
because it's mainly been psilocybin in the modern era.
link |
I've recently gotten a grant
link |
from the Heftar Research Institute to do an LSD study.
link |
So I haven't started it yet,
link |
but I'm going through the paperwork and everything.
link |
Therapeutic meaning there's some issue
link |
and you're trying to treat that issue.
link |
In terms of just like, what's the most fascinating,
link |
understanding the nature of these experiences,
link |
if you really wanna like wrap your head around
link |
what's going on when someone has a completely altered sense
link |
of reality and sense of self,
link |
there I think you're talking about the high dose,
link |
either smoked vaporized or intravenous injection,
link |
which all kind of, they're very similar pharmacologically,
link |
of DMT and 5 methoxy DMT.
link |
This is like when people, this is what,
link |
I don't know if you're familiar with Terrence McKenna,
link |
he would talk a lot about smoking DMT,
link |
Joe Rogan has talked a lot about that.
link |
People will say that,
link |
and there's a close relative called 5 methoxy DMT.
link |
Most people who know the terrain will say
link |
that's an order of magnitude or orders of magnitude beyond,
link |
I mean, anything one could get from even a high dose
link |
of psilocybin or LSD.
link |
I think it's a question about whether, you know,
link |
I think there is a therapeutic potential there,
link |
but it's probably not as sure of a bet
link |
because one goes so far out,
link |
it's almost like they're not contemplating
link |
their relationship and their direction in life.
link |
They are like reality is ripping apart at the seams
link |
and the very nature of the self and of the sense of reality.
link |
And the amazing thing about these compounds
link |
and same to a less degree with oral psilocybin and LSD
link |
is that unlike some other drugs
link |
that really throw you far out there,
link |
you know, anesthetics and even alcohol,
link |
like as reality starts to become different
link |
at higher and higher doses, there's this numbing,
link |
there's this sort of,
link |
there's this ability for the sense of being the center,
link |
having a conscious experience that's memorable,
link |
that is maintained
link |
throughout these classic psychedelic experiences.
link |
Like one can go as far, so far out while still
link |
being aware of the experience
link |
and remembering the experience.
link |
Interesting, so being able to carry something back.
link |
Can you dig in a little deeper, like what is DMT,
link |
how long is the trip usually,
link |
like how much do we understand about it?
link |
Is there something interesting to say
link |
about just the nature of the experience
link |
and what we understand about it?
link |
One of the common methods for people to use it
link |
is to smoke it or vaporize it.
link |
And it usually takes,
link |
this is a pretty good kind of description
link |
of what it might feel like on the ground.
link |
The caveat is it's a completely insufficient description
link |
that someone's gonna be listening to.
link |
It's like nothing you could say is gonna come close.
link |
But it'll take about three big hits, inhalations,
link |
in order to have what people call a breakthrough dose.
link |
And there's no great definition of that,
link |
but basically meaning moving away from,
link |
not just having the typical psilocybin or LSD experience
link |
where like things are radically different,
link |
but you're still basically a person in this reality
link |
to go in somewhere else.
link |
And so that'll typically take like three hits.
link |
And this stuff comes on like a freight train.
link |
So one takes a hit
link |
and around the time of the first exhalation,
link |
so we're talking about a few seconds in,
link |
or maybe just sometime between the first and the second hit,
link |
like it'll start to come on.
link |
And they're already up to, let's say,
link |
what they might get from a 30 milligram
link |
or 300 microgram LSD trip, a big trip.
link |
They're already there at the second hit,
link |
but their consciousness is geared,
link |
this is like acceleration, not speed, to speak of physics.
link |
It's like those receptors are getting filled like that
link |
and they're going from zero to 60 in like Tesla time.
link |
And at the second hit, again,
link |
they're at maybe the strongest psychedelic experience
link |
And then if they can take that third hit,
link |
and some people can't,
link |
they're propelled into this other reality.
link |
And the nature of that other reality will differ
link |
depending on who you ask,
link |
but folks will often talk about it.
link |
And we've done some survey research on this.
link |
Entities of different types, elves tend to pop up.
link |
The caveat is that I strongly presume
link |
all of this is culturally influenced,
link |
but thinking more about the psychology and the neuroscience,
link |
there is probably something fundamental,
link |
like for someone that might be colored as elves,
link |
others that might be colored as,
link |
Terrence McKenna called them self dribbling basketballs.
link |
For someone else, it might be little animals
link |
or someone else, it might be aliens.
link |
I think that probably is dependent on who they are
link |
and what they've been exposed to.
link |
But just the fact that one has this sense
link |
that they're surrounded by autonomous entities.
link |
Right, intelligent autonomous entities.
link |
Right, and people come back with stories
link |
that are just astonishing.
link |
Like there's communication between these,
link |
communication between these entities
link |
and often they're telling them things
link |
that the person says are self validating,
link |
but it seems like it's impossible.
link |
Like it really seems like, and again,
link |
this is what people say oftentimes,
link |
that it really is like downloading some intelligence
link |
from a higher dimension or some whatever metaphor
link |
Sometimes these things come up in dreams
link |
like someone is exposed to something that,
link |
I've had this in a dream,
link |
where it seems like what they are being exposed to
link |
is physically impossible,
link |
but yet at the same time self validating, it seems true.
link |
Like they really are figuring something out.
link |
Of course, the challenge is to say something
link |
in concrete terms after the experience
link |
where you could verify that in any way.
link |
And I'm not familiar of any examples of that.
link |
Well, there's a sense in which I suppose the experience
link |
is like you're a limited cognitive creature
link |
that knows very little about the world
link |
and here's a chance to communicate
link |
with much wiser entities that in a way
link |
that you can't possibly understand
link |
are trying to give you hints of deeper truths.
link |
And so there's that kind of sense
link |
that you can take something back,
link |
but you can't where our cognition is not capable
link |
to fully grasp the truth.
link |
We'll just get a kind of sense of it
link |
and somehow that process is mind expanding
link |
that there's a greater truth out there.
link |
That seems like what from the people
link |
I've heard talk about that seems to be what it is.
link |
And that's so fascinating that there's fundamentally
link |
to this whole thing is a communication
link |
between an entity that is other than yourself, entities.
link |
So it's not just like a visual experience
link |
like you're like floating through the world
link |
is there's other beings there,
link |
which is kind of, I don't know.
link |
I don't know what to sort of,
link |
from a person who likes Freud and Carl Jung,
link |
I don't know what to think about that.
link |
That being of course from one perspective
link |
is just you looking in the mirror.
link |
But it could also be from another perspective
link |
like actually talking to other beings.
link |
Yeah, you mentioned Jung
link |
and I think he's particularly interesting
link |
and it kind of points to something
link |
I was thinking about saying is that,
link |
I think what might be going on
link |
from a naturalistic perspective.
link |
So regardless, whether or not there are,
link |
it doesn't depend on autonomous entities out there.
link |
What might be happening is that just the associative net,
link |
the level of learning,
link |
the comprehension might be so beyond what someone is used to
link |
that the only way for the nervous system,
link |
for the aware sense of self to orient towards it
link |
is all by metaphor.
link |
And so I do think,
link |
when we get into these realms as a strong empiricist,
link |
I think we always gotta be careful
link |
and be as grounded as possible,
link |
but I'm also willing to speculate
link |
and sort of cast the nets wide with caveat.
link |
But I think of things like archetypes
link |
and it's plausible that there are certain stories,
link |
there are certain,
link |
we've gone through millions of years of evolution.
link |
It may be that we have certain characters and stories
link |
that our central nervous system is sort of wired
link |
Yeah, those stories, we carry those stories in us.
link |
And this unlocks them in a certain kind of way.
link |
And we think about stories.
link |
Like our sense of self is basically,
link |
narrative self is a story.
link |
And we think about the world of stories.
link |
This is why metaphors are always more powerful
link |
than sort of laying out all the details all the time,
link |
speaking in parables.
link |
It's like, if you really get some,
link |
this is why, as much as I hate it,
link |
if you're presenting to Congress or something
link |
and you have all the best data in the world,
link |
it's not as powerful as that one anecdote
link |
as the mom dying of cancer that had the psilocybin session
link |
and it transformed her life.
link |
That's a story, that's meaningful.
link |
And so when this kind of unimaginable kind of change
link |
and experience happens with a DMT ingestion,
link |
these stories of entities, they might be that,
link |
stories that are constructed that is the closest,
link |
which is not to say the stories aren't real.
link |
I mean, I think we're getting to layers where
link |
it doesn't really, right.
link |
Yeah, but it's the closest we can come
link |
to making sense out of it.
link |
Because what we do know about these psychedelics,
link |
one of the levels beyond the receptor
link |
is that the brain is communicating it with itself
link |
in a massively different way.
link |
There's massive communication with areas
link |
that don't normally communicate.
link |
And so I think that comes with both,
link |
it's casting the nets wide.
link |
I think that comes with the insights
link |
and helpful novel ways of thinking.
link |
I do think it comes with false positives,
link |
that could be some of the delusion.
link |
And so when you're so far out there,
link |
like with the DMT experience,
link |
like maybe alien is the best way
link |
that the mind can wrap some arms around that.
link |
So I don't know how much you're familiar with Joe Rogan,
link |
but he does bring up DMT quite a bit.
link |
It's almost a meme, it is a meme.
link |
Have you ever, what is it, have you ever tried DMT?
link |
I mean, I think he talks about this experience
link |
of having met other entities
link |
and they were mocking him, I think,
link |
if I remember the experience correctly,
link |
like laughing at him and saying F you, F you,
link |
or something like that.
link |
I may be misremembering this,
link |
but there's a general mockery.
link |
And what he learned from that experience
link |
is that he shouldn't take himself too seriously.
link |
So it's the dissolution of the ego and so on.
link |
Like what do you think about that experience?
link |
And maybe if you have more general things
link |
about Joe's infatuation with DMT
link |
and if DMT has that important role to play
link |
in popular culture in general.
link |
I'm definitely familiar with it.
link |
I remember telling you offline
link |
that when I first, the first time I learned
link |
who Joe Rogan was, it was probably 15 years ago.
link |
And I came upon a clip and I realized
link |
there's another person in the world
link |
who's into both DMT and Brazilian Jiu Jitsu.
link |
And I think both those worlds have grown dramatically since
link |
and it's probably not such a special club these days.
link |
So he definitely got onto my radar screen quickly.
link |
You were into both before it was cool.
link |
Right, I mean, this is all relative
link |
because there's people that were before the late 90s
link |
and early 2000s who were into it
link |
to say you're a Johnny come lately.
link |
But yeah, compared to where we're at now.
link |
But yet one of the things I always found fascinating
link |
by Joe's telling of his experiences I think
link |
is that they resemble very much
link |
Terrence McKenna's experiences with DMT
link |
and Joe has talked very much about Terrence McKenna
link |
and his experiences.
link |
If I had to guess, I would guess
link |
that probably just having heard Terrence McKenna
link |
talk about his experiences that that influenced
link |
the coloring of Joe's experience.
link |
It's funny how that works
link |
because I mean, that's why McKenna hasn't,
link |
I mean, poets and great orators give us the words
link |
to then like start to describe our experiences
link |
because our words are limited, our language is limited.
link |
And it's always nice to get some kind of nice poetry
link |
into the mix to allow us to put words to it.
link |
Right, but I also see some elements
link |
that seem to relate to Joe's psychology
link |
just from what I've seen from hours
link |
of watching him on his podcast
link |
is that he's a self critical guy.
link |
And I think with always his positive been,
link |
I'm always struck being a behavioral pharmacologist
link |
and no one else really says it about cannabis.
link |
I'll get back to the DMT thing about
link |
he likes the kind of the paranoid side of things.
link |
He's like, that's you radically examining yourself.
link |
It's like, that's not just a bad thing.
link |
That's you need to like look hard at yourself
link |
and something's making you uncomfortable,
link |
like dig into that.
link |
And like, that's his,
link |
it's sort of along the lines of Goggins with exercise.
link |
And it's like, yeah, like things,
link |
learning experiences aren't supposed to be easy.
link |
Like take advantage of these uncomfortable experience.
link |
It's why we call in our research
link |
in a safe context with psychedelics,
link |
they're not bad trips, they're challenging experiences.
link |
Yes, yeah, that's fascinating.
link |
Just that's the tiny tangent.
link |
It's always cool for me to hear him talk about marijuana,
link |
like weed as the paranoia, the anxiety or whatever
link |
that you experience as actually the fuel for the experience.
link |
Like I think he talks about smoking weed when he's writing.
link |
That's inspiring to me because
link |
then you can't possibly have a bad experience.
link |
I'm a huge fan of that.
link |
Like every experience is good.
link |
Right, which is very Goggins.
link |
Yeah, yeah, is it bad?
link |
Okay, all right, great, you know.
link |
Well, see Goggins is one side of that.
link |
Like he wants the experience to be challenging always.
link |
But I mean like both are good.
link |
Like the few times of taking mushrooms,
link |
the experience was like everything was beautiful.
link |
There's zero challenging aspect to it.
link |
It was just like the world is beautiful
link |
and it gave me this deep appreciation of the world.
link |
I would say, so like that's amazing,
link |
but also ones that challenge you are also amazing.
link |
Like all the times I drink vodka,
link |
but that's another, let's not.
link |
Yeah, Joe's treating cannabis as a psychedelic,
link |
which is something that I'd say like a lot of people
link |
treat it more like Xanax or like beer or vodka.
link |
But he's really trying to delve into those minor,
link |
it's been called a minor psychedelic.
link |
So with DMT, as you brought up,
link |
it's like the entity's mocking him.
link |
And it's like, you're not, I mean, this reminds me of him,
link |
him describing his, like writing his,
link |
or just his entire method of comedy.
link |
It's like, watch the tape of yourself.
link |
Don't just ignore it.
link |
Like that's where I screwed up.
link |
That's where I need to do better.
link |
This like sort of radical self examination,
link |
which I think our society is kind of getting away from
link |
because like, all the children win trophies type of thing.
link |
And it's like, no, no, don't go overboard,
link |
but like recognize when you've messed up.
link |
And so that's a big part of the psychedelic experience.
link |
Like people come out sometimes saying,
link |
my God, I need to say sorry to my mom.
link |
It's so obvious, or whatever interpersonal issue
link |
or like, my God, I'm not pulling enough weight
link |
around the house and helping my wife.
link |
And these things that are just obvious to them,
link |
the self criticism that can be a very positive thing
link |
You've mentioned addiction.
link |
Maybe we could take a little bit detour
link |
into a darker aspect of things,
link |
or not even darker, it's just an important aspect of things.
link |
What's the nature of addiction?
link |
You've mentioned some things within the big umbrella
link |
of psychedelics may be usually not addictive,
link |
but maybe MDMA, I think you said
link |
might have some addictive properties,
link |
but the point is stuff outside of the psychedelics umbrella
link |
can often be highly addictive.
link |
So you've studied addiction from several angles,
link |
one of which is behavioral economics.
link |
What have you understood about addiction?
link |
What is addiction from the biological physiological level
link |
to the psychological to whatever is the interesting way
link |
to talk about addiction?
link |
Yeah, and the lenses that I view addiction through
link |
very much are behavioral economic,
link |
but I also think they converge on,
link |
I think it's beautiful at the other end of the spectrum,
link |
sort of just a completely humanistic psychology perspective.
link |
It converges on what people come out of,
link |
12 step meetings talking about.
link |
Can you say what is behavioral economics
link |
and what is humanistic psychology?
link |
Like, what do you mean by that?
link |
And more importantly, behavioral economics lens,
link |
Yeah, so behavioral economics,
link |
my definition of it is the application
link |
of economic principles, mostly microeconomic principles.
link |
So understanding the behavior of individual agents
link |
surrounding commodities in the marketplace,
link |
applying microeconomic types of analyses
link |
to non economic behavior.
link |
So basically at one point,
link |
like psychologists figured out
link |
that there's this whole other discipline
link |
that's been studying behavior,
link |
it just happened to be all focused on monetary behavior,
link |
spending and saving money, et cetera.
link |
But it comes with all of these like principles
link |
that can be wildly and fruitfully applied
link |
to understanding behavior.
link |
So for example, I've studied things like
link |
demand curve analysis of drug consumption.
link |
So I look at, for example, tobacco, cigarettes
link |
and nicotine products through the lens of demand curves.
link |
And in other words, at different prices,
link |
if there's different work requirements
link |
for being able to smoke cigarettes, sort of modeling price.
link |
Within that price data,
link |
there is some indication of addiction,
link |
how much the habits that you form
link |
around these particular drugs.
link |
It's one important dimension.
link |
So I think a particularly important one there
link |
is elasticity or inelasticity, two ends of the spectrum.
link |
So that's the price sensitivity.
link |
So for example, you could have something
link |
that's pretty price inelastic, like gasoline.
link |
So the price of gas at times can keep going up
link |
and Americans are just gonna pretty much
link |
buy the same amount of gas.
link |
Or maybe the price of gas doubles,
link |
but their consumption only decreases by 10%.
link |
So it's a sub proportional reduction.
link |
So that's an inelastic.
link |
And that changes, like you push the price up high enough.
link |
I mean, if it was $100 a gallon, it would eventually turn,
link |
the curve would turn and go downward more drastically
link |
and it would be elastic.
link |
But you can apply that to someone who,
link |
a regular cigarette smoker who was working
link |
for cigarette puffs, who's gone six hours without smoking.
link |
And you're asking questions like,
link |
how many times are they willing to pull this knob
link |
in the lab during this three hour session?
link |
I do a lot of work like this in order to earn a cigarette.
link |
How does the content of nicotine in that affect?
link |
It has the availability of nicotine replacement products
link |
like nicotine gum or eCigarettes affect those decisions.
link |
So it's a certain lens of, it's sort of a way to take
link |
the kind of the classic behavioral psychology definition
link |
of reinforcement, which is just basically reward.
link |
How much is this a good thing?
link |
And it kind of breaks that apart
link |
into a multi dimensional space.
link |
So it's not just the ideas reward or reinforcement
link |
is not unit dimensional.
link |
So for example, you can unpack that with demand curves.
link |
At a cheap price, you might prefer one good to another.
link |
So the classic example is luxury versus necessity.
link |
So diamonds versus toilet paper.
link |
So at those cheap prices,
link |
you can look at something called intensity of demand.
link |
If it was basically as cheap as possible,
link |
or essentially zero, how much would you buy of this good?
link |
But then you keep jacking up the price and you'll see,
link |
so diamonds will look like the better reward
link |
at that low price sort of intensity of demand side of things.
link |
But as you keep jacking up the price,
link |
you gotta have some toilet paper.
link |
And again, we can get into the whole bidet thing,
link |
but forget that, I know Joe's been pushing that too.
link |
You're gonna hang on and keep buying the toilet paper
link |
to a greater degree than you will the diamonds.
link |
So you'll see a crossing of demand curves.
link |
So what's the better reinforcer?
link |
What's the better reward?
link |
Depends on your price.
link |
And so that's an example of one way to look at addiction.
link |
So specifically drug consumption,
link |
which isn't all of addiction,
link |
but it's like in order for something to be addictive,
link |
it has to be a reward.
link |
And it has to compete with other rewards in your life.
link |
And one of the two main aspects of addiction in my view,
link |
and this doesn't map onto how the DSM,
link |
the psychiatry Bible defines addiction,
link |
which I think is largely bunk,
link |
but there's some value to have some common description,
link |
but it's how rewarding is it
link |
from this multi dimensional lens?
link |
And specifically, how does that rewarding value compete
link |
with other rewards, other consequences in your life?
link |
So it's not a problem if the use of that substance
link |
Okay, yeah, you like to have a couple of beers
link |
every once in a while, and it's like not a problem.
link |
But then you have the alcoholic who is drinking so much
link |
that it tanks their career, it ruins their marriage.
link |
It's in competition with these pro social aspects
link |
It's all about comparing to the other choices you're making,
link |
the other activities in your life.
link |
And if you evaluate it as a much higher reward
link |
than anything else, that becomes an addiction.
link |
And so it's not just the rewarding value,
link |
but it's the relative rewarding value.
link |
And the other major aspect, again, from behavioral economics,
link |
that the thing that makes addiction
link |
is something called delayed discounting.
link |
So in economics, sometimes it's called time preference.
link |
It's what compound interest rates are based upon.
link |
It's the idea that delaying a good access to a good
link |
or a reward comes with a certain decrement to its value.
link |
So we'd all rather have things now than later.
link |
And we can study this at the individual level of,
link |
would you rather have $9 today or $10 tomorrow?
link |
And when you do that, you get huge differences
link |
between addicted populations and non addicted,
link |
not just heroin and cocaine, but like just cigarette smokers,
link |
like normal everyday cigarette smokers.
link |
And even when you look at something like monetary rewards.
link |
And so you can go into the rabbit hole
link |
with this delayed discounting model.
link |
So it's not only those huge differences
link |
that seem to have a face valid aspect to it.
link |
Like the cigarette smoker is choosing this thing
link |
that's rewarding today,
link |
but I know it comes with increased risk
link |
of having these horrible consequences down the line.
link |
So it's this competition between what's good for me now
link |
and what's good for me later.
link |
And the other aspect about delayed discounting
link |
is that if you quantitatively map out
link |
that discounting curve over time,
link |
so you don't just do that $10 tomorrow,
link |
how much is it worth to you today?
link |
So you can say, what about nine?
link |
And you can titrate it to find that indifference point.
link |
And so we can say, aha, $10 tomorrow is worth $6 today.
link |
So it's by the one day it's decreased by 40%.
link |
We can do that also at one week and one month
link |
and one year and 10 years and map out that curve,
link |
get a shape of that curve.
link |
And one of the fascinating things about this
link |
is that whether you're talking about pigeons,
link |
making these types of choices
link |
between a little bit of food now
link |
or a little bit of food a minute from now or rats,
link |
or like dozens of species of animals tested,
link |
the tendency is pretty consistently
link |
that we discount hyperbolically rather than exponentially.
link |
And what exponentially means is that every unit of time
link |
is associated with the same proportional reduction.
link |
Every unit of delay is associated with the same,
link |
causes the same proportional reduction in value.
link |
And that's the way the compound interest rate works.
link |
Every day you get this sort of out of whatever values
link |
in there at the beginning of that day,
link |
you get this, we'll give you this amount of extra money
link |
to compensate you for that delay.
link |
But then the way that all animals tend to function
link |
is of this very different way where the reductions,
link |
the initial, that initial delay,
link |
so like one day's worth of delay,
link |
you see a much stronger discounting rate
link |
or reduction in value than you do over those.
link |
So you see the super proportional,
link |
then it changes to these lesser rates.
link |
And so the implication of that,
link |
I know I've gone like really into the weeds quantitatively,
link |
but what that means is that
link |
there's these preference reversals.
link |
When you have curves of that nature,
link |
the decay that's hyperbolic,
link |
it maps onto this phenomenon we see
link |
both in terms of how people deal with future rewards,
link |
but also how perception works.
link |
When two things are far away,
link |
whether it's physical distance
link |
or whether in terms of perception
link |
or whether it's in terms of time,
link |
when you're really far away,
link |
the value, the subjective value for that further,
link |
that delayed reward is larger.
link |
So for example, like,
link |
let's say we're talking about 360,
link |
364 days from now, you can get $9 or 365 days a year.
link |
Now you get $10 and you're like,
link |
dude, it's like, it's a year, like no difference.
link |
Like I'll take, why not get one more dollar?
link |
You bring that same exact set of choices closer.
link |
Nothing's changed other than the time to both rewards.
link |
And it's like, would you rather have $9 today
link |
or $10 tomorrow and plenty of people would say,
link |
eh, just about the same, let's go ahead and take it today.
link |
So you see this preference reversal.
link |
And so that's a model of addiction
link |
in the sense that consistently with true addiction,
link |
I would argue, you see this competition
link |
between molar and molecular utility.
link |
It's like interpersonal,
link |
like within the person competing agents.
link |
Someone sometimes has control of the bus
link |
that wants to do what's good for you in the short term.
link |
And someone at other times is in control of driving the bus
link |
and they want to do what's good for you in the long term.
link |
So you tell the, you're trying to quit
link |
and you see a doctor, you see your 12 step therapist
link |
and say, God, I know this stuff is killing me.
link |
Like, I'm really, I'm on the path, like I'm done.
link |
And that's when you're kind of in their office
link |
or wherever you're not, it's not around you.
link |
And then later on that day, your buddy says that,
link |
hey man, I just scored.
link |
I got it right here.
link |
And that reward is right in front of you.
link |
That's like bringing those two choices right in front of you.
link |
And it's like, hell yeah, I want to use.
link |
And then you can go through that cycle for like years
link |
of the person telling themselves, I want to quit.
link |
But then other times that same person is saying,
link |
I don't want to, you know, functionally,
link |
they're saying, I don't want to,
link |
because they're saying, yeah, like, yeah, give me some.
link |
So in the moment, it's very difficult to quit.
link |
And this isn't just something,
link |
this is something that has huge clinical ramifications
link |
with addiction, but it's like all humans do it.
link |
Anyone who's hit the snooze alarm in the morning,
link |
like the night before they realize,
link |
oh, I got to get up extra early tomorrow.
link |
That's what's ultimately better for me.
link |
So I'm going to set the alarm for, you know, 5 a.m.
link |
And it goes off at 5 a.m., you know,
link |
and then, so now those two consequences have come sooner
link |
and it's like, what the hell?
link |
And they hit the snooze alarm.
link |
And sometimes not just once,
link |
but then five minutes later and five minutes later,
link |
you know, and so, and it's why it's easier
link |
to exercise self control at the grocery store
link |
compared to in your fridge.
link |
Like if that snack is like 30 seconds away in your fridge,
link |
you're going to more likely yield to temptation
link |
than if it is further away.
link |
So then just take a step back to something
link |
you brought up earlier, the inelasticity of pricing.
link |
Is it from a perspective of the dealers,
link |
whether we're talking about cigarettes
link |
or maybe venturing slightly into the illegal realm,
link |
you know, of people who sell drugs illegally,
link |
they also have an economics to them
link |
that they set prices and all those kinds of things.
link |
Does addiction allow you to mess with the nature of pricing?
link |
Like, so I kind of assume that you meant
link |
that there's a correlation between things you're addicted to
link |
and the inelasticity of the price.
link |
So you can jack up the price.
link |
Is there something interesting to be said
link |
both for legal drugs and illegal drugs
link |
about the kind of price games you can play
link |
because the consumers of the product are addicted?
link |
Right, I mean, I think you just described it.
link |
Yeah, you can jack up the price
link |
and you know, some people are going to drop off,
link |
but the people, you know, and it's not dichotomous
link |
because you could just consume less,
link |
but some people are going to consume less
link |
and the people that are most addicted are going to keep,
link |
you know, I mean, you see this,
link |
they're going to keep purchasing.
link |
So you see this with cigarettes.
link |
And so it's interesting when you interface this with policy,
link |
like in one respect, heavily taxing cigarettes
link |
We know it keeps adolescents particularly price sensitive.
link |
So you definitely, people smoke less
link |
and especially kids smoke less when you keep
link |
cigarette prices high and you tax the hell out of them.
link |
But one of the downsides you've got to balance
link |
and keep in mind is that you disproportionately
link |
have working class, poor people.
link |
And then you get into a point where someone's spending,
link |
you know, a quarter of their paycheck on cigarettes.
link |
So they're going to smoke no matter what.
link |
And basically because they're addicted,
link |
they're going to smoke no matter what.
link |
And you're just, yeah, you're taxing their existence.
link |
Right, so you're making it worse for them.
link |
If they don't, if they are completely inelastic,
link |
you're actually making that person's life worse.
link |
Because we know that by interfering with the amount
link |
of money they have, you're interfering with the other
link |
pro social, the potential competitors to smoking, you know.
link |
And we know that when someone's in more impoverished
link |
environments and they have less sort of non drug alternatives,
link |
you know, the more likely they're going to stay addicted.
link |
Is there data, this is interesting,
link |
from a scientific perspective of those same kind of games
link |
Sort of, because that's where most drug,
link |
I was, I mean, I don't know, maybe you can correct me,
link |
but it seems like most drugs are currently illegal.
link |
And so, but there's still an economics to them, obviously.
link |
That's the drug war and so on.
link |
Is there data on the setting of prices
link |
or like how good are the business people running
link |
the selling of drugs that are illegal?
link |
Are they all the same kind of rules apply
link |
from a behavioral economics perspective?
link |
I mean, they're basically, whether they're crunching
link |
the numbers or not, they're basically sensitive
link |
to that demand curve and they're doing the same thing
link |
that businesses do in a legal market.
link |
And, you know, you want to sell as much of a product
link |
to get as much money.
link |
You're looking more at the total income.
link |
So if you jack the price a little bit,
link |
you're going to get some reduction in consumption,
link |
but it may be that the total amount of money
link |
that you rake in is going to be more than,
link |
it's going to overcompensate for that.
link |
So you're willing to take,
link |
okay, I'm going to lose 10% of my customers,
link |
but I'm getting more than enough to compensate
link |
from that, from the extra money
link |
from the people who still are buying.
link |
So I think they're more, you know,
link |
and especially when we get to the lower,
link |
I wouldn't be surprised if people are crunching those numbers
link |
and looking at demand curves, maybe at the, you know,
link |
at the really high levels of the, you know,
link |
up the chain with the cartels and whatnot.
link |
I don't know, that wouldn't surprise me at all,
link |
but I think it's probably more implicit
link |
at the lower levels where something,
link |
you brought up drug policy.
link |
I will say that for years now,
link |
it's been this kind of unquestioned goal by, for example,
link |
the drug czar's office in the US
link |
to make the price of illegal drugs as high as possible
link |
without this kind of nuanced approach that,
link |
yeah, if you make, you know,
link |
for some people, if you make the price so high,
link |
you're actually making things worse.
link |
I mean, I'm all about reducing the problems associated
link |
with drugs and drug addictions.
link |
And part of that is the,
link |
are more direct consequences of those drugs themselves,
link |
but a whole lot is what you get from indirectly
link |
and, you know, sort of the,
link |
both for the individual and for society.
link |
So like making a poor person
link |
who doesn't have enough money for their kids,
link |
making them even poorer.
link |
So now you've made their children's future worse
link |
because they're growing up in deeper poverty
link |
because you've essentially levied a tax
link |
onto this person who's heavily addicted.
link |
But then at the societal level, you know,
link |
so everything we know about the drug war
link |
in terms of the heavy criminalization
link |
and filling up prisons and reducing employment
link |
and educational opportunities,
link |
which in the big picture,
link |
we know are the things that in a free market
link |
compete against some of the worst problems of addiction
link |
is actually having educational
link |
and employment opportunities.
link |
But when you give someone a felony, for example,
link |
you're pretty much guaranteeing
link |
they're never gonna go very high on the economic ladder.
link |
And so you're making drugs a better reward
link |
for that person's future.
link |
So this is a quick step into the policy realm.
link |
And I think for both you and I,
link |
I'm not sure you can correct me,
link |
but I'm more comfortable into studying the effects of drugs
link |
on the human behavior and human psychology
link |
versus like policy.
link |
It seems like a whole giant mess,
link |
but yeah, there's some libertarian candidates for president
link |
and just libertarian thinkers
link |
that had a nice thought experiment
link |
of possibly legalizing,
link |
I've spoken about possibly legalizing basically all drugs.
link |
In your intuition,
link |
do you think a world where all drugs are legal
link |
is a safer world or a less safe world
link |
for the users of those drugs?
link |
It really depends on what we mean by legalization.
link |
So this is one of my beefs with this,
link |
how these things are talked about.
link |
I mean, we have very few completely laissez faire,
link |
you know, legal drugs.
link |
So even caffeine is one of the few examples.
link |
So for example, caffeine and tea and coffee is in that realm.
link |
Like there's no limits, no one's testing,
link |
there's no laws, regulation at any level
link |
of how much caffeine you're allowed to buy
link |
or how much is in the product.
link |
But even like with this Starbucks, like nitro,
link |
there are rules with soda and with canned products,
link |
you can only put so much.
link |
So this is FDA regulated.
link |
And it's kind of weird because there's a limit to sodas
link |
that's not there for energy drinks and other things.
link |
But, you know, so even caffeine,
link |
it depends on what product we're talking about.
link |
Like if you're like no dose
link |
and other caffeine products over the counter,
link |
like you can't just put 800 milligrams in there.
link |
The pills are like one or 200 milligrams.
link |
And so it's FDA regulated as an over counter drug.
link |
Some of the most dangerous drugs in society,
link |
I would say arguably one of the most dangerous classes
link |
of drugs is the volatile anesthetics, huffing.
link |
People huffing gasoline and, you know, airplane glue,
link |
toluene, whatnot, severely damaging to the nervous system.
link |
Pretty much legal, but there's some regulation
link |
in the sense that there's a warning label,
link |
like it's illegal to do it for,
link |
not that they're busting people for this,
link |
but, you know, it's against federal law
link |
to use this in a way other than intended type of,
link |
basically saying like, yeah, don't huff this, you know,
link |
your paint thinner or whatnot.
link |
It at least keeps people from selling it for that.
link |
Like, no, because they're gonna go after that person.
link |
They're not gonna be able to find
link |
the 12 year old who's huffing.
link |
So anyway, just as some extreme examples at the end.
link |
And then, you know, even the so called illegal,
link |
like schedule one drugs, psilocybin,
link |
we do plenty in terms of schedule two,
link |
which is ironically less restrictive than psilocybin,
link |
but methamphetamine and cocaine,
link |
I've done human research with.
link |
My research has been legal.
link |
So they're scheduled compounds,
link |
but they're not completely illegal.
link |
Like you can do research with them
link |
with the appropriate licenses and approval.
link |
So there really is no such thing.
link |
And like alcohol, well, it's illegal
link |
if you're 12 years old or 18 years old or 20 years old.
link |
And for anyone, it's illegal to be drinking it
link |
while you're driving.
link |
So there's always a nuance.
link |
It's not dichotomy.
link |
And I actually should admit,
link |
it's been on my to do list for a while
link |
to buy in Massachusetts, some like edible,
link |
or buy weed legally.
link |
Yeah, haven't done that in Massachusetts,
link |
let's put it this way.
link |
And I wonder what that experience is like,
link |
because I think it's fully legal in Massachusetts.
link |
And so I wonder what legal drugs look like to me.
link |
You know, I grew up with even weed being like,
link |
you know, it's like this forbidden thing,
link |
you know, not forbidden, but it's illegal.
link |
You know, most people, of course, I never partook,
link |
but most people I knew would attain it illegally.
link |
And so that big switch that's been happening
link |
across the country, there's like federal stuff going on
link |
to make marijuana legal federally.
link |
I'm half paying attention.
link |
There's some movement there.
link |
I mean, the House passed a bill
link |
that's not gonna be passed by the Senate,
link |
but yeah, it's progress.
link |
There's clearly a change.
link |
Right, it's moving in a trend.
link |
So that's the example of a drug that used to be illegal
link |
is now becoming more and more and more legal.
link |
So like, I wonder what like cocaine being legal looks like,
link |
what a society with cocaine being legal looks like,
link |
the rules around it, you know, the processes
link |
in which you can consume it in a safer way
link |
and be more educated about its consequences,
link |
be able to control dose and like purity much better,
link |
be able to get help for overdose.
link |
I don't know, all those kinds of things.
link |
It does in a utopian sense feel like legalizing drugs
link |
at least should be talked about and considered
link |
versus keeping them in the dark.
link |
But yeah, so that in your sense,
link |
it's possible that in 50 years we legalize all drugs
link |
and it makes for a better world.
link |
The way I like to talk about it is that I would say
link |
that it's possible and it would probably be a good thing
link |
if we regulate all drugs.
link |
How would you regulate like cocaine, for example?
link |
Is there ideas there?
link |
So yeah, and you were already, you know, going, you know,
link |
where I was going with that kind of first I described
link |
how there's always a new ones.
link |
And even like the cannabis in Massachusetts,
link |
federally illegal.
link |
So for example, if I was like, and I, you know,
link |
colleagues that do cannabis research
link |
where they get people high in the lab,
link |
like you're a federal funded researcher with NIH funds,
link |
you can't get that stuff from the dispensary
link |
because you're breaking a federal law.
link |
Even though the feds don't have the resources to go after,
link |
they don't want the controversy at this point
link |
to go after the individual users
link |
or even the sellers in those legal states.
link |
So there's always this nuance,
link |
but it's about the right regulation.
link |
So I think we already know enough that, for example,
link |
like I think safe injection sites for hard drugs
link |
makes a lot of sense.
link |
Like I wouldn't want heroin and cocaine
link |
at the convenience stores.
link |
And I don't think, maybe there's some extreme libertarians
link |
I think even the folks that identify as libertarians,
link |
probably most of them don't, well, I don't know.
link |
Like not all of them want that, you know?
link |
I think, you know, that as a form of regulation,
link |
like, look, if you're using these hard drugs
link |
on a regular basis, you're putting yourself at risk
link |
for lethal overdose.
link |
You're putting yourself at risk for catching HIV
link |
If you're gonna do it, if you're doing it anyway,
link |
come to this place where at least you're not like,
link |
you know, like pulling the water out of like,
link |
you know, the puddle on the side of the street.
link |
Yeah, so it's done by professionals
link |
and those professionals are able to educate you also.
link |
So like a 711 clerk may not be both capable
link |
of helping you to inject the drug properly,
link |
but also won't be equipped to educate you
link |
at the negative consequences, all those kinds of things.
link |
That's a huge part of it, the education.
link |
But then I think with the opioids,
link |
like the big part of it is just like with naloxone,
link |
which is an antagonist, it goes into the receptor,
link |
it's called Narcan, that's the trade name,
link |
but it's what they revive people on an opioid overdose.
link |
That's almost completely effective.
link |
Like if there's a medical professional there
link |
and someone's ODing on an opioid,
link |
they're virtually guaranteed to live.
link |
Like that's remarkable that if 100% at the opioid crisis,
link |
you know, if all of those people right now that are dying
link |
were doing that in the presence of a medical professional,
link |
like even like a nurse with Narcan,
link |
there'd be basically almost no deaths.
link |
There's always some exceptions, but you know,
link |
almost no deaths, like that's staggering to me.
link |
So the idea that people are doing this,
link |
that we could have that level of positive effect
link |
without encouraging the drug.
link |
And this is where like you get into this like terrain
link |
of like sending the wrong message.
link |
And it's like, no, you can do that.
link |
You can say like, we're not encouraging this.
link |
In fact, probably one of the greatest advertisements
link |
for not getting hooked on heroin
link |
is like visiting a methadone clinic,
link |
visiting a safe injection site.
link |
Like this is not like an advertisement
link |
for getting hooked on this drug,
link |
but knowing that we can save people.
link |
Now you have a landscape here
link |
because a lot of times it's just like supervised injection,
link |
but you bring your own stuff, you know,
link |
you bring your own heroin, which could still be, you know,
link |
dirty and filled with fentanyl and fentanyl derivatives,
link |
which because of the incredible potency
link |
and the more difficulty measuring it,
link |
and some differences at the receptor,
link |
like you may be more likely,
link |
you are more likely on average to lethally overdose on it.
link |
You know, so you could,
link |
the level that's been more explored in Switzerland
link |
is in some places is you actually provide the drug itself
link |
and you supervise the injection.
link |
Do you like that idea?
link |
Yeah, the public health data are completely on the side of,
link |
there's really no credible evidence to this.
link |
If we allow that, we're sending the wrong message
link |
and everyone's gonna, I mean, I'm not showing up.
link |
Like, you know, and it's different by drug.
link |
Like, yeah, you legalize, you set up cannabis shops
link |
and some people are gonna say,
link |
so you go, I'm gonna go there.
link |
I don't think a whole lot of people
link |
are gonna go to one of these places
link |
and say, I'm gonna shoot up heroin for the first time.
link |
And even if like, you know,
link |
it's a country of 300 million people,
link |
like even if someone does that,
link |
you have to compare this to the every day
link |
people are dying from opioid overdoses.
link |
Like people's kids, people's uncles,
link |
people's like, these are real lives
link |
that are being shattered.
link |
So you just look at that.
link |
And then the other thing,
link |
and I know this from having done residential,
link |
even like non treatment research,
link |
where we just have a cocaine user or something,
link |
stay on our inpatient ward for a month
link |
and you really get to know them.
link |
And sometimes you see like, oftentimes
link |
that's the first time this person has had a discussion
link |
with a medical professional, any type of professional
link |
in their entire life around their drug use.
link |
Even if they're not looking to quit.
link |
And it's like, you know, you could imagine that
link |
in the safe injection settings where it's like,
link |
it might be a year into treatment and they're like,
link |
you know, doc, I know you're not the cops.
link |
Like you really care for me.
link |
Like, I think I'm ready to try that methadone thing.
link |
I think I'm really, I think I wanna be done.
link |
I'm really patient about it, yeah.
link |
Yeah, they get to trust the people
link |
and realize that they're there
link |
cause they truly like, they have a compassion,
link |
a love for this community, like as human beings,
link |
and they don't want people to die.
link |
And you get real human connections and that,
link |
and again, like those are the conditions
link |
where people are gonna ultimately seek treatment
link |
and not everyone always will, but you're gonna get that.
link |
And then, you know, you're gonna get people
link |
like looking into treatment options sometimes,
link |
you know, maybe it's years into the treatment.
link |
So it's like, they're just all of these indirect benefits
link |
that I think at that level,
link |
I don't know if you'd call that legalizing,
link |
you know, I think again, at least well regulated.
link |
Right, whatever that word is.
link |
Yeah, well regulated, but out in the open.
link |
Right, minimizing as many harms as we can
link |
while not encouraging.
link |
I mean, we don't encourage people to drink all the,
link |
I mean, people die every year from caffeine overdose.
link |
Like, you know, there's different ways to like, you know,
link |
just by allowing something doesn't mean
link |
we're sending the message that, you know,
link |
by saying we're not gonna give you a felony,
link |
which is actually often the penalty for psychedelics.
link |
I just actually testified for the Judiciary Committee
link |
of the Senate, the Assembly in New Jersey.
link |
And just to move psilocybin from a felony to misdemeanor,
link |
they use different language in New Jersey, it's weird,
link |
but like the equivalent of felony and misdemeanor.
link |
And that was like, two people didn't vote for that
link |
on this committee because it was might,
link |
one of them said it might be sending the wrong message.
link |
And it's like, a felony, I mean, there's real harms.
link |
Like, that's the scarlet letter the rest of your life.
link |
You're stuck at the lower ends of the employment ladder.
link |
You're not gonna get, you know, loans for education,
link |
all of this, maybe because of a stupid mistake
link |
you made once as a 19 year old.
link |
Doing something that like, you know,
link |
a presidential candidate could have done and admitted to
link |
and had no problem, you know?
link |
Yeah, what drug is the most addictive,
link |
the most dangerous in your view?
link |
Not maybe, like not technically,
link |
like specifically which drug,
link |
but more like in our society today,
link |
what is a highly problematic drug?
link |
We talked about psychedelics not being that addictive
link |
on the other flip side of that.
link |
You mentioned cocaine, is that the top one?
link |
Is there something else?
link |
That's a concern to you?
link |
It depends, and you've already alluded to this nuance.
link |
It depends on how you define it.
link |
If we're talking about on the ground today,
link |
in, you know, a modern society,
link |
I'd say nicotine, tobacco.
link |
I mean, in terms of mortality,
link |
it kills far more than any other drug known to humankind.
link |
Four times more than alcohol,
link |
like a half million deaths in the US every year
link |
and about five to six million worldwide due to tobacco.
link |
That's four times more in the US than alcohol.
link |
And if you graph all of the drugs, legal and illegal,
link |
like, you know, put all of the illegal drugs
link |
in like one category on that figure,
link |
and you put alcohol and tobacco on that figure,
link |
all the illegal drugs combined,
link |
they're a barely visible blip to this incredible,
link |
like there's no, even all of the opioid epidemic rolled up
link |
along with cocaine and everything else,
link |
the meth barely shows up compared to tobacco.
link |
That's one of those uncomfortable truths
link |
that I don't know what to do with.
link |
It's like where everybody's freaking out
link |
about coronavirus, right?
link |
And nobody's... The relative.
link |
It's all relative.
link |
If you look at the relative thing,
link |
it's like, well, why aren't we freaking out
link |
about cigarettes, which we are increasingly so
link |
over the, historically speaking, right?
link |
Right. It's like terrorism versus swimming pools.
link |
I remember that being back in the,
link |
after the war on terror started.
link |
It's like, yeah, there's not even comparison.
link |
Okay. So, you know, that's a little sobering truth there.
link |
Cause I was thinking like cocaine,
link |
I was thinking about all of these hard drugs,
link |
but the reality is relatively nicotine is the big one.
link |
And you didn't ask about mortality or deaths.
link |
You asked about addiction,
link |
but that really is hard to evaluate.
link |
It gets into those nuances I spoke of before
link |
about there's not a unidimensional way
link |
to measure reinforcement.
link |
It kind of depends on the situation
link |
and what measure we're looking at.
link |
But you know, more people have access to tobacco
link |
and I'm not advocating that we make it an illegal drug.
link |
I think that would be a horrible mistake.
link |
Although there is a very credible push
link |
to mandate the reduction of nicotine in cigarettes,
link |
which I have most scientists that study it are for it.
link |
I think there's some real dangers there
link |
cause I see that in the broader history of drug use.
link |
It's like when has drug prohibition worked broadly speaking?
link |
And it's to me that path would only make sense
link |
in very good conjunction with eCigarettes,
link |
which once they're fully regulated can be a safer,
link |
not safe, but much safer alternative.
link |
And if we tax the hell out of eCigarettes
link |
and ban every attractive feature
link |
like flavors and everything,
link |
then that's gonna push people to a black market
link |
if they can't get the real thing from real cigarette.
link |
Like some people will just quit straight out.
link |
But I think with the regulators
link |
and what a lot of scientists that study tobacco,
link |
like myself, it's a big part still of what I study.
link |
They're not used to thinking about the like tobacco really
link |
as a drug largely speaking in terms of,
link |
for example, the history of prohibition.
link |
And I think of like,
link |
we already know there's an illicit market,
link |
a black market for tobacco to get around taxes.
link |
I mean, and for selling even loose cigarettes,
link |
that's what initially caused in Staten Island
link |
the police to approach Eric Garland
link |
who was selling loose cigarettes and he got choked out.
link |
I mean, the thing that caused that police contact
link |
was he was selling, well, I think reported
link |
to sell individual cigarettes for like,
link |
he gets home for court, it happens in Baltimore.
link |
And it's like, that's technically illegal.
link |
But are you not gonna have massive boats
link |
of supplies coming over from China and elsewhere
link |
of real deal cigarettes if you ban the sale of nicotine?
link |
Like it's obviously gonna happen.
link |
And you have to weigh that against,
link |
you're gonna create a black market to one size or another.
link |
And your intuition that really hasn't worked
link |
throughout the history when we've tried it.
link |
Right, but I see a potential path forward,
link |
but only if it's well,
link |
if it's not in conjunction with eCigarettes.
link |
If there's a clear alternative,
link |
that's a positive alternative
link |
that it kind of stares the population towards an alternative.
link |
The difference here, the unique thing
link |
that could be taken advantage of here
link |
is nicotine is by and large, not what causes the harm.
link |
It's the aromatic hydrocarbons,
link |
it's the carcinogens and tobacco,
link |
it's burning tobacco smoke, it's not the nicotine.
link |
So it's not like alcohol prohibition
link |
where like you couldn't create the O'Douls,
link |
the near beer is not gonna have the alcohol.
link |
And so people like, here you do have the possibility
link |
of giving another medium the ability to deliver the drug,
link |
which still aren't to a lot of people
link |
isn't preferred to the tobacco, but nonetheless,
link |
again, if you overregulate those
link |
and make them less attractive,
link |
like if you aren't thoughtful about the nicotine limits
link |
and thoughtful about whether you're allowing flavors
link |
and everything, and if you overtax them,
link |
you're actually decreasing the ability to compete
link |
with the more dangerous products.
link |
So I feel like there is a potential path forward,
link |
but I don't have a lot of confidence
link |
that that's gonna be done in a thoughtful analytical way.
link |
And I'm afraid that it could decrease the increase
link |
of black market calls all of the harms.
link |
Like every other drug we're moving away from the prohibition
link |
model slowly, but the big barge ship
link |
is like making a very slow turn.
link |
And like, okay, we really had to step back
link |
and question if we went with nicotine, tobacco,
link |
are we moving into that direction?
link |
It doesn't quite make sense.
link |
You've done a study on cocaine and sexual decision making.
link |
Can you explain the findings?
link |
I mean, in a broad sense, how do you do a study
link |
that involves cocaine and the other,
link |
how do you do a study involving sexual decision making?
link |
And then how do you do a study that combines both?
link |
Yeah, sex and drugs too.
link |
I'm just missing the rock and roll.
link |
It's like the two controversial,
link |
rock and roll isn't very controversial anymore.
link |
Yeah, so the cocaine, lots of hoops to jump through.
link |
You gotta have a lot of medical support.
link |
You gotta be at a basically an institution,
link |
a research unit like I'm at that has a long history
link |
and the ability to do that and get ethics approval,
link |
get FDA approval, but it's possible.
link |
And whenever you're dealing with something like cocaine,
link |
you would never wanna give that to someone
link |
who hasn't already used cocaine.
link |
And you wanna make sure you're not giving it to someone
link |
who is an active user who wants to quit.
link |
So the idea is like, okay,
link |
if you're using this type of drug anyway,
link |
and we're really sure you're not looking to quit,
link |
hey, use a couple of times in the lab with us
link |
so we can at least learn something.
link |
And part of what we learn is maybe to help people not use
link |
and it'll reduce the harms of cocaine.
link |
So there's hoops to jump through.
link |
With the sexual decision making,
link |
I looked at the main thing I looked at was this model
link |
of I applied delayed discounting
link |
to what we talked about earlier, the now versus later,
link |
that kind of decision making that goes along with addiction.
link |
I applied that to condom use decisions.
link |
And I've done probably published about 20 or so papers
link |
with this and different drugs.
link |
So the primary metric is whether you do
link |
or don't use a condom?
link |
Right, and so this is using hypothetical decision making,
link |
but I've published some studies looking at,
link |
showing a tight correspondence to self report it
link |
in correlational studies to self reported behavior.
link |
So this is like, so like how do you,
link |
did you do a questionnaire kind of thing?
link |
Right, so it's not quite a questionnaire,
link |
but it's a behavioral task requiring them to respond to.
link |
So you show pictures of a bunch of individuals
link |
and it's kind of like one of these fun behavioral,
link |
like a lot of them you get like numbers are boring,
link |
but it's like, okay, hot or not,
link |
like which of these 60 people
link |
would you have a one night stand with?
link |
Men, women, so pick whatever you like,
link |
a little bit of this, a little bit of that,
link |
whatever you're into, it's all variety there.
link |
Out of that group, you pick some subsets of people.
link |
Who do you think is the one you most want to have sex
link |
with the least, he thinks most likely to have an STI
link |
or least likely a sexually transmitted disease by STI.
link |
And then you could do certain decision making questions.
link |
So what I've done is asked,
link |
say this person you read a vignette,
link |
this person wants to have sex with you now you've met them,
link |
you get along casual sex scenario,
link |
like a one night stand with a condoms available,
link |
just rate your likelihood from one to 100
link |
on this kind of scale, would you use it?
link |
But then you can change your scenario to say,
link |
okay, now imagine you have to wait five minutes
link |
So the choice is now instead of using condom
link |
versus not in terms of your likelihood scale,
link |
it now what ranges from have sex now without a condom
link |
versus on the other end of the scale
link |
is wait five minutes to have sex with a condom.
link |
So you rate your likelihood of where your behavior
link |
would be along that continuum.
link |
And then you could say, okay, well, what about an hour?
link |
What about three hours?
link |
What about 24 hours?
link |
Misunderstanding, now without a condom
link |
or five minutes later with a condom?
link |
So what's supposed to be the preference for the person?
link |
There's a lot of factors coming into play, right?
link |
There's like pleasure, a personal preference
link |
and then there's also the safety.
link |
Those are two like, are those competing objectives?
link |
Right, and so we do get at that
link |
through some individual measures
link |
and this task is more of a face valid task
link |
where there's a lot underneath the hood.
link |
So for most people, sex with the condom is the better reward
link |
but underneath the hood of that
link |
is just at the purely physical level,
link |
they'd rather have sex without the condom.
link |
It's gonna feel better.
link |
What do you mean by reward?
link |
Like when they calculate their trajectory through life
link |
and try to optimize it,
link |
then sex with the condom is a good idea?
link |
Well, it's really based on, I mean, yeah, yeah.
link |
Presumably that's the case that there's,
link |
but it's measured by like what would you,
link |
really that first question where there is no delay.
link |
Most people say they would be at the higher end scale
link |
a lot of times 100% they would say
link |
they would definitely use a condom.
link |
Not everybody and that we know that's the case.
link |
See, it's like that some people don't like condoms,
link |
some people say, yeah, I wanna use a condom
link |
but quarter of the time ended up not
link |
because I just getting lost in the passion of the moment.
link |
So for the people, I mean, the only reason that people,
link |
so behaviorally speaking,
link |
at least for a large number of people
link |
in many circumstances condom use as a reinforcer
link |
just because people do it.
link |
Like, why are they doing it?
link |
They're not because it makes the sex feel better
link |
but because it makes that it allows
link |
for at least the same general reward.
link |
Even if actually, even if it feels a little bit
link |
not as good with the condom, nonetheless,
link |
they get most of the benefit without the concurrent,
link |
oh my gosh, there's this risk of either unwanted pregnancy
link |
or getting HIV or way more likely than HIV,
link |
herpes in general awards, et cetera, all the lovely ones.
link |
And we've actually done research saying like
link |
where we gauge the probability
link |
of these individual different SDIs.
link |
And it's like, what's the heavy hitter
link |
in terms of what people are using to judge
link |
and to evaluate whether they're gonna use a condom.
link |
So that's why the condom use is the delayed thing,
link |
five minutes or more.
link |
And then, yeah, because that's the prefer.
link |
Which would normally be the larger later reward
link |
like the $10 versus the nine, it's like the $10,
link |
which is counterintuitive
link |
if you just think about the physical pleasure.
link |
So that's a good thing to measure.
link |
So condom use is a really good concrete,
link |
quantifiable thing that you can use in a study.
link |
And then you can add a lot of different elements
link |
like the presence of cocaine and so on.
link |
Yeah, you can get people loaded on like any number of drugs
link |
like cocaine, alcohol and methamphetamine
link |
are the three that I've done and published on.
link |
And it's interesting that.
link |
These are fun studies, man.
link |
Right, I love to get people loaded in a safe context
link |
and like, but to really, it started,
link |
like there was some early research with alcohol.
link |
I mean, the psychedelics are the most interesting,
link |
but it's like all of these drugs are fascinating.
link |
The fact that all of these are keys
link |
that unlock a certain like psychological experience
link |
And so there was this work with alcohol
link |
that showed that it didn't affect those monetary
link |
delay discounting decisions,
link |
$9 now versus $10 later.
link |
And I'm like getting people drunk.
link |
And I thought to myself, are you telling me
link |
that getting someone,
link |
that people being drunk does not cause people
link |
at least sometimes to make,
link |
to choose what's good for them in the short term
link |
at the expense of what's good for them in the long term.
link |
It's like, bullshit, like we see like,
link |
but in what context does that happen?
link |
So that's something that inspired me to go
link |
in this direction of like, aha, risky sexual decisions
link |
is something they do when they're drunk.
link |
They don't necessarily go home.
link |
And even though some people have gambling problems
link |
and alcohol interacts with that,
link |
the most typical thing is not for people to go home,
link |
log on and change their allocation
link |
in their retirement account or something like that.
link |
But they're more likely, risky sexual decisions,
link |
they're more likely to not wait the five minutes
link |
for the condom and instead go no condom now.
link |
Right, that's a big effect.
link |
And interestingly, we do not see,
link |
with those different drugs, we don't see an effect
link |
if we just look at that zero delay condition.
link |
In other words, the condoms right there waiting to be used,
link |
how likely are to use it?
link |
I mean, people are by and large gonna use the condom.
link |
So, and that's the way most of this research
link |
outside of behavioral economics
link |
that just looked at condom use decisions,
link |
very little of which has ever actually administered
link |
the drugs, which is another unique aspect.
link |
But they usually just look at like assuming
link |
the condom is there.
link |
But this is more using behavioral economics
link |
to delve in and model something that,
link |
and I've done survey research on this,
link |
modeling what actually happens.
link |
Like you meet someone at a laundromat,
link |
like you weren't planning on like,
link |
and it's like one thing leads to another,
link |
they live around the corner, these things.
link |
And like we did one survey with men who have sex with men
link |
and found that 25% of them, 24%, about a quarter,
link |
reported in the last six months
link |
that they had unprotected anal intercourse,
link |
which is the most risky
link |
in terms of sexually transmitted infection.
link |
In the last six months, in a situation
link |
where they would have used a condom,
link |
but they simply didn't use one
link |
just because they didn't have one on them.
link |
So this to me, it's like,
link |
if unless we delve into this and understand this,
link |
these suboptimal conditions,
link |
we're not gonna fully address the problem.
link |
There's plenty of people that say,
link |
yep, condom use is good.
link |
I use it a lot of the time.
link |
It's like, where is that failing?
link |
And it's under these suboptimal conditions,
link |
which in Frank, if you think about it,
link |
it's like most of the case.
link |
Action is unfolding, things are getting hot and heavy.
link |
Someone's like, do you got a condom?
link |
It's like, do they break the action
link |
and take 10 minutes to go to the convenience store
link |
Maybe everything's closed.
link |
Maybe they gotta wait till tomorrow.
link |
And there's something to be studied there on the,
link |
that just seems like an unfortunate set of circumstances.
link |
Like, what's the solution to that is,
link |
I mean, what's the psychology
link |
that needs to be taken apart there?
link |
Because it just seems like that's the way of life.
link |
We don't expect the things to happen.
link |
Are we supposed to expect them better
link |
to be self aware enough about our calculations?
link |
Or you see the 10 minute detour to a convenience store
link |
as a kind of thing that we need to understand
link |
how we humans evaluate the cost of that.
link |
I think in terms of like how we use this to help people,
link |
it's mostly on the environment side,
link |
rather than on the individual side.
link |
Yeah, although those interact.
link |
So it's like, in one sense, if you're,
link |
especially if you're gonna be drinking
link |
or using another substance that is associated
link |
with a stimulant, alcohol and stimulants
link |
go along with risky sex.
link |
Good to be aware that you might make decisions
link |
just to tell yourself you might make a decision
link |
that you wouldn't have made in your sober state.
link |
And so, hey, throwing a condom in the purse,
link |
in the pocket, might be a good idea.
link |
I think at the environmental level,
link |
just more condom, I mean, it highlights what we know
link |
about just making condoms widely available.
link |
Something that I'd like to do
link |
is like reinforcing condom use.
link |
So just getting people used to carrying a condom
link |
everywhere they go.
link |
Because once it's in someone's habit,
link |
if they are, say, like a young, single person,
link |
and they occasionally have unprotected sex,
link |
like training those people,
link |
like what if you got a text message
link |
once every few days saying,
link |
ah, if you send back a photo of a condom,
link |
within a minute you get a reward of $5.
link |
You could shape that up like that.
link |
It's a process called contingency management.
link |
It's basically just straight up operant reinforcement.
link |
You could shape that up with no problem.
link |
And I mean, those procedures of contingency management,
link |
giving people systematic rewards is like,
link |
for example, the most powerful way
link |
to reduce cocaine use in addicted people.
link |
And by saying, if you show me a negative urine for cocaine,
link |
I'm gonna give you a monetary reward.
link |
And like that has huge effects
link |
in terms of decreasing cocaine use.
link |
If that can be that powerful
link |
for something like stopping cocaine use,
link |
how powerful could that be for shaping up
link |
just carrying a condom?
link |
Because the primary, unlike cocaine use,
link |
here, we're not saying you can't have the main reward,
link |
like you could still have sex,
link |
and you can even have sex in the way
link |
that you tell yourself you'd rather do it
link |
if the condom is available.
link |
Relatively speaking, it's way easier
link |
than like not using cocaine if you like using cocaine.
link |
It's just basically getting in the habit
link |
of carrying a condom.
link |
So that's just one idea of like why.
link |
There could be also the capitalistic solutions
link |
of like, there could be a business opportunity
link |
for like a door dash for condoms.
link |
I thought about this.
link |
Within five minute delivery of a condom at any location,
link |
like Uber for condoms.
link |
I've thought about it, not with condoms,
link |
but a very similar line of thinking,
link |
a line that you're going into in terms of Uber
link |
and people getting drunk when they enter the bar
link |
playing to have one or two,
link |
they ended up having five or six,
link |
and it's like, okay, yeah, you can take the cab home,
link |
the Uber home, but you've left your car there.
link |
It might get towed.
link |
You might like, there's also the hassle of just,
link |
you wanna wake up tomorrow with your hangover
link |
and forget about it and move on.
link |
And I think a lot of people in their situation,
link |
they're like, screw it.
link |
I'm gonna take the risk, just get it.
link |
What if you had an Uber service where two,
link |
you have a car come out with two drivers
link |
and one of them, two sober drivers, obviously,
link |
and the person, the one driver drops off the other
link |
that then drives you home in their car, in your car,
link |
so that you can, I mean,
link |
I think a lot of people would pay 50 bucks.
link |
It's gonna be more than a regular Uber,
link |
but it's like, it's gonna be done.
link |
I already spent 60 bucks at the bar tonight.
link |
Like, just get the damn thing done tomorrow.
link |
I wake up, my car's in front of my house.
link |
I think that would be, I think someone could,
link |
I'm not gonna open that business,
link |
so if anyone hears this and wants to take off with that,
link |
I think it could help a lot of people.
link |
And Uber itself, I would say,
link |
helped a huge amount of people,
link |
just making it easy to make the decision
link |
of going home, not driving yourself.
link |
I read about in Austin where they,
link |
I don't know where it's at now,
link |
where they outlawed Uber for a while.
link |
You know, because of the whole taxicab union type thing
link |
and how just, yeah, there were like hordes of drunk people
link |
that were used to Uber
link |
that now didn't have a cheap alternative.
link |
So just, we didn't exactly mention,
link |
you've done a lot of studies in sexual decision making
link |
with different drugs.
link |
Is there some interesting insights or findings
link |
on the difference between the different drugs?
link |
So I think you said meth as well.
link |
So cocaine, is there some interesting characteristics
link |
about decision making that these drugs alter
link |
versus like alcohol, all those kinds of things?
link |
I think, and there's much more to study with this,
link |
but I think the biggie there is that the stimulants,
link |
they create risky sex by really increasing
link |
the rewarding value of sex.
link |
Like if you talk to people that are really,
link |
especially that are hooked on stimulants,
link |
one of the biggies is like sex on coke or meth
link |
is like so much better than sex without.
link |
And that's a big part of why they have trouble quitting
link |
because it's so tied to their sex life.
link |
So it's not that your decision making is broken,
link |
it's just that you, well, you allocate.
link |
It's a different aspect of their decision.
link |
Yeah, on the reward side.
link |
I think on the alcohol, it works more through disinhibition.
link |
It's like, alcohol is really good at reducing the ability
link |
of a delayed punisher to have an effect on current behavior.
link |
In other words, there's this bad thing
link |
that's gonna happen tomorrow or a week from now
link |
or 20 years from now.
link |
Being drunk is a really good way,
link |
and you see this in like rats making decisions.
link |
A high dose of alcohol makes someone less sensitive
link |
to those consequences.
link |
So I think that's the lever that's being hit with alcohol
link |
and it's the more, just the increasing the rewarding value
link |
of sex by the psycho stimulants on that side.
link |
We actually found that it, and it was amazing
link |
because like hundreds of millions of dollars have been spent
link |
by NIH to study the connection between cocaine and HIV.
link |
Like we ran the first study on my grant
link |
that like actually just gave people cocaine
link |
under double blind conditions and showed that like,
link |
yeah, when people are on coke,
link |
like their ratings of sexual desire,
link |
even though they're not in a sexual situation,
link |
yeah, you've shown them some pictures,
link |
but they're just saying they're horny.
link |
Like you get subjective ratings
link |
of like how much sexual desire are you feeling right now.
link |
People get horny when they're on stimulants.
link |
And a lot of people say, duh,
link |
if they really know these drugs.
link |
But that's a rigorous study that's in the lab
link |
that shows like there's a plot.
link |
Right, the dose effects of that, the time course of that.
link |
Yeah, it's not just.
link |
Can you please tell me there's a paper with a plot
link |
that shows dose versus evaluation of like horniness.
link |
Yeah, we didn't say horniness.
link |
We said sexual arousal, yeah, basically, yeah.
link |
There's a plot, I'm gonna find this plot.
link |
Right, I'll send it to you.
link |
There was one headline from some publicity on the work
link |
that said, horny cocaine users don't use condoms
link |
or something like that.
link |
You gotta love journalism.
link |
I wouldn't have put it that way, but like, yeah, that's right.
link |
I guess that's what it finds.
link |
So you've published a bunch of studies on psychedelics.
link |
Is there some especially favorite insightful findings
link |
from some of these that you could talk about?
link |
So maybe favorite studies or just something
link |
that pops to mind in terms of both the goals
link |
and like the major insights gained
link |
and maybe the side little curiosities
link |
that you discovered along the way.
link |
Yeah, I think of the work with like using psilocybin
link |
to help people quit smoking.
link |
And we've talked about smoking being such a serious addiction
link |
and so that what inspired me to get into that
link |
was just kind of having like behavioral psychology
link |
as my primary lens, sort of this sort of like,
link |
you know, kind of radical empirical basis of,
link |
I'm really interested in the mystical experience
link |
and all of these reports, very interested.
link |
And, but at the same time, I'm like, okay,
link |
let's get down to some behavior change
link |
and something that we can record,
link |
like quantitatively verify biologically.
link |
So find all kinds of negative behaviors
link |
that people practice and see if we can turn those
link |
into positive or change their behavior.
link |
Right, like really change it, not just people saying,
link |
which again is interesting, I'm not dismissing it,
link |
but folks that say my life has turned around,
link |
I feel this has completely changed me.
link |
It's like, yep, that's good.
link |
All right, let's see if we can harness that and test that.
link |
And just something that's real behavior change.
link |
You know what I mean?
link |
It's quantifiable.
link |
It's like, okay, you've been smoking for 30 years,
link |
you know, like that's a real thing.
link |
And you've tried a dozen times, like seriously to quit
link |
and you haven't been able to long term, like, okay.
link |
And if you quit, like we'll ask you and I'll believe you,
link |
but I don't trust everyone reading the paper to believe you.
link |
So we're gonna have you pee in a cup and we'll test that.
link |
And we'll have you blow into this little machine
link |
that measures carbon monoxide and we'll test that.
link |
So multiple levels of biological verification.
link |
Like now we're getting like,
link |
to me that's where the rubber meets the road
link |
in terms of like therapeutics.
link |
It's like, can we really shift behavior?
link |
And since, and so much as we've talked about
link |
my other scientific work outside of psychedelics
link |
is about understanding addiction and drug use.
link |
So it's like, you know, looking at addiction,
link |
it's a no brainer and smoking is just a great example.
link |
And so back to your question,
link |
like we've had really high success rates.
link |
I mean, it really, it rivals anything that's been published
link |
in the scientific literature.
link |
The caveat is that, you know,
link |
that's based on our initial trial of only 15 people,
link |
but extremely high longterm success rates,
link |
80% at six months per smoke free.
link |
So can we discuss the details of this?
link |
So first of all, which psychedelic are we talking about?
link |
And maybe can you talk about the 15 people
link |
and how the study ran and what you found?
link |
So the drug we're using is psilocybin
link |
and we're using moderately high and high doses of psilocybin.
link |
And I should say this about most of our work,
link |
these are not kind of museum level doses.
link |
In other words, nothing,
link |
even big fans of psychedelics wanna take
link |
and go to a concert or go to the museum.
link |
If someone's at Burning Man on this type of dose,
link |
like they're probably gonna wanna find their way back
link |
to their tent and zip up and hunker down
link |
for, you know, not be around strangers.
link |
By the way, the delivery method,
link |
so psilocybin is mushrooms, I guess.
link |
What's the usual, is it edible?
link |
Is there some other way?
link |
Like, how is people supposed to think
link |
about the correct dosing of these things?
link |
Cause I've heard that it's hard to dose correctly.
link |
So in our studies, we use the pure compound psilocybin.
link |
So it's a single molecule, you know, a bunch of molecules.
link |
And we give them a capsule with that in it.
link |
And so it's just, you know, a little capsule, they swallow.
link |
What people, when psilocybin is used outside of research,
link |
it's always in the context of mushrooms
link |
cause they're so easy to grow.
link |
There's no market for synthetic psilocybin.
link |
There's no reason for that to pop up.
link |
The high dose that we use in research is 30 milligrams,
link |
body weight adjusted.
link |
So if you're a heavier person,
link |
it might be like 40 or even 50 milligrams.
link |
We have some data that, based on that data,
link |
we're actually moving into like getting away
link |
from the body weight adjusting of the dose
link |
and just giving an absolute dose.
link |
It seems like there's no justification
link |
for the body weight based dosing, but I digress.
link |
Generally 30, 40 milligrams, it's a high dose.
link |
And based on average, even though, as you alluded to,
link |
there's variability, which gets people into some trouble
link |
in terms of mushrooms, like psilocybe cubensis,
link |
which is the most common species
link |
in the illicit market in the US.
link |
This is about equivalent to five dried grams,
link |
which is right at about where McKenna and others,
link |
they call it a heroic dose.
link |
This is not hanging out with your friends,
link |
going to the concert again.
link |
So this is a real deal dose, even to people that really,
link |
just even to psychonauts.
link |
And we've even had a number of studies.
link |
Yeah, people that, yeah, astronaut or cosmonaut,
link |
like for psychedelics.
link |
Yeah, going as far out as possible.
link |
But even for them, even for those
link |
who've flown to space before.
link |
Right, right, they're like, holy shit,
link |
I didn't know the orbit would be that far out.
link |
Or I escaped the orbit, I was in interplanetary space there.
link |
So these folks, the 15 folks in the study,
link |
there's not a question of dose being too low
link |
to truly have an impact.
link |
Right, right, out of hundreds of volunteers over the years,
link |
we've only seen a couple of people
link |
where there was a mild effect of the 30 milligrams.
link |
And who knows, that person's, their serotonins,
link |
they might have lesser density
link |
of serotonin 2A receptors or something, we don't know.
link |
But it's extremely rare.
link |
For most people, this is like something interesting
link |
is gonna happen, put it that way.
link |
Speaking of Joe Rogan, I think that Jamie,
link |
his producer, is immune to psychedelics.
link |
So maybe he's a good recruit for the study to test.
link |
So that's interesting.
link |
Now I'm not, the caveat is I'm not encouraging
link |
anything illicit, but just theoretically,
link |
my first question as a behavioral pharmacologist
link |
is like, you know, increase the dose.
link |
You know, like really, let's see the full dose.
link |
I'm not telling him, Jamie, to do that,
link |
but like, okay, like, you know,
link |
you're taking the same amount
link |
that friends might be taking, but yeah.
link |
But he was also referring to the psychedelic effects
link |
of edible marijuana, which is,
link |
is there rules on dosage for like marijuana?
link |
Like what place where it's, this is, this all goes,
link |
it probably is state by state, right?
link |
It is, but most, they've gone that direction
link |
in states that didn't initially have these rules
link |
have now have them.
link |
So it was like, you'll get, I think, you know,
link |
five, 10 mil, I think 10, five or 10 milligrams of THC
link |
being a common, and like, and this is an important thing,
link |
like where they've moved from not being allowed to say,
link |
like have a whole candy bar
link |
and have each of the eight or 10 squares
link |
on the candy bar being 10 milligrams,
link |
but it's like, no, the whole thing,
link |
because like, you know, someone gets a candy bar,
link |
they're eating the freaking candy bar.
link |
And it's like, unless you're a daily cannabis user,
link |
if you take, you know, a hundred milligrams,
link |
it's like, that's what could lead to a bad trip for someone.
link |
And it's like, you know, a lot of these people,
link |
it's like, oh, you used to smoke a little weed in college,
link |
they might say they're visiting Denver
link |
for a business trip and they're like, why not?
link |
Let's give it a shot, you know?
link |
And they're like, oh, I don't want to smoke something
link |
because it's going to, so I'm going to be safer
link |
with this edible, they might consume this massive,
link |
you know, but there's huge tolerance.
link |
So a regular, like for someone who's smoking weed every day,
link |
they might take five milligrams
link |
and kind of hardly feel anything.
link |
And they may really need something like 30, 40, 50 milligrams
link |
to have a strong effect.
link |
But yeah, so they've evolved in terms of the rules
link |
about like, okay, what constitutes a dose, you know?
link |
Which is why you see less big candy bars and more,
link |
or if it is a whole candy bar,
link |
you're only getting a smaller dose like 10 milligrams or,
link |
yeah, because that's where people get in trouble
link |
more often with edibles.
link |
Yeah, except Joey Diaz, which I've heard.
link |
That's definitely somebody I want to talk to
link |
out of the crazy comedians I want to talk to as well.
link |
Anyway, so yeah, the study of the 15
link |
and the dose not being a question.
link |
So like, what was the recruitment based on?
link |
What was the, like, how did the study get conducted?
link |
Yeah, so the recruitment, and I really liked this fact,
link |
it wasn't people that, you know, largely were, you know,
link |
we were honest about what we were studying,
link |
but for most people, it was,
link |
they were in the category of like, you know,
link |
not particularly interested in psychedelics,
link |
but more of like, they want to quit smoking.
link |
They've tried everything but the kitchen sink.
link |
And this sounds like the kitchen sink.
link |
You know, and it's like, well, it's Hopkins.
link |
So, you know, thinking that sounds like it's safe enough.
link |
So like, what the hell, let's give it a shot.
link |
Like most of them were in that category,
link |
which I really, you know, I appreciate
link |
because it's more of a test, you know, of, yeah,
link |
just like a better model of what,
link |
if these are approved as medicines,
link |
like what you're going to have the average participant,
link |
you know, be like.
link |
And so the therapy involves a good amount
link |
of non psilocybin sessions, of preparatory sessions,
link |
like eight hours of getting to know the person,
link |
like the two people who are going to be their guides
link |
or the person in the room with them during the experience,
link |
having these discussions with them
link |
where you're both kind of rapport building,
link |
just kind of discussing their life, getting to know them,
link |
but then also telling them, preparing them
link |
about the psilocybin experience.
link |
Oh, it could be scary in this sense,
link |
but here's how to handle it, trust, let go, be open.
link |
And also during that preparation time,
link |
preparing them to quit smoking,
link |
using really standard bread and butter techniques
link |
that can all fall under the label typically
link |
of the cognitive behavioral therapy,
link |
just stuff like before you quit,
link |
we assign a target quit date ahead of time,
link |
you're not just quitting on the fly.
link |
And that happens to be the target quit date
link |
in our study was the day
link |
where they got the first psilocybin dose,
link |
but doing things like keeping a smoking diary,
link |
like, okay, during the three weeks until you quit,
link |
every time you smoke a cigarette,
link |
just like jot down what you're doing,
link |
what you're feeling, what situation, that type of thing.
link |
And then having some discussion around that
link |
and then going over the pluses and minuses in their life
link |
that smoking kind of comes with
link |
and being honest about the, this is what it does for me,
link |
this is why I like it, this is why I don't like it.
link |
Preparing for like, what if you do slip, how to handle it,
link |
like don't dwell on guilt
link |
because that leads to more full on relapse,
link |
just kind of treat it as a learning experience,
link |
that type of thing.
link |
Then you have the session day where they come in,
link |
five minutes of questionnaires,
link |
but pretty much they jump into the,
link |
we touch base with them and we give them the capsule.
link |
It's a serious setting, but a comfortable one.
link |
They're in a room that looks more like a living room
link |
than like a research lab.
link |
We measure their blood pressure, their experience,
link |
but kind of minimal kind of medical vibe to it.
link |
And they lay down on a couch
link |
and it's a purposefully an introspective experience.
link |
So they're laying on a couch
link |
during most of the five to six hour experience
link |
and they're wearing eye shades,
link |
which is a better connotation as a name than blindfold.
link |
But like, yeah, so they're wearing eye shades,
link |
but that's, and they're wearing headphones
link |
through which music is played, mostly classical,
link |
although we've done some variation of that.
link |
I have a paper that was recently accepted
link |
kind of comparing it to more like gongs
link |
and harmonic bowls and that type of thing,
link |
kind of like sound, you know, kind of.
link |
You've also added this to the science
link |
and have a paper on the musical accompaniment
link |
to the psychedelic experience, that's fascinating.
link |
Right, and we found basically that about the same effect,
link |
even by a trend, not significant,
link |
but a little bit better of an effect,
link |
both in terms of subjective experience and longterm,
link |
whether it helped people quit smoking,
link |
just a little tiny non significant trend
link |
even favoring the novel playlist
link |
with the Tibetan singing bowls and the gongs
link |
and didgeridoo and all of that.
link |
And so anyway, just saying, okay,
link |
we can deviate a little bit from this,
link |
like what goes back to the 1950s of this method
link |
of using classical music as part of this psychedelic therapy,
link |
but they're listening to the music
link |
and they're not playing DJ in real time.
link |
You know, it's like, you know, they're just,
link |
be the baby, you're not the decision maker for today,
link |
go inward, trust, let go, be open.
link |
And pretty much the only interaction,
link |
like that we're there for is to deal
link |
with any anxiety that comes up.
link |
So guide is kind of a misnomer in a sense.
link |
It's, we're more of a safety net.
link |
And so like, tell us if you feel some butterflies
link |
that we can provide reassurance,
link |
a hold of their hand can be very powerful.
link |
I've had people tell me that that was like the thing
link |
that really just grounded them.
link |
Can you break apart trust, let go, be open?
link |
What, so in a sense,
link |
how would you describe the experience,
link |
the intellectual and the emotional approach
link |
that people are supposed to take
link |
to really let go into the experience?
link |
Yeah, so trust is, trust the context,
link |
you know, trust the guides,
link |
trust the overall institutional context.
link |
I see it as layers of like safety,
link |
even though it's everything I told you
link |
about the relative bodily safety of psilocybin.
link |
Nonetheless, we're still getting blood pressure
link |
throughout the session, just in case.
link |
We have a physician on hand who can respond just in case.
link |
We're literally across the street
link |
from the emergency department, just in case.
link |
You know, all of that, you know.
link |
Privacy is another thing you've talked about
link |
is just trusting that you're,
link |
and whatever happens is just between you
link |
and the people in the study.
link |
Right, and hopefully they've really gotten that
link |
by that point deep into the study
link |
that like they realize where do we take that seriously
link |
and everything else, you know.
link |
And so it's really kind of like a very special role
link |
that you're playing as a researcher or a guide
link |
and hopefully they have your trust.
link |
And so, you know, and trust that they could be as emotional,
link |
everything from laughter to tears,
link |
like that's gonna be welcomed.
link |
We're not judging them.
link |
It's like, it's a therapeutic relationship
link |
where, you know, this is a safe container.
link |
It's a safe space.
link |
It's a lot of baggage to that term,
link |
but it truly is, it's a safe space for that,
link |
for this type of experience and to let go.
link |
So trust, let's see, let go.
link |
So that relates to the emotional, like,
link |
you feel like crying, cry.
link |
You feel like laughing your ass off, laugh your ass off.
link |
You know, it's like all the things actually
link |
that sometimes it's more challenging
link |
with someone has a large recreational use,
link |
sometimes it's harder for them
link |
because people in that context, and understandably so,
link |
it's more about holding your shit.
link |
Someone's had a bunch of mushrooms at a party.
link |
Maybe they don't wanna go into the back room
link |
and start crying about these thoughts
link |
about the relationship with their mother.
link |
And they don't wanna be the drama queen or king
link |
that bring their friends down
link |
because their friends are having an experience too.
link |
And so they wanna like compose, you know.
link |
And also just the appearance in social settings
link |
versus the, so like prioritizing how you appear to others
link |
versus the prioritizing the depth of the experience.
link |
And here in the study, you can prioritize the experience.
link |
Right, and it's all about, like you're the astronaut
link |
and there's only one astronaut.
link |
We're ground control.
link |
And I use this often with,
link |
I have a photo of the space shuttle on a plaque
link |
in my office and I kind of often use that as an example.
link |
And it's like, we're here for you.
link |
Like we're a team, but we have different roles.
link |
It's just like, you don't have to like compose yourself.
link |
Like you don't have to like be concerned about our safety.
link |
Like we're playing these roles today.
link |
And like, yeah, your job is to go as deep as possible
link |
or as far out, whatever your analogy is, like as possible.
link |
And we're keeping you safe.
link |
And so, yeah, and the emotional side is a hard one
link |
because you really want people to,
link |
like if they go into realms of subjectively
link |
of despair and sorrow, like, yeah, like cry, it's okay.
link |
And especially if someone's more macho
link |
and you want this to be the place where they can let go.
link |
And again, something that they wouldn't or shouldn't do
link |
if someone were to theoretically use it
link |
in a social setting.
link |
And like, and also these other things,
link |
like even that you get in those social settings of like,
link |
yeah, you don't have to like worry about your wallet
link |
for being taken advantage or especially for a woman
link |
sexually assaulted by some creep at a concert or something.
link |
Cause they're, you know, they're laying down,
link |
There's like a million sources of anxiety
link |
that are external versus internal.
link |
So you can just focus on your own,
link |
like the beautiful thing that's going on in your mind.
link |
And even the cops at that layer,
link |
even though it's extremely unlikely for most people
link |
that cops would come in and bust them right when,
link |
like even at that theoretical,
link |
like that one in a billion chance,
link |
like that might be a real thing psychologically.
link |
In this context, we even got that covered.
link |
This is, we've got DEA approval.
link |
Like you are, this is okay by every level of society
link |
that counts, you know, that has the authority.
link |
So it's, so go deep, trust the, you know, trust the setting,
link |
trust yourself, you know, let go and be open.
link |
So in the experience, and this is all subjective
link |
and by analogy, but like, if there's a door, open it,
link |
If there's a stairwell, go down it or a stairway, go up it.
link |
If there's a monster in the mind's eye, you know,
link |
don't run, approach it, look in the eye and say, you know,
link |
Yeah, what's up, what are you doing here?
link |
Let's talk Turkey, you know?
link |
Dave Goggins entered the chat, okay.
link |
Right, right, it really is that,
link |
that really is a heart of it, this radical courage.
link |
People are often struck by that coming out.
link |
Like this is heavy lifting, this is a hard work.
link |
People come out of this exhausted and it can be extremely,
link |
some people say it's the most difficult thing
link |
they've done in their life.
link |
Like choosing to let go on a moment,
link |
a microsecond by microsecond basis.
link |
Everything in their inclination is to say stop,
link |
sometimes stop this, I don't like this,
link |
I didn't know it was gonna be like this, this is too much.
link |
And Terrence McKenna put it this way,
link |
it's like comparing to meditation and other techniques,
link |
it's like spending years trying to press the accelerator
link |
to make something happen.
link |
High dose psychedelics is like you're speeding down
link |
the mountain in a fully loaded semi truck
link |
and you're charged with not slamming the brake.
link |
It's like, let it happen.
link |
So it's very difficult and to engage,
link |
always go further into it and take that radical,
link |
radical courage throughout.
link |
What do they say in self report?
link |
If you can put general words to it,
link |
what is their experience like?
link |
What do they say it's like?
link |
Because these are many people, like you said,
link |
that haven't probably read much about psychedelics
link |
or they don't have like with Joe Rogan,
link |
like language or stories to put on it.
link |
So this is very raw self report of experiences.
link |
What do they say the experience is like?
link |
Yeah, and some more so than others,
link |
cause everyone has been exposed at some level or another,
link |
but some it is pretty superficial as you're saying.
link |
One of the hallmarks of psychedelics
link |
is just their variability.
link |
So I'm more stressed, it's like not the mean,
link |
but the standard deviation is so wide that it's like,
link |
it could be like hellish experiences
link |
and just absolutely beautiful and loving experiences,
link |
everything in between and both of those,
link |
like those could be two minutes apart from each other.
link |
And sometimes kind of at the same time concurrently.
link |
So let's see, there's different ways to,
link |
there were some Jungian psychologists back in the 60s,
link |
masters in Houston that wrote a really good book,
link |
The Varieties of Psychedelic Experience,
link |
which is a play on varieties of religious experience
link |
by William James, that they described this,
link |
a perceptual level.
link |
So most people have that when,
link |
whether they're looking at the room without the eyeshades on
link |
or inside their mind's eye with the eyeshades on,
link |
colors, sounds like this,
link |
it's a much richer sensorium,
link |
which can be very interesting.
link |
And then at another level, a master's in Houston
link |
called it the psychodynamic level.
link |
And I think you could think about it more broadly than,
link |
that's kind of Jungian,
link |
but just the personal psychological levels,
link |
how I think of it, like this is about your life.
link |
There's a whole life review.
link |
Oftentimes people have thoughts about their childhood,
link |
about their relationships, their spouse or partner,
link |
their children, their parents, their family of origin,
link |
their current family, that stuff comes up a lot,
link |
including people just pouring with tears
link |
about how much, it hits them so hard
link |
how much they love people.
link |
Like in a way, for people that they'd love their family,
link |
but it just hits them so hard that how important this is
link |
and the magnitude of that love
link |
and what that means in their life.
link |
So those are some of the most moving experiences
link |
to be present for is where people like it hits home,
link |
like what really matters in their life.
link |
And then you have this sort of what masters in Houston
link |
called the archetypal realm,
link |
which again is sort of Jungian with the focus on archetypes,
link |
which is interesting,
link |
but I think of that more generally as like symbolic level.
link |
So just really deep experiences where you have,
link |
you do have experiences that seem symbolic of,
link |
very much in like what we know about dreaming
link |
and what most people think about dreaming,
link |
like there's this randomness of things,
link |
but sometimes it's pretty clear in retrospect,
link |
oh, like this came up
link |
because this thing has been on my mind recently.
link |
So it seems to be, there seems to be this symbolic level.
link |
And then they have this,
link |
the last level that they describe
link |
is the mystical integral level,
link |
which this is where there's lots of terms for it,
link |
but transcendental experiences, experiences of unity,
link |
mystical type effects we often measure.
link |
Europeans use a scale
link |
that will refer to oceanic boundlessness.
link |
This is all pretty much the same thing.
link |
This is like at some sense,
link |
the deepest level of the very sense of self
link |
seems to be dissolved, minimize, or expanded,
link |
such that the boundaries of the self go into in here.
link |
I think some of this is just semantics,
link |
but whether the self is expanding
link |
such that there's no boundary between the self
link |
and the rest of the universe,
link |
or whether there's no sense of self,
link |
again, might be just semantics,
link |
but this radical shift or sense of loss
link |
of sense of self or self boundaries.
link |
And that's like the most,
link |
typically when people have that experience,
link |
they'll often report that as being the most remarkable thing.
link |
And this is what you don't typically get with MDMA,
link |
these deepest levels of the nature of reality itself,
link |
the subjectivity and objectivity,
link |
just like the seer and the seen become one,
link |
and it's a process, and yeah.
link |
And they're able to bring that experience back
link |
and be able to describe it?
link |
Yeah, but one of the, to a degree,
link |
but one of the hallmarks going back to William James
link |
of describing a mystical experience is the ineffability.
link |
And so even though it's ineffable,
link |
people try as far as they can to describe it,
link |
but when you get the real deal, they'll say,
link |
and even though they say a lot of helpful things
link |
to help you describe the landscape,
link |
they'll say, no matter what I say,
link |
I'm still not even coming anywhere close to what this was.
link |
Like the language is completely failing.
link |
And I like to joke that even though it's ineffable,
link |
and we're researchers,
link |
so we try to eff it up
link |
by asking them to describe the experience.
link |
I love it, it's a good one.
link |
But to bring it back a little bit,
link |
so for that particular study on tobacco,
link |
what was the results, what was the conclusions
link |
in terms of the impact of psilocybin on their addiction?
link |
So in that pilot study, it was very small
link |
and it wasn't a randomized study, so it was limited.
link |
The only question we could really answer was,
link |
is this worthy enough of followup?
link |
And the answer to that was absolutely,
link |
because the success rates were so high,
link |
80% biologically confirmed successful at six months,
link |
that held up to 60% biologically confirmed abstinent
link |
at an average of two and a half years, a very long fall.
link |
Yeah, and so, I mean, the best that's been reported
link |
in the literature for smoking cessation
link |
is in the upper 50%, and that's with not one,
link |
but two medications for a couple of months,
link |
followed by regular cognitive behavioral therapy,
link |
where you're coming in once a week or once every few weeks
link |
for an entire year.
link |
And so it was very heavy.
link |
This is just like a few uses of psilocybin?
link |
So this was three doses of psilocybin
link |
over a total course, including preparation, everything,
link |
a 15 week period, where there's mainly like,
link |
for most part, one meeting a week,
link |
and then the three sessions are within that.
link |
And so it's, and we scaled that back
link |
in the more, the study we're doing right now,
link |
which I can tell you about,
link |
which is a randomized controlled trial.
link |
But it's, yeah, the original pilot study
link |
was these 15 people.
link |
So given the positive signal from the first study
link |
telling us that it was a worthy pursuit,
link |
we hustled up some money
link |
to actually be able to afford a larger trial.
link |
So it's randomizing 80 people
link |
to get either one psilocybin session,
link |
we've scaled that down from three to one,
link |
mainly because we're doing fMRI neuroimaging
link |
and it made it more experimentally complex
link |
to have multiple sessions.
link |
But one psilocybin session versus the nicotine patch
link |
using the FDA approved label,
link |
like standard use of the nicotine patch.
link |
So it's randomized, 40 people get randomized to psilocybin,
link |
one session, 40 people get nicotine patch.
link |
And they all get the same cognitive behavioral therapy
link |
sort of the standard talk therapy.
link |
And we've scaled it down somewhat,
link |
so there's less weekly meetings,
link |
but it's within the same ballpark.
link |
And right now we're still,
link |
the study's still ongoing.
link |
And in fact, we just recently started recruiting again,
link |
we paused for COVID.
link |
Now we're starting back up with some protections
link |
like masks and whatnot.
link |
But right now for the 44 people
link |
who have gotten through the one year followup,
link |
and so that includes 22 from each of the two groups,
link |
the success rates are extremely high.
link |
For the psilocybin group,
link |
it's 59% have been biologically confirmed as smoke free
link |
at one year after their quit date.
link |
And that compares to 27% for the nicotine patch,
link |
which by the way is extremely good for the nicotine patch
link |
compared to previous research.
link |
So the results could change because it's ongoing,
link |
but we're mostly done
link |
and it's still looking extremely positive.
link |
So if anyone's interested,
link |
they have to be sort of be in commuting distance
link |
to the Baltimore area, but you know.
link |
Right, right, to participate.
link |
This is a good moment to bring up something.
link |
I think a lot of what you talked about is super interesting.
link |
And I think a lot of people listening to this,
link |
so now it's anywhere from 300 to 600,000 people
link |
for just a regular podcast.
link |
I know a lot of them will be very interested
link |
in what you're saying and they're going to look you up.
link |
They're going to find your email
link |
and they're going to write you a long email
link |
about some of the interesting things they've found
link |
in any of your papers.
link |
How should people contact you?
link |
What is the best way for that?
link |
Would you recommend?
link |
You're a super busy guy.
link |
You have a million things going on.
link |
How should people communicate with you?
link |
Thanks for bringing this up.
link |
This is a, I'm glad to get the opportunity to address this.
link |
If someone's interested in participating in a study,
link |
the best thing to do is go to the website.
link |
Of the study or of like, yeah, which website?
link |
So we have all of our psilocybin studies.
link |
So everything we have is up on one website
link |
and then we link to the different study websites,
link |
but hopkinspsychedelic.org.
link |
So everything we do, or if you don't remember that,
link |
just go to your favorite search engine
link |
and look up Johns Hopkins Psychedelic
link |
and you're going to find one of the first hits
link |
is going to be our, is this website.
link |
And there's going to be links to the smoking study
link |
and all of our other studies.
link |
If there's no link to it there,
link |
we don't have a study on it now.
link |
And if you're interested in psychedelic research more broadly,
link |
you can look up, like at another university
link |
that might be closer to you.
link |
And there's a handful of them now across the country.
link |
And there's some in Europe that have studies going on,
link |
but you can, at least in the US,
link |
you can look at clinicaltrials.gov
link |
and look up the term psilocybin.
link |
And in fact, optionally people even in Europe
link |
can register their trial on there.
link |
So that's a good way to find studies.
link |
But for our research, rather than emailing me,
link |
like a more efficient way is to go straight
link |
and you can do that first, the first phase of screening.
link |
There's some questions online
link |
and then someone will get back in touch with you.
link |
But I do already, you know,
link |
and I expect it's like going to increase,
link |
but I'm already at the level where my simple limited mind
link |
and limited capacity is already,
link |
I sometimes fail to get back to emails.
link |
I mean, I'm trying to respond to my colleagues,
link |
my mentees, all these things, my responsibilities.
link |
And as many of the people just inquiring
link |
about I wanna go to graduate school,
link |
I'm interested in this, I had this,
link |
I have a daughter that took a psychedelic
link |
and she's having trouble.
link |
And it's like, I try to respond to those,
link |
but sometimes I just simply can't get to all of it already.
link |
To be honest, like from my perspective,
link |
it's been quite heartbreaking
link |
because I basically don't respond to any emails anymore.
link |
And especially as you mentioned mentees and so on,
link |
like outside of that circle,
link |
it's heartbreaking to me how many brilliant people
link |
there are, thoughtful people, like loving people.
link |
And they write long emails that are really,
link |
by the way, I do read them very often.
link |
It's just that I don't,
link |
the response is then you're starting a conversation.
link |
And the heartbreaking aspect is you only have
link |
so many hours in the day to have deep,
link |
meaningful conversations with human beings on this earth.
link |
And so you have to select who they are.
link |
And usually it's your family,
link |
it's people like you're directly working with.
link |
And even I guarantee you with this conversation,
link |
people will write you long, really thoughtful emails.
link |
Like there'll be brilliant people,
link |
faculty from all over, PhD students from all over.
link |
And it's heartbreaking
link |
because you can't really get back to them.
link |
But you're saying like many of them,
link |
if you do respond, it's more like here,
link |
go to this website when you're interested into the study,
link |
just it makes sense to directly go to the site
link |
if there's applications open, just apply for the study.
link |
Right, right, right, as either a volunteer
link |
or if we're looking for somebody,
link |
we're gonna be posting,
link |
including on the Hopkins University website,
link |
we're gonna be posting if we're looking for a position.
link |
I am right now actually looking through
link |
and it's mainly been through email and contacts,
link |
but should I say it?