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Comment by NeuroCoder | Hacker News Reader

Beginning of my MD PhD program a guy who was big in that field and tried small scale trials gave a whole schpill about how big pharma was unfairly blocking this. Then I spent over an hour talking to him about it. This field has a huge challenge finding a consistent and reproducible outcome to aim for. When I pressed the guy he was pretty clear that there were participants in these studies that has pretty bad outcomes and would have been in bad shape if there wasnt a medical team on hand.

Im sure we will find a use for this someday but research has to do more than prove it is sometimes good for people. We need to know how to consistently identify those people who need it and the outcome desired.

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> When I pressed the guy he was pretty clear that there were participants in these studies that has pretty bad outcomes and would have been in bad shape if there wasnt a medical team on hand

Are you aware of source-able examples of this?

I’ve been paying attention to the field for awhile, and I was under the impression that between pre-screening (people at risk for psychosis and a few other specific psychiatric issues should not participate), and proper set/setting, negative outcomes have been rare, and there is a high percentage of extremely positive outcomes.

TBH Id have to dig into my notes more than I care to now, but recall looking up his and his coauthors research at the time and the verbage was very similar to what you described. But that's kind of the point. Requiring a specific controlled setting with a medical team and someone to guide the individual through throughout the process is a lot of work to require for "good" outcomes.

The only time you can expect a drug will get approval without large reproduction of quantifiable outcomes is treating some aspect of a rare disease.

> Requiring a specific controlled setting with a medical team and someone to guide the individual through throughout the process is a lot of work to require for "good" outcomes.

Honestly this sounds like an incredibly small amount of work when considering the work involved in traditional therapy and/or psychiatric treatment, which plays out on a timescale of years if not an entire lifetime for some, and collectively requires a “medical team” numerous times.

And when the outcomes involve radical (lasting) improvement to everyday experience for individuals with treatment-resistant depression, I strongly question the urge to trivialize this with scare quotes about “good” experiences and their apparent cost.

> The only time you can expect a drug will get approval without large reproduction of quantifiable outcomes is treating some aspect of a rare disease

The good news is that there’s been quite a bit of progress, and growing interest in medical circles due to the positive outcomes. I’d strongly recommend looking at the latest studies/results; it sounds like you may be operating on some very dated information.

I apologize if what I shared sounded like a "scare quote". I was just responding to the question about whether this will be an available diagnosable drug anytime soon. It is really unlikely and there are some basic intuitive reasons why without going deep into any research.

Also, I didn't say I was unaware of anything in this field recently. I was replying to the specific individuals' research I mentioned earlier. I've seen plenty meta analyses and case studies but you need way more for this to be a viable medical prescription.

Finally, none of what I said is a statement on my opinion about whether this should be adopted or pursued more aggressively in medicine. You'd have a hard time finding anyone that wouldn't agree that prevention would be cheaper in the long run but that's not what you need to prove to a hospital system and the FDA. You need to have multiple phases of clinical trials and then convince a medical system that addition dedicated clinics are worth setting up for this.

I guess I just couldn't understand the position you were taking when framing this as a "lot of work". It sounded like you were dismissing it casually, and if that was a misread, I appreciate the clarification.

There's a certain common form of hostility that often emerges from some circles when this subject comes up, and I may have read into something that's not there.

Yes, this needs trials. Yes, that's what's in progress right now. And the results so far are worthy of attention.

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