Please enjoy this transcript of a special episode of The Tim Ferriss Show in which I am interviewed by two experts on several topics I’ve both studied and supported, including psychedelic-assisted psychotherapy and what it can do to heal trauma and—broadly speaking—possible futures for mental health. The audio was recorded on a new show, The Psychedelic News Hour, soon to be a podcast, and I’m in conversation with two people: David Rabin, MD, PhD, (@drdavidrabin), a board-certified psychiatrist and neuroscientist, executive director of The Board of Medicine, and co-founder of Apollo Neuroscience, and Molly Maloof, MD (@drmolly.co), a physician, Stanford lecturer, and ketamine-assisted psychotherapist.
Transcripts may contain a few typos. With some episodes lasting 2+ hours, it can be difficult to catch minor errors.
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This interview was transcribed by Rev.com.
Dr. David Rabin: Welcome back to another Psychedelic News Hour on Clubhouse. We are so, so thankful and grateful to have all of you join us here again today. I’m Dr. Dave Rabin. I’m a psychiatrist and neuroscientist, as well as a ketamine assisted psychotherapist and an MDMA assisted psychotherapist. And I’m joined by my co-host, Dr. Molly Maloof, who is also a physician and a ketamine assisted psychotherapist. And we are very excited and humbled to bring to you our very special guest this week. He has done some incredible work in the psychedelic research space and investment space, and the mental health space actually, which is where I think all of this ties together.
One of the things that we often forget about, and I really wanted to tell you this, Tim, for a long time, because I’ve been following your work and I’m so grateful for the fact that you’ve done two major things that I think have really radically transformed the landscape of mental health in this country. And it’s not just mental health. We’re really talking about health. Because part of the problem with health, looking at mental health in the US and in the Western paradigm is we separate mental health and physical health, where they’re really just health.
Mental health left unchecked over time causes physical health problems. And physical health left unchecked over time can cause mental health problems. And we know that this is the case. And you had the courage a while back to come out and actually talk about your experiences with mental health in public. And to have these conversations and bring them to the forefront of our community, so that other people could feel no longer afraid to start to have these conversations. And I think that as a psychiatrist, as somebody who does psychedelic work, and Molly too, I speak for both of us when I say that we could not be more grateful.
And I don’t think the field of mental health could be more grateful to you. And we should probably do, in terms of the field, we should probably do a better job of showing that gratitude because you’ve really helped people help de-stigmatize trauma and de-stigmatize mental illness, so that people can feel comfortable talking about this in public settings. And just more often in general, which is really the first step along the healing process. And then you’ve transformed that by taking the next step and actually putting money, and putting resources and encouraging others to put resources into the research development and commercialization of these powerful tools that were also stigmatized heavily, that now can be used to do something that we never thought we could do in mental health.
Which is tell someone that it’s possible that there could be a cure for what you’re experiencing right now. And we may not be there yet, but we’re closer than we’ve possibly ever been. And I just want to take this moment to thank you for all of your hard work and everything you’ve done to help facilitate this cause and to really share joy with the world of people who are suffering right now. So, thank you.
Tim Ferriss: Thank you very much. I feel, as someone who’s spent decades in darkness, experiencing many of the conditions that these compounds may have the capability to treat, and believing them as many even in psychiatry currently believe them to be intractable or at the very best treated with some type of suppression of symptoms, it’s an honor for me to play whatever small role that I can. And it’s also a moral imperative, I feel. It’s been an incredible journey in every respect of the word. I’m hoping to continue to be a supporter and catalyst to the extent that I can. So thank you for saying all of that.
Dr. David Rabin: Well, in speaking of that journey, I think we would be remiss if we did not start out by giving you the opportunity to update everyone on Clubhouse, who was not a party to the incredible announcement by MAPS that you and Joe Green played such an important role in recently. Would you mind telling everyone a little bit about Capstone and the great success that that has been, that was announced yesterday?
Tim Ferriss: My pleasure. There’s a piece that does a good job of summarizing this in the Wall Street Journal. It is online. And by Shalini Ramachandran, which has the headline, “Silicon Valley and Wall Street Elites Pour Money Into Psychedelic Research.” And the subtitle gets closer to the summary, which is donors raised 30 million for psychedelic nonprofit, that’s MAPS, to complete clinical trials, phase three trials, around drug assisted psychotherapy for trauma. That’s MDMA, assisted psychotherapy for post traumatic stress disorder. So certainly trauma of many different types. Whether that’s war veterans, first responders, victims of sexual abuse or otherwise. Any type of abuse, certainly. And the Capstone campaign was… It’s funny to say it in the past tense now.
Dr. David Rabin: Yeah.
Tim Ferriss: The capstone campaign was a campaign to raise the $30 million necessary to complete phase three trials of MDMA, otherwise known as ecstasy. I think it’s methylenedioxy methamphetamine, in the amplified psychotherapeutic treatment of PTSD. And it’s very important to emphasize that this is not phase three trials for MDMA as a standalone treatment. It is the combination of context and molecule, which is extremely, extremely important, as I’m sure you’ve discussed previously in these meetings. And $30 million is, or would have been even three years ago, an almost unthinkable amount of money, an unattainable amount of money to raise for this. As [crosstalk 00:06:53] would also say —
Dr. David Rabin: … I was going to say, it took Rick almost what, like almost 30 years to raise the first 30 million?
Tim Ferriss: Yeah. Yeah, exactly. A handful of years ago, the number of people contributing or just committing seven figures to psychedelic research would have been a handful. And that has changed a lot in the last two years. I think that’s a credit to Rick. I think it’s a credit to many things. And the increased de-stigmatization of supporting the scientific research. There are many things one can support within the realm of, let’s call it psychedelics or psychedelic science, which I think is part of the reason there’s a lot of scattered focus. And historically in some cases, a lack of results. It’s because you can go a millimeter in a million directions very easily if you don’t focus.
But in this case, the piece summarized some very notable names who have contributed a lot. And what I would like to personally underscore about this is that there were donors and donations made from $1 all the way up to five million. And there were more than 2,500 donors, including probably many people listening to this, who put their trust after reading or hearing what they evaluated into supporting this. And every donor mattered. And the number of donors to me is just as important as the number of dollars raised, because it signals to me a real phase shift in the cultural conversation about these compounds.
And we don’t have to revisit the sort of historical mistakes that were made in say the ’60s, nor the cultural context then, which is very different from the cultural context now. But I think it’s very exciting that more and more people are realizing that it is actually an incredible reputational opportunity to align yourself with exploring these unconventional treatments for extremely expensive, sometimes fatal, often paralyzing conditions that we seem utterly unable to treat properly via other means currently. So the fact that we have such an incredibly low toxicity profile for, if we’re talking about MDMA and psilocybin specifically, because let’s not forget that there are hundreds and thousands of what we could call psychedelic compounds. But among those, two that have received breakthrough therapy designation by the FDA with vast amounts of data to support their clinical use have incredible safety profiles, low toxicity. Certainly, you’re going to find many more people in emergency rooms because of acetaminophen, Tylenol, which can be incredibly toxic compared to any of these. And the fact that they have the results they appear to have.
If you look at say, phase two data from MAPS, would lead one to believe either that people are lying, right?—they’re misrepresenting the results, they cannot be true, or something is happening that defies any conventional psychiatric or psychological explanation for how the brain changes and how thoughts and thought patterns change—the capability of humans to rewrite their software, to rewrite the stories they tell themselves with incredible durability of effect, right? In the case of MDMA or psilocybin, I’d say Hopkins, you’re looking at one to three total treatment sessions with durability of various effects, six months, 12 months, 18 months later. That is more interesting to me than just about anything else I could possibly focus on. So I’ll stop my monologue there.
Dr. David Rabin: You’re absolutely right, Tim. It’s phenomenal. It really demonstrates or highlights what we’re seeing as this paradigm shift, complete paradigm shift in mental illness. And I can say as a Western trained psychiatrist, we’re taught that to tell people that you prescribe medicine or therapy, and you tell people that the studies show that if they discontinue medicine or discontinue therapy at any time, that their chances of relapse go up and the severity of their relapses will likely go up. And what we’re seeing from MDMA, for those who are not familiar with the phase two trial results, is that with people who have had treatment or resistant PTSD for an average of 17 years, something like 53% are no longer meeting diagnostic criteria after just three doses of MDMA and 12 weeks of psychotherapy, as you were saying. And what’s even more remarkable is five years out, without any more subsequent treatment, 67% of these people are no longer meeting diagnostic criteria.
And from having trained in the MDMA protocol and the ketamine assisted psychotherapy protocol, which were very, very similar. I can tell you that my perspective on this, which I think is very similar to a lot of the practitioners who work in this area, is that the reason why this works so differently is because we’re actually teaching people how to heal themselves. We’re reminding them of this innate, as Mike and Annie Mithoefer say, the inner healing intelligence that we were all born with, has the capacity to be reactivated when we recognize that it’s there. And this allows us an opportunity to start to heal ourselves. Because the center of our healing, we now recognize, comes from within us, not from some pill that we have to take every day and not from some person we have to see every week, but actually from within ourselves, which is so remarkable.
Tim Ferriss: It is. And I want to underscore something you said, or two names you mentioned, Annie and Michael Mithoefer, who are incredible practitioners. I should say, therapists. And who have helped define and formalize the format for the psychotherapy that is assisted by MDMA in these mass trials. And I do, whenever I can, try to play the role of conservative voice in media related to psychedelics, because I do not view psychedelics as panacea. I do not think they’re suitable for all people. And it’s very easy to throw the baby out with the bath water by viewing psychiatry as it exists or therapy as it exists as obsolete.
And I think that’s a huge mistake, because the results that are achieved are I think in many cases dependent on tools from therapy or psychiatry. Like internal family systems, IFS, parts work. These types of conversations when conducted, this type of self inquiry, when aided by a therapist with the empathogen, let’s just call it, of MDMA, something that generates empathy not just towards others, but that can be directed at the self, within the self, is incredibly potent. And it is the combination. It is the combination. This is why if you go to an EDM festival, it’s not automatic that 1,000 people on ecstasy are resolving all of their childhood trauma. It just doesn’t work that way.
Nor does every pothead who tries, and all due respect to potheads, but any pothead in college who tries mushrooms once doesn’t automatically stop smoking. But on the other side, when you look at the nicotine addiction studies that have been done, with proper planning, format support, and integration and follow up by say Dr. Matt Johnson at Hopkins, the results are staggering. They are literally staggering. So I just wanted to take that opportunity to indicate that we can borrow best practices from psychiatry and therapy, and effectively put them on performance enhancing drugs by adding some of these compounds with the right safety profiles. And certainly ketamine is of interest to me as well.
Dr. Molly Maloof: Yeah. I love everything you guys are saying, because the thing that we’ve always emphasized in the News Hour is it’s just fundamentally important that people recognize that the best outcomes come from therapy plus medicine. But I’m curious to both of you guys, just to ask from both of you, because I know you’re probably even more well versed than I am on all the research, even though I’ve read through quite a lot of it. Do you guys want to explain to the audience how these studies have been performed? Assume that there’s some scientists out there in the audience, I’m sure there’s some people that are questioning and wondering about, okay, so how was this study done? Was there a control of just medicine or a control of just therapy? Can you teach people a little bit about how this has been performed, so that people kind of get a better understanding of the specific research?
Tim Ferriss: Yeah. I’m happy to share one aspect of it. That is a very valid and important part of the conversation. And then I’d love to hand the mic off, because I am on the line with two doctors, and I am most certainly not a doctor and do not play one on the internet. But have spent a lot of time looking at, and being involved with the study design, just as a funder of a lot of this research. Because you have to pick and choose your targets. You have to pick and choose your study design very, very carefully. You don’t get an infinite number of investments for leverage in science, just like you don’t get it in business. These things cost a lot of money and they take a lot of time. So you have to really think about your parameters from the outset.
Well, let me give the short answer first. Yes, these are placebo controlled, randomized studies. And the intervention, the active intervention, let’s just say MDMA, is contrasted with a placebo combined with the same therapy, the same therapeutic approach. The placebo effect is the most consistent, powerful effect across all of medicine. So we need to take it very seriously. And there are entire books written about placebo and nocebo, which is the opposite of that, where you can negate the, say, pharmacological intervention by believing that it doesn’t work, which is just as crazy, if you begin to think about it, yet real. And blinding and including placebo in psychedelic studies is remarkably challenging, because it is very quickly obvious to almost everyone, whether or not they have been given a psychedelic, even if they have had no prior exposure, if they do enough reading and so on.
Rick would be much more qualified to talk about this, but there are ways to use what one might deem an active placebo to create a physiologic effect, physiological effect. Such as by using something like niacin, where you have skin flushing, the so-called niacin flush. And these types of active placebos can be used, I think particularly well with respect to MDMA. It is more challenging when you are using what we might consider a classic psychedelic with strong visionary or visual components, such as psilocybin. But I would love to pass the mic because that’s where I feel like I start wading into the deep end of my ignorance pool. So I’d prefer to defer to the experts.
Dr. David Rabin: Yeah. Thank you so much for that, Tim. I think you covered the great majority of it actually. And I think bringing up placebo and nocebo, and the importance of those things is really critical. Because I think what a lot of people don’t understand is a placebo and nocebo are really having a factor in the study design that takes into account the power of belief in our treatments. So placebo is really about, is really a matter of saying in a Western scientific lingo, that if you believe a treatment is going to work for you, then it’s going to work. It’s more like 30-50% of the time, more likely to work if you believe in it. These are the numbers roughly for mental health studies. And for nocebo, I think the numbers are actually a little higher. Which means if you believe that a treatment will not work for you, it is 30-50% less likely to work. Which is really fascinating.
That is really the power of the mind in the healing process, right? Getting back to what we were talking about before, is using this combination of psychotherapy to enable or amplify the power of the medicine. And in turn, using the medicine in the case of MDMA, to catalyze the radical safety and radical healing potential for psychotherapy to facilitate these incredible healing experiences with people that are really rooted in intention and belief. Which goes back to a lot of the tribal history of how traditional psilocybin and cactus ceremonies and ayahuasca ceremonies are performed.
It’s all about intention to heal and curating a safe space for that intention to manifest in healing. And that you can see that consistently when you look in how these MDMA trials are put together, it really pulls that intentionality that is rooted in these traditional tribal cultures in their ancient healing practices that are, who knows, probably five, ten, twenty thousand years old. It pulls those in as best as we can into a Western paradigm, that’s double blinded, and placebo controlled and randomized. Where subjects get this incredible 12 weeks of psychotherapy protocol. But the results for people going through, just to compare, I said earlier of the people who have 17 years plus on average of treatment resistant PTSD, in the MAPS phase two trial with MDMA, what we saw was that two months after this treatment wrapped up in the active group that actually received MDMA—and again, these were crossover studies, so all the subjects got MDMA eventually, but there were also groups of subjects that only got, or they got placebo first and some groups got placebo second, which is, typically in these studies, and correct me if I’m wrong, I believe it was low dose MDMA, which was not critical enough to hit the threshold… MDMA is a really interesting molecule because it’s… You have to hit a threshold to be able to get the active effect, which makes MDMA probably the worst medicine to microdose, because it has a paradoxical effect where you kind of don’t feel good if you take too little of a dose and you don’t hit that threshold peak dose, which is somewhere between 80 and 120 milligrams for most people. And so, they use that as the placebo. But what’s really interesting is that in these people who had 17 years on average of treatment resistant PTSD, we see that 53% who had the active MDMA, two months out are no longer meeting diagnostic criteria for PTSD.
I believe that in the placebo group that only received the sub therapeutic dose of MDMA, what we saw was something like 20 something percent. I think it was like 25 or 27% were no longer meeting diagnostic criteria. Which is actually pretty amazing, because that means that the therapy alone, this 12 weeks of intensive therapy with two therapists, is actually very powerful at helping people. But then you go and look at the five year followup data, which is really where it counts. And what you see is the people who did not get MDMA at five years out, they did not continue to get better.
In fact, many of the 27% that were no longer meeting symptom criteria at the end of that first 12 weeks actually relapsed and ultimately had a recurrence of PTSD symptoms. Whereas, more people who got MTMA were symptom free or not meeting diagnostic criteria five years out, than were at two months out. Which then goes to continuously reinforce this idea that the medicine and the therapy, and the intention to heal are facilitating this radically transformative experience that allows people to remember how to heal themselves. Which is just such an incredible opportunity in mental health. We’ve really never seen anything like this before.
Dr. Molly Maloof: I think it’s super interesting, just to tie this up, that if you look at the esketamine research, this drug came along by J & J, and it was frankly, just not a very good drug. Because it’s not much better than regular ketamine. And they didn’t combine it with any therapy. And doctors aren’t really using it that much, especially the doctors in the ketamine space. Because it’s basically designed to just go to the clinic, take the medicine and go home. And that’s what’s so inspiring about this MAPS research is by its design, it’s combining these two therapeutic modalities in order to create the best effects longterm.
Tim Ferriss: Yeah. And one way to think about it. Let me back into that. So I should say, which is something that might be surprising to people, and that is to most people who ask me, should I do X? Fill in the blank. Should I use psilocybin? Should I use DMT? Should I use ayahuasca? Should I use MDMA? Generally speaking, I would say 90 plus percent of the time, after I ask a few follow up questions, my answer is no. Which might be surprising to people, given how public I am about supporting the research. And the reason for that is pretty simple.
I think that there’s a lot of preparation you can do to increase the odds of a very good outcome. Much like if you’re going to bet in a casino, you should probably read a few books beforehand, do a little bit of role-playing, maybe some rehearsal online, play for real stakes to see how your psychology changes. And then maybe you consider going to the casino. And only then should you even consider a game where you might have, you might, if you are exceptional, have a chance of bending the odds, right?
So you’re playing blackjack, single deck blackjack, instead of slot machine or the roulette wheel. And I think a lot of people play roulette with psychedelics. And I think it’s a terrible idea. For the following reason, a simple way to think about psychedelics. And I’m not saying this is scientifically comprehensive because it’s not. That’s a metaphor. But what psychedelics do, and this is whether you’re dealing with tryptamines, or whether you’re dealing with phenethylamines. But I think particularly tryptamines in a lot of contexts. We could put psilocybin in that category, certainly DMT. Dimethyltryptamine would fall into that category. These compounds, MDMA, although I consider it an empathogen, more than a psychedelic, is similar in respects. What it’s doing is heating up the clay of your mind, and psyche, and brain structurally also, such that it’s more malleable. And you can reshape these narratives, and stories, and behaviors that have governed much of your life.
And many of these stories, many of these narratives, many of these behaviors, compulsive loops, whether that compulsion manifests as OCD, eating disorder, treatment resistant depression, chronic anxiety, alcoholism, or otherwise, I happen to think that these are all symptoms of a shared underlying set of issues. The psychedelics heat up the clay, so that you can re-mold those stories. Most of which you never chose for yourself, they were absorbed somehow, or caused by the environment. Trauma in childhood, for instance. Absent parent, whatever it might’ve been. And then the question is, you’ve heated the clay. What do you do to ensure it is molded, remolded in the most beneficial way possible?
Do you have an expert sculptor with lots of experience helping you? If we think about it as a keyboard—we’re rewriting a story—do you have a seasoned proofreader helping you? Or do you have a cat running across the keyboard? Which is how a lot of people take psychedelics and just play roulette. Or still, are you in an environment that is utterly unsupportive? Where if you have mischievous friends, who want to prank you, or you have negligent friends, who’ve taken a compound and are enjoying the experience and don’t want to be taken down by the trauma that is surfacing for you. If that’s the case, it’s important to realize that the clay can be molded into a misshapen form that is worse than your original state. I think this is really important to emphasize.
Dr. David Rabin: Critical.
Tim Ferriss: So you’re introducing a period of plasticity in the brain where it is flexible, and then the question, one of the questions is, what are you doing beforehand, during and afterwards to ensure that you are shaping it in the most beneficial way possible? And for that reason, if people aren’t willing to do quite a lot of upfront preparation to take it seriously, to allocate sufficient time for a very spacious on-ramp and off-ramp from the experience, in other words, you’re not having your first psychedelic experience as 5-MeO-DMT on a Sunday night, and then going into your office on Monday morning, only then, and in addition to that, committing to post-care, having a therapist, psychiatrist or otherwise, on board as a safety net, so that they have a support structure that is not one of their volunteer friends, will I recommend that someone consider use of psychedelics. That is how seriously I take them.
Dr. Molly Maloof: And that’s not to mention the quality of the medicine on the street these days is so patchy and you’re really rolling the dice every time you go and try a psychedelic that you’ve procured through the dark web, through your drug dealer, through wherever you get your medicine, you just don’t know what the quality is, especially with MDMA, which is notorious for having adulterants in it and all sorts of things that people cut it with. So that too.
Tim Ferriss: Yeah. It pays to tread carefully and thoughtfully, I do think that caution is the better part of valor here, and that, just to continue to lay on the metaphors, measuring twice and cutting once counts for a lot, because in controlled settings, with proper supervision, with the pre and post carefully thought through, which means it’s not impromptu, there is a plan, just like you would have a plan going into reconstructive knee surgery, you would have prehab surgery, you would have medication to assist postop and intraop, and you would have a significant amount of attention dedicated pre-operation to your rehabilitation. I look at this the same way.
If you don’t do that, although it’s not as common to read about or hear about these stories, you can end up very dislocated, you can end up becoming unmoored. And I have seen firsthand, I’ve seen dozens of lives directly changed in ways that are inconceivable based on the textbooks of psychology and psychiatry used in colleges today, for instance, or medical schools, inconceivable. And that tells me that, as any good doctor will tell you, 50% of what we know is wrong, we just don’t know which 50%. We operated on newborns and infants without anesthesia until 1987, let’s not forget. We are still in-
Dr. Molly Maloof: That was [inaudible 00:33:31] by the way.
Tim Ferriss: Yeah. Like the medical dark ages in many respects, and that will always be the case, there’ll be great unknowns of great value, and I think that many of them are in psychedelics. On the opposite end of the spectrum, I’ve seen people get so destabilized and knocked sideways that they are effectively in a psychotic state for days, weeks, or in a handful of cases, years afterwards, generally associated with ayahuasca and getting lost in that world in South America. So it is very smart, it is very tactically useful to do your homework, and if you want to go fast, to borrow for the military, slow is smooth and smooth is fast.
Dr. David Rabin: You could not be more right there, Tim and I thank you for echoing a sentiment that we talk about frequently on News Hour, because what you’re mentioning is really one of the most common mistakes that I think people make with the psychedelic medicines. And I think your metaphor about the clay, remolding the clay, warming the clay is such a good one because our brains really learn more, I think, in metaphor than in any other way. And that metaphor of warming the clay, giving the opportunity for the clay to take a new shape, or for us to effectively reshape it, reform it, and then have it solidify in the way that we want or intend it to be in the future, that’s aligned with our goals, maybe not as much aligned with whatever we absorbed in the first several years of our lives from whoever happened to be around us at those times, or whatever we were seeing on TV or what have you or in our schools, but actually what we want ourselves to be, not knowing what our potential really is, is just such a powerful metaphor and I really appreciate you bringing that up because that is such a great way to think about this.
And I think, interestingly, I think that metaphor actually plays into a lot of different other areas of our lives, speaking of which, we’re kind of stuck in a mold for a long time in the scientific and medical community, where research only was done a certain way. Research was only funded a certain way, it was only conducted at certain places, in certain contexts, and so a lot of these different approaches got left out and were not even evaluated, and the clay wasn’t even ever really warmed thoroughly for us to have an opportunity to say, “Hey, maybe there’s a different way we could be doing this.”
And then someone like you comes around and says, “Hey guys, wait a minute. If I take some money and some of my friends’ money and we put it towards this stuff, then all of a sudden it doesn’t really matter what the NIH or the NIMH says, we can make new research happen.” Why is it so important, or more important than ever right now, to have diverse sources of research funding in the mix?
Tim Ferriss: I’ll take a stab at it. I appreciate you setting that up so nicely. But before I do that, just a quick recommendation for a few resources for people who might be contemplating psychedelics, or perhaps are engaged but want to increase their exposure to perhaps a few different inputs that could be helpful. The Healing Journey by Claudio Naranjo, N A R A N J O, is an exceptional book I highly recommend. The introduction alone makes the cost, any cost associated, very cheap. The Secret Chief, both of these are actually published by MAPS, and it just so happens, not because they’re published by MAPS, but because they are great books, I’m recommending them, The Secret Chief, which is a discussion of different modalities of facilitation. And I would also recommend to anyone who is engaged with, or considering being engaged with psychedelics, that you download the Waking Up app by Sam Harris and do the introductory course, 10 minutes a day for, I think it’s between 30 and 50 days. This will help you navigate and squeeze the most juice from your experiences, particularly when combined with a book called Awareness by Anthony de Mello, so do those two concurrently.
Back to your question, why are diverse sources of funding important? Well, I would say first, that the citizen philanthropy, the capital from individual donors is important, first and foremost, because there is such a lack of funding from many other sources. And my intention with committing many millions of dollars of my own capital, the largest such commitment to anything for-profit or non-profit, in my life, certainly, especially beginning a few years ago, whether it’s Hopkins, Imperial College, the Phase 3 trials with MAPS and MDMA’s psychotherapy, the intention is to provide seed capital to something that can be a world-changer. Just as I would in the world of startups, my goal is to get 50K to something that I think can raise 50 million, no problem, a few years later.
And therefore, the strategy, or the objective for me, rather, objective, the strategy would be different, but the objective has been to pave the way through de-stigmatizing and reputationally de-risking, not just de-risking, but clearly showing the reputational upside of supporting the science as an individual, to grease the wheels for individuals, then foundations, then larger foundations that have more reputation management in place and more systems and processes, these larger name brands, dynastic wealth foundations, and ultimately government agencies. So my plan, starting at least a year ago, probably 18 months ago, has been to try to set certain things in motion that will likely increase the odds of federal funding within, say, three to five years, I hope closer to three years. And I’m very optimistic about that.
Nonetheless, as it stands right now, the research that we are seeing is almost entirely dependent on individuals finding conviction in the data, sometimes in their own experiences, to look at this as an opportunity to bend the arc of history from a mental health perspective, in much like medicine, or at least pharmacology, within medicine can be separated into pre-antibiotics, post-antibiotics, that was addressing physical bugs for the sake of simplicity. If we’re addressing mental psycho-emotional bugs, fixing the software, I think psychedelics have the potential to mark that type of before and after line.
And it’s up to individual philanthropists right now, much in the same way that oral contraceptives were up to Katharine McCormick, who’s an incredible woman—everyone should read her Wikipedia page, from her history at MIT, to ultimately almost single handedly developing oral contraception with the equivalent of, I want to say $24 million in today’s money, adjusting for inflation, over a period of five or 10 years. And it was initially approved, if my memory serves me, for the indication of menstrual disorders and to super important, and ties into the strategy of how to shepherd some of these compounds through byzantine regulatory affairs. Although the FDA has been incredibly supportive, I want to add, they’re not the enemy here, they’ve been incredibly supportive of both psilocybin and MDMA, that the initial indication is very important.
And that bent the arc of history. You think about the longterm global effects of that type of liberation for half of our species in the form of oral contraception, being able to family plan with that as a tool in the toolkit for such a small dollar amount. That is like one in 10 billion out. And I look for that startups, I look for that science, and I should say, psychedelics is not the only place I have allocated capital that’s in the world of scientific research, but they are the primary focus.
So for that reason, if anyone is sitting on the sidelines for now, and they’ve been considering where they might want to put their capital, you can’t take your marbles with you. We’re all going to die and you could be buried like a Pharaoh with golden thrones and gold bars and so on, but it’s probably not going to help you very much. I think this is a golden window of time, over the next, let’s just call it one to three years, where people can go down in history as having been the spark that lit the bonfire, that lit the world on fire, in the most productive way possible.
Dr. Molly Maloof: That is so inspiring. And I think to dovetail on that is the real big question that plagues me every day as I’m thinking about building a company in this space. Actually, I’m building a company in this space, but very much trying to figure out, how are we going to go from a hundred hours of therapy to hundreds of thousands of people who have trauma right now from what’s happening in our country over the next five years? We can get these drugs approved, but the reality is that the delivery of these medicines… If you just look at our healthcare system right now, it’s failing at its most basic function, which is to treat sickness.
And so what is your vision of how this gets to scale? Because that’s the real question that I think is going to truly lead to whether or not, like, this changes the world or where we’re stuck with the expensive, very expensive treatments for only people who can afford it. And that’s what I’m trying to figure out right now, do we need to design new studies that enable groups of people to have treatments together? If you look at indigenous cultures, ayahuasca is delivered in groups. And so I have an issue personally with, I know we have to design studies that will get approved by the FDA, but I have a really hard time understanding how we’re going to get this to scale with the current-
Tim Ferriss: I can take a stab at it. I think this is a better question for the MAPS professionals, but I can give you my lens through which I look at this, or the lenses.
The first is that, and this may sound strange given what I just said, but scale, and believe me, I can count, so I know I’m getting this off slightly, but I can be a four-letter word. And Seth Godin talks quite a bit about how easy it is to escape into the big, as opposed to focusing on the small in front of you. Even Airbnb before it was Airbnb focused on doing things that didn’t scale, and there’s actually an excellent episode of the Masters Of Scale podcast by Reid Hoffman, with interviews of Brian Chesky and the other founders of Airbnb, about doing things in the beginning that did not scale, very deliberately.
And that might seem antithetical to becoming very big, but in fact, it is not. It is necessary for prototyping and refining and throwing a lot against the wall so that you can build on early successes. So the things that we do in the beginning are almost certainly not going to be the things, at least not copy and paste, that are done three years later, nor five years later. That’s the first assumption I would say that I’m making. The second is that it is very challenging to scale in person. Period. Full stop. So I don’t expect it to be easy. That is just another assumption, is that this is not going to be easy. And then if something appears easy, we should double down on scrutiny to really stress test it because there are probably weaknesses.
Third is looking at historic adoption of different behaviors and systems. Like it, or hate it, or even if you’re a neutral, many, many, many, many things that end up at scale like recycling in the United States started as something piloted in very, very small communities and generally in affluent areas. And that, I think, these days, can produce a visceral negative response, but it’s important to realize that the more affluent, generally speaking, are going to have more capital and more time with which they can use to serve as guinea pigs, if that makes sense. You’re not going to ask the single mom of four to be a guinea pig. It would be unfair, it would be unreasonable, and it would be extremely problematic.
So a lot of the guinea pigs end up being small-ish groups of people with more capital and time. And I think that’s okay. If you look at startups in the very early stages, they very often use the initial premium pricing for a small subset of people, to completely pay for the R&D and subsidize developing cheaper versions that can be deployed or widely. That’s certainly true with Uber, which I know very, very well since I was one of the initial advisers. I saw them deliberately do that. But in the beginning, they caught incredible flack for being elitist in that respect. And Uber has its own challenges, we don’t have to get into that now, but suffice to say that was an effective strategy. It’s a strategy that we’ve seen over and over again in different areas, and I would expect for us to see it in psychedelic therapy as well.
And the ultimate form that it takes, I don’t know, but another base assumption, that keeps me going quite frankly, with all that I’m involved with with respect to psychedelic science and indigenous communities and psychedelics, there’s a lot that I haven’t talked about publicly that I’m involved with, but even if we just look at the forward facing stuff, it’s very time consuming, it’s very energy intensive, it’s very capital hungry. And part of what keeps me going is the realization, which is not a copout in any sense, because I do want to reach millions of people ultimately, but not rush it and self-incinerate in the process, is that to change the world, you do not need to treat a hundred million people. If you can help one person overcome paralyzing trauma, you have changed the world. Full stop.
Dr. Molly Maloof: That’s so helpful. Thank you.
Tim Ferriss: And the ripple effect from that one person can be incredible. Let’s say that one person is the daughter of a senator or a Congress person who has lifelong eating disorder, multiple brushes with death, multiple hospitalizations and psychedelic therapies able to allow that person to find peace and rewrite their narrative such that they’re not battling this demon every day. That’s one person technically, but what are the far reaching implications of that? They are many. And I’m happy to speak, if it’s helpful at any point, and that I can certainly, I can also go a little longer. I know we’re slated for an hour, but if you want to go longer, I’m happy to continue talking. If you want to talk about ayahuasca, we can talk about that as well.
There are a number of people in the psychedelic science world, researchers who are looking at group integration, and I think that’s very important, to your point. And so that is going to happen, it’s going to happen. And it is happening. And I’m sure that there are multiple researchers who are looking at the effectiveness and cost effectiveness of operating in groups, not necessarily for treatment sessions, but certainly for prep and more frequent integration. I am optimistic that in some cases, groups will not just be as effective, but more effective than one on one, or one on two, meaning one patient and two facilitators’ integration.
So I’m very, very optimistic, and I think one of the ways the various factions of the psychedelic movement will hurt each other and themselves and hobble things is by trying to boil the ocean at once. If you try to go too big too fast, that is a recipe for disaster in my opinion. Now, I’m still aggressive, I’m fucking aggressive. It’s who I am, it’s how I am with this type of thing, I’m very aggressive. So I push, I really push. But there is a point at which you could push too hard and things can break. So it’s a balance, it’s a challenge for me as well.
Dr. Molly Maloof: A really beautiful answer, and part of why I’m so inspired by it is my own medical practice has always been fairly elitist and it weighs on me a lot because I have charged a lot of money for early adoption of technologies that now are becoming scalable. And what’s really cool is that there’s a lot of companies that are taking things that I’ve been doing manually and they’re digitizing them.
So I think there is a lot of hope and promise, and I think the hard part of being an early adopter is that you see the future and you know what’s coming and you just so badly want it to be now, because never have we ever seen so much trauma all at once. And it’s just heartbreaking to see society right now with so much pain and knowing we have to wait for this. And I know this is necessary, but it’s still painful. And watching so much pain in the world, it’s like you just want to alleviate it as a doctor, that’s why you went to medical school.
Tim Ferriss: Yeah, totally. And I would just say for anybody listening, historically, I think many participants in the psychedelic space, and there are, I used the word factions very deliberately, because I find the infighting within the psychedelic world particularly hilarious and hypocritical, but nonetheless we’re humans and tribal and all of that, that one of the greatest weaknesses in the psychedelic world is having everything become a priority and trying to do everything.
If everything is your priority, nothing is your priority. And I’m not saying that to you specifically, Molly, at all, it’s just a lead into a broader observation of why the psychedelic subcultures coordinating the different pieces can often be like hurting cats, is because there is a pervasive lack of focus. So pick your shots. If you have your patients, and you’re doing a good job with your patients, then you are doing a good job, period. So I want to just, if that is any reassurance.
Dr. David Rabin: Yeah. Tim, I want to echo what Molly was saying, and I really appreciate your perspective on that because I think it is a unique perspective. I, for one, have had these conversations about scaling with Liana who just joined us to provide the MAPS opinion, which we will allow her to give in a minute, not opinion, I should say the MAPS framework for planning for scaling, these kinds of things since Tim, you brought it up. And also with Rick Doblin and really talking about how we can expand access, and I think what always comes back to me is reminding myself of, what are these medicines really trying to teach us?
And there has been this constant pattern of ancient knowledge that keeps coming to me through the work that I work with my own clients, with and without medicine, and also through some of the experiences that I’ve had in my own trainings. For example, training for ketamine assisted psychotherapy, where it really comes back to these tribal tenants of ancient wisdom, which are gratitude, forgiveness, compassion, and self-love as the foundation of trust that all of this is built on, not only trust in ourselves that allows everything else to grow from a stable foundation, but also trust in everything else that we’re doing and trust in each other and trust in this whole adventure that we’re on together, that we can do this together.
And the interesting one of those four that I think people, including myself, have the most struggle, trouble, with on a regular basis is self-compassion, because self-compassion is most commonly on a moment to moment, day to day basis, really the practice of patience for allowing things to unfold as they will in time, with focus and with dedication and devotion, but without rushing, because when we rush, we make mistakes. And that patience and that allowing that time and that opportunity for that compassion to come into our lives allows us to recognize and take a breath and take a step back and say, “You know what? There is no rush right now. We have a lot to do, and there’s a lot of other people helping, and there’s a lot of work on the horizon and a lot of things that we need to do, but there is no rush.”
And the more we can be patient with this process and all work together to see it through, not quickly, but effectively, then the better this will be for everyone. But I just wanted to thank you for bringing up the patience-driven approach and reminding us of that. And I just wanted to give Liana an opportunity to quickly catch us up on MAPS plan and concepts for scaling some of these treatments more effectively.
Liana: Yeah. Thanks so much for calling me up. Hi, Tim, good to see you here.
Tim Ferriss: Good to see you too.
Liana: Yeah. I really appreciate this conversation that’s being had right now in the direction of this, and Molly, I really hear, there is such incredible need, and I see it every day with the amount of messages and I work with another group that works with veterans, and there is a very urgent need for these treatments. And just two quick points on scaling that I wanted to bring in is, one, let us remember that the MDMA protocol was first developed 14 years ago, and it’s taken a very long time to get this work to where it is, and it was developed in the model with the dual therapists in the room for the eight hour sessions, with the understanding that, to create the most comprehensive protocol that had the highest likelihood of success within the FDA framework.
And so it was coming from that place, it was highly stigmatized, it took a long time to get the research to where it is today. So I just wanted to bring that piece in, and then also to say that it is an unknown factor and to see what happens when we start treating thousands, tens of thousands, hundreds of thousands of people with MDMA and this controlled growth model that we’re working with, which there are some natural frictions built in into the rate in which we can adequately train therapists, due to the need for supervision, and there’s only so many participants in our study, so there’s only so many opportunities for therapists to receive supervision in their training. We want to be prepared for any adverse events, and we want to shore up the potential for there to be backlash against this work so that we can continue the success into the future. And so it will be a very controlled kind of growth model. There will be a very limited amount of therapists available to do this work on day one of FDA approval, but then quickly after that, it will start to grow exponentially. So it will take time, and patience is needed, and that’s a hard thing when there’s so much need, but it is the way to do this work, right? And I just, Tim, I really appreciated your comments on all of that, so thanks.
Tim Ferriss: Thanks, Liana. Yeah. It’s nice to see you, first of all, and hear you, and I appreciate your texts from earlier today also, so thank you for that.
Tim Ferriss: From a long term planning perspective, it is, I think, important to scenario-plan, meaning anticipate that there are going to be some significant challenges and significant blow back in different forms, as this scales, as there would be with anything new. It’s the same reason that there are thousands and thousands and thousands of people who die on highways in the United States every—I don’t know what the timeframe would be—week, day, month? But nonetheless, it is stadiums full of people who die in automobile accidents, but if one person dies in a Tesla that has some degree of autonomous driving, it is news and headlines everywhere.
And I fully anticipate that even though you could go to any ER and find both critical patients and deaths caused by things that you can purchase over the counter, like acetaminophen, and liver failure associated with that, when there are, and it’s not if, when there are human tragedies associated with psychedelics, because there’s certain scale achieved, just given the law of large numbers, there are going to be complications, there are going to be cases that get a massively disproportionate response from the media in negative coverage. These things are going to happen if we are successful in making this widely available. That is part of the part of the—I wouldn’t say reward—but natural outgrowth of this reaching some degree of scale.
And so while it pays to be optimistic, and there are many reasons to be optimistic, from a planning perspective, this is going to be, if it is successful, a very challenging, and we will need to have very organized groups of people like those who are doing the direct development and handling other capacities within MAPS, who have thought this through ahead of time. This is also true with the decrim movements nationwide and the various initiatives in Oregon.
It’s challenging to think about, sometimes impossible, the second, third, fourth order effects of different innovations, different changes, regulatory modifications, and so on, but I think it’s very important, because this is not going to be easy, and we’re going to need more than hope. As James Cameron, the director, said, hope is not a strategy. Hope is not a strategy. Fortunately, though, more and more people are involved with this space who have spent a lot of time working on strategy and other areas. So I am optimistic, but I’m not relying on hope as a strategy.
Dr. David Rabin: Yeah. I thank you for that as well. I think you’re absolutely right. And it could not be more important that we, as difficult as it is sometimes, and as much as we are struggling as a community, especially right now, to take our time, to make sure that we usher these medicines in in the right way. They do have the capacity to spread contagiously. We saw it in the sixties and seventies, and we saw what happened.
I think even now, if you really want a comparison, there’s hundreds of thousands, I can’t remember the exact number, but it’s hundreds of thousands if not millions of people dying of opioid related deaths every year, and yet we are seeing more news about people going to the jungle in Peru or in South America when one person has, or two people have a negative consequence as a result of an ayahuasca ceremony when they forgot to stop taking their antidepressant medication, or whatever it might have been. Some medication effect that was combined with the ayahuasca, that caused a negative result, that resulted in someone having either a psychotic break or dying, and which is still extraordinarily rare, and yet that becomes something that the mainstream media ends up associating with these medicines, which is so unfortunate. And at the same time, I think it just serves as a constant reminder to us to be extra, extra careful.
And I think that I really appreciate you, Tim, and your generosity for sticking on with us for a little bit longer. I did want to mention one thing that stuck out to me about your work, which is, again, going back to helping to destigmatize these medicines, destigmatize trauma and mental illness in our communities at large.
One of the things that a lot of people don’t actually recognize, and I think a lot of doctors themselves don’t recognize, is for doctors and caregivers, we are not really allowed to admit mental illness. In fact, as a physician, we can have our licenses taken away for having a diagnosis of mental illness in our medical record, if that ends up getting reported to our licensing board, or if it gets found out by our licensing board and we did not report it. There are all of these different punitive restrictions that can really impact our ability to even provide care. And this isn’t just for doctors. This extends to anyone who is board certified as a care provider with a license, which is really quite destructive, because it makes you realize that many of our physicians, especially on the front lines right now, are facing symptoms of burnout, but we can’t admit it or seek care easily, because as soon as we do, we directly jeopardize our ability to deliver said care.
And that’s such a wild paradox in the way that we wound up having, ultimately, as a result of that, more physicians and more caregivers on the front lines who have potentially untreated symptoms of mental illness, and we could have the alternative, which would be caregivers and physicians on the front lines, who have adequately addressed their issues because of overwork, work-related stress, or the stress of training and the trauma of training, or whatever it might be. And yet that is not being addressed, and it’s being, in fact, punished, because mental health and physical health are still looked at as separate things. You would never see a doctor lose his license for having a coronary bypass episode, for instance, which is much more dangerous and brings you much closer to death than most mental illnesses.
And I was wondering, from your perspective, Tim, as someone who is a non-physician, kind of looking at this, how do you see our society overcoming this incredible stigma of mental illness?
Tim Ferriss: Well, let me gather my thoughts. I’m glad you didn’t ask me how to overcome the stigma as it associates, or maybe you are, specifically to licensed professionals. It’s important to keep in mind this does not just apply to physicians, as you mentioned.
Dr. David Rabin: Right.
Tim Ferriss: It applies to police officers. It applies to airline pilots, or pilots of any type. It applies to truck drivers. It applies to anyone with a license. I do not have a quick answer to that. I don’t actually even have a compelling answer to that. So I hope other people are working on it, but I don’t have an immediate answer to that. I can say that I’ve personally, as a friend, worked with a police officer who was in exactly this position. He was suicidal, and he was on duty carrying a firearm every day. Sweetheart, beautiful human being. Understood how precarious that situation was, and yet was not in a financial position to go to his superiors, and ultimately ended up referring him to a ketamine clinic for a five or six intravenous intravenously delivered infusion sequence, which was extremely helpful for him. But the fact that he had to do that covertly is fucking absurd, and patently unstable, right? I mean, that is systemically not a viable solution.
So I don’t have an answer to that. I wish I did, but I think telling that type of story can catalyze those who are in a position to perhaps make change or implement policies whereby people can get paid sick leave, or otherwise not fear for their livelihoods, and paying rent, or putting food on the table for their families. But I don’t have a succinct solution to that. And just so I can rest my flopping around with numbers, 2019, an estimated 38,800 people lost their lives to car crashes. 4.4 million were injured seriously enough to require medical attention. So there you have the numbers.
And I want to mention just one more thing, and this is just because it’s come up a few times. So I have a decent amount of exposure to ayahuasca. I would just offer that I would never recommend that, much less going out of the country to South America to consume ayahuasca as a first rodeo, probably not even a 10th rodeo. There are very particular risks involved that we would take hours to fully flesh out here, but suffice to say that if you’re strapping on skis for the first or even the 10th time, it’s probably not a good time to go ayahuasca-ing.
Dr. Molly Maloof: It’s always, to me, the thing that I tell everybody is always start low, go slow, titrate up. If you’re going to get experience with psychedelics, start with the lowest possible dose. In my practice, I actually start people out on a pretty low dose of sublingual ketamine, and then graduate them up to a psychedelic dose, and I’ve found that it’s pretty darn safe and people feel like they’re in more control of their experience. And I also have had clients decide to go to Peru and say they’re ready to do that kind of work, and they have friends, they have guides, they have reputable sources. And I’ve had people who’ve had lifelong depression, literally since they remember being a child, being depressed, have complete recovery. So even though I’m not recommending people go to the Amazon and do a bunch of ayahuasca, I’m still astonished by the fact that there are miraculous, miraculous recoveries in certain people with the right guides, and the right set and setting, and the right preparation.
I actually think we need gateway drugs that are safe and recommended by doctors. And I think people need to put the training wheels on before they go and learn … I’ve always described it like this. You start with training wheels, you learn to ride a bike. From riding a bike, you learn to mountain bike, and then you learn to drive a car, and then you learn to fly a plane. And then when you have been a pilot for a long time, and maybe you’re ready, you can pilot a spaceship. But I don’t recommend people go from sublingual ketamine clinically to 5-MeO DMT. That, to me, is super irresponsible, and there’s a lot of people who don’t realize just how dangerous some of these drugs can be. And I know enough people who have had, like you said, their lives completely altered in a negative way, to know that these are powerful tools, but they are also dangerous and they need to be in the hands of professionals.
So it’s kind of fascinating. I feel like the last 10 years in San Francisco, we experienced this kind of total renaissance of psychedelics. And there was a lot of irresponsible behavior, but at the same time, it led to so many people figuring out, “Oh my god, these can change the world. We can maybe bring these to market.” And it’s led to a much more conservative and steady approach to legalization. There’s a lot of work that needs to be done.
And I just want to add on to what you were saying about physician suicide, Dave. There’s a great TED talk by a doctor called “Why Doctors Kill Themselves,” and it’s potent and it’s powerful, and it’s all about this factor of doctors are suffering more than ever, and they can’t tell anyone. And it’s really a huge problem. And I think we need medicines for them, too. Not just for the patients, but for the physicians. And so what’s really cool about even ketamine assisted therapy, and what Phil Wilson’s doing, what you’ve been doing with him, is Phil Wilson’s training actually brings together practitioners therein, and has them sit together and experience psychedelics together so that they have firsthand knowledge of what this medicine can do. And so I’ll let Dave take it from there, but I think this is a really exciting time to be a part of this movement.
Tim Ferriss: It is. Dave, if you don’t mind, I’m just going to jump in with one more observation.
Dr. David Rabin: Please.
Tim Ferriss: And that is to use your comparison, Molly, with the spaceship. We don’t need everybody to be that astronaut, and not everybody should end up … I’m saying that because I know you’re not implying it, but just to underscore this, there is, to me, a comically imprudent sort of cultural norm within a lot of the psychedelic circles, which is you start with A, you go to B, then you do C, then you do E, then you do F, and you have to progress from starting with a ketamine or an MDMA, or holotropic breath work, and you work your way up to psilocybin, then to LSD, then to this, then to that, and then at step seven, you’re at 5-MeO DMT. There is, to my knowledge, not a single indigenous culture that does this, just to be super clear.
Dr. David Rabin: Nope.
Tim Ferriss: And I’ve spent time with quite a few of indigenous cultures who have cultivated these medicine traditions, or certainly their own indigenous ethnobotany, which can span hundreds of thousands of plants. That’s also easy to forget, that these are not psychedelic cultures. These are cultures that use psychedelics for very specific purposes. Which, by the way, have often centered, at least in South America, on warfare and hunting. So just to put that in proper context.
But it is not necessary to fuss with every tool in the toolbox. Maybe you just need the hammer and some shingles. And guess what? A hammer is going to be fine for that. You don’t need to pull out the power saw and start cutting off corners of your house, which is what I see a lot of people doing in this space, and it can be very, very dangerous. And if you think that you haven’t, or you cannot be tumbled and humbled, you have not met the right molecule at the right dose. I guarantee you that there is something that will completely unravel you, right? Maybe it’s 5-MeO. Maybe it’s ayahuasca. Maybe it’s 2C-E. Maybe it’s just LSD, and you took 300 mics instead of 100 mics. So that is all to say-
Dr. Molly Maloof: I totally agree with that.
Tim Ferriss: … be careful.
Dr. Molly Maloof: And also just to add a caveat, that there are contraindications to psychedelics. I mean, there are plenty of things that will keep you from being a good candidate for these medicines. Ketamine alone can cause schizophrenic symptoms to emerge, in this thing called the emergence phenomenon. It can cause high blood pressure. It can cause seizures. There are risks, and you have to be fully informed before you consent to any of these medicines. And if you don’t know what you’re putting in your body, you could have a really bad experience and it could change your life for the negative forever.
And so everything seems to need to come with warning labels, just like all drugs have, yet most people don’t read. Most people get prescribed drugs at the pharmacy and they don’t open up the little booklet, and they don’t realize that there are all these horrible things that can happen to you if you do it wrong, you take the wrong dose, or maybe it’s not right for your body. And yet we have a drug addicted culture that is looking for the next big thing.
And so we definitely don’t want this to become, “Okay, if this didn’t work, then maybe I try this. If this didn’t work, then maybe I try that.” And that’s, frankly, the psychiatric culture right now. And it is a big, huge risk of this movement, because there are so many different compounds and companies/ literally every day I hear of another company that got seed funding to develop their special molecules they’re going to patent, that they’re going to figure out it’s going to be the next big drug, and in psychedelics alone. And so there’s a lot of things that we need to be thinking about when this movement really … Once one drug is approved, we need to think about, “Okay, what are we going to do when there’s 15 of these? And how are we going to make sure that people don’t end up habitually consuming these medicines, thinking they’re just going to get fixed by taking a new psychiatric medicine?”
Tim Ferriss: Yes. One more thing to add to that. Sorry, Dave. I keep saying “one more thing,” and it’s 17 new things.
Dr. David Rabin: No worries.
Tim Ferriss: The point I was going to make is, and to just reinforce a lot of what you just said, Molly, these are very powerful compounds. They can be used safely with proper screening and protocol. And if you approach any type of work with psychedelic medicine in the way you would approach getting complete reconstructive knee surgery or neurosurgery, you will probably be fine. You would not go on Craigslist to find your orthopedic surgeon to replace your knee. And similarly, you should not go on Facebook to find some shaman to have unprotected spiritual sex with you and save your soul. It’s likely not going to turn out very well. And if you look at this just in terms of significance, as you would when doing due diligence and planning for something like knee or hip replacement or neurosurgery, then you will probably sort of tick all the boxes of prep and safety that are important, aside from the compound-specific screening and so on, that Molly alluded to.
Dr. Molly Maloof: I’m wondering, I’ll let Dave talk, but I’m wondering if we want to let some people come up and ask you questions. I know I just got a text from a friend who was asking Tim specifically about why he felt 5-MeO was the last stop on the train, and I don’t really totally understand his question, so I’m wondering, is it time for us to bring people up? And if individuals want to ask questions, do we want to go there, or where do we want to take this?
Dr. David Rabin: I mean, I think that-
Tim Ferriss: I’m happy to answer questions. Just to touch on that person’s question, I think a lot of folks in the psychedelic community view 5-MeO as like the Everest of psychedelics. I don’t operate within that paradigm, so I have my own thoughts on 5-MeO DMT and its uses and abuses, and risk factors, but I don’t view it as the last stop. I view it as another tool in the toolkit with a much narrower band of application to a much narrower segment of the population.
Dr. David Rabin: Yeah. I think that’s a great, great way to describe it. I think, just to echo what both of you have been saying, I think that what we’re really talking about, if anybody tuned into our last Psychedelic Clubhouse with Dr. Phil Wilson, we really talk about healing from the standpoint of the restoration of balance. It’s not about becoming a cyborg, super altered state individual, where you’re constantly on the go, go, go, and it’s not about being asleep, or living in some fantasy world for the rest of your life. It’s about balance and the restoration and maintenance of balance, which is really the recognition that when we live so much of our day to day waking lives separated and feeling and perceiving a sense of separation from our minds and our bodies from ourselves, from others, particularly the time of a pandemic, from ourselves and the earth, and our environment around us, the plants, et cetera.
As Tim referenced, these cultures in South America are plant medicine-based cultures. They live in harmony with the plants. They’re not psychedelic cultures. It’s a difference in perspective of balance, and that healing and the restoration of balance really means the restoration of unity, a sense of united union between ourselves and everything else around us in the universe, which is something that is so radically clear when we have these altered state experiences, whether you’re doing a holotropic breathwork or a deep meditation, or a MDMA or ketamine experience, or an ayahuasca experience. It’s the sense of union that really brings us all together, where the boundary between self and other, whether the other is ourselves, our own intuition, our deep inner parts of ourselves that we were told not to respect growing up, because they didn’t get us anything that we thought was good, or whether it’s the earth around us, or people in our family, or whatever it is. It’s recognizing that that sense of self and other is really a perceptive capacity that is malleable and can change.
And so these medicines help restore or catalyze the restoration of balance in a lot of ways that allow us to heal. And so approaching these in that way, with that foundation, is critical to make sure that we’re always not only respecting the medicine and what the medicine has to teach us, but also respecting ourselves in the process because that’s what’s going to be most likely to allow us to have the powerful, transformative healing experiences that we want to get out of these medicine experiences.
And I do want to respect Tim’s time, so let us know when you have to head out. We really appreciate it. I think Sohaib was the first one to ask me to ask a question, so I’ll let him jump in whenever he’s ready, and then Gina, you can go next.
Sohaib: Hey, Molly. Hey, Dave. A really great show. I’m glad you’ve got Tim on. Tim, I’ve been listening to your podcast, and this discussion has been very revelational, and I’ve discussed in the past with Molly and Dave, we discussed a lot about digital mental health and tech, and the place that will play, as well as psychedelics. So I just want to ask, so Dave touched upon medical residencies and burnout, and I think at the moment, there’s a study going on with the WHOOP Strap, and it finishes in 2021, where they’re correlating kind of HRV with cortisol in saliva. So I just wanted to take Tim’s perspective on what he thinks about monitoring levels of stress and burnout, and where he thinks there’s a limit to monitoring it. If we could let that data to kind of people we’re working with or managers, is there a line? Is that worse for our mental health? And with psychedelics, would you start to prevent that as you’re seeing yourself kind of going above that curve, that threshold of falling into a disease state?
Tim Ferriss: Thanks for the question, and for the kind words. I am a fan of monitoring and tracking that which is meaningful and that which can be changed. So in other words, there are many devices. You have devices like the Oura Ring, which I use right now. There are other HRV devices that I also use for resting state morning measurements. I find HRV very interesting. Cortisol fluctuates tremendously throughout the day. It can make saliva collection and reliability sometimes challenging. But the real question for me is, are these levers you can pull? Are they meaningful? And can you sufficiently isolate these variables in the mess of a multivariate sort of chaos pie that is real life outside of a laboratory?
So those are the questions that are in my mind, but certainly looking at different types of physiological responses, both in session and out of session, are very interesting to me. It is going to be an extraordinary challenge, maybe an impossible challenge to attribute some of the changes that we are able to monitor to a single intervention. Was it due to the psilocybin session, or was it due to the therapy session? Was it due to the daily journaling that started after the therapy session? Was it due to that single conversation with a parent that had been weighing on them somewhat heavily for 20 years? It’s incredibly challenging to trace cause and effect between variables those circumstances. But as far as I’m concerned, if it could be done easily and consistently, the more data we can capture, the better, even if they’re slightly inaccurate. But the algorithms are all subject to debate, with, say, WHOOP, or Oura, or any of these devices. But if they’re consistently inaccurate, if that makes sense, then you can still plot trendlines that are very interesting.
Dr. Molly Maloof: I want to add to that that I actually, in my clinical practice, recommend most of my patients that have chronic stress related mental health disorders, wear a Lief Therapeutics device. You can find the link to it. It’s getleif.com, but it’s a really cool HRV monitor. It’s a little bit different than Oura Ring and WHOOP because it gives you HRV visualization throughout the day, so it’s a continuous monitor, and I’m biased towards continuous monitoring, but love that device. And I’ll also just plug Dave’s device, Apollo Neuro, which is something I wear every day to modulate HRV. And I think these tools are valuable as adjacent tools to helping people triangulate specifically where their stress in their life is coming from. A lot of people have no idea what’s really stressful to them, and then they wear these devices and they say, “Oh my god. I can’t believe it’s this person that every time I talk to them, I just have this massive stress response.” And it’s a fascinating thing. So for some people, it’s their family life. For some people it’s their family life, for some people it’s their work life, for some people it’s their inner life, but figuring out where your sources of stress are coming from and being able to do something about them is paramount to healing.
Dr. David Rabin: Right you are. Gina?
Gina: Hi. Yeah, my question is given the issues of the moment around sexism and racism and the fact that a lot of sexism and racism can be hardwired in the brain and these substances can really create the malleability to cure some sexism and racism, have you thought of using these substances? Raising funds around … We can use things like MDMA to address sexism and racism.
Dr. Molly Maloof: I’m going to answer that, just because I’m very well versed in the structure of the medical system. Medicine today is a pathology based program, so it’s all about billing and coding for disease states. Right now, racism and sexism are not disease states that you can code for with the [inaudible 01:31:07], and that means you can’t actually prescribe for doing that. But we do know that racism increases the risk of chronic diseases, but there’s probably not a good indication right now for us to be able to administer these medicines for that.
Tim Ferriss: One quick chime in on that also and then we can take a few more questions, as a primary outcome measure or intervention Molly is totally on point, so I won’t repeat what she said. It is possible in some types of design studies to use secondary measures, or even primary outcome measures really, [inaudible 01:31:48] conflict resolution that are more observational in nature.
So I do think that the perception and sense of oneness and lack of separation that many of these compounds can produce have applications to conflict resolution and the demonization of the other. Within MAPS this has been looked at between Israelis and Palestinians, for instance, and there’ve been a lot of promising reports. So I am optimistic that we can see those types of effects. They then need to survive as fledgling eaglets of reorientation the brutality of reentering the real world with its related pressures and habits and default tribal behaviors.
That is the challenging part. Having the realization in the experience, less so. Ensuring is has some durability over time requires very careful integration. But I do think there’s a place for that.
I’ll pass it to Eamon next.
Eamon: Hey. Thank you, Dr. Dave. Thanks, Dr. Molly. And really appreciate everything you’re doing, Tim. So important.
Tim Ferriss: Thank you.
Eamon: Yeah. Really important work. You talked about the factionalism in the psychedelic community and I think a lot of that comes around different perspectives of ethical considerations coming into commercialization. I’m curious what you think are the most pressing ethical considerations that this kind of burgeoning psychedelic movement needs to come into alignment on.
Tim: That’s an excellent question. I’m sad that we don’t have more time to explore this, but I’ll give my very, very short version. First and foremost, just as a disclosure of sorts, I’ve not invested … I’ve very deliberately not allocated any money to any for-profit ventures because I do not want to have or be perceived as having any conflict of interest that affects how I think about or speak to any of these subjects. That’s a costly decision on my part, but one that I feel very comfortable with.
There are many ethical considerations. We could talk about sexual abuse within the context of South America specifically. It happens elsewhere but, at least as far as I know, it’s most prevalent culturally in South America. We could talk about any number of different things. The most critical to get right, I think, is the management of intellectual property and preventing broad claims of patents such that we end up in an entirely non-competitive field or a world of psychedelic medicine where there are only a handful of players who file patents to prevent others from entering the field. This happens elsewhere, it is a known playbook. We have seen some of this already. I know people who are funding legal teams to object to, via the patent office in the United States at least and also overseas, broad patent claims.
If it becomes a land grab where a few companies who are aggressive with no counterbalancing opposition or a watchdog, opposition are able to file very broad patent claims where they are perhaps capitalizing on preexisting means of synthesizing certain molecules, et cetera. They’re trying to do something from the playbook of Big Pharma where they establish an isomer, right? They grab the right handed version instead of the left handed version and then they slap a whole lot of restrictions around it to inhibit other players from entering the field. I think that could be catastrophic. There are many different ethical considerations, but from a practical ‘what can we do?’ perspective it would be keeping a very, very close eye on patents that are filed for opposition and having the will to oppose patents that seem too broad for the good of the ecosystem.
Dr. David Rabin: Great. So we have Greg and Tash. Who should we take next?
Tash: Me. Or Greg, sorry. You’ve been good, Greg. As long as you have time to answer both of our questions.
Tim Ferriss: I’ll do both. I’ll do both, so whoever wants to go first.
Dr. David Rabin: Thank you so much, Tim.
Greg: Yeah, thank you, Tim. I’ll make mine super quick. Thanks Doctor. Thanks, Molly and thanks, Tim. So this has to do with another current issue of today, which is COVID. As you know, the global mental health crisis that’s going on and everything we’re facing right now, a ton of people are still isolated and I’m one of them. Meditation has had a huge, positive impact on my whole life but especially now, along with morning routines and a lot of stuff I got from your media, Tim, which I really appreciate.
I’m wondering if there’s a way for … I’ve never dove into psychedelics at all and I feel like it would have a profoundly positive impact on me to even try it a little bit in conjunction with the other positive explorations I’m doing to try to just curate the best self that I can curate. Do you, or any of the three of you, have any suggestions on what one can do if they’re still trying to isolate and if there’s any way to begin getting involved and beginning that exploratory process? Are there any resources for that?
Tim Ferriss: Yeah, I appreciate everything you said and the question, Greg. My thought, if you were looking for a non-ordinary state of consciousness that can be used to facilitate the beneficial manifesting of the mind, which is literally what psychedelic means etymologically speaking, mind manifesting, there are tools available that do not involve ingestion.
One option would be looking at breath work and breath work facilitators who are able to work at a safe distance outside. You could look at something like holotropic breath work and practitioners who are willing to do something outside. You could be seated separately, there could be face masks if you wanted there to be contact allowed. But there are means through breath work and otherwise of achieving non-ordinary states of consciousness that one could consider psychedelic without ingestion of compounds, which I would not suggest doing solo, certainly without a lot of prior experience.
Dr. David Rabin: Tash, you’re up.
Tash: Awesome. So I guess my last psychedelic experience wasn’t of the positive kind, as you can imagine. [inaudible 01:42:04] debilitating nostalgia. I’m just wondering if you have any suggestions for overcoming maybe previous … Let’s say you molded the clay and it didn’t mold very well. How would you come out of that? Would you try the psychedelic again? Would you go through therapy? What would you read? That kind of stuff.
Tim Ferriss: Let me ask a follow-up question; what did you take? If you don’t mind me asking.
Tash: I think I did two tabs of acid.
Tim Ferriss: Okay. So I’m going to defer to the doctors on this, I’ll just give you my perspective. I’ll speak from personal experience. This is not prescriptive, right? It’s for informational purposes only.
If you have enough at-bats. Let’s just say you are a clay spinner. You sit at a circular table, you press a pedal with your foot and you spin clay. Every once in a while that piece of clay is going to go flopping over and become a total mess. If you have enough repetitions with psychedelics, eventually you are going to have a very difficult experience. I do not distinguish between good and bad trips. I distinguish between safe and unsafe trips.
I would recommend first … And this is general, it’s not specific to you … Doing some journaling with prompts and questions about whether it was a bad experience or an unsafe experience, or a difficult experience within a safe context. If it is the latter then there may be some juice to squeeze from it. Whether you should use or not use the same compound or others I’ll leave that to the doctors.
One thing that I will say is that depending on individual tolerance and sensitivity there are certain dose ranges that can be more problematic than others for people. One might think it is due to higher doses but that’s not always the case because psychedelics, if we’re talking about psilocybin, act almost like different drugs at different dosages. So if you’re taking a sub-perceptual microdose, let’s just say of 50 to 100 milligrams, there’s one effect, which is almost like taking an anti-anxiety medication. It is mostly, I would say, a physiological response. And then you have doses going all the way up to heroic per Terrence McKenna five grams and beyond, but a lot of people end up getting stuck.
If we’re going to use an airplane metaphor, so let’s just say you consume the psychedelic, you’re in the airplane on the tarmac, you accelerate, you have take off to gradual ascent, you go through cloud cover, quite often there’s a lot of turbulence and then you pop through on the other side. Let’s just say that popping through on the other side with three grams or more would be the equivalent of just cresting over the peak of the experience, or peaking.
Sometimes … And it’s highly individual … But for something like … Let’s just say it’s powdered homogenized mushrooms, right? It could just be dried mushrooms, psilocybe mushrooms. For a lot of people that one to two gram range is going to put them right in the cloud turbulence and they will not pop through. That can be very, very unsettling. It can be very, very unpleasant. A lot of emotions and material can come up, but you are so firmly rooted in this ordinary reality still that you don’t feel equipped to metabolize them or work with them. So I would say there’s also a possibility, although it seems unlikely with 200 micrograms of LSD … One should be cognizant of certain dosage ranges in the moderate range sometimes being particularly challenging.
Molly and Dave, do you guys have any thoughts on her question?
Dr. Molly Maloof: I mean, for me, two hits of acid and I am out on another planet, so for me that’s a big dose.
Tim Ferriss: Yeah, 200 I’m stardust.
Dr. David Rabin: Tim, I should say kudos to you sir. Being a non-physician I thought your response to that was excellent. A really valuable perspective on how to approach this.
I think, Tash, again, as Tim was saying, the bad trips, or bad, uncomfortable experiences from psychedelic medicine or psychedelic drugs are not always actually bad, it’s just that they’re difficult and they need to be worked through a little bit. They can actually be stepping stones on our way to great personal growth if the right support is there. As a psychiatrist who works in this field I see this all the time. One of my specialties … Not to make this go on much longer because I know Tim needs to leave … One of my specialties is actually helping people integrate difficult and bad trip experiences. So if you want to reach out to me I’m happy to chat with you personally and we can talk through it, or I can recommend you someone who can be a good integration therapist for you who specifically has experience with psychedelic medicines that can really help facilitate you working through this and coming out of it the other side.
I want you to know, without a doubt, that these changes that occur and these experiences are almost never permanent, almost never. It just requires the right kind of support and the right kind of collaborative effort together to help you through it. But you can absolutely get through this, as difficult as it might feel right now. Just reach out to me at drdave.io, or you can reach out to me on Twitter @daverabin, or on Instagram @drdavidrabin. I’m happy to help you or recommend you to somebody who can. But thanks for bringing that up. I really appreciate that you felt comfortable bringing that up in a place like this.
Tash: I think you need to be honest about the experiences. And just to let everyone know, it was a safe but difficult experience I guess is what you could say. So I think, as Tim was saying, unsafe or safe, and journaling and mediation, I really appreciate the suggestions and I’ll definitely follow up with you. Thank you so much.
Tim Ferriss: You’re welcome. I’ll add one more thing that may apply to others, and that is if you have a challenging experience like that it doesn’t mean that you got thrown off the horse, it doesn’t mean that your technique was shitty. In fact, if you walk to anyone, especially a facilitator, and you ask them to describe the more challenging experiences that have gone sideways, if they don’t have any the reality is they don’t have enough experience or they don’t have a lot of experience.
Exercising, trying to display as much self-compassion in these circumstances as possible is very, very helpful, particularly taking into account that you were using LSD which has a particularly tricky, long tail of low effect. [crosstalk 01:52:55] we’re talking about eight to 12 hours. I should say that it’s like one out of every 100 people have a 24- to 36-hour experience. That does happen. But let’s assume that you’re, let’s call it a normal responder, and you have an eight- to 12-hour experience. For a lot of people, the last four hours of that you will feel almost sober but not entirely, and it can be very challenging, similar to the one-to-two gram dose of psilocybe mushrooms to navigate because your friends are talking to you, they’re eating crackers and they’re blah, blah, blah, they’re blasting these questions and jokes. Meanwhile, all of this sadness from feeling isolated as a child because A, B, and C was absent and DA, DA, DA, all of this is welling up inside of you, and you don’t know what to do.
So LSD is, I think, particularly tricky in that respect because it has a long tail of effect that can be very challenging. So I would give yourself, also, some credit in that respect because it’s very common that people challenge with that and come out of it with the recency of the end, the tail end, coloring the entirety of the experience. That is very common.
Dr. David Rabin: That is very, very true. Thank you for adding that in. Tim, I want to be respectful of your time, you’ve given us so much of it. We are so grateful and so grateful for all of the incredible work you’ve done, the Capstone, helping to de-stigmatize mental illness, spread awareness of the importance of mental health and prioritizing it to all of us, and taking the time to dedicate your life’s work to helping the world be a slightly brighter, better place for all of us.
We could not be more grateful, and we really appreciate you joining us here on your first Clubhouse.
Tim Ferriss: My pleasure. I appreciate you guys facilitating so well and inviting me. There’s a lot more to come. Much more excitement coming. I’m looking forward to some additional big news, not from me but from other groups around the country. If people are thinking about, or looking for, a very high leverage place where a little capital goes a really long way … I mean, you can have billions of dollars of impact with a few hundred thousand dollars, I think, this is one of the very, very few spaces. There’s an incredible window of opportunity right now.
So reach out to people like Dave and Molly and others who are aware of attractive, high leverage places to donate or invest, and get engaged. Can’t take the marbles with you.
Dr. Molly Maloof: Yeah.
Tim Ferriss: And really appreciate you guys.
Dr. Molly Maloof: We should actually take that advice. We have started a webpage to document these talks, and I think one really cool next step we could take is starting to list some of these investment opportunities that we have come across that could potentially really move the needle.
So Dave and I will get on that, that’s really great advice. Thank you so much, Tim, for being here and offering your wisdom and your experience and your knowledge and your personal anecdotes. Everything you have to say has just been really inspiring. I think a lot of people here … This is our biggest crowd so far, so I’m really grateful to have everyone in the crowd show up and listen. If anyone has any suggestions and questions or comments on this feel free to contact me or Dave. You know you can find me on Instagram, at doctormolly.co. You can find me on my email. Just Google me, I’m on LinkedIn. Tim, you rock, so thank you. And, Dave, thanks again for co-hosting this.
Dr. David Rabin: Of course, it was my pleasure.
Tim Ferriss: Thanks very much.
Dr. David Rabin: Yeah, thank you, Tim.
Tim Ferriss: Pleasure to be here. To everyone on the call and elsewhere, I suppose, have a wonderful week, have a fantastic weekend, and be safe out there. Be safe and be kinder than necessary. I’ll talk to you guys soon.
Dr. David Rabin: Take care, everyone.
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