Rick Doblin: Psychedelics
心理与人性音乐与艺术生物与进化历史与文明技术与编程
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🎙️ 完整对话（3278 条）
Lex Fridman (00:00.000)
The following is a conversation with Rick Doblin,
以下是与 Rick Doblin 的对话，
Lex Fridman (00:02.480)
founder and executive director
创始人兼执行董事
Lex Fridman (00:04.640)
of the Multidisciplinary Association
多学科协会
Lex Fridman (00:06.920)
for Psychedelic Studies, MAPS.
迷幻研究，MAPS。
Lex Fridman (00:09.720)
He is one of the seminal figures
他是具有影响力的人物之一
Rick Doblin (00:11.520)
in both the cultural history
无论是在文化史上
Lex Fridman (00:12.920)
and the cutting edge science of psychedelics.
以及迷幻药的尖端科学。
Rick Doblin (00:15.440)
He was there along with the biggest characters
他和最大的人物一起在那里
Lex Fridman (00:18.360)
throughout this fascinating history of psychedelics,
在这段迷人的迷幻药历史中，
Lex Fridman (00:20.800)
and he is here to tell the story.
他是来讲述这个故事的。
Lex Fridman (00:23.660)
Quick mention of our sponsors,
快速提及我们的赞助商，
Rick Doblin (00:25.360)
Theragun, ExpressVPN, Blinkist, and Asleep.
Theragun、ExpressVPN、Blinkist 和 Asleep。
Lex Fridman (00:29.660)
Check them out in the description to support this podcast.
在说明中查看它们以支持此播客。
Rick Doblin (00:33.240)
As a side note, let me say
作为旁注，我要说的是
Lex Fridman (00:34.960)
that exploring the places the human mind can go
探索人类思维可以去的地方
Rick Doblin (00:37.800)
can help us understand where it comes from,
可以帮助我们了解它从何而来
Lex Fridman (00:40.120)
how it works, and how to engineer mental journeys,
它是如何运作的，以及如何设计心理旅程，
Rick Doblin (00:43.640)
whether that's through life experiences,
无论是通过生活经历，
Lex Fridman (00:46.360)
chemical substances, brain computer interfaces,
化学物质、脑机接口、
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or interactions with artificial intelligence systems.
或与人工智能系统的交互。
Lex Fridman (00:52.800)
On a personal level, I think the dissolution of the ego
Rick Doblin (00:56.160)
for stretches of time is a powerful tool
Lex Fridman (00:58.120)
for understanding yourself.
Rick Doblin (01:00.080)
A lot of things can do this,
Lex Fridman (01:01.740)
including jiu jitsu, literature, meditation,
Lex Fridman (01:04.800)
but psychedelics is definitely, or at least arguably,
Lex Fridman (01:07.880)
one of the most powerful, from psilocybin to DMT.
Rick Doblin (01:11.720)
I'm excited that people like Rick
Lex Fridman (01:13.520)
are leading the scientific research
Rick Doblin (01:15.400)
that reveals the efficacy and the safety of these substances
Lex Fridman (01:18.880)
so that their proper dosage and usage protocols
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can be understood and people like me
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can safely and effectively use them,
Rick Doblin (01:27.240)
not just for recreation,
Lex Fridman (01:29.720)
but for rigorous exploration of my own mind.
Rick Doblin (01:33.600)
This is the Lex Friedman Podcast,
Lex Fridman (01:35.600)
and here is my conversation with Rick Doblin.
Rick Doblin (01:39.960)
Could you give an introduction to psychedelics,
Lex Fridman (01:42.760)
like a big, bold, whirlwind overview?
Lex Fridman (01:47.200)
What are psychedelics?
Lex Fridman (01:48.920)
What are the kinds of psychedelics out there?
Rick Doblin (01:51.640)
In whatever way you think is meaningful.
Lex Fridman (01:54.920)
All right, well, when I started MAPS,
Rick Doblin (01:58.040)
the Multidisciplinary Association for Psychedelic Studies,
Lex Fridman (02:00.800)
it was very important for me that psychedelic be in the name.
Lex Fridman (02:04.080)
And the way in which the original meaning of psychedelic,
Lex Fridman (02:09.600)
it's mind manifesting.
Rick Doblin (02:11.680)
It was created by Humphrey Osmond
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in a dialogue with Aldous Huxley.
Lex Fridman (02:17.160)
And so psychedelic means mind manifesting.
Lex Fridman (02:20.440)
And so we interpret that very broadly
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to mean dreams are psychedelic.
Lex Fridman (02:27.600)
Anything that kind of brings things to the surface,
Rick Doblin (02:30.520)
holotropic breath work, hyperventilation is psychedelic.
Lex Fridman (02:34.160)
So most people think psychedelic
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is only about certain kind of chemical substances,
Lex Fridman (02:37.920)
either natural or synthetic,
Lex Fridman (02:40.260)
but we've got a much broader view of that.
Lex Fridman (02:42.920)
Meditation can be psychedelic in some ways,
Lex Fridman (02:45.500)
but our primary focus is on the drugs,
Lex Fridman (02:48.120)
is on the medicines or the, you might call them,
Rick Doblin (02:52.140)
some people might call them spiritual tools or sacraments.
Lex Fridman (02:57.000)
There's sort of two general categories of those.
Rick Doblin (03:00.520)
One are what are called the classic psychedelics,
Lex Fridman (03:03.200)
and those are the ego dissolving,
Rick Doblin (03:06.480)
sort of merged into unitive states.
Lex Fridman (03:10.200)
Those are like LSD, psilocybin, mescaline, ayahuasca,
Rick Doblin (03:15.120)
ibogaine, DMT, things like that.
Lex Fridman (03:18.160)
And then there is MDMA, which some people even argue
Rick Doblin (03:21.520)
is not a psychedelic.
Lex Fridman (03:22.880)
They'll say it's an empathogen or an intactogen,
Rick Doblin (03:25.520)
it's about touching within or empathy.
Lex Fridman (03:28.000)
It doesn't do the same kind of ego dissolution
Rick Doblin (03:32.160)
that the classic psychedelics do,
Lex Fridman (03:35.040)
but it brings material to the surface
Lex Fridman (03:39.280)
and it changes the way we process information.
Lex Fridman (03:44.160)
And so I think you can quibble about whether it's,
Rick Doblin (03:48.680)
it's certainly not a classic psychedelic,
Lex Fridman (03:50.480)
but I think MDMA is also a psychedelic.
Rick Doblin (03:52.680)
Marijuana, I would say, is a psychedelic.
Lex Fridman (03:55.760)
Marijuana is closer to the classic psychedelics
Rick Doblin (03:58.240)
than it is to MDMA.
Lex Fridman (04:00.040)
One point I like to make is dreams,
Rick Doblin (04:03.120)
because then everybody can relate to that.
Lex Fridman (04:05.560)
Dreams are psychedelic.
Rick Doblin (04:06.560)
Dreams bring emotions, feelings, ideas, concepts,
Lex Fridman (04:12.880)
in symbolic form a lot of times,
Rick Doblin (04:14.480)
or just in raw emotions to the surface.
Lex Fridman (04:16.440)
So when people hear the word psychedelic,
Rick Doblin (04:19.100)
often they are frightened by it.
Lex Fridman (04:22.120)
It's about loss of control.
Lex Fridman (04:25.240)
And it is, to an extent, loss of conscious control,
Lex Fridman (04:29.200)
particularly with the classic psychedelics.
Lex Fridman (04:31.960)
And we know with dreams
Lex Fridman (04:33.080)
that we can have frightening dreams, nightmares,
Lex Fridman (04:35.560)
but I think that anchoring the concept of psychedelic
Lex Fridman (04:40.560)
in dreams is really helpful for people to know
Rick Doblin (04:43.000)
that it's kind of a natural state
Lex Fridman (04:45.460)
and that there are other ways that you can catalyze it
Rick Doblin (04:48.320)
than by going to sleep,
Lex Fridman (04:49.640)
and that for thousands of years,
Rick Doblin (04:51.640)
substances have been used in that way.
Lex Fridman (04:54.160)
So you mentioned this idea of bringing something
Rick Doblin (04:55.920)
to the surface, which is really interesting.
Lex Fridman (04:58.540)
So can you maybe elaborate the surface
Lex Fridman (05:01.640)
and what is there in the depths of things
Lex Fridman (05:04.880)
and how does ego dissolution fits into that?
Rick Doblin (05:10.040)
Well, Aldous Huxley talked about the brain
Lex Fridman (05:13.460)
as a reducing valve,
Rick Doblin (05:15.260)
that we have an enormous amount of information.
Lex Fridman (05:18.120)
So right now there's an air conditioning sound
Rick Doblin (05:20.240)
in the background,
Lex Fridman (05:21.880)
but that's not crucial to what you and I are doing,
Rick Doblin (05:24.360)
talking to each other, so we kind of tune that out.
Lex Fridman (05:27.560)
There's all sorts of sights and sounds.
Rick Doblin (05:29.800)
There's incoming information
Lex Fridman (05:32.160)
in all the different sense modalities,
Lex Fridman (05:36.080)
and we have to figure out what's important to us.
Lex Fridman (05:42.020)
And so the mind, in a way, focuses a lot on
Lex Fridman (05:47.020)
what are our core needs?
Lex Fridman (05:50.300)
And we filter all the incoming information
Rick Doblin (05:53.420)
that we get towards focusing on what our core needs,
Lex Fridman (05:55.860)
and we can even get to Abraham Maslow
Lex Fridman (05:58.580)
and the hierarchy of needs about survival needs,
Lex Fridman (06:01.580)
belonging needs, esteem needs, go on.
Lex Fridman (06:04.720)
So I think what I mean by bringing things to the surface
Lex Fridman (06:09.720)
is that we tend to not focus on a lot of things
Rick Doblin (06:17.600)
that are coming, but we also push away
Lex Fridman (06:21.760)
things that are difficult emotionally,
Rick Doblin (06:24.160)
difficult cognitively.
Lex Fridman (06:26.760)
We all know that we're on this very short trajectory
Rick Doblin (06:29.360)
from birth to death,
Lex Fridman (06:30.360)
but we're not constantly thinking about dying,
Rick Doblin (06:35.160)
although that can actually be helpful
Lex Fridman (06:37.480)
to focus us on what's really important.
Rick Doblin (06:40.960)
Traumas are often suppressed.
Lex Fridman (06:46.080)
Conflicts, we see in America and around the world
Rick Doblin (06:49.480)
a kind of rise of irrationality
Lex Fridman (06:53.680)
where people push away their logic
Rick Doblin (06:56.280)
in order for their emotional tribal needs to be met.
Lex Fridman (07:01.240)
A lot of people are suffering from early childhood traumas
Rick Doblin (07:04.880)
of a different kinds or abandonment issues
Lex Fridman (07:06.880)
or anything.
Lex Fridman (07:08.040)
So we tend to focus on just what we need to survive
Lex Fridman (07:11.840)
and what we need for work and esteem.
Lex Fridman (07:13.920)
And so psychedelics, by dissolving this ego control
Lex Fridman (07:19.580)
or by with MDMA kind of strengthening our sense of self
Lex Fridman (07:23.980)
and our sense of self acceptance,
Lex Fridman (07:25.940)
we can bring in other information
Rick Doblin (07:28.740)
that have previously been too complicated or too painful.
Lex Fridman (07:32.360)
You don't think of psychedelics
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as conjuring up something new.
Lex Fridman (07:36.520)
It is more revealing something that is already there.
Rick Doblin (07:39.680)
I think that's a very crucial thing.
Lex Fridman (07:41.600)
So yes, Sasha Shulgin who sort of the godfather of MDMA,
Rick Doblin (07:51.320)
he sort of rediscovered it
Lex Fridman (07:52.980)
and brought it back into use.
Rick Doblin (07:57.600)
He talked about his first experience was with mescaline.
Lex Fridman (08:01.240)
His first psychedelic experience was with mescaline
Lex Fridman (08:04.360)
and he had a tremendous experience.
Lex Fridman (08:06.000)
But what he said about it was he was having
Rick Doblin (08:09.520)
a human experience that the mescaline was helping him access
Lex Fridman (08:13.800)
rather than that he was having a mescaline experience.
Lex Fridman (08:17.760)
So that it's not like you pop a pill
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and you always have the same kind of experience
Rick Doblin (08:21.640)
as everybody else.
Lex Fridman (08:22.560)
The experience is not contained in the pill.
Rick Doblin (08:24.760)
The pill opens you up
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and you have an experience of yourself.
Rick Doblin (08:29.320)
Sometimes these are experiences
Lex Fridman (08:30.840)
that we've never consciously had.
Lex Fridman (08:32.600)
But we can say right now that we know
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that our body below the level of our conscious awareness
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has all these self healing mechanisms.
Lex Fridman (08:42.560)
And we don't modulate them
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to a large extent by conscious control.
Lex Fridman (08:48.640)
I mean, eventually we are learning more about the mind body
Lex Fridman (08:51.420)
and we learn about the placebo effect,
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how what we think is the case.
Lex Fridman (08:54.280)
But I think that there's experiences
Lex Fridman (08:57.800)
that are below our level of conscious awareness,
Rick Doblin (09:00.660)
particularly once we're adults
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that are more of these unit of mystical experiences,
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sense of connection.
Lex Fridman (09:06.200)
I think kids are like this a lot.
Rick Doblin (09:07.680)
We kind of come from the void, you could say,
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and you're born and you have
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a different way of processing information.
Lex Fridman (09:14.520)
One interesting point about that has to do with ketamine,
Rick Doblin (09:18.320)
which is been approved as ketamine for depression,
Lex Fridman (09:22.560)
but it's used for anesthesia.
Lex Fridman (09:25.440)
And roughly one 10th the anesthetic dose
Lex Fridman (09:29.800)
is a psychedelic dose.
Lex Fridman (09:31.840)
And when it's used in anesthesia,
Lex Fridman (09:34.360)
there's what's called the emergent phenomena.
Lex Fridman (09:36.520)
So this is, you get enough ketamine for,
Lex Fridman (09:40.380)
you can be operated on, you're not in pain,
Rick Doblin (09:42.360)
you're not really there, your ego's knocked out,
Lex Fridman (09:44.840)
but you can still breathe.
Lex Fridman (09:46.600)
But as the operations get over
Lex Fridman (09:49.240)
and then people metabolize the ketamine,
Rick Doblin (09:52.000)
there's a process that they call the emergent phenomena.
Lex Fridman (09:54.780)
It's like as you're emerging from this tranquilized state,
Lex Fridman (09:58.840)
and that's where you pass through the psychedelic phase.
Lex Fridman (10:01.020)
And they don't prepare people for that.
Lex Fridman (10:03.520)
And what we see is that a lot of adults
Lex Fridman (10:07.000)
have difficult times with that,
Lex Fridman (10:09.200)
but children don't seem to have those problems.
Lex Fridman (10:12.120)
Children are a little bit more already in this kind of state.
Lex Fridman (10:15.960)
And so ketamine is used quite frequently
Lex Fridman (10:18.880)
in children now for anesthesia.
Lex Fridman (10:22.120)
So all of that is to say to your question
Lex Fridman (10:24.600)
that I think the psychedelics
Rick Doblin (10:27.120)
reveal things that are within us.
Lex Fridman (10:30.120)
Some things that are how we process information
Rick Doblin (10:32.800)
back when we were children.
Lex Fridman (10:35.000)
Other things that we've never thought of before
Rick Doblin (10:36.960)
that are sort of baked into our consciousness.
Lex Fridman (10:41.960)
There's one drug, 5MeO DMT.
Rick Doblin (10:46.160)
It's this toxin from a Sonoran toad
Lex Fridman (10:49.920)
that many people consider it to be the most powerful
Rick Doblin (10:52.200)
of all the psychedelics.
Lex Fridman (10:54.020)
And it kind of knocks the ego structures completely out of it
Lex Fridman (10:57.660)
and we experience something different,
Lex Fridman (11:01.500)
but it's something I think that's always within us.
Rick Doblin (11:03.760)
It's at a deeper layer.
Lex Fridman (11:04.800)
So we knock out some of the higher cognitive functions
Lex Fridman (11:07.260)
and then we experience things in a different way.
Lex Fridman (11:09.240)
So my sense is that these are human experiences
Rick Doblin (11:13.080)
that the psychedelics bring us to.
Lex Fridman (11:15.080)
Yeah, it's really profound.
Lex Fridman (11:16.440)
And DMT is a really interesting example.
Lex Fridman (11:18.960)
So Terence McKenna has talked about these machine elves.
Lex Fridman (11:24.040)
And there's this, I think from the people I've heard speak
Lex Fridman (11:28.820)
about the experience,
Rick Doblin (11:30.280)
there's a sense that you are traveling elsewhere
Lex Fridman (11:33.800)
to meet entities, whether they're elves or not.
Lex Fridman (11:38.080)
So in your sense, you're not traveling elsewhere.
Lex Fridman (11:42.640)
You're just revealing something that's within
Lex Fridman (11:44.760)
and maybe it's a particular mechanism
Lex Fridman (11:47.720)
of revealing what's already within.
Rick Doblin (11:50.220)
Yeah, and I knew Terence.
Lex Fridman (11:51.640)
I spent a lot of time talking with Terence
Lex Fridman (11:53.400)
and I do not ascribe to a lot of things that he was saying.
Lex Fridman (11:58.200)
He was a tremendous entertainer and I think he did a lot
Rick Doblin (12:02.040)
of really good things and focused us
Lex Fridman (12:03.680)
on the power of psychedelics.
Lex Fridman (12:05.960)
But I think I've never seen these quote machine elves.
Lex Fridman (12:10.220)
I think culture is more determinative
Rick Doblin (12:14.160)
of what people experience under psychedelics,
Lex Fridman (12:17.240)
your preconceptions, than we give it credit for.
Lex Fridman (12:22.120)
And so I think there's a lot of priming that you could say
Lex Fridman (12:26.920)
that people receive by stories from their culture.
Rick Doblin (12:33.120)
With ayahuasca, it's about jaguars and Amazonian animals.
Lex Fridman (12:37.000)
And so I think these machine elves are this construct
Rick Doblin (12:41.920)
of Terence that other people do see.
Lex Fridman (12:46.880)
There's actually some people that are very interested
Rick Doblin (12:50.560)
in doing a study and that they're well funded
Lex Fridman (12:54.280)
and moving toward it to keep people on an IV infusion
Rick Doblin (12:59.320)
of DMT for them specifically to see,
Lex Fridman (13:02.600)
do they contact machine elves or aliens
Lex Fridman (13:05.480)
and what kind of information do they bring back
Lex Fridman (13:07.480)
from these other selves, other places or other entities?
Lex Fridman (13:14.320)
One question is, who are we?
Lex Fridman (13:16.520)
Are we connected to everything in the universe?
Rick Doblin (13:20.480)
We certainly know in many cases,
Lex Fridman (13:23.060)
you talk about waves or particles, the quantum approach.
Lex Fridman (13:27.160)
So I don't interpret experiences that we have
Lex Fridman (13:32.600)
of some entity that's somehow or other
Rick Doblin (13:36.460)
deep in our consciousness that's not us.
Lex Fridman (13:39.480)
It's a part of who we are.
Lex Fridman (13:41.680)
So I tend to interpret it in that way.
Lex Fridman (13:43.480)
The question is, how big are we?
Lex Fridman (13:49.560)
And how many ideas are within us
Lex Fridman (13:52.840)
that can be revealed by changing the perspective?
Rick Doblin (13:56.120)
You mentioned physics.
Lex Fridman (13:59.240)
What physicists, especially mathematical physicists
Rick Doblin (14:03.040)
or mathematicians do is they reveal truths
Lex Fridman (14:07.200)
by taking a slightly different perspective on a problem
Rick Doblin (14:12.440)
that reveals the simplicity of how it actually works
Lex Fridman (14:17.200)
in totally new ways.
Rick Doblin (14:18.760)
That's what Einstein did.
Lex Fridman (14:20.200)
Like every progress in physics
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and certainly every progress in mathematics
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requires you to take a different perspective.
Lex Fridman (14:28.000)
And then perhaps that's exactly what psychedelics are doing.
Lex Fridman (14:32.560)
It's not that they're contacting aliens that are elsewhere.
Rick Doblin (14:36.840)
It may be revealing the connection between us
Lex Fridman (14:39.280)
and other living life forms,
Rick Doblin (14:41.240)
or actually it might be revealing
Lex Fridman (14:45.000)
a totally new perspective on what life is
Rick Doblin (14:47.300)
or what consciousness is and giving us a glimpse at that
Lex Fridman (14:50.800)
even though our cognitive capabilities are limited
Rick Doblin (14:53.920)
to fully grasp and understand it.
Lex Fridman (14:56.040)
So it's just giving us an inkling of that somehow.
Lex Fridman (14:58.480)
And it seems perhaps a little ridiculous
Lex Fridman (15:01.080)
not from a scientific perspective
Rick Doblin (15:03.520)
in the sense that we don't have a good physics of life
Lex Fridman (15:06.620)
or physics of intelligence or physics of consciousness,
Lex Fridman (15:09.900)
but getting a glimpse of that
Lex Fridman (15:11.920)
is giving us a little bit of maybe an intuition
Rick Doblin (15:15.680)
of which way to head to build such a physics.
Lex Fridman (15:22.240)
Yeah, yeah, I think so.
Rick Doblin (15:23.560)
I think that there's this other concept
Lex Fridman (15:28.600)
I guess I would like to talk about briefly,
Rick Doblin (15:30.700)
this Jungian collective unconscious,
Lex Fridman (15:33.540)
this idea that somehow or other everything
Rick Doblin (15:36.100)
that has ever happened is still accessible,
Lex Fridman (15:40.280)
maybe not with as much data
Rick Doblin (15:43.720)
or as much resolution,
Lex Fridman (15:46.600)
but that there's wave resonances.
Lex Fridman (15:49.720)
So that I do believe that we can have experiences
Lex Fridman (15:55.320)
as part of this human collective unconscious
Rick Doblin (15:58.280)
that we're not from our own life.
Lex Fridman (16:01.080)
Yeah.
Lex Fridman (16:01.920)
And that we can, it's like the holographic realities
Lex Fridman (16:06.240)
and that there is a way to gather information
Rick Doblin (16:10.780)
that can be accurate about other times and places
Lex Fridman (16:15.560)
through depth investigations of our own consciousness.
Lex Fridman (16:20.040)
But I think what I tend to believe
Lex Fridman (16:22.560)
is that it's because there's emotional resonances
Rick Doblin (16:26.040)
between where we're at now in this life
Lex Fridman (16:28.840)
and other kind of experiences
Rick Doblin (16:35.520)
that people have had before.
Lex Fridman (16:37.240)
And we always hear about everybody
Rick Doblin (16:40.440)
who talks about past lives,
Lex Fridman (16:41.560)
they're always kings and queens.
Lex Fridman (16:44.800)
So I think that's again,
Lex Fridman (16:46.520)
you filter things what you want to be true.
Lex Fridman (16:48.840)
But I do think that there is a way to access information
Lex Fridman (16:53.760)
beyond what we've taken in in our own temporal existence
Rick Doblin (16:58.120)
through our own five senses.
Lex Fridman (16:59.720)
In some ways, I really find that compelling,
Rick Doblin (17:01.560)
the notion that that information is already there
Lex Fridman (17:04.160)
and you're simply just moving the attention of your mind
Rick Doblin (17:08.160)
to different parts of that.
Lex Fridman (17:10.040)
Yeah, I mean, we have that with the radio.
Rick Doblin (17:12.280)
I mean, you got a frequency, you turn all this information,
Lex Fridman (17:17.000)
you could actually say right now in the space between us,
Rick Doblin (17:19.960)
we have the whole world's knowledge
Lex Fridman (17:21.640)
that's up on the internet.
Rick Doblin (17:23.080)
It's right here.
Lex Fridman (17:24.560)
But we don't see it. We just have to tune in.
Rick Doblin (17:26.480)
Yeah.
Lex Fridman (17:28.580)
What are the interesting differences,
Rick Doblin (17:31.680)
would you say, between the various psychedelics
Lex Fridman (17:34.560)
that you mentioned, ayahuasca, DMT, acid, LSD,
Lex Fridman (17:38.140)
marijuana, mescaline, PCP, psilocybin, MDMA?
Lex Fridman (17:42.720)
You mentioned a few of them that are really interesting.
Rick Doblin (17:44.800)
We'll talk about scientifically some of the different
Lex Fridman (17:47.800)
studies that have been conducted on each,
Lex Fridman (17:49.960)
but sort of at the high level.
Lex Fridman (17:52.440)
What are some interesting differences?
Rick Doblin (17:54.160)
Well, one of the big ones that people make a big deal of
Lex Fridman (17:57.300)
that I think is completely misplaced
Rick Doblin (17:59.920)
is some are from nature, some are from the lab.
Lex Fridman (18:03.080)
So there's this kind of like romantic thought
Rick Doblin (18:05.400)
that if it's from nature, it's good.
Lex Fridman (18:06.960)
If it's from the lab, it's somehow tainted by humanity.
Lex Fridman (18:10.600)
And therefore, some people are like
Lex Fridman (18:13.960)
all for plant psychedelics.
Rick Doblin (18:15.480)
We see the policy changes that have been happening
Lex Fridman (18:19.060)
in a couple of cities, Cambridge, Somerville,
Rick Doblin (18:23.280)
not far from where we're at now,
Lex Fridman (18:24.720)
where they decriminalize plant medicines.
Lex Fridman (18:27.320)
So they call it decriminalizing nature.
Lex Fridman (18:30.640)
So I think that there is,
Rick Doblin (18:32.800)
from my perspective,
Lex Fridman (18:37.360)
certain things from nature are poison,
Rick Doblin (18:40.160)
certain things from the lab are spiritual,
Lex Fridman (18:44.800)
even if they don't show up in nature, like LSD.
Rick Doblin (18:47.600)
Now there is something, LSD is lysergic acid diethylamide.
Lex Fridman (18:51.560)
There is lysergic acid amide, LSA,
Rick Doblin (18:54.800)
which comes from morning glory seeds.
Lex Fridman (18:56.320)
So it's very similar.
Lex Fridman (18:57.620)
But at the same time, I'd say,
Lex Fridman (19:02.260)
I don't buy into that distinction
Rick Doblin (19:03.740)
that there's some fundamental preference.
Lex Fridman (19:06.260)
One of the things that Terence McKenna,
Rick Doblin (19:07.860)
since we talked about him,
Lex Fridman (19:09.460)
he talked about how if it's from nature, it's good.
Lex Fridman (19:12.500)
And if it's not, we should be suspect.
Lex Fridman (19:16.540)
Of course, he had a lot of great LSD experiences.
Lex Fridman (19:18.580)
But actually Terence, in 1984,
Lex Fridman (19:22.060)
we were at Esalen with a bunch of other people.
Rick Doblin (19:24.820)
This was before the crackdown on MDMA.
Lex Fridman (19:28.800)
And this was some of the underground therapists
Lex Fridman (19:31.540)
and the above ground researchers
Lex Fridman (19:32.940)
who were trying to talk about how to protect MDMA
Rick Doblin (19:36.340)
from this eventual crackdown.
Lex Fridman (19:37.720)
And Terence was like, forget about it.
Rick Doblin (19:40.300)
It's from the lab.
Lex Fridman (19:41.940)
It's dangerous.
Rick Doblin (19:42.760)
We have thousands of years of history,
Lex Fridman (19:44.140)
all these other things.
Lex Fridman (19:45.220)
And what do we know about MDMA and blah, blah, blah.
Lex Fridman (19:48.460)
I was like, Terence, you're so unscientific.
Rick Doblin (19:51.460)
Another way to say it is, and I just said,
Lex Fridman (19:54.300)
we need a study of the safety of MDMA.
Lex Fridman (19:58.100)
And so then Dick Price, who started Esalen,
Lex Fridman (1:00:01.520)
things get out of their control,
Lex Fridman (1:00:03.460)
what they think they can do
Lex Fridman (1:00:04.480)
and it turned in to be a disaster for them.
Rick Doblin (1:00:08.580)
I think there was some thought
Lex Fridman (1:00:09.840)
that some of the people at the CIA had
Rick Doblin (1:00:11.640)
is that if you can turn people inside,
Lex Fridman (1:00:14.400)
take drugs and they just focus on their internal experience,
Rick Doblin (1:00:16.660)
they're not gonna be involved politically.
Lex Fridman (1:00:18.680)
It's a way to sort of take people offline.
Lex Fridman (1:00:21.720)
And what I don't think they counted on
Lex Fridman (1:00:23.360)
is that when you're offline
Lex Fridman (1:00:24.600)
and you have these unit of special experiences
Lex Fridman (1:00:27.720)
and you realize how we're all connected,
Rick Doblin (1:00:29.520)
then why do you wanna go out and kill these Vietnamese
Lex Fridman (1:00:32.780)
and put one dictator over another dictator,
Lex Fridman (1:00:37.880)
dictators on both sides in North Vietnam and South Vietnam?
Lex Fridman (1:00:40.840)
Why are we doing that?
Lex Fridman (1:00:42.760)
So MKUltra has just a very disreputable.
Lex Fridman (1:00:48.480)
We're learning more and more about what they did
Lex Fridman (1:00:51.120)
and one of the unintended consequences was Ken Kesey
Lex Fridman (1:00:53.920)
and not only that, but then the Grateful Dead
Rick Doblin (1:00:56.320)
who began at the acid tests that Kesey was helping
Lex Fridman (1:01:00.160)
to organize and out of that emerged,
Rick Doblin (1:01:04.000)
you could say just this incredible psychedelic culture.
Lex Fridman (1:01:08.680)
And you look at the bands that began in the 60s
Lex Fridman (1:01:12.720)
and which ones have really survived to this day
Lex Fridman (1:01:17.160)
and the Grateful Dead has survived longer
Rick Doblin (1:01:20.140)
than most any other band.
Lex Fridman (1:01:22.300)
I mean, some of them have died and all,
Lex Fridman (1:01:23.560)
but it was like the tightness,
Lex Fridman (1:01:25.220)
the sort of telepathy we talked about before
Rick Doblin (1:01:27.600)
that they could just get so tuned in to each other
Lex Fridman (1:01:31.240)
and each other's energies and they could do improvisations
Lex Fridman (1:01:34.080)
and they can do this incredible work
Lex Fridman (1:01:36.120)
that I think the sustainability of the Grateful Dead
Rick Doblin (1:01:40.160)
as a group was a testament
Lex Fridman (1:01:43.880)
to the power of the LSD experiences
Lex Fridman (1:01:46.380)
and that might've never happened if not for MKUltra.
Lex Fridman (1:01:48.880)
But can we talk about the darkness a little bit?
Lex Fridman (1:01:56.160)
So Ted Kaczynski, the Unabomber was allegedly part
Lex Fridman (1:01:59.800)
of the MKUltra studies while at Harvard.
Lex Fridman (1:02:03.680)
Do you think this is true?
Lex Fridman (1:02:05.160)
Do you think it had an impact
Lex Fridman (1:02:06.440)
on him psychologically, intellectually and so on?
Lex Fridman (1:02:09.520)
I do think it's true and I do think it had an impact.
Lex Fridman (1:02:12.200)
So we talked before about are these drugs somehow
Lex Fridman (1:02:16.320)
or other producing a certain kind of drug experience
Lex Fridman (1:02:20.200)
or do they bring out what's within?
Lex Fridman (1:02:23.040)
So we have this experience, yeah, on the one hand,
Rick Doblin (1:02:26.040)
Ken Kesey and he sort of took positive things out of this.
Lex Fridman (1:02:30.020)
On the other hand, we can get this opposition
Rick Doblin (1:02:36.480)
to the modern world, to technology
Lex Fridman (1:02:38.400)
and to the point of creating bombs to try to go after it.
Lex Fridman (1:02:42.180)
So that the experience is not in the drug,
Lex Fridman (1:02:45.360)
it's this interaction between the drug,
Rick Doblin (1:02:48.280)
the person, the context.
Lex Fridman (1:02:50.580)
And so we can heal people with psychedelics
Rick Doblin (1:02:55.720)
or people can be driven crazy with psychedelics.
Lex Fridman (1:02:59.360)
It depends again on the context.
Lex Fridman (1:03:01.920)
And so I think both these things can be true.
Lex Fridman (1:03:05.360)
And I think it was really good
Rick Doblin (1:03:06.560)
that you kind of highlighted this,
Lex Fridman (1:03:08.120)
that there is this polarities and that it's not in the drug,
Rick Doblin (1:03:13.040)
it's in the other factors and it's who they were beforehand
Lex Fridman (1:03:17.200)
and then how you use that experience.
Lex Fridman (1:03:19.000)
So all that's to say is if we put LSD in the water
Lex Fridman (1:03:22.240)
and everybody were to get it,
Rick Doblin (1:03:23.840)
it doesn't mean that all of a sudden
Lex Fridman (1:03:25.280)
everybody's gonna have a mystical experience
Lex Fridman (1:03:27.000)
and then that's all we need to do
Lex Fridman (1:03:29.320)
and humanity is spiritualized or end war and all of this.
Rick Doblin (1:03:32.600)
It's not about the drug.
Lex Fridman (1:03:35.520)
And that actually is why for me,
Rick Doblin (1:03:38.960)
we've also talked about engineering new psychedelics
Lex Fridman (1:03:43.000)
and all the people that are gonna be trying
Rick Doblin (1:03:44.920)
for profit companies to develop and patent new psychedelics.
Lex Fridman (1:03:48.040)
For me, the most important challenge
Rick Doblin (1:03:50.240)
is new cultural contexts that can create legality,
Lex Fridman (1:03:55.640)
safety, support for the existing psychedelics
Rick Doblin (1:03:59.320)
that we already have.
Lex Fridman (1:04:00.960)
I mean, we have so much incredible tools
Rick Doblin (1:04:04.480)
in these existing psychedelics
Lex Fridman (1:04:06.320)
that it's more about creating context for them
Rick Doblin (1:04:09.840)
to be used in safe medical or personal growth
Lex Fridman (1:04:12.680)
or recreational even with harm reduction,
Rick Doblin (1:04:14.640)
all these different ways.
Lex Fridman (1:04:15.480)
That's more important to me than finding some new molecule
Rick Doblin (1:04:18.560)
that's somewhat similar or somewhat different
Lex Fridman (1:04:20.520)
but it can be patented.
Lex Fridman (1:04:22.560)
So it's the social context.
Lex Fridman (1:04:24.440)
So I do believe that Ted Kaczynski was part of NKUltra
Lex Fridman (1:04:28.880)
and I think it affected him in a negative way
Lex Fridman (1:04:31.840)
and that's a cautionary tale that it's not in the drug,
Rick Doblin (1:04:36.120)
it's in the context.
Lex Fridman (1:04:37.520)
The context, the person, still it feels like if viewed
Rick Doblin (1:04:44.680)
from a therapy perspective, perhaps there was a way
Lex Fridman (1:04:47.760)
to use psychedelics to help Ted Kaczynski find a path
Rick Doblin (1:04:52.680)
out of the darkness.
Lex Fridman (1:04:53.960)
I think so and I think that this is where I think MDMA
Rick Doblin (1:04:58.640)
comes in in a way that MDMA is, he felt very isolated
Lex Fridman (1:05:03.640)
and very much out of society in some ways.
Rick Doblin (1:05:08.000)
MDMA stimulates oxytocin, which we haven't mentioned,
Lex Fridman (1:05:12.200)
which is the hormone of nursing mothers,
Rick Doblin (1:05:14.080)
of love and connection.
Lex Fridman (1:05:15.680)
It provides a lot of this sense of self acceptance
Lex Fridman (1:05:18.800)
and safety and wanting to be in a relationship.
Lex Fridman (1:05:21.560)
There's Gould Dolan is a neuroscientist at Hopkins.
Rick Doblin (1:05:24.920)
She's given octopuses MDMA, they're solitary creatures
Lex Fridman (1:05:30.080)
except mating season, which is not very often
Lex Fridman (1:05:32.920)
but you give them MDMA and they become more interested
Lex Fridman (1:05:35.240)
in hanging out with other octopuses.
Lex Fridman (1:05:37.480)
So I think this, for people that have had difficult
Lex Fridman (1:05:40.960)
psychedelic experiences, MDMA helps them integrate them.
Rick Doblin (1:05:45.200)
We've worked with people that had a difficult LSD experience
Lex Fridman (1:05:48.640)
40 years before and are still able to get back to that
Rick Doblin (1:05:52.240)
under the influence of MDMA and work out some
Lex Fridman (1:05:54.480)
of the conflicts that they weren't able to resolve
Rick Doblin (1:05:58.680)
all those decades before.
Lex Fridman (1:06:00.320)
So I think that psychedelics could have been helpful
Rick Doblin (1:06:04.720)
in a different context for Ted Kaczynski.
Lex Fridman (1:06:07.720)
But the other big part of it is that people have to be
Rick Doblin (1:06:11.840)
willing to cooperate with the experience.
Lex Fridman (1:06:14.200)
We talked about resistance.
Lex Fridman (1:06:16.120)
So people can resist these things.
Lex Fridman (1:06:18.000)
It's the saying is you can bring a horse to water
Lex Fridman (1:06:21.440)
but you can't make them drink.
Lex Fridman (1:06:22.920)
This is about how people have to be willing
Rick Doblin (1:06:25.400)
to go to these spaces.
Lex Fridman (1:06:26.920)
So one of the essence of our therapeutic approach
Rick Doblin (1:06:30.180)
is that we help people to heal themselves,
Lex Fridman (1:06:33.640)
that we are not giving them the healing.
Rick Doblin (1:06:36.560)
It's a flip on the power dynamics that existed,
Lex Fridman (1:06:41.680)
you would say in the fifties and sixties,
Rick Doblin (1:06:43.120)
my dad was a doctor and the doctors were gods
Lex Fridman (1:06:45.520)
and whatever they said was right.
Lex Fridman (1:06:47.600)
And we no longer, of course, believe that.
Lex Fridman (1:06:50.180)
But for a while, psychoanalysis with Freud,
Rick Doblin (1:06:54.400)
that they gave the interpretation to the patient.
Lex Fridman (1:06:56.920)
The patient couldn't help themselves
Lex Fridman (1:06:58.200)
but they would do the free associations
Lex Fridman (1:06:59.840)
and the psychoanalyst would see these conflicts
Lex Fridman (1:07:02.280)
and would be the one that does the healing,
Lex Fridman (1:07:04.960)
would give this interpretation and that would open things up.
Lex Fridman (1:07:07.680)
So I think it's this idea of empowering people
Lex Fridman (1:07:11.000)
to heal themselves.
Lex Fridman (1:07:12.860)
And so if Ted Kuznicki had been in a therapeutic setting
Lex Fridman (1:07:16.600)
with psychedelics and if they'd had something
Rick Doblin (1:07:19.800)
like MDMA available or MDA,
Lex Fridman (1:07:23.760)
which was popular during the sixties,
Rick Doblin (1:07:25.520)
which is a more like MDMA LSD combination,
Lex Fridman (1:07:28.160)
the outcomes might've been different.
Rick Doblin (1:07:31.700)
Let's take a step into the world of studies.
Lex Fridman (1:07:35.700)
Timothy Leary, who was he
Lex Fridman (1:07:38.660)
and what were the most important ideas
Lex Fridman (1:07:41.500)
you've learned from him?
Rick Doblin (1:07:43.460)
Well, I did have the opportunity to get to know him personally
Lex Fridman (1:07:48.300)
and to spend some time with him.
Rick Doblin (1:07:50.300)
Timothy Leary, well, let's start with Nixon saying
Lex Fridman (1:07:55.300)
he's the most dangerous man in America.
Rick Doblin (1:07:58.640)
That's a good place to start.
Lex Fridman (1:08:00.520)
Yeah.
Lex Fridman (1:08:01.720)
And why did Nixon say that?
Lex Fridman (1:08:03.360)
It's because of this turn on, tune in, drop out.
Rick Doblin (1:08:11.640)
Timothy Leary was just an incredible advocate
Lex Fridman (1:08:14.320)
for think for yourself, question authority.
Rick Doblin (1:08:18.800)
Those were the things he said all the time.
Lex Fridman (1:08:19.960)
Think for yourself, question authority.
Rick Doblin (1:08:21.480)
He was a rebel.
Lex Fridman (1:08:23.080)
He was kicked out of West Point.
Rick Doblin (1:08:25.440)
He was a psychologist who was at Harvard for three years
Lex Fridman (1:08:30.760)
from 60 to 63.
Rick Doblin (1:08:34.040)
Before he got to Harvard,
Lex Fridman (1:08:35.760)
he had an experience with mushrooms in Mexico.
Lex Fridman (1:08:41.920)
And he said he learned more in that experience
Lex Fridman (1:08:44.840)
than he'd had in his entire academic career before then
Rick Doblin (1:08:47.320)
about how the human mind works.
Lex Fridman (1:08:49.300)
And so he came to Harvard wanting to do research
Rick Doblin (1:08:53.480)
into psychedelics.
Lex Fridman (1:08:56.600)
And he did some very important studies, both of which,
Rick Doblin (1:09:01.200)
well, one was called the Good Friday Experiment,
Lex Fridman (1:09:03.520)
which was whether psychedelics in religiously inclined
Rick Doblin (1:09:06.920)
people taking psilocybin in a religious setting,
Lex Fridman (1:09:09.860)
whether it could produce a mystical experience.
Rick Doblin (1:09:12.060)
That took place at Marsh Chapel at the Boston University.
Lex Fridman (1:09:15.140)
Because it's a little bit subjective,
Rick Doblin (1:09:18.000)
where you can say entirely subjective,
Lex Fridman (1:09:19.600)
what people describe happens to them.
Rick Doblin (1:09:23.000)
He wanted to do another study,
Lex Fridman (1:09:24.800)
which would be a more objective measure,
Lex Fridman (1:09:26.640)
and that was called the Concord Prison Experiment.
Lex Fridman (1:09:28.640)
And that was the thought, if you can give people
Rick Doblin (1:09:32.280)
psilocybin mystical sense of connection type experiences
Lex Fridman (1:09:35.740)
while they're in prison, when they get out,
Rick Doblin (1:09:38.000)
they'll be more pro social and they'll have reduced
Lex Fridman (1:09:41.120)
recidivism.
Lex Fridman (1:09:43.340)
So Tim did that.
Lex Fridman (1:09:44.440)
He also did the naturalistic studies
Rick Doblin (1:09:46.560)
of giving loads of people psilocybin
Lex Fridman (1:09:48.140)
and sort of writing down what their experiences were,
Rick Doblin (1:09:50.500)
the range of experiences.
Lex Fridman (1:09:52.400)
Later on in his time at Harvard,
Rick Doblin (1:09:56.720)
they started doing LSD.
Lex Fridman (1:09:58.900)
And LSD is more cerebral, longer lasting,
Rick Doblin (1:10:02.280)
not as reassuring in a way as psilocybin.
Lex Fridman (1:10:04.920)
Sometimes he used to say that if they never got into LSD,
Rick Doblin (1:10:08.680)
they'd still be at Harvard with the psilocybin.
Lex Fridman (1:10:12.480)
So he was a great American psychologist,
Lex Fridman (1:10:14.820)
but then he got tired of the psychology game,
Lex Fridman (1:10:19.680)
you could say, or he would say that.
Rick Doblin (1:10:22.040)
He got more and more interested in cultural change
Lex Fridman (1:10:27.700)
and various musicians and artists
Lex Fridman (1:10:30.640)
and all sorts of people started coming to him
Lex Fridman (1:10:32.160)
for the psychedelic experience that they are in a way
Rick Doblin (1:10:34.720)
for creativity, for other things.
Lex Fridman (1:10:36.240)
So he started hanging out with all sorts of famous people
Rick Doblin (1:10:40.680)
or creative people and he stopped going to classes a lot.
Lex Fridman (1:10:47.200)
And Ram Dass, Richard Alpert had given LSD to a student
Rick Doblin (1:10:54.920)
that Ram Dass was courageous enough to admit
Lex Fridman (1:10:59.640)
that he had a sexual interest in.
Rick Doblin (1:11:02.560)
They weren't supposed to give it undergraduates.
Lex Fridman (1:11:04.440)
That was about the only time that they ever did it.
Lex Fridman (1:11:06.320)
And psychedelics just getting more and more controversial
Lex Fridman (1:11:09.980)
even in the early 60s, eventually got kicked out of Harvard
Lex Fridman (1:11:13.320)
and then he became kind of a cultural icon
Lex Fridman (1:11:16.280)
for the counterculture and was hounded by the police
Lex Fridman (1:11:23.000)
and Nixon and spent a lot of time in jail.
Lex Fridman (1:11:24.880)
I mean, he's an incredible person.
Rick Doblin (1:11:28.160)
One thing that Ram Dass said is that Richard Alpert,
Lex Fridman (1:11:33.240)
Ram Dass said, I'm a rascal, but Leary's a scoundrel.
Lex Fridman (1:11:37.280)
What's the distinction?
Lex Fridman (1:11:39.880)
Rascals like in good fun.
Rick Doblin (1:11:41.560)
A scoundrel is like, you can't quite trust them, I think.
Lex Fridman (1:11:47.360)
I think that.
Rick Doblin (1:11:48.200)
It's a spectrum of sorts.
Lex Fridman (1:11:50.040)
Yeah, I think that Leary was someone
Rick Doblin (1:11:52.120)
who a little bit got addicted to media attention.
Lex Fridman (1:11:57.160)
But I think that overall he gets blamed a lot
Rick Doblin (1:12:01.280)
for the backlash against the 60s,
Lex Fridman (1:12:04.000)
the shutdown of psychedelic research.
Rick Doblin (1:12:05.680)
I think that he is unfairly blamed for a lot of that.
Lex Fridman (1:12:10.160)
I think when you look back at the 60s,
Rick Doblin (1:12:13.480)
the common narrative is that it was
Lex Fridman (1:12:15.800)
because psychedelics going wrong.
Rick Doblin (1:12:17.760)
People took psychedelics, they weren't prepared,
Lex Fridman (1:12:19.580)
they had emotional breakdowns, they weren't psychotic,
Rick Doblin (1:12:21.780)
they killed themselves, they did this or that,
Lex Fridman (1:12:24.280)
different problems of people taking psychedelics
Rick Doblin (1:12:27.120)
in context that they didn't feel fairly safe in
Lex Fridman (1:12:31.540)
or just they weren't prepared
Rick Doblin (1:12:33.020)
or they didn't know how much they were taking
Lex Fridman (1:12:34.480)
or all this.
Lex Fridman (1:12:35.320)
So the backlash was because psychedelics going wrong.
Lex Fridman (1:12:39.440)
But I think the real reason, while that did happen,
Rick Doblin (1:12:42.680)
I think the real reason is psychedelics going right
Lex Fridman (1:12:45.560)
and people having this sense of connection.
Lex Fridman (1:12:48.160)
And then the opposite of what the CIA was hoping
Lex Fridman (1:12:50.960)
that it would kind of turn people inward
Lex Fridman (1:12:54.240)
and take them away from political struggles,
Lex Fridman (1:12:56.320)
it actually motivated people.
Rick Doblin (1:12:58.960)
Once you actually have these psychedelic experiences,
Lex Fridman (1:13:02.200)
your attitude towards death changes also
Rick Doblin (1:13:05.040)
this idea of death becoming an intrinsic part of life,
Lex Fridman (1:13:09.080)
it's a natural cycle, it's not so much.
Lex Fridman (1:13:12.160)
So I think people realize that,
Lex Fridman (1:13:15.560)
while there's this billions of years of evolution,
Rick Doblin (1:13:18.840)
infinity, whatever that means in terms of time,
Lex Fridman (1:13:21.420)
that we're here for a very limited time
Lex Fridman (1:13:22.920)
and they end up wanting to use their time well,
Lex Fridman (1:13:24.800)
they have a lessened fear of death
Lex Fridman (1:13:26.720)
and they wanna build this paradise on earth here now
Lex Fridman (1:13:29.800)
instead of later.
Lex Fridman (1:13:31.200)
So a lot of people really did get motivated
Lex Fridman (1:13:35.200)
to challenge the Vietnam War,
Rick Doblin (1:13:36.880)
to work on the environmental movement,
Lex Fridman (1:13:38.440)
civil rights movement, women's rights movement,
Rick Doblin (1:13:40.560)
anti militarism.
Lex Fridman (1:13:42.320)
And it was that challenge to the status quo
Rick Doblin (1:13:44.640)
that caused the backlash.
Lex Fridman (1:13:46.360)
So Leary is someone who in 1990,
Rick Doblin (1:13:50.540)
we had the maps I started in 86.
Lex Fridman (1:13:52.960)
So in 1990, we had this conference
Rick Doblin (1:13:56.040)
to raise money out in California
Lex Fridman (1:13:57.760)
and Leary was there and Ram Dass was there
Lex Fridman (1:13:59.600)
and Ralph Metzner was there and Andy Weil was there
Lex Fridman (1:14:01.760)
and Terrence McKenna was there
Lex Fridman (1:14:02.840)
and Dennis McKenna was there and all these.
Lex Fridman (1:14:04.800)
But there was one point where Tim was speaking
Lex Fridman (1:14:09.800)
and afterwards I was asking him some questions.
Lex Fridman (1:14:11.920)
And I said, do you have any advice for us
Rick Doblin (1:14:15.240)
on how to work with the government
Lex Fridman (1:14:17.120)
and how to bring these psychedelics forward?
Rick Doblin (1:14:19.600)
That's what we're trying to do.
Lex Fridman (1:14:20.760)
I've got this nonprofit for it.
Rick Doblin (1:14:22.720)
We're trying to do this research.
Lex Fridman (1:14:23.980)
What is your advice on how to bring this forward
Lex Fridman (1:14:27.080)
and how to work with the government?
Lex Fridman (1:14:29.280)
And he said, fuck the government.
Rick Doblin (1:14:31.920)
He said, I am so far past asking for permission
Lex Fridman (1:14:36.440)
for anything, but I'm glad that you're doing it.
Lex Fridman (1:14:40.720)
And then he held up my hand like passing the torch.
Lex Fridman (1:14:44.040)
So it was, and that's one of my favorite photographs
Rick Doblin (1:14:47.400)
of me and Tim where he's sort of like,
Lex Fridman (1:14:48.880)
but it was after this, fuck the government.
Rick Doblin (1:14:50.680)
I'm so far past asking for permission for anything,
Lex Fridman (1:14:53.160)
but I'm glad that you are.
Rick Doblin (1:14:54.840)
Now I did follow ups to the Good Friday experiment
Lex Fridman (1:14:57.760)
and I did follow ups, 25 year follow up
Rick Doblin (1:14:59.880)
to the Good Friday experiment,
Lex Fridman (1:15:01.040)
about a 34 year follow up
Rick Doblin (1:15:02.420)
to the Concord Prison experiment.
Lex Fridman (1:15:05.880)
What I discovered in some ways I would say
Rick Doblin (1:15:08.200)
is the key to the 60s, what I just told you,
Lex Fridman (1:15:10.400)
but in the follow up to the Good Friday experiment
Rick Doblin (1:15:12.820)
that I did in the 80s for my undergraduate thesis
Lex Fridman (1:15:16.100)
at New College in Sarasota, Florida,
Rick Doblin (1:15:18.640)
I eventually found 19 out of the 20 people.
Lex Fridman (1:15:21.040)
It was just, that was an enormous challenge
Rick Doblin (1:15:23.620)
because their names were all lost
Lex Fridman (1:15:24.960)
and it just took forever years and years and years
Rick Doblin (1:15:27.320)
to find them all.
Lex Fridman (1:15:29.080)
But I discovered that those people
Rick Doblin (1:15:30.640)
that had the psilocybin experience
Lex Fridman (1:15:32.200)
in the midst of 25 years later with Nancy Reagan
Lex Fridman (1:15:35.900)
and Ronald Reagan, and if there ever were there
Lex Fridman (1:15:38.260)
a social pressure to disavow the validity
Rick Doblin (1:15:41.160)
of the psychedelic experience, that was then.
Lex Fridman (1:15:43.960)
And instead they affirmed it,
Rick Doblin (1:15:47.120)
that they thought with all of this years of hindsight,
Lex Fridman (1:15:51.120)
now looking back, they thought it was
Rick Doblin (1:15:52.380)
a valid mystical experience.
Lex Fridman (1:15:53.920)
But I discovered that one of the persons
Rick Doblin (1:15:59.240)
who had the psilocybin had this experience
Lex Fridman (1:16:03.680)
during the Good Friday service
Rick Doblin (1:16:05.680)
that Reverend Howard Thurman was the minister.
Lex Fridman (1:16:09.080)
He was Martin Luther King's mentor
Lex Fridman (1:16:11.040)
and Reverend Howard Thurman was the minister
Lex Fridman (1:16:12.800)
at Boston at Marsh Chapel.
Rick Doblin (1:16:16.240)
Martin Luther King got his PhD at Boston University.
Lex Fridman (1:16:20.480)
And Howard Thurman had spent time with Gandhi.
Lex Fridman (1:16:24.320)
And so he was really kind of this hidden person
Lex Fridman (1:16:26.820)
behind the civil rights movement
Rick Doblin (1:16:28.260)
about nonviolence as their strategy.
Lex Fridman (1:16:31.120)
But he was interested in the political implications
Rick Doblin (1:16:33.600)
of the mystical experience.
Lex Fridman (1:16:34.540)
So he permitted this experiment to take place.
Lex Fridman (1:16:37.600)
And there were 20 divinity students
Lex Fridman (1:16:39.520)
from Andover Newton in the basement
Lex Fridman (1:16:41.180)
and 10 experimenters, all the people on religion
Lex Fridman (1:16:44.060)
and psychology, like Houston Smith and Walter Huston Clarke
Lex Fridman (1:16:47.840)
and Leary and Ramdas, Mr. Others were there
Lex Fridman (1:16:50.520)
as a support part of it.
Lex Fridman (1:16:51.980)
And the sermon was like three hours later.
Lex Fridman (1:16:54.520)
We actually have, three hours long,
Rick Doblin (1:16:56.440)
we actually have the original sermon
Lex Fridman (1:16:58.560)
from the Good Friday experiment
Rick Doblin (1:16:59.880)
from Howard Thurman up on our website.
Lex Fridman (1:17:02.240)
It's incredible.
Lex Fridman (1:17:03.320)
But part of it was tell people there's a man on the cross.
Lex Fridman (1:17:06.280)
And this one person sort of heard that
Lex Fridman (1:17:09.280)
and he thought, okay, I gotta do that.
Lex Fridman (1:17:12.400)
Howard Thurman was such a dynamic speaker.
Rick Doblin (1:17:14.160)
He said, I gotta tell people there's a man on the cross.
Lex Fridman (1:17:16.780)
And so he said, what am I doing here
Lex Fridman (1:17:18.180)
in this basement chapel listening to this service?
Lex Fridman (1:17:20.720)
I gotta go tell people there's a man on the cross.
Lex Fridman (1:17:22.200)
So he went, they thought he was just going to the bathroom,
Lex Fridman (1:17:24.540)
but he ran out the door.
Rick Doblin (1:17:25.380)
He's running down Commonwealth Avenue
Lex Fridman (1:17:27.480)
and Houston Smith and Tim Leary go after him.
Lex Fridman (1:17:31.440)
And he had thought that since he should tell somebody,
Lex Fridman (1:17:34.560)
he should tell the president, like why not?
Lex Fridman (1:17:38.320)
But then he realized, well, the president's in Washington.
Lex Fridman (1:17:40.380)
I'm here in Boston.
Rick Doblin (1:17:42.400)
I'll just tell the president of the university.
Lex Fridman (1:17:44.320)
So anyway, he's running down the street
Lex Fridman (1:17:46.120)
and Leary and Houston Smith go after him.
Lex Fridman (1:17:48.800)
And he doesn't want to go back inside.
Rick Doblin (1:17:50.120)
They finally get him.
Lex Fridman (1:17:50.960)
He's not hit by a car,
Lex Fridman (1:17:53.560)
but they end up giving him a shot of Thorazine.
Lex Fridman (1:17:57.280)
What's Thorazine?
Rick Doblin (1:17:58.200)
Thorazine is like a major antipsychotic drug.
Lex Fridman (1:18:02.240)
It's a horrible drug, but it knocks people out,
Rick Doblin (1:18:07.020)
tranquilizes them.
Lex Fridman (1:18:08.680)
We would never do that today.
Rick Doblin (1:18:11.060)
We don't abort a difficult experience like that.
Lex Fridman (1:18:14.280)
But in any case, they hid that.
Rick Doblin (1:18:15.620)
That was not part of the writeup of this experiment.
Lex Fridman (1:18:20.040)
So what they did is in a sense,
Rick Doblin (1:18:22.320)
a little bit exaggerated the benefits.
Lex Fridman (1:18:24.640)
It later became out three years later after the experiment
Rick Doblin (1:18:27.340)
or four years in Time Magazine,
Lex Fridman (1:18:28.680)
it said everybody that got psilocybin
Rick Doblin (1:18:30.400)
had a mystical experience.
Lex Fridman (1:18:32.400)
Say it wasn't true, not everybody.
Rick Doblin (1:18:34.060)
Eight out of the 10 did, but not all 10, not this guy.
Lex Fridman (1:18:37.520)
And they minimize the risks.
Lex Fridman (1:18:40.960)
So there was a bit of that.
Lex Fridman (1:18:41.960)
I think Tim was reckless in that way.
Rick Doblin (1:18:43.960)
It was underplayed the risks and overpromised the benefits.
Lex Fridman (1:18:48.440)
And then the Concord Prison experiment,
Rick Doblin (1:18:51.240)
it turned out that Tim had fudged the data completely
Lex Fridman (1:18:56.000)
and it wasn't really successful.
Lex Fridman (1:18:57.920)
So I fault him for that.
Lex Fridman (1:19:00.360)
The outside world was doing the opposite.
Rick Doblin (1:19:02.320)
It was exaggerating the risks and blocking research.
Lex Fridman (1:19:06.160)
So he felt justified to fudge the data
Rick Doblin (1:19:09.360)
because the outside world was fudging in a sense,
Lex Fridman (1:19:12.280)
the response to the.
Rick Doblin (1:19:13.920)
Yeah, yeah, exactly.
Lex Fridman (1:19:15.280)
Yeah, so that presents a very nice context.
Rick Doblin (1:19:21.680)
Fuck the government, but I'm glad that somebody
Lex Fridman (1:19:26.200)
is fighting the good fight from within
Lex Fridman (1:19:28.520)
and doing it the right way, which is where you are.
Lex Fridman (1:19:32.920)
So the 80s, let me ask, what is MAPS,
Rick Doblin (1:19:38.200)
the Multidisciplinary Association for Psychedelic Studies
Lex Fridman (1:19:42.000)
and what is its mission throughout the years,
Lex Fridman (1:19:45.240)
throughout the decades?
Lex Fridman (1:19:46.360)
Yeah, so MAPS is a nonprofit organization.
Rick Doblin (1:19:49.960)
I created it as a nonprofit pharmaceutical company.
Lex Fridman (1:19:53.920)
I created it in 86 after DEA,
Rick Doblin (1:19:57.180)
the Drug Enforcement Administration,
Lex Fridman (1:19:58.760)
criminalized MDMA in 1985.
Lex Fridman (1:20:01.560)
And that was after they started trying to do that in 1984.
Lex Fridman (1:20:05.800)
And as I mentioned, this Terence McKenna is sponsoring,
Rick Doblin (1:20:09.640)
motivating us to do this safety study.
Lex Fridman (1:20:12.280)
So we did that in preparation for this eventual crackdown
Rick Doblin (1:20:15.440)
because MDMA was called Adam, used as a therapy drug,
Lex Fridman (1:20:18.960)
but it was also beginning to be sold as ecstasy
Rick Doblin (1:20:21.760)
as a party drug.
Lex Fridman (1:20:22.600)
And that was taking place in public settings and bars.
Lex Fridman (1:20:25.560)
And so it was inevitable that the crackdown would happen.
Lex Fridman (1:20:29.000)
And so I had a nonprofit connected to Buckminster Fuller,
Rick Doblin (1:20:32.760)
Earth Metabolic Design Lab,
Lex Fridman (1:20:35.100)
that we used to support this lawsuit against the DEA
Rick Doblin (1:20:38.680)
to block them from criminalizing MDMA.
Lex Fridman (1:20:41.160)
We were winning in the court of public opinion
Lex Fridman (1:20:43.520)
and winning in the court.
Lex Fridman (1:20:45.120)
The DEA freaked out
Lex Fridman (1:20:46.280)
and the emergency scheduled MDMA in 85.
Lex Fridman (1:20:49.680)
The handwriting was on the wall
Rick Doblin (1:20:51.040)
that they were not gonna permit
Lex Fridman (1:20:52.520)
the therapeutic use to continue
Rick Doblin (1:20:54.280)
because it gets in the way of the narrative of the drug war
Lex Fridman (1:20:56.480)
and these are terrible drugs.
Lex Fridman (1:20:58.320)
So in 86 is when I started MAPS as a nonprofit pharma
Lex Fridman (1:21:02.760)
because the strategy that I realized is that
Rick Doblin (1:21:05.600)
Americans are open to medicines,
Lex Fridman (1:21:10.420)
that tools to ease suffering,
Rick Doblin (1:21:13.100)
that was the opening wedge,
Lex Fridman (1:21:14.540)
the opening door to changing attitudes.
Lex Fridman (1:21:17.300)
And it would be through science.
Lex Fridman (1:21:18.740)
I would say that my religion is more science
Rick Doblin (1:21:21.700)
than anything else.
Lex Fridman (1:21:23.260)
And culture and religion are metaphorical,
Lex Fridman (1:21:28.400)
but often too much they become literal.
Lex Fridman (1:21:31.040)
But I felt that through science, through medicine,
Rick Doblin (1:21:34.400)
there would be a way to bring these drugs
Lex Fridman (1:21:36.820)
back to the surface.
Lex Fridman (1:21:37.900)
And the mission was always this mass mental health,
Lex Fridman (1:21:42.340)
this idea that what we need is to spiritualize humanity.
Rick Doblin (1:21:46.660)
Einstein said the splitting of the atom
Lex Fridman (1:21:49.180)
has changed everything except our mode of thinking.
Lex Fridman (1:21:52.240)
And hence we drift towards unparalleled catastrophe,
Lex Fridman (1:21:56.220)
which shall be required if mankind is to survive
Rick Doblin (1:21:59.300)
is a whole new mode of thinking.
Lex Fridman (1:22:01.180)
So what is that new mode of thinking?
Rick Doblin (1:22:05.560)
My presumption is that it's more of this mystical sense
Lex Fridman (1:22:10.720)
of thinking that we're all connected.
Lex Fridman (1:22:12.920)
And then if we realize that we're all connected,
Lex Fridman (1:22:14.800)
we're not gonna blow up the world.
Lex Fridman (1:22:16.360)
So a lot of people say that if we could just give LSD
Lex Fridman (1:22:20.080)
all to the world leaders, that would be,
Rick Doblin (1:22:22.920)
then they'd have these spiritual experiences,
Lex Fridman (1:22:24.520)
the world would be better.
Lex Fridman (1:22:25.360)
But I actually had a ketamine experience
Lex Fridman (1:22:27.200)
the day after that DMT experience I described
Rick Doblin (1:22:29.600)
with the inner Hitler.
Lex Fridman (1:22:31.480)
This ketamine experience was,
Rick Doblin (1:22:34.520)
I was above and behind Hitler as he was giving a speech,
Lex Fridman (1:22:37.280)
like the Nuremberg rallies kind of thing.
Lex Fridman (1:22:40.220)
And I was trying to think, how do I get into his head?
Lex Fridman (1:22:42.280)
How do I undo what he wants to do?
Lex Fridman (1:22:44.560)
How can we deal with him?
Lex Fridman (1:22:46.280)
And I realized this whole new thing
Rick Doblin (1:22:48.960)
about the Heil Hitler salute.
Lex Fridman (1:22:50.520)
And he would like push energy out
Lex Fridman (1:22:53.240)
and then everybody would do the salute back to him.
Lex Fridman (1:22:55.600)
And so it's like the one to the many
Lex Fridman (1:22:57.180)
and the many to the one,
Lex Fridman (1:22:58.020)
giving all these people giving away their power
Lex Fridman (1:23:00.040)
and then how it would just sort of ratchet up in intensity
Lex Fridman (1:23:03.240)
like these vibrations.
Lex Fridman (1:23:04.960)
And I realized there's no way to get into his head.
Lex Fridman (1:23:07.480)
This idea we've talked about before
Rick Doblin (1:23:08.800)
about you have to be willing.
Lex Fridman (1:23:10.980)
So what that sort of helped me understand
Rick Doblin (1:23:13.680)
is that the strategy has to be mass mental health.
Lex Fridman (1:23:16.800)
It's not about changing a few leaders.
Rick Doblin (1:23:18.540)
We need to change the mass of humanity
Lex Fridman (1:23:21.280)
to this new mode of thinking, this new spiritual way.
Lex Fridman (1:23:24.280)
So MAPS was a nonprofit pharmaceutical company
Lex Fridman (1:23:28.680)
focused on psychedelics.
Rick Doblin (1:23:30.600)
Big Pharma wasn't doing this work.
Lex Fridman (1:23:32.120)
Government wasn't funding it.
Lex Fridman (1:23:33.920)
So the only source of funds
Lex Fridman (1:23:35.160)
I thought would be through nonprofit donations.
Lex Fridman (1:23:37.200)
And that's been true up until just a couple of years ago
Lex Fridman (1:23:39.160)
now that we have the rise of these for profits.
Lex Fridman (1:23:41.440)
But that's because we've cleared out
Lex Fridman (1:23:42.560)
the regulatory obstacles.
Rick Doblin (1:23:45.000)
We've got more scientific data about the benefits
Lex Fridman (1:23:47.600)
funded through philanthropy.
Rick Doblin (1:23:49.320)
We've changed public opinion
Lex Fridman (1:23:51.240)
and there's a lot less zeal for the drug war.
Lex Fridman (1:23:53.840)
So all of those things have changed.
Lex Fridman (1:23:55.280)
But at the time it was mass mental health was the goal.
Rick Doblin (1:23:58.960)
Two tracks, one was drug development,
Lex Fridman (1:24:01.600)
the other was drug policy reform.
Lex Fridman (1:24:03.800)
So then it's not just available to people
Lex Fridman (1:24:05.960)
that have a clinical diagnosis,
Lex Fridman (1:24:07.360)
but people who are personal growth
Lex Fridman (1:24:10.560)
or they should have access to it as well.
Rick Doblin (1:24:13.960)
I did not know at the time that no drug
Lex Fridman (1:24:16.560)
had ever been made into a medicine by a nonprofit.
Rick Doblin (1:24:20.480)
That was really good I didn't know that.
Lex Fridman (1:24:23.160)
I might've been a little bit more daunted.
Lex Fridman (1:24:26.040)
And actually that didn't happen for 13 more years.
Lex Fridman (1:24:28.440)
It happened in 1999.
Lex Fridman (1:24:30.600)
And that was the abortion pill, RU46,
Lex Fridman (1:24:34.200)
that was approved in Europe, but it's controversial.
Rick Doblin (1:24:36.760)
Nobody, no pharmaceutical company would take it.
Lex Fridman (1:24:39.400)
And it was John D. Rockefeller the third
Rick Doblin (1:24:41.480)
through the population council
Lex Fridman (1:24:42.760)
with the major donor being Warren Buffet.
Lex Fridman (1:24:45.600)
And the Rockefellers and the Buffets
Lex Fridman (1:24:48.560)
and some of the Pritzkers were involved in funding this.
Lex Fridman (1:24:51.360)
So that was the first nonprofit.
Lex Fridman (1:24:54.160)
But the MAPS was designed as from the very beginning,
Rick Doblin (1:25:00.600)
not academic research into psychedelics,
Lex Fridman (1:25:03.440)
but drug development.
Lex Fridman (1:25:04.640)
And that's a fundamental distinction.
Lex Fridman (1:25:06.360)
And that's why I think we're years ahead now
Rick Doblin (1:25:08.600)
with everybody else in terms of making
Lex Fridman (1:25:11.120)
a psychedelic assisted therapy into a medicine.
Rick Doblin (1:25:13.780)
Because our goal from the very beginning was not knowledge,
Lex Fridman (1:25:16.840)
not academic research, it was practical.
Rick Doblin (1:25:19.040)
It was drug development.
Lex Fridman (1:25:20.080)
How do we create new social structures?
Lex Fridman (1:25:22.440)
How do we create legal access to these things?
Lex Fridman (1:25:25.120)
Now, in December of 2014,
Rick Doblin (1:25:28.400)
we created the MAPS Public Benefit Corporation.
Lex Fridman (1:25:31.880)
So MAPS is a nonprofit, but in our 35 years,
Rick Doblin (1:25:36.680)
we've raised about $110 million in donations.
Lex Fridman (1:25:41.600)
What I didn't know when I started MAPS,
Lex Fridman (1:25:43.800)
and it took me quite a few years,
Lex Fridman (1:25:46.520)
I didn't even know this till about eight, nine years ago,
Rick Doblin (1:25:50.440)
was that in 1984, Ronald Reagan had signed a bill
Lex Fridman (1:25:54.840)
to create incentives for developing drugs
Rick Doblin (1:25:57.140)
that were off patent.
Lex Fridman (1:25:58.840)
So MDMA was invented by Merck in 1912.
Rick Doblin (1:26:02.040)
It's in the public domain.
Lex Fridman (1:26:03.720)
These incentives are called data exclusivity,
Rick Doblin (1:26:06.320)
which means that if you make a drug into a medicine
Lex Fridman (1:26:08.360)
that has no patent protection,
Rick Doblin (1:26:10.260)
nobody can use your data for a period of time
Lex Fridman (1:26:13.440)
to market a generic.
Lex Fridman (1:26:14.660)
And that will effectively be,
Lex Fridman (1:26:16.520)
well, it's five years, you do pediatric studies,
Rick Doblin (1:26:18.880)
you get six months extension,
Lex Fridman (1:26:20.520)
and we are being required, if we succeed in adults,
Rick Doblin (1:26:24.120)
to work with adolescents with PTSD.
Lex Fridman (1:26:26.520)
It blocks a generic competitor
Rick Doblin (1:26:28.140)
from applying till that five and a half years is over,
Lex Fridman (1:26:30.840)
takes FDA at least six months to review.
Lex Fridman (1:26:33.140)
So more or less six years of data exclusivity,
Lex Fridman (1:26:35.940)
10 years in Europe is data exclusivity.
Lex Fridman (1:26:38.820)
So the story then became to the donors
Lex Fridman (1:26:42.300)
that you're not gonna have to give us money forever
Rick Doblin (1:26:45.240)
because we can make money selling MDMA,
Lex Fridman (1:26:48.300)
but we wanna do two revolutionary things, you could say.
Rick Doblin (1:26:51.700)
One is psychedelic assisted psychotherapy,
Lex Fridman (1:26:53.800)
but the other is marketing drugs.
Rick Doblin (1:26:56.440)
When you market it with the profit maximization motive,
Lex Fridman (1:26:59.740)
we end up in the extreme getting the distortions
Rick Doblin (1:27:02.480)
that we have in America,
Lex Fridman (1:27:03.520)
where we have the most expensive healthcare system
Rick Doblin (1:27:06.720)
in the world per capita,
Lex Fridman (1:27:07.840)
but our outcomes are down like 40 or 50 among the countries,
Rick Doblin (1:27:11.000)
our average outcomes.
Lex Fridman (1:27:11.880)
We don't have, third of the people or so
Rick Doblin (1:27:13.900)
don't have insurance, and it's just very inequitable.
Lex Fridman (1:27:17.360)
So what we're trying to do
Rick Doblin (1:27:19.440)
is show a different way to market drugs.
Lex Fridman (1:27:22.640)
And it's a modification of capitalism
Rick Doblin (1:27:24.560)
that's called the benefit corporation,
Lex Fridman (1:27:26.640)
where you maximize public benefit, not profit.
Rick Doblin (1:27:29.560)
You still make a profit.
Lex Fridman (1:27:31.320)
So selling MDMA for a profit
Rick Doblin (1:27:33.420)
is not something we could keep inside the nonprofit
Lex Fridman (1:27:36.560)
because it's taxable, it's a business.
Lex Fridman (1:27:39.480)
So we've created the MAPS Public Benefit Corporation,
Lex Fridman (1:27:42.740)
which is 100% owned by the nonprofit.
Lex Fridman (1:27:45.120)
So we have a nonprofit that owns a pharma company.
Lex Fridman (1:27:49.520)
And the mission of that pharma company
Rick Doblin (1:27:51.240)
is to maximize not profit,
Lex Fridman (1:27:53.680)
but maximize benefit for society.
Rick Doblin (1:27:55.620)
Yeah, yeah.
Lex Fridman (1:27:56.720)
Although there still will be profits,
Lex Fridman (1:27:58.720)
and the profits that we're gonna make
Lex Fridman (1:28:00.760)
are going to be used towards the mission of MAPS,
Rick Doblin (1:28:03.940)
which is again, is this mass mental health
Lex Fridman (1:28:05.920)
and ending the drug war.
Lex Fridman (1:28:08.040)
And in fact, we've hired the Boston Consulting Group
Lex Fridman (1:28:10.600)
to help us plot our commercialization strategy.
Lex Fridman (1:28:15.360)
And so there is some suggestions based,
Lex Fridman (1:28:18.040)
there's so many different assumptions in this,
Rick Doblin (1:28:19.920)
the number of therapists that we train,
Lex Fridman (1:28:22.040)
the price that we set for the MDMA,
Rick Doblin (1:28:24.480)
whether insurance companies will cover it.
Lex Fridman (1:28:27.440)
But there's the possibility of somewhere in the range
Rick Doblin (1:28:30.680)
of three quarters of a billion dollars in profits
Lex Fridman (1:28:33.760)
during this period of data exclusivity,
Rick Doblin (1:28:36.160)
just from the US and we're talking about
Lex Fridman (1:28:40.720)
trying to do this research around the world as well.
Lex Fridman (1:28:42.960)
So that's what the Benefit Corporation is.
Lex Fridman (1:28:45.120)
The Benefit Corporation is our pharmaceutical arm.
Rick Doblin (1:28:47.360)
We're about 130 people now,
Lex Fridman (1:28:50.000)
somewhere in that fluctuates,
Lex Fridman (1:28:51.720)
but one third of them are in the nonprofit.
Lex Fridman (1:28:54.140)
We do harm reduction, psychedelic harm reduction.
Rick Doblin (1:28:57.880)
We help create programs for people
Lex Fridman (1:29:02.000)
with difficult psychedelic experiences
Rick Doblin (1:29:04.480)
at Burning Man, at festivals all over the world,
Lex Fridman (1:29:06.680)
even in cities we're now negotiating with the police,
Rick Doblin (1:29:11.040)
the city of Denver, because Denver has made the mushrooms
Lex Fridman (1:29:14.200)
the lowest enforcement priority.
Rick Doblin (1:29:16.680)
Oregon has passed the Oregon psilocybin initiative.
Lex Fridman (1:29:18.960)
So in those areas where maybe more people
Rick Doblin (1:29:21.500)
are gonna gravitate to do psychedelics,
Lex Fridman (1:29:23.060)
we want there to be harm reduction
Lex Fridman (1:29:24.640)
so that we don't have bad stories coming up
Lex Fridman (1:29:27.600)
that would change that.
Lex Fridman (1:29:29.120)
So MAPS does the psychedelic harm reduction.
Lex Fridman (1:29:31.040)
We do public education.
Rick Doblin (1:29:32.560)
We do a lot of it.
Lex Fridman (1:29:33.400)
That's what you and I are doing right now.
Rick Doblin (1:29:35.120)
We're doing that now.
Lex Fridman (1:29:38.240)
But also research towards.
Rick Doblin (1:29:40.280)
Well, the research now is done in the Benefit Corp.
Lex Fridman (1:29:42.960)
In the Benefit Corp.
Rick Doblin (1:29:43.800)
Yeah, so what happens is people donate to MAPS,
Lex Fridman (1:29:46.120)
get a tax deduction, MAPS transfers the money,
Rick Doblin (1:29:48.480)
or you could say invests in the Benefit Corp.
Lex Fridman (1:29:50.840)
Yes.
Rick Doblin (1:29:51.680)
The Benefit Corp will do the research
Lex Fridman (1:29:53.000)
and then MAPS is the sponsor,
Lex Fridman (1:29:55.640)
but then we will license the sale of MDMA
Lex Fridman (1:29:57.640)
to the Benefit Corp, so.
Rick Doblin (1:29:58.720)
Got it, but the research is done with an eye
Lex Fridman (1:30:01.240)
towards creating something that has a big impact
Rick Doblin (1:30:03.480)
versus just research for knowledge's sake.
Lex Fridman (1:30:06.120)
Yeah, yeah, because I'm interested in political change.
Rick Doblin (1:30:13.080)
The other part of it, which is that the brain
Lex Fridman (1:30:16.640)
is the most complex thing we know in the universe.
Rick Doblin (1:30:21.040)
It's endless.
Lex Fridman (1:30:22.400)
I mean, when are we gonna really, like this idea of,
Lex Fridman (1:30:24.600)
will we figure out telepathy?
Lex Fridman (1:30:26.000)
Will we figure out tapping into the collective unconscious?
Lex Fridman (1:30:28.760)
What is the extents of our brain?
Lex Fridman (1:30:31.160)
How does the brain actually work?
Lex Fridman (1:30:32.320)
Do you ask chemistry questions?
Lex Fridman (1:30:33.880)
So if it's just the pursuit of knowledge,
Rick Doblin (1:30:36.480)
that is an endless thing.
Lex Fridman (1:30:37.920)
And how does that end the drug war?
Lex Fridman (1:30:39.440)
How does that help people directly?
Lex Fridman (1:30:41.120)
So that's why we're focused on drug development
Rick Doblin (1:30:43.720)
more than mechanism of action.
Lex Fridman (1:30:45.800)
Before I ask you about one,
Lex Fridman (1:30:48.520)
but several really exciting studies,
Lex Fridman (1:30:51.880)
let me ask sort of a personal question for me.
Lex Fridman (1:30:54.760)
So if I wanted to get psychedelics
Lex Fridman (1:30:59.080)
from the MAPS Public Benefit Corporation
Lex Fridman (1:31:04.240)
and explore my own mind, how do I get to do that?
Lex Fridman (1:31:10.040)
And when?
Rick Doblin (1:31:10.880)
You won't be able to.
Lex Fridman (1:31:12.000)
You'll never be able to.
Rick Doblin (1:31:12.840)
This is very unfortunate.
Lex Fridman (1:31:14.400)
Because the reason is because the Benefit Corp
Rick Doblin (1:31:17.160)
is designed as a pharmaceutical company.
Lex Fridman (1:31:20.120)
So we can only work on clinical indication.
Lex Fridman (1:31:23.800)
So let's say you come to me and you just say,
Lex Fridman (1:31:25.840)
oh, I'm really depressed.
Rick Doblin (1:31:27.080)
Can I get MDMA to overcome my depression
Lex Fridman (1:31:30.560)
or overcome my PTSD?
Rick Doblin (1:31:32.880)
We'll have to do research in those indications.
Lex Fridman (1:31:35.760)
And by when you say me, you mean like a doctor.
Lex Fridman (1:31:38.200)
So this would be prescribed in theory by doctors.
Lex Fridman (1:31:40.560)
Well, this would go through a doctor and a prescription.
Rick Doblin (1:31:43.560)
Okay, let me ask another question.
Lex Fridman (1:31:46.480)
To further answer,
Lex Fridman (1:31:47.320)
so that's where the drug policy arm comes in,
Lex Fridman (1:31:49.600)
the drug policy reform.
Lex Fridman (1:31:51.160)
So you should be able to get access to psychedelics
Lex Fridman (1:31:54.520)
for your own personal growth.
Lex Fridman (1:31:56.560)
But that's not medicine.
Lex Fridman (1:31:59.160)
So that's why we need to medicalize,
Rick Doblin (1:32:02.160)
to have things covered by insurance,
Lex Fridman (1:32:04.600)
to change people's attitudes, the public attitudes.
Lex Fridman (1:32:07.440)
And then we get this subsequent drug policy reform.
Lex Fridman (1:32:11.720)
And we're talking about it
Rick Doblin (1:32:12.840)
in terms of licensed legalization.
Lex Fridman (1:32:14.720)
So my view is you should get a license to do psychedelics,
Rick Doblin (1:32:18.280)
you get a little education stuff,
Lex Fridman (1:32:19.880)
and then you should be able to buy it
Lex Fridman (1:32:21.160)
and do it on your own.
Lex Fridman (1:32:22.000)
So let me rephrase the question in more specifically.
Lex Fridman (1:32:24.160)
So when can I, if I happen to have ailments of some kind
Lex Fridman (1:32:29.080)
where the doctor decides that psychedelics could help,
Rick Doblin (1:32:31.880)
when would you be a loose estimate for you
Lex Fridman (1:32:35.160)
of when a doctor will be able to prescribe to me
Rick Doblin (1:32:37.720)
something from MAPS Public Benefit Co.
Lex Fridman (1:32:41.480)
And then when for my personal growth and creativity,
Lex Fridman (1:32:45.000)
would I be able to get something?
Lex Fridman (1:32:46.360)
So like, just looking out, this isn't like guaranteed,
Lex Fridman (1:32:49.160)
but like your vision, your hope for,
Lex Fridman (1:32:53.160)
yeah, for psychedelics in society.
Rick Doblin (1:32:56.000)
Well, the end of 2023, so two and a half years from now,
Lex Fridman (1:32:59.960)
we anticipate FDA approval
Rick Doblin (1:33:02.240)
for the prescription use of MDMA for PTSD.
Lex Fridman (1:33:05.840)
Because the FDA does not regulate the practice of medicine,
Rick Doblin (1:33:11.680)
there is what's called off label prescription.
Lex Fridman (1:33:14.720)
What that means, the label is what it's approved for.
Lex Fridman (1:33:16.840)
So the label will say, oh, this is approved for PTSD.
Lex Fridman (1:33:20.320)
But let's say you come and anything else, social anxiety
Rick Doblin (1:33:23.200)
or whatever, you can go to the doctor,
Lex Fridman (1:33:24.720)
they can give it to you.
Rick Doblin (1:33:26.360)
It might not be covered by insurance,
Lex Fridman (1:33:27.920)
they have to be a little bit careful about malpractice.
Lex Fridman (1:33:30.560)
But I think the end of 2023
Lex Fridman (1:33:32.640)
is when you will be able to do that.
Rick Doblin (1:33:34.880)
Now, there's actually another program, very limited,
Lex Fridman (1:33:38.800)
called Expanded Access, which is compassionate use,
Rick Doblin (1:33:42.640)
which means that, and we have approval for 50 people
Lex Fridman (1:33:45.640)
for compassionate use right now, we think that'll grow.
Lex Fridman (1:33:48.960)
So that's gonna open up in about two months.
Lex Fridman (1:33:51.320)
And so those are people with PTSD,
Rick Doblin (1:33:53.680)
they have to be treatment resistant,
Lex Fridman (1:33:55.080)
nothing has worked for them.
Lex Fridman (1:33:56.120)
And they can access MDMA
Lex Fridman (1:33:58.480)
while we're doing the phase three studies.
Lex Fridman (1:34:01.920)
But they have to pay for it themselves.
Lex Fridman (1:34:04.280)
The sponsor has to pay for all the research.
Lex Fridman (1:34:06.320)
But Expanded Access, because there's no control group,
Lex Fridman (1:34:09.760)
everybody gets the MDMA, people can pay for it themselves.
Lex Fridman (1:34:12.960)
And we think that'll start in a couple months.
Lex Fridman (1:34:15.320)
But it's very limited, it's limited to certain cities.
Rick Doblin (1:34:17.760)
There's also a program called Right to Try,
Lex Fridman (1:34:20.520)
which is passed through Congress.
Rick Doblin (1:34:23.000)
It's similar to this idea of compassionate use,
Lex Fridman (1:34:26.080)
but it cuts the FDA out of it.
Lex Fridman (1:34:28.280)
And patients can negotiate directly with pharma companies
Lex Fridman (1:34:32.960)
to get access to their drugs.
Rick Doblin (1:34:35.520)
That's starting to happen, I think, in Canada now,
Lex Fridman (1:34:38.800)
they're letting people have compassionate access
Rick Doblin (1:34:41.200)
to psilocybin for life threatening illness,
Lex Fridman (1:34:44.160)
because there has been studies with psilocybin
Rick Doblin (1:34:46.560)
for cancer patients and others with life threatening illness.
Lex Fridman (1:34:49.720)
As far as your question about when will you be able
Lex Fridman (1:34:51.800)
to access this for personal growth outside of medicine?
Lex Fridman (1:34:56.840)
I'll take that to mean fully legally,
Rick Doblin (1:34:59.000)
where you can just go buy pure drugs somewhere,
Lex Fridman (1:35:00.960)
when will that happen?
Rick Doblin (1:35:02.240)
We already are starting to see the decriminalization
Lex Fridman (1:35:05.640)
in certain areas of plant psychedelics.
Lex Fridman (1:35:09.240)
And we see overall drug decrim, like that passed in Oregon,
Lex Fridman (1:35:13.440)
so that any drug is now, it's not legal,
Rick Doblin (1:35:16.040)
you can't really fully set up clinics to offer it to people
Lex Fridman (1:35:20.720)
or there's no legal supply like that,
Lex Fridman (1:35:22.640)
but it's decriminalized.
Lex Fridman (1:35:24.240)
So my sense of things is based a lot on watching
Lex Fridman (1:35:27.480)
what happened with medical marijuana
Lex Fridman (1:35:28.960)
and marijuana legalization.
Lex Fridman (1:35:30.160)
So we're sitting here in Massachusetts
Lex Fridman (1:35:31.800)
where marijuana is legal,
Lex Fridman (1:35:33.600)
but what happened first was medical marijuana.
Lex Fridman (1:35:36.240)
So what we see is that medicalization,
Rick Doblin (1:35:40.000)
by demonstrating that under certain contexts,
Lex Fridman (1:35:43.320)
the risks are much less than the benefits,
Lex Fridman (1:35:47.640)
and then there are benefits,
Lex Fridman (1:35:49.320)
and then people hear stories about people
Rick Doblin (1:35:51.440)
that have gotten better,
Lex Fridman (1:35:53.000)
and then that changes their minds,
Lex Fridman (1:35:54.520)
and then eventually that builds up to why are we throwing
Lex Fridman (1:35:57.080)
people in jail for this?
Rick Doblin (1:35:57.920)
Just the culture, yeah.
Lex Fridman (1:35:59.200)
Yeah, so I think that what we're gonna have 2023
Rick Doblin (1:36:02.520)
is MDMA approved by the FDA, chances are.
Lex Fridman (1:36:07.040)
Psilocybin will be a year or two after that.
Rick Doblin (1:36:09.800)
Then what we're gonna need is a decade
Lex Fridman (1:36:11.600)
of psychedelic clinics that are gonna roll out
Rick Doblin (1:36:14.120)
across America, also other countries as well,
Lex Fridman (1:36:17.920)
thousands of these psychedelic clinics.
Rick Doblin (1:36:20.040)
We already have hundreds of ketamine clinics
Lex Fridman (1:36:23.560)
that are ketamine for depression.
Rick Doblin (1:36:26.120)
More and more people are realizing that ketamine,
Lex Fridman (1:36:28.200)
when it's used with therapy, it's better than when it's not.
Lex Fridman (1:36:31.520)
But the therapists wanna be psychedelic therapists.
Lex Fridman (1:36:34.120)
They don't wanna be a ketamine therapist or an MDMA therapist.
Lex Fridman (1:36:36.720)
So they'll be cross trained.
Lex Fridman (1:36:38.360)
So we will have a decade of these thousands
Rick Doblin (1:36:40.480)
of psychedelic clinics and all these stories
Lex Fridman (1:36:42.360)
of people getting better.
Lex Fridman (1:36:43.200)
And 2035 is when I think that we will move
Lex Fridman (1:36:46.400)
to licensed legalization, which is when you will
Rick Doblin (1:36:49.800)
have the option of just going somewhere
Lex Fridman (1:36:52.960)
once you've done this educational stuff.
Rick Doblin (1:36:55.440)
Potentially, I also think it would be better
Lex Fridman (1:36:58.040)
to have the opportunity for people to go for free,
Rick Doblin (1:37:02.080)
paid for by tax money, to these clinics,
Lex Fridman (1:37:04.360)
and you have your first experience
Rick Doblin (1:37:05.760)
with psychedelics under supervision.
Lex Fridman (1:37:08.080)
And you know what you're getting into.
Rick Doblin (1:37:09.720)
You've, you know, to ask the questionnaire,
Lex Fridman (1:37:12.840)
what the risks are with the drugs,
Rick Doblin (1:37:14.120)
then you get your license.
Lex Fridman (1:37:15.760)
So 2035 is when I think that'll happen.
Lex Fridman (1:37:18.000)
And the clinics will be sites of these initiations.
Lex Fridman (1:37:20.880)
Yes.
Lex Fridman (1:37:21.840)
And so it'd be a safe environment, just like you said,
Lex Fridman (1:37:23.760)
all the things that are actually maximize the likelihood
Rick Doblin (1:37:27.240)
of a pleasant experience and all those kinds of things.
Lex Fridman (1:37:30.120)
It is a frustratingly slow process.
Lex Fridman (1:37:32.520)
And the FDA being part of that process is very frustrating.
Lex Fridman (1:37:36.600)
But of course there's benefits,
Lex Fridman (1:37:40.000)
but boy, I wish it could move a lot faster.
Lex Fridman (1:37:44.000)
Yeah, well, one thing that I've learned
Rick Doblin (1:37:45.800)
from being a parent is that when you have little kids,
Lex Fridman (1:37:52.640)
it seems like they'll be with you forever.
Lex Fridman (1:37:55.320)
But then when they grow up and they go to college
Lex Fridman (1:37:58.280)
and they leave, do you look back and like,
Lex Fridman (1:37:59.760)
where did that 20 years go?
Lex Fridman (1:38:01.800)
Yeah.
Rick Doblin (1:38:02.640)
You know, so we're still dealing with the legacy
Lex Fridman (1:38:05.240)
of the civil war and slavery in America.
Lex Fridman (1:38:08.000)
So actually a 20 year plan is not that long.
Lex Fridman (1:38:11.560)
So while we say it's frustratingly slow, and it is,
Rick Doblin (1:38:17.680)
I mean, it's 50 years since the psychedelic sixties.
Lex Fridman (1:38:21.400)
And right now it's 36 years since MDMA was criminalized.
Lex Fridman (1:38:29.000)
And you think about all those people that committed suicide
Lex Fridman (1:38:31.600)
from PTSD or from anything else.
Lex Fridman (1:38:34.240)
And all those people that could have been helped
Lex Fridman (1:38:36.840)
if the DEA had accepted the Administrative Law Judge
Rick Doblin (1:38:40.440)
recommendation that MDMA stay in schedule three.
Lex Fridman (1:38:42.920)
It's tremendously sad.
Rick Doblin (1:38:45.320)
At the same time, culture evolves slowly.
Lex Fridman (1:38:48.360)
You know, you read the Bible or you read all this stuff,
Rick Doblin (1:38:50.420)
we're not that different from people thousands of years ago.
Lex Fridman (1:38:53.260)
So how are we gonna really evolve enough
Rick Doblin (1:38:56.880)
over the next couple of decades
Lex Fridman (1:38:58.440)
so we don't destroy the planet and don't kill each other?
Rick Doblin (1:39:01.520)
That's why I think psychedelics have an important role
Lex Fridman (1:39:04.600)
to play, that's why I've devoted my life to psychedelics.
Lex Fridman (1:39:07.800)
And it is frustratingly slow.
Lex Fridman (1:39:09.600)
And what I said to myself is our whole effort
Rick Doblin (1:39:13.360)
has not been fast enough.
Lex Fridman (1:39:15.340)
Can we talk a little bit about PTSD and MDMA?
Rick Doblin (1:39:18.600)
There's this fascinating paper came out
Lex Fridman (1:39:22.720)
on a fascinating study that you're a part of.
Rick Doblin (1:39:26.520)
That's a phase three study.
Lex Fridman (1:39:27.920)
Can you describe what the study is?
Lex Fridman (1:39:29.580)
Can you describe what phase three means?
Lex Fridman (1:39:31.780)
Can you describe what the findings are
Lex Fridman (1:39:35.000)
and why it's in fact so important and impactful?
Lex Fridman (1:39:39.020)
Yeah, this study came out May 10th in Nature Medicine.
Lex Fridman (1:39:41.840)
So one of the highest impact factors in medicine,
Lex Fridman (1:39:44.680)
journals, it was tremendous.
Lex Fridman (1:39:46.160)
So to make a drug into a medicine,
Lex Fridman (1:39:48.780)
the first thing you need to do is what are called
Rick Doblin (1:39:52.360)
nonclinical or preclinical studies,
Lex Fridman (1:39:54.240)
meaning safety established in animals.
Lex Fridman (1:39:57.040)
What does the drug do?
Lex Fridman (1:39:58.440)
What are the side effects in animals?
Lex Fridman (1:40:00.080)
Where do you see the risks?
Lex Fridman (1:40:01.240)
And then you negotiate with FDA to do phase one studies.
Lex Fridman (1:40:05.600)
And phase one studies are where you move
Lex Fridman (1:40:07.440)
from animals to humans.
Lex Fridman (1:40:09.280)
And those are more safety studies
Lex Fridman (1:40:11.960)
and trying to describe what the drug does
Lex Fridman (1:40:14.500)
so that you can determine
Lex Fridman (1:40:16.160)
if there is potential medical value there.
Rick Doblin (1:40:19.120)
Certain drugs like cancer drugs are so toxic
Lex Fridman (1:40:24.120)
that you don't have phase one studies in healthy volunteers.
Rick Doblin (1:40:29.120)
That's like phase one slash two,
Lex Fridman (1:40:31.440)
where you bring in the patients,
Lex Fridman (1:40:33.840)
but you still are doing sort of dose response
Lex Fridman (1:40:35.880)
safety studies, but you use patients.
Lex Fridman (1:40:38.640)
But most phase one studies are healthy volunteers.
Lex Fridman (1:40:41.640)
Phase two are where you start bringing in the patients
Lex Fridman (1:40:45.440)
and you start experimenting with various different things.
Lex Fridman (1:40:48.400)
The purpose of phase two is really just to design phase three.
Rick Doblin (1:40:52.120)
Now, again, I'm sort of putting out of the picture
Lex Fridman (1:40:55.480)
in another area is mechanism of action.
Lex Fridman (1:40:57.240)
How do these drugs work?
Lex Fridman (1:40:58.680)
Phase two, you're trying to figure out what they do,
Rick Doblin (1:41:02.800)
who your patient population is, what are the risks,
Lex Fridman (1:41:05.400)
who do you include, who do you exclude,
Lex Fridman (1:41:07.800)
what are the doses, what is your treatment,
Lex Fridman (1:41:10.520)
what are your measures.
Lex Fridman (1:41:13.560)
In our case, it was how do you do a double blind study?
Lex Fridman (1:41:18.160)
That was a big part of phase two.
Rick Doblin (1:41:20.240)
That's a big challenge for psychedelic drugs.
Lex Fridman (1:41:22.800)
Any kind of drugs that have a real strong effect,
Lex Fridman (1:41:25.880)
how do you do a double blind study?
Lex Fridman (1:41:27.480)
The double blind, sorry to interrupt,
Rick Doblin (1:41:28.960)
would mean that the patient should not be aware
Lex Fridman (1:41:33.480)
whether it's a placebo or not.
Lex Fridman (1:41:35.800)
And the researcher.
Lex Fridman (1:41:36.960)
And the researcher is not aware.
Lex Fridman (1:41:39.160)
And so for that lack of awareness,
Lex Fridman (1:41:41.000)
when the effect is really strong,
Rick Doblin (1:41:42.320)
it's very difficult to do on both the researcher
Lex Fridman (1:41:44.160)
and the patient side.
Rick Doblin (1:41:45.680)
Yes, and sometimes they talk about triple blind.
Lex Fridman (1:41:49.200)
So the other part is the raters
Rick Doblin (1:41:51.280)
that evaluate the symptoms and before and after.
Lex Fridman (1:41:54.080)
So you ideally want triple blind.
Rick Doblin (1:41:55.880)
You want the patients, the researchers,
Lex Fridman (1:41:58.880)
and the evaluators of the outcomes, all of them,
Rick Doblin (1:42:02.200)
not to know what the drug, whether it was drug or placebo,
Lex Fridman (1:42:05.320)
and that's to reduce experiment or bias.
Lex Fridman (1:42:10.200)
And then you move to phase three,
Lex Fridman (1:42:12.040)
once you've figured out how to design the phase three studies.
Lex Fridman (1:42:15.560)
And phase three are the large scale multiple studies
Lex Fridman (1:42:18.800)
multi site, placebo controlled, double blind studies,
Rick Doblin (1:42:23.000)
where you must prove safety and efficacy
Lex Fridman (1:42:25.520)
in order to get permission to market the drug.
Rick Doblin (1:42:29.760)
Now, for us, when we started MAPS in 86,
Lex Fridman (1:42:34.000)
as I said, it was one year after the criminalization
Rick Doblin (1:42:36.040)
of MDMA in 85, we had five different protocols
Lex Fridman (1:42:39.880)
that were rejected by the FDA for studying with MDMA.
Lex Fridman (1:42:43.960)
And these were all various phase one studies.
Lex Fridman (1:42:46.800)
They came from Harvard, from UC San Francisco,
Rick Doblin (1:42:49.240)
from the University in Arizona,
Lex Fridman (1:42:51.360)
and Albuquerque, New Mexico, all over.
Lex Fridman (1:42:53.840)
And they were all rejected.
Lex Fridman (1:42:55.640)
1992, six years after we started,
Rick Doblin (1:42:59.040)
we got the first permission for phase one.
Lex Fridman (1:43:02.720)
And that took us through much of the 90s.
Rick Doblin (1:43:05.560)
Again, things are slow because we have to raise the money
Lex Fridman (1:43:08.160)
through donations.
Lex Fridman (1:43:09.320)
And then in 1999 is when we started the work with PTSD.
Lex Fridman (1:43:14.320)
And that then took us till November 29th, 2016,
Rick Doblin (1:43:22.720)
which is when we had the end of phase two meeting with FDA.
Lex Fridman (1:43:25.920)
So it took 30 years from the start of MAPS
Rick Doblin (1:43:29.200)
to the end of phase two meeting with FDA.
Lex Fridman (1:43:31.960)
And what we had discovered during phase two
Rick Doblin (1:43:35.520)
was several different key points.
Lex Fridman (1:43:38.960)
The drugs that are available right now for PTSD,
Rick Doblin (1:43:42.440)
the SSRIs, Zoloft and Paxil,
Lex Fridman (1:43:45.320)
that have been approved by FDA and regulators in Europe
Rick Doblin (1:43:47.960)
as well, the European Medicines Agency, for PTSD,
Lex Fridman (1:43:52.200)
they work better in women than in men,
Lex Fridman (1:43:54.600)
and they failed in combat related PTSD.
Lex Fridman (1:43:58.560)
All right, so what we learned is that MDMA assisted therapy
Rick Doblin (1:44:02.000)
works just as well in men or women,
Lex Fridman (1:44:03.880)
and it works in combat related PTSD.
Rick Doblin (1:44:06.480)
It works in regardless of the cause of PTSD.
Lex Fridman (1:44:09.280)
We also discovered that even though there are stories
Rick Doblin (1:44:12.960)
that people take MDMA at raves and they dance all night
Lex Fridman (1:44:16.080)
and they overheat and they get hypothermia
Lex Fridman (1:44:18.040)
and they die from overheating, which is true
Lex Fridman (1:44:20.400)
and can happen from pure MDMA,
Rick Doblin (1:44:23.200)
or that sometimes people have heard about
Lex Fridman (1:44:25.400)
needing to cool down and so they drink water
Lex Fridman (1:44:29.080)
and then while they're dancing all night
Lex Fridman (1:44:31.440)
and then they drink too much water
Lex Fridman (1:44:32.840)
and then they dilute their blood
Lex Fridman (1:44:34.280)
and they die from hyponatremia.
Lex Fridman (1:44:36.520)
So there are risks of MDMA, but we discovered
Lex Fridman (1:44:39.440)
that in a therapeutic setting,
Rick Doblin (1:44:41.040)
we can control all those risks,
Lex Fridman (1:44:42.680)
those things don't happen at all.
Lex Fridman (1:44:44.960)
So we discovered safety, we could demonstrate safety.
Lex Fridman (1:44:49.680)
We also figured out that our measure, the CAPS,
Rick Doblin (1:44:53.680)
the Clinician Administrative PTSD Scale,
Lex Fridman (1:44:55.920)
that it's the gold standard all over the world
Rick Doblin (1:44:58.320)
for measuring PTSD symptoms,
Lex Fridman (1:44:59.840)
it's what the FDA and the EMA require.
Rick Doblin (1:45:02.440)
We discovered that it was a good measure for us
Lex Fridman (1:45:04.760)
and that we could show changes in that.
Rick Doblin (1:45:07.880)
The other big thing that we learned is that,
Lex Fridman (1:45:11.400)
and we haven't mentioned this yet,
Lex Fridman (1:45:13.040)
but the work in the 50s and 60s with LSD and psilocybin
Lex Fridman (1:45:16.800)
and the modern research over the last 20 years
Rick Doblin (1:45:19.000)
with psilocybin and classic psychedelics
Lex Fridman (1:45:20.840)
has demonstrated that there's a link
Rick Doblin (1:45:23.120)
between this mystical experience,
Lex Fridman (1:45:24.960)
this unit of mystical experience and therapeutic outcomes
Rick Doblin (1:45:28.280)
for the treatment of addiction,
Lex Fridman (1:45:29.560)
for working with people with life threatening illnesses
Rick Doblin (1:45:32.320)
that for OCD, for Obsessive Compulsive Disorder,
Lex Fridman (1:45:36.760)
that there's with the classic psychedelics,
Rick Doblin (1:45:39.800)
both in the 50 years ago and then the research now
Lex Fridman (1:45:42.600)
has been that there's a link between the depth
Rick Doblin (1:45:45.240)
of the mystical experience and therapeutic outcome.
Lex Fridman (1:45:48.680)
What we discovered is that that's not the case for MDMA,
Rick Doblin (1:45:52.320)
that people do score fairly high
Lex Fridman (1:45:55.000)
on the scales of mystical experience,
Rick Doblin (1:45:56.960)
not as high as they do with the classic psychedelics,
Lex Fridman (1:45:59.240)
but they do score pretty high on average.
Lex Fridman (1:46:02.480)
And a significant number of them have over the cutoff
Lex Fridman (1:46:06.360)
for what would be considered a full mystical experience.
Lex Fridman (1:46:09.120)
So enough to say that we could look at a correlation
Lex Fridman (1:46:11.840)
and we didn't find any.
Rick Doblin (1:46:13.600)
The other thing that we discovered,
Lex Fridman (1:46:15.120)
and this was more humbling, I would say for me personally,
Rick Doblin (1:46:20.000)
is that my dissertation at the Kennedy School,
Lex Fridman (1:46:22.400)
a big part of it was on the,
Rick Doblin (1:46:24.440)
it's about the regulation of the medical use
Lex Fridman (1:46:26.240)
of psychedelics in marijuana.
Rick Doblin (1:46:27.840)
A big part of my dissertation was how to do
Lex Fridman (1:46:29.680)
the double blind study.
Lex Fridman (1:46:31.760)
And I thought I'd solve the problem
Lex Fridman (1:46:33.200)
and I persuaded my dissertation committee
Rick Doblin (1:46:35.560)
that I'd solve the problem.
Lex Fridman (1:46:37.480)
And the solution was therapy with low dose MDMA
Rick Doblin (1:46:41.240)
versus therapy with full dose MDMA.
Lex Fridman (1:46:43.960)
And everybody knows that they're gonna get MDMA,
Rick Doblin (1:46:46.840)
most of these people have never done it before,
Lex Fridman (1:46:49.040)
they'll be confused about is it full dose or low dose.
Lex Fridman (1:46:52.640)
And then the challenge is to pick a dose
Lex Fridman (1:46:56.200)
that's high enough so that there is this confusion,
Lex Fridman (1:47:00.080)
but not so high that it's so therapeutic
Lex Fridman (1:47:02.120)
that we can't tell the difference between the groups.
Lex Fridman (1:47:04.800)
So we studied zero, meaning inactive placebo,
Lex Fridman (1:47:09.360)
25 milligrams, 30 milligrams, 40 milligrams,
Rick Doblin (1:47:12.120)
50 milligrams, 75 milligrams, 100 milligrams,
Lex Fridman (1:47:14.680)
125 and 150.
Lex Fridman (1:47:18.120)
What we discovered is that my dissertation was wrong
Lex Fridman (1:47:21.960)
and that there is no good solution
Rick Doblin (1:47:24.320)
to the double blind problem.
Lex Fridman (1:47:26.280)
What we found is that, to our surprise actually,
Rick Doblin (1:47:31.320)
was that 75 milligrams was an effective dose.
Lex Fridman (1:47:34.840)
We didn't think that.
Rick Doblin (1:47:36.880)
I mean, the normal dose is like,
Lex Fridman (1:47:39.120)
full dose is like 125 milligrams, something like that.
Lex Fridman (1:47:42.720)
But 75 milligrams was an effective dose.
Lex Fridman (1:47:45.560)
And we discovered that the lower doses,
Lex Fridman (1:47:48.000)
so I was half right, you could say,
Lex Fridman (1:47:50.160)
the doses of 25, 30, 40, 50,
Rick Doblin (1:47:53.440)
they could produce enough confusion
Lex Fridman (1:47:57.040)
that you could say that they were successful at blinding,
Rick Doblin (1:47:59.440)
not perfectly, but enough confusion
Lex Fridman (1:48:02.080)
so that people, therapists, couldn't know for sure
Lex Fridman (1:48:05.120)
so that there was this reduction of bias, you could say.
Lex Fridman (1:48:09.680)
But what we discovered, again, to our surprise,
Rick Doblin (1:48:14.120)
was that the low doses made people uncomfortable.
Lex Fridman (1:48:17.400)
They stimulated them, but they didn't reduce the fear.
Lex Fridman (1:48:23.400)
And so people still got better
Lex Fridman (1:48:25.920)
with the therapy with low dose MDMA.
Lex Fridman (1:48:28.080)
But if we gave them therapy with inactive placebo,
Lex Fridman (1:48:31.800)
they did even better
Rick Doblin (1:48:33.840)
than if we gave them therapy with low dose MDMA.
Lex Fridman (1:48:37.360)
So we call it an anti therapeutic effect.
Rick Doblin (1:48:41.320)
I don't mean to imply that they got worse,
Lex Fridman (1:48:43.520)
but it made people uncomfortable.
Rick Doblin (1:48:45.440)
People didn't like it.
Lex Fridman (1:48:47.360)
But we would still help them make some progress.
Lex Fridman (1:48:49.840)
So we had the blinding,
Lex Fridman (1:48:51.520)
but what it meant by reducing the effect of therapy
Rick Doblin (1:48:54.720)
with inactive placebo is that it would make it easier
Lex Fridman (1:48:57.480)
for us to find a difference between the two groups.
Lex Fridman (1:49:01.080)
And so the real question is,
Lex Fridman (1:49:02.760)
if you can do it with therapy, why bother add a drug?
Lex Fridman (1:49:07.240)
So we went to the FDA,
Lex Fridman (1:49:09.160)
and so this was what we discovered during phase two.
Rick Doblin (1:49:12.000)
We went to the FDA at this end of phase two meeting,
Lex Fridman (1:49:15.120)
and we said, we can give you blinding,
Lex Fridman (1:49:17.600)
but it will make it easier for us
Lex Fridman (1:49:20.240)
to find a difference between the two groups.
Lex Fridman (1:49:22.040)
And so we suggest that we do therapy with inactive placebo
Lex Fridman (1:49:26.320)
versus therapy with full dose MDMA.
Rick Doblin (1:49:29.440)
That will cause a problem
Lex Fridman (1:49:30.920)
because most people will be able to tell what they've got.
Lex Fridman (1:49:34.320)
What Tom Loughran, a doctor
Lex Fridman (1:49:36.920)
who used to be head of psychiatry products at FDA
Rick Doblin (1:49:39.400)
is our main advisor.
Lex Fridman (1:49:41.640)
So the first thing he said
Rick Doblin (1:49:42.880)
is that the double blind fails in practice a lot,
Lex Fridman (1:49:45.480)
even with SSRIs,
Rick Doblin (1:49:47.360)
because there's certain side effects
Lex Fridman (1:49:49.400)
that you have with these drugs.
Lex Fridman (1:49:50.720)
And the doctors who are doing these research
Lex Fridman (1:49:52.640)
when you're reporting your side effects,
Rick Doblin (1:49:55.240)
they can say, oh, that's probably,
Lex Fridman (1:49:56.400)
you got the active drug instead of the placebo.
Lex Fridman (1:49:58.280)
So the double blind is in theory is terrific,
Lex Fridman (1:50:01.800)
but in practice, it doesn't always work quite as well.
Lex Fridman (1:50:05.760)
And so what Tom said is that there are two main approaches
Lex Fridman (1:50:10.160)
that they think are important to reduce bias.
Rick Doblin (1:50:13.240)
The first one is easy to do.
Lex Fridman (1:50:15.160)
It's called random assignment.
Lex Fridman (1:50:17.800)
So sometimes there are studies
Lex Fridman (1:50:19.720)
where you'll treat a bunch of people with something
Lex Fridman (1:50:24.200)
and some fraction of them will get better and some won't.
Lex Fridman (1:50:26.720)
And then you say, okay, all those who didn't get better,
Lex Fridman (1:50:29.160)
who volunteers to get this new treatment?
Lex Fridman (1:50:31.800)
And then you give them the new treatment,
Lex Fridman (1:50:33.200)
but the people that volunteer
Lex Fridman (1:50:34.320)
are more likely to wanna get better.
Rick Doblin (1:50:36.000)
They're not representative sample of everybody that has.
Lex Fridman (1:50:39.680)
So when you have random assignment,
Rick Doblin (1:50:41.680)
everybody is similarly motivated
Lex Fridman (1:50:43.880)
and meets the same inclusion, exclusion criteria.
Lex Fridman (1:50:47.280)
So that's what we told,
Lex Fridman (1:50:48.680)
of course we need random assignment.
Rick Doblin (1:50:50.400)
The other part was when the bias double blind
Lex Fridman (1:50:54.040)
doesn't work as well,
Rick Doblin (1:50:55.760)
then the system of independent raters
Lex Fridman (1:50:59.800)
is especially important of how you do that.
Lex Fridman (1:51:03.000)
So we have over a pool of raters, over 20 of them,
Lex Fridman (1:51:08.000)
and we do this monthly interrater reliability tests
Rick Doblin (1:51:11.880)
to make sure that they evaluate this,
Lex Fridman (1:51:15.200)
so that they're given a videotape of a PTSD patient
Lex Fridman (1:51:17.640)
and then they're supposed to rate them
Lex Fridman (1:51:19.640)
according to their symptoms.
Lex Fridman (1:51:20.800)
And then we sort of make sure
Lex Fridman (1:51:22.760)
that we've got this calibrated rater pool
Lex Fridman (1:51:25.840)
and it's all done by Zoom, by telemedicine,
Lex Fridman (1:51:28.760)
and they're randomly assigned to the next person
Rick Doblin (1:51:30.880)
that needs a rating.
Lex Fridman (1:51:32.600)
So they said 20 raters.
Lex Fridman (1:51:34.280)
So we've got like 20 raters
Lex Fridman (1:51:35.800)
and what we wanna do is make it so that each rater
Rick Doblin (1:51:40.280)
sees each patient only once, maybe twice,
Lex Fridman (1:51:43.640)
but not tracking them through the study.
Lex Fridman (1:51:47.120)
So that tries to reduce the bias in the raters
Lex Fridman (1:51:49.440)
that they don't know where this person is in the study.
Lex Fridman (1:51:54.760)
And so there's a fellow, Bob Temple,
Lex Fridman (1:51:59.040)
who's like the old wise man at the FDA.
Rick Doblin (1:52:01.280)
He's been there since 1972.
Lex Fridman (1:52:03.680)
He was in charge of the Office of Science Policy
Lex Fridman (1:52:05.880)
and they brought him into the final meeting of this process
Lex Fridman (1:52:09.840)
where we are trying to design phase three.
Lex Fridman (1:52:11.880)
So once FDA said, yes, you can go to phase three,
Lex Fridman (1:52:14.640)
that was November 29th, 2016,
Rick Doblin (1:52:17.840)
we then negotiated for eight months
Lex Fridman (1:52:20.320)
on the design of phase three
Lex Fridman (1:52:21.760)
and all of the other information that FDA is gonna need.
Lex Fridman (1:52:25.320)
This process of design.
Rick Doblin (1:52:28.920)
To the extent that I have any artistic creativity,
Lex Fridman (1:52:31.920)
it's in protocol design.
Rick Doblin (1:52:34.520)
I really love that.
Lex Fridman (1:52:35.760)
So you enjoy this process.
Rick Doblin (1:52:36.960)
I love it.
Lex Fridman (1:52:37.800)
I love it because it's always trade offs
Lex Fridman (1:52:39.480)
and I acknowledge that we are all biased.
Lex Fridman (1:52:44.840)
And so how do you,
Rick Doblin (1:52:46.080)
there's something beautiful about the scientific process
Lex Fridman (1:52:49.600)
designed to get you to the truth.
Rick Doblin (1:52:52.720)
Especially when that scientific process
Lex Fridman (1:52:54.520)
is trying to get to the truth of the human organism,
Rick Doblin (1:52:57.080)
which is so complicated.
Lex Fridman (1:52:58.760)
So it's very difficult to dissect,
Rick Doblin (1:53:01.960)
to get the strong effects.
Lex Fridman (1:53:04.360)
And when you're analyzing,
Rick Doblin (1:53:06.320)
when you have like raters, they're watching a video.
Lex Fridman (1:53:11.920)
Removing subjectivity from that is very, very challenging.
Rick Doblin (1:53:15.480)
Yeah, very much so.
Lex Fridman (1:53:18.800)
And so we came to this agreement with FDA though
Rick Doblin (1:53:21.640)
that we would use this independent rater pool.
Lex Fridman (1:53:25.840)
And so we learned in phase two again,
Rick Doblin (1:53:30.840)
that the double blind,
Lex Fridman (1:53:31.880)
there was no solution to the double blind problem.
Lex Fridman (1:53:34.000)
And both the FDA and the European Medicines Agency
Lex Fridman (1:53:37.040)
in the end agreed that the best design
Rick Doblin (1:53:39.680)
was therapy with inactive placebo
Lex Fridman (1:53:41.800)
versus therapy with full dose MDMA,
Rick Doblin (1:53:43.800)
accepting the fact that most people will be able to tell
Lex Fridman (1:53:47.120)
whether they got nothing or they got full dose MDMA.
Rick Doblin (1:53:50.240)
Most therapists will be able to tell the difference,
Lex Fridman (1:53:52.400)
but that makes a harder test for us
Rick Doblin (1:53:55.880)
to show a difference between the two groups
Lex Fridman (1:53:57.760)
because we're giving them inactive placebo
Lex Fridman (1:54:00.120)
and not the anti therapeutic effect of low dose MDMA.
Lex Fridman (1:54:03.960)
So once we started phase three,
Lex Fridman (1:54:06.080)
so then we were able to start in 2018 phase three.
Lex Fridman (1:54:10.520)
And the paper in Nature Medicine that just came out
Rick Doblin (1:54:13.680)
was the results of our first phase three study.
Lex Fridman (1:54:18.160)
We came to agreement with FDA
Rick Doblin (1:54:20.240)
that we would do two phase three studies,
Lex Fridman (1:54:22.680)
each would have 100 persons in them.
Lex Fridman (1:54:25.960)
And what the FDA said to us is that they thought
Lex Fridman (1:54:29.240)
that we could prove efficacy with smaller numbers
Rick Doblin (1:54:33.520)
than they wanted to see for safety.
Lex Fridman (1:54:36.400)
The reason they said that is it in phase two,
Rick Doblin (1:54:38.880)
we had a large effect size.
Lex Fridman (1:54:41.360)
So from a statistical point of view,
Rick Doblin (1:54:43.440)
the bigger of an effect that you're looking for,
Lex Fridman (1:54:47.040)
the fewer number of people you need
Rick Doblin (1:54:49.080)
to get statistical significance.
Lex Fridman (1:54:51.360)
When you're trying to find small differences,
Rick Doblin (1:54:53.320)
you need large numbers of people
Lex Fridman (1:54:54.800)
to sort of work out the noise.
Lex Fridman (1:54:59.800)
So we came to agreement on two 100 person phase three studies.
Lex Fridman (1:55:05.280)
And the idea is that it's very possible
Rick Doblin (1:55:07.480)
that the first study would show the efficacy
Lex Fridman (1:55:11.160)
because the effect is so strong.
Rick Doblin (1:55:13.120)
Yeah, yeah, and the second, but also safety as well.
Lex Fridman (1:55:16.120)
So one of the things we also realized
Rick Doblin (1:55:19.600)
when you work with a highly stigmatized drug
Lex Fridman (1:55:22.400)
in the midst of still the drug war and prohibition
Rick Doblin (1:55:26.920)
that we need highly sympathetic subjects
Lex Fridman (1:55:31.280)
and we need to make the best case we can,
Rick Doblin (1:55:34.020)
which means we need to work with the hardest cases
Lex Fridman (1:55:37.040)
so that this is really needed.
Lex Fridman (1:55:38.400)
And so we end up enrolling people.
Lex Fridman (1:55:40.920)
The first study was chronic severe PTSD.
Lex Fridman (1:55:45.040)
And unlike many studies of PTSD,
Lex Fridman (1:55:47.280)
we enroll people that have previously attempted suicide.
Rick Doblin (1:55:50.640)
Wow.
Lex Fridman (1:55:51.480)
So we have multiple people
Rick Doblin (1:55:53.040)
that have tried to kill themselves
Lex Fridman (1:55:54.560)
that we felt like if we were to exclude them,
Lex Fridman (1:55:57.520)
what are we doing?
Lex Fridman (1:55:58.440)
Those are the people that need it the most.
Lex Fridman (1:56:00.520)
So we came to this agreement with FDA.
Lex Fridman (1:56:04.320)
We're gonna work with chronic severe PTSD patients,
Rick Doblin (1:56:09.120)
including those that had attempted suicide.
Lex Fridman (1:56:11.600)
And we would do these two 100 person studies.
Lex Fridman (1:56:14.840)
And we also negotiated what's called an interim analysis.
Lex Fridman (1:56:19.760)
So what that means is that
Rick Doblin (1:56:22.240)
when the study is underway,
Lex Fridman (1:56:26.800)
and often big, big studies,
Rick Doblin (1:56:28.640)
they have this kind of interim analysis
Lex Fridman (1:56:30.360)
where what you do is,
Lex Fridman (1:56:31.600)
and for us, we negotiate when we had 60% or 60 people
Lex Fridman (1:56:35.120)
had reached the primary outcome measure
Lex Fridman (1:56:37.440)
and all 100 had been enrolled,
Lex Fridman (1:56:39.880)
then we would take a look at the data.
Lex Fridman (1:56:42.040)
And if the statistical analysis that we did
Lex Fridman (1:56:46.960)
was showing based on a certain effect size that we chose
Rick Doblin (1:56:52.680)
based on what we saw in phase two,
Lex Fridman (1:56:55.040)
the interim analysis
Rick Doblin (1:56:56.080)
is for what's called sample size reestimation.
Lex Fridman (1:56:59.240)
So what it means is if the results aren't as good
Rick Doblin (1:57:01.200)
as you thought they would, you can add more people.
Lex Fridman (1:57:04.080)
And then you'll get statistical significance.
Rick Doblin (1:57:07.720)
It means that your effect isn't as strong as you thought.
Lex Fridman (1:57:10.440)
It'll be harder to get insurance to cover it,
Lex Fridman (1:57:12.360)
but FDA will still approve it
Lex Fridman (1:57:14.400)
because FDA also believes that these are group averages.
Rick Doblin (1:57:18.760)
There may be some people that will later figure out
Lex Fridman (1:57:20.760)
respond better than others.
Lex Fridman (1:57:22.480)
So they'll approve it if it's statistically significant,
Lex Fridman (1:57:25.080)
even if it has a low effect size.
Rick Doblin (1:57:27.240)
The SSRIs have low effect size.
Lex Fridman (1:57:30.120)
So we did the interim analysis in March of 2020.
Lex Fridman (1:57:35.840)
And what we discovered to our delight
Lex Fridman (1:57:38.080)
was that we did not need to add any subjects.
Rick Doblin (1:57:41.760)
That's all we were told.
Lex Fridman (1:57:42.800)
We weren't told like, what is the results?
Rick Doblin (1:57:45.800)
We were just told all we were gonna get is a number, zero,
Lex Fridman (1:57:48.680)
or you need to add X numbers of people to the study
Rick Doblin (1:57:50.960)
to get statistical significance.
Lex Fridman (1:57:53.200)
That's right around the time that COVID hit
Lex Fridman (1:57:55.400)
and lockdowns happened.
Lex Fridman (1:57:56.720)
And we ended up negotiating with FDA
Rick Doblin (1:57:59.240)
that we would end the study with 90 people instead of 100.
Lex Fridman (1:58:04.800)
It took a while for us to end up doing that.
Lex Fridman (1:58:06.680)
So the paper that we just published
Lex Fridman (1:58:08.360)
is on the results of 90 people.
Rick Doblin (1:58:10.960)
I think it was 46 in the MDMA group,
Lex Fridman (1:58:13.280)
44 in the placebo group.
Lex Fridman (1:58:16.960)
And what we discovered was that the study worked better
Lex Fridman (1:58:21.400)
than we had even hoped.
Lex Fridman (1:58:23.280)
So the first thing is that
Lex Fridman (1:58:25.520)
you look at statistical significance.
Rick Doblin (1:58:27.240)
You have to get 0.05,
Lex Fridman (1:58:28.560)
which basically means a nickel out of a dollar,
Rick Doblin (1:58:30.600)
a one in 20 chance that the difference
Lex Fridman (1:58:33.160)
between the two groups is due to some random factor
Rick Doblin (1:58:36.320)
rather than to your intervention.
Lex Fridman (1:58:38.200)
And in this case, the placebo group gets therapy
Lex Fridman (1:58:42.920)
and then with inactive placebo
Lex Fridman (1:58:44.800)
and then the group gets MDMA with active placebo.
Lex Fridman (1:58:49.200)
So you have to get 0.05.
Lex Fridman (1:58:52.200)
There's another measure
Rick Doblin (1:58:53.800)
that the FDA uses sometimes called robust,
Lex Fridman (1:58:56.840)
which means one in a thousand,
Rick Doblin (1:58:59.520)
instead of one in 20, one in a thousand.
Lex Fridman (1:59:01.600)
And if you get a robust results, 0.001,
Lex Fridman (1:59:06.680)
and you meet some other criteria,
Lex Fridman (1:59:09.440)
they might agree to approve the drug
Rick Doblin (1:59:11.520)
on the basis of just one phase three study instead of two.
Lex Fridman (1:59:15.120)
Because when you think about it,
Rick Doblin (1:59:16.600)
a one in 20 chance for your first phase three study,
Lex Fridman (1:59:20.160)
a one in 20 chance for your second phase three study,
Rick Doblin (1:59:23.200)
you multiply that together, it's one in 400, 0.025.
Lex Fridman (1:59:28.120)
So that's pretty good.
Lex Fridman (1:59:32.680)
So robust 0.001 is even better
Lex Fridman (1:59:35.760)
than two independent phase three studies, each at 0.05.
Lex Fridman (1:59:41.160)
What we ended up getting was one in 10,000, 0.0001.
Lex Fridman (1:59:46.560)
Outrageous, incredibly.
Lex Fridman (1:59:49.400)
So that's a measure of both the difference
Lex Fridman (1:59:51.440)
between the two groups and the variability.
Lex Fridman (1:59:53.560)
And so what it meant is that we had minimal variability,
Lex Fridman (1:59:58.600)
that most people who got the MDA
Rick Doblin (20:01.820)
I said, I'll put a thousand, Dick Price, he put a thousand.
Lex Fridman (20:04.180)
So Terence was actually the catalyst
Rick Doblin (20:06.100)
for the first study with MDMA.
Lex Fridman (20:07.860)
Just because he was so frustrating
Rick Doblin (20:10.580)
about how plants are okay.
Lex Fridman (20:11.900)
And if it's from the lab, it's bad.
Lex Fridman (20:14.740)
So that's one distinction.
Lex Fridman (20:16.500)
The other distinction is that he was a scientist.
Rick Doblin (20:19.780)
The other distinction is this sense of classic psychedelics
Lex Fridman (20:26.420)
versus things like MDMA.
Lex Fridman (20:27.620)
So to what extent do they dissolve the ego?
Lex Fridman (20:31.020)
And you could say, to what extent do they cause visions?
Rick Doblin (20:34.460)
The 5HT2A serotonin receptor subtype,
Lex Fridman (20:39.060)
which is responsible for a lot of that
Rick Doblin (20:41.540)
where these drugs are activating.
Lex Fridman (20:45.460)
Now, mescaline of all the psychedelics,
Rick Doblin (20:48.380)
chemically, it's the most similar to MDMA.
Lex Fridman (20:51.100)
It's a phenethylamine, which is MDMA.
Lex Fridman (20:53.980)
So in the 50s, there was the, 53, I think it was,
Lex Fridman (20:57.720)
the Army Chemical Warfare Service
Rick Doblin (21:00.180)
wanted to look at drugs for interrogations,
Lex Fridman (21:03.360)
mind control, nonlethal incapacitants.
Rick Doblin (21:05.780)
They did a study in eight substances.
Lex Fridman (21:10.980)
These were now toxicity studies in animals.
Lex Fridman (21:13.740)
And on the one side was methamphetamine,
Lex Fridman (21:15.620)
and the other was mescaline, and MDMA was in the middle,
Rick Doblin (21:18.740)
chemically.
Lex Fridman (21:19.920)
So mescaline of these psychedelics
Rick Doblin (21:23.500)
tends to have the warmth that MDMA has.
Lex Fridman (21:27.440)
It's not as ego dissolving quite as some of the others.
Rick Doblin (21:30.580)
I mean, it's the main active ingredient in peyote.
Lex Fridman (21:32.620)
It is very psychedelic, very visual.
Rick Doblin (21:36.500)
Another distinction with these different drugs
Lex Fridman (21:39.260)
is how long they last.
Lex Fridman (21:41.160)
And a lot of that has to do with the route of administration.
Lex Fridman (21:45.080)
So for example, if you smoke DMT,
Rick Doblin (21:49.100)
it takes 10, 15 minutes, and you're,
Lex Fridman (21:52.300)
within seconds, you're off in another world.
Rick Doblin (21:54.540)
Similarly, 5MeO DMT, very rapid.
Lex Fridman (21:59.620)
When you take DMT in the form of ayahuasca,
Rick Doblin (22:03.140)
where it's mixed with another substance
Lex Fridman (22:05.740)
that makes it so that it's orally active,
Rick Doblin (22:08.420)
then it's a couple hours.
Lex Fridman (22:10.360)
So LSD is eight, 10, 12 hours sometimes.
Rick Doblin (22:16.640)
Psilocybin is more like five or six hours,
Lex Fridman (22:18.880)
or four to six hours.
Rick Doblin (22:21.280)
MDMA is similar.
Lex Fridman (22:23.720)
It's one reason why in our research,
Rick Doblin (22:25.960)
we give an initial dose of MDMA,
Lex Fridman (22:28.080)
and then two hours later,
Rick Doblin (22:28.960)
we give half the initial amount to extend the plateau,
Lex Fridman (22:32.440)
because we want it to last longer
Rick Doblin (22:34.800)
for people to be in this therapeutic state.
Lex Fridman (22:37.100)
So that's another distinction is how long these drugs last.
Rick Doblin (22:42.300)
Another distinction is which of them
Lex Fridman (22:44.360)
come from a religious context,
Rick Doblin (22:47.180)
have a religion built around them.
Lex Fridman (22:49.280)
We have this sense that some people are saying
Rick Doblin (22:52.180)
that 5MeO DMT and the Sonoran Toad,
Lex Fridman (22:54.820)
that they have this long history of indigenous use,
Lex Fridman (22:57.420)
but they don't, that's all modern,
Lex Fridman (22:58.780)
it's made up, and it's kind of a new approach.
Rick Doblin (23:01.940)
However, there was thousands of years of use
Lex Fridman (23:05.100)
of psilocybin mushrooms in religious contexts.
Rick Doblin (23:09.260)
From 1600 BC to 396 AD,
Lex Fridman (23:14.700)
the world's longest mystery ceremonies,
Rick Doblin (23:17.100)
the Eleusinian Mysteries,
Lex Fridman (23:19.900)
sort of the heart of Greek culture,
Rick Doblin (23:21.240)
the heart of Western culture,
Lex Fridman (23:22.500)
that was a psychedelic potion called Kikion
Rick Doblin (23:25.780)
that seems like it's very much like an LSD like substance.
Lex Fridman (23:29.520)
Aragat on grain and LSD comes from Aragat.
Lex Fridman (23:36.920)
So I think that there are a lot of ways
Lex Fridman (23:39.640)
to look at these different substances.
Rick Doblin (23:41.120)
Another distinction is which one of them
Lex Fridman (23:45.000)
are being researched right now in scientific context
Lex Fridman (23:48.280)
and which are not.
Lex Fridman (23:50.100)
And because of the rise of all these for profit companies
Lex Fridman (23:52.720)
and everybody's looking for what they can patent,
Lex Fridman (23:54.800)
what they can claim, the land grab,
Rick Doblin (23:57.440)
more and more there are companies
Lex Fridman (24:01.200)
looking at every different kind of psychedelics.
Rick Doblin (24:04.360)
The ones that are most important
Lex Fridman (24:06.400)
that are not being researched, Mescaline,
Lex Fridman (24:09.080)
but now there's a company to do Mescaline,
Lex Fridman (24:11.080)
the Jernico Lab, Ibogaine,
Rick Doblin (24:14.000)
which is crucial for opiate addiction.
Lex Fridman (24:17.160)
There's a new company, a branch of this company,
Rick Doblin (24:21.400)
Atai, that's gonna be looking at Ibogaine.
Lex Fridman (24:23.720)
So I'd say the rise of the for profit companies
Rick Doblin (24:27.480)
is making it so that there's just gonna be
Lex Fridman (24:30.200)
an enormous amount of investigations
Rick Doblin (24:32.520)
into all these different psychedelics.
Lex Fridman (24:36.000)
But what we're gonna see is the development
Rick Doblin (24:39.680)
of new psychedelics that we don't know anything about
Lex Fridman (24:41.760)
that have not existed yet
Rick Doblin (24:42.840)
because a lot of these for profit companies
Lex Fridman (24:45.480)
are gonna wanna invent and patent
Lex Fridman (24:48.280)
and have composition of matter patents on new molecules.
Lex Fridman (24:51.880)
So I think we'll see a lot of that happening too.
Rick Doblin (24:53.680)
That's really fascinating.
Lex Fridman (24:54.520)
I mean, there's a lot of doors you've opened
Lex Fridman (24:57.520)
and we're gonna walk through all of them,
Lex Fridman (24:58.960)
including the research and so on,
Lex Fridman (25:00.380)
but on this one little tangent
Lex Fridman (25:03.680)
of the future of psychedelics,
Lex Fridman (25:06.480)
so engineering new psychedelics,
Lex Fridman (25:08.640)
can you comment on maybe the chemistry
Lex Fridman (25:12.120)
and the biology of how psychedelics work
Lex Fridman (25:14.200)
and where is the space of possible engineering
Rick Doblin (25:17.480)
of psychedelics and what kind of things
Lex Fridman (25:19.080)
might they unlock in terms of the possible places
Rick Doblin (25:24.560)
our mind would be able to go
Lex Fridman (25:26.580)
and the effects of that of improving health,
Lex Fridman (25:32.360)
but maybe at the basic level of chemistry
Lex Fridman (25:35.760)
and the space of what could be engineered?
Rick Doblin (25:39.000)
Well, you reminded me,
Lex Fridman (25:41.200)
I'll get to exactly what you said,
Lex Fridman (25:42.540)
but you reminded me of a talk I heard
Lex Fridman (25:45.760)
by Buckminster Fuller shortly before he died.
Lex Fridman (25:49.160)
And what he talked about is how technology
Lex Fridman (25:52.960)
was making things ever smaller,
Rick Doblin (25:57.200)
that we are able to pack more and more information
Lex Fridman (25:59.800)
into smaller and smaller spaces
Lex Fridman (26:02.440)
and that we're developing technologies
Lex Fridman (26:04.560)
of communications with people,
Rick Doblin (26:06.880)
we now know the internet and things like that.
Lex Fridman (26:08.780)
But what he said is that he thought the eventual evolution
Rick Doblin (26:13.280)
of this sort of research would move
Lex Fridman (26:16.680)
from this miniaturization to telepathy.
Rick Doblin (26:21.680)
Yeah.
Lex Fridman (26:22.840)
And that was like a shocking thing
Rick Doblin (26:24.640)
for somebody like scientific like that to say that.
Lex Fridman (26:27.760)
So will we unlock those parts
Lex Fridman (26:31.440)
where I talked about the collective unconscious?
Lex Fridman (26:33.760)
Will we be able to more consciously explore those areas?
Lex Fridman (26:39.280)
So I think that that's a possibility.
Lex Fridman (26:42.080)
There was Stan Groff,
Rick Doblin (26:44.200)
who's the world's leading LSD researcher
Lex Fridman (26:47.720)
and has been my mentor, his wife Brigida.
Rick Doblin (26:51.640)
They were talking about stories that they had heard
Lex Fridman (26:54.200)
about MDMA that people take
Lex Fridman (26:59.440)
and then on top of that, they do 5MEO DMT.
Lex Fridman (27:02.760)
And so you get this ego dissolution,
Lex Fridman (27:05.360)
but underneath it, you have this sense of ego,
Lex Fridman (27:09.240)
sort of sense of self safety, of self acceptance,
Rick Doblin (27:14.320)
kind of grounds it.
Lex Fridman (27:15.260)
So Stan was like, that's the future of psychiatry,
Rick Doblin (27:19.240)
that you can watch without the terror
Lex Fridman (27:21.680)
of the ego dissolution,
Rick Doblin (27:22.960)
the sense that you're losing your mind
Lex Fridman (27:24.600)
or you're going crazy or you're dying,
Rick Doblin (27:26.240)
or that you have this grounded sense of safety
Lex Fridman (27:29.920)
while you're dissolving your normal sense
Rick Doblin (27:32.160)
of how you see things.
Lex Fridman (27:33.840)
And being able to engineer in a fine tuned way
Rick Doblin (27:37.300)
that exact experience, maybe fine tuned to the person,
Lex Fridman (27:41.020)
as opposed to sort of this manual potion
Rick Doblin (27:43.240)
that's through experiment.
Lex Fridman (27:46.960)
Although I don't know about fine tuning things
Rick Doblin (27:48.760)
to the person in the sense that
Lex Fridman (27:50.680)
we believe there's this inner healer,
Rick Doblin (27:52.320)
this kind of inner healing intelligence.
Lex Fridman (27:55.080)
We talked about it, the body repairs itself.
Lex Fridman (27:57.980)
So I think we more need to create safety for people
Lex Fridman (28:03.860)
and then what emerges will be customized
Rick Doblin (28:06.200)
to what they need to be looking at
Lex Fridman (28:07.480)
from this inner healing intelligence.
Rick Doblin (28:09.160)
At the same time, we will move to,
Lex Fridman (28:12.400)
we hear so much about the new approaches to oncology
Rick Doblin (28:18.560)
where you do genetic analysis of different kinds of tumors
Lex Fridman (28:23.260)
and then you have certain kind of chemotherapy agents
Lex Fridman (28:25.960)
and you do like personalized chemotherapy.
Lex Fridman (28:27.980)
I think we will have more like
Rick Doblin (28:29.840)
personalized psychedelic therapy,
Lex Fridman (28:32.040)
but it'll be more like a sequence of different drugs
Rick Doblin (28:34.680)
that people go through over an extended period of time
Lex Fridman (28:37.440)
and then you kind of customize what's next
Lex Fridman (28:40.320)
and sometimes you'll combine different drugs together
Lex Fridman (28:42.560)
like this 5MeO DMT and MDMA
Rick Doblin (28:45.440)
or a lot of times people do LSD MDMA combinations
Lex Fridman (28:48.920)
or psilocybin MDMA combinations.
Rick Doblin (28:52.720)
Chemistry is not my strength.
Lex Fridman (28:56.720)
I'm more into clinical applications and policy,
Lex Fridman (29:01.200)
but I can say that from what I've learned
Lex Fridman (29:03.760)
from reading from others and research done by others
Rick Doblin (29:06.920)
that different psychedelics have an impact
Lex Fridman (29:10.540)
on different neurotransmitters,
Rick Doblin (29:12.440)
different other parts of energies in the brain.
Lex Fridman (29:16.400)
The default mode network is what's considered
Rick Doblin (29:20.480)
to be like our sense of self and it's part of the brain
Lex Fridman (29:25.780)
that sort of is what I described before,
Rick Doblin (29:27.240)
scanning the world and filtering information
Lex Fridman (29:30.260)
for what's really important to us
Lex Fridman (29:33.400)
and both focusing us on things
Lex Fridman (29:36.260)
and also helping us to ignore a lot of things.
Lex Fridman (29:40.440)
And the classic psychedelics all weaken the energy
Lex Fridman (29:43.840)
in this default mode system
Lex Fridman (29:45.920)
and therefore you get this flood of information
Lex Fridman (29:48.000)
that you're not normally paying attention to
Lex Fridman (29:49.840)
and then you start seeing in the more creative waves
Lex Fridman (29:52.840)
or more connected, you actually move to
Rick Doblin (29:56.360)
beyond the verbal kind of thinking
Lex Fridman (29:57.980)
into sort of symbolic thinking a lot of times
Rick Doblin (2:00:00.400)
got quite a large amount of benefit from it.
Lex Fridman (2:00:03.480)
And most people who got the placebo
Rick Doblin (2:00:05.160)
were more or less in the same range as well.
Lex Fridman (2:00:07.320)
That's really exciting, by the way.
Rick Doblin (2:00:08.920)
I mean, I suppose it's exciting
Lex Fridman (2:00:13.520)
from a perspective of approval by the FDA.
Rick Doblin (2:00:16.440)
Maybe perhaps that's the way you're seeing it,
Lex Fridman (2:00:18.280)
but it's also exciting because it has a chance
Rick Doblin (2:00:22.960)
to help people that are truly suffering, yeah.
Lex Fridman (2:00:26.000)
Well, if we can get one in 10,000
Rick Doblin (2:00:29.040)
in the first phase three study,
Lex Fridman (2:00:31.360)
chances are we can get one in 20 in the second.
Lex Fridman (2:00:34.440)
So it's really gonna be about safety for us
Lex Fridman (2:00:36.960)
in the second phase three study.
Rick Doblin (2:00:39.800)
Now, you can have a large P value, a large significance,
Lex Fridman (2:00:45.720)
but you could have an effect that's not very significant.
Rick Doblin (2:00:49.720)
It's not clinically significant.
Lex Fridman (2:00:51.160)
You can have statistical significance
Rick Doblin (2:00:52.840)
without clinical significance.
Lex Fridman (2:00:55.400)
And as I said, the more people you get in the study,
Rick Doblin (2:00:58.040)
you can find smaller and smaller differences
Lex Fridman (2:00:59.960)
between two groups.
Rick Doblin (2:01:02.040)
Now, we showed that we had a very large effect size.
Lex Fridman (2:01:07.320)
So effect size is based on...
Lex Fridman (2:01:10.280)
That scale you mentioned?
Lex Fridman (2:01:11.480)
Well, the scale of the effect size
Rick Doblin (2:01:13.560)
is based on standard deviations.
Lex Fridman (2:01:17.320)
So an effect size of one means that your results
Rick Doblin (2:01:20.400)
are one standard deviation away from the norm.
Lex Fridman (2:01:23.320)
That's considered very large.
Rick Doblin (2:01:26.320)
The SSRIs, because they were like 0.3, 0.4 effect size,
Lex Fridman (2:01:32.240)
that's considered small effect size.
Rick Doblin (2:01:34.120)
Medium is starting to be around 0.6
Lex Fridman (2:01:36.920)
and 0.8 and above are large effect sizes.
Rick Doblin (2:01:41.400)
We had what's called placebo subtracted effect size.
Lex Fridman (2:01:45.680)
There's two different ways to look at it.
Rick Doblin (2:01:46.880)
Placebo subtracted means you kind of look at the difference
Lex Fridman (2:01:49.440)
between your two groups.
Lex Fridman (2:01:51.600)
And what that is for us, since one group had therapy
Lex Fridman (2:01:54.480)
and one had therapy plus MDMA,
Rick Doblin (2:01:56.240)
the placebo subtracted effect size
Lex Fridman (2:01:58.880)
is basically the effect of just the MDMA
Rick Doblin (2:02:02.000)
because you've kind of washed out the therapy.
Lex Fridman (2:02:03.600)
That was 0.91.
Lex Fridman (2:02:05.240)
So we had a large effect size, which was different.
Lex Fridman (2:02:08.440)
Wow, so 0.91 over just the therapy, so over the placebo.
Rick Doblin (2:02:13.040)
Yeah. Wow.
Lex Fridman (2:02:13.960)
Now, when we do the within group,
Rick Doblin (2:02:17.440)
meaning the group that just got the MDMA plus therapy,
Lex Fridman (2:02:21.560)
look at their baseline and their outcomes.
Rick Doblin (2:02:23.920)
That's another way to look at it.
Lex Fridman (2:02:25.320)
And that's what's gonna actually happen in practice
Rick Doblin (2:02:27.440)
because people are gonna get MDMA plus therapy.
Lex Fridman (2:02:30.880)
That's 2.1 effect size.
Rick Doblin (2:02:32.680)
Two standard deviations away from the norm
Lex Fridman (2:02:35.000)
is enormous effect size.
Rick Doblin (2:02:38.200)
The other part is that we had no effect by site,
Lex Fridman (2:02:44.040)
which is very important.
Lex Fridman (2:02:44.960)
So we had 15 sites, two in Israel, two in Canada,
Lex Fridman (2:02:47.720)
11 throughout the United States.
Lex Fridman (2:02:50.800)
The FDA looks at, is there a side effect?
Lex Fridman (2:02:53.320)
Because what that might mean is
Rick Doblin (2:02:54.600)
maybe you've got all your patients
Lex Fridman (2:02:56.280)
or most of your patients going to this one site,
Rick Doblin (2:02:58.240)
which is these highly experienced therapists
Lex Fridman (2:03:01.000)
and they're like hippies from way back
Lex Fridman (2:03:03.160)
and they're super experienced with psychedelics
Lex Fridman (2:03:05.120)
and they're getting great results,
Lex Fridman (2:03:07.360)
but nobody else gets good results.
Lex Fridman (2:03:09.240)
So we had no effect by site.
Rick Doblin (2:03:11.080)
That's incredible.
Lex Fridman (2:03:12.320)
That we've been able to train all these new therapists.
Rick Doblin (2:03:14.920)
We had about 80 therapists working at all these 15 sites.
Lex Fridman (2:03:20.320)
We also discovered that there's a group
Rick Doblin (2:03:23.560)
that's considered to be very difficult to treat,
Lex Fridman (2:03:26.960)
which is called the dissociative subtype.
Lex Fridman (2:03:29.960)
So when people are traumatized,
Lex Fridman (2:03:32.960)
one of the ways to psychologically survive that
Rick Doblin (2:03:37.720)
is you dissociate.
Lex Fridman (2:03:38.960)
It's like you're not there.
Rick Doblin (2:03:41.040)
When you do that though, it's hard to come back
Lex Fridman (2:03:43.480)
because when you come back,
Rick Doblin (2:03:45.000)
then you get all these painful memories and fearful.
Lex Fridman (2:03:47.520)
And so the extreme of that
Rick Doblin (2:03:50.320)
is called dissociative identity disorder,
Lex Fridman (2:03:53.120)
kind of like schizophrenia, almost dissociative identity.
Lex Fridman (2:03:56.440)
So we let people in who are on the dissociative subtype
Lex Fridman (2:04:01.080)
and those are considered to be the hardest to treat
Rick Doblin (2:04:03.120)
because the theory is that you need to be ego intact.
Lex Fridman (2:04:07.720)
As I said, the mystical experience is not correlated
Rick Doblin (2:04:10.200)
with therapeutic outcomes.
Lex Fridman (2:04:11.240)
And you need to be talking about what traumatized you
Lex Fridman (2:04:13.800)
and working through that and expressing it,
Lex Fridman (2:04:15.800)
letting it out, not keeping it in.
Lex Fridman (2:04:18.000)
So the dissociative subtype seems like it's harder
Lex Fridman (2:04:22.520)
for them to get back into the event
Rick Doblin (2:04:24.480)
because they're so dissociated.
Lex Fridman (2:04:26.240)
What we showed is that those people did even better
Rick Doblin (2:04:29.040)
on average than everybody else.
Lex Fridman (2:04:31.400)
So that MDMA is integrative.
Rick Doblin (2:04:33.200)
It helps people who are so separate
Lex Fridman (2:04:36.920)
that they make even more rapid progress.
Lex Fridman (2:04:39.080)
So it's almost like the MDMA made it more difficult
Lex Fridman (2:04:41.960)
for them to dissociate.
Rick Doblin (2:04:43.440)
Yes.
Lex Fridman (2:04:44.280)
Yeah, or you could say it made it easier
Rick Doblin (2:04:45.760)
for them to remember.
Lex Fridman (2:04:47.200)
Yes, exactly.
Rick Doblin (2:04:48.280)
To reverse the dissociation.
Lex Fridman (2:04:49.520)
Yeah.
Lex Fridman (2:04:50.360)
And we find that MDMA enhances memory for the trauma
Lex Fridman (2:04:54.600)
so that you can have these unconscious memories
Rick Doblin (2:04:57.600)
or memories that you cannot remember
Lex Fridman (2:04:59.440)
or that you've suppressed so much,
Lex Fridman (2:05:00.920)
but they distort your view.
Lex Fridman (2:05:02.560)
Your filter of the world is distorted
Rick Doblin (2:05:04.720)
by these fearful memories that the world can't be trusted.
Lex Fridman (2:05:07.400)
People can't be trusted.
Rick Doblin (2:05:08.400)
It's always about to happen.
Lex Fridman (2:05:10.040)
So we find that MDMA increases memory for the trauma,
Lex Fridman (2:05:13.640)
but by reducing the fear,
Lex Fridman (2:05:15.280)
then the memories can come to the surface.
Rick Doblin (2:05:16.880)
Then you can process them, let out the emotions,
Lex Fridman (2:05:18.960)
cry, scream, shake, whatever.
Lex Fridman (2:05:21.480)
And then through this MDMA effect
Lex Fridman (2:05:24.480)
on the amygdala and the hippocampus,
Rick Doblin (2:05:26.040)
it helps you store these memories into longterm storage
Lex Fridman (2:05:29.400)
so that they're not always about to happen.
Rick Doblin (2:05:31.320)
They're in the past.
Lex Fridman (2:05:32.600)
They're part of your story, but they're not the whole story.
Lex Fridman (2:05:35.320)
So we discovered that the dissociative subtype works better.
Lex Fridman (2:05:38.640)
Now, none of this would be enough unless safety.
Lex Fridman (2:05:42.800)
So from a safety perspective,
Lex Fridman (2:05:45.000)
what we discovered is that there was one woman in the study
Rick Doblin (2:05:48.040)
that attempted to kill herself twice during the study.
Lex Fridman (2:05:52.040)
There was another woman that was so worried
Rick Doblin (2:05:57.200)
that she might kill herself,
Lex Fridman (2:05:58.400)
that the therapy brought these things to the surface
Rick Doblin (2:06:00.480)
that she's been pushing away,
Lex Fridman (2:06:01.600)
that she checked herself into a hospital
Rick Doblin (2:06:03.920)
in order to avoid self harm.
Lex Fridman (2:06:06.800)
At the end of the study,
Lex Fridman (2:06:08.200)
what we learned is both of them were in the placebo group.
Lex Fridman (2:06:11.840)
We didn't have anybody in the MDMA group
Rick Doblin (2:06:14.280)
attempt to kill themselves.
Lex Fridman (2:06:16.920)
So the MDMA is really helpful
Rick Doblin (2:06:21.080)
for giving people a sense of hope
Lex Fridman (2:06:24.160)
and that they can somehow process this.
Rick Doblin (2:06:27.120)
Now, it's not to say that nobody will ever commit suicide.
Lex Fridman (2:06:30.800)
That's our big concern in the second phase three study.
Rick Doblin (2:06:34.200)
As I said, it's more gonna be about safety
Lex Fridman (2:06:36.000)
than about efficacy.
Rick Doblin (2:06:37.000)
We think we'll get the efficacy,
Lex Fridman (2:06:38.360)
but we're very concerned about safety.
Rick Doblin (2:06:42.200)
Because we had problems in the first phase three study
Lex Fridman (2:06:46.320)
of somebody trying to kill herself twice
Rick Doblin (2:06:47.760)
in the placebo group,
Lex Fridman (2:06:49.960)
it's the background for having PTSD.
Lex Fridman (2:06:52.920)
So there'd have to be a disproportionate number of people
Lex Fridman (2:06:55.480)
in the MDMA group try to kill themselves
Rick Doblin (2:06:57.400)
or succeed in killing themselves
Lex Fridman (2:06:58.800)
than in the placebo group for the FDA to say,
Rick Doblin (2:07:01.440)
oh, this MDMA, it's too dangerous.
Lex Fridman (2:07:04.320)
We don't think that's gonna happen.
Lex Fridman (2:07:05.920)
So the other findings from safety
Lex Fridman (2:07:11.120)
is that the side effects are transitory.
Rick Doblin (2:07:13.240)
They're minor, they're sweating or jaw clenching
Lex Fridman (2:07:17.760)
or a slight temperature increase.
Lex Fridman (2:07:19.760)
And everybody that's been to a rave knows about it.
Lex Fridman (2:07:23.040)
Take an ecstasy, there are some side effects.
Lex Fridman (2:07:26.200)
But they're minor, they're transitory
Lex Fridman (2:07:27.640)
and there has been this massive problem
Rick Doblin (2:07:30.920)
of during the eighties, the nineties,
Lex Fridman (2:07:33.440)
NIDA, the National Institute on Drug Abuse
Rick Doblin (2:07:34.920)
was trying to say that MDMA was neurotoxic
Lex Fridman (2:07:37.760)
and that you take it
Lex Fridman (2:07:38.840)
and it's gonna cause nerve terminal degeneration.
Lex Fridman (2:07:41.200)
It's gonna be major brain damage.
Rick Doblin (2:07:42.960)
It's gonna be significant functional consequences.
Lex Fridman (2:07:45.400)
And back then they were saying that MDMA is too dangerous.
Rick Doblin (2:07:48.520)
It should never even be researched.
Lex Fridman (2:07:49.960)
Nobody should even get it once
Rick Doblin (2:07:51.400)
because it's poison and brain damage.
Lex Fridman (2:07:54.120)
Well, we no longer believe that, that was exaggerated.
Rick Doblin (2:07:57.560)
That was in service of the drug war.
Lex Fridman (2:08:00.840)
But we've done in phase two neurocognitive tests
Rick Doblin (2:08:04.520)
before and after in two of our different sites
Lex Fridman (2:08:07.320)
and showed no decline in cognitive functioning.
Lex Fridman (2:08:09.880)
So we don't think that there's any neurotoxicity happening
Lex Fridman (2:08:14.680)
and the doses that we use.
Rick Doblin (2:08:16.760)
There's no obvious functional consequences.
Lex Fridman (2:08:18.800)
People are getting better.
Lex Fridman (2:08:20.240)
And the other thing that we've learned in phase two
Lex Fridman (2:08:24.160)
and that we still have to learn from this study.
Lex Fridman (2:08:25.720)
So what we showed is the durability of the effect.
Lex Fridman (2:08:29.400)
We showed that 32% of the people
Rick Doblin (2:08:32.160)
that got the therapy without MDMA
Lex Fridman (2:08:34.440)
at two months after the last experimental session
Rick Doblin (2:08:36.880)
no longer had PTSD.
Lex Fridman (2:08:38.840)
Just with the therapy, which is phenomenal
Rick Doblin (2:08:41.160)
because these are on average 14 years PTSD,
Lex Fridman (2:08:44.200)
one third had PTSD over 20 years.
Lex Fridman (2:08:48.000)
And just with the therapy,
Lex Fridman (2:08:51.120)
32% no longer had PTSD at the two months.
Rick Doblin (2:08:54.640)
However, those people that got MDMA, it was 67%.
Lex Fridman (2:08:58.440)
No longer had PTSD, more than twice as good.
Rick Doblin (2:09:02.320)
In phase two and in phase three,
Lex Fridman (2:09:04.840)
we're also gonna do the 12 month followup.
Rick Doblin (2:09:07.600)
That's not for the FDA.
Lex Fridman (2:09:09.320)
That's not for approvability.
Rick Doblin (2:09:10.760)
That's more for insurance companies
Lex Fridman (2:09:12.400)
because this is expensive, a lot of therapy time.
Rick Doblin (2:09:15.360)
If it fades, if it's great results initially
Lex Fridman (2:09:18.080)
but then it fades after six months, what's the point?
Lex Fridman (2:09:20.880)
And what we showed in phase two
Lex Fridman (2:09:24.880)
is that people keep getting better.
Rick Doblin (2:09:28.960)
At the two month followup, they're doing pretty well
Lex Fridman (2:09:31.960)
but at the 12 month followup, they're even better.
Lex Fridman (2:09:34.960)
So it's durable.
Lex Fridman (2:09:35.960)
People have learned how to process trauma.
Rick Doblin (2:09:38.440)
They keep getting better.
Lex Fridman (2:09:39.280)
So we've not reached that point in this phase three study
Rick Doblin (2:09:41.680)
where everybody's got their one year followup.
Lex Fridman (2:09:43.440)
But we have also done three and a half year followups
Rick Doblin (2:09:46.320)
to some of the groups that were in phase two
Lex Fridman (2:09:48.840)
and showed that it was durable.
Lex Fridman (2:09:50.600)
And we're doing a long term followup now
Lex Fridman (2:09:53.040)
to many of the people in phase two,
Rick Doblin (2:09:55.280)
some of them treated 15 years ago.
Lex Fridman (2:09:57.640)
So that's all more for the insurance companies.
Lex Fridman (2:09:59.960)
So basically what we found in the paper
Lex Fridman (2:10:02.800)
that we just published is that it was highly efficacious,
Rick Doblin (2:10:05.360)
highly significant, no effect by sight,
Lex Fridman (2:10:07.920)
works in the hardest cases and the safety record was great.
Rick Doblin (2:10:13.120)
That's an incredible success.
Lex Fridman (2:10:14.640)
And that's really exciting, especially given
Rick Doblin (2:10:17.640)
that the people who've committed, who attempted
Lex Fridman (2:10:21.720)
to commit suicide were let into the study.
Lex Fridman (2:10:23.920)
And so these are people who are truly suffering.
Lex Fridman (2:10:30.120)
I mean, that's incredibly exciting.
Lex Fridman (2:10:36.120)
And I mean, just to speak to the frustration
Lex Fridman (2:10:38.360)
why things can't move faster,
Lex Fridman (2:10:39.920)
but for what it is, it's incredibly exciting.
Lex Fridman (2:10:44.920)
Is there other studies of this nature
Rick Doblin (2:10:48.160)
that you foresee enabling that same kind
Lex Fridman (2:10:51.160)
of positive impact, whether it's MDMA
Rick Doblin (2:10:53.480)
for other things like treating addiction,
Lex Fridman (2:10:55.360)
or maybe it's psilocybin for other conditions?
Lex Fridman (2:10:59.400)
Is there something else that's promising?
Lex Fridman (2:11:01.160)
Yeah, I think that what we've discovered
Rick Doblin (2:11:05.800)
I don't think is unique to MDMA.
Lex Fridman (2:11:08.920)
So it's MDMA assisted psychotherapy.
Rick Doblin (2:11:12.360)
MDMA is ideal for PTSD.
Lex Fridman (2:11:15.560)
Maybe it won't work as well for OCD or other things.
Rick Doblin (2:11:18.920)
It was very strategic why we chose MDMA
Lex Fridman (2:11:21.040)
and why we chose PTSD.
Lex Fridman (2:11:23.640)
But I don't think that the results that we've got
Lex Fridman (2:11:26.400)
are so unique to MDMA assisted therapy.
Rick Doblin (2:11:29.160)
I think that psilocybin assisted therapy
Lex Fridman (2:11:31.320)
is gonna be great for people
Rick Doblin (2:11:33.720)
with life threatening illnesses,
Lex Fridman (2:11:35.560)
cancer who are anxious about dying.
Rick Doblin (2:11:37.920)
It looks like it's really good
Lex Fridman (2:11:39.480)
in the treatment of addiction.
Rick Doblin (2:11:41.040)
Again, these are in combination
Lex Fridman (2:11:44.480)
with sort of the psilocybin tobacco
Rick Doblin (2:11:47.120)
is cognitive behavioral therapy with psilocybin.
Lex Fridman (2:11:51.480)
I think that it's gonna be a little bit more difficult,
Rick Doblin (2:11:54.000)
psilocybin for depression.
Lex Fridman (2:11:55.680)
I don't know if it'll be quite as good.
Rick Doblin (2:11:58.400)
There are some biological aspects sometimes to depression,
Lex Fridman (2:12:01.880)
but I think that there'll be really good results
Rick Doblin (2:12:03.480)
for psilocybin for depression.
Lex Fridman (2:12:04.880)
I think it'll be approved.
Rick Doblin (2:12:05.960)
It's considered a breakthrough therapy by the FDA.
Lex Fridman (2:12:09.080)
Ibogaine is phenomenal for opiate addiction,
Rick Doblin (2:12:12.320)
helping people go through withdrawal
Lex Fridman (2:12:14.000)
and then giving them this chance
Rick Doblin (2:12:15.800)
to deal with the material that drives them for addiction.
Lex Fridman (2:12:21.000)
There was Ben Sessa, Dr. Ben Sessa in England
Rick Doblin (2:12:23.600)
did MDMA for alcohol use disorder.
Lex Fridman (2:12:26.440)
And that was really great, the results he got.
Lex Fridman (2:12:28.640)
And it's the case that he ended up
Lex Fridman (2:12:31.760)
basically treating people for trauma.
Rick Doblin (2:12:33.440)
It's the trauma that people run,
Lex Fridman (2:12:35.320)
the emotional challenges that people run from
Rick Doblin (2:12:37.680)
into quieting that pain through drug addiction or alcoholism.
Lex Fridman (2:12:43.000)
So trauma is behind a lot of addiction.
Rick Doblin (2:12:44.960)
I think that we are going to see a revolution in psychiatry
Lex Fridman (2:12:50.680)
and that there will be a lot of conditions
Rick Doblin (2:12:54.760)
that have left a lot of people still suffering
Lex Fridman (2:12:59.320)
that psychedelic assisted therapy,
Rick Doblin (2:13:01.240)
different psychedelics, different approaches.
Lex Fridman (2:13:03.080)
But I think that we will see a lot of hope
Rick Doblin (2:13:06.360)
for psychiatry and psychotherapy
Lex Fridman (2:13:08.040)
and that psychedelics would be a big part
Rick Doblin (2:13:09.720)
of changing the practice of psychiatry and psychotherapy.
Lex Fridman (2:13:13.680)
Yeah, this is really to me fascinating.
Lex Fridman (2:13:15.820)
So I actually, when I was younger,
Lex Fridman (2:13:19.180)
for the longest time, wanted to be a psychiatrist.
Lex Fridman (2:13:21.920)
So I was excited by psychotherapy,
Lex Fridman (2:13:24.740)
but then I perhaps incorrectly, maybe you can correct me,
Lex Fridman (2:13:28.160)
but became more and more cynical
Lex Fridman (2:13:30.600)
because it felt like it was more about prescribing drugs
Rick Doblin (2:13:33.520)
than psychotherapy.
Lex Fridman (2:13:34.560)
I'm not going to correct you.
Rick Doblin (2:13:36.360)
I mean, right now, there is a crisis in psychiatry
Lex Fridman (2:13:39.760)
that there are so many psychiatrists that are so fed up
Rick Doblin (2:13:42.440)
because they have been pharmaceuticalized.
Lex Fridman (2:13:45.740)
They meet people for 15 minutes,
Rick Doblin (2:13:47.400)
they adjust their medications.
Lex Fridman (2:13:49.200)
This is the way they make the most money,
Lex Fridman (2:13:51.360)
but they've lost the art of talking to people.
Lex Fridman (2:13:55.760)
And that's why we see that so many young psychiatric
Rick Doblin (2:13:58.600)
residents are so thrilled by psychedelics
Lex Fridman (2:14:02.920)
that they really want to get back to treating people
Rick Doblin (2:14:05.640)
as individuals, not just a bunch of chemicals.
Lex Fridman (2:14:08.320)
Yeah, that's truly fascinating.
Rick Doblin (2:14:09.600)
Because the reason it was appealing to me,
Lex Fridman (2:14:11.640)
it was a way to study the human mind
Lex Fridman (2:14:14.760)
and to see ways through talking
Lex Fridman (2:14:18.400)
that you can make people feel better,
Rick Doblin (2:14:23.600)
make people better, make people suffer less.
Lex Fridman (2:14:28.000)
And that was really exciting at the time.
Rick Doblin (2:14:30.920)
I ended up then going to AI because then
Lex Fridman (2:14:33.680)
I can understand the mind from that angle.
Lex Fridman (2:14:35.680)
But it's exciting that that could be also
Lex Fridman (2:14:42.120)
revolutionized the field of psychotherapy,
Rick Doblin (2:14:43.900)
take it from its back to its origins,
Lex Fridman (2:14:47.040)
to where a psychiatrist would be a scholar of the mind.
Rick Doblin (2:14:51.160)
Yeah, well, Freud talked about dreams
Lex Fridman (2:14:53.880)
as the railroad to the unconscious.
Lex Fridman (2:14:56.440)
And there was a lot of,
Lex Fridman (2:14:57.600)
you really spent a lot of time with people.
Rick Doblin (2:15:00.920)
Now, right before he died, in his last book,
Lex Fridman (2:15:05.800)
Freud wrote something, and again,
Rick Doblin (2:15:07.580)
this will be a rough paraphrase,
Lex Fridman (2:15:09.400)
but he said that in the future,
Rick Doblin (2:15:11.520)
we may learn about the energies of the brain
Lex Fridman (2:15:15.680)
and there'll be ways with chemicals to influence that
Rick Doblin (2:15:18.480)
that will help the therapeutic process.
Lex Fridman (2:15:21.880)
Yeah.
Lex Fridman (2:15:22.720)
So you could say he was ahead of his time.
Lex Fridman (2:15:27.760)
Yeah.
Rick Doblin (2:15:28.600)
This study paints a fascinating picture of a future
Lex Fridman (2:15:33.600)
where first for medical applications,
Lex Fridman (2:15:35.760)
but then also in general, psychedelics of various forms
Lex Fridman (2:15:39.300)
could be used by the broader society.
Rick Doblin (2:15:42.300)
Forgive the perhaps ridiculous question,
Lex Fridman (2:15:44.540)
but if much of society, including our politicians,
Rick Doblin (2:15:49.540)
are taking psychedelics and dissolving their ego
Lex Fridman (2:15:56.500)
and going through this whole process,
Lex Fridman (2:15:58.460)
how do you think the world may look different
Lex Fridman (2:16:01.940)
in 20, 30, 50 years?
Rick Doblin (2:16:04.740)
Ah, okay, so I said that I think
Lex Fridman (2:16:08.100)
licensed legalization happens in 2035.
Rick Doblin (2:16:11.040)
Yes.
Lex Fridman (2:16:12.860)
And I think by 2050, we will have enough people,
Rick Doblin (2:16:17.860)
hopefully, spiritualized.
Lex Fridman (2:16:22.100)
We're also talking about,
Rick Doblin (2:16:24.680)
we hear so much in terms of climate change
Lex Fridman (2:16:27.280)
about net zero carbon.
Lex Fridman (2:16:29.980)
So our goal is net zero trauma.
Lex Fridman (2:16:33.020)
When do we have a world with net zero trauma?
Rick Doblin (2:16:35.700)
I mean, right now, we have two sites in Israel.
Lex Fridman (2:16:39.580)
So we help a few people,
Lex Fridman (2:16:41.220)
but the recent war with Gaza has traumatized
Lex Fridman (2:16:44.820)
millions of people on both sides.
Lex Fridman (2:16:46.800)
So we are a long way away from net zero trauma.
Lex Fridman (2:16:52.060)
But that's the hope, and that's, I think, possible.
Rick Doblin (2:16:56.360)
I think humanity as a whole
Lex Fridman (2:17:01.460)
is like lemmings heading over a cliff
Rick Doblin (2:17:04.620)
with climate change and with the nuclear proliferation
Lex Fridman (2:17:09.660)
and just the religious hatreds
Lex Fridman (2:17:11.740)
and the more the retreat to authoritarianism
Lex Fridman (2:17:13.940)
and fundamentalism and tribalism.
Lex Fridman (2:17:17.120)
So I think that there's a very good chance, though,
Lex Fridman (2:17:20.020)
that psychedelics used wisely.
Lex Fridman (2:17:22.700)
So it's not just make psychedelics legal
Lex Fridman (2:17:25.060)
and everybody takes them,
Rick Doblin (2:17:26.380)
as you talked about Ted Kaczynski.
Lex Fridman (2:17:28.420)
It's the context that people take it in.
Lex Fridman (2:17:31.260)
But I think that there's a reasonable chance
Lex Fridman (2:17:35.340)
that enough people can,
Rick Doblin (2:17:38.320)
sort of, you could say, clean their filters
Lex Fridman (2:17:42.420)
to see people as more similar to them than different,
Rick Doblin (2:17:48.620)
not to label them as the enemy.
Lex Fridman (2:17:50.500)
Stan Groff, again, had this beautiful phrase
Rick Doblin (2:17:52.460)
about transparent to the transcendent.
Lex Fridman (2:17:56.580)
That's what, so for our ego,
Lex Fridman (2:18:00.380)
can we be transparent to the transcendent?
Lex Fridman (2:18:02.900)
Can the filter that we look through the world at
Rick Doblin (2:18:05.800)
be cleaned to, you could say,
Lex Fridman (2:18:08.420)
cleansing the doors of perception?
Rick Doblin (2:18:10.460)
Can it be cleaned to the point where we can see
Lex Fridman (2:18:12.500)
the humanity in everybody and see that,
Rick Doblin (2:18:17.420)
one way to say this is that,
Lex Fridman (2:18:19.580)
can we get to the point where religions
Lex Fridman (2:18:21.180)
are seen as like languages?
Lex Fridman (2:18:23.260)
Where we all have this need to communicate,
Rick Doblin (2:18:25.880)
there's thousands of different languages,
Lex Fridman (2:18:28.500)
we don't say that this language
Rick Doblin (2:18:29.820)
is fundamentally better than this language,
Lex Fridman (2:18:32.220)
this language is the only right language,
Rick Doblin (2:18:33.620)
everybody must speak English
Lex Fridman (2:18:34.960)
and Russian is bad or German is better.
Rick Doblin (2:18:38.020)
Maybe we'll get to that point that religions are like that,
Lex Fridman (2:18:41.060)
that there are different cultural backgrounds,
Rick Doblin (2:18:42.700)
different symbol systems,
Lex Fridman (2:18:44.020)
different saints and heroes and messiahs and all this,
Lex Fridman (2:18:47.060)
but that, yeah, Jesus is the son of God,
Lex Fridman (2:18:50.060)
but so is everybody.
Rick Doblin (2:18:52.380)
Or the Jews are the chosen people, but so is everybody.
Lex Fridman (2:18:55.860)
So can we get there?
Rick Doblin (2:18:57.540)
I think that we can.
Lex Fridman (2:18:59.380)
And I think that we need to,
Rick Doblin (2:19:00.980)
to survive the challenges that we're facing.
Lex Fridman (2:19:03.900)
And the hope is that by bringing psychedelics
Rick Doblin (2:19:08.100)
as tools forward and trying to bring the context around them
Lex Fridman (2:19:14.140)
to be one of responsibility
Rick Doblin (2:19:15.720)
rather than just profit maximization
Lex Fridman (2:19:18.580)
and just get as many people to do them
Rick Doblin (2:19:20.680)
from all these for profit companies,
Lex Fridman (2:19:23.460)
can we, and then also drug policy reform
Lex Fridman (2:19:26.620)
and embed knowledge in the society,
Lex Fridman (2:19:28.420)
can we get to honest drug education?
Rick Doblin (2:19:31.060)
DARE, the Drug Awareness Resistance Education,
Lex Fridman (2:19:36.580)
is fundamentally twisted.
Lex Fridman (2:19:39.140)
But it's the program that's used in a lot of schools now.
Lex Fridman (2:19:42.780)
So can we get honest drug education,
Rick Doblin (2:19:44.620)
pure drugs, harm reduction,
Lex Fridman (2:19:47.060)
and knowledge about therapeutic uses
Lex Fridman (2:19:49.340)
and on the one hand,
Lex Fridman (2:19:51.860)
and more of these thousands of psychedelic clinics?
Rick Doblin (2:19:55.420)
I'm hopeful and that's our goal.
Lex Fridman (2:19:59.100)
But in this landscape of pharma companies,
Rick Doblin (2:20:04.020)
they make a lot of money.
Lex Fridman (2:20:05.820)
Some people are worried about the impact
Rick Doblin (2:20:07.820)
of those, you know, of big pharma
Lex Fridman (2:20:10.740)
on the landscape of human trauma.
Rick Doblin (2:20:13.020)
Yeah, yeah.
Lex Fridman (2:20:14.100)
So there's, of course, some companies could do good,
Lex Fridman (2:20:17.540)
but that's not inherent,
Lex Fridman (2:20:20.100)
like many of these companies are not optimizing for good,
Rick Doblin (2:20:24.780)
they're optimizing for profit.
Lex Fridman (2:20:26.380)
Exactly, exactly.
Lex Fridman (2:20:27.460)
Does this rise of for profit pharma companies worry you?
Lex Fridman (2:20:31.860)
How do you navigate it?
Rick Doblin (2:20:33.660)
Do we still have for profit companies
Lex Fridman (2:20:35.580)
that basically do what MAPS does,
Rick Doblin (2:20:39.460)
which is like fight the good fight
Lex Fridman (2:20:41.420)
for the benefit of humanity?
Rick Doblin (2:20:42.820)
Like how do we proceed in this,
Lex Fridman (2:20:45.420)
in landscape where drugs can make a lot of money?
Rick Doblin (2:20:49.580)
Well, I am concerned.
Lex Fridman (2:20:52.100)
Overall, I think the rise of the for profit companies,
Rick Doblin (2:20:55.660)
we have to realize is a sign of success,
Lex Fridman (2:20:58.460)
that we have overcome the regulatory prohibitions,
Rick Doblin (2:21:04.260)
we've overcome a lot of the public attitudes
Lex Fridman (2:21:06.620)
that are against it, we've demonstrated some success.
Lex Fridman (2:21:09.780)
So the rise of the for profit companies
Lex Fridman (2:21:12.140)
are a sign of the progress that we've made.
Rick Doblin (2:21:13.940)
On the other hand, turning things over
Lex Fridman (2:21:15.860)
to profit maximizing companies,
Rick Doblin (2:21:19.100)
the big concern is that they're gonna try
Lex Fridman (2:21:20.980)
to minimize the amount of therapy
Lex Fridman (2:21:24.900)
and make it so the cost is less,
Lex Fridman (2:21:26.740)
so insurance companies are more likely to cover it
Lex Fridman (2:21:28.940)
and then that they just sell the most drugs.
Lex Fridman (2:21:32.060)
The other thing we've seen as an example of this
Rick Doblin (2:21:34.500)
is S ketamine by Johnson and Johnson for depression.
Lex Fridman (2:21:37.740)
And it's done by a profit maximizing company.
Rick Doblin (2:21:40.700)
They don't know anything about psychedelic psychotherapy
Lex Fridman (2:21:43.180)
or psychotherapy at all.
Lex Fridman (2:21:44.900)
And so they've gotten approval for S ketamine
Lex Fridman (2:21:48.460)
on the basis of it's just a pharmacological treatment
Lex Fridman (2:21:51.980)
and it's not delivered with therapy,
Lex Fridman (2:21:54.980)
the results fade pretty quickly,
Lex Fridman (2:21:57.100)
so you need to get more ketamine.
Lex Fridman (2:21:59.860)
And so it's designed in a way to maximize the profits
Rick Doblin (2:22:02.820)
for the pharmaceutical company,
Lex Fridman (2:22:04.980)
but it doesn't maximize patient outcomes.
Lex Fridman (2:22:07.780)
What we're seeing though in these various clinics
Lex Fridman (2:22:10.420)
that are being set up is that a lot of people are realizing
Rick Doblin (2:22:14.100)
that it works better with therapy.
Lex Fridman (2:22:17.620)
And so the clinics are run by people that are therapists
Lex Fridman (2:22:20.660)
so that when they provide therapy,
Lex Fridman (2:22:22.980)
they're making more money and then you need less ketamine.
Rick Doblin (2:22:26.500)
Also ketamine itself, S ketamine is a isomer of ketamine
Lex Fridman (2:22:31.540)
that's been patented for depression
Lex Fridman (2:22:33.540)
and they sell it for hundreds of dollars,
Lex Fridman (2:22:35.020)
but ketamine itself
Rick Doblin (2:22:37.140)
is one of the world's essential medicines.
Lex Fridman (2:22:39.300)
It's off patent, it's been around for a long time,
Rick Doblin (2:22:41.580)
it was the main battlefield anesthetic in Vietnam.
Lex Fridman (2:22:44.580)
And it's only a few bucks because it's generic.
Lex Fridman (2:22:47.380)
So a lot of the ketamine clinics are saying,
Lex Fridman (2:22:49.740)
great, thank you, Johnson and Johnson,
Rick Doblin (2:22:51.860)
you've helped demonstrate that ketamine is good
Lex Fridman (2:22:53.940)
for depression, but we're not gonna buy it from you.
Rick Doblin (2:22:56.300)
We're gonna buy it for a few bucks
Lex Fridman (2:22:58.060)
and we're gonna add therapy to it.
Rick Doblin (2:23:00.660)
Now there's a bunch of ketamine mills you could say
Lex Fridman (2:23:02.700)
that are just prescribing the ketamine
Lex Fridman (2:23:05.180)
and people are making a lot of money there.
Lex Fridman (2:23:07.140)
So I am worried about that.
Rick Doblin (2:23:09.380)
I think the best thing that we can do
Lex Fridman (2:23:11.300)
is create an alternative narrative,
Rick Doblin (2:23:15.620)
a different kind of example.
Lex Fridman (2:23:16.940)
We can lead by example.
Rick Doblin (2:23:18.060)
We can't make for profit companies
Lex Fridman (2:23:20.300)
into benefit corporations unless they wanna do that.
Rick Doblin (2:23:23.620)
We can't make them to really maximize patient outcomes.
Lex Fridman (2:23:28.420)
But if we create an example of something that's different,
Rick Doblin (2:23:32.500)
the hope is that people will gravitate towards that
Lex Fridman (2:23:36.100)
and some of the other companies.
Rick Doblin (2:23:37.860)
Like even now we have Exxon and other these companies,
Lex Fridman (2:23:41.220)
oil companies saying, oh, we're big
Rick Doblin (2:23:42.660)
into alternative energy and we're, you know.
Lex Fridman (2:23:45.860)
And that starts with companies that show an example
Rick Doblin (2:23:48.860)
that then communicates to the public
Lex Fridman (2:23:51.060)
that this is something exciting
Lex Fridman (2:23:53.140)
and then they demand the same of Exxon and so on.
Lex Fridman (2:23:56.380)
The public demands it and you could say the same thing
Rick Doblin (2:23:58.780)
for the public demanding the big pharma
Lex Fridman (2:24:03.500)
to optimize for benefit versus optimize for profit
Lex Fridman (2:24:08.340)
and maybe giving power to the therapists,
Lex Fridman (2:24:11.060)
more power to the therapists, more power to the doctors
Rick Doblin (2:24:13.540)
that ultimately want.
Lex Fridman (2:24:16.420)
I think incentives are interesting,
Lex Fridman (2:24:21.020)
but I think doctors ultimately care more
Lex Fridman (2:24:25.220)
because they're in direct contact with humans.
Rick Doblin (2:24:27.380)
They want to make people better.
Lex Fridman (2:24:29.020)
It's not, you know, sure they wanna make money,
Lex Fridman (2:24:31.340)
but they ultimately want to make people feel better
Lex Fridman (2:24:33.860)
because they get to look at people
Lex Fridman (2:24:35.420)
and it's so joyful to make people feel better
Lex Fridman (2:24:38.460)
at the end of the day.
Lex Fridman (2:24:39.300)
So giving more power to them is also perhaps
Lex Fridman (2:24:43.060)
one of the ways that you then incentivize
Rick Doblin (2:24:46.940)
the pharma companies that are trying to do good
Lex Fridman (2:24:51.660)
because the doctors will choose those companies.
Rick Doblin (2:24:53.820)
Yeah, now the other part of this is drug policy reform.
Lex Fridman (2:24:57.300)
So that if we make it so that you can buy MDMA
Rick Doblin (2:25:00.020)
for 10 or 20 bucks on your own
Lex Fridman (2:25:03.140)
and we've trained people on here's our therapeutic method,
Rick Doblin (2:25:06.500)
here is our ways for peer support,
Lex Fridman (2:25:09.440)
then people have an alternative from buying it
Rick Doblin (2:25:13.380)
from the pharma companies.
Lex Fridman (2:25:15.020)
So most of the for profit companies
Rick Doblin (2:25:18.340)
have come to this conclusion
Lex Fridman (2:25:20.300)
that drug policy reform is bad for their business model.
Rick Doblin (2:25:25.580)
I think they're making a fundamental mistake.
Lex Fridman (2:25:28.300)
And I think the reason is that
Rick Doblin (2:25:30.380)
the more that we de stigmatize this,
Lex Fridman (2:25:32.300)
the more that we sensitize people to this is an approach,
Rick Doblin (2:25:35.720)
even when people can get it on their own
Lex Fridman (2:25:37.860)
and do it with their friends or do it with themselves,
Rick Doblin (2:25:40.700)
there's gonna be even more people that say,
Lex Fridman (2:25:42.720)
oh my God, I've got real serious issues.
Rick Doblin (2:25:44.860)
I would rather go to trained professionals
Lex Fridman (2:25:47.780)
covered by insurance.
Lex Fridman (2:25:49.720)
And I think it'll increase the business,
Lex Fridman (2:25:52.580)
but most of the for profit companies don't see it that way.
Lex Fridman (2:25:56.140)
And so as a nonprofit that owns a benefit corp,
Lex Fridman (2:26:00.780)
we're not trying to maximize sales or profits.
Lex Fridman (2:26:03.700)
But I do believe that drug policy reform
Lex Fridman (2:26:06.740)
creates this alternative access point for people
Lex Fridman (2:26:10.180)
and that will help keep the for profits in check
Lex Fridman (2:26:12.800)
to some extent as well.
Rick Doblin (2:26:15.820)
I love it.
Lex Fridman (2:26:18.580)
Let's put on your wise visionary hat
Lex Fridman (2:26:22.460)
and ask when you look to young folks,
Lex Fridman (2:26:25.980)
is there advice you can give to young people today,
Lex Fridman (2:26:28.900)
whether in high school or college about career, about life?
Lex Fridman (2:26:33.900)
You've lived quite a nonlinear
Lex Fridman (2:26:36.820)
and fascinating life yourself.
Lex Fridman (2:26:39.020)
Is there advice you can give
Lex Fridman (2:26:40.220)
either on career or more generally on life?
Lex Fridman (2:26:43.820)
Well, I would say what people often hear is that,
Rick Doblin (2:26:51.580)
we're not actually here for that long a period of time.
Lex Fridman (2:26:55.960)
And the world is on fire.
Lex Fridman (2:26:59.700)
And whether humanity survives is not clear.
Lex Fridman (2:27:03.020)
And how many species are we gonna kill
Lex Fridman (2:27:05.740)
before we figure out not to do that anymore?
Lex Fridman (2:27:08.440)
So I would advise you to really try to
Rick Doblin (2:27:15.060)
develop a combination of what do you need
Lex Fridman (2:27:17.760)
in terms of income for your own survival,
Lex Fridman (2:27:20.400)
but what does the world need in terms of
Lex Fridman (2:27:25.680)
help to make the world better?
Lex Fridman (2:27:27.580)
And Howard Thurman, who we talked about,
Lex Fridman (2:27:30.880)
who ran the Good Friday experiment, the minister there,
Rick Doblin (2:27:33.740)
he said, he's got a famous quote attributed to him.
Lex Fridman (2:27:36.300)
He says, and this is exactly it to young people.
Rick Doblin (2:27:40.180)
He said, there's nothing particular that you should do,
Lex Fridman (2:27:43.900)
but find what makes you come alive
Rick Doblin (2:27:46.300)
because what the world needs is people
Lex Fridman (2:27:48.180)
that have come alive and are passionate.
Lex Fridman (2:27:52.300)
So I would say that be aware of this trap
Lex Fridman (2:27:57.300)
that you need vast resources, that you need all this stuff.
Rick Doblin (2:28:03.900)
I keep thinking of the super wealthy people
Lex Fridman (2:28:07.460)
in first class on the Titanic,
Rick Doblin (2:28:09.980)
as the Titanic is sinking.
Lex Fridman (2:28:12.100)
Their money's not gonna help them.
Rick Doblin (2:28:13.940)
The Earth is like Titanic.
Lex Fridman (2:28:15.980)
We're sinking, we're destroying the planets,
Rick Doblin (2:28:18.100)
destroying the environment.
Lex Fridman (2:28:18.940)
So you need a certain amount of money to be comfortable
Rick Doblin (2:28:23.940)
to be able to do that.
Lex Fridman (2:28:25.740)
You need to be comfortable to not be
Rick Doblin (2:28:28.260)
at that edge of survival,
Lex Fridman (2:28:29.440)
because once you're at that edge of survival,
Rick Doblin (2:28:31.060)
it's hard to think about anything else.
Lex Fridman (2:28:32.420)
But I'd say to young people,
Rick Doblin (2:28:36.940)
to the extent that you're able to do this,
Lex Fridman (2:28:39.040)
and again, student debt and all this kind of stuff
Rick Doblin (2:28:41.300)
is a big problem there too,
Lex Fridman (2:28:42.740)
but really just try to find this combination
Rick Doblin (2:28:48.540)
of what the world needs and what you need.
Lex Fridman (2:28:50.220)
The other thing to say to young people is
Rick Doblin (2:28:52.660)
that life is a lot shorter than you think,
Lex Fridman (2:28:57.600)
and a 20 year plan is not really that long.
Lex Fridman (2:29:00.400)
So if it takes you 20 years to get in a position
Lex Fridman (2:29:03.120)
to do what you wanna do, go for it.
Rick Doblin (2:29:07.280)
Have longterm plans.
Lex Fridman (2:29:08.820)
The other part that was so important for me
Rick Doblin (2:29:11.400)
to keep doing what I've been doing,
Lex Fridman (2:29:14.360)
basically now it's 49 years
Rick Doblin (2:29:17.320)
that I've sort of been devoting my life
Lex Fridman (2:29:18.880)
on psychedelics since I was 18.
Lex Fridman (2:29:20.440)
But when I started, I didn't think it would ever work.
Lex Fridman (2:29:23.620)
I just thought this is the only idea I have
Rick Doblin (2:29:25.500)
in this crazy world, this is what I wanna work on.
Lex Fridman (2:29:29.220)
Luckily, I had support from my family
Rick Doblin (2:29:30.980)
that took care of my survival needs, so I could do that.
Lex Fridman (2:29:34.660)
But I realized that if my happiness
Rick Doblin (2:29:37.860)
was dependent upon accomplishments,
Lex Fridman (2:29:40.940)
that I might never be happy,
Rick Doblin (2:29:42.760)
that I was able to reframe happiness in terms of effort.
Lex Fridman (2:29:47.760)
So if I'm trying hard to get stuff to be better,
Rick Doblin (2:29:54.120)
whether it's better or not,
Lex Fridman (2:29:55.480)
I can be happy at the end of each day, I tried.
Lex Fridman (2:29:58.640)
And so I think you try to separate out
Lex Fridman (2:30:01.600)
the goals that you have and your happiness
Rick Doblin (2:30:03.720)
to whether you're trying hard.
Lex Fridman (2:30:06.520)
The other thing I would say
Rick Doblin (2:30:08.080)
is that everybody has this humanity within them.
Lex Fridman (2:30:13.000)
So be very careful about dividing the world
Rick Doblin (2:30:14.940)
into us and them, and try to...
Lex Fridman (2:30:20.880)
So one of the things that I've done
Rick Doblin (2:30:23.600)
that has taken a long time,
Lex Fridman (2:30:27.760)
because I feel like drugs are illegal.
Rick Doblin (2:30:31.040)
I always felt like the police were the predator
Lex Fridman (2:30:33.540)
and I'm the prey.
Rick Doblin (2:30:35.040)
Yes.
Lex Fridman (2:30:36.480)
But now we're working with the police,
Lex Fridman (2:30:38.100)
and the police have tremendous trauma
Lex Fridman (2:30:39.980)
from the work that they do.
Rick Doblin (2:30:41.080)
We have one police officer who is now going,
Lex Fridman (2:30:43.400)
he's a full time police officer,
Rick Doblin (2:30:45.240)
he's also a psychotherapist.
Lex Fridman (2:30:47.880)
And he's going through our training program
Rick Doblin (2:30:50.120)
to learn how to give MDMA therapy to other police officers.
Lex Fridman (2:30:53.880)
And I met his police chief a couple of times,
Rick Doblin (2:30:56.680)
he got permission from his police chief
Lex Fridman (2:30:58.760)
to go to the second part of our training program,
Rick Doblin (2:31:01.080)
which is where we give MDMA to therapists
Lex Fridman (2:31:03.720)
who volunteer as a patient.
Lex Fridman (2:31:06.320)
So we have just a couple of weeks ago,
Lex Fridman (2:31:08.360)
dosed the police with MDMA.
Lex Fridman (2:31:11.360)
And so I think this idea of those people
Lex Fridman (2:31:13.760)
that are on the quote, other side,
Rick Doblin (2:31:16.080)
try to see through that to their humanity,
Lex Fridman (2:31:19.760)
to what their pains and suffering,
Lex Fridman (2:31:21.320)
what their struggles are, to the extent that you can.
Lex Fridman (2:31:24.920)
And that I think, and build long term relationships.
Rick Doblin (2:31:28.480)
You never know what's gonna come around 20 years from now.
Lex Fridman (2:31:32.640)
So you help some people try to keep these relationships
Rick Doblin (2:31:35.320)
going 20 years from now, something could come.
Lex Fridman (2:31:38.160)
And also be persistent.
Rick Doblin (2:31:47.600)
I think that's been the key to success.
Lex Fridman (2:31:49.960)
I mean, once the FDA or DEA figured out
Rick Doblin (2:31:52.720)
we're not going anywhere,
Lex Fridman (2:31:53.800)
they're gonna have to deal with us,
Rick Doblin (2:31:55.760)
then we started getting some progress.
Lex Fridman (2:31:57.840)
So a mix of patience and stubbornness
Rick Doblin (2:32:00.520)
that gets things done.
Lex Fridman (2:32:02.320)
Is there something you've figured out
Rick Doblin (2:32:05.440)
through your journey with psychedelics
Lex Fridman (2:32:08.400)
about some of the big why questions about life?
Lex Fridman (2:32:11.920)
Like, what the heck's the value of love?
Lex Fridman (2:32:18.200)
Why does it suck so much that we die?
Lex Fridman (2:32:21.720)
And for some of us, maybe it's the Russian in me,
Lex Fridman (2:32:25.440)
but it's quite terrifying, the notion of it.
Rick Doblin (2:32:28.080)
Or the biggest why question of them all,
Lex Fridman (2:32:30.080)
which is what's the meaning of it all?
Rick Doblin (2:32:33.040)
Well, yeah, what I've discovered is
Lex Fridman (2:32:35.640)
that we don't need answers to those questions.
Rick Doblin (2:32:40.560)
That the fact that we can feel happy,
Lex Fridman (2:32:46.400)
that we can love, that we can have moments of happiness,
Rick Doblin (2:32:50.160)
that's enough.
Lex Fridman (2:32:52.640)
Figuring out these big questions, you can get lost in that.
Lex Fridman (2:32:56.160)
And we all can come up with our answers.
Lex Fridman (2:32:58.840)
What's the meaning of life?
Lex Fridman (2:33:00.600)
Why is there life?
Lex Fridman (2:33:01.880)
Why is there consciousness?
Lex Fridman (2:33:02.920)
But I don't know that we need those answers.
Lex Fridman (2:33:06.000)
What we know is that we're social creatures,
Rick Doblin (2:33:10.120)
that other people can make us happy by certain things,
Lex Fridman (2:33:14.720)
we can make other people happy, that one life is enough.
Lex Fridman (2:33:17.800)
So this other part about why is it so tragic that we die?
Lex Fridman (2:33:23.160)
I don't think it's tragic that we die.
Lex Fridman (2:33:25.320)
So first off, if you believe in this collective unconscious,
Lex Fridman (2:33:27.800)
but we have an impact that lasts.
Lex Fridman (2:33:32.480)
But I think that for me at least,
Lex Fridman (2:33:35.160)
I've been of the view that we should be grateful for death,
Rick Doblin (2:33:40.520)
that death makes life precious,
Lex Fridman (2:33:42.600)
that if we had an infinite amount of time,
Rick Doblin (2:33:46.120)
I mean, I'm a bit of a procrastinator about stuff,
Lex Fridman (2:33:49.200)
particularly things that are really hard to do
Lex Fridman (2:33:52.280)
and you just don't do it.
Lex Fridman (2:33:54.200)
And then like, where'd the day go?
Rick Doblin (2:33:55.400)
I was gonna do this.
Lex Fridman (2:33:56.240)
So if we had infinite life, we never died,
Lex Fridman (2:33:59.320)
and would life be precious?
Lex Fridman (2:34:03.440)
Would we do anything?
Rick Doblin (2:34:04.400)
I don't think so.
Lex Fridman (2:34:05.280)
So my parents gave every Jewish new year,
Rick Doblin (2:34:11.160)
they would make their new year's card.
Lex Fridman (2:34:14.000)
And one of the quotes was fantastic.
Rick Doblin (2:34:16.360)
It was just, we have to make up for the brevity of life
Lex Fridman (2:34:20.320)
with the intensity of life.
Rick Doblin (2:34:22.480)
Oh man, that is good.
Lex Fridman (2:34:24.520)
Well, the end makes things precious.
Rick Doblin (2:34:29.080)
Death makes life precious.
Lex Fridman (2:34:30.600)
The end of this conversation makes it precious,
Lex Fridman (2:34:34.480)
and which is a great way to end, Rick.
Lex Fridman (2:34:38.200)
I wanted to talk to you for a long time.
Rick Doblin (2:34:40.760)
I share, you were very excited about the study.
Lex Fridman (2:34:43.280)
I can now understand exactly why this is really promising.
Rick Doblin (2:34:46.920)
This is really exciting, gives me hope about the future,
Lex Fridman (2:34:50.240)
even if it doesn't come fast enough.
Lex Fridman (2:34:53.720)
But like you said, I have to be patient and stubborn.
Lex Fridman (2:34:56.560)
Thank you so much for wasting
Rick Doblin (2:34:58.360)
all your valuable time with me today.
Lex Fridman (2:34:59.960)
It's truly an honor to meet you and talk to you.
Rick Doblin (2:35:01.760)
Not a waste at all.
Lex Fridman (2:35:02.840)
I really appreciated this time together.
Rick Doblin (2:35:06.840)
Thank you for listening to this conversation
Lex Fridman (2:35:08.400)
with Rick Doblin, and thank you to Theragun, ExpressVPN,
Rick Doblin (2:35:12.480)
Blinkist, and Asleep.
Lex Fridman (2:35:14.640)
Check them out in the description to support this podcast.
Lex Fridman (2:35:17.920)
And now let me leave you with some words
Lex Fridman (2:35:19.640)
from Terrence McKenna.
Rick Doblin (2:35:21.520)
Nature loves courage.
Lex Fridman (2:35:23.120)
You make the commitment, and nature will respond
Rick Doblin (2:35:25.760)
to that commitment by removing impossible obstacles.
Lex Fridman (2:35:29.280)
Dream the impossible dream,
Lex Fridman (2:35:30.840)
and the world will not grind you under.
Lex Fridman (2:35:33.160)
It will lift you up.
Rick Doblin (2:35:34.680)
This is the trick.
Lex Fridman (2:35:36.040)
This is what all the teachers and philosophers
Rick Doblin (2:35:38.680)
who really counted, who really touched the alchemical gold,
Lex Fridman (2:35:42.880)
this is what they understood.
Rick Doblin (2:35:44.640)
This is the shamanic dance in the waterfall.
Lex Fridman (2:35:47.480)
This is how magic is done,
Rick Doblin (2:35:49.320)
by hurling yourself into the abyss
Lex Fridman (2:35:51.440)
and discovering that it's a feather bed.
Rick Doblin (2:35:54.600)
Thank you for listening, and hope to see you next time.
Lex Fridman (30:01.400)
and that's where you sometimes get
Rick Doblin (30:03.840)
these mystical sense of connection, how it's all one
Lex Fridman (30:06.620)
and you get the sense also of how big the universe is
Lex Fridman (30:12.560)
and how small each one of us is.
Lex Fridman (30:15.520)
So there's a lot of work that Sasha Shulgin
Lex Fridman (30:18.520)
and Albert Hoffman who invented LSD
Lex Fridman (30:20.940)
and first synthesized psilocybin
Rick Doblin (30:22.320)
on what they call structure activity relationships.
Lex Fridman (30:24.960)
What is the structural molecule
Lex Fridman (30:27.300)
and then how do you predict what that new molecule
Lex Fridman (30:31.000)
that never existed before is going to do
Lex Fridman (30:33.320)
once you actually take it?
Lex Fridman (30:35.520)
And you can get close, but you never really know
Rick Doblin (30:40.680)
until you actually take the drug.
Lex Fridman (30:43.020)
And the way that Sasha ran his experiments
Rick Doblin (30:47.480)
is that he would take the drugs himself first in low doses
Lex Fridman (30:51.920)
and he would sort of step up the doses
Rick Doblin (30:55.000)
to have more experiences.
Lex Fridman (30:56.000)
If he thought it was valuable,
Rick Doblin (30:56.960)
he'd share it with his wife, Ann,
Lex Fridman (30:58.720)
but then what they would do is
Rick Doblin (31:01.280)
if they both thought it was valuable,
Lex Fridman (31:02.560)
they had a group of 12 people
Rick Doblin (31:04.920)
that they were with for many, many years
Lex Fridman (31:07.360)
and they would distribute these new drug to these 12 people
Lex Fridman (31:10.800)
and they would get the different perspectives.
Lex Fridman (31:13.560)
And he felt that 12 was like a minimum number
Rick Doblin (31:15.920)
because we're so unique how each of us see things,
Lex Fridman (31:18.840)
but then you kind of get a little bit of a consensus
Rick Doblin (31:21.040)
on how a lot of people are gonna see it
Lex Fridman (31:22.560)
and then if that 12 people were positive about it,
Rick Doblin (31:25.580)
then they would turn it over to Leo Zeph,
Lex Fridman (31:27.360)
who we called the secret chief,
Rick Doblin (31:29.240)
the leader of the underground psychedelic therapy movement
Lex Fridman (31:31.320)
and then he would start exploring it in therapy.
Lex Fridman (31:34.760)
So there's still a lot of mysteries
Lex Fridman (31:38.320)
as far as structure activity relationships
Lex Fridman (31:40.560)
and it's not gonna be the case that people go into the lab
Lex Fridman (31:43.400)
and they tinker with molecules
Lex Fridman (31:45.400)
and they know exactly what they're gonna get.
Lex Fridman (31:48.760)
And a lot of it has to do with
Rick Doblin (31:51.560)
not so much chemistry as morphology.
Lex Fridman (31:54.840)
You could say the shape of the molecule
Lex Fridman (31:56.720)
and how does that interact with receptor sites.
Lex Fridman (31:59.560)
And so we're getting better at modeling all of that.
Lex Fridman (32:03.400)
And how does that interaction relate
Lex Fridman (32:04.800)
to the morphing of the human experience
Lex Fridman (32:08.280)
and deeply understanding that perhaps
Lex Fridman (32:11.040)
there's no equations yet for that kind of thing.
Rick Doblin (32:13.200)
You really have to build up intuition by experiencing it.
Lex Fridman (32:17.240)
And over time and sort of subjective self report,
Rick Doblin (32:20.620)
like trying to build an understanding
Lex Fridman (32:22.960)
of the effects of the different chemistries.
Rick Doblin (32:24.800)
Yeah, you can have approximate ideas, but to know exactly.
Lex Fridman (32:29.280)
So when I first tried MDMA, which was 1982
Lex Fridman (32:34.080)
and this was after I had done lots of LSD
Lex Fridman (32:37.400)
and mescaline and mushrooms,
Rick Doblin (32:41.200)
I was shocked at how different it was
Lex Fridman (32:44.600)
than these other substances and yet how profound it was.
Lex Fridman (32:49.280)
So are there whole new kind of categories
Lex Fridman (32:52.120)
of classes of drugs that we're not aware of
Rick Doblin (32:54.600)
that would be not so much this like eco dissolution
Lex Fridman (33:00.120)
or emotional?
Rick Doblin (33:01.960)
Well, what MDMA does is reduces activity in the amygdala,
Lex Fridman (33:05.880)
the fear processing part of the brain.
Lex Fridman (33:08.220)
So it's not just chemistry, but it routes energy
Lex Fridman (33:11.160)
throughout the brain in a different way.
Rick Doblin (33:12.680)
It increases activity in the prefrontal cortex.
Lex Fridman (33:15.880)
So you think more logically,
Rick Doblin (33:17.600)
that I think has an enormous impact on the effect of MDMA.
Lex Fridman (33:21.680)
The other thing it does is it increases connectivity
Rick Doblin (33:25.200)
between the amygdala and the hippocampus.
Lex Fridman (33:26.760)
So it helps facilitate processing of things
Rick Doblin (33:30.340)
into longterm memory.
Lex Fridman (33:32.820)
And with PTSD, trauma is like never in the past,
Rick Doblin (33:35.440)
it's always about to happen.
Lex Fridman (33:36.520)
So will we one time develop drugs
Lex Fridman (33:39.560)
that would even be specific to certain kinds of memories?
Lex Fridman (33:43.520)
We're working with a woman, Rachel Yehuda,
Rick Doblin (33:46.400)
who is at the Bronx VA,
Lex Fridman (33:50.120)
and she's done some studies
Rick Doblin (33:52.320)
that are with the epigenetics of trauma.
Lex Fridman (33:55.320)
So she's worked with Holocaust survivors and their children,
Lex Fridman (33:58.800)
and she has identified epigenetic mechanisms
Lex Fridman (34:03.560)
by which trauma is passed
Rick Doblin (34:05.120)
from generation to the generations.
Lex Fridman (34:07.400)
Sort of like set points for anxiety,
Rick Doblin (34:10.120)
fear, certain things like that.
Lex Fridman (34:11.760)
But the question is, can you actually transmit memories
Lex Fridman (34:16.080)
from one generation to the next?
Lex Fridman (34:18.720)
Now, this is not DNA changes
Rick Doblin (34:24.360)
which happen over a very long period of time
Lex Fridman (34:26.520)
and evolutionary scale.
Lex Fridman (34:28.760)
But within one lifetime, within some experiences,
Lex Fridman (34:31.680)
your epigenetics, what turns on the genes
Rick Doblin (34:34.240)
or turns off certain genes, that can be impacted.
Lex Fridman (34:37.160)
And that's what we know now can be transmitted
Rick Doblin (34:39.560)
from generation to generation,
Lex Fridman (34:41.880)
either by the father or the mother
Rick Doblin (34:43.560)
through the sperm or the egg.
Lex Fridman (34:45.820)
So it's pretty remarkable.
Lex Fridman (34:48.720)
So what Rachel's gonna try to do is MDMA research for PTSD
Lex Fridman (34:53.460)
and look at these epigenetic markers before and after
Lex Fridman (34:56.400)
and see if they change as a consequence of therapy.
Lex Fridman (35:00.280)
So will we develop one day certain kind of chemicals
Rick Doblin (35:05.440)
that will be able to bring certain kind of memories
Lex Fridman (35:08.080)
to the surface?
Rick Doblin (35:10.400)
That's not inconceivable.
Lex Fridman (35:12.600)
The epigenetic angle is fascinating,
Rick Doblin (35:14.960)
that there'll be these epigenetic perturbations
Lex Fridman (35:17.600)
that lead to memories living
Rick Doblin (35:19.840)
from one generation to the other
Lex Fridman (35:22.840)
and then bringing those memories to the surface
Lex Fridman (35:25.200)
and using that as signal to understand
Lex Fridman (35:30.280)
what exactly the psychedelics bring to the surface and not.
Rick Doblin (35:34.640)
Yeah, yeah.
Lex Fridman (35:35.480)
Now, the other portion of that though is culture.
Rick Doblin (35:38.240)
I mean, culture is where we store all these memories
Lex Fridman (35:40.680)
and in the stories that we get passed out.
Rick Doblin (35:44.200)
Especially with a lot of shared,
Lex Fridman (35:46.000)
you talk about the Holocaust or World War II,
Rick Doblin (35:48.880)
where it's deeply ingrained in the culture,
Lex Fridman (35:53.560)
the impact of those events
Lex Fridman (35:55.360)
and sort of in aggregate the different perspectives
Lex Fridman (35:57.680)
on that particular event create a set of stories
Rick Doblin (36:01.440)
that you can plug into.
Lex Fridman (36:03.120)
And then they kind of resonate with some aspect of you
Rick Doblin (36:06.560)
that creates a memory that's connected to,
Lex Fridman (36:09.560)
like when I think about World War II and the Holocaust,
Rick Doblin (36:12.080)
I think about my own family,
Lex Fridman (36:13.760)
but in some sense,
Rick Doblin (36:15.700)
it's also resonating with stories of many others.
Lex Fridman (36:19.000)
So it's like somehow the two echo each other
Lex Fridman (36:22.040)
and I'm just providing my own little flavor on top.
Lex Fridman (36:24.960)
The meat of the stories
Rick Doblin (36:26.760)
are probably those that are shared with others.
Lex Fridman (36:29.280)
It's plugging into the collective unconscious.
Rick Doblin (36:32.320)
That's really fascinating,
Lex Fridman (36:34.760)
really plugging into like precisely
Rick Doblin (36:38.720)
plugging into particular memories
Lex Fridman (36:40.680)
as a way to deal with trauma and PTSD, that kind of thing.
Rick Doblin (36:47.960)
Yeah, I'll just add that the most important dream
Lex Fridman (36:51.120)
of my life ever was of a Holocaust survivor
Rick Doblin (36:54.180)
telling me that he was miraculously saved from death
Lex Fridman (37:02.320)
and he knew that he was saved for a particular purpose,
Lex Fridman (37:04.780)
but he never knew what that purpose was.
Lex Fridman (37:06.560)
So in the dream, I'm seeing him on his deathbed
Lex Fridman (37:08.360)
and then he shows me whatever happened to him
Lex Fridman (37:11.600)
during the Holocaust.
Lex Fridman (37:13.560)
And then we're back in the room on his deathbed
Lex Fridman (37:16.360)
and he says, well, I know what my purpose was now.
Lex Fridman (37:20.520)
And I'm like, oh, great, what was it?
Lex Fridman (37:22.100)
He says, it's to tell you to be a psychedelic therapist
Lex Fridman (37:24.440)
and to study psychedelics
Lex Fridman (37:25.740)
and bring back psychedelic research.
Lex Fridman (37:28.440)
And I thought to myself, I've already decided to do this.
Lex Fridman (37:31.920)
You can lay this on me.
Rick Doblin (37:33.080)
I can say yes and then you can die in peace.
Lex Fridman (37:35.240)
And then he died in front of my eyes in the dream.
Lex Fridman (37:38.160)
So I think that that kind of cultural transmission
Lex Fridman (37:43.040)
that I got from when I was really young,
Rick Doblin (37:45.680)
then manifested in this dream.
Lex Fridman (37:47.500)
And that was this story about how people
Rick Doblin (37:51.800)
can be incredibly vicious
Lex Fridman (37:55.240)
and can be very motivated by irrational factors.
Lex Fridman (37:58.920)
And so I just feel that this kind of
Lex Fridman (38:02.400)
multi generational transmission of this story
Rick Doblin (38:05.680)
of the irrational being a murderous factor
Lex Fridman (38:10.800)
and something I needed to respond to was deeply ingrained.
Lex Fridman (38:15.400)
And I would say my guess is more culturally
Lex Fridman (38:19.960)
than this epigenetic mechanism.
Rick Doblin (38:22.080)
Yes.
Lex Fridman (38:23.440)
Yeah, but your sense is that whatever stimulated
Rick Doblin (38:27.240)
a certain part of human nature in World War II,
Lex Fridman (38:32.240)
especially Nazi Germany, but also in Stalinist Soviet Union,
Rick Doblin (38:37.680)
still is within us, within all of us.
Lex Fridman (38:40.280)
Just like what we're saying,
Rick Doblin (38:44.520)
we embody quite a lot of things.
Lex Fridman (38:47.000)
Yeah.
Lex Fridman (38:47.840)
And one of those is whatever the capacity for evil
Lex Fridman (38:53.680)
seems to be one of those things.
Rick Doblin (38:56.400)
Yeah, there's a quote from Carl Jung
Lex Fridman (38:58.880)
from just a few years before he died.
Lex Fridman (39:03.360)
What he says, and I'll just paraphrase it is
Lex Fridman (39:05.980)
that we need to understand psychology.
Rick Doblin (39:10.200)
We need to understand who man is,
Lex Fridman (39:14.220)
that the greatest danger to us is man.
Rick Doblin (39:18.360)
There are no other dangers really that impact our species.
Lex Fridman (39:23.760)
And then he goes on to say that
Rick Doblin (39:25.920)
we are the source of all coming evil.
Lex Fridman (39:30.120)
Now this was 15 years or so after World War II.
Lex Fridman (39:34.000)
But yeah, and I'd say one of the most important
Lex Fridman (39:36.320)
psychedelic experiences of my life was a DMT experience.
Rick Doblin (39:39.240)
Also Terrence was there, Ralph Metzner,
Lex Fridman (39:43.120)
Andy Weil, a few others.
Lex Fridman (39:44.880)
And we were sitting around at Esalen smoking DMT.
Lex Fridman (39:50.800)
And under the influence of DMT,
Rick Doblin (39:53.440)
which now this was the first time I've ever smoked DMT,
Lex Fridman (39:57.720)
I had this super rapid fraction of a second,
Rick Doblin (40:01.260)
like dissolving of everything that I,
Lex Fridman (40:03.520)
well, first off I saw a horizontal line,
Rick Doblin (40:06.200)
then I saw a vertical line, then it turned into a color,
Lex Fridman (40:09.060)
red, then it was red, then it turned into cubes,
Rick Doblin (40:11.440)
then it turned into like an MC Escher kind of like,
Lex Fridman (40:14.220)
I don't know, you know, didn't make logical sense.
Lex Fridman (40:17.040)
And then I was gone.
Lex Fridman (40:18.700)
And then it was just this period of five, 10 minutes
Rick Doblin (40:23.340)
of just feeling part of this enormous wave
Lex Fridman (40:26.560)
of billions of years of evolution,
Lex Fridman (40:29.080)
how I had this sense that in my innermost sense
Lex Fridman (40:32.740)
of who I am uniquely individually,
Rick Doblin (40:35.920)
this inner voice that's talking to me
Lex Fridman (40:37.800)
that I didn't develop English,
Rick Doblin (40:40.000)
that it's like a gift to me from millions of people.
Lex Fridman (40:43.520)
So that even in my most innermost sense, it's not just me.
Rick Doblin (40:48.680)
It's the product of everything that came before me.
Lex Fridman (40:51.060)
I'm part of this bigger system.
Lex Fridman (40:53.640)
And then I just thought, wow,
Lex Fridman (40:55.080)
just how many billions of years does it take
Lex Fridman (40:57.240)
to reach this point of self awareness and all this?
Lex Fridman (40:59.820)
And it was glorious, beautiful.
Lex Fridman (41:01.080)
And then I had this thought,
Lex Fridman (41:03.400)
and this is where this kind of intellectual honesty,
Rick Doblin (41:06.860)
I guess you could say, I just thought,
Lex Fridman (41:08.120)
well, if I'm part of everything
Lex Fridman (41:09.360)
and everything's part of me,
Lex Fridman (41:11.040)
then it's not just the good parts,
Rick Doblin (41:12.880)
that Hitler's part of me too.
Lex Fridman (41:15.080)
And that was just this shock, like a stone sunk,
Lex Fridman (41:19.120)
and I just was very moody for the whole next day.
Lex Fridman (41:22.800)
But it was that acknowledgement
Rick Doblin (41:24.800)
that each of us carries these potentials,
Lex Fridman (41:27.440)
and what we activate is what matters,
Lex Fridman (41:29.460)
but what our potential are is the whole full range of things.
Lex Fridman (41:34.120)
I don't know if you can comment
Rick Doblin (41:35.200)
about the DMT trip itself and what it's like,
Lex Fridman (41:39.000)
starting from the very basic geometric shapes
Lex Fridman (41:42.080)
and then launching yourself into the context
Lex Fridman (41:46.080)
of the enormity of space and time in the human history.
Rick Doblin (41:52.400)
Is there anything else to be said
Lex Fridman (41:54.040)
about that kind of visually or physically
Lex Fridman (42:00.240)
or emotionally about that journey?
Lex Fridman (42:02.760)
What it's like, that brief journey that reveals so much?
Rick Doblin (42:07.900)
Well, I was with a group of people.
Lex Fridman (42:10.040)
The way we were doing it was each of us would smoke DMT,
Rick Doblin (42:14.800)
have 10, 15 minutes experience while we closed our eyes,
Lex Fridman (42:17.600)
and everybody else was just chatting,
Lex Fridman (42:19.320)
and then the person who did the DMT would come back
Lex Fridman (42:21.840)
and tell their story of what happened.
Lex Fridman (42:24.240)
And then we'd think about it for a bit
Lex Fridman (42:26.000)
and then pass the pipe to the next person.
Lex Fridman (42:27.600)
And so this was like a whole evening.
Lex Fridman (42:30.920)
So even the, sorry to interrupt,
Rick Doblin (42:32.320)
even the conversations themselves then
Lex Fridman (42:34.100)
is part of the experience.
Rick Doblin (42:35.840)
Exactly, yes, yes, because it's also what you bring back.
Lex Fridman (42:39.240)
I mean, I think that's particularly for therapy.
Rick Doblin (42:42.280)
It's not so much about what the experience is,
Lex Fridman (42:45.240)
but it's what you bring back and what do you integrate.
Lex Fridman (42:48.720)
And then also, how do you learn how to do these things
Lex Fridman (42:52.560)
on your own without the drugs?
Rick Doblin (42:54.560)
There is this way, because we're saying
Lex Fridman (42:56.340)
it's sort of a core human experience,
Lex Fridman (42:58.360)
the drug is the mediator, but can we do this on our own?
Lex Fridman (43:01.920)
And once you've seen it and felt it,
Rick Doblin (43:04.440)
then you have a little bit better sense
Lex Fridman (43:06.000)
to recreate it on your own.
Rick Doblin (43:08.240)
Although, I've had dreams where I've been doing LSD
Lex Fridman (43:11.860)
and tripping and it was just incredible.
Rick Doblin (43:14.560)
It was, I was tripping in my dreams,
Lex Fridman (43:17.320)
but I had not taken LSD.
Lex Fridman (43:19.760)
So there's this way in which we do that.
Lex Fridman (43:22.020)
So I would say that from the DMT experience,
Rick Doblin (43:26.040)
the sense of safety, that's what I was trying to get at
Lex Fridman (43:28.160)
with this, the group of us and this group of friends
Rick Doblin (43:30.760)
trying to do this common exploration,
Lex Fridman (43:32.500)
that if you have this sense of safety,
Rick Doblin (43:34.880)
you're incredibly vulnerable
Lex Fridman (43:38.200)
because you are giving up your awareness really
Rick Doblin (43:43.080)
of what's happening around you.
Lex Fridman (43:44.840)
I think there's, what we're finding is that
Rick Doblin (43:49.440)
in our psychedelic research for PTSD
Lex Fridman (43:54.860)
and what we see with the vaccines,
Rick Doblin (43:56.480)
that even African Americans are reluctant
Lex Fridman (43:59.200)
to volunteer for vaccines because they haven't had
Rick Doblin (44:02.560)
that sense of safety from the medical establishment.
Lex Fridman (44:05.700)
They don't volunteer for psychedelic therapy even as much.
Lex Fridman (44:10.500)
So the overlay has to be this sense of safety
Lex Fridman (44:14.280)
as you become vulnerable and looking inside, you're not.
Rick Doblin (44:18.300)
I was just actually told about how there's a lot of work
Lex Fridman (44:22.180)
being done inside prisons to teach mindfulness.
Lex Fridman (44:25.520)
And so one of the,
Lex Fridman (44:29.840)
Charlene who's my assistant is trying to do work
Rick Doblin (44:32.280)
on helping people in prison with trauma,
Lex Fridman (44:36.400)
potentially one day with MDMA or meditation or mindfulness.
Lex Fridman (44:39.520)
But one of the exercises was teaching people to,
Lex Fridman (44:42.840)
okay, here's how you deal with stress,
Rick Doblin (44:45.020)
just close your eyes and deep breathe.
Lex Fridman (44:46.800)
And what Charlene was saying is people don't close their eyes
Rick Doblin (44:49.400)
in prison, you don't feel safe to do that.
Lex Fridman (44:52.360)
So all that is just to say is that the context
Rick Doblin (44:57.840)
is the most important factor.
Lex Fridman (44:59.780)
So while I'll talk about the DMT experience,
Rick Doblin (45:02.240)
the context was this supportive sense of safety
Lex Fridman (45:07.160)
that I could be completely vulnerable
Lex Fridman (45:09.120)
and out of any kind of controlled women,
Lex Fridman (45:12.920)
I think often are less safe in this way than men
Rick Doblin (45:16.820)
because of all the sexual assaults.
Lex Fridman (45:20.760)
But what it can do by taking the ego orientation offline
Rick Doblin (45:26.920)
to some extent, it opens you up to much more.
Lex Fridman (45:29.960)
And to make a bigger point of that,
Rick Doblin (45:33.720)
we could say that it's very similar
Lex Fridman (45:35.920)
to the Copernican revolution.
Lex Fridman (45:38.060)
And people thought that the earth
Lex Fridman (45:40.060)
was the center of the universe
Lex Fridman (45:41.720)
and the inquisition murdered people that questioned that.
Lex Fridman (45:47.240)
Father Bruno burned at the stake.
Rick Doblin (45:48.840)
Actually, one of the things he said,
Lex Fridman (45:50.440)
I think that's worth all these years later saying
Rick Doblin (45:54.280)
is that when the inquisition sentenced him
Lex Fridman (45:58.880)
to burn at the stake for espousing this idea
Rick Doblin (46:02.040)
that the earth was not really the center of the universe,
Lex Fridman (46:05.720)
he said to the inquisition, he said,
Rick Doblin (46:08.400)
your fear in sentencing me is greater
Lex Fridman (46:11.320)
than my fear in being sentenced.
Rick Doblin (46:15.280)
That their worldview was so rigid
Lex Fridman (46:18.120)
that they had to wipe out anybody that would question it.
Lex Fridman (46:21.720)
And so this idea of psychedelics displacing our ego
Lex Fridman (46:26.720)
is the center of the universe.
Lex Fridman (46:28.640)
And to realize that we are just rotating
Lex Fridman (46:31.320)
about on something much bigger than our individual life.
Rick Doblin (46:35.040)
Our ego is designed almost to protect this body
Lex Fridman (46:38.520)
while we're alive.
Lex Fridman (46:40.280)
And you can understand all the good reasons why that is,
Lex Fridman (46:44.040)
but it also disconnects us from this bigger reality.
Lex Fridman (46:47.520)
And so the psychedelics, DMT,
Lex Fridman (46:49.080)
by knocking this sort of ego orientation
Rick Doblin (46:52.480)
or the default mode network offline,
Lex Fridman (46:55.640)
you open up to the bigger sweeps of history.
Lex Fridman (47:00.600)
So in that place of safety and vulnerability
Lex Fridman (47:03.560)
in that fascinating group of people,
Rick Doblin (47:06.000)
when their ego was dissolved in this way,
Lex Fridman (47:08.080)
did they have similar experiences?
Lex Fridman (47:09.960)
Is there different places that their minds went?
Lex Fridman (47:12.240)
Yeah, so once I had this kind of shattering experience
Rick Doblin (47:17.460)
that Hitler's part of me,
Lex Fridman (47:19.640)
no one else in the group had that.
Rick Doblin (47:21.440)
Probably a lot of them have maybe had that before
Lex Fridman (47:24.080)
or they realized that they're not just the good,
Rick Doblin (47:28.440)
the white hat, good people and that they're all good
Lex Fridman (47:31.520)
and we got to fight against the bad people.
Lex Fridman (47:35.360)
So no, people will go in different places.
Lex Fridman (47:37.200)
And not only that, if you do it again,
Rick Doblin (47:39.360)
you'll go into a different place
Lex Fridman (47:40.480)
than you went to the first time.
Rick Doblin (47:42.520)
Unless you have not resolved the issue.
Lex Fridman (47:45.000)
So I had a sequence of LSD trips that were very difficult,
Lex Fridman (47:48.520)
but it was like coming to the same sort of conundrum,
Lex Fridman (47:52.720)
the same challenge that I was unable to overcome.
Rick Doblin (47:57.280)
This idea of letting go and really fully dissolving,
Lex Fridman (48:01.640)
letting the ego fully go.
Lex Fridman (48:02.980)
And I would have this sequence of trips
Lex Fridman (48:04.840)
over a couple of months where I would reach this point
Rick Doblin (48:07.320)
where I was too scared to move forward
Lex Fridman (48:08.800)
and I would just be holding on.
Lex Fridman (48:11.880)
So there are repeated themes sometimes.
Lex Fridman (48:15.360)
What Stan Groff has said, which I find very beautiful,
Rick Doblin (48:18.280)
is that the full expression of an emotion
Lex Fridman (48:21.720)
is the funeral pyre of that emotion.
Lex Fridman (48:25.240)
And what that means is if you can fully let in something,
Lex Fridman (48:29.200)
then the essence of life has changed,
Rick Doblin (48:32.600)
is that it moves on, that everything's in motion.
Lex Fridman (48:35.640)
And if you can fully experience it,
Rick Doblin (48:37.320)
even if it's a sense that you're gonna be trapped
Lex Fridman (48:39.400)
in eternity in this hellish state,
Rick Doblin (48:42.640)
if you surrender to that, that's the way out.
Lex Fridman (48:46.200)
This full experience of something
Rick Doblin (48:48.160)
is this funeral pyre of that emotion.
Lex Fridman (48:52.220)
And so that runs against a lot
Rick Doblin (48:54.720)
of what modern psychiatry is doing too,
Lex Fridman (48:56.320)
which is to suppress symptoms.
Rick Doblin (49:00.360)
Instead of supporting people
Lex Fridman (49:01.640)
to kind of explore these insecurities
Lex Fridman (49:03.920)
so that then they can contain them
Lex Fridman (49:06.300)
and then they can move on.
Lex Fridman (49:09.080)
So yeah, resistance is not a way to make progress.
Lex Fridman (49:13.680)
Right, right.
Rick Doblin (49:15.060)
Although one of the reasons
Lex Fridman (49:17.860)
why we do the supplemental dose during the MDMA
Rick Doblin (49:21.380)
or why there's advantages in a 10 hour LSD experience
Lex Fridman (49:26.140)
is that you have a lot of opportunities
Rick Doblin (49:28.540)
to come up against this resistance
Lex Fridman (49:31.060)
that may be too difficult to deal with
Lex Fridman (49:32.940)
and then you kind of push it aside
Lex Fridman (49:34.680)
and then a couple hours later you come back to it
Rick Doblin (49:36.580)
or you come back to it.
Lex Fridman (49:37.580)
Press snooze every once in a while if you're not ready.
Rick Doblin (49:40.500)
It's hard to do that.
Lex Fridman (49:41.460)
I think with MDMA, you can negotiate.
Rick Doblin (49:45.140)
That's, I think, a part of its safety in a sense.
Lex Fridman (49:48.140)
You can have this like, oh, I should be talking about this
Rick Doblin (49:50.860)
or I'm feeling this, but it's too much for me now.
Lex Fridman (49:53.740)
You can push it away.
Lex Fridman (49:54.700)
But with the classic psychedelics,
Lex Fridman (49:57.080)
this kind of membrane between the conscious
Lex Fridman (49:59.500)
and the unconscious,
Lex Fridman (50:00.940)
that once you take the drug and it weakens this membrane
Lex Fridman (50:04.940)
and things are coming up,
Lex Fridman (50:07.500)
it's very difficult to negotiate with it.
Rick Doblin (50:10.660)
The key to successful classic psychedelic trips is surrender.
Lex Fridman (50:18.100)
You've talked about that you first began
Rick Doblin (50:20.060)
to reconsider the negative health myths around psychedelics
Lex Fridman (50:24.260)
when you learned that the book One Flew Over the Cuckoo's Nest
Rick Doblin (50:27.860)
was written by Ken Kesey when he was in part
Lex Fridman (50:30.580)
under the influence of LSD.
Lex Fridman (50:32.640)
So how do you think LSD helped him, Ken Kesey,
Lex Fridman (50:36.180)
in writing that incredible book?
Rick Doblin (50:39.540)
Yeah, there's a process that's called semantic priming.
Lex Fridman (50:45.060)
And so what that means is that I say night, you say day.
Rick Doblin (50:49.380)
There's kind of normal patterns of kind of,
Lex Fridman (50:52.420)
you say one word, what kind of words come to you next?
Lex Fridman (50:56.660)
And so they've done some research.
Lex Fridman (50:58.500)
They, meaning scientists, have done some research
Rick Doblin (51:01.280)
where you give people a psychedelic
Lex Fridman (51:04.720)
and then you do this semantic priming.
Lex Fridman (51:07.420)
And what you find is they have a wider range of associations
Lex Fridman (51:12.060)
than they normally would
Rick Doblin (51:13.340)
when they're not under psychedelics.
Lex Fridman (51:15.780)
So I think for Ken Kesey,
Rick Doblin (51:18.900)
he was able with psychedelics to get
Lex Fridman (51:24.140)
a deeper kind of emotional connection
Rick Doblin (51:26.400)
to some of these states of mind
Lex Fridman (51:28.300)
that people were in this mental institution
Lex Fridman (51:31.680)
and that he could explore them more in depth
Lex Fridman (51:35.580)
and more eloquently.
Lex Fridman (51:37.420)
And also one of the things he talked about
Lex Fridman (51:40.080)
was the fog machine,
Rick Doblin (51:41.840)
was how people's minds were sort of clouded
Lex Fridman (51:46.340)
by the people that ran the institution
Lex Fridman (51:48.440)
and the fog machine would be coming in.
Lex Fridman (51:51.120)
So I think the imagery and the metaphors
Rick Doblin (51:56.420)
that he used a lot in the book
Lex Fridman (51:58.580)
could come to him during LSD experiences.
Lex Fridman (52:00.980)
And then now he wasn't doing very,
Lex Fridman (52:05.700)
when you're writing, you have to be literate.
Rick Doblin (52:10.500)
You have to be able to write.
Lex Fridman (52:13.420)
So it would be more like beginning and ends of LSD trips
Rick Doblin (52:16.320)
instead of at the peak.
Lex Fridman (52:17.740)
But I think you would get a lot of these,
Rick Doblin (52:20.740)
the feeling tones or the images, the metaphors,
Lex Fridman (52:23.240)
I think he would get these extent,
Rick Doblin (52:26.220)
also LSD lasts so long, you can get these extended focus
Lex Fridman (52:30.180)
and you can really elaborate on images.
Lex Fridman (52:34.060)
And so much of psychedelic experiences
Lex Fridman (52:37.860)
are poetic and metaphorical.
Rick Doblin (52:40.420)
I mean, you could take veterans
Lex Fridman (52:43.700)
who've never read a book of poetry in their lives.
Lex Fridman (52:49.580)
And under the influence of MDMA,
Lex Fridman (52:52.020)
just what they describe, the imagery
Lex Fridman (52:54.260)
and the way they describe their experiences,
Lex Fridman (52:56.580)
metaphorical, poetic, it's incredible.
Lex Fridman (53:00.500)
And so I think that Ken Kesey was able to channel
Lex Fridman (53:06.460)
what LSD did to his mind in a way
Rick Doblin (53:09.660)
that most people couldn't do,
Lex Fridman (53:13.060)
that he did because he was trying to write this novel
Lex Fridman (53:15.500)
and because he was so brilliant.
Lex Fridman (53:17.940)
Yeah, I mean, we'll talk about psychedelics
Lex Fridman (53:22.940)
and treating, in bringing some of trauma to the surface
Lex Fridman (53:28.300)
and dealing with all those kinds of things,
Lex Fridman (53:29.640)
but there's something also to the opening up of creativity
Lex Fridman (53:34.780)
for whether it's for writing purposes
Rick Doblin (53:37.380)
or for in my world for engineering, for invention,
Lex Fridman (53:41.940)
innovation and invention itself is a very,
Rick Doblin (53:44.940)
is a deeply creative process.
Lex Fridman (53:47.300)
And it's fascinating to think with the aid of psychedelics,
Lex Fridman (53:53.660)
what kind of ideas can be brought to life?
Lex Fridman (53:57.300)
Yeah, well, we have the whole phenomena
Rick Doblin (53:59.060)
of a lot of the people in Silicon Valley
Lex Fridman (54:00.900)
and else microdosing psychedelics
Rick Doblin (54:02.680)
in order to have a little touch more
Lex Fridman (54:05.300)
of this creative approach to things.
Rick Doblin (54:07.620)
I would love it to see if it was,
Lex Fridman (54:10.260)
that's more like Terrence McKenna territory,
Rick Doblin (54:12.460)
correct me if I'm wrong,
Lex Fridman (54:13.460)
but I would love to sort of more scientific
Rick Doblin (54:16.100)
to where there'll be the rigor
Lex Fridman (54:17.860)
of saying how to do it effectively,
Lex Fridman (54:21.220)
how to sort of understand sort of not just almost,
Lex Fridman (54:30.820)
to take the full journey of creative exploration
Lex Fridman (54:35.020)
and to do it for prolonged periods of time,
Lex Fridman (54:39.260)
for years, lifelong kind of part of your life
Rick Doblin (54:43.140)
of how it empowers creativity.
Lex Fridman (54:46.020)
I think, of course, you start with helping people
Rick Doblin (54:53.340)
deal with trauma, and then the next step
Lex Fridman (54:55.900)
is people who have moved past their trauma
Lex Fridman (55:00.620)
and are trying to do something,
Lex Fridman (55:02.300)
create something special in their life.
Lex Fridman (55:04.400)
How can then psychedelics empower that?
Lex Fridman (55:07.220)
Yeah, now, that also,
Rick Doblin (55:08.700)
just to not shy away from anything controversial,
Lex Fridman (55:11.980)
that gets us to this idea of psychedelics for vision quest,
Rick Doblin (55:17.220)
particularly for younger people.
Lex Fridman (55:19.420)
You know, when you're sort of moving
Rick Doblin (55:21.660)
into this adulting kind of phase
Lex Fridman (55:23.460)
and you have to figure out
Lex Fridman (55:24.500)
what are you gonna do with your life,
Lex Fridman (55:27.540)
there's so many options.
Rick Doblin (55:29.780)
A lot of people, of course, feel constrained
Lex Fridman (55:31.860)
that they have very few options,
Lex Fridman (55:33.280)
but I think this idea of psychedelics
Lex Fridman (55:36.660)
as a way to help you find your calling
Rick Doblin (55:40.180)
or find your vision or find your unique leverage point,
Lex Fridman (55:44.240)
I think we'll see that more and more
Rick Doblin (55:45.580)
as our culture evolves and gets healthier
Lex Fridman (55:48.420)
around the use of psychedelics.
Lex Fridman (55:49.860)
So it's both the science,
Lex Fridman (55:52.420)
having the rigor of understanding how to do it safely
Lex Fridman (55:55.020)
and the culture catching up
Lex Fridman (55:56.740)
to the fact that this is both safe and very useful.
Rick Doblin (56:03.540)
Yeah, although I would question this idea of safety.
Lex Fridman (56:07.580)
So we can understand physiological risks
Lex Fridman (56:11.340)
and we can minimize them.
Lex Fridman (56:13.100)
And I think there's very minimal physiological risks
Rick Doblin (56:16.180)
from the classic psychedelics, virtually none,
Lex Fridman (56:18.460)
or for even MDMA under safe conditions.
Rick Doblin (56:23.740)
Psychological risks are harder to address,
Lex Fridman (56:29.660)
but we can do that through the sense of safety and support.
Lex Fridman (56:32.980)
But I think there's a level of risk there
Lex Fridman (56:37.520)
that we shouldn't overlook.
Lex Fridman (56:39.820)
And so to make a drug into a medicine,
Lex Fridman (56:42.700)
what we have to do is prove to the satisfaction
Rick Doblin (56:45.200)
of the FDA and other regulatory agencies
Lex Fridman (56:47.740)
that things are safe and efficacious.
Lex Fridman (56:50.360)
But even though they use those words,
Lex Fridman (56:52.420)
proving safety and safe and efficacious,
Rick Doblin (56:55.820)
it's in relationship to the disease
Lex Fridman (56:57.940)
that you're trying to treat
Lex Fridman (56:59.180)
and you accept a certain amount of risk.
Lex Fridman (57:01.760)
So it's the risk benefit ratio rather than pure safety.
Rick Doblin (57:06.760)
Yeah, absolutely.
Lex Fridman (57:10.360)
Let me ask you about Ken Kesey a little bit longer
Rick Doblin (57:13.560)
because fascinating him being.
Lex Fridman (57:16.680)
He was also part of Project MKUltra.
Rick Doblin (57:19.760)
Yeah, yes.
Lex Fridman (57:21.320)
What was Project MKUltra
Lex Fridman (57:23.000)
and what lessons we should take away from it?
Lex Fridman (57:27.640)
Well, MKUltra was a program by the CIA.
Lex Fridman (57:33.600)
What they were looking at was,
Lex Fridman (57:35.600)
can you take these drugs, these psychedelic drugs,
Lex Fridman (57:39.400)
and weaponize them in different ways
Lex Fridman (57:43.120)
for interrogation, for true serums,
Rick Doblin (57:45.200)
for exposing somebody before they give a big talk
Lex Fridman (57:49.620)
to something like LSD and then they can't talk
Lex Fridman (57:52.460)
or make a fool of themselves?
Lex Fridman (57:53.680)
Or can you spray LSD over the battlefield
Lex Fridman (57:57.460)
and have everybody tripping and drop their weapons
Lex Fridman (57:59.560)
and then you just walk up and nobody dies
Lex Fridman (58:02.080)
and you've won the battle?
Lex Fridman (58:04.660)
So it's a fascinating concept.
Rick Doblin (58:07.240)
Yeah, they call it nonlethal incapacitance
Lex Fridman (58:09.800)
and I think that's how it's.
Rick Doblin (58:11.840)
One way to win a war is to enforce peace.
Lex Fridman (58:16.120)
To get everybody not caring about the war, but yes.
Rick Doblin (58:19.040)
Well, I think Gandhi said something even better,
Lex Fridman (58:21.120)
which is that the true way to win a war
Rick Doblin (58:22.840)
is to turn your enemy into your friend.
Lex Fridman (58:24.520)
Yes, that's a beautiful way to put it.
Rick Doblin (58:26.520)
Yeah, but MKUltra was really nefarious
Lex Fridman (58:29.920)
and it was part of our military and it was done in secret
Lex Fridman (58:32.220)
and they would dose people against their will.
Lex Fridman (58:36.600)
I mean, one of the most infamous things
Rick Doblin (58:41.400)
was that they had a house of prostitution in San Francisco
Lex Fridman (58:44.560)
and they would have one way mirrors, all this stuff
Lex Fridman (58:47.800)
and then they would just dose people with LSD
Lex Fridman (58:50.880)
and they would have the prostitutes dose these guys with LSD
Lex Fridman (58:53.960)
and observe what they would do and how they would act.
Lex Fridman (58:56.120)
And the CIA actually for a while
Rick Doblin (58:58.840)
was dosing each other secretly
Lex Fridman (59:01.580)
and that there's a famous case of this fellow Olson
Rick Doblin (59:04.000)
that either jumped out of a window or was pushed,
Lex Fridman (59:08.640)
he might've been killed.
Rick Doblin (59:10.560)
He was a CIA guy and they gave him LSD
Lex Fridman (59:13.880)
and then they're trying to see can they break him down
Lex Fridman (59:17.140)
and get him to tell secrets.
Lex Fridman (59:18.480)
And I think he felt uncomfortable with what happened to him
Rick Doblin (59:21.000)
while he was under the influence of LSD
Lex Fridman (59:22.560)
and whether he was pushed or not,
Rick Doblin (59:26.560)
I don't know if we'll ever know.
Lex Fridman (59:28.360)
But MKUltra was violating people's human rights.
Rick Doblin (59:35.160)
It was done in secret and the irony of it
Lex Fridman (59:41.720)
is that Ken Kesey is one of the people,
Rick Doblin (59:45.640)
one of the main early people that got LSD in this context
Lex Fridman (59:49.240)
and then he was one of the main people
Rick Doblin (59:51.520)
that helped inspire the hippies to use psychedelics
Lex Fridman (59:54.380)
to oppose the Vietnam War.
Lex Fridman (59:56.160)
So I think the CIA kind of in many cases,
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