Psychedelics and the future of medicine

0:00Support for Here and Now Anytime comes from MathWorks, creator of MATLAB and Simulink software, to design and develop engineered systems, accelerating the pace of discovery in engineering and science. Learn more at mathworks.com. WBUR Podcasts, Boston. A patient who is very, very sick and really has not responded to anything else may, under approval in specific cases and with supervision, be allowed to try some of these medications. The FDA is expediting reviews of some psychedelics, which could be a game changer for people to access necessary treatment.

0:55It's Tuesday, May 5th, and this is Here and Now Anytime from NPR and WBOR Boston. I'm Chico Tingumi. Today on the show, bestselling author Michael Pollan has been helping us rethink what we eat. Now he's encouraging us to rethink how we think. How deep in nature does sentience, which is a kind of very simple form of consciousness, how far does it go? But first, the FDA says it will offer ultra-fast review to two psychedelic drugs, psilocybin and methadone. And the FDA has authorized initial testing of a drug related to ibogaine for people with alcohol use disorder. This follows a White House executive order directing the FDA to speed up research on psychedelics, which right now are illegal under federal law.

1:47Dr. Gail Saltz is a clinical associate professor of psychiatry at Weill Cornell Medical College. She also hosts the podcast How Can I Help? Here's her conversation with Scott Tong. So this FDA announcement of these expedited reviews of psychedelic drug products, what does it mean? It means basically that we can hope for somewhat fast-tracked FDA reviews of these drugs when a drug company or a group that has done clinical trials within one of these medications is ready to do that. So instead of waiting closer to 10 months, it might be more like two months for these particular breakthrough therapies.

2:30And it also means funding. So supposedly, you know, they're going to hallmark$50 million from, this is not a new pot. This is already government research and development pot. But it will go toward increasing research, supplying funding for clinical trials, for example, partnering with states and institutions, academic institutions that are already, frankly, already at work on this. In other words, these are companies that are already testing these things. These are clinical trials that were already going to go forward. These were state programs that were already in the works. It may also open up the potential for right to try, which means basically that a patient who is very, very sick and really has not responded to anything else may under approval in specific cases and with supervision be allowed to try some of these medications.

3:31and ultimately it might push toward rescheduling some of these drugs, which really matters in terms of bringing it to the public, obviously, because as you pointed out, they're all illegal now, and in terms of doing more trials. I mean, this is all happening as there is increasing public support for some of these mind-altering substances. Let me ask you about them individually. First, psilocybin, the active ingredient in magic mushrooms. Talk about what we know about the benefits, the risks. Well, this is the one that is actually probably closest to FDA approval because it has had, you know, in terms of its pathway of study, it is closest to being brought to review anyway.

4:15I think what, first of all, just for all of these meds we'll talk about, it's important to understand they would have to be done under a controlled clinical setting. And so they're really considered a therapy system, not just a here's this drug, but this is done under, you know, with a therapist. It's the closest. In early studies, it looks like response rate may be as high as 50 % for people with treatment-resistant depression. So this is a group that has failed medication after medication, is very severely depressed, which you should know, carries at least a 1 in 10 mortality rate from death by suicide.

4:51And so these are very ill patients, and close to a 50 % response rate is a big deal. You know, there's risks of everything from abuse potential. There are potentially some side effects. If you have a bad experience, that's possible to have. That can be rather traumatic. But safety-wise, reasonably safe under a controlled setting. All right. And let me ask you now about methadone and its possibilities for people with post-traumatic stress disorder. So again, this is a mind-altering drug that's related to MDMA, which is also part of this package, MDMA itself, and methadone, which is a drug-related.

5:35The issue with MDMA, which people may know as ecstasy, is on the good side. It's probably the next closest. It's had some phase three studies. It looks like response rate can be up to like 70%. this is for people with PTSD who have not responded to standard medications and standard psychotherapy. And sometimes they can't respond without sort of some changes. And so MDMA has a potential to increase what's called neuroplasticity or, you know, the making of new brain circuitry. And that flexibility change and that decrease of paranoia from ecstasy can actually make you respond to a therapy. So it would be used in conjunction with a therapy.

6:20It can be very helpful for some people, but it does cause potentially, again, a bad trip, hallucinations that are disturbing, some nausea, vomiting, it can be uncomfortable. And also MDMA actually was rejected by the FDA when it was brought initially in 2024, which is why they're going with methadone, which actually has fewer side effects. in hopes that that would be able to pass. If you're just joining us, we're talking to Dr. Gail Saltz of Weill Cornell Medical College of the FDA, announcing expedited reviews of some psychedelic drug products. The third and final one I want to kind of ask you about, Ibogaine, is being tested to treat alcohol abuse.

7:07Tell me about that. Yeah, and other abuse disorders. And I know this has just gotten a lot of recent attention, but from an African shrub, This is a hallucinogenic as well. And, you know, there are reports, and that's what's important, reports are not like well-funded, ongoing clinical trials of success in terms of having even just, you know, one session and loss of all cravings and therefore an ability to really treat those abuse disorders. On the other hand, and there's been the least work on this one, this is definitely the third of the one that would even come to market, I think, if possible, is that it has some real dangers.

7:49Those are, you know, things like heart arrhythmias and seizures, which can lead to death. So it has some potentially very serious consequences. And so that really, in terms of safety, has to be studied more. And so I think, you know, it reigns to be seen. And there's a focus for this in terms of the Trump executive order, particularly on veterans who are affected by these, you know, at higher rates, PTSD, treatment-resistant depression, abuse disorders. And so part of this executive order is really aimed at trying to address that population who does have a high death by suicide rate. Dr. Saltz, surely there are listeners seeking treatment, wondering if psychedelic drugs might be an option.

8:37How should they start the conversation? How should they set their expectations for all this? Well, I think they have to understand that this is not tomorrow. But in the next year or two, yeah, maybe. But they should also know there are other treatments for treatment-resistant depression or severe PTSD. And for example, transmagnetic stimulation, which has a similar rate of success, which has to do with an electrical current and, you know, again, changing neuroplasticity and can be really helpful for people who failed medications. Ketamine is in the form of esketamine, which is a nasal spray, Spravato, is currently available, is approved, does have a 60 % to 75 % response rate, and again, with a clinician, with therapy, but that is a current option available for people.

9:40Medication augmentation with other medications like lithium or antipsychotics, switching medications, and really the most successful, believe it or not, of all of these for very, very severely ill people who've responded to nothing is electroconvulsant therapy, which I know scares a lot of people, but is really a safe treatment and has a fantastic response rate. So people should understand that they should talk to a psychiatrist who is knowledgeable about their particular issue, about what is currently available for them. People should get treatment. These are serious illnesses. They do have a mortality rate, and they really harm quality of life.

10:20So there are treatments available that people do respond to. This hope is that it would bring something else in. We've been talking to Dr. Gail Saltz, Clinical Associate Professor of Psychiatry at Weill Cornell Medical College. She also hosts the podcast, How Can I Help? Dr. Saltz, thanks very much. Thanks for having me.

10:50Coming up next, is consciousness something that can be studied? Bestselling author Michael Pollan explores that idea in his latest book. That's after the break.

11:04Bestselling author Michael Pollan has made us rethink how we eat with books like The Omnivore's Dilemma and Food Rules. You've probably heard his famous seven-word mantra, eat food, not too much, mostly plants. Books like This Is Your Mind on Plants and How to Change Your Mind asked us to reconsider drugs like caffeine, opium, and psychedelics, the latter he famously explored himself. And now Michael Pollan's most recent book, A World Appears, takes on something entirely different, consciousness itself. It's a topic that sent him down a rabbit hole, exploring the work of psychologists, cognitive scientists, plant biologists, and stream-of-consciousness authors.

11:45Michael Pollan shares what he found with Indira Lakshman on. It felt to me as a reader that this whole journey began with a magic mushroom trip in your garden, where you felt as if plants around you were somehow sentient. Tell us about that. Yeah. So as part of my research into psychedelics for how to change your mind, I did a few trips with psilocybin and some other substances. And there was one I did in my garden on a late summer afternoon where I had taken some mushrooms and had this powerful experience that the plants in my garden were awake, that they were returning my gaze, that they were conscious.

12:28And it was not frightening at all. It was actually kind of nice. They clearly felt well disposed to me, their gardener. But I had this sense that there was more going on than I had ever realized. So that became one of the inspirations for a part of the book, which is finding out how deep in nature does sentience, which is a kind of very simple form of consciousness, how far does it go? You make a case for plant sentience and you cite research on plant's ability to learn, remember, or even see. How is that the same or different from being conscious in a human sense? Sentience is kind of the base default case of having a certain awareness of your environment and a sense of the changes taking place in your environment and whether they're good for you or bad for you.

13:20And then the ability to move toward the positive and away from the negative. Consciousness is kind of how we do sentience. For animals like us, we need a much more elaborate sentience. We need the ability, say, to imagine what's going on so that we can have counterfactuals. If we do this, this happens. If we do that, that happens. And the reason we need this is because we exist, we're profoundly social beings. We depend on other people. We live in a very complex social reality where we have to anticipate what the other person is going to do and imagine our way into their head. That's all behavior that you can't program in the genes.

14:00It's just too complex. But where does consciousness lie? Do you believe there is a physical location? Have we been conditioned to think of consciousness as being located in the brain? Yeah. The assumption has always been that like other phenomena that can be understood by reductive science, which is to say, find the matter or the energy that underlies this phenomenon, on that. You can reduce consciousness to something we understand, something material. And this is the philosophy called materialism. It's utterly failed when it comes to consciousness. We have no success connecting a particular address in the brain with conscious experience.

14:42So we have to open our minds to other ideas, and people are. I'll give you a couple examples. There's panpsychism, which basically stipulates that consciousness is in everything, any particle, any of the stuff around you is infinitesimally conscious. Other people say that consciousness is a field outside of our brains and that we should think of the brain. The brain is very involved, but more of the way a radio receiver or a television set is involved. You would never expect to find the weatherman inside your TV set. Maybe we thought that when we were children, though. We probably did. It's true.

15:21But your TV set is nevertheless bringing his or her image and sound to you from a field that's outside you. Well, you actually mentioned, do we imagine things when we're children that we don't imagine when we're adults? And it makes me think about how we think of ourselves as an eye that never changes. But as we grow up, it seems that our consciousness changes. And you use the phrase lantern consciousness, where you say that children have a really broad, unfocused attention, whereby they experience the world in an almost magical way every single day up until the age of six. They take in everything, the beauty, the sound, the light.

16:05Everything is amazing and surprising. But that upon age six, and this seems very sad to me, that suddenly we start to develop spotlight consciousness where we're focused on something, and that is what allows us to go to school, to have jobs, but we lose something of that magic. And you talk about the lantern consciousness as something that you were able to regain through your experience with psychedelics. Talk about that. Yeah. So that distinction I learned from Alison Gopnik, who's a psychologist at Berkeley, a colleague of mine. One of the things she says is that psychedelics return us to a state of lantern consciousness where it's very difficult to focus.

16:47And we do take in sensory information in these great waves of information, whether it's visual or auditory or whatever, and that we give something up. It's a trade-off though. I mean, spotlight consciousness allows us to get a lot done. It allows us to focus. And we insist on it in school, obviously. And that's when we sort of knock it out of children. But it is very sad because there's something beautiful living in a world that seems so magical. Kids need that kind of consciousness to learn their way around reality. And that's what they're doing. That's their job is figuring out how the world works.

17:24I have to ask, robots and AI are everywhere in our life now. Everything from a Roomba to a smart refrigerator to, you know, asking questions in our browsers that get answered by AIs. Can these machines and programs be considered conscious? Can artificial consciousness be created? And if so, wouldn't that necessarily imply that we are enslaving robots and enslaving AI? Well, you're making a big leap there. It's a big if, and I don't accept that it can happen. I think there are very good reasons to doubt AI can be conscious. The belief that they can is based on a faulty metaphor. It's this metaphor that the brain is a computer.

18:15The brain does do computations. It has neurons that fire on and off a little bit like transistors. But if you press on that metaphor, you realize it doesn't hold up. Every experience you have physically rewires your brain. Your brain is the product of your life experiences. It's been shaped and pruned in a completely different way than mine, and they're not interchangeable. So this idea that consciousness is an algorithm, you could run on something else is nuts. The other reason I don't think they can become conscious is that there's good reason to think that consciousness begins with our feelings, that it's our body talking to our brain that generates feelings that then become thoughts.

19:00And so the sensation of hunger is a bodily sensation, travels up to our brainstem, then into our cortex where we make a plan to find some food. But it begins with these simple bodily feelings. And I don't see computers having feelings. To have feelings, you need a body, you need vulnerability, you probably need mortality, and computers don't have that. All right. Well, you looked at plants, you looked at robots, you looked at AI, And of course, you looked at yourself and the human race in general. In the end, what did you take away from your journey? And do you feel like at the end, you know anything more about consciousness than you did before?

19:47Oh, I think I know a lot more about it. I may not know how it springs from brains or wherever it springs from, but I acquired just a deep appreciation of this incredible gift we have. We have this private space of incredible freedom and imagination, and that I think we're kind of squandering it. I think by forming relationships with chatbots, by filling our time scrolling on our phones rather than looking at what's going on around us, we're squandering this gift we have. You know, I found that meditation was a wonderful way to kind of put a fence around my consciousness for a certain period every day, you know, just 20 minutes.

20:32But it's a precious time where I put down my phone, I let my mind do what it wants to do, and come out of it feeling this is too precious a gift to squander. Well, that's a lovely thought, the idea that meditation can possibly bring us into a deeper connection to our own consciousness, and also perhaps a return to the lantern consciousness that you talked about that children have. and I should note that we, of course, are not endorsing the use of psychedelics. I feel I need to say that. You can certainly say that it's worked for you, but we are not endorsing that. That is obviously up to each individual.

21:12All right. Any last thought you would like readers to take away from your book? Only this, that I really think we're approaching a very interesting moment for humanity. It has to do with AI. There may be machines that, even though they're not conscious, are smarter than we are and can do things we can't do. And at the same time, we are learning that more of nature is conscious. And so who are we? Are we more like the thinking machines or are we more like the feeling animals? And I don't know which team we should be on. I'm kind of leaning toward the animal team. Michael Pollan's new book is A world appears, a journey into consciousness.

21:52Michael, thank you so much. Thank you, Indira. It was a pleasure talking to you.

22:07Before we go, can you believe it's been 30 years since five British women spiced up our lives? You know who I'm talking about.

22:29Three decades later, Melanie C., known as Sporty Spice, just released a new heart-pumping solo album titled Sweat.

22:55This album has been so much fun to work on because what I was trying to achieve was this world where all of my passions came together. So I've been DJing for about eight years and I play a lot of house music. I DJ over in Ibiza and festivals all over the world. But as a musician and a solo artist, I'm very much a pop singer. and pop songwriter. So I just wanted to try and bring those worlds closer together, try and express the joy that I'm having right now and just like living my best life.

23:32You can hear more at hereandnow.org. Here and Now Anytime comes from NPR and WBOR Boston. Today's stories were produced by Emiko Tamagawa and Jenna Griffiths. Today's editors were Todd Munt, Michael Scotto, and Kat Welch. technical direction from Caleb Green and James Trout. Our theme music is by Mike Moschetto, Max Liebman, and Chris Bentley. Our digital producers are Alison Hagen and Grace Griffin, and the executive producer of Here and Now is Alan Price. Thanks for listening. We'll see you tomorrow.

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