tl;dr – Comment below with arguments for why psychedelic research & advocacy should not be an EA cause area. On June 3rd, the most upvoted argument will win $400. The second- and third-most upvoted arguments will win $200 & $100, respectively.
1. Background on why I’m making this post & offering a prize
This effort was inspired by Grue_Slinky’s prize for the best argument against the EA Hotel.
I’m offering a $400 USD prize for the best argument against psychedelic research & advocacy being an EA cause area. I’m also offering $200 for the second-best argument & $100 for the third-best.
Uncovering another high-impact cause area seems very valuable, as EA’s impact is closely correlated with the quantity & quality of the cause areas it supports. This prize is a small effort towards assessing whether psychedelics should be taken up as an EA cause area.
The primary motivation here is to surface previously unconsidered arguments for why psychedelics should not be an EA cause area. My current view is that psychedelics are an extremely promising altruistic cause area – I’d like to stress-test that view to see what I’ve missed.
Below, I offer some arguments for why psychedelics should be an EA cause area. These arguments are provided as a jumping-off point for arguments against.
2. Specification of the prize
To be considered for the prize, add your argument against psychedelics being an EA cause area as a top-level comment on this post. (Only top-level comments on this post will be considered as valid submissions.)
On Monday, June 3rd, I’ll award $400 USD to the most-upvoted argument against, $200 USD to the second-most-upvoted argument against, and $100 USD to the third-most-upvoted argument against. I will break any ties, by choosing my favorite of the tied arguments.
I’ll contact the prize winners via a Forum direct message to coordinate the remittance of their prizes. Once payouts are complete, I’ll announce the winners in a comment on this post.
Feel free to upvote other people’s submissions, even if you submit an argument yourself. (I suppose you could also downvote other submissions, though that doesn’t feel very sporting.)
To avoid potential bias, I will not upvote or downvote any prize submissions.
You can also comment with things that aren’t arguments against psychedelics being an EA cause area, though note that such comments will not be considered as prize submissions.
3. Arguments for the importance of psychedelics
To seed discussion, here are some arguments for the importance of psychedelics as an altruistic cause area.
3(a). Psychedelics are appealing to both long-termist & short-termist views
Almost everyone in EA holds either a long-termist view (everyone who will exist over the entire of course of the future deserves moral consideration) or a short-termist view (only people who exist before some time horizon deserve moral consideration).
If you hold a long-termist view (i.e. all future people deserve moral consideration) & you're a consequentialist (as far as I know, almost every long-termist is consequentialist), then it’s very difficult to do long-term cause prioritization, because you have limited visibility into the outcomes occurring 10,000+ years into the future – and these are outcomes you want to know about when assessing today’s actions. Practically, we're clueless about many long-term consequences of our present actions. You can read more about consequentialist cluelessness here.
Given this theoretical problem, long-termist cause prioritization should include “robustness to cluelessness” as a major factor.
Some x-risk interventions seem pretty robust to cluelessness, e.g. Eliezer Yudkowsky’s work raising awareness of the AI alignment problem. Eliezer’s advocacy work seems robust because in almost every scenario you can imagine, it’s good for more researchers to be aware of the AI alignment issue.
Interventions that increase the set of well-intentioned + capable people also seem quite robust to cluelessness, because they allow for more error correction at each timestep on the way to the far future.
Rationality training programs like CFAR & Paradigm Academy are aimed at increasing the number of well-intentioned + capable people.
The psychedelic experience also seems like a plausible lever on increasing capability (via reducing negative self-talk & other mental blocks) and improving intentions (via ego dissolution changing one's metaphysical assumptions).
I compare the mechanisms of impact of the psychedelic experience and of programs like CFAR & Paradigm below.
By “changing one’s metaphysical assumptions,” I mean that the psychedelic state can change views about what the self is, and what actions constitute acting in one’s “self-interest.” Consider Michael Pollan’s account of one of his psilocybin trips, in How to Change Your Mind:
“I” now turned into a sheaf of little papers, no bigger than Post-its, and they were being scattered to the wind. But the “I” taking in this seeming catastrophe had no desire to chase after the slips and pile my old self back together. No desires of any kind, in fact. Whoever I now was was fine with whatever happened. No more ego? That was okay, in fact the most natural thing in the world.
For what was observing the scene was a vantage and mode of awareness entirely distinct from my accustomed self; in fact I hesitate to use the “I” to denote the presiding awareness, it was so different from my usual first person.
Where that self had always been a subject encapsulated in this body, this one seemed unbounded by any body, even though I now had access to its perspective… Everything I once was and called me, this self six decades in the making, had been liquefied and dispersed over the scene. What had always been a thinking, feeling, perceiving subject based in here was now an object out there.
Like Pollan describes, people often experience extremely altered self-awareness during psychedelic trips. This is part of the “mystical experience,” which appears to be correlated with the therapeutic benefits of psychedelics (see Roseman et al. 2017, Griffiths et al. 2008).
To sum up, under a long-termist view, psychedelic interventions are plausibly in the same ballpark of effectiveness of other interventions that increase the set of well-intentioned + capable people. This is because these interventions seem quite robust to consequentialist cluelessness – the extreme difficulty of confidently assessing far-future consequences of today's actions.
If you hold a short-termist view (i.e. only people who exist before some time horizon deserve moral consideration), mental health appears to be a cause area on par with global poverty, i.e. if global poverty interventions meet the criteria for being an EA cause area, so too should mental health interventions.
Mental illness appears to cause more suffering than poverty in developed countries, and it seems to cause roughly as much suffering worldwide as poverty does. Unlike poverty, the mental health burden isn’t shrinking. (See Michael Plant's cause profile on mental health for an analysis of how mental illness causes roughly as much suffering as global poverty.)
Psychedelics are showing a ton of promise as treatment for a battery of chronic mental health issues: anxiety (see Gasser et al. 2015, Griffiths et al. 2016), depression (see Carhart-Harris et al. 2018, Palhano-Fontes et al. 2019), OCD (see Moreno et al. 2006), and addictive disorders including smoking (see Johnson et al. 2017) & alcoholism (see Bogenschutz et al. 2015, Krebs & Johansen 2012).
For a summary of some of these findings, see dos Santos et al. 2016, a systematic review of the mental health effects of psychedelic therapy.
So, under a short-termist view, psychedelic interventions are plausibly in the same ballpark of effectiveness as global poverty interventions.
In summary, psychedelic research & advocacy seems particularly compelling as a cause area, because it performs well under both short-termist and long-termist worldviews. Given our uncertainty about morality, this appears to make psychedelics more robust than cause areas that rely on a single sequence of reasoning to justify their impact.
3(b). Comparison of rationality training to the psychedelic experience
As discussed above, both rationality training and the psychedelic experience seem to be levers that increase the number of well-intentioned + capable people. This is plausibly robust to cluelessness (the difficulty of assessing outcomes that occur 10,000s of year in the future), because well-intentioned + capable people can course correct as we head into the future.
Comparing rationality training programs (e.g. CFAR, Paradigm Academy) to psychedelic experiences is tricky. It's hard to make an apples-to-apples comparison, because the interventions are operating on very different levels of abstraction.
The rationality training programs I know of operate almost entirely on the conceptual level (though I believe Paradigm uses some bodywork modalities also). The basic structure of conceptual rationality training is something like:
- Instructor says some words about a rationality topic
- Trainee hears these words & tries to internalize the topic
- Trainee practices their internalized version of the rationality topic (by themselves, with other trainees, or with the instructor)
- Instructor provides feedback to trainee to improve the trainee's internalized model of the topic
I think this structure can work really well for information & technique transfer, especially when the trainee is engaged & the instructor is skillful.
The basic structure of a psychedelic trip is very different:
- Participant thinks about and articulates the intentions & expectations they have for their upcoming psychedelic experience (to themselves, or to a facilitator)
- Participant ingests a psychedelic (by themselves, or with a sober facilitator present)
- Participant has a psychedelic experience. This experience can include a wide range of subjective elements:
- Old memories can come up and/or become salient
- New perspectives on relationships with friends, family, one's immediate environment can be adopted
- Emotions can be felt very intensely, especially emotions about salient people & topics in the one’s life
- Insights can be had about the participant's psychology, social assumptions, epistemic assumptions, and metaphysical assumptions
- New personal narratives ("this is the story of my life; this is what my life's about") can be adopted
- Once sober, participant integrates the experience (by themselves, or in dialogue a facilitator)
- How did the actual trip match up to your expectations about the trip?
- What came up? What was interesting? What was trivial, or silly?
- Did anything come up that's worth incorporating into your everyday life?
(See the Psychedelic Explorer’s Guide for more on how to structure an effective, safe trip.)
I think this structure can be really helpful for surfacing emotional blocks (e.g. things that generate akrasia, i.e. acting against one’s better judgment), as well as for resolving known emotional blocks.
The psychedelic experience can also help change one's assumptions, internal monologue, and personal narrative. (See the above Michael Pollan quote for an example of this. Also note that the psychedelic experience doesn't do this automatically, it can just help "loosen you up." The participant still has to intentionally work towards changing these things.)
So, to the extent that the EA community is limited by information & technique transfer, I'd expect conceptual rationality training to be more leveraged.
To the extent that the EA community is limited by emotional blocks & unhelpful personal narratives, I'd expect the psychedelic experience to be more leveraged.
My current view is that the EA community is more limited by emotional blocks & unhelpful personal narratives. The 2019 Slate Star Codex reader survey offers some data here: 17.4% of survey respondents have a formal diagnosis of depression (another 16.7% suspect they are depressed but haven’t been diagnosed); 12.6% of respondents have a formal diagnosis of anxiety (another 18.7% suspect they have anxiety but haven’t been diagnosed).
3(c). Interlude – on quantitative comparison
The above is merely a theoretical comparison – a quantitative comparative analysis would be helpful for thinking through the potential of psychedelics relative to other causes. Here’s one attempt at quantifying the benefits of a psychedelic intervention using DALYs, concluding that the intervention has a cost-per-DALY-averted of $472.
Note that DALY & QALY frameworks probably underweight mental health interventions due to the retrospective survey methodology used to construct their weightings.
Also note that there aren't many quantitative analyses that compare across EA cause areas. (e.g. comparing animal welfare interventions to global poverty interventions, or comparing x-risk interventions to animal welfare interventions.) Michael Dickens' cause prioritization app attempts this, though as far as I know it hasn't been used to drive much decision-making.
3(d). Trauma alleviation
Childhood trauma is plausibly upstream of several burdensome problems. See this excerpt from The Body Keeps Score, a pop-sci review of academic trauma research (on p. 150):
The first time I heard Robert Anda present the results of the ACE study, he could not hold back his tears. In his career at the CDC he had previously worked in several major risk areas, including tobacco research and cardiovascular health.
But when the ACE study data started to appear on his computer screen, he realized that they had stumbled upon the gravest and most costly public health issue in the United States: child abuse.
[Anda] had calculated that its overall costs exceeded those of cancer or heart disease and that eradicating child abuse in America would reduce the overall rate of depression by more than half, alcoholism by two-thirds, and suicide, IV drug use, and domestic violence by three-quarters. It would also have a dramatic effect on workplace performance and vastly decrease the need for incarceration.
Psychedelic therapy seems very promising for resolving PTSD, which could plausibly break the cycle of abuse that creates new traumatic experiences. (Trauma appears to transfer from generation to generation via multiple pathways.)
In particular, MDMA-assisted psychotherapy for PTSD is yielding extremely promising results in recent randomized controlled trials (see Mithoefer et al. 2012, Mithoefer et al. 2018, Ot’alora et al. 2018). From the abstract of Mithoefer et al. 2018:
At the primary endpoint, the 75 mg and 125 mg groups had significantly greater decreases in PTSD symptom severity (mean change CAPS-IV total scores of −58·3 [SD 9·8] and −44·3 [28·7]; p=0·001) than the 30 mg group (−11·4 [12·7]). Compared with the 30 mg group, Cohen's d effect sizes were large: 2·8 (95% CI 1·19–4·39) for the 75 mg group and 1·1 (0·04–2·08) for the 125 mg group.
PTSD symptoms were significantly reduced at the 12-month follow-up compared with baseline after all groups had full-dose MDMA (mean CAPS-IV total score of 38·8 [SD 28·1] vs 87·1 [16·1]; p<0·0001).
A Cohen’s d of 2.8 is extremely large (“Cohen suggested that d = 0.2 be considered a 'small' effect size, 0.5 represents a 'medium' effect size and 0.8 a 'large' effect size” source). Here’s a good resource for interpreting Cohen’s d.
In this study, 30 mg of MDMA was used as an active placebo, and the intervention groups were given 75 mg or 125 mg of MDMA.
From Mithoefer et al. 2012, a long-term follow-up of the first MDMA RCT:
We found the majority of these subjects with previously severe PTSD who were unresponsive to existing treatments had symptomatic relief provided by MDMA-assisted psychotherapy that persisted over time...
MDMA helped resolve severe PTSD symptoms in patients who had not responded to other treatment regimens. For 86% of patients, this benefit persisted 17+ months after the MDMA session.
3(e). Other (speculative) arguments for impact
Below are a few other mechanisms by which psychedelics could be highly impactful. These are speculative and I suggest holding them weakly – most of my own interest in psychedelic research & advocacy as an EA cause area is driven by the arguments given above.
Psychedelics may boost creativity & problem-solving. See Harman et al. 1966 – 27 white-collar professionals took mescaline and worked on a problem they had been stuck on.
Outcomes for the problems participants had been stuck on:
- A commercial building design, accepted by the client
- Design of a linear electron accelerator beam-steering device
- Engineering improvement to a magnetic tape recorder
- A chair design, modeled and accepted by the manufacturer
- A mathematical theorem regarding NOR gate circuits
- Design of a private dwelling, approved by the client
Anecdotally, Steve Jobs said that taking LSD was “one of the most important things in my life.”
Eric Weinstein (mathematician, venture capitalist), Sam Harris (public intellectual), Aldous Huxley (writer), Kary Mullis (inventor of the polymerase chain reaction), and Douglas Engelbart (computer scientist, inventor of the computer mouse) have all spoken highly of psychedelics and/or are known to use them.
Psychedelics may expand one’s circle of moral concern. As far as I know, there hasn’t yet been a randomized study of the relationship between psychedelic use & altruism. (Though I’d love to see one!)
Lerner & Lyvers 2006 found that psychedelic users scored higher on empathy scales than non-drug users, though non-psychedelic drug users also had higher empathy scores than non-drug users, so it’s not clear if there was an effect driven by psychedelic use.
Anecdotally, see this essay by anonymous philanthropist Pine, who attributes their decision to set up the Pineapple Fund to a psychedelic experience: “I’ve had the idea to donate a large portion of my bitcoins for a while, and it is through this journey of discovering myself [with the help of psychedelics] that made me actually commit to it.”
Info hazard. Finally, there’s a pathway to impact that I give some weight to, but can’t discuss publicly due to concern that talking about the pathway would be an information hazard. If you’re interested in learning more about this consideration, shoot me an email.
(This consideration is only a small part of why I’m excited about psychedelics, and I’d still be bullish about psychedelics as an EA cause area in its absence.)
4. Neglectedness and tractability
How do psychedelics perform under the importance, neglectedness, tractability framework? The “importance” consideration is discussed above. Neglectedness and tractability are considered below.
In short, psychedelic research is neglected. As discussed here, scientific research is very expensive, and current psychedelic research is happening only because a handful of private donors are funding it. (For more background, see this list of Open Phil analyses of the scientific research funding landscape.)
Governments are a major driver of scientific funding (NIH intends to grant $39.1 billion in 2019), and governments have not funded psychedelic research at all (presumably due to concern about optics, as well as bureaucracies being generally slow to update their stance).
From conversations I’ve had over the past two years, psychedelic research seems highly funding constrained, such that more money would convert into more research.
Roughly $40 million has been committed to psychedelic research since 2000.
In comparison, the Open Philanthropy Project has granted $104 million to scientific research since 2011.
Another comparison point: Open Phil’s grant to establish CSET ($55 million) is larger than the total amount spent on psychedelic research in the last 20 years, worldwide.
I’ve spent the last two years learning about the various projects going on in the psychedelic community. My general conclusion is that there are many tractable projects that could be happening but aren’t, due to lack of funding & capacity.
Here are the most important lines of psychedelic work currently happening:
- MDMA is being shepherded through the FDA approval process for PTSD treatment by MAPS.
- Psilocybin is being shepherded through the FDA approval process as a treatment for depression by both Compass Pathways and the Usona Institute (independently).
- State-level political campaigns to liberalize psychedelics are underway in Oregon & California. The city of Denver recently decriminalized psilocybin, by a narrow margin.
Both MDMA for PTSD & psilocybin for depression have received breakthrough therapy designation from the FDA, which indicates that the FDA thinks that these treatments “may demonstrate substantial improvement over available therapy.”
MDMA therapy is on track be made available as a prescription medicine in 2021 or 2022. Psilocybin therapy is on track to be made available as prescription medicine sometime between 2022 and 2025.
There’s a huge amount of work that needs to be done to make these rescheduling processes go well. There are insurance considerations, marketing considerations, regulatory considerations, and legal considerations that haven’t been figured out yet but need to be.
There isn’t an obvious place for psychedelic therapy in the current US healthcare infrastructure, so new infrastructure will need to be built (e.g. clinics for administering psychedelic therapy). There are opportunities to address this from both non-profit and for-profit approaches.
Furthermore, we still don’t granularly understand how psychedelics work neurologically, and we haven’t explored much of the space of possible applications of these substances. More research is needed – research groups at Johns Hopkins, NYU, Yale, the Heffter Research Institute, and Imperial College London all have deep research agendas they’d like to pursue, and they are all funding-limited.
Finally, as rescheduling approaches & psychedelics gain popularity, there’s a massive amount of public education work that needs to be done. The psychedelic experience is not without risk. As a greater number of inexperienced people have psychedelic trips, it’s important to propagate good guidelines for how to approach psychedelics in a safe & respectful way.
I’m offering three prizes for the best arguments against psychedelic research & advocacy being an EA cause area. Any argument submitted as a comment on this post will be considered for these prizes.
I’ll award $400 to the most-upvoted argument, $200 to the second-most-upvoted argument, and $100 to the third-most-upvoted argument. Winners will be assessed on Monday, June 3rd.
The driving motivation for this post is to surface arguments against psychedelic research & advocacy being an EA cause area. My current view is that psychedelics are an extremely promising altruistic cause area (on par with global health & x-risk reduction) – I’d like to learn more about how this might be mistaken.
If my view about psychedelics being a very promising cause area isn't mistaken, I’d like to see more attention paid to psychedelic research & advocacy by the EA community.
Cross-posted to LessWrong. Thanks to the Clarity Health Fund for a microgrant that enabled me to offer these prizes. This post was inspired by Grue_Slinky’s prize for the best argument against the EA Hotel.
: More arguments in support of psychedelics being an EA cause area in these posts: Legal psychedelic retreats launching in Jamaica, Psychedelics Normalization, "A Psychedelic Renaissance" (Chronicle of Philanthropy)
: Even for this case, you could imagine some scenarios where the intervention doesn't result in good outcomes.
To the extent there are not-good scenarios you could say it's not robust. It's probably best to model "robustness to cluelessness" as a continuum, wherein some interventions are more robust than others.
: In correspondence with one of the study authors, it was revealed that some of the study participants were also given methamphetamine. The author said that back in the 1960s, they were considering methamphetamine to be similar to caffeine, so did not think much about administering it. Nevertheless, the study results are seriously confounded because of this.
: Estimate confirmed via private correspondence.
The real goal you seem to be advancing, Milan, is spirituality, not psychedelics per se. Based on testimony from people I trust and some slightly dubious research, I think psychedelics can likely be helpful in that, but they shouldn't be our frontline tool. I think meditation is a much better candidate for that.
Sam Harris and Michael Pollan argue that psychedelics are useful for convincing people there's a there there, and that makes sense to me. You have to put a lot of time and blind effort into meditation to get that same assurance. But the struggle, and particularly "asking" for deeper wisdom through your faithful efforts, is a really important part of spiritual realization according to most traditions (and in my personal experience). Based on what I've read (haven't taken them), I don't think taking psychedelics often does the trick on its own.
And there are many downsides to psychedelics. People who don't know how mentally unstable they are may take them and be thrown badly off-kilter. Bad trips are harrowing and can reach unimaginable heights of terror. I don't think most people have the slightest clue how deeply and completely their minds could torture them. Even if people o... (read more)
Quick Summary: Despite presumed benefits, legalization would likely not increase psychedelic use in low/middle income countries, while legalization in high income countries is way too expensive to be worth funging against conventional global poverty interventions, even with extreme optimism about the necessary budget to cause legalizing and the resulting increase in usage.
Long Summary: For the purposes of this, I’m going to boldly just assume that psychedelics are a very good thing, and treat "giving people who want psychedelics access to psychedelics" as an endpoint. I don’t have any strong opinions about whether they actually are good or not, but I see that plenty of other people are trying to answer that question.
Hypothesis 1 (high confidence): For most of the world, the bottlenecks to accessing psychedelics have nothing to do with the law, so fighting to “decriminalize” them is premature. Populations whose bottlenecks are primarily legal live in high income countries, so everything to do with helping them is rather more expensive than other interventions. It’s therefore highly unlikely that legalizing psychedelics would effectively impact global health. Considering ... (read more)
Let's approach the amount of EA causes as finite. We must prioritize issues and approaches to maximize relevant altruism.
Psychedelics have a not insignificant history and period of use, and a limited set of initial research that shows some promise and some bias.
Highlighted by the recent crystallization of the binding of LSD to SERT, the serotonin transporter, we generally can categorize the mechanisms of psychedelics so far to match pathways we currently have agents on, and that have some limitations.
Pursuing psychedelics as a strong target may come at the... (read more)
For anyone worried their comment won't get attention vs the existing ones, I'm enjoying this thread and am watching for and voting where relevant on new ones, FYI.
I’d guess the best argument is the obvious one:
I would push back against this somewhat. It's historically been the case that the general view of psychedelics is negative, but I think a case can be made that this is changing fairly quickly. Media coverage of psychedelics over the past ~5 years has been positive, e.g. The Guardian, The Wall Street Journal, Rolling Stone, Vox, CBC Radio, The New Yorker. Michael Pollan's latest book How to Change Your Mind was pretty pro-psychedelic and was a New York Times #1 bestseller. Denver also recently decriminalized psilocybin mushrooms, and there are decriminalization ballot initiatives planned for Oregon and California in 2020.
A common misconception is that if something is being talked about publicly there is probably funding available for it somewhere. But the number of weirdness dollars actually available in the wild for anything not passing muster with Ra can still be safely rounded to zero for most purposes. Even people who have had past success in more conventional areas often have trouble getting funding for weirder ideas, and if they do wind up spending a lot of time fundraising.
Reminder: one week left before the prizes are assessed! (Deadline is June 3rd.)
Now's a good time to read the submissions & upvote the ones that seem best.
1. In the 70s a lot of people in the West were taking psychedelic drugs, however, no major public health and/or civilization-level changes happened.
2. More compassion (operational definition = empathy + desire to reduce another person's suffering) does not necessarily equal more prosocial behavior.
2.1. Most modern tribes have been taking psychedelics regularly for generations. First, they are still living in tribes (see point 3). Second, with their increased moral concern they, nevertheless, go to war, kill, rape, pillage, torture, and enslave.
2.2. SJWs and radical vegans score really high on compassion and are willing to engage in violent behavior to defend their ideological beliefs. Most people already have a decent physiological capacity for compassion. Battling ideological possession may be more important.
2.3. You need people who score low in empathy and compassion for certain professions like trauma surgery, burns units, firefighters, judges, warfare and so on. Being high in empathy and compassion AND working in such fields leads to burnout, compassion fatigue, depression, PTSD and so on => 1. you increase suffering in the population + 2. you decrease the effectivene... (read more)
Boring answer warning!
The best argument against most things being 'an EA cause area'† is simply that there is insufficient evidence in favour of the thing being a top priority.
I think future generations probably matter morally, so the information in sections 3(a), 3(b) and 4 matter most to me. I don't see the information in 3(a) or 3(b) telling me much about how leveraged any particular intervention is. There is info about what a causal mechanism might be, but analysis of the strength is also needed. (For example, you say that psychedelic interventions are plausibly in the same ballpark of effectiveness of other interventions that increase the set of well-intentioned + capable people. I only agree with this because you use the word 'plausibly', and plausibly...in the same ballpark isn't enough to make something an EA cause area.) I think similarly about previous discussion I've seen about the sign and magnitude of psychedelic interventions on the long-term future. (I'm also pretty sceptical of some of the narrower claims about psychedelics causing self-improvement.††)
I did appreciate your coverage in section 4 of the currently small amount of... (read more)
To explicitly separate out two issues that seem to be getting conflated:
The former seems very likely true.
The latter seems very likely false. You would need the additional cost of researching, advocating for and implementing a specific new treatment (here, psilocybin) across some entire geography to be justified by the expected improvement in mental health care (above what already exists) for specifically long-term-focused EAs in that geography (<0.001% of the population). The math for that seems really unlikely to work out.
I continue to focus on the claims about this being a good long-term-focused intervention because that's what is most relevant to me.
Let's go. Upside 1:
Adding optimistic numbers to what I already said:
Suppose we would trade off $300k for the average person-year††††. This gives a return on investment of about $300k/$3.3m = 0.09x. Even with optimistic numbers, upside 1 justifies a small fraction of the cost, and with midline esti... (read more)
0) I don't know what the bar should be for calling something a 'cause area' or 'EA interest' should be, but I think this bar should be above (e.g.) 'promising new drug treatment for bipolar disorder', even though this is unequivocally a good thing. Wherever exactly this bar falls (I don't think it needs to be 'as promising as global health'), I don't think psychedelics meet it.
1) My scepticism on the mental health benefits of psychedelics mainly rely on second-order causes for concern, namely:
1.1) There's some weak wisdom of nature prior that blasting one of your neurotransmitter pathways for a short period is unlikely to be helpful. This objection is pretty weak, given existing psychiatric drugs are similarly crude (although one of their advantages by the lights of this consideration is they generally didn't come to human attention by previous recreational use).
1.2) I get more sceptical as the number of (fairly independent) 'upsides' of a proposed intervention increases. The OP notes psychedelics could help with anxiety and depression and OCD and addiction and PTSD, which looks remarkably wide-r... (read more)
The data doesn't support this, and generally suggests that 1-3 psychedelic experiences can have beneficial effects lasting 6 months or longer. See for example Carhart-Harris et al. 2018:
"Although limited conclusions can be drawn about treatment efficacy from open-label trials, tolerability was good, effect sizes large and symptom improvements appeared rapidly after just two psilocybin treatment sessions and remained significant 6 months post-treatment in a treatment-resistant cohort."
Griffiths et al. 2016:
"High-dose psilocybin produced large decreases in clinician- and self-rated measures of depressed mood and anxiety, along with increases in quality of life, life meaning, and optimism, and decreases in death anxiety. At 6-month follow-up, these changes were sustained, with about 80% of participants continuing to show clinically significant decreases in depressed mood and anxiety."
Johnson et al. 2017:
"All 15 participants completed a 12-month follow-up, and 12 (80%) returned for a long-term (≥16 months) foll... (read more)
It does, but although that's enough to make it worthwhile on the margin of existing medical research, that is not enough to make it a priority for the EA community.
The latter. EA shouldn't fund most research, but whether it is confirmatory or not is irrelevant. Psychedelics shouldn't make the cut if we expect (as I argue above) we expect a lot of failure to replicate and regression, and the true effect to be unexceptional in the context of existing mental health treatment.
That sounds a bit like the argument 'either this claim is right, or it's wrong, so there's a 50% chance it's true.'
One needs to attend to base rates. Our bad academic knowledge-generating process throws up many, many illusory interventions with purported massive effects for each amazing intervention we find, and the amazing interventions that we do find disproportionately were easier to show (with the naked eye, visible macro-correlations, consistent effects with well-powered studies, etc).
People are making similar arguments about cold fusion, psychic powers (of many different varieties), many environmental and nutritional contaminants, brain training, carbon dioxide levels, diets, polyphasic sleep, assorted purported nootropics, many psychological/parenting/educational interventions, etc.
Testing how your prior applies across a spectrum of other cases (past and present) is helpful for model checking. If psychedelics are a promising EA cause how many of those others qualify? If many do, then any one isn't so individually special, although one might want to have a systematic program of systematically doing rigorous testing of all the wacky claims of large impact that can be tested cheaply.
If not, then it would be good to explain what exactly makes psychedelics different from the rest.
I think the case for psychedelics the OP has made doesn't pass this standard yet, so doesn't meet the standard for an EA cause area.
From what I understand, effect size is one of the better ways to predict whether a study will replicate. For example, this paper found that 77% of replication effect sizes reported were within a 95% prediction interval based on the original effect size.
As a spot check, you say that brain training has massive purported effects. I looked at the research page of Lumosity, a company which sells brain training software. I expect their estimates of the effectiveness of brain training to be among the most optimistic, but their highlighted effect size is only d = 0.255.
A caveat is that if an effect size seems implausibly large, it might have arisen due to methodological error. (The one brain training study I found with a large effect size has been subject to methodological criticism.) Here is a blog post by Daniel Lakens where he discusses a study which found that judges hand out much harsher sentences before lunch:... (read more)
> I'm at like 30-40% that the beneficial effects are real.)
Right, so you would want to show that 30-40% of interventions with similar literatures pan out. I think the figure is less.
Scott referred to [edit: one] failure to replicate in his post.
Scott referred to one failure to replicate, for a finding that a psychedelic experience increased trait openness. This isn't one of the benefits cited by the OP.
I think small studies are also more vulnerable to publication bias.
On the flip side, it may be possible that the "true believers" actually are on to something, but they have a hard time formalizing their procedure into something that can be replicated on a massive scale. So if larger studies fail to replicate the results from the small studies, this may be the reason why.
Do you have any examples of this actually happening? I have seen it as an excuse for things that never pan out many times, but I don't recall an instance of it actually delivering. E.g. in Many Labs 2 and other mass reproducibility efforts, you don't find a minority of experimenters with a 'knack' who get the effect but can't pass it on to others.
I don't have data either way, but "knacks" for psychotherapy feel more plausible to me than "knacks" for producing the effects in Many Labs 2 (just skimming over the list of effects here). Like, the strongest version of this claim is that no one is more skilled than anyone else at anything, which seems obviously false.
Suppose we conduct a study of the Feynman problem-solving algorithm: "1. Write down the problem. 2. Think real hard. 3. Write down the solution." A n=1 study of Richard Feynman finds the algorithm works great, but it fails to replicate on a larger sample. What is your conclusion: that the n=1 result was spurious, or that Feynman has useful things to teach us but the 3-step algorithm didn't capture them?
I haven't read enough studies on psychedelics to know how much room there is in the typical procedure for a skilled therapist to make a difference though.
I think that the wisdom of nature prior would say that we shouldn't expect blasting a neurotransmitter pathway to be evolutionarily adaptive on average. If we know why something wouldn't be adaptive, then it seems like it doesn't apply. This prior would argue against claims like "X increases human capital", but not claims like "X increases altruism", since there's a clear mechanism whereby being much more altruistic than normal is bad for inclusive genetic fitness.
I would worry about this more if the OP were referring to a specific intervention rather than a class of interventions. I think that the concern about being good on longterm and shortterm perspectives is reasonable, though ... (read more)
I think it might prove quite difficult to scale effective use of psychedelics out to a large population, due to bottlenecks on facilitation. I'd guess that becoming an effective facilitator requires quite a bit of in-person training with an established facilitator and contact with a mature psychedelic culture, in much the same way that becoming an effective meditation teacher seems to require quite a bit (years and years) of in-person contact with an already-established meditation teacher and culture.
I expect that this cannot easily be worked around via more or better written instruction. I'd expect that simply reading The Psychedelic Explorer's Guide (or a future improved version thereof) and then facilitating trips with no other exposure to teachers or culture would produce mediocre or ineffective results for trippers, in much the same way that teaching meditation under the same circumstances would, or teaching entrepreneurship having mostly just read business books would.
I particularly expect that non-facilitated trips will be ineffective on average if scaled out to a large population.
Perhaps a person can become a mature facilitator by extensive solo tripping expe... (read more)
I've contributed small amounts of money to MAPS , but I haven't been thinking of those as EA donations.
My doubts overlap a fair amount with those of Scott Alexander , but I'll focus on somewhat different reasoning which led me there.
It sounds like MAPS has been getting impressive results, and MAPS would likely qualify as an EA charity if FDA approval were the main obstacle to extending those results to the typical person who seeks help with PTSD. However, I suspect there are other important obstacles.
I know a couple of people, who I think consider themselves EAs, who have been trying to promote an NLP-based approach to treating PTSD, which reportedly has a higher success rate than MAPS has reported. The basic idea behind it has been around for years , without spreading very widely, and without much interest from mainstream science.
Maybe the reports I hear involve an improved version of the basic technique, and it will take off as soon as the studies based on the new version are published.
Or maybe the glowing reports are based on studies that attracted both therapists and patients who were unusually well suited for NLP, and don't generalize to random therapists a... (read more)
I want to note that mental health as a general EA cause area was the subject of another EA forum contest in December 2018.
Investing into researching psychedelics will damage the "brand value" of EA. While many peoples' opinions of EA would likely improve if the organization began investing into researching psychedelic, I imagine most ultra-wealthy donors would not fall into this group and are more likely to dislike this pursuit. Donating may even become associated with promoting drug use, and even if the ultra-wealthy donors are personally okay with this, they may see donating to EA as damaging the reputation of their business ventures.
Furthermore, while resear... (read more)
If psychedelics are to actually become accepted as a legitimate treatment for any psychiatric disorders and to become widely used, the spearhead will almost certainly have to be a new compound designed and tested by a mainstream pharmaceutical company. This will solve the legality problem: the drug in question will be one that has not actually been banned because it will be different (a genuinely new compound? An enantiomer of an existing one?) than any banned substance. It will solve the skepticism problem because it will undergo rigorous clinical tria... (read more)
If psychedelics are a low hanging fruit, for-profits are gonna take the first step and grab it
Epistemic status: >50%
(I hope SSC is wrong and Griffe is right, and I'd like to see more research , too - but I think it's way more likely that psychedelics end up being provided by big companies than by startups or non-profits)
I feel tempted to invoke epistemic (and financial) modesty: depression (and mental health) is not a very neglected disease which only affects a small or poor population; there's a lot of money to be made in this area by pharmaceutical research, and I see no coordination problem or similar obstacle. If big companies such as Bayer or Pfizer (more capable of providing adequate funding, research and lobby) are not willing to bet on that, why should we?
P.S.: I didn't read every other comment, but I searched a little bit and concluded that only GnomeGnostic mentioned big pharma. His argument is sound.
Slate Star Codex just published on this. His argument is basically "lots of things look very promising and then fail, and LSD is especially prone to this because it stimulates the insight part of your brain.", although I encourage everyone to read the full post because obviously there's more to it.
If this comment wins a prize I'll pass it on to Scott.
I can't believe I didn't read this until just now. You are attacking unstated assumption of the philanthropy community writ large, but which includes EA. One is that better psychology is an area for philanthropy and altruism minded people to care about. Most people in our society put the needs of the body far higher than psychological/"spiritual" needs (and neglect taking care of the psychological distress of others as a work of charity). I think this argument would actually have to be won in order for the psychedelics argument to work as a promising new s... (read more)
My biggest qualm against most psychedelics is not that they don’t work per say, but that they are kind of redundant and not the most effective long term, when compared to the various meditations we have.
Mindfulness-based practices have been found to reduce anxiety, depression, pain, stress and can help people bounce back faster from negative events. They can be used alongside CBT or be employed when CBT fails to make an impact. The jhanas are highly pleasurable and virtually unknown to most people. The boundless attitudes / viharas may make one feel better... (read more)
Arguments have been assessed & prizes awarded!
The winners –
And I also paid out a prize to Holly_Elmore, who made what seemed to me to be the best counterargument, though it wasn't one of the top three most upvoted.
No further comments or votes on this thread will be considered for the assessment of the prize.
Because the competition ends tomorrow, I'm curious: Did any of these arguments change your views? Did people say what you expected them to say? Did you get what you wanted out of this exercise? What do you think the next steps are?
Semantic point: I can't see any way that psychedelics are a 'cause area'. Either they're one of many possible interventions in the cause area of mental health, or they're one of many interventions in the cause area of the long term future, or possibly both. The psychedelics are means to an end, not an end in themselves.
Argument in OP:
I view this as a weak argument. I think one could make this sort of argument for a large number of interventions: reading great literature, yoga, a huge number of productivity systems, participating in healthy communities, quantified self, volunteering for local charities like working at a soup kitchen, etc. Some of these interventions focus more on the increasing capability aspect (productivity systems, productivity systems) and some focus more on improving intentions (participating in healthy communities, volunteering). Some focus on both to some degree.
The reason it seems like a weak argument to me is because:
(a) the average effects of psychedelics on increasing capability seem unlikely to be strong. They may be high for a smal... (read more)
Although psychadelics is plausibly good from a short-termist view, I think the argument from the long-termist view is quite weak. Insofar as I understand it, psychadelics would improve the long term by
1. Making EAs or other well-intentioned people more capable.
2. Making people more well-intentioned. I interpret this as either causing them to join/stay in the EA community, or causing capable people to become altruistically motivated (in a consequentialist fashion) without the EA community.
Regarding (1), I could see a case for privately encouraging well-intentioned people to use psychadelics, if you believe that psychedelics generally make people more capable. However, pushing for new legislation seems like an exceedingly inefficient way to go about this. Rationality interventions are unique in that they are quite targeted - they identify well-intentioned people and give them the techniques that they need. Pushing for new psychadelic legislation, however, could only help by making the entire population more capable, including the much smaller population of well-intentioned people. I don't know exactly how hard it is to change legislation, but I'd be surprised if it was wort... (read more)
Tangentially related and perhaps of interest to some readers of this thread, though not a prize submission comment:
My nomination for the "three books" for psychedelic therapy would be
The "Why" Book: Pollan's How to Change Your Mind
The "What" Book: MAPS's A Manual for MDMA-Assisted Psychotherapy in the Treatment of PTSD (alternatives would be this treatment protocol from Phase 2 MDMA trials and Grof's LSD Psychotherapy)
The "How" Book: R. Coleman's Psychedelic Psychotherapy: A User-friendly Guide for Psychedelic Drug-assisted Psychotherapy (the runner up would be Fadiman's The Psychedelic Explorer's Guide)
The best way to increase long term aggregate wisdom in our time is probably to push for better governance. If the gov had better policies, voting methods, and higher research funding, that would likely lead not only to more psychedelic and other pharma research, but also numerous other benefits.
From a longtermist perspective, other technologies and trends might promise a better cure for mental health problems. Genetic engineering, AI based therapy, nanotechnology, declining levels of global trauma as war and material hardship diminish.
This contest itself is evidence that global priorities research is neglected. Why devote yourself to one particular trendy medication when we have such a limited wisdom base for making such decisions? Better to focus on running contests like this, or finding ways to build a career in developing better frameworks or technologies for evaluating impact generally.
Psychedelic therapy isn’t that neglected - it’s in a stage 3 clinical trial and has had a major book published on it already, and plenty of mental health professionals have been covertly working on it as underground psychedelic therapists. There are so many biology PhDs already that th
+1 for the prediction that earlier posts will get more votes.
We already have one gateway drug: poverty alleviation. We don't need more. Psychedelics won't change the civilisation's path. Next.