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Hello, ladies and germs, boys and girls, this is Timber's, and welcome to another episode of the Tim Ferris show, where it is normally my job to deconstruct world class performers of all different types, all different ilks, all different sectors, whatever you get the idea in this special episode, the tables are completely turned. Instead of interviewing someone else, I am interviewed by two experts on several topics I've both studied and supported for quite some time, including psychedelic assisted psychotherapy and what it can do to heal trauma and, broadly speaking, possible futures for mental health.

We cover a lot. I'm not a doctor. I don't play one on the Internet. So this is for informational purposes only. This audio was recorded on a new show, The Psychedelic News Hour, The Psychedelic News, Our Dotcom, soon to be a podcast. And I'm in conversation with two people, Dr. David Raybon, MD PhD. Dr. David, I know you can find him on Instagram at Dr. David Raybon, a rabbi and a board certified psychiatrist and neuroscientists executive director of the Board of Medicine and co-founder of Apollo Neuroscience, as well as Dr.

Molly Maloof, M.D., Dr. Molcho. And on Instagram at Dr. Molcho, a physician, Stanford lecturer and ketamine assisted psychotherapist. This episode was recorded on an app called Clubhouse. You can find it at joint clubhouse, dotcom and Apostille in private beta and defined by their tagline, which is Clubhouse is a space for casual drop in audio conversations with friends and other interesting people around the world. I don't have any stake in this app. I wish I did.

I guess since I'm giving it a free plug, this one's on me. Lebas One final note. I recorded this on my phone, a necessity for using the app. So the audio quality is not studio quality, but it was polished as much as possible. It is listenable. You'll be able to make it out. You should be fine. So thank you for understanding and thanks to everyone who joined and asked very thoughtful questions. I had a lot of fun doing this and we covered a ton of ground that has not been covered on this podcast before.

So without further ado, here we go.

Welcome back to another psychodelic news hour on clubhouse. We are so, so thankful and grateful to have all of you join us here again today, I'm Dr. Dave Raybon. I'm a psychiatrist and neuroscientist, as well as a ketamine assisted psychotherapist and MDMA assisted psychotherapist. And I'm joined by my co-host, Doctor Molly Maloof, who is also a physician and a psychotherapist. And we are very excited and humbled to bring to you our very special guest this week. He has done some incredible work in the psychedelic research space and investment space and the mental health space, actually, which is where I think all of this ties together.

And I think that one of the things that we often forget about and I really wanted to tell you this, Tim, for a long time, because I've been following your work and I'm so grateful for the fact that you've done two major things and I think have really radically transformed the landscape of mental health in this country. And it's not just mental health. We're really talking about health because part of the problem with health, looking at mental health in the US and in the Western paradigm, is we separate mental health and physical health where there really just health and, you know, mental health, left unchecked over time, causes physical health problems and physical health left unchecked over time, can cause mental health problems.

And we know that this is the case. And you had the courage a while back to come out and actually talk about your experiences with mental health in public and to have these conversations and bring them to the forefront of our community so that other people could feel no longer afraid to start to have these conversations. And I think that as a psychiatrist, as somebody who does psychedelic work and Marletta, I speak for both of us when I say that we could not be more grateful.

And I don't think the field of mental health could be more grateful to you. And we should probably do in terms of the field, we do a better job of showing that gratitude because you really help destigmatize trauma and stigmatize mental illness so that people can feel comfortable talking about this in public settings and just more often in general, which is really the first step along the healing process. And then you've transformed that by taking the next step and actually putting money and putting resources and encouraging others to put resources into the research, development and commercialisation of these powerful tools that were also stigmatized heavily, that now can be used to do something that we never thought we could do in mental health, which is tell someone that it's possible that there could be a cure for what you're experiencing right now.

And we may not be there yet, but we're closer than we've possibly ever been. And I just want to take this moment to thank you for all of your hard work and everything you've done to help facilitate this cause and to really share joy with the world of people who are suffering right now. So thank you and please welcome Tim Ferriss.

Thank you very much. I feel as someone who spent decades in darkness experiencing many of the conditions that these compounds may have the capability to treat and believing them as many, even in psychiatry, currently believes them to be intractable or the very best treated with some type of suppression of symptoms. It's an honor for me to play whatever small role that I can, and it's also a moral imperative. I feel so it's been an incredible journey in every respect of the word, hoping to continue to be a supporter and a catalyst to the extent that I can.

So thank you for saying all that.

Well, and speaking of that journey, I think we would be remiss if we did not start out by giving you the opportunity to update everyone on clubhouse who is not a party to the incredible announcement by maps that you and Joe Green played such an important role in recently. Would you mind telling everyone a little bit about the capstone and the great success that that has been that was announced yesterday, but my pleasure.

So there's a piece that does a good job of summarizing this in The Wall Street Journal is online by Shalini Ramachandran, which has the headline, Silicon Valley and Wall Street Elites Pour Money into Psychedelic Research. The subtitle gets closer to the summary, which is Donors raise 30 million for psychedelic nonprofit. That's BAPS to complete clinical trials. Phase three trials around drug assisted psychotherapy for trauma, that's MDMA, assisted psychotherapy for post-traumatic stress disorder. So certainly trauma of many different types, whether that's war veterans, first responders, victims of sexual abuse or other.

Any type of abuse and the castellan campaign was funny to say in the past tense now the capstone campaign was a campaign to raise the thirty million dollars necessary to complete phase three trials of MDMA, full deoxy methamphetamine, otherwise known as ecstasy, in the amplified psychotherapeutic treatment of PTSD. And it's very important to emphasize that this is not phase three trials for MDMA as a standalone treatment. It is the combination of context and molecule, which is extremely, extremely important, as I'm sure you've discussed previously in these meetings.

And 30 million dollars is or would have been even three years ago and almost unthinkable amount of money, an unattainable amount of money to raise for this.

And I was going to say it took almost, what, like 30 years to raise the first 30 million? Yeah, exactly. So, you know, a handful of years ago, the number of people contributing or just committing seven figures to psychedelic research would have been a handful. And that has changed a lot in the last few years. I think that's a credit to Rick. I think it's a credit to many things and the increased stigmatization of supporting the scientific research.

There are many things one can support within the realm of let's call it psychedelic psychedelic science, which I think is part of the reason there's a lot of scattered focus and historically, in some cases, a lack of results. But you can you can go a MM in a million directions very easily if you don't focus. But in this case, the piece summarized some very notable names who have contributed a lot. And what I would like to personally underscore about this is that there were donors and donations made from one dollar all the way up to five million and there were more than twenty five hundred donors, including probably many people listening to this, put their trust after reading or hearing what they evaluated into supporting this.

And every donor mattered. And the number of donors to me is just as important as the number of dollars raised because it signals to me a real phase shift in the cultural conversation about these compounds. We don't have to revisit the sort of historical mistakes that were made in, say, the 60s, nor the cultural context then, which is very different from the cultural context now. But I think it's very exciting that more and more people are realizing that it is actually an incredible reputational opportunity to align yourself with exploring these unconventional treatments for extremely expensive, sometimes fatal, often paralyzing conditions that we seem utterly unable to treat properly via other means currently.

So the fact that we have such an incredibly low toxicity profile for if we're talking about MDMA and suicide and specifically because let's not forget that there are hundreds and thousands of what we could call psychedelic compounds. Among those two that have received breakthrough therapy designation by the FDA with vast amounts of data to support their clinical use, have incredible safety profiles, low toxicity. Certainly you're going to find many more people in emergency rooms because of acetaminophen Tylenol, which can be incredibly toxic compared to any of these and the fact that they have the results they appear to have.

If you look at, say, phase two data from Bab's would lead one to believe either that people are lying, they're misrepresenting the results that cannot be true or something is happening that defies any conventional psychiatric or psychological explanation for how the brain changes and how thoughts and thought patterns change the capability of humans to rewrite their software, to rewrite the stories they tell themselves with incredible durability of effect. In the case of MDMA or psilocybin, I'd say, Hopkins, you're looking at one to three total treatment sessions with durability of various effects, six months, 12 months, 18 months later.

That is more interesting to me than just about anything else I could possibly focus on. So I'll stop by my monologue there. You're absolutely right.

I mean, it's phenomenal. It really demonstrates or highlights what we're seeing is this complete paradigm shift in mental illness. And I can say as a Western trained psychiatrist, we're taught to tell people that you prescribe medicine or therapy and you. People to the studies show that if they discontinue medicine or discontinue therapy at any time, that their chances of relapse go up and the severity of their relapses will likely go up. And what we're seeing from MDMA, for those who are not familiar with the phase two trial results, is that people who have had treatment resistant PTSD for an average of 17 years, something like fifty three percent, are no longer meeting diagnostic criteria after just three doses of MDMA in 12 weeks of psychotherapy is as you were saying.

And what's even more remarkable is five years out without any more subsequent treatment. Sixty seven percent of these people are no longer meeting diagnostic criteria. And from having trained in the MDMA protocol and the ketamine assisted psychotherapy protocol, which were very, very similar, I can tell you that my perspective on this, which I think is very similar to a lot of the practitioners who work in this area, is the reason why this works so differently is because we're actually teaching people how to heal themselves.

We're reminding them of this innate, as mikitani metaphor, say the inner healing intelligence that we were all born with had the capacity to be reactivated when we recognize that it's there. And this allows us an opportunity to start to heal ourselves because the center of our healing we now recognize comes from within us, not from some pill that we have to take every day and not from some person we have to see every week, but actually from within ourselves, which is so remarkable.

It is. And I want to underscore something you said or two names. You mentioned Annie and Michael Middleford, who are incredible practitioners. I should say that therapists and who have helped define and formalize the format for the psychotherapy that is assisted by MDMA in these mass trials. And I do whatever I can try to play the role of conservative voice in media related to psychedelics, because I do not view psychedelics as a panacea. I do not think they're suitable for all people.

And it's very easy to throw the baby out with the bathwater by viewing psychiatry as it exists or therapy as it exists, as obsolete. And I think that's a huge mistake because the results that are achieved are, I think in many cases, dependent on tools from therapy or psychiatry, like internal family systems, IFES parts for these types of conversations when conducted this type of self inquiry, when aided by a therapist with the pathogen, let's just call it, of MDMA, something that generates empathy not just towards others, but that can be directed at the self within the self is incredibly potent.

And it is the combination. It is the combination. And this is why if you go to an EDM festival, it's not automatic that a thousand people on ecstasy hear resolving all through childhood trauma. It just doesn't work that way. Nor does every pothead who tries in all due respect. But it's like any any pothead in college who tries mushrooms once doesn't automatically stop smoking. But on the other side, when you look at the nicotine addiction studies that have been done with proper planning format, support and integration that follow up by, say, Dr.

Johnson at Hopkins, the results are staggering. They are literally staggering. So I just want to take that opportunity to indicate that we can borrow best practices from psychiatry and therapy and effectively put them on performance enhancing drugs by adding some of these compounds with the right safety profiles. And certainly ketamine is of interest to me as well. So, yeah, I love everything you guys are saying, because the thing that we've always emphasized and then news hour is it's just fundamentally important that people recognize that the best outcomes come from therapy plus medicine.

But I'm curious to both of you guys, just ask from both of you, because I know you're probably even more well versed than I am on all the research, even though I read through quite a lot of it doesn't explain to the audience how these studies have been performed and assume that there's some scientists out there in the audience. I'm sure there are some people that are questioning and wondering about, OK, so how is the study done? Was there a control of just medicine or control?

Is just therapy a little bit about how this has been performed so that you kind of get a better understanding of the specific research? Yeah, I'm happy to share one aspect of it that is very valid and important part of the conversation. And then I'd love to hand the mic off because I am off on the line with two doctors and I'm most certainly not a doctor and do not play one on the Internet, but I have spent a lot of time.

Looking at and being involved with study design, just as a funder of a lot of this research, because you have to pick and choose your targets, you have to pick and choose your study design very, very carefully. You don't get an infinite number of investments for leverage in science, just like you don't get in business. These things cost a lot of money and they take a lot of time. So you have to really think about your parameters from the outset.

Well, let me give the short answer first. Yes. These are placebo controlled randomized studies and the intervention, the active intervention, let's say MDMA is contrasted with a placebo combined with the same therapy, the same therapeutic approach. And the placebo effect is the most consistent, powerful across all of medicine. So we need to take it very seriously. And their entire books written about placebo and nocebo, which is the opposite of that, where you can they get the same pharmacological intervention by believing that it doesn't work, which is just as crazy if you begin to think about it, get real and blinding and including placebo in psychedelic studies is remarkably challenging because it is very quickly obvious to almost everyone whether or not they've been given a psychedelic, even if they have had no prior exposure, if they do enough reading and so on.

Rick would be much more qualified to talk about this. But there are ways to use what one might deem an active placebo to create a physiological set, such as by using something like niacin where you have skin flushing so called niacin flush and these types of active placebos can be used, I think particularly well with respect to MDMA, it is more challenging when you are using what we might consider a classic psychedelic with strong visionary or visual components such as as side.

But I would love to pass the mike because that's where I feel like I start wading into the deep end of my ignorance. So I'd prefer to defer first. Thank you so much for that, Tim. I think you covered the great majority of it, actually. And I think bringing up placebo and nocebo and the importance of those things is really critical, because I think what a lot of people don't understand is a placebo and nocebo are really having a factor in the study design that takes into account the power of belief in our treatments.

So placebo is really a matter of saying and if Western scientific lingo, that if you believe a treatment is going to work for you, then it's going to work. It's 30 to 50 percent of the time, more likely to work if you believe in it. And these are the numbers roughly for mental health studies and for nocebo. I think the numbers are actually a little higher, which means if you believe that a treatment will not work for you, it is 30 to 50 percent less likely to work, which is really fascinating.

That is really the power of the mind in the healing process. Right. Getting back to what we were talking about before is using this combination of psychotherapy to enable or amplify the power of the medicine and in turn using the medicine in the case of MDMA to catalyze the radical safety and radical healing potential for psychotherapy, to facilitate these incredible healing experiences for people that are really rooted in intention and belief, which goes back to a lot of the tribal history of how traditional psilocybin and cactus ceremonies and ayahuasca ceremonies are performed.

It's all about intention to heal and curating a safe space for that intention to manifest in healing. And that you can see that consistently when you look in how these MDMA trials are put together, it really pulls that intentionality that is rooted in these traditional tribal cultures, in their ancient healing practices that are whoknows probably five, 10, 20 thousand years old. It pulls those in as best as we can into a Western paradigm that's double blinded and placebo controlled and and randomized, where your subjects get this incredible 12 weeks of psychotherapy protocol.

You know, the results for people going through. Just to compare, I said earlier of the people who have 17 years plus on average of treatment resistant PTSD in the maps phase two trial with MDMA. What we saw was that two months after this treatment wrapped up in the active group that actually received MDMA and again, these were crossover studies. So all the subjects got MDMA eventually. But there were also groups of subjects that got placebo first in some groups got placebo second, which is typically in these studies.

And correct me if I'm wrong, I believe it was low dose MDMA, which was not critical enough to hit the threshold. MDMA is a really interesting molecule because it's you have to hit a threshold to be able to get the active effect, which makes MDMA probably the worst medicine to microdots because it has a paradoxical effect where you kind of don't feel good if you take. Too little of a dose and you don't hit that threshold peak dose, which is somewhere between 80 and one hundred and twenty milligrams for most people, and so they use that as the placebo.

But what's really interesting is that in these people who had 17 years, an average of treatment resistant PTSD, we see that 53 percent who had the active MDMA two months out are no longer meeting diagnostic criteria for PTSD. I believe that in the placebo group that only received the subtherapeutic dose of MDMA, what we saw was something like 20 something percent, I think was like twenty five or twenty seven percent. We're no longer meeting diagnostic criteria, which is actually pretty amazing because that means that the therapy alone is 12 weeks of intensive therapy with two therapists is actually very powerful and helping people.

But then you go and look at the five year follow up data, which is really where it counts. And what you see is the people who did not get MDMA at five years out, they did not continue to get better. In fact, many of the twenty seven percent that were no longer meeting symptoms criteria at the end of that first 12 weeks actually relapsed and ultimately had a recurrence of PTSD symptoms, whereas more people who got MDMA were symptom free or not meeting diagnostic criteria five years out, then were at two months out, which then goes to continuously reinforce this idea that the medicine and the therapy and the intention to heal or facilitating this radically transformative experience that allows people to remember how to heal themselves, which is just such an incredible opportunity in mental health.

We've really never seen anything like this before.

I think it's super interesting. Just tie this up that if you look at the academy research, this drug came along by grandey and it's frankly just not a very good drug because it's not much better than regular. And they didn't combine it with any therapy. And doctors aren't really using it that much, especially the doctors in the academy in space, because it's basically designed to just go to the clinic, take the medicine and go home. And that's what's so inspiring about this research, is by its design, it's combining these two therapeutic modalities in order to create the best long term.

To most people who ask me, should I do X fill in the blank, should I do or should I use sort of what should I use? Should I use it? What should I use? MDMA, generally speaking, as a 90 plus percent of the time. After I ask if you follow up questions, my answer is no, which would be surprising to people given how public I am about supporting the research and the reason for that. Pretty simple.

I think that there is a lot of preparation you can do to increase the odds of a very good outcome, much like if you're going to bet in a casino, you should probably read a few books beforehand, do a little bit of role roleplaying, maybe some reversal online play for real stakes to see how your psychology changes. And then maybe you consider going to the casino. And only then should you even consider a game where you might have might, if you are exceptional, have a chance of bending the odds as you're playing blackjack, single deck blackjack instead of slot slot machine or the roulette wheel.

And I think a lot of people play roulette with psychedelics and I think it's a terrible idea for the following reason, a simple way to think about psychedelics. I'm not saying this is scientifically comprehensive because it's not it's a metaphor, but with psychedelics do and this is whether you're dealing with demons or you're dealing with the lemons. But I think particularly true demands and a lot of context we could put that sort of in that category certainly doesn't fall into that category.

These compounds MDMA, although I consider it a pathogen, a more than a psychedelic is similar in respects. What it's doing is heating up the clay of your your mind and psyche and brain structurally also such that it's more malleable and you can reshape these narratives and stories and behaviors that have governed much of your life. And many of these stories, many of these narratives, many of these behaviors, compulsive loop's, whether that compulsion manifests as OCD, eating disorders, depression, chronic anxiety, alcoholism or otherwise.

I happen to think that these are all symptoms of a shared underlying set of issues. These psychedelics heat up the clay so that you can rebuild those stories, most of which you never chose for yourself. They were absorbed somehow or caused by the environment, trauma in childhood, for instance, absent parents, whatever it might have been. And then the question is, you heated the clay. What do you do to ensure it is remolded in the most beneficial way possible?

Do you have an expert sculptor with lots of expert? It's helping you, if we think about it as a keyboard or rewriting a story like you have a seasoned proofreader helping you or do you have a cat running across the keyboard, which is how a lot of people take psychedelics or still, are you in an environment that is utterly unsupportive, where maybe you have mischievous friends who want to prank you, or you have friends who have taken a compound that are enjoying the experience and don't want to be taken down by the trauma that is surfacing for you.

If that's the case. Important to realize that the clay can be molded into a misshapen form that is worse than your original state. I think this is really important to emphasize if you're using a period of plasticity in the brain where it is flexible and then the question or one of the questions is what are you doing beforehand, during and afterwards to ensure that you're shaping it in the most beneficial way possible? And for that reason, if people aren't willing to do quite a lot of upfront preparation to take it seriously, to allocate sufficient time for a very spacious on ramp, an off ramp from the experience.

In other words, you're not having your first psychedelic experience as far as five a.m. on a Sunday night and then going into your office now on Monday morning only then. And in addition to that, committing to post care, having a therapist, psychiatrist or otherwise on board as a safety net so that they have a support structure that is not one of their volunteer friends. Will I recommend that someone consider use of psychedelics? That is how seriously I take them.

And that's not to mention the quality of the medicine on the street these days is so patchy and it really rolling the dice every time you go and try a psychedelic that you've procured through the dark lab, through a drug dealer, through wherever you get your medicine, you just don't know what the quality is. And especially with MDMA, which is for furious, for having adulterants and other sorts of things to work with. So, yeah, it pays to tread carefully and thoughtfully.

And I do think that caution is the better part of valor here and that just to continue to lay on the metaphors, measuring twice of cutting once cuts for a lot because in controlled settings, with proper supervision, with the pre and post carefully thought through, which means it's not impromptu, there is a plan just like you would have a plan going into reconstructive surgery. You would have pre have surgery, you would have medication to assist post up and up, and you would have a significant amount of attention, dedicated pre operation to your rehabilitation.

I look at this the same way. And if you don't do that, although it's not as common to read about or hear about these stories, you can end up very dislocated. You can end up becoming unmoored. And I have seen firsthand I've seen dozens of lives directly changed in ways that are inconceivable based on the textbooks of psychology and psychiatry used in colleges today, for instance, from medical schools and people. And that tells me that that is, as any good doctor would tell you, like 50 percent of what we know is wrong.

We just don't know which 50 percent. Right. I mean, it was like we operated on newborns and infants without anesthesia until nineteen eighty seven. Let's not forget. Right. I mean, we are still in the medical dark ages in many respects, and that will always be the case. There will be great unknowns of great value. And I think that many of them are in fact on the opposite end of the spectrum. I've seen people get so destabilized and knocked sideways that they are effectively in a psychotic state for days, weeks or in a handful of cases years afterwards, generally associated with ayahuasca and getting lost in that world in South America.

So it is very smart. It is very tactically useful to do your homework. And if you want to go fast to borrow for the military, slow is smooth and that you could not be more right there.

Tim and I thank you for echoing a sentiment that we talk about frequently on the News Hour, because that's what you're mentioning is really one of the most common mistakes that I think people make with psychedelic medicines.

And I think your metaphor about the clay, the remolding, the clay warming, the clay is such a good one because our brains really learn more, I think, in metaphor than in any other way. And that metaphor of of warming, the clay giving the opportunity for the clay to take a new shape or for us to effectively reshape it, reform it, and then have it solidify in the way that we want or intended to be in the future.

That's aligned with our goals. Maybe not as much. Aligned with whatever we absorbed in the first several years of our lives, from whatever happened to be around us at those times or whatever we were seeing on TV or what have you or in our schools, but actually what we want ourselves to be, not knowing what our potential really is, is just such a powerful metaphor. And I really appreciate you bringing that up because that is such a great way to think about this.

And I think, you know, interestingly, I think that metaphor actually plays into a lot of different other areas of of our lives. Speaking of which, we're kind of stuck in a mold for a long time in the scientific and medical community where research only was done a certain way. Research was only funded a certain way. It was only conducted at certain places in certain contexts. And so a lot of these different approaches kind of got left out and we're not even evaluated.

And the clay wasn't even ever really warmed thoroughly for us to have an opportunity to say, hey, maybe there's a different way we could be doing this. And then someone like you comes around and says, hey, guys, wait a minute.

If I take the money and some of my friends money and we put it towards this stuff, then all of a sudden it doesn't really matter what the NIH or the NIH says, we can make new research happen. Why is it so important or more important than ever right now to have diverse sources of research funding in the mix?

I'll take a stab at you setting that up so nicely. But before I do that, just a quick recommendation for a few resources for people who might be contemplating psychedelics or perhaps are engaged, but want to increase their exposure to perhaps a few different inputs that could be helpful in the healing journey by doing. But Uncle Ray and Jafo is an exceptional book. I highly recommend the introduction alone makes any cost associated very cheap. Both of these are actually published by MABS and it just so happens not because they're published by maps, but because they're great books.

And I'm recommending them Super Chief, which is a discussion of different modalities of siltation. And I would also recommend to anyone who is engaged with or considering being engaged with psychedelics that you download The Waking Up by Sam Harris and do the introductory course 10 minutes a day for I think it's between 30 and 50 days. This will help you navigate and squeeze the most juice from your experiences, particularly when combined with a book called Awareness by Anthony DeMello. So do those two concurrently back your question?

Why are diverse sources of funding important? Well, I would say first that the citizen philanthropy, the capital from individual donors is important, first and foremost, because there is such a lack of funding from many other sources. And my intention with committing many millions of dollars of my own capital, the largest such commitment to anything for profit or non-profit in my life, certainly especially beginning a few years ago, whether it's Hopkins' Imperial College or the Phase three trials with maps and MDMA psychotherapy.

The intention is to provide seed capital to something that can be a world changer, just as I would in the world of startups. My goal is to give 50 to something that I think can raise 50 million, no problem, a few years later. And therefore the objective has been to pave the way through destigmatizing and reputational risk and not just Bubriski, but clearly showing the reputational upside of supporting this science as an individual to grease the wheels for individuals and foundations, then larger foundations that have more reputation management in place and more systems and processes at these larger name, brand, dynastic wealth, foundations and ultimately government agencies.

So my plan, starting at least a year ago, probably 18 months ago, has been to try to set certain things in motion that will likely increase the odds of federal funding within, say, three to five years, I hope closer to three years. And I'm very optimistic about that. Nonetheless, as it stands right now, the research that we are seeing is almost entirely dependent on individuals finding conviction in the data, sometimes in their own experiences.

To look at this as an opportunity to bend the arc of history from a mental health perspective, much like pharmacology within medicine can be separated into pre antibiotics, post antibiotics. And that was addressing physical bugs for the sake of simplicity. If we are addressing mental psycho emotional bugs and fixing the software, I think psychedelics have the potential. To mark that type of before and after line, and it's up to individual philanthropists right now, much in the same way that oral contraceptives were up to Katharine McCormick, who's an incredible woman, everyone should read her Wikipedia from her history at MIT to ultimately almost single handedly developing oral contraception with the equivalent of, I want to say, twenty four billion dollars in today's money, adjusted for inflation over a period of five or ten years.

And it was initially approved. If my memory serves me for the indication of menstrual disorders and to superimportant and ties into the strategy of how to shepherd some of these compounds through this Antin regulatory affairs. Although the FDA has been incredibly supportive, I want to add that they're not the enemy here. They've been incredibly supportive of both Sohaib and MDMA, that the initial indications are very important and that bent the arc of history. You think about the long term global effects of that type of liberation for half of our species in the form of contraception, being able to family plan with that as a tool in the toolkit for such a small dollar amount.

I mean, that is like one in 10 billion out. And I look for that sort of and look for that science and I should say is not the only place I have allocated capital and place bets in the world of scientific research, but they are the primary focus. So for that reason, if anyone is sitting on the sidelines for now and they've been considering where they might want to put their capital, you can't take your marbles with you. We're all going to die.

And you could be buried like a pharaoh with golden thrones and gold bars and so on. But it's probably not going to help you very much. I think this is a golden window of time over the next let's just call it one to three years where people can go down in history as having been the spark that kind of lit the bonfire, that lit the world on fire in the most productive way possible. That is so inspiring. And I think the death toll on that is the real kind of big question that plagues me every day as I'm thinking about trying to figure out how are we going to go from one hundred hours of therapy to hundreds of thousands of people who have trauma right now from what's happening in our country over the next five years, we can get these drugs approved.

But the reality is that the delivery of these medicines, because look at our health care system right now, I mean, it's failing at its most basic function, which is to treat sickness. And so what is your vision of how this gets to scale? Because that's the real question that I think is going to truly lead to whether or not this changes the world or we're stuck with the expensive treatments for all these people can afford it. And that's what I'm trying to figure out right now, is do we need to design new studies that enable groups of people to have treatments together?

I mean, if you look at indigenous cultures, ayahuasca is delivered in groups. And so I kind of have an issue personally with I know we have to design studies that will get approved by the FDA, but I have a really hard time understanding how we're going to get the scale that current stab at it. I think this is a better question for the maps professionals, but I can give you my lens through which I look at this or the lenses.

The first is that this may sound strange given what I just said, but the scale and believe me, I can count. So I know I'm getting this off slightly, but I can be a four letter word. And Seth Godin talks quite a bit about how easy it is to escape into the big as opposed to focusing on the small in front of you and even Airbnb before it was Airbnb focused on doing things that didn't scale. And there's actually an excellent episode of the Masters of Scale podcast by Reid Hoffman with interviews of Brian Chesky and the other founders of Airbnb about doing things in the beginning that did not scale very deliberately.

That might seem antithetical to becoming very big, but in fact, it is not. It is necessary for prototyping and refining and throwing a lot against the wall so that you can build on early successes. So the things that we do in the beginning are almost certainly not going to do the things, at least not copying paste that are done three to four or five years later. That's the first assumption I would say that I'm making. The second is that it is very challenging to scale in person, period, full stop.

So I don't expect it to be easy. That is just another assumption is that this is not going to be easy and that if something appears easy, we should double down on scrutiny and really stress test it because there are probably weaknesses. Third is looking at historic adoption of different behaviors and systems like it or hate it, or even if you're neutral, many, many, many things that end up in scale, like recycling in the United States started as something piloted in very, very small communities and generally.

In affluent areas that I think these days can produce a visceral negative response, but it's important to realize that the more affluent, generally speaking, are going to have more capital, more time with which they can use to serve as guinea pigs, if that makes sense. You're not going to add a single bar before to be a guinea pig. It would be unfair. It would be unreasonable to be extremely problematic. So a lot of the guinea pigs end up being small groups of people with more capital and time.

And I think that's OK. If you look at startups in the very early stages, they very often use the initial premium pricing for a small subset of people to completely pay for the R&D and subsidize developing cheaper versions that can be deployed more widely. That's certainly true with Uber, which I know very, very well since it was one of the initial advisors. So I saw them deliberately do that. But in the beginning they caught incredible flak for being elitist in that respect.

But suffice to say, that was an effective strategy. It's a strategy that we've seen over and over again in different areas. And I would expect for us to see it in psychedelic therapy as well. And the ultimate form that it takes, I don't know. But another base assumption that keeps me going, quite frankly, with all that I'm involved with, with respect to psychedelic science and indigenous communities and psychedelics is a lot that I haven't talked about publicly that I'm involved with.

But even if we just look at the forward facing stuff, it's very time consuming. It's very energy intensive. It's very capital hungry. And part of what keeps me going is the realisation, which is not a cop out in any sense, because I do want to reach millions of people ultimately, but not rush into self incinerate the process. Is that to change the world, you do not need to treat one hundred million people. If you can help one person overcome paralyzing trauma, you've changed the world full stop.

The ripple effect from that one person can be incredible. Let's say that one person is the daughter of a senator or congressperson who has lifelong eating disorder. Multiple brushes with death, multiple hospitalizations and psychedelic therapy is able to allow that person to find peace and rewrite their narrative such that they're not battling this team every day. That's one person, technically. But what are the far reaching implications of that? There are many if it's helpful at any point, if you want to talk about I want to go, we can talk about that as well.

There are a number of people in the psychedelic science world, researchers who are looking at group integration. And I think that's very important to point. And so that is going to happen. It's going to happen and it is happening. And I'm sure that there are multiple researchers who are looking at the effectiveness and cost effectiveness of operating in groups that are certainly for treatment sessions, but certainly for prep and more frequently integration. I am optimistic that in some cases groups will not just be as effective but more effective than one on one or one on to meeting one patient and two facilitators.

Integration. I'm very, very optimistic and I think one of the ways the various factions of the psychedelic movement will hurt each other and themselves and hobble things is by trying to boil the ocean at once. If you try to go too big, too fast, that is a recipe for disaster. In my opinion. I'm still aggressive. I'm fucking aggressive. That's how I am with this type of thing. I'm very aggressive. So I push. I really push.

But there is a point at which you can push too hard and things can break. It's it's a challenge for me as well. That is a really beautiful answer. And part of why I'm so inspired by it is in my own medical practice. It's always been fairly elitist and it weighs on me a lot because I have charged a lot of money for early adoption of technologies that now are becoming scalable. And what's really cool is that there's a lot of companies that are taking things that I've been doing manually and they're digitizing them.

So I think there is a lot of hope and promise. And I think the hard part giving it to early adopter is that you see the future and you know what's coming and you just so badly want it to be now, because never have we ever seen so much trauma all at once. And it's just heartbreaking to see society right now with so much pain and knowing we have to wait for this. And I know it's necessary, but it's still painful and wanting so much pain in the world.

It's like you just want to alleviate it as a doctor. That's kind of why you went to medical school. Yeah, and I would just say for anybody listening, you know, historically, I think many participants in the psychedelic space and there are I use the word factions very deliberately because I find the infighting within the psychedelic world particularly. Areas and hypocritical, but nonetheless for humans and tribal and all of that, that's one of the greatest weaknesses in the psychedelic world, is having everything become a priority and trying to do everything.

If everything is your priority, nothing is your priority. And I'm not saying that to you specifically, Molly, at all. It's just a lead into a broader observation of why these psychedelic subcultures coordinating the different pieces can also be like herding cats is because there is a pervasive lack of focus. So pick your shots. If you have your patients and you're doing a good job with your patients and you are doing a good job, period. So I want to just if that is any reassurance that I want to echo what Molly was saying.

And I really appreciate your perspective on that, because I think it is a unique perspective. I, for one, have had these conversations about scaling with Liano, who just joined us to provide the maps framework for planning for scaling these kinds of things. Since you brought it up and also with Rick Doblin and really talking about how we can expand access. And I think what always comes back to me is reminding myself of what are these medicines really trying to teach us.

And there has been this constant pattern of ancient knowledge that keeps coming to me through the work that I work with my own clients, with and without medicine, and also through some of the experiences that I've had in my own trainings, for example, training for ketamine, assisted psychotherapy, where it really comes back to these tribal tenets of ancient wisdom, which are gratitude, forgiveness, compassion and self love as the foundation of trust that all of this is built on not only trust in ourselves that allows everything else to grow from a stable foundation, but also trust in everything else that we're doing and trust in each other and trust in this whole adventure that we're on together, that we can do this together.

And the interesting one of those four that I think people, including myself, have the most trouble with on a regular basis is self compassion, because self compassion is most commonly on a moment to moment, day to day basis, really the practice of patience for allowing things to unfold as they will in time with focus and with dedication and devotion, but without rushing, because when we rush, we make mistakes. And that patience and allowing that time and that opportunity for that compassion to come into our lives allows us to recognize and take a breath and take a step back and say, you know what, there is no rush right now.

We have a lot to do and there's a lot of other people helping. And there's a lot of work on the horizon and a lot of things that we need to do. But there is no rush. And the more we can be patient with this process and all work together to see it through, not quickly but effectively, then the better this will be for everyone. But I just wanted to thank you for bringing up the patients driven approach and reminding us of that.

And I just wanted to give Leanna an opportunity to quickly catch us up on maps, plan concepts for scaling some of these treatments more effectively. Thanks so much for coming up.

I can see you here. I really appreciate this conversation that's being had right now in the direction of this valley. Everybody here, I mean, there is such incredible need and I see it every day with the amount of messages. And I work with another group that works with veterans. And there is a very urgent need for these treatments. And just two quick points on staling that I wanted to bring in is just what let us remember that the MDMA protocol was first developed 14 years ago and it's taken a very long time to get this work away, I guess.

And it was developed in the model with the dual therapists in the room for the eight hour sessions with the understanding to create the most comprehensive protocol that had the highest likelihood of success within the FDA framework. So it was coming from that place was highly stigmatized. It took a long time to get the research to where it is today. So I just want to bring that in and then also to say that there is an unknown factor to see what happens when you start treating thousands, tens of thousands, hundreds of thousands of people with MDMA and this controlled growth model that we're working with, which there are some natural friction still dating to the rate in which we can adequately train therapists due to the need for supervision.

And there's only so many participants in our study. So there's only so many opportunities for therapists to receive supervision in their training. We want to be prepared for any adverse events, and we want to shore up the potential for there to be a backlash against this work so that we can continue the success in the future. And so it will be a very useful kind of growth model. There'll be a very limited amount of therapists available to do this work on day one of FDA approval.

But then quickly after that, it will start to grow exponentially. So it will take time and patience is needed. And that's a hard thing going on, so much fun is the way to do this work. Right. And I just I really appreciated your comments on all of that. So thank you, first of all. And here, you know, it's from a long term planning perspective. It is, I think, important to scenario plan, meaning anticipate that there are going to be some significant challenges and significant blowback in different forms as the skills as there would be with anything new.

It's the same reason that there are thousands and thousands and thousands of people who die on the highways in the United States. I don't know what the time frame would be week, day, month, but nonetheless, it is stadiums full of people who die in automobile accidents. But if one person dies in a Tesla that has some degree of autonomous driving, it is news that headlines everywhere. And I fully anticipate that even though you could go to any E.R. and find both critical patients and deaths caused by things that you can purchase over the counter, like acetaminophen and liver failure associated with that, when there are and it's not if when there are human tragedies associated with psychedelics because there are certain scale achieved, just given the law of large numbers, there are going to be complications.

There are going to be cases. They get massively disproportionate response from the media and negative coverage. These things are going to happen if we are successful in making this widely available. That is part of the, I would say, reward the natural outgrowth of this reaching some degree of scale. And so while it pays to be optimistic and there are many reasons to be optimistic from a planning perspective, this is going to be, if it is successful, very challenging, we will need to have very organized groups of people like those who are doing drug development and handling other capacities within maps who have thought this through ahead of time.

This is also true with the different movements nationwide and the various initiatives in Oregon. It's challenging to think about sometimes impossible, the second, third, fourth order effects of different innovations, different changes, regulatory modifications and so on. But I think it's very important because this is not going to be easy and we're going to need more than hope. As James Cameron director said, hope is not a strategy, but hope is not a strategy. Fortunately, though, more and more people are involved with the space, have spent a lot of time working on strategy in other areas.

So I am optimistic, but I'm not relying on hope. I thank you for that as well.

I think you're absolutely right. And it could not be more important that we, as difficult as it is sometimes, and as much as we are struggling as a community, especially right now, to take our time to make sure that we usher these medicines in in the right way, you know, they do have the capacity to spread contagiously. We saw it in the 60s and 70s and we saw what happen. I think even now there are if you really want a comparison, there's hundreds of thousands, if not millions of people dying of opioid related death every year.

And yet we are seeing more news about people going to the jungle in Peru or in South America when one person has or two people have a negative consequence as a result of an ayahuasca ceremony when they forgot to stop taking their antidepressant medication or some medication effect that was combined with the ayahuasca, that caused a negative result that resulted in someone having either a psychotic break or dying, which is still extraordinarily rare.

And yet that becomes something that the mainstream media ends up associating with these medicines, which is so unfortunate. And at the same time, I think it just serves as a constant reminder to us to be extra, extra careful. I did want to mention one thing that stuck out to me about your work, which is, again, going back to helping to destigmatize these medicines, destigmatize trauma and mental illness in our communities at large. One of the things that a lot of people don't actually recognize and I think a lot of doctors themselves don't recognize this for doctors and caregivers, we are not really allowed to admit mental illness.

In fact, as a physician, we can have our licenses taken away for having a diagnosis of mental illness in our medical record. If that ends up getting reported to our licensing board or if it gets found out by our licensing board and we did not report it, there are all of these different punitive restrictions that can really impact our ability to even provide. And this isn't just for doctors, this extends to anyone who is board certified as a care provider with a license, which is really quite destructive because it really makes you realize that many of our physicians, especially on the front lines right now, are facing symptoms of burnout.

But we can't admit it or seek care easily because as soon as we do, we directly jeopardize our ability to deliver said care. And that's such a wild paradox in the way that we wound up having ultimately, as a result of that, more physicians and more care givers on the front lines who have potentially untreated symptoms of mental illness. And we could have the alternative, which would be caregivers and physicians on the front lines who have adequately addressed their issues because of overwork, work related stress or the stress of training and the trauma of training or whatever it might be.

And yet that is not being addressed. And it's being, in fact, punished because mental health and physical health are still looked at as separate things. You would never see a doctor lose his license for having a coronary bypass episode, for instance, which is much more dangerous and brings you much closer to death and most mental illnesses. And I was wondering, from your perspective, as someone who is a nonphysician kind of looking at this, how do you see our society overcoming this incredible stigma of mental illness?

I'm glad you didn't ask me how to overcome the stigma that associates or maybe you are specifically to licensed professionals. It's important to keep in mind this does not just apply to physicians and applies to police officers. It applies to airline pilots or pilots of any type that applies to truck drivers. It applies to anyone with a license. I don't have a quick answer to that. I don't actually have an answer to that. So I hope other people are working on it.

But I don't have an immediate answer to that. I can say that I personally, as a friend, worked with a police officer who was in exactly the position. He was suicidal and he was on duty carrying a firearm every day. Sweetheart, beautiful human being, understood how precarious that situation was and yet was not in a financial position to go to his superiors and ultimately ended up referring to a Kaddoumi clinic for a five or six intravenously delivered funeral sequence, which was extremely helpful for him.

But the fact that he had to do that covertly is fucking absurd and patently unstable. That is systemically not a viable solution. So I don't have an answer to that. I wish I did, but I think telling that type of story can catalyze those who are in a position to perhaps make change or implement policies whereby people can get paid sick, leave or otherwise not fear for their livelihoods to pay rent or putting food on the table for their families.

But I don't have a solution to that. And just so I can, I can address my flopping around numbers, just making an estimated thirty eight thousand eight hundred people lost their lives to car crashes, four point four million were injured seriously enough to require medical attention. So you have the numbers. And I want to mention just one more thing. Just because it's come up a few times, I've a decent amount of exposure to ayahuasca. I would never recommend that, much less going out of the country to South America to consume ayahuasca as a first rodeo, probably not even a tenth.

There are very particular risks involved that would take hours to fully flush out here. But suffice to say that if you're strapping on skis for the first or even the tenth time, it's probably not a good time to go skiing. It's always to me, the thing I tell everybody is always start low, go slow it up. If you're going to get experience with psychedelics, start with the lowest possible dose. In my practice, I actually start people out on a pretty low dose of sublingual ketamine and then graduate them up to a psychedelic dose.

And I found that it's pretty darn safe and they'll feel like they're in more control of their experience. And I also have had clients decide to go to Peru and say they're just they're ready to do that kind of work. And they have friends, they have guides, they have reputable sources. And I've got people who have lifelong depression, literally. So they remember being a child, being depressed, have complete recovery. So even though I'm not recommending people go to the Amazon to do about Alaska, I'm still astonished by the fact that there are miraculous recovery and certain people with the right guides and setting in the right preparation.

And I actually think we need gateway drugs that are safe and recommended by doctors. And I think people need to put the training wheels that I've always described like this. You start with getting those willing to ride a bike, riding a bike like a mountain bike, and then you learn to drive a car and then you learn to fly a plane. And then when you have been a pilot for a long. And maybe you're ready, but I don't recommend people go from a sublingual five feet like that to me is super irresponsible.

There's a lot of people who don't realize just how dangerous some of these drugs can be. And I know enough people who, like you, said their lives completely altered in a negative way to know that these are powerful tools, but they are also dangerous and they need to be in the hands of professionals. So it's kind of fascinating. I feel like the last 10 years in San Francisco, we experienced this kind of total renaissance of psychedelics and there was a lot of irresponsible behavior.

But at the same time, it led to so many people figuring out, oh, my God, this can change the world. We can maybe bring this to market. And it's led to a much more conservative and steady approach to legalization. There's a lot of work that needs to be done. And I just want to add on to what you're saying about physician suicides. There's a great TED talk by a doctor called by Dr. Phil himself. And it's potent and it's powerful and it's all about this factor of doctors are suffering more than ever and they can't tell anyone.

And it's really a huge problem. And I think we need these medicines for them to not just for the patients, but for the physicians. And so what's really cool about even ketamine is as a therapy and what else is doing what you've been doing with him is training actually brings together practitioners in their end and has them sit together and experience psychedelics together so that they have firsthand knowledge of what this medicine can do. I'll let Dave take it from there.

But this is a really exciting time to be a part of this. It is. Dave, if you don't mind, I'm just going to jump in with observation, and that is your comparison with the spaceship. We don't need everybody to be an astronaut. I'm saying that because I know you're not implying it, but just to underscore this, there is to be a comically imprudent cultural norm with a lot of the psychedelic circles, which is you start with A, you go to B, then you do see that you do E, that you do this and you have to progress from starting with the ketamine or an MDMA or a whole lot of breath work.

And you work your way up to full side and then to you then to listen to that. And then at step seven, you're at five. And there is, to my knowledge, not a single indigenous culture that does this super cool and have spent time with quite a few indigenous cultures that have cultivated these traditions or certainly their own indigenous body, which can spend hundreds of thousands of plants. It's also easy to forget that these are not psychedelic cultures.

These are cultures that use psychedelics for very specific purposes, which, by the way, have often centered, at least in South America, on warfare and hunting. So just to put that in proper context, but it is not necessary to fuss with every tool in the toolbox. Maybe you just need to hammer its shingles and guess what? A hammer is going to be fine for that. For you to pull out the power saw started cutting off corners of your house, which is what I see a lot of people doing in this space.

And it can be very, very dangerous if you think that you haven't or you cannot be humbled and humbled. You just have not met the right molecule at the right dose. I guarantee you that there is something that will completely unravel you. Maybe it's five a.m. maybe. So I was going to see maybe it's just LSD and you took three hundred bucks instead of one hundred bucks. I totally agree with that. And also to add a caveat that there are contraindications to psychedelics.

I mean, there are plenty of things that will keep you from being a good candidate to these medicines like ketamine alone can cause schizophrenic symptoms to emerge and become an emergent phenomenon. It can cause high blood pressure, seizures, like there are risks. And you have to be fully informed before you consent to any of these medicines. And if you don't know what you're putting in your body, you could have a really bad experience and it could change your life to the negative forever.

And so these to come with warning labels, just like all drugs have. Yet most people don't read most. If you can be prescribed drugs at the pharmacy and they don't open up a little booklet and they don't realize that there are all these awful things that can happen to you if you do is wrong, you take the wrong dose or maybe it's not right for your body. And yet we have a drug addicted culture that is looking for the next big thing.

And so we definitely don't want this to become OK. This didn't work and it didn't work. I maybe I tried that. And that's simply the psychiatric culture right now. And it is a big, huge risk of this movement because there are so many different compounds and companies. Literally every day I hear of another company that a seed funding to develop their special molecules. They're going to patent that. They're going to figure out it's going to be the next big drug.

In psychedelics alone, and so there's a lot of things that we need to be thinking about. What's one drugs approved? I mean, we need to think about, OK, like what are we going to do when there's 15 of these? And how are we going to make sure that people don't end up habitually consuming these medicines thinking they're just going to get sex by taking a new psychiatric medicine? One more thing to add to that. Sorry to say one more thing.

And it's 17 new things, but the point I was going to make is to just reinforce a lot of what you just said. These are very powerful compounds. They can be used safely with proper screening and protocol. And if you approach any type of work with psychedelic medicine in the way you would approach getting complete reconstructive surgery or neurosurgery, you will probably be fine. You would not go on Craigslist to find your orthopedic surgeon to replace your knee. Similarly, on Facebook, to find some shava to have unprotected spiritual sex with you and save yourself, it's likely not going to turn out very well.

And if you look at this just in terms of significance, as you would when doing due diligence and planning for something like your hip replacement for neurosurgery, then probably tick all the boxes of prep and safety that are important. Aside from the compound, specific screening and and so on. That's all I'm wondering. But I'm wondering if we want to let some people come up and ask questions. I know I just got a text from a friend who is asking specifically about why he that was the last stop on the train.

And I don't really understand the questions. I'm wondering, is it time for us to bring people up? And individuals want to ask questions like, do they want to go there or where we want to take this? I'm happy to answer some questions just to touch on that person's question. I think a lot of folks in the psychedelic community view five of it's like the Everest of psychedelics. I don't operate within that paradigm. So I have my own thoughts on five Imodium and its uses and abuses and risk factors.

But I don't view it as the last stop. I view it as another tool in the toolkit with a much narrower band of application to a much narrower segment of the population.

Yeah, I think that's a great way to describe it. I think just to echo what both of you have been saying, I think that what we're really talking about, if anybody tuned into our last psychedelic clubhouse with Dr. Phil Wilson, you know, we really talk about healing from the standpoint of the restoration of balance. It's not about becoming a cyborg, super altered state individual where you're constantly on the go, go, go. And it's not about being asleep or living in some fantasy world for the rest of your life.

It's about balance and the restoration and maintenance of balance, which is really the recognition that when we live so much of our day to day waking lives separated and feeling and perceiving a sense of separation from our minds and our bodies, from ourselves, from others, particularly at a time of a pandemic, from ourselves and the earth and our environment around us, the plants, et cetera. As Tim referenced, these cultures in South America are plant medicine based cultures.

They live in harmony with the plants. They're not psychedelic cultures. It's a difference in perspective of balance in that healing. And the restoration of balance really means the restoration of unity, a sense of union between ourselves and everything else around us in the universe, which is something that is so radically clear when we have these altered state experiences, whether you're doing a whole or tropic breath work or a deep meditation or a MDMA or ketamine experience where Nawash experience, it's the sense of union that really brings us all together, where that boundary between self and other, whether the other is ourselves, our own intuition, our deep inner parts of ourselves that we were told not to respect growing up because they didn't get us anything that we thought was good or whether it's the earth around us or people in our family or or whatever it is, it's recognizing that that sense of self and other is really a perceptive capacity that is malleable and can change into these medicines, help restore or catalyze the restoration of balance and a lot of ways that allow us to heal.

And so approaching these in that way with that foundation is critical to make sure that we're always not only respecting the medicine and what the medicine has to teach us, but also respecting ourselves in the process, because that's what's going to be most likely to allow us to have the powerful, transformative healing experiences that we want to get. Out of these medicin experiences, and I do want to respect Tim's time, so let us know when you have to head out.

We really appreciate it. Sohaib was the first one to ask me to ask a question, so I'll let him jump in whenever he's ready.

And then you can go next to the really great show. I'm glad to be listening to a podcast. Discussion is very privileged to have discussed in the past with a movie about mental health plays or plays, well, psychedelics. So I thought so, Dave, upon medical residencies. But now and I think at the moment, this study going on with the Superstruct in twenty twenty one, whether it correlates with cortisol in saliva. So I just want to take perspective on what he thinks about monitoring levels of stress and burnout, where you think there's a limit to monitoring.

And if we could let that kind of people we're working with or manage their lives with mental health and with psychedelics, would you start to prevent that as you're seeing yourself kind of going above the threshold of falling into the question and the kind words? I am a fan of monitoring and tracking that which is meaningful and that which can be changed. So in other words, there are many devices. You have devices like your ring I use right now. There are other HRB devices that I also use for resting state morning measurements.

I find it to be very interesting. Cortisol fluctuates tremendously throughout the day, saliva collection and reliability sometimes challenging. But the real question for me is, are these levers you can pull off? Are they meaningful and can you sufficiently isolate these variables in the best of a multivariate Caspi that is real life outside of a laboratory? So those are the questions that are in my mind. But certainly looking at different types of physiological responses, both in session and out of session are very interesting to me.

It is going to be an extraordinary challenge, maybe an impossible challenge to tributed some of the changes that we are able to monitor to single intervention. Was it due to the of session or was it due to the therapy session? Was it due to the daily journaling that started after the therapy session? Was it due to that single conversation with a parent that had been weighing somewhat heavily for 20 years? It's incredibly challenging to trace cause and effect between variables and circumstances.

But as far as I'm concerned, if it can be done easily and consistently, the more data we can capture, the better, even if they're slightly inaccurate by the algorithms are all subject to debate with, say, Ruth or for or any of these devices. But if they're consistently inaccurate, if that makes sense, then you can still plot trend lines that are very interesting. I want to add to that that I actually am. The practice recommends most of my patients that have chronic stress related mental health disorders where a therapeutic device, you can find a link to it.

At least it's a really cool HRB monitor that is a little bit different than Oring and and because it gives you HRB visualization throughout the day. So it's a continuous monitor and I'm biased towards continuous monitoring, but I love that device. And also just like Dave's device, Apollinaire, which is something I wear every day. Modula HRB. And I think these tools are super valuable as adjacent tools to helping people triangulate specifically where there's stress in their life is coming from.

A lot of people have no idea what's really stressful to them, and they wear these devices and they say, oh my God, I can't believe it's this person that I every time I talk to them, I just have this massive stress response. And it's a fascinating thing for some people. It's the family life. For some people, it's the workplace. For some people, it's their inner life. But figuring out where your sources of stress are coming from and being able to do something about them is paramount to feeling right.

You are Gina, this is Tim reading Gina's question because we weren't able to get permissions in time to use her voice. And here's what she says. I'll paraphrase here. My question is, given the issues of the moment around sexism and racism and the fact that a lot of sexism and racism can be hardwired in the brain and these substances can really create the malleability to possibly cure some form of sexism and racism. Have you thought of using these substances, raising funds around this?

Can we use things like MDMA to address sexism and racism?

I'm going to answer that because I'm very well versed in the structure of the medical system in medicine. Today is a pathology based program. So it's all about dealing in. Or disease states, and right now, racism and sexism are not disease states you can code for with the ICD 10, and that means you can't actually prescribe for doing that. But we do know that raises the risk of heart diseases. But there's probably not that indication right now for us to be able to administer one quick training on that also.

And then we can take a few more questions as a primary outcome measure would be or intervention is totally on point. So I won't repeat what she said. It is possible in some types of design studies to use secondary measures or even primary outcome measures related to conflict resolution that are more observational in nature. So I do think that the perceptions, sense of oneness and lack of separation that many of these compounds to produce have applications to conflict resolution and the demonization of the other.

And within this has been looked at between Israelis and Palestinians, for instance, and there have been a lot of promising reports. So I am optimistic that we can see those types of effects. They then need to survive as fledgling of reorientation, the brutality of re-entering the real world with its related pressures and habits and sort of default travel behaviors. So that is the challenging part. Having the realization in the experience less so, ensuring that it has some durability over time requires very careful integration.

I'll pass it to Eamon next. Hey, thank you, Dr. Gave.

Thanks, Dr. Molly, and really appreciate everything you're doing so important. You talked about the factionalism in the community, and I think a lot of that comes around different perspectives of ethical considerations coming into commercialization. And I'm curious what you think are the most pressing ethical considerations that this kind of burgeoning psychedelic movement needs to come into alignment on. Yeah, thanks for the question. So I said that we don't need more time to explore this, but I'll give a very, very short version.

First and foremost, just as a disclosure of sorts, I have not invested very deliberately, not allocated any money to any for profit ventures because I do not want to have or be perceived as having any conflict of interests. That affects how I think about it or speak to any of these subjects. And that's a costly decision on my part. But the one that I feel very comfortable with the ethical consideration, there are many ethical considerations. We could talk about sexual abuse within the context of South America specifically.

It happens elsewhere, but it's at least as far as I know, the most prevalent culturally in South America. We could talk about any number of different things. The most critical to get right, I think, is the management of intellectual property and preventing broad claims of patents such that we end up in a entirely non competitive field or a world of psychedelic medicine, where there are only a handful of players who file patents to prevent others from entering the field.

And this happens elsewhere. It is a known playbook. We have seen some of this already. I know people who are funding legal teams to object to the patent office in the United States at least, and also overseas broad patent claims. But if it becomes a land grab where a few companies who are aggressive with no counterbalancing opposition or watchdog position are able to file very broad patent claims where they are perhaps capitalizing on pre existing means of synthesizing certain molecules, et cetera.

And they're trying to do something from the playbook of Big Pharma, where they establish an isomer, they grab the right handed version instead of the left handed version, and then they slap a whole lot of restrictions around it to inhibit other players from entering the field. I think that could be catastrophic and there are many different ethical considerations. But from a practical what can we do perspective, it would be keeping a very, very close eye on patents that are filed for opposition and having the will to oppose patents that seem too broad for for the good of the ecosystem to move Greg and Tarshish to take as long as you have time to.

I'll do so I much time.

This is Tim chiming in again with Greg's question since we couldn't get permissions for his voice recording. Here's the question. Thanks, Doctor. Thanks, Molly. And thanks, Tim. So this has to do with another current issue of today, which is covid, as you know, the global mental health crisis that's going on and everything we're facing right now, a ton of people. Are still isolated, and I'm one of the meditation, is that a huge positive impact on my whole life, but especially now, along with a lot of stuff I got from your media team, which I really appreciate.

I'm wondering if there's a way and I've never gone into psychedelics at all, and I feel like it would have a positive impact on me to even try a little bit in conjunction with the other positive explorations I'm doing to try to curate the best self that I can. Do you or any of the three of you have suggestions on what one can do if they're still trying to isolate and if there's any way to begin getting involved and exploring this process. So there are any resources for that?

Yeah, I appreciate everything you said. And the question my thought is you are looking for a non ordinary state of consciousness that can be used to facilitate the beneficial manifesting of the mind, which is literally what the psychedelic means, etymologically speaking mind manifesting. There are tools available that do not involve digestion. So one option would be looking at breath work and breath facilitators who are able to work at a safe distance outside. So you could look at something like entropic breath work and practitioners who are willing to do something outside.

You could be seated separately. There could be things that you wanted there to be contact allowed. But there are means through breath work and other ways of achieving non ordinary seeds of consciousness that one could consider psychedelic without ingestion of compounds, which I would not suggest doing so certainly without a lot of prior experience. Toshiro also. And so I guess my last psychedelic experience was a kind of positive kind, as you can imagine, debilitating like the soldier. And I'm just wondering if you have any suggestions for overcoming, like maybe previous Uvalda the clay and it didn't hold very well.

How would you like it? How would you come out of that? Would you like try this again? Would you like a therapy? What? Would you read that stuff. So let me ask a follow up question. What did you take, if you don't mind me asking? I think I'd like to talk about, OK, I'm going to defer to the doctors on this. I'll just give you my perspective. I'll speak from personal experience. This is not prescriptive informational purposes only if you have enough at bats.

Let's just say you are a clay spinner and you sit at a circular table, you press a pedal with your foot and you spin clay. Every once in a while I felt that piece of clay is going to go flopping over and become a total mess. And if you have enough repetitions with psychedelics, eventually you are going to have a very difficult experience. I do not distinguish between good and bad. I distinguish between safe and unsafe trips. So I would recommend first and this is general stuff of Q but doing some journaling with prompting questions about whether it was a bad experience or an unsafe experience or a difficult experience within context.

If it is the latter, then there may be some juice to squeeze from it. Whether you should use or not use the same compound or others. I'll leave that to the doctors. One thing that I will say is depending on individual tolerance and sensitivity, there are certain dose ranges that can be more problematic than others for people. And one might think it is due to higher doses. But that's not always the case because psychedelics, if we're talking about six or seven acts, almost like different drugs at different dosages.

So if you're taking a sub perceptual microdots, let's just say a fifty to one hundred milligrams, there's one effect, which is almost like taking an anti anxiety medication. It is mostly, I would say, a physiological response. And then you have Phyllis's going all the way up to heroic per five grams and beyond. But a lot of people end up getting stuck. If we are going to use this airplane metaphor. Let's just say you consume the psychedelic.

You're in the airplane on the tarmac, you accelerate, you have takeoff. It's a gradual ascent. You go through cloud cover quite often. There's a lot of turbulence and then you pop through on the other side. Let's just say that popping through on the other side with three grams or more would be the equivalent of just crossing over the peak of the experience or peaking sometimes. And it's just a highly individual. But for something like let's just say it's powdered homogenised mushrooms here, it could just be dried mushrooms selected the mushrooms for a lot of people, that one to two gram range is going to put them.

Right in the cloud turbulence, and they will not pop through, and that can be very, very unsettling. It can be very, very unpleasant. A lot of emotions and material can come up. But you are so firmly rooted in this ordinary reality still so that you don't feel equipped to metabolize them or work with them. So I would say there's also a possibility, although that likely with two hundred of what should be cognizant of certain dosage ranges, moderate range, sometimes being particularly challenging, but following.

You guys have any thoughts on your question? I mean, for me to get the best that I have on another planet, so for me, that's a good dose.

Tim, I should say kudos to you, sir. Being a nonphysician, I thought your response to that was excellent.

Really, really, really valuable perspective on how to approach this. And I think Toshiro there, again, as Tim was saying, the bad trips or bad uncomfortable experiences from psychedelic medicine or psychedelic drugs are not always actually bad. It's just that they're difficult and they need to be worked through a little bit and they can actually be steppingstones on our way to great personal growth if the right support is there. And so as a psychiatrist who works in this field, I see this all the time.

And one of my specialties, not to make this go on much longer, but because I know Tim needs to leave, one of my specialties is actually helping people integrate difficult and bad trip experiences. So if you want to reach out to me, I'm happy to chat with you personally and we can talk through it. Or I can recommend you someone who can be a good integration therapist for you, who specifically has experience with psychedelic medicines that can really help facilitate you working through this and coming out of it.

And the side I want you to know without a doubt that these changes that occur in these experiences are almost never permanent, almost never. And it just requires the right kind of support and the right kind of of collaborative, collaborative effort together to help you through it. But you can absolutely get through this as difficult as it might feel right now. And just reach out to me at Dr. Dave, or you can reach out to me on Twitter at Dave Raybon or on Instagram at Dr.

David Raybon. And I'm happy to help you or recommend you to somebody who can. But thanks for bringing that up. I really appreciate that you felt comfortable bringing that up in a place like this.

I think you need to be honest about the experiences and just let everyone know, like it was safe but difficult experience, like what you could do something like unsafe or safe and journaling and meditation. Like, I really appreciate the suggestions and I'll definitely follow up with you. So thank you so much. You're welcome. I'll add one more thing that may apply to others, and that is if you have a challenging experience like that, it doesn't mean that you got thrown off the horse.

It doesn't mean that your technique was shitty. And in fact, if you talk to anyone, especially facilitator and you ask them to describe the more challenging experiences that have gone sideways, they don't have any. The reality is they don't have enough experience or they don't have a lot of experience. And exercising trying to display as much self compassion in these circumstances as possible is very, very helpful, particularly taking into account that you were using LSD, which has a particularly tricky long tail of low effects.

We're talking about eight to 12 hours. And I should say that one out of every hundred people have a twenty four to thirty six hour experience. That does happen. But let's assume that you're a normal responder and you have an eight to 12 hour experience. For a lot of people, the last four hours of that, you will feel almost sober, but not entirely. And it can be very challenging. Similar to this. Wanted to grab a dose of celestially mushrooms to navigate because your friends are talking to you.

They're eating crackers and they're blah, blah, blah. They're kind of blast of questions, jokes. And meanwhile, like all of this sadness from feeling isolated as a child because A, B and C was absent in all of this is welling up inside of you. You don't know what to do. So LSD, I think particularly tricky in that respect, because there's a long tail of effect that can be very challenging. So I would give yourself also some credit in that respect, because it's very common that people challenged with that and come out of it with the recency of the end, the tail end coloring the entire.

The experience that is very common, that is very, very true, and thank you for adding that in. And Tim, I want to be respectful of your time. You've given us so much of it and we are so grateful and so grateful for all the incredible work you've done. The capstone, helping to destigmatize mental illness, spread awareness of the importance of mental health and prioritizing it to all of us, and taking the time to dedicate your your life's work to helping the world be slightly brighter, better place for all of us.

We could not be more grateful. And we really appreciate you joining us here on your first clubhouse.

My pleasure. I appreciate you guys facilitating so well and inviting me. There's a lot more to come. So what's more excitement coming? And I'm looking forward to some additional big news from me, from other groups around the country. And if people are thinking about or looking for a very high leverage place where a little capital goes a really long way, I mean, you can have billions of dollars of impact with a few hundred thousand dollars. I think this is one of the very, very few spaces is an opportunity right now.

So reach out to people like Damali and others who are aware of attractive high leverage places to donate or invest and get engaged can take the marbles with you. And really appreciate you guys. We should actually take that advice that we have started a Web page to document and I think one be really cool. Next step we could take is starting to list some of these investment opportunities that we have come across that could potentially really move the needle. So Dave and I will get on that.

That's really great advice. Thank you so much for being here and offering your wisdom and your experience and your knowledge and your personal anecdotes and everything you have to say. It's just been really inspiring. And I think a lot of people here, I guess, is our biggest crowd so far. So I'm really grateful to have everyone in the crowd show up. My pleasure. If anyone has any questions or comments on this, feel free to contact me.

Or do you find me on Instagram? You can find me on my email on just Google me on my LinkedIn. But Tim rocks, so thank you. And Dave, thanks again for posting this. Take care, everyone.

And to everyone on the hall and elsewhere, I have a wonderful week, has a fantastic weekend, and I'm safe out there, you seems to be kinder than necessary. You guys. Hey, guys, this is Tim again. Just a few more things before you take off. No. One, this is five Bullett Friday. Do you want to get a short email from me? And would you enjoy getting a short e-mail from me every Friday that provides a little morsel of fun before the weekend?

And Black Friday is a very short email where I share the coolest things I've found or that I've been pondering over the week that could include favorite new albums that I've discovered. It could include gizmos and gadgets and all sorts of weird shit that I've somehow dug up into the world of the esoteric as I do. It could include favorite articles that I have read and that I've shared with my close friends, for instance. And it's very short. It's just a little tiny bite of goodness before you head off for the weekend.

So if you want to receive that, check it out. Just go to four hour work week dotcom. That's four hour work week dot com all spelled out. And just drop in your email and you will get the very next word. And if you sign up, I hope you enjoy it. This episode brought to you by the book How to Lead by David Rubenstein. David Rubenstein is one of the visionary founders of the Carlyle Group and host of David Rubenstein Show, where he speaks to leaders from every walk of life about who they are, how they define success and what it means to lead.

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