What has Professor David Nutt been up to lately?

He’s been appointed Chief Research Officer, no less, to an organisation with the unpronounceable name of Awakn [sic] Life Sciences.

And what will his role be? It’s as muddled as the name and repetitively set out thus:

Prof. Nutt Will Drive Progression of a Pipeline of New Psychedelic Medicines, Helping to Define a Clear Development Pathway to Treat Addiction Through Psychedelic Medicines

I suppose one could say that he will drive progression of something through a pipeline, in this case psychedelic medicines, stated twice. And the purpose of the driving, we are informed, is to help define a clear development pathway, etc.

But the driving of progression through the pipeline surely wouldn’t be to help define an unclear development pathway, so we can leave out the word ‘clear’. Even so, we have a conflict between a pipeline and a pathway. Which is it? Mind you, it’s not just any old pathway but a development (!) pathway. Well, blow me down! What is a pathway or pipeline in this context for if it isn’t the development of something or other? Anyway, a pipeline sounds rather grander than a mere pathway, so we’ll let the former word take precedence. Incidentally, what is waiting at the end of the pipeline? The worthy aim of treatment of addiction.

Then they could simply say: Prof. Nutt will investigate psychedelic drugs in the treatment of addiction.

The Count of Monte Cristo
To be fair to Prof. Nutt, in a publication of the Conservative Drug Policy Reform Group called Medical Use of Psilocybin, which is a plea for this drug to be made available to researchers without its current onerous restrictions, there is a quotation from a participant in a clinical trial of psilocybin in depression:

There were times in the whole experience where I felt like I was being purged of self doubt and guilt and was being shown ways of handling all that was bringing me down. It was like having the best therapist in the world inside your mind, but all the answers were within. I cried at times, I laughed and afterwards felt totally moved by it all…My doctor was amazed also. I didn’t want any more anti-depressants, nor have I taken any in five years now.

It reminds me of the celestial wonders of hashish described by Alexandre Dumas in his thrilling story, The Count of Monte Cristo. This is the effect it had on the character called Franz:

His body seemed to acquire an airy lightness, his perception brightened in a remarkable manner, his senses seemed to redouble their power, the horizon continued to expand…a blue, transparent, unbounded horizon, with all the blue of the ocean, all the spangles of the sun, all the perfumes of the summer breeze; then in the midst of the songs of his sailors—songs so clear and sonorous, that they would have made a divine harmony had their notes been taken down.

Anecdotal evidence
The problem with the statement of the clinical trial participant is that it’s anecdotal evidence, which is notoriously unreliable. It assumes that what apparently applies in one or a few cases will apply generally. Again, to be fair, they don’t make this assumption but hope to prove it if only they could have unrestricted access to psilocybin for research purposes.

Fair enough, but you need more than anecdotal evidence to persuade regulators to allow a trial of this drug in the large numbers required to show whether it’s effective, or not, in depression:  you would need to have a plausible hypothesis of how the drug might work in the first place.

This is where we run into two insurmountable problems. To start with, what is depression? It undoubtedly causes much suffering but it’s a symptom, not a diagnosis; it doesn’t arise in a vacuum. It’s caused by adverse life events and there’s no reliable evidence that it’s a primary brain disorder. Therefore, there is no known mechanism by which psilocybin might work. In the above paper there’s a reference to a study of functional MRI brain scans of volunteers who took the drug, which showed that certain areas of the brain used more or less oxygen compared with controls. Very interesting no doubt, but what does this tell us about the effect of psilocybin on the brain?

What do we know of how the mind works?
What we know about consciousness and how the mind works is almost zero. Our ignorance in this area has been likened to the situation where, hearing a symphony coming out of a radio, we unscrew the box and look inside for the musicians.

Any beneficial effect of psilocybin, therefore, is empirical, but if the anecdotal evidence could be shown to apply generally we would have a cure for people suffering from normal human misery!

This is only the background. Now Prof. Nutt wants to use psilocybin to treat addiction. Does he, then, regard addiction as a single disease entity? Is alcoholism the same as heroin addiction? And is this the same as nicotine addiction? And as caffeine addiction, if there is such a thing? Are all addictions fundamentally the same?

Here we run into another difficulty. Psychedelic drugs, or for that matter any drug used to treat what are called mental illnesses, by definition and intent will cause a chemical imbalance or some other kind of disturbance in the patient’s brain. In other words, they will produce an altered state of consciousness. That’s why all these treatments have side-effects such as sedation, depersonalisation, and emotional blunting.

So if you believe, as Prof. Nutt apparently does, that patients who are diagnosed as suffering from a mental illness have a brain abnormality, does it make sense to compound this with an exogenous psychedelic substance the action of which we know very little about?

Dr Samuel Johnson’s last words
He even wants to use psychedelic drugs to help people who are dying deal with their fear and anxiety. A worthy aim, but is there no better way to do this than to induce an altered state of consciousness? Evidently Prof. Nutt is unfamiliar with, or is unimpressed by, the dying words of Dr Samuel Johnson as recorded by his biographer, James Boswell.

Dr Johnson suffered all his life from a fear of death; he could not even bear to hear the subject mentioned.

BOSWELL: But is not the fear of death natural to man?
JOHNSON: So much so, Sir, that the whole of life is but keeping away the thought of it.

Nonetheless, when on his deathbed at the age of seventy-five he asked his physician for a direct answer and was told that only a miracle could save him, Johnson resolutely faced death.

Then, (said Johnson) I will take no more physick, not even my opiates; for I have prayed that I may render up my soul to God unclouded.

Text © Gabriel Symonds