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Psilocybin for treating depression in cancer patients: Informative 5-star release from Johns Hopkins

Hallucinogenic Drug Psilocybin Eases Existential Anxiety in People with Life-Threatening Cancer

Our Review Summary

Psilocybin, magic mushrooms, Psilocybe Cubensis mushroomThis release focuses on a recent study that found a single application of the hallucinogen psilocybin is effective at providing meaningful relief to cancer patients suffering from severe depression or anxiety. The release is exceptionally thorough, addressing benefits, potential side effects and study design in a meaningful way.

The study is one of two on the subject that were published recently in the Journal of Psychopharmacology. We also reviewed a news story by the LA Times that reported on the studies. Reviewers found that article balanced overall, but with an unsubstantiated claim that psilocybin was beneficial for conditions outside the scope of the research.

 

Why This Matters

We have done three reviews related to these studies: one on a news story from the LA Times, one on a news release from NYU, and this review on the release from Johns Hopkins. And the core issues involved are similar across all three items. Cancer is a widespread health problem that affects many millions of Americans. According to the National Cancer Institute, just under 1.7 million people in the United States will be diagnosed with cancer in 2016 alone. If you consider that each of those people has a family and loved ones who are also affected by the diagnosis, you can begin to appreciate the scope of the problem. According to a report from the National Institutes of Health’s 2002 State-of-the-Science Conference on Symptom Management in Cancer: Pain, Depression, and Fatigue, “The clinical ‘rule of thumb’ is that 25 percent of cancer patients are likely depressed enough at some point in the course of disease to warrant evaluation and treatment.” Again, that depression affects not only the patients, but their loved ones. This makes it especially important for research institutions and news outlets to write responsibly about studies like those discussed in this release. You want to give readers enough information to help them make informed decisions. You don’t want to raise false hopes, or sensationalize the work. This release does a very good job of handling a delicate subject well.

Criteria

Does the news release adequately discuss the costs of the intervention?

Not Satisfactory

Cost is not addressed at all.

The costs associated with cancer treatments has been the topic of discussion for some time. So, cost of palliative treatments are important.  While there may not be any good estimates of a commercially available product at the moment, the regulatory issues associated with psilocybin are considerable and are likely to have a large impact on cost. The release could have addressed this in a general way, even if specific cost figures are not available. 

Does the news release adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

This is a tricky one. The release does tell us what percentage of patients benefited from psilocybin treatment, but does not explicitly quantify the extent of those benefits — which is what this category is designed to address.

However, the release does address benefits in a meaningful way. Here’s how: First, the release makes clear that all of the study participants had received a formal psychiatric diagnosis. That tells us that they were suffering from symptoms of clinical anxiety or depression. Second, the release states that six months after the treatment “about 80 percent of participants continued to show clinically significant decreases in depressed mood and anxiety, with about 60 percent showing symptom remission into the normal range.” That language telling us that about 60 percent were in the normal range is important, because it means they were no longer exhibiting clinical anxiety or depression — and that is sufficiently meaningful to earn the release a satisfactory rating here.

The release would have been better if it had been more clear that this was a cross-over study so all participants received both the low-dose (placebo) and the full therapeutic dose in either the first or second treatment session. In addition, no comparison is given between the low-dose and high-dose therapeutic effects. Instead, the release describes benefits five weeks and six months after the second session, after all participants had received the strong dose.

Does the news release adequately explain/quantify the harms of the intervention?

Satisfactory

The release does a good job here, stating that “15 percent of participants were nauseated or vomited, and one-third of participants experienced some psychological discomfort, such as anxiety or paranoia, after taking the higher dose. One-third of the participants had transient increases in blood pressure. A few participants reported headaches following the session.” Well done.

Does the news release seem to grasp the quality of the evidence?

Satisfactory

The release does an exceptionally good job here, laying out the study design over the course of seven paragraphs. The description of the study was both detailed and accessible to non-experts. Nicely done.

Does the news release commit disease-mongering?

Satisfactory

No disease mongering here.

Does the news release identify funding sources & disclose conflicts of interest?

Satisfactory

The release clearly lists the sources of funding for the research. That’s enough to earn it a satisfactory rating.

Does the news release compare the new approach with existing alternatives?

Satisfactory

Again, the release does a good job here. For example, the release cites a lead researcher from the Johns Hopkins team saying that “traditional psychotherapy offered to people with cancer, including behavioral therapy and antidepressants, can take weeks or even months, isn’t always effective, and in the case of some drugs, such as benzodiazepines, may have addictive and other troubling side effects.” Would a more detailed comparison be valuable? Yes. Do we think the language in the release is sufficiently meaningful to merit a satisfactory rating? Also yes.

Does the news release establish the availability of the treatment/test/product/procedure?

Not Satisfactory

It is not clear from the release whether psilocybin treatment is currently available, or what the short- or long-term prospects are for psilocybin treatment availability.

Psylocybin is categorized as a Schedule 1 drug by the Drug Enforcement Administration and its availability is tightly controlled. There is a precautionary note in the release,”…they do not recommend use of the compound outside of such a research or patient care setting.”  But given the availability of “magic mushrooms” and the availability of DIY instructions on identifying and growing same, we think that some additional comments would have been worthwhile.

Does the news release establish the true novelty of the approach?

Satisfactory

The release places the work in the context of previous research from Johns Hopkins, which is enough — barely — to earn it a satisfactory rating here. What we would really like to see is how this work compares to previous research done specifically on the use of psilocybin to treat anxiety in cancer patients — such as this 2007 study, this one from 2011, or this one from 2013. We don’t necessarily expect an exhaustive comparison, but there needs to be at least some recognition that other work has been done in this field over the past 10 years.

Does the news release include unjustifiable, sensational language, including in the quotes of researchers?

Satisfactory

The release refrains from bombastic language, offers meaningful detail, and is written in clear, understandable language. We particularly liked that the release states up front that this was a small, and double-blind, study. We also liked the note that “the drug was given in tightly controlled conditions in the presence of two clinically trained monitors and [researchers] said they do not recommend use of the compound outside of such a research or patient care setting.” Well done.

Total Score: 8 of 10 Satisfactory

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