A very small study of the therapeutic potential of the illegal narcotic Ecstasy has produced what, on the surface, appears to be counterintuitive findings. The study indicates that taking Ecstasy may help people recover from post-traumatic stress disorder. The actual data to back these findings are shaky, at best, and readers should have been told more about the funders of this study. The story, though, is framed as if the case already has been proven and that if people can just find some Ecstasy that is pure enough, they will be able to cure their PTSD. While some counter-balancing facts are tossed in, the overall tone of the piece reads like a press release for the group that funded the study. The story seems like an attempt to generate some quick web hits by riding the Ecstasy titillation factor – and little more.
The medical benefits of illegal drugs are often touted by the drug legalization lobby as a wedge to open more avenues for the legal use of narcotics. Some drugs have shown promising therapeutic benefits, but, in part because of the difficulty of conducting a study based on an illegal drug, the evidence base is thin. Legitimate studies that showed improvements in treatment for PTSD would be hugely beneficial, particularly for veterans returning from Iraq and Afghanistan.
At a minimum, the story could quote the DEA, FBI or other law enforcement source on a price range for a typical dose of MDMA. The reporter also could have asked the authors how they obtained MDMA and how much it cost them.
The story quickly shows the actual numbers behind the hype in the lead. The second graph says, "The study, which appears in the Journal of Psychopharmacology, included 20 people with PTSD stemming from traumas such as sexual assault and combat stress. On two separate occasions, 12 of the people took a dose of MDMA and then spoke for several hours with a pair of trained therapists. The others took a placebo but received the same therapy. (All of the participants received additional therapy sessions that did not involve the drug.)" One dozen people took a drug twice and talked to a therapist. Of those, "Two months later, 10 of the 12 people who took MDMA had improved to the point where they no longer met the diagnostic criteria for PTSD, and three participants whose condition had prevented them from holding down a job were able to return to work." What the story fails to do, though, is explain whether, even with this small number of people, a significant benefit could be attributed to the drug. The press release actually does a better job by explaining that "Prior to enrolling in the MDMA study, subjects were required to have received, and failed to obtain relief, from both psychotherapy and psychopharmacology."
It does not quantify the potential harms. It does, at least, mention a few of the dangerous effects of the drug. "Don’t try this experiment at home. Ecstasy use can cause depression, severe anxiety, and potential cognitive problems, according to the National Institute on Drug Abuse. And when purchased on the street it can be contaminated." The possibility of an overdose would have been a nice mention.
No attempt was made to evaluate the quality of the evidence in this story. The press release actually offers more caveats than the story, saying, "The authors caution that the study does have limitations – for example they did not look at gender and ethnic factors in their sample selection. Another important limitation was that most participants and trial investigators guessed accurately whether they were in the treatment or the placebo group. The placebo had no psychoactive effect and investigators could detect raised blood pressure and other symptoms in the MDMA group. A long-term follow-up to the study just published, evaluating subjects an average of about 40 months post-treatment, is underway." So, if the participants in the study knew that they were taking a placebo, what would that do to their mindset during therapy? Conversely, those taking drugs knew they were taking drugs and may have responded in a positive way to please the researchers, a very real response. On the plus side, the story didn’t use percentages, which would have been even more misleading. Instead, it just gave readers the raw numbers, which to anyone who has read more than a few medical studies or health stories would be underwhelming.
MAPS is a drug legalization organization. In its stated mission, it says, "We believe that psychedelics and marijuana, when used in proper settings, can be beneficial for such uses as psychotherapeutic treatment, physiological research and treatment, treatment of addiction, pain relief, spiritual exploration, creativity research, shamanic healing, psychic research, brain physiology research and related scientific inquiries….We also provide psychedelic emergency services at festivals where psychedelics are likely to be used in an effort to model harm reduction techniques in a post–prohibition world." There aren’t many purely scientific research organizations that sell posters of celestial beings shooting light rays from their eyes. This is noted nowhere in the story and is important information for the reader to have in deciding how to evaluate the findings. There are no independent sources in this story, and they are sorely needed.
The story says that "MDMA is believed to raise levels of the feel-good brain chemical serotonin and the so-called "bonding hormone," oxytocin." Existing anti-depressants and anti-anxiety drugs do the same thing, but none of these drugs are mentioned. Also, because these patients were talking to therapists, there should have been some control in the study design for the therapy itself. How do we know how much the drug was raising people’s sense of euphoria and how much of the change was due to the therapy?
The first sentence states that "The drug MDMA—better known by its street name, Ecstasy—may be illegal, but a new study suggests that it’s also a promising treatment for post-traumatic stress disorder." The story underscores the point several times that the drug is illegal and currently unavailable for therapeutic use.
At least the story stated, "This was the first clinical trial to explore the therapeutic potential of MDMA since the drug was outlawed in 1985."
This story provides almost no information outside of the press release from the journal. The one added detail about the downsides of Ecstasy would have required 30 seconds of Google searching. Nonetheless, we can’t be sure of the extent to which the story actually relied on a news release, so we rule this not applicable.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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