Our society believes that some mind-altering substances help make you "sane" (if prescribed), others make you happy (or less depressed), some may change the way you think about life, and some of these – aficionados hope – are also "good for you." Last year, about a third of US adults got seriously high on alcohol, a fifth used an illegal mind-altering drug, and perhaps a sixth were prescribed mind-alerting medication. These substances were used intermittently, and – with the possible exceptions of psychedelics and prescription drugs – did not necessarily affect users’ thinking all the time. But even so, many got into accidents or engaged in violence while under their influence. Wouldn’t it be great if the mind-altering drug that leads to feeling good also improved your health? If so, it would tend to compensate for these untoward effects.

Are marijuana and psilocybin (from "magic mushrooms") candidates for improving health? Aficionados, some of whom are professionals (Sigmund Freud once touted cocaine as miraculous), claim marijuana and/or psilocybin have done them so much good they should be available to all. The believers in marijuana as "generally healthy" were influential enough to generate a large pre-2016 study of complications from elective surgeries. Sure enough, marijuana users seemed to fare no worse, and this result helped arm those claiming "pot is at least harmless." But the findings didn’t support the "beneficial" claim. Those taken with pot are persistent, and many are professionals. So another study was carried out involving 6,211 adults diagnosed with "cannabis use disorder" (e.g., heavy pot users, not just "users") undergoing major surgeries. They were matched with non-users undergoing the same surgery [JAMA Surg.2023;158(9): 935-944]. If pot were generally beneficial, would the "pot-supported" die less or heal better? A tiny statistically significant difference favored the non-pot-addicted (7.73% of the addicted v 6.57% of the non-addicted had complications or died). The pot-addicted also cost the medical system somewhat more. The differences in the new study were so small and the number of surgeries so large, that the outcomes should probably be counted as basically "no difference."

Considerable money is riding on whether marijuana becomes more available. As the President and his party support its nationwide legalization, politics is involved as well. There is no way to prove that pot doesn’t cure something – how would you test every possible malady? Both studies of surgeries failed to support "pot is good for you," but also supported it as medically harmless. Given so many enthusiastic users, more studies on whether pot use is healthy are destined to appear.

In October 2023, psilocybin (from magic mushrooms) was used to treat depression with claims of spectacular success [JAMA. 2023;330(9):843-853]. Prior studies suggested that PTSD, anxiety, and depression were often diminished when psilocybin was administered. This study administered psilocybin to adults aged 21-65: 51 got a dose of psilocybin and 54 were given niacin (as a comparison). The outcome was their scores on a clinician-administered depression scale after six weeks. The psilocybin group dropped 19.1 units while the niacin group dropped by 6.8 – 12.3 points better for psilocybin. While the study was well done – but with modest numbers of subjects and a powerful drug that may have effects for much longer than six weeks – it is far from dispositive. We live in a culture in which being featured in a prestigious publication as the Journal of the American Medical Association means that how these two groups scored on a depression scale after six weeks might be enough to affect drug policy. Indeed, liberal enthusiasm was enough to legalize psilocybin in Colorado and Oregon. At least these authors noted that “psilocybin…was associated with a higher rate of overall adverse events and a higher rate of severe adverse events.” Since some claim that they have been drug-free or alcohol-free years after taking psilocybin, a much, much longer-term follow-up of the subjects in psilocybin research is needed.

Psychiatry was excited by the astounding possibilities of psilocybin since its administration and follow-up are labor intensive. Hospitals and MDs seemed on the verge of a gigantic new money-maker like gender dysphoria. Wow, the buzz was getting louder and louder.

Then, on October 22, a "nice married father with kids" on psilocybin (who happened to be a pilot) tried to crash an airliner. His "confusion" put the possible medical bonanza into perspective. Reducing depression in a few more patients at the cost of airliners crashing (or worse) was hardly a reasonable trade. Though still legal in Oregon and Colorado, psilocybin enthusiasm has been squelched for at least a while.

Any number of neurological experts and countless media personalities claim “research has validated anxiety and depression as legitimate brain disorders.” As Dr. Daniel Zeidner wrote in the Wall Street Journal (4/22/22) “decades of research have failed to show any proof that ‘research has validated anxiety and depression as legitimate brain disorders.’” Notice – “any proof” – a clear empirical link between some brain differences associated with either anxiety or depression has yet to be established. Dr. Zeidner said “There isn't a single abnormal biologic or medical test – blood test, X-ray, biopsy – that psychiatrists use to diagnose ‘mental illness.’” We talk about people being happy, or fearful, etc. all the time – but there isn’t a single biological test we can use to "prove" those mental conditions are present in someone without their telling us.

We think "mind = brain" all the time, and it seems likely true in some sense from what we know of brain injuries and their effects on the victim’s behavior or mental state. But showing the locus of the disorder in the brain or showing the nature of the "problem"

with the brain that "causes" these mental/emotional problems still eludes us.

But the brain/mind connection isn’t all that we don’t know. Dr. Zeidner: “No medical test can fully answer the brain alterations in patients given pharmacological treatments, either.” That we can’t explicate what changes in the brain occur and apparently cause the mental states because of a drug’s use (such as psilocybin) is also agonizingly true. When the pilot on psilocybin entered the plane, there was no "brain test" that could have detected it. We know that "strange things" happen in the thinking of those who take psilocybin – but from their reports or actions, not from a physical test of their nervous system.

Dr. Zeidner wrote before the discovery (announced October 10, 2023), that there are over 3,000 different kinds of cells in the brain. Current textbooks mention perhaps hundreds of different kinds of cells whose differential functioning is only partially known. While we have some knowledge of brain functioning, it is still close to a black box when it comes to understanding the effects a drug is having on it.

Dr. Zeidner is also skeptical of "mental illness:" “Our society is awash with disorders of all sorts according to psychiatrists.” To back up his point, almost every year a large study is released (often from the government) claiming ever more are "in need" of "therapy" because mental illness is growing due to "covid," "loneliness," or whatever. Might professionals be "inventing" mental problems to drum up business? Their "treatment" of "gender dysphoria" with counseling, hormones, and surgeries could certainly be viewed that way – especially since the official "condition" didn’t exist until the 1960s. If a "medical necessity" is established simply by professional associations agreeing that X is a "medical necessity" it lets those with a financial interest in certifying X be both judge and jury. And although we’d not like to think it, financial incentives do influence judgment.

Dr. Zeidner warned that “antidepressants and antipsychotics used to treat these supposed disorders come with warnings that their use, as well as their discontinuation, may cause the very same thoughts and emotions for which they are prescribed, or worse.” Imagine, a "treatment" whose “use, as well as discontinuation” could cause the same conditions is a win/win for the professional and – given that almost all drugs have side-effects – a real risk for the patients.

Zeidner opines: “drugging people to cloud out thoughts should be short term and reserved for extreme cases….” When you take a mind-altering drug, your thoughts are "clouded" to be sure, but is it worth whatever risks go with the medications – for you and for society? Given that most therapies don’t always work, but work for some, it is hard to be certain.

We are constantly bombarded with advertisements that promise a cure if a medication is taken and our dramas reinforce the notion that "doctors know how to cure." But counter to what seems to be promised by "empirically based medicine," the efficacy of commonly used drugs is fairly modest. The research by S Leucht, et al, "How effective are common medications: a perspective based on meta-analyses of major drugs. doi.org/10.1186/s12916-015-0494-1" is highly instructive.

The authors attempted “a realistic perspective on the general efficacy of common pharmacological treatments” by summarizing “systematic reviews of randomized controlled trials with meta-analysis comparing drugs used in [20] specific therapy types with placebo.” These benchmarks are sobering because only one drug therapy "cured" even half the time.

For instance, using the proton pump for the reduction of gastric acid scored as the most effective therapy, with the treated having 58% less difficulty with reflux, etc. than the controls. Oxycodone for post-operative pain reduction by at least half, scored 28% better. Antidepressants for major depressive disorders scored 17% better (it was 19% for “sustained remission” for the remaining 81 subjects in the 6 week psilocybin study above). Statins scored 4% and taking aspirin 1.5% for lowering adverse cardiovascular events – considerably less than their extensive laudatory coverage would seem to warrant. Alas, since studies that find something that "works" get published and those that don’t seldom see print, these percentages would probably be lower if the "no difference" studies could somehow be located and included.

Enthusiasm for a "new treatment" should be tempered by our experience in which drug therapies seldom worked even half the time. But they worked for some – making our lives, on average, considerably healthier than for those who lived before us. Also, the uncertainties accompanying almost any mind-altering drug should make us reluctant to use it except in “extreme cases” and then possibly with the patient under complete supervision.

All of us don’t drive responsibly, eat responsibly, exercise as we should, etc. And while some of this irresponsibility is due to drug effects, most is associated with our choice of entertainment and otherwise living a life. Yes, we know far less – about what treatments or drugs might cure us and how various substances affect the brain – than our experts pretend to know. Yes, the efficacy of drugs and treatments are exaggerated and usually don’t do what we hoped or expected. But we are fortunate to live when many maladies might be cured – and these cures emerged from the cacophony of our money- and attention-driven culture. All in all, an interesting time to live.