Most ‘Evidence-Based’ Treatments are Bullshit (for the One Person that Counts)

For the past five years, I’ve been funding medical research into using psychedelics to treat mental disorders. What I’ve realized over that time is that the current system for evaluating new drugs is horribly flawed.

In order to avoid the risk of a bad outcome, we routinely reject treatments that work for thousands of test subjects, because if they don’t work for nearly everyone, they fail the evidence test.

If you have hundreds of millions of dollars to fund trial after trial until you get two of them to pass the magical threshold of statistical significance, then you get approved by the FDA. Ignore the 10 trials where the drug had no or negative effects, we’ll take the best two please. Here’s your billion dollar patent to raise the price of a generic treatment (ketamine) to 100x the street price. You’re welcome.

And if you have a treatment with clear benefits and reduced side effects, like psilocybin for depression in patients with no previous history of SSRI use (study from Imperial University in London), the system will still recommend SSRIs as a first line treatment, no matter what the doctor or the patient think.

When I was diagnosed with bipolar disorder, I was given the first-line evidence based treatment, which was Lithium. It gave me terrible jitters and nausea, but didn’t do anything for the depression phase I was in. Then on to five other evidence-based treatments that didn’t work until one enlightened psychiatrist put me on Lamotrigine, which had just been accidentally discovered to work on treating depressive bipolar disorders in epilepsy patients.

The initial clinical evidence to support the use of Lamotrigine for my condition was mixed, but because the drug was proved safe for epilepsy treatment, It was allowed off-label for bipolar disorder (I was one of the first patients to receive it). Thank god, because I’ve been on it for 20 years and it has changed my life.

When my daughter was diagnosed with an eating disorder, the first line “evidence based” treatment is to force the patient to eat until they’re at a normal weight. Forget for a moment that the term ‘normal’ isn’t one anybody can agree on, it still only works in 25% of cases and may cause needless suffering and further trauma in many others. It’s never been subjected to a clinical trial, because, well, it’s food. But it was developed based on a number of military studies between World War I and World War II on starvation. Not so applicable to teenagers 100 years later.

Just because the “evidence” says it’s the only treatment that works doesn’t mean it’s the only treatment that works. Studies that show treatments don’t work aren’t done, because there’s no profit in it.

This is the flaw in government and medical reasoning on how to deploy treatments, and on how to decide what gets funded. We don’t know all the solutions out there. If someone thinks something will work and there’s a little evidence that it’s not going to do more harm than good, let people try it.

There has never been a randomized placebo-controlled trial to determine whether Ayahuasca is safe and effective. But hundreds of thousands of people have used it to positive effect. In a talk I attended, Dr. Gabor Maté said, “I’ve personally witnessed over one thousand people benefit from Ayahuasca. You don’t need a randomized placebo controlled trial to know every damn thing works.”

A friend of mine suffered from debilitating cluster headache attacks. In the course of reading about people’s experiences on psychedelics, I had run across a couple of Reddit posts of people saying that psilocybin (magic mushrooms) had helped them treat their cluster headaches. I suggested it to my friend, who used to get these horrible attacks three or four times a year, and taking a small dose of mushrooms regularly, he hasn’t had an attack in five years and counting.

Psilocybin is not an “evidence-based” treatment for cluster headaches. But psilocybin is also not harmful when taken with proper guidance (primarily, know your dose). If you have cluster headaches, you may want to consider it.

I think there’s this notion in the term “evidence-based” that some things work for everyone and some things don’t work for anyone. That’s just not true. Sometimes, you have to try a lot of different approaches to figure out what works for YOU, and you should feel free to try anything that doesn’t harm you and you think might work.

I do worry a little that if everybody takes this advice, ERs will get flooded with people who drank Lysol to cure COVID. So a word of caution: don’t get evidence just from Facebook or Instagram posts. Do a Google search, look for corroborating information. Reddit is a great source for personal stories. Personal experiences of someone you actually know are best. And of course the best test subject for you is you.

SSRI antidepressants work for some people. That doesn’t make them better for you. And when you do find something that works for you, don’t treat it as the best and only solution. It might not work as well for others.

Don’t be a drug or therapy elitist. It took me seven tries to find something that worked for my bipolar issues. My fifth physical trainer is the one who finally got me into shape. It took 25 years of therapy before I stumbled onto Internal Family Systems, which has been the most remarkable and transformative. Keep looking. Understand the nuance underlying the statistics. If something isn’t likely to be harmful, then you only need evidence from one person — you.

1. One of the Military Experiments on Starvation.

2. My fifth physical trainer, Darrin Robinson, who stopped training me because he became famous on TikTok.