Hacker News new | past | comments | ask | show | jobs | submit login
FDA grants Breakthrough Therapy designation to MDMA for treatment of PTSD (maps.org)
428 points by anythingnonidin on Aug 28, 2017 | hide | past | favorite | 113 comments



To the extent that anyone on HN knows an active philanthropist looking for potentially highly impactful but severely underfunded causes - send them one of these articles: https://www.inverse.com/article/32376-mdma-ptsd-therapy-dr-b..., https://www.vice.com/en_us/article/j5x748/the-refugee-fundin..., http://www.newyorker.com/magazine/2015/02/09/trip-treatment, or encourage them to read the book/audiobook called 'Acid Test.'

I believe there's a case that funding MDMA research has very high dollar/impact returns - or at least that it's likely enough that it's worth a thorough exploration.

It sounds like they still need to raise about $12 million, which is shockingly small compared to the ~$1.5bn/yr NIMH budget - and all of it will come from private philanthropists, as governments aren't yet willing to fund the work and for-profit companies don't see much profit yet due to the lack of patentability.

If you're on HN and this is the first you're hearing about this research, some resources:

- A short video excerpt from a documentary on MDMA therapy - https://www.youtube.com/watch?v=W9iKx2MKS70

- NY Times article - https://www.nytimes.com/2016/11/29/us/ptsd-mdma-ecstasy.html


Or donate yourself... I have donated money to maps. Small amounts add up. I don't often donate to charities. But this is an opportunity to contribute to something that is likely to provide a long term solution for a serious problem.

https://store.maps.org/np/clients/maps/donation.jsp?campaign...


Yes, please. I'm the same way - I don't really donate to things, wouldn't consider myself the type of person who "donates," but I donated to MAPS last year and this year. Felt good.


I know MDMA is frequently defended as being a "safe" drug insofar that there's no physiological health risks (e.g. alcohol's liver damage, cocaine's cardiotoxicity) but I understand the MDMA is neurotoxic (e.g. https://www.ncbi.nlm.nih.gov/pubmed/28801175 and https://www.ncbi.nlm.nih.gov/pubmed/16499508 ) - much like methamphetamine and amphetamine, which are both similar drugs, chemically and psychoactively. I've never taken MDMA but I know people who have - who describe how they refuse to take it more than once every six months to prevent said neurotoxic damage, as well as taking dietary supplements that allegedly mitigate damage - which corroborates what I've read on Erowid.

Obviously for certain classes of PTSD sufferers the tradeoff would be worthwhile (similar to how the negatives of stimulant therapy for ADD are a trade-off if it enables an otherwise healthy and productive life) - so I'm hoping this will enable further research into the negative side-effects of stimulant therapy for PTSD - as well as better research into supposed damage-mitigation techniques - so far a lot of published research on stimulants has been only performed on rodents whose CNS are considerably different compared to our own.

Anecdotally, I have comorbid ASD and ADD with an anxiety disorder and I found that amphetamine-based drugs prescribed for my ADD (Adderall, Vyvanse, et cetera) have worked wonders for my anxiety issues - which surprised my psychiatrist because typically worsening anxiety is a side-effect of amphetamine.


My brother and I, along with our siblings, all have various psychological issues (like PTSD, anxiety, etc) caused by a pretty brutal period in our childhood that resulted in the neighbors calling Child Protective Services and us being placed in foster care.

When I was 19 years old I went to a rave and took a pill which definitely contained MDMA (in addition to whatever else the dealers put in it) and what I will say is this:

It was literally a life-changing experience for me. I felt emotions that I had literally turned off, and walls I didn't know I had were opened up. I remember being shocked days later, when I realized that the drug was no longer in my system, and yet I was smiling and making eye contact with my roommates and classmates, holding real conversations with them. These were things that had been pretty crippled in me before.

MDMA is powerful stuff, and it's a shame that this hasn't been properly researched due to our Federal Government's juvenile, ignorant attitude on drugs.


Have some childhood issues too and a hit of acid changed me for about fifteen years. Hadn't done it before or since. It was like my brain was suddenly rewired to see good in the world and desire to be a part of it. Literally I sprung out of my support job and launched a superstar career, changed the world a little through good honest work.

I'd done some 'e' before that but the positive effects lasted more on the order of several weeks, while I have some fond memories of feeling loved for the first time and meeting people and being social, I'm not sure if or how it contributed to my good years.

So apparently it is common for childhood issues to resurface during middle age. Common as in the therapists retort "Well what else do you expect?" I hope this doesn't happen to you... I am too old and responsible to be taking risks with street drugs. Mainstream pharma seems to affect patients very differently, and I have heard regrets about doing mdma and bad trip stories about LSD.

Thanks for relating your experience, it is very interesting to me because we have some similar background and got such great assistance from taboo chems. I have related the results of my acid trip to various kinds of people across the social spectrum, from beatniks to white shirt C levels and a USN Admiral, and not many people get it.


I have an older family member who experienced something very similar, having suffered abuse and self-abuse for 50+ years. A single experience unlocked their life in ways that they could have never imagined and allowed proper healing and recovery to begin. This person is now doing better than ever.


Thanks for sharing your experience.


Worth reading:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3053129/

> In a study designed to minimize limitations found in many prior investigations, we failed to demonstrate marked residual cognitive effects in ecstasy users.

> We found little evidence of decreased cognitive performance in ecstasy users, save for poorer strategic-self-regulation, possibly reflecting increased impulsivity. However this finding might have reflected a premorbid attribute of ecstasy users, rather than a residual neurotoxic effect of the drug.

Good news, seems like even in long-term ecstasy users they have good cognition.

Edit, also:

> MDMA researcher Matthew Baggott: “To the best of my understanding, doses around 1.5-1.7 mg/kg MDMA (roughly 100 to 125 mg MDMA) are unlikely to cause long-lasting serotonin changes. Studies by MAPS have looked for changes in mental abilities after people participated in their studies, with some participants receiving 125 mg followed by 62.5 mg, and have not found any changes.” MAPS study protocol involves 3 - 5 week breaks, and a total of 2 or 3 MDMA sessions in total.

https://rollsafe.org/mdma-side-effects/#possible-long-term-s...

And if you want to become an expert and get a summary of all of the safety research, ~1 page of reading here: https://www.mdmawiki.org/wiki/Is_MDMA_Neurotoxic%3F


The verdict is still up in the air

> Our largely negative findings appear inconsistent with many past studies as well as some more recent investigations (55-57) that report lowered cognitive functions in ecstasy users. Indeed, our findings are inconsistent with several findings in our own pilot study (15)


Thus why this new approval is such a big deal. We can finally research it and make some scientific conclusions instead of DEA conclusions.


p-values. They gotta stop relying on p<0.05 which is really a low bar.


Something to keep in mind is that cumulative toxicity is important. The regimens typically used in non-human primates were 5.0mg/kg doses twice daily for 4 days taken subcutaneously instead of orally. A regimen of 2.5mg/kg given orally (p.o.) to Rhesus Monkeys once every 2 weeks for a total of 8 doses over 4 months produced no detectable effect on 5-HT and 5-HIAA levels.

Its likely that the monkeys that are seeing neurotoxic effects are taking something like 4-8+ doses at once and doing that twice a day for four days straight. That would fry anyone.

https://www.maps.org/news-letters/v05n3/05310neu.html


I personally worked on developing the Investigative Brochure for procedure in preparation for the Phase 3 clinical trials at MAPS. The concerns regarding neurotoxicity are mitigated through dosage and low frequency. The ideal treatment plan would only include one session with a therapist in which the patient is given a dosage of MDMA, over a six month period. During that session it's possible for the patient to receive a supplemental dosage dependent on the needs of the patient and the recommendations of the therapist. This can be adjusted and in previous trials some patients have had 2 MDMA-assisted sessions over 6 months but it is not common so far and other options are being considered.


Can you comment at all about how the MDMA therapy session is conducted and/or structured, compared to a normal 50 minute session?


Rick Doblin, founder of MAPS, talks a bit about this in his interview with Duncan Trussel: http://www.duncantrussell.com/episodes/2016/7/18/rick-doblin

(i'd imagine this information is available elsewhere, this is just the instance i happened to come across myself...)



Anecdotally, I went to a lot of raves in the 90s and did what I would consider to be a stupid amount of ecstasy now, as did most of my friends, and everyone that I've kept in touch with are fully functioning members of society. Most of us are making six figures, have families, etc. The people whose life turned into a mess were people that got sidetracked into methamphetamines or opiates.


Less anecdotally, millions of other people did much the same as you.

It would appear that the risk of severe and/or long-term side effects is actually pretty low, otherwise we'd be seeing many, many cases by now.

Note that this isn't evidence that there weren't more subtle long-term effects, but it seems clear that the fear of devastating brain damage was somewhat overblown, especially given that you and many of your peers were consuming drug of dubious purity in uncontrolled settings.

Note that this isn't an endorsement of taking MDMA recreationally, but it seems to me that it's almost certainly safe enough to use in treatment, especially for something as devastating as PTSD (where no treatment or ineffective treatment so often result in death).


The death of every drug study thread is anecdotal stories. They are doing these studies so we can stop referring to that time we got shit faced with our friends.


It's likely your "ecstasy" in the 90s was laced with something else too like MDA, methamphetamines, etc.

But yes, MDMA anecdotally is much safer than anything else.


From my experience in the 90s rave scene the most common adulterants were DXM and speed since they're cheap and press more easily than meth. Acid was the drug of choice when I started going to parties in 94 but then ecstasy overtook it by a long shot and acid pretty much dried up.

I think RCs as adulterants like 2cb or similar phenethylamines started to creep into the scene in the early 2000s. Then cat was _huge_ mid 2000s until it and the other RCs started to get prohibited.

This is just what I picked up from people I knew doing these things btw. I was there for the music and girls.

This sort of subject matter is absolutely fascinating to me. The intersection of pharmacology, law, society and culture and the actual evolution and changes they all go through.

I feel like you could tie phases of electronic music to the drugs people were taking at the time.


I'm not suggesting lacing mdma with dxm would be out of the question, and maybe it was more common in the 90s, but it's my understanding that the biggest adulterant of mdma (besides meth) in 2000-2013 was methylone, which could be ordered online until recently, and is known for having a relatively similar profile to mdma, with relatively few side effects and a low risk profile (to the best of our current knowledge)


In the early 2000s I don't think it would have been methylone. MDEA was a big one that was similar (although not legal, was less scheduled and / or was semi legal at some point so there were big stockpiles of it. This was for the UK


Your body metabolizes MDMA into MDA, though. And MDA is actually just the amphetamine analog to MDMA. Just thought that's important to mention, despite it not changing the fact that putting mda into mdma is still "lacing".


This is misleading - a bit like saying "ethanol is metabolized to acetaldehyde". Technically true, but you can't just take acetaldehyde and expect the same effect as alcohol. Alcohol itself is bioactive. You also don't want to injest acetaldehyde directly since you don't want high concentrations of it in your blood (its quite a bit more toxic than alcohol).

MDMA is itself bioactive/psychoactive, and MDA is more neurotoxic.


Fair point and good analogy. While I can't comment on the neurotoxicity, I will definitely say MDA itself has a more LSD like effect than MDMA does and contributes significantly to differing effects.


ahhhh, those were the days...


The data is really difficult to make sense of, and that does indeed make many people weary of overdoing it. But from the anecdata I have, it seems the 6-month intervals are often motivated by the desire to reset one's tolerance. One surprisingly effective safety feature of MDMA (unlike other amphetamines) is how self-limiting it is. A second dose within even a month never creates the same, life-changing experience as the first, not even if the dosage is increased.

Some people still enjoy the effects of such a second dose and freely consume MDMA every weekend, but for many it seems to be more of a 'meh' in comparison, and not worth the health and legal risks.


As with any substance, it can get toxic with larger doses (you can die from to much water for example). From what I remember when I read toxicity studies about MDMA about 150mg in around 3 month time is "ok", leaving no damage. Now, that is medical grade MDMA. Buying stuff on the street is a lottery every time and you will NEVER get pure stuff. One of the reasons why substances should be legal and regulated in a different way. Regarding supplements for MDMA, yeah things like 5HTP could help mitigate the damage and speed up the recovery if you take too much.


The first study you cite involves an examination of “ecstasy” users, which makes it fairly useless since pill producers can put anything they want in what is sold as “ecstasy pills”, including known neurotoxins (e.g. methamphetamine).

We won’t really have proper evidence on the neurotoxicity of MDMA unless we can study people whom we know actually ingested MDMA - rather than MDA, speed, 2-CB etc.

Furthermore, neurotoxicity is not inherent to any substance, since it must depend on dosage (I know no substance which is toxic when a single molecule is ingested). Dosage must be a parameter, or the study makes no sense — ingesting 100 grams of table salt will kill you, but we don’t call salt “toxic” because of this.


It's pretty well known that stimulants have a calming effect on patients with ADHD. Anxiety can often be a symptom of understimulation.


best source I could find for the 'understimulation' claim was this: https://academic.oup.com/ije/article/39/2/370/684049/Bored-t.... although they attribute boredom as a proxy and not a direct cause of poor health.


Your ADD meds can be as neurotoxic as MDMA, especially with seratonin syndrome. The real discussion here isn't quite safety though. It's more just having the ability to legally study them in the first place. As schedule 1 drugs, its nearly impossible for researchers to even obtain/synthesize the drugs to study in the first place leaving existing research limited to small sample sizes, old data, or subjective stories. This is a huge deal for a lot of reasons.


Citation for first point? Do you mean taking amps with an MAOI?


I would guess that MDMA neurotoxicity is highly correlated with dose.

The therapeutic dose is likely a fraction of a single recreational dose (1/10-1/2). Neurotoxicity is likely most pronounced by crazy recreation drug users taking tens of doses in a single day/weekend. I'd be surprised if therapists found it useful for their PTSD patients to be 'rolling face', but I'm no expert.

EDIT: Seems like I'm wrong - therapists are using roughly 1 full dose for therapy

See http://journals.sagepub.com/doi/full/10.1177/026988111246482...


The "high" people experience at recreational doses can take any number of forms depending on the circumstances. Enjoyment of repetitive music is certainly among them, and so is intense enjoyment of borderline-sexual behaviour. But even in a club setting, many people tend to get intensely open about their feelings. I'm no expert on PTSD, but I believe therapy is almost always limited by our reluctance to open up, especially about personal issues that we consider embarrassing, shameful, or that could be considered vulnerabilities.

The really interesting thing is that these effects somehow persist beyond the acute trip. The experience seems to include learning, i.e. the patient experiences positive emotions while (and possibly because of) connecting with people, and sees that any fears they may have had do not materialise (i.e. judgement). As a consequence they tend to become more open in everyday life, and especially with the therapist they shared this experience with.

I'd love to read some therapists' experiences. For them, it must be quite an exhilarating experience as well–just imagine how you'd feel if you suddenly became 10x as effective as your job.


>just imagine how you'd feel if you suddenly became 10x as effective as your job.

I wish I could feed my laptop a pill that would make it write better code for me


> The really interesting thing is that these effects somehow persist beyond the acute trip

This is why I am so glad to see this approach tightly coupling carefully controlled monitoring and talk therapy alongside administration of the drug. I myself had a great experience of 'opening up' at a rave once upon a time, but the comedown was horrible and I felt much worse afterward than before. It was like rising out of purgatory, getting a glimpse of heaven and then having to go live in hell, with a strong sense that heaven had only been an illusion.

A later experience was better. Which reminded me that as with anything else that's strongly psychoactive, set and setting are absolutely key.


Thanks for writing this. I think that you're second paragraph helps to explain the life-altering, and permanent, behavioral changes I experienced after taking MDMA at a rave when I was 19.


Neurotoxicity is probably also related to people overheating and overexerting themselves while on the drug - I've seen people sweating profusely and not noticing while rolling a few too many times.. which generally results in me giving them water, salty crackers, and nudging them to consider taking a quick break.


Indeed - the more visible research papers about amphetamine-related neurotoxicity in rodents reported most effects when the temperature in the brain exceeded 40 degrees - contributing towards massive oxidative stress.

Is oxidative-stress the only mechanism of neurotoxic action, or are there other effects at work, such as dopamine-downregulation or exhaustion?


125mg. Should be "rolling face".


I think a very significant risk of MDMA use has more to do with the difficulty of getting pure, uncut MDMA. Methamphetamine or some of the designer drug alternatives is frequently cut into MDMA to save money because drug dealers are drug dealers.


Hats off to MAPS! What we need for drugs like MDMA are data. The FDA has turned down other drug companies who have sought breakthrough status, because their data didn't support it.

What will be interesting is if the phase 3 is successful. The DEA won't have any choice but move MDMA from schedule 1 to a lower schedule, as schedule 1 is defined as "no currently accepted medical use in the United States".

The hilarious part is MDMA is given as an example of such schedule 1 drug on their website.[1]

[1]https://www.deadiversion.usdoj.gov/schedules/


>The DEA won't have any choice but move MDMA from schedule 1 to a lower schedule, as schedule 1 is defined as "no currently accepted medical use in the United States".

The DEA has demonstrated pretty clearly that it doesn't give a rat's ass what the medical community thinks about a substance if the DEA has decided it doesn't want to remove it from Schedule 1 classification


Yes, this is most hilarious when GHB is in both Schedule 1 and Schedule 3 at the same time, or as Wikipedia puts it:

"Schedule I but Schedule III when in an FDA-approved drug product"

So it's "no currently accepted medical use in the United Sates", apart from when it is in a FDA approved medical use. wut? :D


Well, that depends on whether CI is a logical AND, or a logical OR. No accepted medical use AND high potential for abuse? Or can it be "any of the above"?

21 U.S.C § 812[0] doesn't say anything at all except to give the list of findings:

> (A) The drug or other substance has a high potential for abuse.

> (B) The drug or other substance has no currently accepted medical use in treatment in the United States.

> (C) There is a lack of accepted safety for use of the drug or other substance under medical supervision.

This is a little surprising because the "trailing AND/OR" is fairly common in other areas of the law. Makes me wonder if it's ever been clarified in court.

There is some precedent for having a single active ingredient listed in multiple schedules though, the one that immediately comes to mind is hydrocodone.

Until very recently, we listed hydrocodone in both CII and CIII, depending on which other active ingredients it was combined with.

If it was in a pill loaded with acetaminophen, which would supposedly deter addicts from eating 20 of them at a time, it could be in CIII, otherwise it was strictly CII. Because naturally, anyone getting ready to swallow 20 Vicodin at a time is going to know that acetaminophen can cause acute liver failure and make the rational choice to avoid it.

That was one of the primary reasons Vicodin has been handed out like skittles for every little injury, it's every bit as powerful as the others in CII, but it could be prescribed with less oversight.

In that light it's not too surprising to have GHB listed in more than one schedule, but it's still absurd that one of them is CI, given that as far as I'm aware, there is nothing particularly abuse-resistant about Xyrem.

[0] https://www.law.cornell.edu/uscode/text/21/812


> No accepted medical use AND high potential for abuse?

That is Schedule II.

21 U.S.C § 812.b states:

(2) Schedule II.—

(A) The drug or other substance has a high potential for abuse.

(B) The drug or other substance has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions.

(C) Abuse of the drug or other substances may lead to severe psychological or physical dependence.

https://www.law.cornell.edu/uscode/text/21/812

Additional reading at wikipedia: https://en.wikipedia.org/wiki/Controlled_Substances_Act#Sche...


Probably that it's prosecuted as Schedule I if you don't have a prescription, or maybe that you just made it in your kitchen. I heard someone describe how easy it is to make just last week.


What we need for [problem] are data.

If only it were that simple.


I think refurb wasn't saying "all we need for this is data" but rather "we need data for this" (so hats off to the people actually producing it).


Breakthrough therapy, huh?

Let's remember that the DEA head (John C. Lawn) in the 80's forced a Schedule I classification, ignoring the recommendation of two separate hearings, and a successful federal lawsuit to do so. This was at a time when MDMA was already in burgeoning, but successful, clinical use.


Yea, the 80s were full of crazy people in government and everywhere. I remember when D&D was honestly considered being a gateway to satanism / Devil worship, and not in jest. And not a short two week news cycle thing, but it went on for years. Oh, and heavy metal too. It all finally started to wind down when the televangelists were exposed as money grubbing perverts.

Paradise Lost took place in that era. If you haven't seen the movies, they're disturbing but good.

https://en.wikipedia.org/wiki/West_Memphis_Three

You millennials think you have it bad, the boomers were absolutely batshit crazy to GenXers (we were also considered lazy BTW).


There's an insane quote from John Ehrlichman about the origin of the war on drugs in the Nixon Whitehouse:

https://harpers.org/archive/2016/04/legalize-it-all/

"The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and black people. You understand what I’m saying? We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did."

I wonder, is that credible? If so, it's kind of amazing how little has actually changed since those laws were put in place.

(Edit: okay, there are some reasons to doubt that quote) https://www.quora.com/Is-John-Ehrlichman-a-credible-source-w...


>it's kind of amazing how little has actually changed since those laws were put in place.

Given there's a lot of bureaucratic inertia and jobs at stake here, and:

"It is difficult to get a man to understand something, when his salary depends upon his not understanding it!"

...is it really so surprising?

This aspect of human nature is not isolated to the Drug War. Jaime Escalante was possibly the best teacher in America, and demoted because his success threatened the jobs of others-1

What about the never ending wars for profit? Wolf Blitzer at CNN tells us it's a moral problem for the US to stop funding war because a lot of jobs will be lost-2

The problem is that if we are to truly care about human dignity and equality, we need to fundamentally change the way in which we approve of jobs without critically looking at what they actually produce. This isn't just isolated within the economy of the War on Drugs.

1-reason.com/reasontv/2017/08/22/stossel-government-run-schools-crush-in

2-https://theintercept.com/2016/09/09/wolf-blitzer-is-worried-...


"It is difficult to get a man to understand something, when his salary depends upon his not understanding it!"

We live in a society that puts people on an economic treadmill for their entire life. The government gives incentives for getting into debt - guarantees on student loans, mortgage interest tax break. We have property taxes in most states, so you always have a bill to pay even if you never borrow.

Then people come along an propose things like basic income which can't work (I'll do the math for you one of these days since nobody else has). What they really want is to offset the costs of basic existence. I believe those costs could be lowered if the government would focus on that instead of profits and GDP.


> I'll do the math for you one of these days since nobody else has

Please do.


Regarding credibility: "Ehrlichman" literally means "honest man" in German, so there you have it :P


That gives Nixon too much credit. That sort of policy is exactly what would be in an FBI manual of the era.


> I remember when D&D was honestly considered being a gateway to satanism / Devil worship, and not in jest. And not a short two week news cycle thing, but it went on for years.

Just because D&D is no longer one of the things people with a religious agenda hired to advise law enforcement are pushing as dangerous doesn't mean things are more sane, just the targets have shifted.

> You millennials think you have it bad, the boomers were absolutely batshit crazy to GenXers (we were also considered lazy BTW).

To be fair to the Boomers, a whole lot of the crazy we in GenX put up with was from the “Greatest Generation”, not the Boomers. (And to be even more fair to the Boomers, they were treated even worse in their youth for their conflicts with the orthodoxy of their elders.)


Too late to edit, but a correction:

> To be fair to the Boomers, a whole lot of the crazy we in GenX put up with was from the “Greatest Generation”, not the Boomers.

While they are sometimes combined under the “Greatest Generation” label, this actually was intended to refer to the Silent Generation (the one mostly too young to fight in WWII, but born before its end.)


Yes, the Greatest Generation were pretty hard core, growing up in a depression of which the only escape was to fight the Nazi and Imperial Japan war machines (and I guess Mussolini too).


Sure, but then they got older, displaced the Lost Generation as the politically dominant generation, and brought us Vietnam, an abundance of abused of foreign intelligence apparatus against domestic political opponents, the War on Drugs, and Watergate.


And then taxed themselves like crazy, while building massive private and public infrastructure, and had decades of middle class income growth that was the envy of the world.


The “taxed themselves like crazy, while building massive private and public infrastructure, and had decades of middle class income growth” was mostly a combination of the Lost and Silent Generations; the “Greatest” started dismantling that when they became politically dominant and had completely wrecked it by the time the Boomers eclipsed them.


The silent generation came after the greatest generation, so I fail to see how they could dismantle it before the generation who enacted it was in power


> And then taxed themselves like crazy

While the marginal tax rate on the top bracket was very high, it applied to almost nobody, and the effective taxation yield rate of revenue to GDP was actually lower than it is today.

> decades of middle class income growth that was the envy of the world

Largely accomplished because the European post-war economy was damaged enough that the US could take over as the de facto imperial force of the world. It's not like it was due to anything that generation did; it was the global geopolitical landscape of the time, and not one we'd like to repeat.


>While the marginal tax rate on the top bracket was very high, it applied to almost nobody, and the effective taxation yield rate of revenue to GDP was actually lower than it is today.

First, it doesn't matter if it's one person, as it was in 1935, or 1000. The idea that a handful of people get to be hoarders makes the system untrustworthy.

Second, very high marginal tax rates incentivize spending money on deductible expenses rather than ones that aren't deductible. When it's a use it or lose it tax rate, and you don't think the government has the best ideas how to spend it, you can avoid the tax by taking your own risks with your own money. But the point is, again, you can't be a hoarder.


I believe the US was also oil rich during this period.


On the other hand, they also expanded into coastal regions and areas rife for economic development and secured first-mover advantages that will last for centuries.

It's not all roses.


As a millennial the one thing I hope I can maintain going forward is a healthy respect for the new, young and different. Watching every new form of media get scrutinized by clueless old people has been endlessly frustrating.


Growing up, you must have known people older than yourself - be they schoolteachers, coworkers, academic professors - who seems to be "with it" who accepted and embraced change. I wondered what made them to be like that compared to the crotchety elders we've known, who are very resistant to change.

Is it merely attitude, or does neuroplasticity come into it? I'm not even old yet (at least I don't think so) but I remember my mind being very resistant to adopting git over SVN and TFS because it was so different to what I was using and "if it ain't broken..." but now I love it. That experience has taught me to persevere: to not criticise something until I understand it, but what if I'm unable to understand something in future? Can I maintain a healthy mental state in that situation?


My bet is that to the degree that neuroplasticity is involved at all, it's effects are largely dominated by more mundane effects, such as the fact that as you get older you have kids and other commitments that keep you from spending as much time learning new things as you used to.

Likewise an 80 year old that sees themselves as having less than 20 years left might require a higher bar for the payoff for dedicating themselves to learning something new than a 20 year old that sees themselves as having 80+ years left.


> 20 year old that sees themselves as having 80+ years left

Any such 20-year-old is delusional; becoming a centenarian (let alone having good enough health to appreciate it) is not much more common than winning the lottery, at best.


> Yea, the 80s were full of crazy people in government and everywhere.

2017 is just as full of crazy people in government and everywhere. They're much easier to spot a few decades later...


I don't know... I think the clarity with which we see the past is illusory and that it comes from reading the over-simplified accounts of the victors.


True.

Also, like all tales from a culture you haven't lived in, people won't understand that actions that seem crazy today made perfect sense without technology X, Y & Z.


> Oh, and heavy metal too.

To be fair though Heavy Metal has been playing on the Satanist/Gore imagery for years, and not just in graphics, but lyrics too. Not because they are satanists, but it because it sold well.


Some acts (like Marilyn Manson) might have played up the satanist image for media attention, but it was really more about rebellion from established social mores and strictures. Metal took the disillusionment that Punk sang about and expressed it through escapism and fantasy. The ultimate source of the anger was the same though.


New priest at our church here is a metal-head. Truth. Says Metallica saved his [temporal] life.


Because it sold well, as compared to non-Satanist/non-gore Heavy Metal? Definitely would like to see the data you used to draw that conclusion. And how inclusive your definition of "gore imagery" is.


To be fair, I think Slayer gets a lot more play than Stryper, but I have no data for you.

That said, the notion that metal bands are fine-tuning lyrical content to minimax paydays is pretty funny. I think income-maximizers generally gravitate towards different careers. But I like picturing a bunch of corpse-paint MBAs sitting on a conference call: "Nice, Sean, I like it, I like it a lot. What about the next line - I think 'Demons dining on your shame' will sell better than 'Demons know this ain't no game'. How does that grab you?"


This is a funny thought. But my guess is that if they were income-maximizers, they wouldn't be writing metal with "satanic" or "gore" content.

Slayer certainly has been successful, and have built a nice consistent career. You can do well with niches. But by one statistic, album sales... well, they've never created an album that's gone platinum. (Stryper actually has once!)

The "money" to "maximize" in music, if anything, is in pop. A large portion of pop these days is written by teams of people these days. I'm not sure how it goes down personally, but I can easily see conference calls coming up with the best love metaphors for a teen idol to croon. :)


Some (not all) of these attitudes were religion-based.

A reason I don't respect people's faith (superstition) because legitimized magical thinking still has an outsized effect on elections, laws, and policy, with many examples during our lifetimes.


The first D&D campaign I ran fell victim to this; two of the players were brothers and their mom picked up on that, despite the fact that I attended the same church as them.


The government is still full of crazy people...


The population in general is full of crazy people. No reason to think the gov't wouldn't be equally represented.


Psychedelics and similar drugs for clinical treatment are a genuine example of a suppressed technology.


>> This was at a time when MDMA was already in burgeoning, but successful, clinical use.

I remember seeing it on TV (Dateline or 20/20 or similar) they were talking with practitioners using it for couples therapy. It seemed really remarkable. That was well before it turned into a street drug (tainted with other stuff).



Ugh. Does the U.S. have to go through this phoney "it's really good for medicine!" process to legalize every drug?

Is that the only community acceptable path to changing long standing beliefs about these terrible terrible drugs?

How about taking a general position that the war on drugs has failed and has created far bigger problems than were ever presented by individual people making decisions that impact their own health.

People of the U.S.A. - it's not necessary for every formerly demonized recreational drug to go through a "hey it's medically valid" process. Unless of course yuour goal is to prop up the system of handing out "legal to use marijuana" certificates that the medical profession now depends on.


> Ugh. Does the U.S. have to go through this phoney "it's really good for medicine!" process to legalize every drug?

While it should not be necessary tactic for ending the war on drugs, don't brandish the label "phony" when it comes to the medical benefits for marijuana and MDMA.

Marijuana has been extensively studied, more so than almost any other prescription drug available today, and its medical benefits are clearly established.

MDMA is not quite as over-exhaustively studied, but it's similarly been shown in a multitude of studies to have real medical benefit. Moreover, that medical benefit is for a disorder which is currently not possible to treat effectively with any other drug available, which makes it all the more important.


i think OP is calling the process phony, not the conclusions. the government theatre that acts like it's learning something new about the benefits of these drugs so they can palletize their legalization. (palletize -- to make palatable -- can i do that?)


Re-branding past sins is an essential part of the political process and community healing. It's also the number one reason why people who see the world in rigid terms tend to have a tough time understanding any political process, whether in an executive suite or Board room or Capitol building.


Another way of putting it: an essential part of any successful negotiation is achieving your desired outcome in a way that doesn't make the other side feel like they've lost.


This is some fucking medicinal grade wisdom right here.


<cynical hat> The goal is to regulate and profit from everything. Criminalizing drugs has created a huge prison industry and a large chunk of government. Since there's little money in MDMA they may as well legalize it for a specific use and regulate it.</cynical hat>

But you're right of course. Blanket regulation where none is needed is the wrong way to go about it.


Yes, because God-forbid a substance makes you feel good without any provable medical benefit.

Sure, Prohibition is long over, but I suspect the Puritanical "if it feels good, stop" memes and ideas that led to it still remain in the minds of many.


I think I'd rather GP's be handing out prescriptions for mdma than OxyContin.


Non-cynical response:

For a governing body, its logical to automatically be suspicious of any recreational drug. Being recrestional means it'll be used more often than a non-recreational or non-addictive drug. The effects of use will be much more widespread.

Even if you have liberal/libertarian beliefs about personal choice and responsibility, the fact is that its not possible to know if a drug is poisonous without careful testing. Putting things in yoyr body by any means is rarely healthy. I'm not saying its a bad idea, just that the odds for any given chemical are objectively long. Its not unreasonable for the government to outlaw a new substance that would be very popular.

Thats how all pharmaceuticals are done; to sell medicine you have to prove not just that it works and is safe but that it works better than the competition. They certainly scoff at the experiences of joe public, and they clearly should. Joe public may know what makes him sick, but he has no idea what may give him liver damage, cancer, etc. Etc.

Once youre on the FDAs bad list, it takes real concerted effort to get off for any drug. The bar should not be lowered for generic remedies. The only problem is that there is no incentive to prove that drugs like this are safe. High profile illegal drugs are not the only examples of this either- melatonin is one of the best sleep aids period, but nobody had any incentive to push it through the FDA until recently, so doctors legally couldn't prescribe an excellent medication.

People making decisions about their own health is a separate issue- there is no data on these drugs (from the governments pov). I'll also note that people having full control over their health is a terrible idea. Sure, it works okay for testosterone, probably. But what about antibiotics? Antibiotic resistance would be a global crisis.

The root of the problem you mean is that theres no process to go from a therapeutic drug like weed to a legal vice like alcohol. The government doednt even have a category for that. Call it moralizing, but still, how would tgat even work? IMO its nontrivial to draw a line there. Weed is definitely on one side, but is testosterone supplementation, or HGH? You can serioudly fuck up your brain taking SSRIs wrong, and you can do much worse with steroids or HGH, and thats without considering extremely dangerous AND addictive drugs like opioids.

I would argue the government has some interest in preventing the abuse of certain drugs. Specifically when a person is addicted and endangering themselves, they are no longer acting like a rational person and its reasonable to assume that they are not in control of themselves. Personally I think the line should be with effect, not cause. If you are an alcoholic I think the government should be able to cut you off. If you want to get high, they should let you. If you want to modify your body, it should be legal until your life is endangered.


Long ago I read an article about Dr.Rick Doblin in Rolling Stone. Thought his ideas on psychedelics and mental health treatment were amazing. Wrote about him and his research for my Honors high schoo English thesis. Got some looks from my teacher, but I digress.

Glad to see this is slowly being taken seriously.


Right on :)


Same news peg, first-person account of how/why MDMA for PTSD saves lives...

https://medium.com/@AliceGut/mdma-for-ptsd-saves-lives-66f78...


Does anyone know where these trials might take place and whether non-veterans might be eligible?


Yes I believe non-veterans with PTSD will be eligible.

I'd say sign up for the maps.org newsletter, they'll likely announce study sites.

http://www.maps.org/news/update


This may be able to reduce systomps, but i sincerely doubt that it can heal scared neuronal tissues, where the pressure wave induced micro-bleeding.


Bit surprised why such news keep coming to the front page? I mean is there really much interest in psychology and especially PTSD treatment here or is it about drug use (doubt that, too)?


I think "hackers" are generally interested in things that solve large problems. And "hackers" are also generally interested in things/interesting technologies or tools that have been stunted but now being realized.


Here's a better write-up (in Science), to avoid the hassle of Forbes' web site: http://www.sciencemag.org/news/2017/08/all-clear-decisive-tr...


They also keep track of news about them here: http://www.maps.org/news/media


Better to change the link to the actual press release from MAPS http://www.maps.org/news/media/6786-press-release-fda-grants...

Also better for anyone who supports this to donate to MAPS or another psychedelic research institute of your choosing!


Agreed. If dang / the admins agree, feel free to change.




Guidelines | FAQ | Lists | API | Security | Legal | Apply to YC | Contact

Search: