Optimal mental. This altitude, I can run flat out for a half mile before my hands start shaking the millions more personal question. I'm a cybernetic organism living tissue over metal endoskeleton.
Hello boys and girls, ladies and germs. This is Tim Ferriss. Welcome to another episode of the Tim Ferriss show. This episode is a special episode. It is a live recording from an event hosted by the Edmund, Hillary Fellowship, the Edmund, Hillary Fellowship, otherwise known as CHF begin in 2016 as a pilot immigration program and has matured into a fellowship of more than 500 technologists. Creatives investors, entrepreneurs Educators and systems designers. Among many other things committed to New Zealand as a base camp for Global impact for more than 50 different.
Melody's, including New Zealand fellow span, a range of high value sectors, such as media education, clean tech, venture capital and mental health, initiatives and research. As we will hear in just a few moments. And that's just to name a few thf and its fellows. Aim to make a meaningful impact in New Zealand, Altera with projects that often have Global applications. We talked a bit about that and certainly explore a lot more with today's guests. You can learn more about ehf a thf org.
Greetings to you all and welcome
to today's ehf live session, the even Hillary Fellowship as a collective of entrepreneurs, scientists storytellers, creatives and investor change makers. Who want to make an impact globally from Altair die. New Zealand and the session today you're going to hear from Tim Ferriss, is Annie active fellow who's an early stage technology, and Vista, and advisor, and term will be interviewing dr. Suresh, and associate professor at Auckland University and the topic today is on mental health and breakthrough therapy decks
I've been plenty of time for Q&A with two Mans race during the 90 minute session. But nearer, the end over to Utah. Thank you very much, Michelle. It's pleasure to be here, and it's a pleasure to be doing a live session. I have been looking forward to this, for some time. And without further Ado, let me introduce the main attraction and the guest of the hour and that is dr. Suresh muthu. Kumaraswamy well here, forward refer to him as Suresh, Suresh is an associate professor of psychopharmacology at
The University of Auckland and he completed his PhD in Psychology at the University of Auckland 2005, after which he joined the newly established Cardiff University brain, research Imaging Center as a postdoctoral fellow while at Cardiff. He started research work with the psychedelics and excited. All compounds in 2011 in collaboration with two, very well-known names, Professor David Nutt and dr. Robin, Carhart Harris, investigating the neuroimaging correlates of the psychedelic drug psilocybin and LSD in 2014, Suresh received a prestigious Rutherford Discovery Fellowship.
And returned to the University of Auckland where he works in the School of Pharmacy at the faculty of medical and Health Sciences. And leads the Auckland, neuropsychopharmacology research group stretches, main research interests are in understanding, how therapies, alter brain function and behavior. And in testing methodologies to measure these changes in both healthy individuals and patient groups, particularly in depressed patients. And of course, this session will have a focus on mental health. So we will delve into that at the University of Auckland has conducted clinical trials in depressed patients involving ketamine's.
Paula mean and transcranial magnetic stimulation. TMS he has received several health research Council of New Zealand research, grants to support this work, including a grant to investigate the effects of micro doses of LSD on brain and cognitive function Suresh has published 117 papers and his work has received more than eight thousand citations Suresh. Welcome to the session. Thanks for being here and taking the time, my pleasure. Tim, I see, hopefully, I didn't butcher the name too badly and I will start.
With trend lines and perhaps just an overview of where we sit currently. And perhaps you could just take some time to describe mental health and/or, addiction statistics trend lines in New Zealand that maybe a meaningful place to start and serve as a canvas upon which we can discuss other things
season, has pretty good data on this because every year, the Ministry of Health runs survey called the New Zealand Health survey and they've asked for a long time about psychological distress,
Yes. And the amount of psychological distress that the adult population is experiencing so seventh in terms of trendlines to, this is conducted every year. So in 2000, and I think 1112 when the survey was conducted four point, six percent of adults experience psychological distress and the last month and we've seen that slowly creeping up to the last data point from 2021 2020, where it was now at nine point six percent. So it's seen a doubling over the last 10 years and in that of adults,
Experiencing psychological distress, which is anxiety, depression or sort of psychological fatigue. So it's more than doubled. And actually the last and covid is definitely going to impact on that. We see a little bump on the last one, from the first sort of impact, to the first wave of covid and those lockdowns than I expect that that's going to only get worse. When the next year's data point comes out because in New Zealand, you might not be aware, but in New Zealand, the second knockdown was quite hard. That just finished at the end of
When t21, so that will definitely impacted on people's mental well-being. So, we'll expect that to go up. So it's not, it's not a good place to run, but it's not just covid. It's been trending up for a long time and it's not getting any better.
And I would imagine although I don't want to assume that the costs are and there are many different types of cost, but the health care costs of these upward trend lines with mental health issues. Let's just call them depression, chronic anxiety, treatment resistant, depression.
Our. If anything like the United States quite high in New Zealand as well, not to mention the the personal costs, let's talk about just a few compounds first and actually is way of background. Could you mention just a few other classes of compounds that you've also done research with? Because I think it's important to note that you have done more than study.
What we would consider to be psychedelics. So perhaps you could just give a bit of context there.
Yes. In my background is in general psychopharmacology. So before studying psychedelics and concurrently to studying psychedelics, I've spent a lot of time studying anesthetics and gabaergic Drug, so gabaergic, drugs tend to be kind of sedative. So alcohol is a gabaergic grab benzodiazepines a lot of the anesthetics like propofol so I've studied all those drugs and various times various Ante Up.
If the drugs so that kind of class of drugs and then also we recently did a study of Scopolamine which is a muscarinic drug and Remy fentanyl we've looked at in the past. I've done a lot of psychopharmacology studies that have nothing to do with psychedelics. Although the Psychedelic studies are the ones that probably I'm most well known for in the public discourse because they attract some interest I
suppose they're catch the attention. So we're going to talk about the contrast between seek head.
I mean and traditional or classical psychedelics, but before we get there because I am personally, very curious why did you decide to study Scopolamine? And what did you find in terms of its effects on conditions, whether depression or otherwise? Because Scopolamine for those who don't know, is also naturally occurring in many plants that are considered psychoactive or a hallucinogenic some of which are considered quite risky. But how did you determine
This is a is a subject of interest for for research,
we had been doing studies on the antidepressant effects of ketamine and we'll talk about this later but you see this rapid antidepressant effect and so what we were interested in was our the other compounds out there that might show a similar rapid antidepressant effects and there was a series of studies that came out of the NIH. Intramural program deals two or three intravenous Scopolamine, studies that appeared to show a similar
sort of pattern of antidepressant effects. So and Scopolamine is works very differently to ketamine or other antidepressants being a muscarinic antagonist. So we thought well that's really interesting if that works then we can study that and even though it's got a completely different kind of receptor binding mechanism that we could investigate there and then potentially look at and now study we look at anti-depression and then if we could then identify a neurobiological markers, that would go along with that. Then we would
Have a converging theory of maybe, what causes a rapid antidepressant. Responses the downside, of course, is that we found that went into prison response study but you know that that's the data, right? We we did a really carefully controlled study, we unlike the previous research that used a inactive Placebo and we'll get back into this, we use their active perceive, oh, a compound called like a Peroni. Mm, that's used a lot in surgery. That doesn't cross the blood-brain barrier, but still
his antimuscarinic and it creates a slightly drowsy feeling and dry mouth. And a lot of the kind of side effects that you might get. We were able to show that the participants could no longer distinguish what should the drugs they had? And actually it will we are ascribing most of the antidepressant response that we seek to a placebo response so lesson learned.
Yeah, that's fascinating, yeah, Scopolamine. I don't take us to off track but has some very interesting effects on memory Source at least is thought to have some very interesting.
Sun producing Amnesia? Yes, it does. Yeah, while still having agency on some level. It's a fascinating compound. So, let's jump to ketamine. Most people or say, many people have perhaps heard of ketamine very commonly used and please, correct me if I get as terminology incorrect, but anesthetic dissociative anesthetic does not suppress respiration. At least of the doses that I'm familiar with it is very widely used in medicine believe it's one of the the
Health. Organization's top 100 most essential medicines. Could you discuss ketamine and classical psychedelics and how they differ in just from an anecdotal perspective? Although there's a lot of really good research, which of course you've been a part of looking at the antidepressant effects of ketamine. I know, multiple people. Now, who would credit their lives, being saved to ketamine and part of what makes it so fascinating to me is not that. It's a silver bullet that works for all people. But it's the
The rapid onset of some of the effects in certain subjects, compared to say traditional or conventional ssris. Which in some folks, it can take six to eight weeks. Say to exert those types of effects if the people respond at all. So could you just perhaps give us a primer on ketamine and classical psychedelics and how they differ? Because both can be described as having psychedelic
effects may be. The easiest thing to start with is with this
Cusco psychedelics because it's relatively simple compared to k, 2 Min. So LSD and psilocybin DMT. They all seem to work through a common. Receptacle, the serotonin 2A receptor, and we think that most of their effect, you know, this probably some other receptors involved in Parts the response. But overwhelmingly think that most of, that sort of psychedelic experience is generated from this serotonin 2A receptor and binding gear. So conversely ketamine has very different even though it
These kind of this dissociative or psychedelic effects, its receptor binding sites and many and complicated. So principally binds to antagonizes receptacle the nmda receptor and that's a glutamate receptor. So glutamate is the most common neurotransmitter in the brain. We don't hear about it a lot and the nmda receptor is kind of interesting because it's actually the receptor. That's really heavily involved in neuroplasticity in something called long-term potentiation so that's essentially how brain.
Tells the recipient involved in how brain cells learn to communicate and strength and sign apses. So that receptors really important there. But then it also has a host of other effects, so it binds to Gaba receptors. Those are kind of the ones involved in inhibition and sedation. It also binds to opiate receptors and if Runway familiar with opiates and then there's other one away, mean sites, like that. It interacts, with serotonin, dopamine norepinephrine hcn.
And sodium channels. It just the list goes on and on as you go up through the concentration. So it's an extremely complicated pharmacology and he goes even worse because actually ketamine metabolizes internal hydroxy ketamine which has newer active sites as well, and also most compounds exist in the lift, and right state, they're called racemic. So there's a left and a right State. And so there we have S ketamine and archaea demean and normal ketamine has both of those, but actually, the aren't is kid means.
Only have different receptor binding Profiles, In addition to all of that. So what we're left with this is the stew. You could either call it a very rich drug or you could call it a dirty drug depending on your
perspective. It's very promiscuous. In terms of its receptor. Affinity, could you explain for a second, two things? So, the first is, why scientists would wade into this super variables? A clinically from the perspective of mental health, what makes it interesting and then second what
Antagonist does just for people who may not have that vocabulary
when drugs are in the brain you know broadly speaking it's more complicated but broadly speaking an antagonist to something that blocks the activity of something that is going on. So in nmda antagonist blocks the nmda receptor. So it stops glutamate working there in terms of for kid, I mean in terms of is this both the clinical and a scientific interest are that's and they're both really interesting study which is why I've been studying,
And ketamine for nigh on ten years. Now, the clinical significance is what you mentioned before. It's you have you can take patients into the lab patients that have had treatment resistant, depression unremitting for years, and years and years and you can give them a kid immune infusion. And they'll get this really rapid remission and symptoms and that would manifest itself in hours now, people will know kidding me in as a street drug. Right? And they would say, oh well maybe that's just because the person's hi you know that
And experiencing this intoxication. So my response to that would be well actually, you know, if you then measure the person's depression, symptoms, 24 hours after the ketamine infusion, you'll see that they're still not depressed. Now what we know about the pharmacokinetics, that's how long can I mean lasts and the body. The half-life is about 4 hours for Kingdom in. So at the 24-hour time Point, there's really no kid Min left in the body at all. So ketamine's gone, they haven't been high for
You know, 20, 20 22 hours so they're not high anymore. The kid means entirely if the body but they're still not depressed and then what that shows is that the ketamine has changed something in their brain. So that's caused some kind of functional change in the brain and that suggests and that to move them from a depressed to a non depressed state. So that's really interesting that this kind of like a switch in there that actually can be clicked. And this kingdom is obviously working on some kind of Target that can flick that switch and that understanding what that is scientifically.
It's really interesting and and while other things can flick that switch, they do it much slower, like ssris, they switch it and maybe four to six weeks or transcranial make tea Miss transcranial, magnetic stimulation. That might take a month to work as well, but here, we can switch in a day for a scientist. It's really am interesting because you can run it really good experiments because you no longer have to wait, six weeks. And all these extraneous variables that get in the way of your interpretations. You can just go depressed, non-depressed within a day and that
Needs to really tight experimental design.
So I want to preface what I'm about to say with the statement which is I know that the plural of anecdote does not equal data. Nonetheless, I do think case studies are interesting and I can speak to one very cute example. Friend of mine and law enforcement, who was suicidal, he had acute suicidal ideation and many people in law enforcement or in the military Pilots would be another category.
We are very hesitant to admit to any type of mental challenges or to seek treatment because it can result in leaves of absence and basically penalties professionally speaking and quetta me and did exert those rapid effects. And again, not to say that this should be the expectation for every patient, but there are people who I know who go in acutely suicidal and have come out.
It literally saying, I don't know what I was so upset about I don't know how I was so concerned about X Y or Z and what I'd love to ask you next. Just again to contrast the say classical psychedelics and you mentioned a number of them which are in the say tryptamine class and we probably won't get into all the fanatical amines and mescaline and mdaa and so on which can be very different in some of their subjective effects. But if we just, if we're looking at, say LSD psilocybin and
And then ketamine, if you look at the durability of some of the effects say for anti-depression, what is your personal perspective on how they might differ in why they have durable effects? And I raise this because I was recently in a conversation with Roland Griffiths from Johns, Hopkins medicine, who's done a lot of work with psilocybin. And also John Chrystal, a tal who's done a lot of work with ketamine. And, you know, Rowland's perspective was that he thinks a lot of the durability of anti-depression.
Facts, 6 months, 12 months of follow-up. Let's just say, I have a lot to do with a change in content, meaning that people are actually able not just to suppress the symptoms of depression, but to address some of the kind of root narratives that are leading to depression, he was less sure about ketamine and maybe there's sort of, more of a mechanistic explanation like neurogenesis or increasing dendrite growth where it's sort of fixing the machinery.
So to speak, on some level. What are your
perspectives the background to this for people? Is that the antidepressant response that we see to a kid? I mean infusion, you know that will last any you know, now experiences anywhere from a day or two to couple of weeks to a month whereas the data for like psilocybin that seems to indicate via like months, half a year long and she's written responses but I think it this kind of falls into the we don't know pile from
Data perspective. Because the models that have been used the experiments we've done between ketamine versus the classical psychedelics. Have been really different in terms of the therapeutic approaches tried. So when people have been doing these psilocybin, assisted therapies have been wrapping around an intense amount of psychotherapy, right? So it's and I think it's really important for people to understand when they think about because you know, you just read these headlines ours. You know, psilocybin improve depression. Well actually, it's not just psilocybin and it's the fact that
That the person's gone into this psycho therapy regimen, you know, with the therapist. And that done hours of preparation for the experience, the therapist is set through them through the experience and then those spend hours and days on integration afterwards. So it's probably about 40 hours of psychotherapy, 411, psilocybin course. So it's not just the drug alone, it's sucked up, assisted Psychotherapy. Now whereas the model for kid, I mean that's mostly being used as basically anyway. It seems to be used in all flavors that people just going to Academy in clinic
And they smashing infusion for now and they go away. And it hasn't really been much studies where people have actually done kid, Amin assisted Psychotherapy and tried to do it. Well, what if we do wrap that similar lip, what would happen if we wrap that similar level of psychotherapeutic support around kid, I mean, would that make that kid? Immune response. Now stretch out Beyond two weeks to maybe a similar kind of time course because the people in the psilocybin
world have come from, that kind of more traditional psychedelic, assisted therapy world and the people that have been studying ketamine have come from more of a kind of traditional Psychiatry world. And so we haven't we don't really I'm not aware of any data that really has kind of tried to find them. The man in the middle is or strip X. Other side meant to just start the side then which I think people were distinctly struggle with trying to do that. Kind of
experiment. Do you say that? Just because of the difficulties that can come up and navigating that
Rinse. Yeah. Because, you know, these so something like psilocybin is very powerful in terms of psilocybin, T&T, I'll see these very powerful psychological fix and they can be destabilizing for people. So people need to be well prepared that they're going to experience very unusual. Profound potentially disturbing things and to not provide that preparation might be not be ethical to strip it back to nothing like is done for kid and in right
then there's probably a middle point where it could.
Could be stripped down to sort of the minimal viable support on the front side, and then still provide the support on the post-session side. And this also highlights for me, you know, the I don't know that we are really in a in a very fertile nascent
Period of psychedelic research and even though studies were conducted much earlier say in the 60s they don't really meet our standards for study design that we would have today. And certainly with the Imaging techniques that you have fmri and and others that are now at hand, you can examine these these tools with a set of lenses that you couldn't before and it's really been astonishing to me.
Me to see how far very little money can go in this space compared to perhaps other areas like oncology or Cardiology for instance, could you speak to how you pick your studies? For instance, the LSD micro dosing study. Why did you choose to pursue that study?
So I had returned to New Zealand and 2015 and having previously done, Cusco slide. So, I went, and I started my research group here. I thought, well, this will start with ketamine because
Proved and we he's recently been easy to get approval for and no one's going to Blink too many eyelids about a new guy coming into town, wanted to study, get a mean new guy coming to town wanted to do LSD is probably going to fluffle a few more feathers around the faculty. I would have thought back in those days but having sort of built a bit of a reputation, I decided it was time to get back into doing some classical psychedelic research now, the micro dosing specifically was, well, no one had really looked at microdose.
Being in a CT at that point. And it's
a randomized, control,
trial, randomized, control trial. And I guess just should, we explain what micro dosing is maybe first?
Why don't you explain what that is? And it also might segue into one of the design challenges, meaning, siebel control, its psychedelics overall. So yes, please define Mike
reducing. Yes. A micro dosing is when people take very low doses of psychedelics about that.
In fact, the dose of a big dose of a wind people going to tripping, so, you know, people might trip on like, you know, 150 micrograms of LSD but from microdose in might take ten micrograms say. So about a 10th and it causes what, we don't really know exactly what it causes it because we haven't studied it properly but users report that they have improved mental well-being, concentration increases. So what they do is that they take these micro doses, maybe every third day is the most common schedule that's called this was popular.
Our Eyes by James fadiman who wrote a book in 2011 and it's great taken off. Since then, you know like before 2011 not many people were doing it and it was really not much Consciousness about it. But now we're seeing hundreds of thousands of probably a people around the world now micro dosing. You look at the size of the red up for and subscriptions, just going up and up and up. So, there's a huge amount of people out there. Mike reducing these classical psychedelics every third day many are giving up their
Medications to do this. But there's really no clinical trial evidence about it. And not even in mental health patients, just not anything. Now, the reason that is, is because if you wanted to run a proper CT, proper randomized, control trial of micro dosing a psychedelic. Then you have to prescribe a Class, A substance, a schedule one substance for people to take home and most legal systems won't allow you to. I don't think you could do that in the
United States that I don't think the DEA is going to be very happy about
that. Could be, I think they might be a little grumpy about
that. Yeah. Yeah. And so there's not many jurisdictions where that could be done. So however, there is one jurisdiction where it can be done legally and that's a little old New Zealand. So as I was as you do every now and then read the reading the misuse of drugs, regulations from 1977 and the misuse of drugs act that goes along with it. What kind of discovered this loophole? I don't know if you call a loophole.
Actually, we are allowed to prescribe Class A substances, it's not even really don't been done, but it's just sitting in the legislation saying that this is allowed to be done. So we engaged in a long process with the Ministry of Health and provided legal reasoning for why this could be done. And so we did it and we applied to Mainland, got the appropriate approvals from Ministry, various parts and Ministry to do it. And that allowed us to run.
The study that we've just finished collecting data for which was to give 80 healthy, volunteers a six-week LSD microdose and course to where they would take the first one in the laboratory. And there are other 13 doses that were taken out in the wild as it were much like people do in real
life. So let's dig into that a little bit. So we're they given the other 13 doses to take home all at once or do they come back to get one at a time? Or two? At a time
they were given X of four, four and five. So
Never gave them like 130 140 150 micrograms to take home, so that they couldn't just stack them all up. But actually, you know, there's a lot of like, theoretical concern about this. But actually, to get into one of our trials, participants have to do multiple screening sessions. They spend hours getting scanned and having all sorts of probes attached to their body. To record all their physiology getting pricked with needles and blood taken all sorts of stuff, right? Kings hours and hours. There are a lot more
More efficient ways to get those as that listing for sure, for sure.
So, yeah,
absolutely. And we check, we check every single dose was administered and video recorded by the participants and sent to us. So we knew there was 100% adherence to protocol
and get a part of the reason that I've been engaging with science in New Zealand is precisely for this reason. I mean you have on some levels a very agile ecosystem compare.
To the United States and you have legislation that would allow you to even consider designing a study like this. Could you speak to how New Zealand can or does Foster scientific and research Innovation? You could speak to certainly what you've already mentioned and Regulatory differences. But what else makes New Zealand unique? What else could make New Zealand unique and we can go from there. I'd love to hear what else is.
Is happening in New Zealand that you find interesting from a scientific standpoint in this domain. But let's begin with how does or how can New Zealand Foster scientific and research Innovation.
We have a strong regulatory environment so I'm not saying a regulatory environments week, it's strong but it's it's capable thing agile and it's small and we're a small country. So it's possible to just ring the person up Who's involved in this that or the next thing. Whereas in another place, you might be trapped behind five layers of
Markussi to these hidden figures that, you know, making decisions and a country of 5 million is only. So many people who know are involved in these kind of decisions. So if you a sensible and polite and appropriate, you can ask questions and get things to move. So with small size, I think does come agility and and I know that there are certainly pharmaceutical companies that are investing into New Zealand psychedelics industry and a general medical and to clinical trials here we're in a
Active place to run clinical trials because also we're relatively cheap in terms of what you can get on a per dollar basis compared to what you might get in Europe or United States. So so that's an attractive. We do have a good regulatory environment in terms of how we can promote more sort of innovation. I think, at the moment, the government does take reasonably hands-off approach, particularly in this area, it's taken a completely hands-off approach is so by comparison and we risk falling behind
By comparison Australia, they created a 15 million dollar fund specifically, for these sort of breakthrough, mental health syrup. You Turks to kind of prime the pump because you do need a certain amount of capacity, you need a certain amount of infrastructure, you need people. So they've set that up as a pump priming exercise, really to sort of provide all the capabilities they need. So we haven't seen any signs of that yet from government that they would actually be sort of a more dedicated funding pathway. Now, we are able to get funding
Ending, but we have to go into the general pop funding. So, we have to compete with all the cancer researchers in the heart researchers, which does mean that when we do stuff and get funds that our workers are very hike, has to be a very high quality because we're competing with our peers that, you know, during very high quality stuff. So, we know when we get funded that what we're doing is
rigorous
Yeah, so good news is there are regulatory Frameworks and federal funding for this type of work. Bad news, you don't have something like the NIMH things, the National Institute on Mental Health in the United States which might give Grant specifically to this type of work. You have to compete against every researcher in any given medical field who is seeking funding.
Yeah that's right. And it. Yeah. And there's actually some, there's actually some data on that and actually what we've seen in
Not just suck it up, just mental health. In general has been underfunded in New Zealand for a very mental health, research online, little own Treatment Services. Mental health research has been underfunded in New Zealand relative to the burden of disease that we see in the country. So there are some parts things. Like, neurology has been relatively speaking overfunded and we spent a huge amount of research dollars on things, like neurology and cancer and heart, they've actually relative to the burden of disease that I've done.
Very
well. But actually mental health relative to the burden of disease with seeing the population. This can be Quantified using and disability adjusted life years. And you can look at research income relative to disability adjusted life is, and mental health is not been given the funding you need. So there is an argument that New Zealand does need to carve out specific. Not psychedelics very mental health, research, to make sure that we're giving that research done to serve the disability that we're seeing population and the health
needs.
Do you have something equivalent in New Zealand to breakthrough therapy designation? And I ask because the FDA here in the US has, granted, both psilocybin and MDMA assisted Psychotherapy, breakthrough therapy designation for depression different types of depression and PTSD. Post-traumatic stress disorder, respectively, do you see ways that the New Zealand government could Foster Innovation and more experimentation
Mission with some type of designation like that, or for instance, I'm sitting here in the state of Texas in the United States which for those who don't know, is generally thought to be very conservative place, but nonetheless, there was legislation recently passed both by the Republican. So let's just call it conservative and liberal parties to get State funding set. Aside for psychedelic, research related to Veterans, for instance, and that was
Artisan and that will be coming online soon. Do you see any particular tools or approaches that New Zealand might use to further Foster? What is I think would already is pretty vibrant ecosystem, but it could certainly do quite a bit more. What are your
thoughts? I think the less it would be the way to go. So I think in terms of things like Breakthrough, designation, we don't have
We in New Zealand sit at the end of the pipeline for wind treatments come, because the way our treatments come as, you know, and international pharmaceutical company will apply for registration here and they'll use all the data basic they've submitted to the FDA. So you know once I've got FDA or EMA approvals in they might come here for approval after a few years and they bother to put the marketing application together. So we're kind of at the back end of that kind of process here and that's why we have in New Zealand, sadly a relatively weak.
The pharmacopoeia where a lot of drugs that are available in the US or Europe and available here because they're just not Market here because we're a small market. So I don't see that the that first approach where but the second approach could certainly work where you know the government's it societal just probably won't be through legislation with direct one of its funding bodies to sort of you know to say and it does this for other read areas of research says okay let's ditch fund this let's fund this things. Like
Growing up in New Zealand. New Zealand has a really good history of funding longitudinal research. So is the Dunedin study and the Christchurch Daddy, and now growing up in New Zealand, we got really strong long, matutinal studies that have been going on for like, 40, 50 years that have been centrally funded. That would be a mechanism that could certainly
work. I'm very excited about new zealanders. The tip of the spear for studies along the lines of what you have done, you and your team have done with the LSD.
Micro dosing study where you have the ability to Pilot and innovate in a way that is simply not possible. In some larger places like the United States and on some level similar to the way that large Global brands in some cases even though you might be last in line or at the back of the line for certain types of say, Global drugs that are available elsewhere. You also have companies like I want to say Adidas and Nike and so on who will actually
Do pilot studies and launches in New Zealand because you have sort of all of the ingredients for English-speaking first world, country with Incredible research faculties. And I mean, in this particular application we're looking at commercial interest but you can pile it and run experiments on a small or longitudinal basis that you can then apply elsewhere, which I think is incredible. So it's a huge gift that New Zealand also has to offer the world in a sense, who are other
Scientific Inspirations inside of New Zealand are there. Other scientists who you think are doing? Particularly interesting work could be limited to psychedelics or adjacent compounds or could be applied really, really any anywhere
else. Yeah. Well, you know there's a New Zealand has a rich biomedical tradition. So yeah, I work in a General Medical Faculty. So the people sitting next to me are doing, you know, cancer research or you know so we have a really amazing.
People doing work in place and Will conclude The ligands Institute where they doing work on preterm babies. And they do really amazing Interventional work there is also really strong stroke research, help New Zealand, looking at how stroke recovery research is doing really well. And you sound and down down in a tiger. I really like the group down there that are doing in the more psychedelic space. They're doing all glues been doing a huge amount of work with kid amine and in various kid mean analogs that and
and ketamine formulations that have been working at. And so there's a lot of is quite a rich group of research happening down there to Target as well. So I guess it's mostly centered around whether to medical schools are located in New zealanders with a kind of where things are happening in the biomedical realm.
What do you find interesting with there? Any particular ketamine analogs that you find interesting and maybe you just Define what that means for a minute. And I also want to just to refer to something you mentioned earlier. You're talking about the metabolites of ketamine.
King bioactive or psychoactive themselves. Just for those who have a general interest in psychedelics, this is true for a lot of compounds. I mean, it's true for ibogaine and nor I began and so on which certainly makes them more interesting to study but what is Academy in analog and are there any analogs or approaches to analogs that you find? Particularly interesting?
Maybe it's not an analog. One of the things is the things that I've been looking at, like slow-release formulations as is one way to go. Right to see if they and this comes back to that thorny issue.
You about with ketamine, like how important is actually having the Psychedelic experience. But if maybe if you could slow down the absorption of ketamine. So you it's not such a hit that came and slower. So these really interesting work happening with slow-release formulations is in New Zealand company who have been looking at that. That is Douglas Pharmaceuticals have been looking at this kind of slow release ketamine, that's quite interesting and then there's different companies overseas as well. Looking at, I just grab that left and right formation that mean,
Stripping key to me into its are in this formulation. Now Jansen, as you'll be aware, they took the East part of ketamine and put that in a nasal spray and so that they could put, this is a Privada. Yes, providing. This is essentially a marketing exercise, right? Like there's no it doesn't seem that doesn't, he has any more efficacy? The normal kidney, but it allowed them to achieve a patent on it.
What is the price? Differential? I think it's something like 125 dollars. Generic like several hundred dollars. Yeah. Well Votto
Yeah, USD something even bigger the differential because in ceiling racemic ketamine is pharmac subsidized. So we can get a vial of ketamine for like $20 or something princess, but of course, this provider was like five or six thousand dollars, so it's just, the differences are insane. But, you know, for condition, who may not be comfortable with prescribing kid, Amin off label because ketamine is not indicated for depression. That's all flavor.
Treatment and because it's a controlled substance people, you know, there are questions that get, you know, Auntie about that and, and fair enough. But that kid, I mean, if ketamine is allowed to be prescribed on label, that may make things easier for the problem with ketamine. No reason. Ketamine is not probably is because he is because it's the generic compound that guess this is sort of background and how medicines get approved as you need a company to sponsor the research that goes into and use em to go to Mid, safe and say look here are all our data key.
Two men should be indicated for depression but no company is going to do that for ketamine because it's just too expensive and basically generic competitor can just come and make more ketamine and and sell it instead. So is my return on investment to be had
with intellectual property. Yeah, let's talk for a second. If you wouldn't mind expanding on Paul glue and his work a bit because I think some of it may give indications for other approaches that can be taken by researchers to do this.
Of work. Would you mind just elaborating a bit on what type of work he's doing?
Yes. He's been looking at the he's been going. Slow release together thing. He's been looking at is other internalizing disorders so he's done a lot of work, looking at ketamine and anxiety disorder. So and this time to build up quite a good evidence base, that ketamine might not just have efficacy in depression, but in a range of sort of room, internalizing disorders. So I think he's done anxiety and
Social anxiety. So ketamine is seems to have therapeutic effects Beyond just the category of depression. These are all kind of these lists data on these at the moment. So there's you would be even more reluctant to prescribe off-label for those things where there's a small evidence base. But there is a emerging even space, that other things in. Paul's definitely been contributing to that.
And I wanted to also for people who may not have familiarity with the odd medley of indications that psychedelics can be used for. First of all, I would recommend to those who haven't read it, how to change your mind by. Michael Pollan, gives a pretty good overview, you know, some of it would be contested like the importance of the default mode Network and the down-regulation of such in some of these experiences, but it would appear and certainly the, I think a lot of data would support this, but
The case studies themselves also would that the let's just say DSM described in our parlance over here at least I'm not sure if you guys have an equivalent of a DSM but we used to do it for insurance. Yeah yeah. For insurance reimbursement purposes you need a an indication and a code, right? So you could have anorexia nervosa, you could have obsessive-compulsive disorder or whatever. The latest rephrase of that is alcohol. Use disorder, right? Otherwise known as alcoholism etcetera. Etc and what is plausibly the case.
Is that these conditions actually share a lot of common DNA so to speak because there are certainly studies being run right now and this is not to say that signature a Panacea at all. That's not the point I'm making, but that from opiate use disorder to anorexia nervosa. 020, CD to chronic anxiety, there are maybe shared characteristics such as a rigidity in thought, looping or patterning that are interrupted by these tools, which
Then provide a window of plasticity within, which you can do very, very interesting things. Which then begs the question that we were discussing a little earlier of how much the therapeutic rapper impacts the clinical outcomes is. So if your heating up the clay, so to speak and adding some moisture by using these compounds like who is actually molding, is that the patient is that the therapist is at the combination of the two is that the experience itself. That's just bathing.
Neurons and various chemicals that produce dendrite growth part of why this whole field is so exciting to me is because there are still so many open questions, the answers to which have just supremely potentially important ramifications. Are there any particular studies that you would like to do or see done in the near future in the next few years?
This song is Endless Possibilities, you know? Like yeah, we're any of the really beginning of
Of what we're doing, right? We've only been doing this stuff for like a couple of years and essentially all the stuff everything has been done so far. As essentially just elaborate pilot studies, right? We're just beginning to learn the end, you know, that's come from 50 years of Prohibition, where we haven't been able to do this work. So you know things were looking and people know, the system might know this history that 1960s when this research that is slowing down early 1960s, you know, there was promising signals but everything just stopped for like almost 50 years and so we're only just
You know, a couple of years into like learning how to do these kind of studies again, so that means that we've got a lot to learn and it's going to take a while before you figure this stuff out, because studies take a long time to do. And the other thing is these are really complicated interventions, you know, when you put them into a clinical trial, when you try to work out, what the hell is going on, you know, because you alluded the first problem we have is diagnosis, right? We analyte for mental health. The really thing to be aware of
So unlike Cardiology or cancer, right? We can't just like, stick someone, get an echocardiogram done and realize I've got some kind of thing, going wrong with your heart, some regurgitation, or valve, whatever it is, or we can't measure a tumor size and your this is it. So the physician is based entirely basically putting aside some organic issues. The diagnosis is basically just subjective reports that symptoms and the diagnostic categories that completely Woolly. And we don't understand the bullet biology of what's going on in terms of the diagnosis and then
Of the problem that we give this intervention that we have, a only a partial knowledge of what it's actually doing in the body. And then actually out how we actually measure the clinical responses, also, kind of Willie because we have to use this kind of subjective scales, you know, like how are you feeling? I'm feeling better. Okay, you feeling better, so, and we don't ya, which which if you're measuring like, you know, tumor size in a Petri dish. You know, that's what Yuma growth. So we have a long way to go before to harden up science, But to answer your question,
Ian was civically, the interventions and cells already complicated. We have this.
Strong drug intervention with these therapeutic wrap arounds. And we have to start to systematically deconstruct what's going on there and start to manipulate some of those factors as variables. So like how much wrap around therapy? Do you need the question? That's never really been asked as well, what type of therapy do you provide or resolve therapy the same? Or is it just heck actually like talking to somebody? What is the actual requirements are to get? Because you will have no shortage of case reports. Like you see the people that just took psilocybin by them.
Selves. And today, I started feeling better and with know, you like thing, not I'm not saying you should do it anyone to do that by the way, but just people report that, of course, at the same time, people report taking psilocybin, having a terrible experience and with terrible psychological shock involved afterwards. So we do have to start to deconstruct what's actually going on and intervention. So these are long complicated experiments. That require a lot of people. A lot of Manpower and each intervention is really complicated. So you
Out of point is like gold dust to collect.
Yeah, absolutely. So I want to add just a little bit of commentary for people who don't have the history. So you mention the prohibition, meaning the Banning of common use of these substances for 50 plus years and I would say at least when we look at the case in the United States that it was mostly if not entirely for political reasons, as opposed to Scientific reasons and one can really learn quite a lot about the history, including Nixon and other colorful characters like
Like Leary and so on and so forth. But the punishment didn't really fit the crime and in the sense, and that's my perspective. That, if you look at the say ld50, so the dose at, which 50% of a given subset of the population would be expected to died of Overdose for these compounds, you have incredibly high if not unknown ceilings for a lot of them, right? I mean, they're physiologically, very innocuous compared to even something like
acetaminophen for instance, where at least in the u.s., I don't know about New Zealand, but the rate of, er, admission, emergency room admissions for acetaminophen is through the roof. It's got to be top 10. That is not to say that there are not significant psychological implications. Particularly for those who are generally going to be excluded by study criteria, like those with family history of schizophrenia. And we're going to jump into into Q&A and about five minutes. But what I would like to just make note of really quickly is that
I feel the LSD micro dosing study that you just finished Gathering data for is a really important, first of its kind and please poke holes in this, if I'm getting any of it wrong for a number of different reasons, but I'd like to highlight one of them and one of them is Placebo control in psychedelic studies, or studies involving psychedelics where it's incredibly difficult to have Placebo controls at larger.
Asses with something like psilocybin or LSD because it is, it is tremendously obvious to anyone who has taken it. That they've taken it. And if they haven't taken it, it's very clear that they have not taken it, and there's going to be expectancy effects. And generally people are going to come in knowing on, sublevel what psychedelics are or believing that they do and having done some reading and so on, right? So you have Placebo effects. We won't even get into nocebo effect. Such people should read up on because that's also something worth.
Looking at, but in the case of micro dosing, it seems like you really can begin to apply Placebo controls and just for people listening could you describe how you thought about that and whether you decided on passive or active Placebo?
The this study we went with an inactive Placebo just because because no one ever done L SD micro SIM before we wanted a rent for in the community we wanted an inactive.
Also that, when we look at safety and like physiological measures of safety, we had a really we've not actually done anything to this deeper. We haven't given them any drug. This is just pure, so we had a very pure safety group to look at and in terms of Alice, whether people are, you know, able to detect the effects. Summer summer. So we are around the
threshold. This was at around 10
micrograms. Yes. About 10 micrograms in male volunteers, so there's quite a history.
80 though. Actually, we saw that some petitions were particularly sensitive to it, and we had to reduce doses with some participants and some hardly notice. So there's quite a variability in people's response and that's interesting and of itself, it's the gist to me that we're probably when we move on to the next phase and actually want to look at a clinical population and run like a, for example, a depression trial, we may need to start looking at lightly active placebos because we're now interested in the clinical outcome, not just sort of like can
Do it. What do people experience? If we wanting to kind of try to fool people? But better in probably, some kind of like Placebo. The little bit of open, say deception but just ambiguity. And the information that we provide to participants might be enough to get us over the top in terms of blinding, the study successively, unlike psychedelic studies which aren't blinded at all. And this is a real methodological problem that the field has to try to conquer it some way and we're working on it.
I just want to jump in for a second. So I would say also that the fact that Placebo controls are so difficult is I don't want to say a feature and not a bug because it does present just from the standpoint of rigor and publication a whole lot of challenges, but the fact that this effectively entire class of drugs has so much trouble with Placebo, controls is very interesting in and of itself. I've been a mess of paper. I yeah, yeah, I bet it's fascinating that it's
Hard. Do you have any, you don't have to give away your secrets, but anything on the short list for potential active, placebos, it would you you would use in such case niacin,
not anything else. Nice. And it's not a great option. That's yeah, vitamin C actually. Nice and was used in the 1960s and has been determined even in 1962. Nice and is a poor control for sale something. But people used to use it for some reason and I'm not sure why
skin flushing. I'm gonna be a subtype of subjective experience that people think it's doing something. Yeah. So what's added to a lot of data
Supplements as well just
getting into the weeds here. But what I would say is actually what the compound is isn't as important as what the participant thinks it's going, it's their belief about what they're receiving. That's the important thing because blinding and clinical trials is really important to prevent expectancy since it's because of person goes into a clinical trial thinking they can either side to side and they do get side to side then, and if they think it might make them better, they work out that they've had it and they go and maybe they're over, you can insulate.
Accentuates the clinical response, which we would call a compound. So, that's potentially a problem. So but what's important is, it's not the compound itself. It's what the participant believes that they've had. And so it's not as much potentially around what the actual Act of placebo is, but what you tell the petitioner about the act of receiving the information that you provide them in the because you're not trying to manipulate your physiology, you're trying to manipulate their beliefs about what they're having. So I think these are subtle things that we need to really think about an hour.
Experimenters science. You know. This is why I really enjoy doing research in this here because he's a fascinating problems and it's a really like fascinating area to try and work out the in scientific problems. I reckon we can do it and I'm not, you know, give me another 10 or 15 years and I might give up. But right now, I think, you know, we can totally crack if we put our brains to it as a scientific discipline.
It's a really exciting time to be for me, certainly observing watching to the extent that I can.
The ecosystem in a really exciting time for people like you to be doing the research. It's really kind of a blue sky opportunity and the payoffs as I think we established very early on in the conversation, a potentially huge. If we look at the trend lines of various diagnoses and illnesses, and the costs, most a personal level familial level and societal level. So let's jump to Q&A at this point. If that makes sense and I'll have
Up over to Michelle to see if you have any any questions for us. I think we have quite a wait, there and nobody.
Yeah, I'm going to hit some questions here. What I'm going to do, those dress is only started off. The first question is going to be
an ask, so you can put your ask out there to the audience because someone has said, is, how can we speed this up? What can be done to make the benefits of this coming forward? A lot quicker.
I think, you know, we've got plenty of awareness around mental health, generally in New Zealand, I think.
Anything government or any signals from funders. And I think that's where we haven't really seen any kind of movement. So, that's where pressure can potentially be applied is not much in the way of like foundational advocacy for this kind of stuff in New Zealand's. Or there's not a huge amount of push to like, make government do anything about it. So I think it's probably where things can be accelerated is by trying to get government to stop paying attention. And for them to take the attitude,
That we can be at the fourth and New Zealand. We can be at the Forefront of this and we already are like, we're way betting above our in terms of like us being this tiny little country is back into the world. We are betting way above our way and we could get onto the front of these things being introduced. If they are appropriate to introduce. But a few people push from government would potentially accelerate their and, you know, and really establish us as leaders in the field.
Stress just to piggyback on that. For those in the audience who might want to support in a philanthropic capacity, certainly I've been interested in the space for a long time. It's deeply affected my life in the lives of many. I know. And the science is important, at the end of the day to push the ball forward. So whether with you at University of Auckland or at University of otago, there are some interesting things happening in New Zealand are there any recommendations you might have for people who would like to consider
Supporting philanthropic
lie. If in terms of philanthropic support, this thing is to get in touch with either myself or Paul. We don't we not top secret then
there's plenty
of mechanisms you know but what I would say is that Sydney philanthropic money is really important. And, you know, the funding you provided us was like essentially seed money that we could use to then get the feasibility, you need to think get a government grant to do the research to establish lie.
Oh, you know to establish that you know, we can run this trial, we can do it because when you have nothing you just can't get started and you apply for a grant this. And then the ground people's over. You can't do this, you can't do that. You haven't shown us that you can do this, then the next thing and then they turn your Grant way, right? So fun Tropicana money can also be seen as a see, not just as your funding the whole thing but it's a seed for future Investments. So
definitely. Yeah, that's so important. I just want to say it again that not only do.
You sort of punch above your weight class in the research that I've seen so far. But the amount of money that you commit from a philanthropic, standpoint can also have much more impact and sort of amplifying effect as a signal, right? Because then it allows researchers to fundraise that much more easily from other sources. So the money is important, of course, but the signal is also really importantly, Michelle. Do you have more? I'm sure you do. So yeah, so this
one what are the
Asks of micro
dosing. So if it's patients that are diagnosed with bipolar or schizophrenia. So they're not looking for a medical advice but just any general commentary about how safe that is. It and is it dangerous?
We have a data set that we've collected and it's really the first status. It it's been click it and so far, we haven't seen any - safety sings, but it's a very small data set in a very healthy population. So I think potentially there are indications such
To schizophrenia or bipolar, where's possibly not a good idea. We know that high doses of psychedelic can trigger psychosis occasionally and cause psychological distress. So I think doing this kind of on your own particular. If you're trying to treat severe mental, health disorder could be, you know, you're hitting into the unknown, I guess, is that kind of thing. So potentially the biggest was probably apply actually in the application area of mental health and particularly with particular
Albert disorders. So I think it's important to tread lightly careful.
I'll add something to that really quickly, which is there are also questions of provenance and legitimacy. So, there are some synthetic. Wow, a lot of synthetic, thousands of synthetic psychedelic compounds that are sometimes confused with or sold as LSD that can launch you into some very at best uncomfortable and at worst very dangerous circumstances.
You could just be in an experience for 24, 48 hours, and on top of that, it's critical I would say to consider legal ramifications. There are legal risks. If you're dealing with schedule, one compounds and secondly, just because I've seen this quite a few times, we're dealing with, in the case, of LSD, for instance micrograms. Okay? So to explain what that means, Suresh, please grab that. I'm getting this wrong with you've got, let's just say mg which are a thousandth of a gram my right so
far. Yeah.
He grounds, this thousands. Yeah.
And microgram is a millionth of a gram if I'm getting that right there. Is that a threat? Yep, so if you're dealing with millionths of a gram even the Albert Hoffman is the father of LSD. I mean went on his first famous huge trip while bicycle riding because got on his fingers. And so you're dealing with such incredibly small quantities that the ability to Mis dos or to absorb it through the skin can lead to something. That is most certainly not.
A micro dosing experience and if you're doing it without supervision and you happen to get in a car, expecting it to be a microdose. For instance, that could be very, very tragic indeed. So I just got to be the stern, dad about it all, but felt the need
to start these absolutely true. That the non-physiological risks are probably far greater than the physiological risks. And even though law enforcement deals with things like visual Secrets, just like, cannabis relatively lightly these days actually, they're not. So
Forgiving with schedule 1 substances. So that is important to be reminded and I could get off and yet, you're absolutely right again and that's the purity of supply and dosing. I mean, I could get this because we have I like to say the best day least in town in my lab but joking aside. Yeah, like illicitly and pain Dallas t or psilocybin could be cut with them things and it's very hard to know.
But we do have drug tricking services and he's on that can provide that kind of
mention though and I'll just actually that's a really good point to just add one thing to which is in the u.s. there are services like dance safe and others that will provide drug testing kits which is not to say, I recommend illicit use of drugs but the reality is that people are going to use what they believe certain compounds to be and there are tools.
Ulcer for testing, so that you try to mitigate. Some of the risk is a few people in the audience first that are doing studies themselves. And so Toronto and the us and one of them's about the questions about open science. So what are your thoughts about open site to replication crisis? It will you be sharing your data, we be, keeping it
private.
So it depends on the study and depends what you're trying to do. So open Sciences is admirable, and it's good, but it's not always possible. Depending on, you know, whose
Suresh could you define that just for people listening who are not
familiar? So open science is essentially sort of releasing your data to the world when you have it and it goes with another thing which is called pre registration which is basically publishing your clinical trial protocols before you actually do the study sir.
So my lab group is definitely started doing publishing clinical trial protocols before we do it. So, and we've done open science things. So I'm in favor of it where you can do it. But there will be times when you free example, you're doing industry-funded work with that's not possible because that's intellectual property of of said to company. So, you know, I'm generally in favorite, but I think we do end up with open science of having a lot of data in the world, but no interpretive framework. We can all do that.
Experiments in release terabytes and petabytes of data into the world with of potentially bad data, which you know, it hasn't been collected. Well. Oh, and just adds confusing signals to the noise. So I don't know that. It's a Panacea for actually a deep theoretical understanding of what's going on. Now, we're going to shift to a
training question. So anticipating legislation change and increasing access to psychedelic assisted Psychotherapy. How do we prepare the workforce? And
to be able to provide this. So what training Pathways exist already for psychologists clinical, social workers to upskill and become
involved.
This is a big controversy and Tim dealings. Yeah, I can take
step. There are number of concurrent experiments being run. So in the United States, a lot of eyes are on organ and within the state of Oregon there will be a lot of action in the next six to 12 months. Looking at developing effectively a parallel structure for registering and supervising administration of psilocybin for
The Seven Sisters therapies. So that is a very Live question for the state of Oregon. So I'd encourage people to watch that very closely on political medical level. Also, you know, my foundation. So this is a foundation s AI SEI foundation.org. For people are interested has also participated in funding a joint program which is focused on Psychiatry and this is at Hopkins.
Has NYU Yale and possibly a few other institutions. I apologize and I'm forgetting where and I'm going to get some of the details wrong here, but in effect a certification program is being created that can be applied into this funnel which already exists. And that is the sort of Psychiatry MD training and people can elect to then add this type of training and qualification to their pre-existing track.
If that makes sense, which is not to say that this should be limited to being administered by MDS or MD Ph.D is. I don't think that will come close to addressing the demand. And need more importantly, the need forgetting about healthy normals, which is a whole separate conversation. Let's just talk about people with actual sort of clinical diagnosis. I do expect that there will be similar experimentation with nursing schools. I hope there will be
Also, experimentation, within accredited, social work programs for allowing social workers, but the fact of the matter I think, is that this is one of the most challenging issues that will be faced in the next five years. The next five to ten years because not only is it necessary to develop a pipeline for training but the training is extremely controversial because there are
Blue feel like the sacred is being secularized and therefore if there aren't enough legally trained, let's just say therapist or facilitators to administer these drugs that there will be a lot of grey market and black market charlatans we're going to pop up to provide services to those in need which will cause its own large host of problems. So it's going to be a challenging road ahead but there are experiments being done and
People can see some of them at the foundation website and now 0 why? This has been New Zealand does is there a way that we can access? Doc delic therapy micro dosing now or how fun
it was? Certainly not now, you know, kids mean is potentially available through there. A couple of clinics around the country, offering kid mean services, for those with depression but psychedelics and micro singer still. The micros in particular, has got a long way to go. There's going to be two to five years, probably. It's
A three to five-year track to to progress that depending on how the results look. But I think the first thing is going to come down the pipeline. If anything will be the Indian, a assisted therapy because that's the most advanced Psychotherapy for PTSD. So it's the most advanced sets in Phase 3. Clinical trials in the u.s. we have a group of maps trained therapist Addiction in New Zealand that could actually deliver that therapy if the data was seen to be okay and a regulator with to improve it which would invariably happen after if the a if
If that were to be approved there so we have that and that might be only a couple of years away. That would be the first kind of cab off the rank, I
think? Yeah. And I'll just add to that that if I could make an unrealistic request of the Psychedelic communities per se, although with the amount of infighting that goes on it, sometimes hard to view it. That way that it's really important to focus on ketamine and MDMA and getting those two, right?
And I think it's very risky. It's fraught with Incredible risk to try to boil the ocean at once, with adding in an ND mt5 Meo DMT Ayahuasca and every other compound you can imagine to try to get them all dealt with in a responsible way simultaneously. Now, I don't think anyone's actually going to follow that advice, but you know, I have a pretty broad spectrum of interaction with these things.
And I would just say not as an expert by any stretch but just someone looking at the risk-benefit profiles of these things, I think a focus on ketamine and mdma-assisted Psychotherapy would go a very, very long way. And psilocybin certainly is in the works and I think it has tremendous potential for a number of different conditions. Whether that be major depressive disorder, treatment resistant, depression alcohol, use disorder and I think many others. I mean, those are the three that are
Kind of furthest along. But each of these compounds has its own complexities and difficulties and I think slow is smooth and smooth is fast with the stuff. We've just come through, half a century of prohibition. Let's, we don't need to figure it all out in the next six
months. Yeah, I totally agree with that. And you know why? Because he's this massive unmet need right to get things out to address these things, and it's heartbreaking and pressing problem, but at the same time, you have to think. Well, if these things really are effective,
The last thing you want to do is like rush it and get it wrong. And then to be safety issues that come up or like badly regulated things in these, in all these horror stories that emerging into the popular Consciousness. And then we put ourselves 50 years back in the hold again. So, I think that's what we really need to avoid with a so, treating really carefully, but hopefully, that won't happen because we do have a stronger regulatory environment and then wasn't the 1960. So hopefully we can avoid that kind of shoe, but I think it requires us to work diligently.
Only on the sling
carefully.
I mean not to paint a bleak picture but it's like he we're I think we really want to mitigate the risk of catastrophe that then becomes a political soapbox and then before, you know it you have an executive order that sends us back to where we were, which is not an impossibility. People might laugh about that because they feel like this isn't the 60s and the generational differences no longer exist and there's bipartisan support Etc but
petitions have certain sets of incentives, and I would really
Say that it is a non zero percent chance that things get sent back to Prohibition. If say one Senators child dies of cavalier, administration of 5, m e0 DMT in fill-in-the-blank location, right? Not to throw five. Amigo DMT under the bus. I think it's very interesting but High degree of thrashing, high, percentage of thrashing, within the subset of people who use it. So you know, bad things can happen and bad things will happen.
So when I think the, the people involved, which is why they decide foundations, also involved with the Harvard Poplar project, which is a law and policy project focused on psychedelics because there are going to be suicides that are attributed to psychedelics. There are going to be deaths attributed to psychedelics Via accidents of various types and this is this would be true with any drug used at scale. It's not specific to psychedelics. This is certainly true for
Our eyes. It's true for just about every drug. You can imagine sleep medications, so it's just the law of big numbers in a sense and I do think the community needs to be prepared for that eventuality and how to deal with it. Because it's going to take the culture quite a bit to metabolize that. And I do think we're going to see a not backlash, but sort of a pendulum swing into negative coverage because the positive coverage is just last too long.
And I think if we want to be strategic about it, we accept and expect that on some level because inevitable with with anything that is purported to have this much promise and certainly anything that has this much coverage Michelle. What else do we have?
Is your research expanding a little bit further and going into addiction
which is more dangerous and obviously deadly than depression and anxiety. Are you doing any research in that
area? We're starting to talk about it. We're starting to talk about a project.
T'. There will be more Maori based intervention that we run by Murray researchers, and we're just in the very beginning stages of staying to sketch some ideas together. A about how that might be done for that population and methamphetamine. You saw alcohol. Use birds for very early stages for us, but definitely, that's something. We're not leaving that. We're just providing support for in terms of intellectual support and learning how to navigate the regulatory system on.
Stuff. So that could be really interesting. And there are elements of, for example, spirituality that have some Synergy with Maori culture, that would be interesting for those researchers to explore.
So just don't let little bit, then what about an included woman? And studies are being mostly males,
we had this one's L SD micro SIM study. We was we was males only because we, I won't say it was ditched Warfare trying to get this trial approved, but it was
And so we just had to like take risk down as much as we could in certain places. So the idea of the problem of potential pregnancy was something that we just for this stage, we just wanted to avoid that as an issue and it was also a Minstrel, quite cycle compounds in them that we wanted to avoid for their first trial, we think we've now got the steps that we need to expand and the future trials, but and I've taken a lot of flack for this and and I'm still wearing my responses where you try and look at this.
Study approved everything because I spent years aging trying to get this thing improved. So, you know, we did the best that we can while we could and we always hope to do better but certainly, what other Studies have him? Good females. And then it stays well. Now that we've got over that first hurdle.
I will also say that there are studies that have very mixed gender ratios. If you look at some of the end of life depression and of Life anxiety, studies say involving psilocybin.
You see how much more sort of heterogeneous group. So definitely easier to do when you have a little bit of escape velocity after the first one or two pilots.
Yeah, it's actually some interesting anecdotal reports of intense and micro dosing for premenstrual dysphoric disorder, people have been using that and that it might affect actual menstrual cycles and make recycle timing. So that's actually quite an interesting is potentially interesting. Separate studies to be done there that we have considered and we'll consider
In the future.
So if someone is wanting to sort of get into this type of research, what did ucation do you recommend for anyone wanting to help assess?
So I get this all the time. Undergraduate student said well I would say you know the best options just go be a medical doctor because you can You Learn by the University degree? I'm just promoting the university walking because it's my employer pays the bills but you know the young people getting us a science degree or a Health Sciences degree need us
In psychology's those are I think that's where the Forefront things will will be and will be in either knit. In New Zealand, it's going to be basically psychiatrists and psychologists that are going to run this. I suspect that that will be where things for. So if you want to to get into being able to prescribe or be involved in this kind of therapy, I think psychology and Psychiatry and general medicine in the places to study. So we'll the things to do.
In this also scientific degrees can do, like Medical Science has strong background in mathematics is always good. Just going to go into one of our corporate. So have you
looked into the clinical trials of the larger public company. So there's mind me compass atai and numerous in. Do you feel there any red flags and how these are current corporations are going about from improving their respective drugs? So there's like LSD MDMA.
Yes. And I should say is a disclosure that
That I consult for some these companies as a disclosure so and actually collaborating with one of them. So, my observations is that the people that these companies are employing, a really exciting to be really experienced pharmaceutical. People have lot of Industry experience in Pharmaceuticals and they seem to do quite a rigorous job. You know, there's obviously going to be tensions there for those companies in terms of wanting to get things through reasonably speedily.
Because they've only got so much Capital, you know, the end of Pathways long and expensive and the intellectual property that they need to gain because of, this is a generic medicines is going to be an issue. But there's red flags within every year as a pharmaceutical development. Are there any more red flags and this area than there are in other parts of the pharmaceutical industry? Probably no more no less. You know, I'm comfortable with the gray.
I'll happen with just a few things. So I would say on the, on the
Clinical actual de study side. I think pre-registration is very important but as you mentioned stretch, that doesn't apply uniquely here but it does apply here. So pre-registration, publishing your protocol ahead of time so that you can't sort of torture, the the data or move the goalposts and declare Victory. When in fact, it was not a victory, I think is incredibly important and then, you know, recommend people take a look at, there's a journalist named Shayla love who's done a fair amount of writing about the
Year, intellectual property battles that are ongoing in the space and there certainly are, I believe non-obvious innovations that should be granted patents, because that is how one in a market-based economy, sort of raises funds, and builds companies and justifies the R&D expenses. There are also obvious relatively unhelpful, non improvements that people sometimes.
Get patents for which are obstructionist in nature and that actually gum up the works and cause problems in the ecosystem overall, especially if they use said pens to try to lock up, manufacturing processes, to dominate a given molecule, that has existed for decades, if not Millennia in some cases. So I do think the IP side of things is very important to to keep an eye on and normalization. That might be worth checking out as freedom to operate, which was
If I carry Turnbull and that is an area that will be increasingly active Mason marks and I Glenn Cohen i period Glencoe NCO hean. Co-authored a paper on intellectual property and patents for those who are interested. That's out of Harvard Law School. It's not the time for a Christians actually time goes fast. All right well well fantastic, thank you so much everybody. And thank you so much Suresh for making the time
I'm very excited to see what you do
next. Thank you. Good. Thanks, Teddy, I'll just close this off for the cutting here. It's been a great session
today and then hopefully this will set you on the wrist of your way. Kyoto, Tim wrangham earlier or
tearing into airtight, he
held me or pop a new career. Tough cornet or Thanh. Thao know. I hear your name called on my are taught at 0 t. Hey morning order up your the team. Thank you kqt and enjoy the rest.
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