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Full Transparency

“It is a shame but it is mechanism based, as we worried it was,” wrote Edward Scolnick, Merck’s chief scientist, in an internal email to colleagues.

The year was 2000, and he was responding to data showing their blockbuster drug Vioxx increased the risk of heart attacks. “They were right about the metabolite meanings,” he continued, acknowledging that their early concerns about blood clotting had been correct all along.

These words would later emerge in court documents, revealing a tragic irony. They came from what was once America’s most trusted pharmaceutical company. For seven straight years, Fortune magazine had named Merck the most admired company in America. The founder, George W. Merck, had set the standard in 1950 when he declared, “Medicine is for the people. It is not for the profits.”

The company didn’t just say these words—they lived by them. When they discovered a cure for river blindness in the 1980s, they gave it away free to millions in the developing world.

That trust took nearly a century to build. It took only five years to destroy.

The Vioxx story revealed how even the most respected institutions can lose their way when billions of dollars are at stake. Between 1999 and 2004, doctors wrote 107 million prescriptions for Vioxx. At its peak, the drug generated annual revenues of $2.5 billion. But none of those prescriptions came with the full story of what Merck knew about the risks.

Instead, the company mounted what internal documents would later reveal as a systematic campaign to downplay concerns. When academic researchers raised questions about cardiovascular risks, Merck executives pressured university department chairs to silence them. When studies showed troubling data, they hired ghostwriters to shape the narrative. A “cardiovascular card” distributed to doctors presented cherry-picked data that made the drug appear safer than it was.

In 2023, at the largest psychedelic science conference ever held, I had a revealing conversation with a group of police officers. When I asked how they felt about being at a psychedelic drug conference, the police chief ’s response was illuminating: “Every one of us has had a family member f***ed up by Big Pharma. If these people have something new to offer, we sure as hell will listen.”

His words captured a profound shift in our cultural relationship with medicine. The same institutions that once condemned all psychedelic research are now funding it. The same halls of academia that once shunned these substances are now studying them. Major universities like Johns Hopkins, New York University (NYU), and Imperial College London are publishing breakthrough findings about psilocybin and MDMA.

But alongside this psychedelic science renaissance, another familiar pattern is emerging. Venture capital is pouring in. Patents are being filed. Companies are positioning themselves for what analysts projected could become a multibillion dollar market. Once again, revolutionary medicines are colliding with profit motives.

Yet this time can be different. Unlike Vioxx, classic psychedelics like psilocybin have been used for centuries, with remarkably few physical adverse effects. The challenge isn’t their toxicity, it’s ensuring that in our rush to turn these powerful tools into mainstream medicines, we don’t repeat the mistakes of the past.

A 2024 systematic review in JAMA Psychiatry supports this optimistic view while highlighting areas needing attention. Examining 214 studies of classic psychedelics, researchers found that serious adverse events were remarkably rare—occurring in only about 4% of participants with preexisting neuropsychiatric conditions and virtually none in healthy participants. However, of sixty-eight analyzed studies published since 2005, only sixteen (23.5%) described systematic approaches to adverse event assessment. This isn’t due to willful concealment as we saw with Vioxx but rather reflects a broader challenge: the difficulty of fully capturing and categorizing the complex ways these substances can affect individuals. To realize the full healing potential of these medicines, we need better systems for understanding and documenting the full spectrum of experiences they can induce.

The stakes are profound. Mental health conditions like depression, anxiety, and post-traumatic stress disorder (PTSD) affect hundreds of millions worldwide. Current treatments fall far short. When studies show that a single session with psilocybin can reduce depression as effectively as a year of traditional medication, it’s natural to feel hope. When MDMA helps combat veterans process and heal trauma that years of therapy did not reach, it’s understandable why investors see opportunity.

But to understand both the promise and the perils ahead, we need to examine how even the most powerful medicines for healing can be undermined by human fallibility because these medicines do not act independently. The effectiveness of psychedelic medicines also depends on the therapist, the patient’s history, the mental set of the patient, the setting in which the medicine is administered, and the post-administration integration of the experience.

Thus, beyond the corporate risks lie equally important challenges, such as untrained guides, inadequate screening, unsafe settings, and a lack of proper integration support. Most importantly, we need to understand how enthusiasm—even well-meaning enthusiasm—can blind us to real risks that demand our attention. We need to understand how data gets shaped, how risks can be hidden, and most importantly, how to create new systems of accountability before history repeats itself.

For the past six decades, I’ve had a unique vantage point on this unfolding story. This book aims to share what I’ve learned from working with and researching these powerful substances—both their remarkable healing potential and the very real risks that come from misunderstanding or misusing them. The path forward isn’t through blind enthusiasm or cynical or moralistic rejection but through honest examination of what can go wrong even with the best intentions.

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Before we dig deeper into this psychedelic renaissance, I’d like to contextualize this book. Nearly twenty years ago, while hosting a program, Mind Body Health & Politics, on the National Public Radio (NPR) affiliate KZYX, I conducted what became the longest-running series of radio programs on psychedelic medicines ever broadcast in the United States at that time. This series contributed to the current renaissance in psychedelic medicine and provided a platform for groundbreaking research, such as Dr. Roland Griffiths’s seminal psilocybin study at Johns Hopkins, Dr. Rick Doblin’s research on MDMA, and Dr. Charlie Grob’s psilocybin research at University of California, Los Angeles (UCLA).

From those interviews, I authored several books, including Psychedelic Medicine: The Healing Power of LSD, Psilocybin, MDMA and Ayahuasca; Psychedelic Wisdom: The Astonishing Rewards of Mind-Altering Substances; and more recently, Psychedelic Medicine at the End of Life: Dying without Fear. I also coedited, along with Drs. Jason Butler and Genesee Herzberg, a trade book titled Integral Psychedelic Therapy.

After decades of prohibition and stigma, psychedelics are once again capturing the imaginations of researchers, clinicians, and the public alike. This resurgence isn’t happening in dimly lit basements, remote communes, or former military silos but in the hallowed halls of institutions like Johns Hopkins; NYU; University of California, Berkeley; UCLA; and Imperial College London.

The roots of this renaissance stretch back to the 1950s and early 1960s, when researchers first began exploring the therapeutic potential of substances like LSD and psilocybin. That early promise of psychedelic medicine was cut short by the cultural and sociopolitical backlash of the late 1960s, led by America’s racist, besotted president, Richard M. Nixon, who declared war on people of color and hippies under the flag of the so-called war on drugs and ushered in a draconian era of prohibition that persists now over half a century later. But the spark of psychedelic science never fully died out.

In the early 1980s, before MDMA was criminalized, I trained under Dr. Robert Kantor, a prominent clinical psychologist and the founder of the Pacific Graduate School of Psychology, now the School of Graduate Psychology at Pacific University. We used MDMA in his therapeutic setting, and the potential was immediately clear to me.

During these sessions, I would take 135 milligrams of MDMA at 9:00 a.m., engage in therapy until noon, when I drove the hour back to my office in time for lunch at 1:00 p.m. I was fully sober and clearheaded to begin consulting with my own patients at 3:00 p.m.

This experience taught me firsthand the benefits and safety of MDMA when used in a controlled, therapeutic context. The drug increased empathy and decreased defensiveness in ways revolutionary for treating everything from relationship conflicts to deep-seated trauma.