The Tim Ferriss Show - #458: The Psychedelic News Hour: New Breakthroughs, Compound Comparisons and Warnings (Psilocybin/LSD/Ayahuasca/N,N-DMT/5-MeO-DMT), Treatment of Trauma, Scalable vs. Unscalable Approaches, Making Sense of “Bad” Trips, and Much More

Starting point is 00:00:00 At this altitude, I can run flat out for a half mile before my hands start shaking. Can I ask you a personal question? Now would have seemed like a perfect time. What if I did the opposite? I'm a cybernetic organism living tissue over a metal endoskeleton. The Tim Ferriss Show. This episode is brought to you by the book How to Lead by David Rubenstein. David Rubenstein is one of the visionary founders of the Carlyle Group and host of The David Rubenstein Show,

Starting point is 00:00:33 where he speaks to leaders from every walk of life about who they are, how they define success, and what it means to lead. Jeff Bezos, Richard Branson, Warren Buffett, Bill Gates, Ruth Bader Ginsburg, Phil Knight, Oprah, all of them and more are featured in his new book titled How to Lead. This comprehensive leadership playbook illustrates the principles and guiding philosophies of the world's greatest game changers. In this book's pages, you can discover the experts secrets to being effective and innovative leaders. Past podcast guest Walter Isaacson has this to say, quote, reading this invaluable

Starting point is 00:01:05 trove of advice from the greatest leaders of our time is like sitting in an armchair and listening to the masters reveal their secrets. Pick up a copy of How to Lead, subtitle Wisdom from the World's Greatest CEOs, Founders, and Game Changers by David Rubenstein in hardcover, ebook, or audio, anywhere books are sold. Hello, ladies and germs, boys and girls, this is Tim Ferriss, and welcome to another episode of The Tim Ferriss Show, where it is normally my job to deconstruct world-class performers of all different types, all different ilks, all different sectors, whatever. You get the idea. In this special episode, the tables are completely turned. Instead of interviewing someone else, I am interviewed by

Starting point is 00:01:45 two experts on several topics I've both studied and supported for quite some time, including psychedelic-assisted psychotherapy and what it can do to heal trauma, and broadly speaking, possible futures for mental health. We cover a lot. I'm not a doctor. I don't play one on the internet. So this is for informational purposes only. This audio was recorded on a new show, The Psychedelic News Hour, thepsychedelicnewshour.com, soon to be a podcast. And I'm in conversation with two people, Dr. David Rabin, MD, PhD, drdave.io. You can find him on Instagram at drdavidrabin, R-A-B-I-N, a board certified psychiatrist and neuroscientist, executive director of the Board of Medicine and co-founder of Apollo Neuroscience, as well as Dr. Molly

Starting point is 00:02:30 Malouf, MD, drmolly.co, and on Instagram, at drmolly.co, a physician, Stanford lecturer, and ketamine-assisted psychotherapist. This episode was recorded on an app called Clubhouse. You can find it at joinclubhouse.com, an app still in private beta and defined by their tagline, which is Clubhouse is a space for casual drop-in audio conversations with friends and other interesting people around the world. I don't have any stake in this app. Wish I did, I guess, since I'm giving it a free plug.

Starting point is 00:03:00 This one's on me, Clubhouse. One final note, I recorded this on my phone, a necessity for using the app. So the audio quality is not studio quality, but it was polished as much as possible. It is listenable. You'll be able to make it out. You should be fine. So thank you for understanding. And thanks to everyone who joined and asked very thoughtful questions. I had a lot of fun doing this and we covered a ton of ground that has not been covered on this podcast before. So without further ado, here we go. Welcome back to another Psychedelic News Hour on Clubhouse. We are so, so thankful and grateful

Starting point is 00:03:38 to have all of you join us here again today. I'm Dr. Dave Rabin. I'm a psychiatrist and neuroscientist, as well as a ketamine-assisted psychotherapist and an MDMA-assisted psychotherapist. And I'm joined by my co-host, Dr. Molly Malouf, who is also a physician and a ketamine-assisted psychotherapist. And we are very excited and humbled to bring to you our very special guest this week. He has done some incredible work in the psychedelic research space and investment space and the mental health space, actually, which is where I think all of this ties together. And I think that one of the things that we often forget about, and I really wanted to tell you this, Tim, for a long time because I've

Starting point is 00:04:23 been following your work, and I'm so grateful for the fact that you've done two major things that I think have really radically transformed the landscape of mental health in this country. And it's not just mental health. We're really talking about health because part of the problem with health, looking at mental health in the U.S. and in the Western paradigm is we separate mental health and physical health where they're really just health. And, you know, mental health left unchecked over time causes physical health problems and physical health left unchecked over time can cause mental health problems. And we know that this is the case. And you had the courage a while back to come out and actually talk about your experiences with mental health in public and to have these conversations and bring them to the forefront of our community so that other people could feel no longer afraid

Starting point is 00:05:13 to start to have these conversations. And I think that, you know, as a psychiatrist, as somebody who does psychedelic work, and Molly too, I speak for both of us when I say that we could not be more grateful. And I don't think the field of mental health could be more grateful to you. And we should probably do, in terms of the field, we should probably do a better job of showing that gratitude because you've really helped destigmatize trauma and destigmatize mental illness so that people can feel comfortable talking about this in public settings and just more often in general, which is really the first step along the healing process. And then you've transformed that by taking the next step and actually putting money and putting

Starting point is 00:05:54 resources and encouraging others to put resources into the research, development, and commercialization of these powerful tools that were also stigmatized heavily that now can be used to do something that we never thought we could do in mental health, which is tell someone that it's possible that there could be a cure for what you're experiencing right now. And we may not be there yet, but we're closer than we've possibly ever been. And I just want to take this moment to thank you for all of your hard work and everything you've done to help facilitate this cause and to really share joy with the world of people who are suffering right now. So thank you. And please welcome Tim Ferriss.

Starting point is 00:06:39 Thank you very much. I feel as someone someone who spent decades in darkness experiencing many of the conditions that these compounds may have the capability to treat and believing them as many even in psychiatry currently believe you know them to be intractable or at the very best treated with some type of suppression of symptoms. It's an honor for me to play whatever small role that I can. And it's also a moral imperative, I feel. journey in every respect of the word. I'm hoping to continue to be a supporter and catalyst to the extent that I can. So thank you for saying all that. Well, and speaking of that journey, I think we would be remiss if we did not start out by giving you the opportunity to update everyone on Clubhouse who is not a party to the incredible announcement by Maps that you

Starting point is 00:07:46 and Joe Green played such an important role in recently. Would you mind telling everyone a little bit about the capstone and the great success that that has been that was announced yesterday? My pleasure. So there's a piece that does a good job of summarizing this in the Wall Street Journal. It is online by Shalini Ramachandran, which has the headline, Silicon Valley and Wall Street elites pour money into psychedelic research. And the subtitle gets closer to the summary, which is donors raised $30 million for psychedelic nonprofit, that's MAPS, to complete clinical trials, phase three trials, around drug-assisted

Starting point is 00:08:23 psychotherapy for trauma. That's MDMA-assisted psychotherapy for post-traumatic stress disorder. So certainly trauma of many different types, whether that's war veterans, first responders, victims of sexual abuse or otherwise, any type of abuse, certainly. And the Capstone campaign was, it's funny to say it in the past tense now. Yeah. campaign was, it's funny to say it in the past tense now. The capstone campaign was a campaign to raise the $30 million necessary to complete phase three trials of MDMA, methyl deoxymethamphetamine, otherwise known as ecstasy, in the amplified psychotherapeutic treatment of PTSD.

Starting point is 00:09:08 And it's very important to emphasize that this is not phase three trials for MDMA as a standalone treatment. It is the combination of context and molecule, which is extremely, extremely important, as I'm sure you've discussed previously in these meetings. And $30 million is, or would have been even three years ago, an almost unthinkable amount of money, an unattainable amount of money to raise for this. I was going to say, it took Rick almost, what, like 30 years to raise the first $30 million? Yeah, exactly. So, exactly. So a handful of years ago, the number of people contributing or just committing seven figures to psychedelic research would have been a handful. And that has changed a lot in the last two years. I think that's a credit to Rick. I think it's a credit to many things. And the increased destigmatization

Starting point is 00:09:59 of supporting the scientific research, there are many things one can support within the realm of, let's call it, psychedelics or psychedelic science, which I think is part of the reason there's a lot of scattered focus and historically, in some cases, a lack of results. It's because you can go a millimeter in a million directions very easily

Starting point is 00:10:20 if you don't focus. But in this case, the piece summarized some very notable names who have contributed a lot. And what I would like to personally underscore about this is that there were donors and donations made from $1 all the way up to $5 million. And there were more than 2,500 donors, including probably many people listening to this, put their trust after reading or hearing what they evaluated into supporting this, and every donor mattered. And the number of donors to me is just as important as the number of dollars raised because it signals to me

Starting point is 00:10:57 a real phase shift in the cultural conversation about these compounds. We don't have to revisit the sort of historical mistakes that were made in, say, the 60s, nor the cultural context then, which is very different from the cultural context now. But I think it's very exciting that more and more people are realizing that it is actually an incredible reputational opportunity to align yourself with exploring

Starting point is 00:11:26 these unconventional treatments for extremely expensive, sometimes fatal, often paralyzing conditions that we seem utterly unable to treat properly via other means currently. So the fact that we have such an incredibly low toxicity profile for, if we're talking about MDMA and psilocybin specifically, because let's not forget that there are hundreds and thousands of what we could call psychedelic compounds. Among those two that have received breakthrough therapy designation by the FDA with vast amounts of data to support their clinical use, have incredible safety profiles, low toxicity. Certainly, you're going to find many more people in emergency rooms because of acetaminophen, Tylenol, which can be incredibly toxic compared to any of these. And the fact

Starting point is 00:12:19 that they have the results they appear to have, if you look at, say, phase two data from maps, would lead one to believe either that people are lying, right? They're misrepresenting the results. They cannot be true. Or something is happening that defies any conventional psychiatric or psychological explanation for how the brain changes and how thoughts and thought patterns change the capability of humans to rewrite their software, to rewrite the stories they tell themselves with incredible durability of effect, right? In the case of MDMA or psilocybin, I'd say Hopkins, you're looking at one to three total treatment sessions with durability of various effects, six months, 12 months, 18 months later. That is more interesting

Starting point is 00:13:14 to me than just about anything else I could possibly focus on. So I'll stop my monologue there. You're absolutely right, Tim. I mean, it's phenomenal. It really demonstrates or highlights what we're seeing as this complete paradigm shift in mental illness. And I can say as a Western-trained psychiatrist, we're taught to tell people that you prescribe medicine or therapy, and you tell people that the studies show that if they discontinue medicine or discontinue therapy at any time, that their chances of relapse go up and the severity of their relapses will likely go up. And what we're seeing from MDMA, for those who are not familiar with the phase two trial results, is that people who have had treatment-resistant PTSD for an average of 17 years,

Starting point is 00:13:58 something like 53% are no longer meeting diagnostic criteria after just three doses of MDMA and 12 weeks of psychotherapy, as you were saying. And what's even more remarkable is five years out, without any more subsequent treatment, 67% of these people are no longer meeting diagnostic criteria. And from having trained in the MDMA protocol and the ketamine-assisted psychotherapy protocol, which were very, very similar, I can tell you that my perspective on this, which I think is very similar to a lot of the practitioners who work in this area, is the reason why this works so differently is because we're actually teaching people how to heal themselves. We're reminding them of this innate, as Mike and Andy Mithoffer say, the inner healing intelligence that we were all born with has the capacity to be

Starting point is 00:14:46 reactivated when we recognize that it's there. And this allows us an opportunity to start to heal ourselves because the center of our healing we now recognize comes from within us, not from some pill that we have to take every day and not from some person we have to see every week, but actually from within ourselves, which is so remarkable. It is. And I want to underscore something you said, or two names you mentioned, Annie and Michael Midhofer, who are incredible practitioners, I should say therapists, and who have helped define and formalize the format for the psychotherapy that is assisted by MDMA in these mass trials. And I do, whenever I can, try to play the role of conservative voice in media related to psychedelics, because I do not view psychedelics as panacea. I do not think they're suitable for all people.

Starting point is 00:15:46 And it's very easy to throw the baby out with the bathwater by viewing psychiatry as it exists or therapy as it exists as obsolete. And I think that's a huge mistake because the results that are achieved are, I think, in many cases dependent on tools from therapy or psychiatry like internal family systems, IFS, parts work. These types of conversations when conducted, this type of self-inquiry when aided by a therapist with the empathogen, let's just call it, of MDMA, something that generates empathy, not just towards others, but that can be directed at the self within the self is incredibly potent. And it is the combination. It is the combination. This is why if you go to an EDM festival, it's not automatic that a thousand people on ecstasy are resolving all

Starting point is 00:16:45 their childhood trauma. It just doesn't work that way. Nor does every pothead who tries, and all due respect to potheads, but any pothead in college who tries mushrooms once doesn't automatically stop smoking. But on the other side, when you look at the nicotine addiction studies that have been done with proper planning, format, support, and integration and follow-up by, say, Dr. Matt Johnson at Hopkins, the results are staggering. They are literally staggering. to indicate that we can borrow best practices from psychiatry and therapy and effectively put them on performance-enhancing drugs by adding some of these compounds with the right safety profiles. And certainly ketamine is of interest to me as well. Yeah, I love everything you guys are saying because the thing that we've always emphasized in the news hour is it's just fundamentally important that people recognize that the best outcomes come from therapy plus medicine. But I'm curious to both of you guys,

Starting point is 00:17:50 just to ask from both of you, because I know you're probably even more well-versed than I am on all the research, even though I've read through quite a lot of it. Do you guys want to explain to the audience how these studies have been performed? And assume that there's some scientists out there in the audience. I'm sure there's some people that are questioning and wondering about, okay, so how was the study done? Was there a control of just medicine or a control of just therapy? Can you teach people a little bit about how this has been performed so that people can kind of get a better understanding of the specific research?

Starting point is 00:18:18 Yeah, I'm happy to share one aspect of it that is very valid and important part of the conversation. And then I'd love to hand the mic off because I am on the line with two doctors and I am most certainly not a doctor and do not play one on the internet, but have spent a lot of time looking at and being involved with study design just as a funder of a lot of this research. Because you have to pick and choose your targets, you have to pick and choose your study design very, very carefully. You don't get an infinite number of investments for leverage in science, just like you don't get it in business. These things cost a lot of money and they take a lot of time. So you have to really think about your parameters

Starting point is 00:18:57 from the outset. Well, let me give the short answer first. Yes, these are placebo-controlled, randomized studies. And the intervention, the active intervention, let's just say MDMA, is contrasted with a placebo combined with the same therapy, the same therapeutic approach. And the placebo effect is the most consistent, powerful effect across all of medicine. So we need to take it very seriously. And there are entire books written about placebo and nocebo, which is the opposite of that, where you can negate the, say, pharmacological intervention by believing that it doesn't work, which is just as crazy if you begin to think about it, yet real. And blinding and including placebo in psychedelic studies is remarkably challenging because it is very quickly obvious to almost everyone whether or not they've to create a physiological effect, such as by using something like niacin, where you have skin flushing, so-called niacin flush. And these types of active placebos can be used, I think, particularly well with respect to MDMA. It is

Starting point is 00:20:18 more challenging when you are using what we might consider a classic psychedelic with strong visionary or visual components such as psilocybin. But I would love to pass the mic because that's where I feel like I start wading into the deep end of my ignorance pool. So I'd prefer to defer to the experts. Thank you so much for that, Tim. I think you covered the great majority of it, actually. And I think bringing up placebo and nocebo and the importance of those things is really critical because I think what a lot of people don't understand is that placebo and nocebo. And the importance of those things is really critical because I think what a lot of people don't understand is that placebo and nocebo are really having a factor in the study design that takes into account the power of belief in our treatments. So placebo is really a matter of

Starting point is 00:20:58 saying in a Western scientific lingo that, you know, if you believe a treatment is going to work for you, then it's going to work. It's 30 to 50% of the time more likely to work if you believe a treatment is going to work for you, then it's gonna work. It's 30 to 50% of the time more likely to work if you believe in it. And these are the numbers roughly for mental health studies. And for nocebo, I think the numbers are actually a little higher, which means if you believe that a treatment will not work for you,

Starting point is 00:21:18 it is 30 to 50% less likely to work, which is really fascinating. That it's really the power of the mind in the healing process, right? Getting back to what we were talking about before, is using this combination of psychotherapy to enable or amplify the power of the medicine, and in turn, using the medicine, in the case of MDMA, to catalyze the radical safety and radical healing potential for psychotherapy to facilitate these incredible healing experiences of people that are really rooted in intention and belief, which goes back

Starting point is 00:21:53 to a lot of the tribal history of how traditional psilocybin and cactus ceremonies and ayahuasca ceremonies are performed. It's all about intention to heal and curating a safe space for that intention to manifest in healing. And that you can see that consistently when you look in how these MDMA trials are put together, it really pulls that intentionality that is rooted in these traditional tribal cultures in their ancient healing practices that are, who knows, probably 5, 10, 20,000 years old, it pulls those in as best as we can into a Western paradigm that's double-blinded and placebo-controlled and randomized, where subjects get this incredible 12 weeks of psychotherapy protocol. The results for people going through, just to compare, I said earlier,

Starting point is 00:22:45 of the people who have 17 years plus on average of treatment-resistant PTSD in the MAPS Phase 2 trial with MDMA, what we saw was that two months after this treatment wrapped up in the active group that actually received MDMA, and again, these were crossover studies. So all the subjects got MDMA eventually. But there were also groups of subjects that got placebo first and some groups got placebo second, which is typically in these studies, and correct me if I'm wrong, I believe it was low-dose MDMA, which was not critical enough to hit the threshold. MDMA is a really interesting molecule because you have to hit a threshold to be able to get the active effect, which makes MDMA is a really interesting molecule because you have to hit a threshold to be able to get the active effect, which makes MDMA probably the worst medicine to microdose

Starting point is 00:23:30 because it has a paradoxical effect where you kind of don't feel good if you take too little of a dose and you don't hit that threshold peak dose, which is somewhere between 80 and 120 milligrams for most people. And so they use that as the placebo. But what's really interesting is that in these people who had 17 years on average of treatment resistant PTSD, we see that 53% who had the active MDMA two months out are no longer meeting diagnostic criteria for PTSD. I believe that in the placebo group that only received the sub-therapeutic dose of MDMA, what we saw was something like 20-something percent, I think it was like 25 or 27 percent, were no longer meeting diagnostic criteria, which is actually pretty amazing because that means that

Starting point is 00:24:18 the therapy alone, this 12 weeks of intensive therapy with two therapists, is actually very powerful at helping people. But then you go and look at the five-year follow-up data, which is really where it counts. And what you see is the people who did not get MDMA at five years out, they did not continue to get better. In fact, many of the 27% that were no longer meeting symptom criteria at the end of that first 12 weeks actually relapsed and ultimately had a recurrence of PTSD symptoms, whereas more people who got MDMA were symptom-free or not meeting diagnostic criteria five years out than were at two months out, which then goes to continuously reinforce this idea that the medicine and the therapy and the intention to heal are facilitating

Starting point is 00:25:05 this radically transformative experience that allows people to remember how to heal themselves, which is just such an incredible opportunity in mental health. We've really never seen anything like this before. I think it's super interesting, just to tie this up, that if you look at the ascetamine research, this drug came along by J&J. And it's frankly just not a very good drug because it's not much better than regular ketamine. And they didn't combine it with any therapy. And doctors aren't really using it that much, especially the doctors in the ketamine space, because it's basically designed to just go to the clinic, take the medicine and go home. And that's what's so inspiring about this MAPS research is

Starting point is 00:25:46 by its design, it's combining these two therapeutic modalities in order to create the best effects long-term. To most people who ask me, should I do X? I fill in the blank. Should I use SIL-7? Should I use DMT? Should I use ayahuasca? Should I use MDMA? Generally speaking, I would say 90 plus percent of the time after I ask a few follow-up questions, my answer is no, which might be surprising to people given how public I am about supporting the research. And the reason for that is pretty simple. I think that there is a lot of preparation you can do to increase the odds of a very good outcome. Much like if you're going to bet in a casino, you should probably read a few books beforehand you might have, might, if you are exceptional, have a chance of bending the odds. So you're playing blackjack, single-deck blackjack, instead of slot machine or the roulette wheel.

Starting point is 00:26:57 And I think a lot of people play roulette with psychedelics, and I think it's a terrible idea for the following reasons. A simple way to think about psychedelics, and I'm not saying this is scientifically comprehensive because it's not, it's a metaphor, but what psychedelics do, and this is whether you're dealing with tryptamines or you're dealing with phenethylamines, but I think particularly tryptamines in a lot of contexts, we could put psilocybin in that category, certainly.

Starting point is 00:27:22 DMT, dimethyltryptamine, would fall into that category. These compounds, MDMA, although I consider it an empathogen more than a psychedelic, is similar in respects. What it's doing is heating up the clay of your mind and psyche and brain, structurally also, such that it's more malleable and you can reshape these narratives and stories and behaviors that have governed much of your life. In many of these stories, many of these narratives, many of these behaviors, compulsive loops, whether that compulsion manifests as OCD, eating disorder, treatment-resistant depression, chronic anxiety, alcoholism, or otherwise. I happen to think that these are all symptoms of a shared underlying set of issues. These psychedelics heat up the clay so that you can remold those stories,

Starting point is 00:28:18 most of which you never chose for yourself. They were absorbed somehow or caused by the environment. Trauma in childhood, for instance, absent parent, whatever it might have been. And then the question is, you've heated the clay. What do you do to ensure it is remolded in the most beneficial way possible, right? Do you have an expert sculptor with lots of experience helping you, right? If we think about it as a keyboard or rewriting a story, like do you have a seasoned peripherator helping you? Or do you have a cat running across the keyboard, which is how a lot of people take psychedelics, just play roulette? Or still, are you in an environment that is utterly unsupportive, where maybe you have mischievous friends who want to

Starting point is 00:28:54 prank you, or you have negligent friends who have taken a compound and are enjoying the experience and don't want to be taken down by the trauma that is surfacing for you. If that's the case, it's important to realize that the clay can be molded into a misshapen form that is worse than your original state. I think this is really important to emphasize, right? So you're introducing a period of plasticity in the brain where it is flexible. And then the question or one of the questions is, what are you doing beforehand, during and afterwards to ensure that you're shaping it in the most beneficial way possible? And for that reason, if people aren't willing to do

Starting point is 00:29:35 quite a lot of upfront preparation to take it seriously, to allocate sufficient time for a very spacious on-ramp and off-ramp from the experience. In other words, you're not having your first psychedelic experience as five-immuno DMT on a Sunday night and then going into your office and now on Monday morning. Only then, and in addition to that, committing to post-care, having a therapist, psychiatrist, or otherwise on board as a safety net so that they have a support structure that is not one of their volunteer friends. Will I recommend that someone consider use of psychedelics? That is how seriously I take them.

Starting point is 00:30:14 And that's not to mention the quality of the medicine on the street these days is so patchy. and you're really rolling the dice every time you go and try a psychedelic that you've procured through the dark web, through your drug dealer, through wherever you get your medicine. You just don't know what the quality is. And especially with MDMA, which is notorious for having adulterants in it and all sorts of things that people cut it with.

Starting point is 00:30:44 So that too. Yeah, it pays to tread carefully and thoughtfully. And I do think that caution is the better part of valor here. And that just to continue to lay on the metaphors, measuring twice and cutting once counts for a lot because in controlled settings with proper supervision, with the pre and post carefully thought through, which means it's not impromptu, there is a plan. Just like you would have a plan going into reconstructive knee surgery, you would have prehab, surgery, you would have medication to assist post-op and intra-op, and you would have a significant amount of attention dedicated pre-operation to your rehabilitation. I look at this the same way. And if you don't do that, although it's not maybe as

Starting point is 00:31:30 common to read about or hear about these stories, you can end up very dislocated. You can end up becoming unmoored. And I have seen firsthand, I've seen dozens of lives directly changed in ways that are inconceivable based on the textbooks of psychology and psychiatry used in colleges today, for instance, or medical schools. Inconceivable. And that tells me that as any good doctor would tell you, like 50% of what we know is wrong. We just don't know which 50%, right? I mean, it was like we operated on newborns and infants without anesthesia until 1987. Let's not forget. We are still in the medical dark ages in many respects, and that will always be the case. There will be great unknowns of great value, and I think that

Starting point is 00:32:17 many of them are in psychedelics. On the opposite end of the spectrum, I've seen people get so destabilized and knocked sideways that they are effectively in a psychotic state for days, weeks, or in a handful of cases, years afterwards, generally associated with ayahuasca and getting lost in that world in South America. smart. It is very tactically useful to do your homework. And if you want to go fast, it's a bar for the military, like slow is smooth and smooth is fast. You could not be more right there, Tim. And I thank you for echoing a sentiment that we talk about frequently on the NewsHour because that's, you know, what you're mentioning is really one of the most common mistakes that I think people make with psychedelic medicines. And I think your metaphor about the clay, remolding the clay, warming the clay is such clay to take a new shape or for us to effectively reshape it, reform it, and then have it solidify in the way that we want or intend it to be in the future that's aligned with our goals, maybe not as much aligned with whatever we

Starting point is 00:33:36 absorbed in the first several years of our lives from whoever happened to be around us at those times or whatever we were seeing on TV or what have you, or in our schools, but actually what we want ourselves to be, not knowing what our potential really is. It's just such a powerful metaphor. And I really appreciate you bringing that up because that is such a great way to think about this. And I think, you know, interestingly, I think that metaphor actually plays into a lot of different other areas of our lives. Speaking of which, we're kind of stuck in a mold for a long time in the scientific and medical community where research only was done a certain way. You know, research was only funded

Starting point is 00:34:16 a certain way. It was only conducted at certain places in certain contexts. And so a lot of these different approaches kind of got left out and were not even evaluated. And the clay wasn't even ever really warmed thoroughly for us to have an opportunity to say, hey, maybe there's a different way we could be doing this. And then someone like you comes around and says, hey guys, wait a minute. If I take some money and some of my friends' money and we put it towards this stuff, then all of a sudden, it doesn't really matter what the NIH or the NIMH says. We can make new research happen. Why is it so important or more important than ever right now

Starting point is 00:34:53 to have diverse sources of research funding in the mix? I'll take a stab at it. I appreciate you setting that up so nicely. But before I do that, just a quick recommendation for a few resources for people who might be contemplating psychedelics or perhaps are engaged but want to increase

Starting point is 00:35:11 their exposure to perhaps a few different inputs that could be helpful. The Healing Journey by Claudio Naranjo, N-A-R-A-N-J-O, is an exceptional book. I highly recommend.

Starting point is 00:35:23 The introduction alone makes any cost associated very recommend. The introduction alone makes Denny Kost Associated very cheap. The Secret Chief, both of these are actually published by MAPS. And it just so happens, not because they're published by MAPS, but because they're great books and I'm recommending them. The Secret Chief, which is a discussion of different modalities of facilitation. And I would also recommend to anyone who is engaged with or considering being engaged with psychedelics that you download the Waking Up app by Sam Harris and

Starting point is 00:35:51 do the introductory course, 10 minutes a day for, I think it's between 30 and 50 days. This will help you navigate and squeeze the most juice from your experiences, particularly when combined with a book called Awareness by Anthony DeMello. So do those two concurrently. Back to your experiences, particularly when combined with a book called Awareness by Anthony DeMello. So do those two concurrently. Back to your question, why are diverse sources of funding important? Well, I would say first that the citizen philanthropy, the capital from individual donors is important, first and foremost, because there is such a lack of funding from many other sources. And my intention with committing many millions of dollars of my own capital, the largest such commitment to anything for-profit or non-profit in my life,

Starting point is 00:36:37 certainly, especially beginning a few years ago, whether it's Hopkins, Imperial College, the phase three trials with MAPS and MDMA psychotherapy, the intention is to provide seed capital to something that can be a world changer. Just as I would in the world of startups, my goal is to get 50K to something that I think can raise 50 million, no problem, a few years later. And therefore, the objective has been to pave the way through destigmatizing and reputationally de-risking, not just de-risking, but clearly showing the reputational upside of supporting this science as an individual to grease the wheels for individuals, then foundations, then larger foundations that have more reputation management

Starting point is 00:37:26 in place and more systems and processes, these larger name brand dynastic wealth foundations, and ultimately government agencies. So my plan starting at least a year ago, probably 18 months ago, has been to try to set certain things in motion that will likely increase the odds of federal funding within, say, three to five years, I hope closer to three years. And I'm very optimistic about that. Nonetheless, as it stands right now, the research that we are seeing is almost entirely dependent on individuals finding conviction in the data, sometimes in their own experiences, to look at this as an opportunity to bend the arc of history from a mental health perspective. Much like pharmacology within medicine can be

Starting point is 00:38:18 separated into pre-antibiotics, post-antibiotics, and that was addressing physical bugs for the sake of simplicity. If we're addressing mental and psycho-emotional bugs, fixing the software, I think psychedelics have the potential to mark that type of before and after line. And it's up to individual philanthropists right now, much in the same way that oral contraceptives were up to Catherine McCormick, who's an incredible woman. Everyone should read her Wikipedia from her history at MIT to ultimately almost single-handedly developing oral contraception with the equivalent of, I want to say, $24 million in today's money, adjusting for inflation over a period of like five or 10 years. And it was initially approved, if my memory serves me, for the indication of menstrual

Starting point is 00:39:06 disorders. And it's super important and ties into the strategy of how to shepherd some of these compounds through Byzantine regulatory affairs. Although the FDA has been incredibly supportive, I want to add that they're not the enemy here. They've been incredibly supportive of both psilocybin and MDMA. The initial indication is very important. And that bent the arc of history. You think about the long-term global effects of that type of liberation for half of our species in the form of oral contraception and being able to family plan with that as a tool in the toolkit for such a small dollar amount, right? I mean, that is like one in 10 billion out. And I look for that in startups. I look for that in science.

Starting point is 00:39:50 And I should say, you know, psychedelics are not the only place I have allocated capital and placed bets in the world of scientific research, but they are the primary focus. So for that reason, if anyone is sitting on the sidelines for now, and they've been considering where they might want to put their capital, you can't take your marbles with you. We're all going to die. And you could be buried like a pharaoh with golden thrones and gold bars and so on, but it's probably not going to help you very much. I think this is a golden window of time over the next, let's just call it one to three years

Starting point is 00:40:22 where people can go down in history as having been the spark that kind of lit the bonfire that lit the world on fire in the most productive way possible. That is so inspiring. And, you know, I think the dovetail on that is the real kind of big question that plagues me every day

Starting point is 00:40:40 as I'm thinking about trying to figure out how are we going to go from 100 hours of therapy to hundreds of thousands of people who have trauma right now from what's happening in our country over the next five years. We can get these drugs approved, but the reality is that the delivery of these medicines, you just look at our healthcare system right now. I mean, it's failing at its most basic function, which is to treat sickness. And so what is your vision of how this gets to scale? Because that's the real question that I think is going to truly lead to whether or not this changes the world or we're stuck with expensive treatments for only people who can afford it. And that's what I'm trying to figure out right now is,

Starting point is 00:41:21 do we need to design new studies that enable groups of people to have treatments together? I mean, if you look at indigenous cultures, ayahuasca is delivered in groups. And so I kind of have an issue personally with, I know we have to design studies that will get approved by the FDA, but I have a really hard time understanding how we're going to get this to scale with that current. I think this is a better question for the maps professionals, but I can give you my lens through which I look at this or the lenses. The first is that, and this may sound strange given what I just said, but scale, and believe me, I can count, so I know I'm getting this off slightly, but I can be a four-letter word. And Seth Godin talks quite a bit about

Starting point is 00:42:03 how easy it is to escape into the big as opposed to focusing on the small in front of you. And even Airbnb before it was Airbnb focused on doing things that didn't scale. And there's actually an excellent episode of the Masters of Scale podcast by Reid Hoffman with interviews of Brian Chesky and the other founders of Airbnb about doing things in the beginning that did not scale very deliberately. That might seem antithetical to becoming very big, but in fact, it is not. It is necessary for prototyping and refining and throwing a lot against the wall so that you can build on early successes. So the things that we do in the beginning are almost certainly not going to be the things, at least not copy and paste, that are done three years later, nor five years later.

Starting point is 00:42:48 That's the first assumption I would say that I'm making. The second is that it is very challenging to scale in person, period, full stop. So I don't expect it to be easy. That is just another assumption is that this is not it to be easy. That is just another assumption, is that this is not going to be easy. And that if something appears easy, we should double down on scrutiny and really stress test it because there are probably weaknesses. Third is looking at historic adoption of different behaviors and systems, like it or hate it, or even if you're neutral, many, many, many things that end up at scale, like recycling in the United States, started as something piloted in very, very small communities and generally in affluent areas, right? And that, I think, these days can produce a visceral negative response, but it's important to realize that the more affluent, generally speaking,

Starting point is 00:43:45 are going to have more capital, more time with which they can use to serve as guinea pigs, if that makes sense, right? You're not going to ask the single mom of four to be a guinea pig. It would be unfair. It would be unreasonable. And it would be extremely problematic, right? So a lot of the guinea pigs end up being small-ish groups of people with more capital and time. And I think that's okay. If you look at startups in the very early stages, they very often use the initial premium pricing for a small subset of people to completely pay for the R&D and subsidize developing cheaper versions that can be deployed more widely. That's certainly true with Uber, which I know very, very well since I was one of the initial advisors. So I saw them deliberately do that. But in the beginning, they caught incredible flack

Starting point is 00:44:34 for being elitist in that respect. But suffice to say, that was an effective strategy. It's a strategy that we've seen over and over again in different areas. And I would expect for us to see it in psychedelic therapy as well. And the ultimate form that it takes, I don't know. But another base assumption that keeps me going, quite frankly, with all that I'm involved with, with respect to psychedelic science and indigenous communities and psychedelics, there's a lot that I haven't talked about publicly that I'm involved with. But even if we just look at the forward-facing stuff, it's very time-consuming. It's very energy-intensive. It's very capital-hungry. And part of what keeps me going is the realization, which is not a cop-out in any sense, because I do want to reach millions of people ultimately,

Starting point is 00:45:19 but not rush it and self-incinerate in the process is that to change the world, you do not need to treat 100 million people. If you can help one person overcome paralyzing trauma, you've changed the world, full stop. The ripple effect from that one person can be incredible, right? Let's say that one person is the daughter of a senator or a congressperson who has lifelong eating disorder, multiple brushes with death, multiple hospitalizations, and psychedelic therapy is able to allow that person to find peace and rewrite their narrative such that they're not battling this demon every day. That's one person technically, but what are the far-reaching implications of that? There are many, right?

Starting point is 00:46:05 If it's helpful at any point. If we want to talk about ayahuasca, we can talk about that as well. There are a number of people in the psychedelic science world, researchers, who are looking at group integration. And I think that's very important to your point. And so that is going to happen. It's going to happen. And it is happening. And I'm sure that there are multiple researchers who are looking at the effectiveness and cost-effectiveness of operating in groups,

Starting point is 00:46:31 not necessarily for treatment sessions, but certainly for PrEP and more frequently integration. I am optimistic that in some cases, groups will not just be as effective, but more effective than one-on-one or one-on-two, meaning one patient and two facilitators integration. I'm very, very optimistic. And I think one of the ways the various actions of the psychedelic movement will hurt each other and themselves and hobble things is by trying to boil the ocean at once. If you try to go too big, too fast, that is a recipe for disaster, in my opinion. Now, I'm still aggressive. I'm fucking aggressive. It's how I am with this type of thing. I'm very aggressive. So I push. I really push. But there is a point at which you can push too hard and things can break. It's a balance.

Starting point is 00:47:22 And it's a challenge for me as well. That is a really beautiful answer. And part of why I'm so inspired by it is, you know, my own medical practice has always been fairly elitist. And it weighs on me a lot because I have charged a lot of money for, you know, early adoption of technologies that now are becoming scalable. And what's really cool is that there's a lot of companies that are taking things that I've been doing manually and they're digitizing them. So I think there is a lot of hope and promise. And I think the hard part of it being an early adopter is that you see the future and you know what's coming and you just so badly want it to be now because never have we ever seen so much trauma all at once. And it's just heartbreaking to see society right now

Starting point is 00:48:05 with so much pain and knowing we have to wait for this. And I know that's what's necessary, but it's still painful. And watching so much pain in the world, it's like you just want to alleviate it. As a doctor, that's kind of why you went to medical school.

Starting point is 00:48:18 Yeah. And I would just say for anybody listening, you know, historically, I think many participants in the psychedelic space, and there are, I use the word factions very deliberately because I find the infighting within the psychedelic world particularly hilarious and hypocritical, but nonetheless, we're humans and tribal and all of that, that one of the greatest weaknesses in the psychedelic

Starting point is 00:48:43 world is having everything become a priority and trying to do everything. If everything is your priority, nothing is your priority. And I'm not saying that to you specifically, Molly, at all. It's just a lead into a broader observation of why the psychedelic subcultures coordinating the different pieces can often be like herding cats is because there is a pervasive lack of focus. So pick your shots. If you have your patience and you're doing a good job with your patients, then you are doing a good job, period. So I want to just, if that is any reassurance. Yeah, Tim, I want to echo what Molly was saying. And I really appreciate your perspective

Starting point is 00:49:22 on that because I think it is a unique perspective. I, for one, have had these conversations about scaling with Liana, who just joined us to provide the MAPS framework for planning for scaling these kinds of things, since Tim, you brought it up. And also with Rick Doblin and, you know, really talking about how we can expand access. And I think what always comes back to me is reminding myself of what are these medicines really trying to teach us? And there has been this constant pattern of ancient knowledge that keeps coming to me through the work that I work with my own clients with and without medicine, and also through some of the experiences that I've had in my own trainings, for example, training for ketamine-assisted psychotherapy, where it really comes back to these tribal tenets of ancient wisdom, which are gratitude, forgiveness,

Starting point is 00:50:09 compassion, and self-love as the foundation of trust that all of this is built on. Not only trust in ourselves that allows everything else to grow from a stable foundation, but also trust in everything else that we're doing and trust in each other and trust in this whole adventure that we're on together, that we can do this together. And the interesting one of those four that I think people, including myself, have the most trouble with on a regular basis is self-compassion. Because self-compassion is most commonly on a moment-to-moment, day-to-day basis, really the practice of patience for allowing things to unfold as they will in time with focus and with dedication and

Starting point is 00:50:54 devotion, but without rushing. Because when we rush, we make mistakes. And that patience and allowing that time and that opportunity for that compassion to come into our lives allows us to recognize and take a breath and take a step back and say, you know what? There is no rush right now. You know, we have a lot to do and there's a lot of other people helping and there's a lot of work on the horizon and a lot of things that we need to do, but there is no

Starting point is 00:51:21 rush. And the more we can be patient with this process and all work together to see it through, not quickly, but effectively, then the better this will be for everyone. But I just wanted to thank you for bringing up the patience-driven approach and reminding us of that. And I just wanted to give Liana an opportunity to quickly catch us up on MAPS plan concepts for scaling some of these treatments more effectively. Yeah, thanks so much for calling me up. Hi, Tim. Good to see you here. I really appreciate this conversation that's being had right now in the direction of this.

Starting point is 00:51:55 And Molly, I really hear, I mean, there is such incredible need and I see it every day with the amount of messages. And I work with another group that works with veterans, and there is a very urgent need for these treatments. And just two quick points on scaling that I wanted to bring in is, one, let us remember that the MDMA protocol was first developed 14 years ago, and it's taken a very long time to get this work to where it is. And it was developed in the model with the dual therapists in the room for the eight-hour sessions with the understanding to create the most comprehensive protocol that had the highest likelihood of success within the FDA framework. And so it was coming from that place, it was highly stigmatized, it took a long time to get the research to where it is today. So I just wanted to bring that piece

Starting point is 00:52:39 in and then also to say that there is an unknown factor to see what happens when we start treating thousands, tens of thousands, hundreds of thousands of people with MDMA. And this controlled growth model that we're working with, which there are some natural frictions built in to the rate in which we can adequately train therapists due to the need for supervision. And there's only so many participants in our study. So there's only so many opportunities for therapists to receive supervision need for supervision. And there's only so many participants in our studies, so there's only so many opportunities for therapists to receive supervision in their training. We want to be prepared for any adverse events, and we want to shore up the potential for

Starting point is 00:53:16 there to be backlash against this work so that we can continue the success into the future. And so it will be a very controlled kind of growth model. There'll be a very limited amount of therapists available to do this work on day one of FDA approval. But then quickly after that, it will start to grow exponentially. So it will take time and patience is needed. And that's a hard thing when there's so much need, but it is the way to do this work, right? And I just, Tim, I really appreciated your comments on all of that. So thanks. Thanks, Liana. Yeah, it's nice to see you, first of all, and hear you. You know, it's from a long-term planning perspective, it is, I think, important to scenario plan, meaning anticipate that there are going to be some

Starting point is 00:53:59 significant challenges and significant blowback in different forms as this scales, as there would be with anything new. It's the same reason that there are thousands and thousands and thousands of people who die on highways in the United States. I don't know what the time frame would be, week, day, month, but nonetheless, it is stadiums full of people who die in automobile accidents. But if one person dies in a Tesla that has some degree of autonomous driving, it is news and headlines everywhere. And I fully anticipate that even though you could go to any ER and find both critical patients and deaths caused by things that you can purchase over the counter, like acetaminophen and liver failure associated with that. When there are, and it's not if, when there are human tragedies associated with psychedelics, because there's a certain scale achieved, just given the law of large numbers, there are going to be complications. There are going to be cases that get a massively disproportionate response from the media in negative coverage. These things are going to be cases that get a massively disproportionate response from

Starting point is 00:55:06 the media in negative coverage. These things are going to happen. If we are successful in making this widely available, that is part of the, I wouldn't say reward, but a natural outgrowth of this reaching some degree of scale. And so while it pays to be optimistic and there are many reasons to be optimistic from a planning perspective this is going to be if it is successful very challenging we will need to have very organized groups of people like those who are doing drug development and handling other capacities within maps who have thought this through ahead of time this is also true with the decrim movements nationwide and the various initiatives in Oregon. It's challenging to think about, sometimes impossible, the second, third, fourth order effects of different innovations, different changes, regulatory

Starting point is 00:56:00 modifications, and so on. But I think it's very important because this is not going to be easy and we're going to need more than hope. You know, as James Cameron, the director, said hope is not a strategy. Hope is not a strategy. Fortunately, though, more and more people are involved with this space who have spent a lot of time working on strategy in other areas. So I am optimistic, but I'm not relying on hope as a strategy. Yeah, I thank you for that as well. I think you're absolutely right. And it could not be more important that we, as difficult as it is sometimes, and as much as we are struggling as a community, especially right now, to take our time to make sure that we usher these medicines in in the right way. They do have the capacity to spread contagiously. We saw it in the right way, you know, they do have the capacity to spread

Starting point is 00:56:45 contagiously. We saw it in the 60s and 70s, and we saw what happened. I think even now, there are, if you really want a comparison, you know, there's hundreds of thousands, if not millions of people dying of opioid-related deaths every year. And yet, we are seeing more news about people going to the jungle in Peru or in South America when one person has or two people have a negative consequence as a result of an ayahuasca ceremony when they forgot to stop taking their, you know, antidepressant medication or some medication effect that was combined with the ayahuasca that caused a negative result that resulted in someone having either a psychotic break or dying, which is still extraordinarily rare. And yet that becomes something that the mainstream media ends up

Starting point is 00:57:36 associating with these medicines, which is so unfortunate. And at the same time, I think it just serves as a constant reminder to us to be extra extra careful. I did want to mention one thing that stuck out to me about your work which is again going back to helping to destigmatize these medicines, destigmatize trauma and mental illness in our communities at large. One of the things that a lot of people don't actually recognize and I think a lot of doctors themselves don't recognize, is for doctors and caregivers, we are not really allowed to admit mental illness. In fact, as a physician, we can have our licenses taken away for having a diagnosis of mental illness in our medical record if that ends up getting reported to our licensing board, or if it gets found out by our licensing board

Starting point is 00:58:25 and we did not report it. There are all of these different putative restrictions that can really impact our ability to even provide care. And this isn't just for doctors. This extends to anyone who is board certified as a care provider with a license, which is really quite destructive because it really makes you realize that many of our physicians, especially on the front lines right now, are facing symptoms of burnout, but we can't admit it or seek care easily because as soon as we do, we directly jeopardize our ability to deliver said care. And that's such a wild paradox in the way that we wound up having, ultimately, as a result of that, more physicians and more caregivers on the front lines who have potentially untreated symptoms of mental illness. And we could

Starting point is 00:59:10 have the alternative, which would be caregivers and physicians on the front lines who have adequately addressed their issues because of overwork, work-related stress, or the stress of training and the trauma of training, or whatever it might be. And yet that is not being addressed and it's being in fact punished because mental health and physical health are still looked at as separate things. You would never see a doctor lose his license for having a coronary bypass episode, for instance, which is much more dangerous and brings you much closer to death than most mental illnesses. And I was wondering from your perspective, Tim, as someone who is a non-physician, kind of looking at this, how do you see our society overcoming this incredible stigma of mental illness? I'm glad you didn't ask me how to overcome the stigma as it associates, or maybe you

Starting point is 00:59:57 are, specifically to licensed professionals. It's important to keep in mind this does not just apply to physicians, as you mentioned. It applies to police officers. It applies to airline pilots or pilots of any type. It applies to truck drivers. It applies to anyone with a license. I don't have a quick answer to that. I don't actually even have a compelling answer to that. So I hope other people are working on it, but I don't have an immediate answer to that. I can say that I've personally, as a friend, worked with a police officer who was in exactly this

Starting point is 01:00:31 position. I mean, he was suicidal and he was on duty carrying a firearm every day. Sweetheart, beautiful human being, understood how precarious that situation was, and yet was not in a financial position to go to his superiors and ultimately ended up referring him to a ketamine clinic for a five or six intravenously delivered infusion sequence which was extremely helpful for him but the fact that he had to do that covertly is fucking absurd and patently unstable right i mean that is systemically not a viable solution so i don't have an answer to that i wish i did but i think telling that type of story can catalyze those who are in a position to perhaps make change or implement policies whereby people

Starting point is 01:01:20 can get paid sick leave or otherwise not fear for their livelihoods and paying rent or putting food on the table for their families. But I don't have a solution to that. And just so I can address my flopping around with numbers, 2019, an estimated 38,800 people lost their lives to car crashes, 4.4 million were injured seriously enough to require medical attention. So there you have the numbers. And I want to mention just one more thing, just because it's come up a few times. I have a decent amount of exposure to ayahuasca. I would never recommend that, much less going out of the country to South America to consume ayahuasca as a first rodeo, probably not even a 10th rodeo. There are very particular

Starting point is 01:02:07 risks involved that would take hours to fully flesh out here. But suffice to say that if you're strapping on skis for the first or even the 10th time, it's probably not a good time to go heliskiing. It's always, to me, the thing I tell everybody is always start low, go slow, titrate up. If you're going to get experience with psychedelics, start with the lowest possible dose. In my practice, I actually start people out on a pretty low dose of sublingual ketamine and then graduate them up to a psychedelic dose. And I found that it's pretty darn safe and people feel like they're in more control of their experience.

Starting point is 01:02:44 And I also have had clients decide to go to Peru and say they're in more control of their experience. And I also have had clients decide to go to Peru and say they're ready to do that kind of work. And they have friends, they have guides, they have reputable sources. And I've had people who've had lifelong depression, literally since they remember being a child, being depressed, have complete recovery. So even though I'm not recommending people go to the Amazon and do a bunch of ayahuasca, I'm still astonished by the fact that there are miraculous recoveries in certain people with the right guides and the right set and setting and the right preparation. And I actually think we need gateway drugs that are safe and recommended by doctors. And I think people need to put the training wheels on. I've always described it like this. You start with training wheels,

Starting point is 01:03:24 you learn to ride a bike. From riding a bike, you learn to mountain bike. And then you learn to drive a car. And then you learn to fly a plane. And then when you have, you know, been a pilot for a long time and maybe you're ready, you can pilot a spaceship. But I don't recommend people go

Starting point is 01:03:38 from a sublingual ketamine clinic to like 5-MeO-DMT. Like that to me is super irresponsible. And there's a lot of people who don't realize just how dangerous some of these drugs can be. And I know enough people who've had, like you said, their lives completely altered in a negative way to know that these are powerful tools, but they are also dangerous and they need to be in the hands of professionals. So it's kind of fascinating. I feel like the last 10 years in San Francisco, we experienced this

Starting point is 01:04:03 kind of total renaissance of psychedelics. And there was a lot of irresponsible behavior. But at the same time, it led to so many people figuring out, oh, my God, these can change the world. We can maybe bring these to market. And it's led to a much more conservative and steady approach to legalization. There's a lot of work that needs to be done. And I just want to add on to what you were saying about physician suicide, Dave. There's a great TED Talk by a doctor called Why Doctors Kill Themselves. And it's potent and it's powerful. And it's all about this factor of doctors are suffering more than ever, and they can't tell anyone. And, you know, it's really a huge problem. And I think we need these medicines for them too, not just for the patients, but for the physicians. And so what's really cool

Starting point is 01:04:52 about even ketamine-assisted therapy and what Phil Wolfson's doing, what you've been doing with him, is Phil Wolfson's training actually brings together practitioners in Marin and has them sit together and experience psychedelics together so that they have firsthand knowledge of what this medicine can do. I'll let Dave take it from there, but I think this is a really exciting time to be a part of this movement. It is. Dave, if you don't mind, I'm just going to jump in with one more observation, and that is to use your comparison, Molly, with the spaceship. We don't need everybody to be an astronaut. I'm saying that because I know you're not implying it, but just to underscore this, there is, to me, a

Starting point is 01:05:31 comically imprudent cultural norm within a lot of the psychedelic circles, which is you start with A, you go to B, then you do C, then you do E, then you do F. And you have to progress from starting with a ketamine or an MDMA or a whole different breathwork. And you work your way up to psilocybin, then to LSD, then to this, then to that. And then at step seven, you're at 5-MeO-DMT. There is, to my knowledge, not a single indigenous culture that does this. It's just to be super clear. And I've spent time with quite a few indigenous cultures who have cultivated these medicine traditions or certainly their own indigenous ethnobotany, which can span hundreds of thousands of plants. That's also easy to forget

Starting point is 01:06:19 that these are not psychedelic cultures. These are cultures that use psychedelics for very specific purposes, which by the way, have often centered, at least in South America, on warfare and hunting. So just to put that in proper context, but it is not necessary to fuss with every tool in the toolbox. Maybe you just need to hammer in some shingles and guess what? A hammer is going to be fine for that. You don't need to pull out the power saw and start cutting off corners of your house, which is what I see a lot of people doing in this space. And it can be very, very dangerous.

Starting point is 01:06:57 And if you think that you haven't or you cannot be tumbled and humbled, you just have not met the right molecule at the right dose. I guarantee you that there is something that will completely unravel you, right? Maybe it's 5-MeO, maybe it's ayahuasca, maybe it's 2-CE, maybe it's just LSD, and you took 300 mics instead of 100 mics. I totally agree with that. And also just to add a caveat that there are contraindications to psychedelics. I mean, there are plenty of things that will keep you from being a good candidate for these medicines. Like ketamine alone can cause schizophrenic symptoms to emerge and this thing called the emergence phenomenon. It can cause high blood pressure, it can cause seizures. Like there are risks and you have to

Starting point is 01:07:34 be fully informed before you consent to any of these medicines. And if you don't know what you're putting in your body, you could have a really bad experience and it could change your life to the negative forever. And so these things need to come with warning labels, just like all drugs have, yet most people don't read. Most people get prescribed drugs at the pharmacy and they don't open up a little booklet and they don't realize that there are all these horrible things that can happen to you if you do it wrong, or take the wrong dose, or maybe it's not right for your body. And yet we have a drug addicted culture that is looking for the next big thing. And so we definitely don't want this to become, okay, if this didn't work, then maybe I tried this. If this didn't work, then maybe I

Starting point is 01:08:14 tried that. And that's frankly the psychiatric culture right now. And it is a big, huge risk of this movement because there are so many different compounds and companies. Literally every day, I hear of another company that got seed funding to develop their special molecules. They're going to patent, but they're going to figure out it's going to be the next big drug and in psychedelics alone. And so there's a lot of things that we need to be thinking about. I mean, once one drug's approved, I mean, we need to think about, okay, like what are we going to do when there's 15 of these? And how are we going to do when there's 15 of these? And how are we going to make sure that people don't end up habitually consuming these medicines, thinking they're just going to get fixed by taking a new psychiatric medicine?

Starting point is 01:08:54 One more thing to add to that. Sorry, David, I should say one more thing, and it's 17 new things. Don't worry. The point I was going to make is to just reinforce a lot of what you just said. These are very powerful compounds. They can be used safely with proper screening and protocol. And if you approach any type of work with psychedelic medicine in the way you would approach getting complete reconstructive knee surgery or neurosurgery, you will probably be fine. You would not go on Craigslist to find your orthopedic surgeon to replace your knee. Similarly, Facebook to find some shaman to have unprotected spiritual sex with you and save your soul. It's likely not going to turn out very well. And if you look at this just in terms of significance,

Starting point is 01:09:46 as you would when doing due diligence and planning for something like knee or hip replacement or neurosurgery, then probably tick all the boxes of prep and safety that are important, aside from the compound-specific screening and so on that Molly alluded to. I'm wondering, I'll let Dave talk, but I'm wondering if we want to let some people come up and ask a few questions. I know I just got a text from a friend who was asking Tim specifically about why he felt 5-MEO was the last stop on the train. And I don't really totally understand his question. So I'm wondering if it's a time for us to bring people up and if individuals want to ask questions, like, do we want to go there or where do we want to take this? I'm happy to answer some questions.

Starting point is 01:10:33 Just to touch on that person's question. I think a lot of folks in the psychedelic community view 5-MeO as like the Everest of psychedelics. I don't operate within that paradigm. So I have my own thoughts on 5-MeO DMT and its uses and abuses and risk factors, but I don't operate within that paradigm. So I have my own thoughts on 5-Ameo DMT and its uses and abuses and risk factors, but I don't view it as the last stop. I view it as another tool in the toolkit with a much narrower band of application to a much narrower segment of the population. Yeah, I think that's a great way to describe it. I think, you know, just to echo what both of you have been saying, I think that, a great way to describe it. I think, you know, just to echo what both of you have been saying, I think that, you know, what we're really talking about, if anybody tuned into

Starting point is 01:11:09 our last psychedelic clubhouse with Dr. Phil Wolfson, you know, we really talk about healing from the standpoint of the restoration of balance. It's not about becoming a cyborg, super altered state individual where you're constantly on the go, go, go. And it's not about being asleep or living in some fantasy world for the rest of your life. It's about balance and the restoration and maintenance of balance, which is really the recognition that when we live so much of our day-to-day waking lives separated and feeling and perceiving a sense of separation from our minds and our bodies, from ourselves, from others, particularly the time of a pandemic, from ourselves and the earth and our environment around us, the plants, etc.

Starting point is 01:12:00 As Tim referenced, these cultures in South America are plant medicine-based cultures. They live in harmony with the plants. They're not psychedelic cultures. It's a difference in perspective of balance in that healing and the restoration of balance really means the restoration of unity, a sense of union between ourselves and everything else around us in the universe, which is something that is so radically clear when we have these altered state experiences, whether you're doing a holotropic breathwork or a deep meditation or a MDMA or ketamine experience or an ayahuasca experience. It's this sense of union that really brings us all together where that boundary between self and other, whether the other is ourselves, our own intuition, our deep inner parts of ourselves that we were told not to respect growing up because they didn't get us anything that we thought was good, or whether it's the earth around us or people in our family or whatever it is, it's recognizing that that

Starting point is 01:12:59 sense of self and other is really a perceptive capacity that is malleable and can change. And so these medicines help restore or catalyze the restoration of balance in a lot of ways that allow us to heal. And so approaching these in that way with that foundation is critical to make sure that we're always not only respecting the medicine and what the medicine has to teach us, but also respecting ourselves in the process, because that's what's going to be most likely to allow us to have the powerful transformative healing experiences that we want to get out of these medicine experiences. And I do want to respect Tim's time. So let us know when you have to head out. We really appreciate it. Soheb was the first one to ask me to ask a question. So I'll let him

Starting point is 01:13:45 jump in whenever he's ready. And then Gina, you can go next. Hey, Molly. Hey, Dave. Really great show. I'm glad you got Tim on. Tim, I've been listening to your podcast and this discussion has been very revelational. I've discussed in the past with Molly and Dave, we just discussed a lot about digital mental health and tech and the place it will play as well as psychedelics. So I just wanted to ask, so Dave touched upon medical residencies and burnout. And I think at the moment there's a study going on with the whoop strap. And it finishes in 2021, where they're correlating kind of HRV with cortisol in saliva. So I just wanted to take Tim's perspective on what he thinks about monitoring levels of stress and burnout and where he thinks there's a limit to monitoring. And if we could let that

Starting point is 01:14:31 data to kind of people we're working with or managers, is there a line that works for our mental health? And with psychedelics, would you start to prevent that as you're seeing yourself kind of going above that curve, that threshold of falling into a disease state? Thanks for the question and for the kind words. I am a fan of monitoring and tracking that which is meaningful and that which can be changed. So in other words, there are many devices. You have devices like the Oura Ring, which I use right now. There are other HRV devices that I also use for resting state morning measurements. I find HRV very interesting.

Starting point is 01:15:11 Cortisol fluctuates tremendously throughout the day. It can make saliva collection and reliability sometimes challenging. But the real question for me is, are these levers you can pull, are they meaningful? And can you sufficiently isolate these variables in the mess of a multivariate sort of chaos pie that is real life outside of a laboratory? So those are the questions that are in my mind, but certainly looking at different types of physiological responses, both in session and out of session, are very interesting to me. It is going to be an extraordinary challenge, maybe an impossible challenge, to attribute some of the changes that we are able to monitor to a single intervention,

Starting point is 01:15:58 right? Was it due to the psilocybin session or was it due to the therapy session? Was it due to the daily journaling that started after the therapy session? Was it due to that single conversation with a parent that had been weighing on someone heavily for 20 years? It's incredibly challenging to trace cause and effect between variables in those circumstances. But as far as I'm concerned, if it can be done easily and consistently, the more data we can capture, the better. Even if they're slightly inaccurate, right? The algorithms are all subject to debate with, say, Whoop or Aura or any of these devices. But if they're consistently inaccurate, if that makes sense, then you can still plot trend lines that are very interesting. I want to add to that, that I actually, in my clinical practice, recommend most of my

Starting point is 01:16:50 patients that have chronic stress-related mental health disorders wear a Leaf Therapeutics device. You can find a link to it. It's getleaf.com. It's a really cool HRV monitor that is a little bit different than Oura Ring and Whoop because it gives you HRV visualization throughout the day. So it's a continuous monitor and I'm biased towards continuous monitoring, but love that device. And I'll also just plug Dave's device, Apollo Neural, which is something I wear every day to modulate HRV. And I think these tools are super valuable

Starting point is 01:17:22 as adjacent tools to helping people triangulate specifically where their stress and their life is coming from. A lot of people have no idea what's really stressful to them. And then they wear these devices and they say, oh my God, I can't believe it's this person that every time I talk to them, I just have this massive stress response. And it's a fascinating thing. So for some people, it's their family life. For some people, it's their work life.

Starting point is 01:17:44 For some people, it's their family life. For some people, it's their work life. For some people, it's their inner life. But figuring out where your sources of stress are coming from and being able to do something about them is paramount to healing. Right. You are. Gina? This is Tim reading Gina's question because we weren't able to get permissions in time to use her voice. And here's what she says. I'll paraphrase here. My question is, given the issues of the moment around sexism and racism and the fact that a lot of sexism and racism can be hardwired in the brain and these substances can really create the malleability to possibly cure some form of sexism and racism, have you thought of using these substances, raising funds around this? Can we use things like MDMA to address sexism and racism? I'm going to answer that just because I'm very well versed in the structure of the medical system. Medicine Today is a pathology-based program. So it's all about billing and coding for disease states.

Starting point is 01:18:35 And right now, racism and sexism are not disease states you can code for with the ICD-10. And that means you can't actually prescribe for doing that. But we do know that racism increases risk of chronic diseases, but there's probably not a good indication right now for us to be able to administer these medicines for that. One quick chime in on that also, and then we can take a few more questions. As a primary outcome measure would be, or intervention, Molly is totally on point, so I won't repeat what she said. It is possible in some types of design studies to use secondary measures or even primary outcome measures related to conflict resolution that are more observational in nature. So I do think that the perception and sense of oneness and lack of separation that many of these compounds can

Starting point is 01:19:26 produce have applications to conflict resolution and the demonization of the other. And within maps, this has been looked at between Israelis and Palestinians, for instance, and there have been a lot of promising reports. So I am optimistic that we can see those types of effects they then need to survive as fledgling eaglets of reorientation the brutality of re-entering the real world with its related pressures and habits and sort of default travel behaviors so that is the challenging part having the realization in the, less so ensuring that it has some durability over time requires very careful integration. I'll pass it to Eamon next. Hey, thank you, Dr. Dave. Thanks, Dr. Molly. And really appreciate everything you're doing,

Starting point is 01:20:19 Tim. So important. You talked about the factionalism in the psychedelic community. And I think a lot of that comes around different perspectives of ethical considerations coming into commercialization. And I'm curious what you think are the most pressing ethical considerations that this kind of burgeoning psychedelic movement needs to come into alignment on. Yeah, thanks for the question. So I'm sad that we don't have more time to explore this, but I'll give a very, very short version. First and foremost, just as a disclosure of sorts, I have not invested, I very deliberately not allocated any money to any for-profit ventures because I do not want to have or be perceived as having any conflict of interest that affects how I think about or speak to any of these subjects. And that's a costly decision on my part, but the one that I feel very comfortable with. The ethical consideration, there are many ethical considerations.

Starting point is 01:21:12 We could talk about sexual abuse within the context of South America specifically. It happens elsewhere, but it's at least as far as I know, the most prevalent culturally in South America. We could talk about any number of different things. The most critical to get right, I think, is the management of intellectual property and preventing broad claims of patents such that we end up in an entirely non-competitive field or a world of psychedelic medicine where there are only a handful of players who file patents to prevent others from entering the field. And this happens elsewhere. It is a known playbook. We have seen some of this already. I know people who are funding legal teams to object to, via the patent office in the United States at least, and also overseas, broad patent claims. But if it becomes a land grab where a few companies who are aggressive with no counterbalancing opposition or watchdog opposition

Starting point is 01:22:23 are able to file very broad patent claims where they are perhaps capitalizing on pre-existing means of synthesizing certain molecules, etc. And they're trying to do something from the playbook of Big Pharma, where they establish an isomer. They grab the right-handed version instead of the left-handed version, and then they slap a whole lot of restrictions around it to inhibit other players from entering the field, I think that could be catastrophic. And there are many different ethical considerations, but from a practical what-can-we-do perspective, it would be keeping a very, very close eye on patents that are filed for opposition and having the will to oppose

Starting point is 01:23:01 patents that seem too broad for the good of the ecosystem. So we have Greg and Tash. Who should we take next? Oh, Greg. Sorry, you can go, Greg. As long as you have time to ask both of our questions. Yeah, I'll do both. I'll do both.

Starting point is 01:23:15 Thank you so much, Tim. This is Tim chiming in again with Greg's question, since we couldn't get permissions for his voice recording. Here's the question. Thanks, Doctor. Thanks, Molly. And thanks, Tim. So this has to do with another current issue of today, which is COVID. As you know, the global mental health crisis that's going on and everything we're facing right now, a ton of people are still isolated and I'm one of them. Meditation has

Starting point is 01:23:36 had a huge positive impact on my whole life, but especially now, along with a lot of stuff I got from your media, Tim, which I really appreciate. I'm wondering if there's a way, and I've never gone into psychedelics at all, and I feel like it would have a profoundly positive impact on me to even try a little bit in conjunction with the other positive explorations I'm doing to try to curate the best self that I can. Do you or any of the three of you have suggestions on what one can do if they're still trying to isolate and if there's any way to begin getting involved and exploring this process. Are there any resources for that? Yeah, I appreciate everything you said and the question, Greg. My thought, if you are looking

Starting point is 01:24:14 for a non-ordinary state of consciousness that can be used to facilitate the beneficial manifesting of the mind, which is literally what psychedelic means, etymologically speaking, mind manifesting. There are tools available that do not involve ingestion. So one option would be looking at breathwork and breathwork facilitators who are able to work at a safe distance outside. So you could look at something like holotropic breathwork and practitioners who are willing to do something outside. You could be seated separately. There could be face masks if you wanted there to be contact allowed, but there are means through breathwork and otherwise of achieving non-ordinary states of consciousness

Starting point is 01:25:02 that one could consider psychedelic without ingestion of compounds, which I would not suggest doing solo, certainly without a lot of prior experience. Tosh, you're up. Awesome. So I guess my last psychedelics experience wasn't a kind of positive kind, as you can imagine, debilitating like nostalgia. and i'm just wondering if you have um any suggestions for overcoming like maybe previous like let's say you molded the clay and it didn't mold very well um how would you like how would you come out of that would you like try the psychedelic again would you like go see therapy what would you read that kind of stuff so uh let me ask a follow-up question what did you take if you don't mind me asking um i think i like two towels of bath okay uh i'm gonna defer to the doctors on this i'll just give you my perspective i'll speak from personal experience this is not prescriptive

Starting point is 01:25:58 informational purposes only if you have enough at-bats let's just say you are a clay spinner right you sit at a circular table you press a pedal with your foot and you spin clay every once in a while that piece of clay is going to go flopping over and become a total mess and if you have enough repetitions with psychedelics eventually you are going to have a very difficult experience. I do not distinguish between good and bad trips. I distinguish between safe and unsafe trips. So I would recommend first, and this is general, it's not specific to you, but doing some journaling with prompts and questions about whether it was a bad experience or an unsafe experience

Starting point is 01:26:46 or a difficult experience within a safe context. If it is the latter, then there may be some juice to squeeze from it. Whether you should use or not use the same compound or others, I'll leave that to the doctors. One thing that I will say is depending on individual tolerance and sensitivity, there are certain dose ranges that can be more problematic than others for people. And one might think it is due to higher doses, but that's not always the case because psychedelics, if we're talking about, say, psilocybin, act almost like different drugs at different dosages, right? So if you're taking a sub-perceptual microdose, let's just say of 50 to 100 milligrams,

Starting point is 01:27:29 there's one effect, which is almost like taking an anti-anxiety medication. It is mostly, I would say, a physiological response. And then you have doses going all the way up to heroic per Terence McKenna, five grams and beyond. But a lot of people end up getting stuck if we are going to use an airplane metaphor. So let's just say you consume the psychedelic, you're in the airplane on the tarmac, you accelerate, you have takeoff. It's a gradual ascent.

Starting point is 01:27:59 You go through cloud cover quite often. There's a lot of turbulence and then you pop through on the other side let's just say that popping through on the other side with three grams or more would be the equivalent of of just cresting over the peak of the experience or peaking sometimes and it's just highly individual but for something like let's just say it's powdered homogenized mushrooms, right? So it could just be dried mushrooms, psilocybin mushrooms. For a lot of people, that one to two gram range is going to put them right in the cloud turbulence and they will not pop through. And that can be very, very unsettling.

Starting point is 01:28:40 It can be very, very unpleasant. A lot of emotions and material can come up, but you are so firmly rooted in this ordinary reality still that you don't feel equipped to metabolize them or work with them. So I would say there's also a possibility, although it seems unlikely with 200 micrograms of LSD, that one should be cognizant of certain dosage ranges, moderate range sometimes being particularly challenging. But Molly and Dave, do you guys have any thoughts on your question? I mean, for me, two hits of acid and I am out on another planet. So for me, that's a big dose. Tim, I should say, kudos to you, sir, being a non-physician. I thought your response

Starting point is 01:29:25 to that was excellent. Really valuable perspective on how to approach this. And I think, Tosh, you know, again, as Tim was saying, the bad trips or bad, uncomfortable experiences from psychedelic medicine or psychedelic drugs are not always actually bad. It's just that they're difficult and they need to be worked through a little bit. And they can actually be stepping stones on our way to great personal growth if the right support is there. And so as a psychiatrist who works in this field, I see this all the time. And one of my specialties, not to make this go on much longer, but because I know Tim needs to leave. One of my specialties is actually helping people integrate difficult and bad trip experiences. So if you want to reach out to me, I'm happy to chat with you personally, and we can talk through

Starting point is 01:30:19 it, or I can recommend you someone who can be a good integration therapist for you. So who specifically has experience with psychedelic medicines that can really help facilitate you working through this and coming out of it on the other side. I want you to know without a doubt that these changes that occur and these experiences are almost never permanent, almost never. And it just requires the right kind of support and the right kind of collaborative effort together to help you through it. But you can absolutely get through this as difficult as it might feel right now.

Starting point is 01:30:53 And just reach out to me at drdave.io, or you can reach out to me on Twitter at Dave Rabin or on Instagram at Dr. David Rabin. And I'm happy to help you or recommend you to somebody who can. But thanks for bringing that up. I really appreciate that you felt comfortable bringing that up in a place like this. I think you need to be honest, you know, about like the experiences and just to let everyone know, like it was safe, but difficult experience, I guess is what you could say. So I think, you know, as Tim was saying, like unsafe or safe and, you know, journaling and meditation,

Starting point is 01:31:21 like I really appreciate the suggestions and I'll definitely follow up with you. So thank you so much. You're welcome. I'll add one more thing that may apply to others. And that is, if you have a challenging experience like that, it doesn't mean that you got thrown off the horse. It doesn't mean that your technique was shitty.

Starting point is 01:31:40 And in fact, if you talk to anyone, especially a facilitator, and you ask them to describe the more challenging experiences that have gone sideways, if they don't have any, the reality is they don't have enough experience or they don't have a lot of experience. And exercising, trying to display as much self-compassion in these circumstances as possible is very, very helpful, particularly taking into account that you're using LSD, which has a particularly tricky long tail of low effect.

Starting point is 01:32:15 We're talking about 8 to 12 hours, and I should say that one out of every 100 people will have a 24 to 36-hour experience. That does happen. But let's assume that you're, let's just call it a normal responder, and you have an eight to 12-hour experience for a lot of people. The last four hours of that,

Starting point is 01:32:38 you will feel almost sober, but not entirely. And it can be very challenging, similar to the one to two gram dose of celosia mushrooms to navigate because your friends are talking to you they're eating crackers and they're blah blah blah they're kind of blasting these questions and jokes and meanwhile like all of this sadness from feeling isolated as a child because a b and c was absent and da, da, da. All of this is welling up inside of you and you don't know what to do. So LSD is, I think, particularly tricky in that respect

Starting point is 01:33:11 because it has a long tail of effect that can be very challenging. So I would give yourself also some credit in that respect because it's very common that people challenge with that and come out of it with the recency of the end, the tail end, coloring the entirety of the experience. That is very common. That is very, very true. And thank you for adding that in. And Tim, I want to be respectful of your time. You've given us so much of it and we are so grateful and so grateful for all the incredible work you've done, the capstone, helping to destigmatize mental illness, spread awareness of the importance of mental health and prioritizing it to all of us,

Starting point is 01:33:58 and taking the time to dedicate your life's work to helping the world be a slightly brighter, better place for all of us. We could not be more grateful. And we really appreciate you joining us here on your first Clubhouse. My pleasure. I appreciate you guys facilitating so well and inviting me. There's a lot more to come. So much more excitement coming. And I'm looking forward to some additional big news, not from me, but from other groups around the country. And if people are thinking about or looking for a very high leverage place where a little capital goes a really long way, I mean, you can have billions of dollars of impact with a few hundred thousand dollars. I think this is one of the very, very few spaces. There's no opportunity right now. So reach out to people like David and Molly and others who are aware of attractive,

Starting point is 01:35:00 high leverage places to donate or invest and get engaged. Can't take the marbles with you. And really appreciate you guys. We should actually take that advice. And we have started a webpage to document these stocks. And I think one really cool next step we could take is starting to list some of these investment opportunities that we have come across that could potentially really move the needle. So Dave and I will get on that. That's really great advice. Thank you so much, Tim, for being here and offering your wisdom

Starting point is 01:35:35 and your experience and your knowledge and your personal anecdotes and everything you have to say has just been really inspiring. And I think a lot of people here, this is our biggest crowd so far. So I'm really grateful to have everyone in the crowd show up. Of course, it's my pleasure. And if anyone has any suggestions and questions or comments on this, feel free to contact me or Dave. You know,

Starting point is 01:35:58 you can find me on Instagram, drmolly.co. You can find me on my email. I'm just Google me. I'm on LinkedIn, but Tim, you're Tim, you rock. So thank you. And Dave, thanks again for co-hosting this.

Starting point is 01:36:09 Take care, everyone. And to everyone on the call and elsewhere, I suppose. Have a wonderful week. Have a fantastic weekend. And be safe out there. Be safe and be kinder than necessary. I'll talk to you guys soon. Hey guys, this is Tim again. Just a few more things before you take off. Number one, this is Five Bullet Friday. Do you want to get a short email from me? Would you enjoy getting a short email from me every Friday that provides a little morsel of fun before the weekend.

Starting point is 01:36:45 And Five Bullet Friday is a very short email where I share the coolest things I've found or that I've been pondering over the week. That could include favorite new albums that I've discovered. It could include gizmos and gadgets and all sorts of weird shit that I've somehow dug up in the world of the esoteric as I do. It could include favorite articles that I've read and that I've shared with my close friends, for instance. And it's very short.

Starting point is 01:37:11 It's just a little tiny bite of goodness before you head off for the weekend. So if you want to receive that, check it out. Just go to fourhourworkweek.com. That's fourhourworkweek.com all spelled out and just drop in your email and you will get the very next one. And if you sign up, I hope you enjoy it. This episode is brought to you by the book How to Lead by David Rubenstein. David Rubenstein is one

Starting point is 01:37:35 of the visionary founders of the Carlyle Group and host of the David Rubenstein Show, where he speaks to leaders from every walk of life about who they are, how they define success, and what it means to lead. Jeff Bezos, Richard Branson, Warren Buffett, Bill Gates, Ruth Bader Ginsburg, Phil Knight, Oprah, all of them and more are featured in his new book titled How to Lead. This comprehensive leadership playbook illustrates the principles and guiding philosophies of the world's greatest game changers. In this book's pages, you can discover the experts' secrets to being effective and innovative leaders. Past podcast guest Walter Isaacson has this to say, quote, reading this invaluable trove of advice from the greatest leaders of our time is like sitting in an armchair and listening to the masters reveal their secrets. Pick up a copy of How to Lead, subtitle Wisdom from the World's Greatest CEOs,

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The Tim Ferriss Show - #458: The Psychedelic News Hour: New Breakthroughs, Compound Comparisons and Warnings (Psilocybin/LSD/Ayahuasca/N,N-DMT/5-MeO-DMT), Treatment of Trauma, Scalable vs. Unscalable Approaches, Making Sense of “Bad” Trips, and Much More

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