John Donvan
This is Open to Debate. I’m John Donvan. Hi, everybody. Right now, it’s not clear how decision-making at the Food and Drug Administration may change now that a new president will be putting new people in charge there. This is something that’s gonna be closely watched by people who want to legitimize the use of psychedelic drugs as, well, as medications for conditions like depression and PTSD. Consider drugs like LSD and MDMA, also known as ecstasy, or psilocybin, also known as magic mushrooms. For most or all of the lifetimes of anybody listening, these drugs have been considered fundamentally, let’s say illegal. They’ve been categorized under Schedule 1 of the 1970 Controlled Substances Act, which makes them basically illegal to manufacture, or to sell, or to use, and that defines drugs like these as having currently, “no accepted medical use.” That’s a quote.

Well, the FDA recently was asked to reconsider this, and to reclassify MDMA out of Schedule 1, and to make it available as part of the medical treatment for PTSD, in combination with traditional methods of therapy. The FDA looked at this, and a few months back, it said no, but it said, “No, but go back and study it more,” which may sound to some like, “Not yet. Maybe. We wanna know more,” and that, this left the door open to further reconsideration pending more data, represents a potentially huge shift in what we might recognize these kinds of drugs to represent, and that excites some people and it deeply concerns others.

And that is the divide we’re gonna debate across in this episode, in the understanding again that we don’t know what change might be coming with new people in charge at the FDA. The question in front of us for this episode is psychedelics for mental health, help or hype? So let’s meet our two debaters. Arguing that psychedelics can help mental health outcomes, I wanna welcome Ismail Ali, who is the director of policy and advocacy at the Multidisciplinary Association of Psychedelic Studies, also known as MAPS. I’m saying that because you’re gonna hear the term MAPS a lot, I think. Ismail, thanks so much for joining us on Open to Debate. It’s great to have you here.

Ismail Ali
So glad to be here. Thank you for the invitation. The name is a lot, it’s got a lot of syllables, so MAPS is a bit-
0002:12
John Donvan
(laughs).

Ismail Ali
(laughs).

John Donvan
Okay, thanks. Let’s keep it with MAPS. And here to take the other side of the argument and, uh, make the case that the use of psychedelics for mental health is mostly hype, I want to welcome Kevin Sabet. He’s a former three-time White House Office of National Drug Control Policy advisor, a fellow at Yale, a columnist at Newsweek, president and co-founder of Smart Approaches to Marijuana, and a former debater on Open to Debate, so Kevin, I wanna say welcome back to the program. Thanks for joining us.

Kevin Sabet
Thanks for having me back, John.

John Donvan
So let’s move on to our opening statements, and in opening statements, you each get to make your case uninterrupted by the other side. Uh, you get four minutes each, up to four minutes each. Ismail, you are up first. You are arguing on the question of whether psychedelics for mental health are help or hurt, you say, you lean very much towards help. Please tell us why.

Ismail Ali
Let’s get to it. All right. First off, I wanna say I’m really grateful to be invited to have this conversation, where I hope we and the audience can better understand and guide the movement toward better mental health treatment solutions, which I’m sure we all agree with. I wanna start by recognizing what you said, that FDA didn’t say no, it said not yet, and I think that’s an important distinction. So when we’re looking at the question today, whether or not psychedelics should be legalized for the treatment of mental health based on currently available evidence, my answer is yes. Evidence demonstrates that psychedelics can help multi, mental health, and they should be legalized.

So I wanna start by noting that legalization is a broad term that does not have a single definition, and today, I’m defining it to mean regulation through some sort of reasonable controls. So when I’m talking about legalizing psychedelics for mental health, I’m talking about psychedelic therapy, psychedelics paired with supported services, like screening, preparation, facilitation, and integration, or something along those lines, which can look different in different jurisdictions and different places.

As I’m sure everyone here knows, we’re having this conversation in the shadow of a serious crisis. Americans today are becoming aware of the massive gap in mental healthcare solutions. The sort of good news is that over the last decade, stigma around PTSD, depression, anxiety, substance use disorders, and other diagnosis has eroded, which has revealed the scope of the problem. However, it’s also showed how people are tired and underserved by the status quo. And with that awareness has come an urgency that current solutions are not sufficient and novel ones need to be explored.

A lot has happened in the last few years, actual legalization in multiple states. We’ve got data starting to come back from the State of Oregon, which legalized, uh, adult use of psilocybin in supported specific contexts in 2020, and one in Colorado on the verge of launching. They’re just finalizing the rulemaking. And the FDA, as you mentioned, asked Lykos for more data and a review of existing data, but multiple more drugs have been granted breakthrough therapy status by the FDA in the last few years. And of course, investment interests from multiple federal agencies, including the NIH, the VA, DOD, SAMHSA, and others, as well as dozens of state task forces, university appropriations, small pilots, and more, have a, have popped up across the country in different states.

The status quo, criminalization, is failing millions of people, so is it any surprise that many of those people look outside of the current legal medical paradigm for relief and care that is unavailable through existing Western models of healthcare? Now, psychedelics are not a silver bullet, and responsible, beneficial use of psychedelics requires some infrastructure. For people across the world that have used psychedelics in traditional contexts throughout history, that looks like cultural training, ceremonial practice, and multigenerational apprenticeship. Of course, those mechanisms should be protected and permitted. For us here in the West, though, and in the Global North, we can’t just wave a magic wand and make everyone culturally attuned. We don’t live in that world right now.

So we need some sort of scaffolding, like responsible regulation, which is only possible through legalization. Without that, we end up in the situation we have now, essentially a free-for-all, where a blunt instrument of criminal enforcement fails to actually steer people towards safer or more responsible use, which requires people to fend for themselves. So taking the no position requires people to do that on their own in a completely regulated environment, where criminalization increases risks, which include, at least, adulteration of the drugs, irresponsible claims, inconsistent education, and stigma that prevents people from seeking help when they need it. Responsible regulation reduces those risks, reduces adulteration, puts guardrails on the inconsistent, and yes, over-hyped claims of the underground inherent in an unregulated economy.

Bringing use out of those criminalized contexts allows for the creation of preventative measures, and an emergency support that catches people that falls through the gaps in a criminalized environment. Oregon’s program, and really any that we create, will have flaws. However, we can’t let the perfect be the enemy of progress, and what an opportunity to live in a country where different states can experiment with different paradigms and teach each other how to be even more responsible over time. This evidence, plus the momentum building among veterans, traditional healers, survivors, and people around the country, in the context of centuries or millennias of use, tells us that it is possible to create regulatory environments that steer people toward responsible use. Thank you.

John Donvan
Thank you very much, Ismail. Um, Kevin, you’re taking the other side. You disagree. You believe that psychedelics for mental health is mostly or potentially all hype. You have four minutes, please, to make your case.

Kevin Sabet
Thanks, John. Appreciate it. Uh, really happy to be back. Uh, you know, it’s interesting this is called Open to Debate, uh, but the issue is, um, you know, the science isn’t really open to debate. We can’t really debate whether something is approved or not scientifically. Um, we can discuss whether something should be, you know, pursued, and let me be very clear, uh, there might be potential with some psychedelics. But right now, it is hype. Uh, right now, there are some very, very concerning signs about what’s going on and what this movement is really about. Uh, namely, first of all, uh, the FDA did reject. They actually said no. Uh, they already said no to a very specific trial of MDMA in PTSD, something that had been hyped up by multiple, uh, for-profit companies and, and organizations for the past, you know, 10 to 30 years, where you had people essentially take this on, um, almost like a religion.

And that’s what this has become. The psychedelic movement has really become, uh, a, some, in some ways, a religious cult, and actually, a very dangerous one, for a lot people participating in it. One of the reasons why the FDA rejected, outright, uh, the, the application… Not only did it reject, by the way. Its, its advisory board rejected it too, so it was rejected twice, um, in a, in a short period of time. But what happened was, uh, one of the reasons it was rejected was ’cause of some very, um, uh, concerning reports of sexual misconduct, which seems to be rampant, actually, among a lot of these studies.

Um, now that doesn’t mean that the actual drug, there isn’t some potential, again, but from what we have seen now, it is hype. Um, the sexual misconduct runs deep, it’s broad, uh, and it actually led to three big papers being retracted in one of the foremost journals in the country, uh, which actually looked at this, and looked at efficacy, and showed efficacy, but, uh, the, the journal did retract those three papers after the FDA rejection.

So, of course when the FDA rejects something, that, it, it never fully closes the door. It just says, “We’re saying no to what you’ve presented now.” There’s no law against, um, you know, redoing, uh, studies, and doing them in the right way, and also doing them in a way that actually could be therapeutic, and resubmitting that application. And again, uh, uh, no one’s against that. N- You know, science needs to be determined not by popular vote, which unfortunately a lot of people have tried to actually have people vote on the science, which I don’t think is helpful. Um, it’s also not determined by how much money you have from, you know, super rich, and in many cases lately, uh, neoconservative right wing donors, uh, and, and sort of tech bros, who see, uh, psychedelics as a, something that they like to play around with.

Um, lest we forget, the reason, uh, Matthew Perry died, and he, actually, Matthew Perry was a f- was a friend of mine, someone I was lucky enough to meet, who was in long-term recovery, uh, but he unfortunately died because of his ketamine prescription, that was given to him by a doctor. Um, and s- and, uh, you can’t tell me that if we make that more likely for people, and you legalize that, and you actually open the floodgates, that that’s gonna make, you know, doctors, and, and situations like Matthew Perry less common. It’s, we, we know it’s gonna actually make it more common.

Um, so, so there are a lot of reasons why I think we need to take a deep breath and sort of move away from the kind of religious cult-like behavior. Um, I have yet to find a per- a researcher who studies psychedelics who isn’t a regular user of them. That’s a problem (laughs). Uh, I’ve yet to find someone who, um, uh, has edited an article, uh, in favor of it and actually got something published that wasn’t an avid advocate or user of them. That’s a problem. And so when the FDA looks at, looked at this blindly in a scientific way, it, it actually, it wasn’t even close. This wasn’t, like, some, you know, five to four Supreme Court decision kinda thing. It, it was almost unanimous, uh, in the FDA Advisory Board as well as internally with the FDA.

So, uh, there are a lot of problems. There are a lot of worries. Um, a study that just came out found that, uh, uh, uh, of over nine million people, by the way, in Ontario, Canada, found that you, there was a 21-fold, which is an incredible number, increase in the likelihood of schizophrenia among those who took psychedelics. I mean, that’s, that’s a remarkable claim. So, I think we really need to take a deep breath, look at the science dispassionately, and make our determinations from there.

John Donvan
Thanks very much, Kevin. So we’re gonna take a break, but before we do, I wanna ask why this is a topic you felt you needed to be addressing in a public way. Like, what, what’s the motivation, in a sense?

Ismail Ali
Yeah. I mean, I’ll start by saying that the simple reason is that it’s a nuanced conversation, and nuance requires visibility. I think that it’s easy to take a simple position that’s a hard yes or a hard no, but the truth is, this conversation, like a lot about public health, has a lot of trade-offs, and I said yes to this because I wanted to have a conversation about trade-offs and where we’re really at in the context.

John Donvan
Okay, thank you. Kevin, same question to you.

Kevin Sabet
Well, this has been thrust into the open debate (laughs) whether we like it or not. Massachusetts voters just voted on this for example. 57% of them rejected it, which is very interesting, given Massachusetts is home to Timothy Leary and sort of the founder of MAPS, uh, you know, mentor Timothy Leary. And so this is being debated in public, so I, you know, I, I think it’s important that we get some facts out there so that when it comes to someone else’s state, they can maybe make a more informed decision.

John Donvan
Okay, thank you both. We’ll get to the facts and where they agree and disagree when we come back from the break. Uh, the question we’re taking on is psychedelics for mental health, help or hype? I’m John Donvan. This is Open to Debate, and we’ll be right back. Welcome back to Open to Debate. I’m John Donvan, and we’re taking on the question psychedelics for mental health, help or hype? Our debaters are Ismail Ali, Director of the Policy and Advocacy at the Multidisciplinary Association of Psychedelic Studies, also known as MAPS, and Kevin Sabet, a former three-time White House Office of National Drug Control Policy advisor, fellow at Yale, columnist at Newsweek, and president and co-founder of Smart Approaches to Marijuana.

So we’ve heard your opening arguments, and if I can v- very briefly summarize what I’ve heard you say in your opening arguments, um, you’re really coming at this from different directions. Ismail, you started by talking about the fact that there is, I would say now, a recognized, uh, mental health crisis in the United States. You’re saying that people are looking for solutions, that the solutions that are available are not adequate to the need, um, and that in that s- uh, situation, novel approaches need to be looked at. Among the novel approaches, you’re suggesting that psychedelics are, y- uh, you’re saying a promising avenue.

Kevin, you’re saying that the situation is far less rosy than that. Um, what you’re talking about is the, uh, popular conversation that is surrounding the increasing, uh, case being made for psychedelics as being dangerous in itself, that the science is not in on this, um, that there are serious dangers, that the drugs themselves have serious dangers. Um, but what I’d really like to start with is kind of the claims that the use of MDMA as a treatment for PTSD did any good at all. What, what is the case that it actually helped, and who were the people that it was, uh, being tested on?

Ismail Ali
So, there were multiple trials in which MDMA-assisted therapy was looked at for the treatment of PTSD. A few hundred people have gone through Phase 2 and Phase 3 trials, and in the Phase 3 trials, it showed that, in some studies, 67% of the people no longer qualified for PTSD after going through it, and in a follow-up, there was a significant number, over half again, that were able to make it through without continuing to have symptoms of PTSD. Those trials included a few different kinds of people. A number of them were veterans, uh, and a number of them were survivors of physical or sexual assault, and that looked at people across gender, across age, acro- across race over the course of a few years, and I’ll start by saying that that’s the, that’s the range of people that were looked at in that first round of studies.

John Donvan
And so I understand that in those studies, uh, each of the participants had three sessions last up to eight hours, of interaction with a therapist and administration of either MDMA or a placebo. You’re saying that the results were very promising, that there was… their, their symptoms were lessened significantly. And so, for you, those are the grounds for having had hope that the FDA would approve, uh, the use of MDMA as a, as a medication in this process. Do I have that correct?

Ismail Ali
Yeah, and I’d clarify the term rejection has been thrown around a lot, and I do think it’s important to note that nobody has the complete response letter from FDA, so Kevin and nobody except for the people at Lykos know exactly why it was rejected, or at least for now, ask for more data.

John Donvan
And sh- please, can you clarify your connection to Lykos? I think you should just have as, as much disclosure on that as possible.

Ismail Ali
Yes, absolutely. So M- MAPS is a f- is a nonprofit that founded the public benefit corporation MAPS PBC in 2014, and earlier this year, that organization went independent, brought in outside investors, and now MAPS is a part owner of Lykos, which is the organization in question. And I would like to note that while we can talk about MDMA, this conversation is about, is about psychedelic therapy in general, which includes other substances and other contexts as well.

John Donvan
Yeah, I in- I intend to do that. It’s just that we have the FDA case in front of us.

Ismail Ali
Of course.

John Donvan
So, but bottom line, your feeling was that Lykos e- e- established in the study, you were disappointed and surprised by the FDA’s decision because you felt that there was benefit shown as a result of the tr- of the trial.

Ismail Ali
I’ll say it was disappointing for sure, but it wasn’t so unusual. A lot of drugs, including cancer drugs and all kinds of drugs, are asked for more data by the FDA. That’s not a super, super unusual outcome within the field.

John Donvan
So, th- um, Kevin, thank you for waiting as we kind of laid that out. What I wanna take to you is w- what we hear from Ismail is the story of a trial in which a number of people, uh, a controlled trial. There w- w- uh, there was a, as I understand, in a blind study. There was a placebo involved, and that benefit was shown for people who were, uh, given the opportunity to, to, uh, have MDMA, uh, as part of the, uh, protocol. What’s wrong with that?

Kevin Sabet
Well, first of all, let’s assume… We’re making an assumption that placebo was (laughs) established. Actually, there have been so many studies with psy- psychedelic drugs showing that, um, first of all, placebo is difficult to establish, you know, because people sort of know whether they’re g- having a trip or not, basically. Uh, but when you do, actually a lot of the studies have even shown that, uh, if somebody thought they were and they were in the placebo, it’s just as effective, by the way, as, as taking the actual drug. Which okay, maybe that’s still a, not necessarily a knock on psychedelics. If you think you’re taking it, you get the same effect, I guess.

But really, when it comes back to the F, this FDA study, which is what you referred to, I’m very concerned about these reports that are actually highly exaggerated of efficacy. For example, there was a report from the Institute, uh, for Clinical and Economic Review, that l- has looked at a lot of these concerns, and they raised concerns that, uh, um, in a lot of the studies that Lykos, which is, again, very connected to MAPS, remember that. Um, what, uh, what happened was, um, there were, this, this report actually said that based on this study, there were concerns that, quote, “Therapists encouraged favorable reports by patients and discouraged negative reports.”

Um, there was another very large review of another drug, the esketamine drug, that, um, found that over 40% of adverse effects were not reported. Uh, and that was just released, actually, that was the, um, that was in a bl- double-blind, uh, uh, sorry, journal, I should say, a peer-reviewed journal, I mean to say, um, Cambridge Core, uh, Reporting of harms in clinical trials of esketamine in depression: a systematic review, a very large review showing that 40% weren’t even reported. So, I don’t think we’re getting to a lot of the negative reports (laughs). I think that, uh, a lot of this is pushed by advocates. The sci- Again, I’m trying to find scientific reviews and papers that are done with people that don’t use psychedelics regularly, and it’s almost impossible.

John Donvan
But are-

Kevin Sabet
People become-

John Donvan
Are you s- Are you suggesting that there’s something nefarious going on? By nefarious, I mean deliberately dishonest.

Kevin Sabet
I think so. I think there is some d- Oh, absolutely. Why? Because these, these companies have had to invest (laughs) hundreds of mil- I mean, people don’t realize the money behind this [inaudible

]-

John Donvan
I know, but that would be, that would be true of any pharmaceutical company.

Kevin Sabet
No, well absolutely.

John Donvan
Are they all nefarious?

Kevin Sabet
Oh, oh, sure.

Ismail Ali
Exactly.

Kevin Sabet
Yeah, but two wrongs don’t make a right, and that’s not a reason why we would go forward with it, but I’m s- What I’m saying is, yes, there’s money all around. And you need money for studies. Let me be very clear. Money is, is needed-

John Donvan
Wait. Wait, I-

Kevin Sabet
… for studies.

John Donvan
I, I have to jump in, because as a rule, we, we try to discourage ad hominem argument.

Kevin Sabet
No, no ad hominem.

John Donvan
… like, uh, uh, if, if you’re saying it’s not ad hominem, I’ll take your, your (laughs) word that it’s not, but I wanna take it to you, Ismail. W- Is your organization involved in dishonest science, as the case, I think is being made by your opponent here?

Ismail Ali
No. No. The reality is that the FDA is new to reviewing psychedelic drugs, which in the case of the modern context, often involve therapy or some sort of supported services, and that is a new context, and they, the FDA, and federal agencies, are also learning as they go. So I would say that the explanation for the shifts is that there were norms established in 2015, 2017, 2019 when these studies were started and established, that as the FDA, like us, like the states, have gotten more information, have also adapted over time and refined over time.

Kevin Sabet
Uh, let me just… John, what I was reporting on is it’s what third party, not me. It’s not like my… It’s not… I’m not saying that, you know, I did a review and I found that people were dishonest. Third parties, many of whom have been published in peer-reviewed journals, their findings, like the esketamine studies, are finding that, uh, there is a, for some of these studies, there are, there is a push to not report negative outcomes. That’s just a fact in these peer-reviewed articles. Happy to share them after this to the listeners. And I just think that’s something-

Ismail Ali
I will say that-

Kevin Sabet
… that we should keep in mind.

Ismail Ali
I don’t think Johnson & Johnson would, um, and Janssen would include esketamine as a psychedelic drug, so I do feel like that’s actually in a different category as a dissociative anesthetic that’s used as a mental health indication.

Kevin Sabet
Okay. (laughs) We can ar- I guess we should have a discussion about what’s a ther- what’s a psychedelic drug, but I, I, I-

Ismail Ali
That could be the whole hour right there, I’ll say.

John Donvan
(laughs).

Ismail Ali
(laughs).

John Donvan
We, we actually had that debate with you once before, Kevin.

Kevin Sabet
(laughs) That’s right.

John Donvan
Um, so it’s a tough issue to, to, to address, but Kevin, let me ask you this. Um, can you conceive of a study which would establish the, the efficacy and the safety of psychedelic-

Kevin Sabet
Oh yeah.

John Donvan
… drugs for [inaudible

]-

Kevin Sabet
Sure.

John Donvan
And what, what does that have to look like for you?

Kevin Sabet
Well, I think, look, I think you wanna have subjects and researchers that don’t have a stake in whether or not something gets approved. Uh, you want to have, try and establish that being able to do a double-blind study, which is somewhat difficult. I think the FDA is going to be putting out, if they haven’t already given it to Lykos. Again, we don’t know. I wish we would know, but, uh, if they haven’t already given these to Lykos, uh, they will be releasing some kind of, you know, guide- clinical guidelines for doing research. I’m not saying that-

Ismail Ali
They already have.

Kevin Sabet
Yeah. Okay, good. So I’m not saying by definition, all research is wrong.

John Donvan
Okay. So, Ismail, I wanna take back to you something that Kevin brought up in the beginning, is that we know that there are episodes and instances of people with all kinds of narcotic drugs, uh, and, and others kinds of psychedelic drugs as well, that there are individuals for whom they cause harm, and you know, Kevin pointed out that a, a world in which the regime is loosened to the point where people have, have greater access, can, can lead to these kinds of harms happening to people. And I just-

Ismail Ali
Right.

John Donvan
… wanna ask you how you would, uh, accommodate for that.

Ismail Ali
Well, I would say that we are in the loosest possible environment right now. Criminalization is pretty loose. We think that the act of enforcement actually keeps things tight, but evidence shows otherwise. Drug use of all kinds of drugs has only increased and gotten worse and more risky over the last 30 or 40 years, so I’m definitely not saying that, uh, regulation means loosening, and in fact, I’m saying the opposite, that regulation would allow more visibility to the pieces of this issue that actually kind of have the biggest points of risk. I agree completely. Psychedelics, like any drug, come with risks, and that regulation would allow those risks to be better managed, with more visibility, and more oversight, more accountability, and more responsibility, and so on.

John Donvan
What do you think of that, uh, as a potential future, um, Kevin?

Kevin Sabet
(laughs) Well, I wish regulation meant safer, uh, when, especially when it came to for-profit drugs in our country (laughs) uh, since, uh, uh, we can look at the playbook. I mean, alcohol is regulated. It kills more people than any other drug after cigarettes, which is also regulated. Tobacco kills more people. It’s promoted, normalized, commercialized, thought to be safe. And look at marijuana. We only have 99% dabs, which the New York Times is now reporting as a major public health threat to our ti- for our time, um, after we have quote-unquote “regulated” or “legalized.” So things don’t get safer necessarily. In, in some products, they might get safer. We don’t wanna have, you know, the chicken that’s gone, that’s gone through, you know, that doesn’t go through some regulation.

I’m not gonna say I wanna have a underground market for that, and that’s safer. Um, in theory, you could th- you know, I, I, I could see, you know, it was one making that argument, but I think in practice, what, that doesn’t happen. Also, nobody’s criminalizing these drugs. Nobody’s in prison. Let’s be honest (laughs) for, for mushrooms. I mean, you know, this isn’t like 1961 in, like, South Texas. Nobody is in prison for these. The idea that we’re criminalizing people. There’s research going on. There’s a very b- uh, one of the most successful no- uh, companies out there, Lykos, the, one of the most successful nonprofits, MAPS, openly buying, openly using, openly promoting, openly normalizing, openly not drug testing at the workplace. So these things are not, these things are not criminalized. Now, you could say they’re not legalized. I underst- uh, yes. Technically, they’re not-

Ismail Ali
That’s what we’re saying, right?

Kevin Sabet
… legalized, but yeah. They’re not criminalized. No one’s going to prison.

Ismail Ali
Also, just to say, dabs were definitely around before the legal regulat- regulated cannabis (laughs) environment. Just wanna be clear about that.

Kevin Sabet
Yeah, yeah. But the, the, the level that we’re seeing. And we never had the gummies. We never had the ice creams. We never had (laughs)… We never had these mass market. My point-

Ismail Ali
M- Maybe not in your circles, Kevin, but I’ll say the underground, because of the fact that people have been looking for other solutions, has gotten very sophisticated, and it has gotten kind of runaway, because there hasn’t been any visibility on the claims made on the fact that the packaging is this or that.

Kevin Sabet
Mm-hmm.

Ismail Ali
And that’s what I’m saying, is that regulation can control that.

Kevin Sabet
It can. I just… In this country, when it comes to drugs, I don’t see it happening.

John Donvan
Ismail, in your view, is the avenue towards decriminalization onto legalization pursued through the medical route because that’s the best way to make the drugs more accessible to people in general, to, to change the culture around these drugs, or is your motivation for, for addressing mental health primarily because there’s a, really a mental health crisis?

Ismail Ali
What I would say is this is a huge conversation that, I think that, uh, people are realizing more and more, including within the medical field, that mental health issues are not caused nearly by biological chemical causes that can be pharmaceuticalized away. So I do think that in many ways, mental health is a proxy, and I f- I think it’s really unfortunate that Kevin brought in this claim that we’re a cult. I think the fact that there is this, um, sense that, uh, mental health can be bigger than just biology is not, um, an unscientific perspective.

Kevin Sabet
Of course not.

Ismail Ali
It’s one that’s-

Kevin Sabet
No.

Ismail Ali
… informed by, like, the crisis of isolation, these other things that are not quite-

Kevin Sabet
Of course.

Ismail Ali
… there. So I think what, a part of what I’m saying here is that, uh, medicalization, the medical framework, allows us to look at some of these issues in a particular evidence-based way, but I don’t think it, uh, think it actually paints the whole picture.

Kevin Sabet
Can I just say s- one thing about… We have… Of course we have a mental health crisis in this country. We have insurers and payers that don’t reimburse people for mental illness where they would reimburse them for physical illness. We treat them completely differe- you know, differently, which we shouldn’t. Uh, we have a suicide epidemic that, that we’re, we’re going on right now, especially among our young people. We have multiple crises when it comes to this. So o- of course we need to be looking for solutions, but the idea that if, if, if this was a real thing for th- these crises, we’d be seeing all the national mental illness organizations p- uh, uh, p- putting their money and time towards psychedelic research. They’re not.

Ismail Ali
More and more have though, over time, as it’s gotten clearer.

Kevin Sabet
Sure, and okay, yes, as this has become more popular, yes, it has increased in popularity. But we are seeing how we have multiple things that we need to be making sure of, for example, next four years, to make sure we don’t lose Medicaid reimbursement, uh, for addictions and mental illness. That’s like the top thing we could do if we care about mental illness, um, to make sure we don’t lose ACA, uh, uh, uh, you know, um, benefits under, with mental health and substance use disorders. So, uh, we have a massive crisis. There’s no doubt about it. I, uh, no one’s ag- Again, I don’t know anybody that would be against research of anything that could be helpful. What we’re saying is right now… What I’m saying at least is right now, when I see the most, one of the most prominent journal in the, uh, uh, journals in the country retract the Phase 2 trials of the MDMA (laughs) study that went on, I mean, that, that tells me that there is something going on here that we need to sniff around and make sure that we’re doing the right thing, and that we should be very, tread very lightly when it comes to this area of psychedelics, not-

John Donvan
Why, why make the association with sexual misconduct if, for, for no other reason than to discredit the work?

Kevin Sabet
I am discrediting the Phase-

John Donvan
Are you, but are you saying it’s rife, it’s rife-

Kevin Sabet
No, no. I am discrediting the Pha- (laughs).

John Donvan
It’s rife through the, the, the body of research that’s being done?

Kevin Sabet
I’m saying that there is a growing body of research beyond these trials at FDA, when you look at different studies that have happened, where people are reporting things like sexual misconduct-

Ismail Ali
Really?

Kevin Sabet
… among-

Ismail Ali
Which-

Kevin Sabet
… other-

Ismail Ali
Which other one? There was one-

Kevin Sabet
Well, there-

Ismail Ali
There was one very visible case in the Phase 2 trials, which is one of the reasons that the retraction happened. That was one case, but I think the idea that the existence of, uh, sexual misconduct, which occurs in every single medical field, including therapy without psychedelics, is very unfortunate, and everyone around the field is working to prevent it, do better formats for preparation, and vetting, and so on. Um, to say that that one case discredits all of the research, ’cause you’re saying that research is good, but none of the research counts. So, like, I think we gotta pick a side here.

Kevin Sabet
No, no. I’m not saying none of the research counts. I’m saying the research that was retracted is something we have to look at why that was retracted, and understand that it was-

Ismail Ali
You’re painting with-

Kevin Sabet
… retracted.

Ismail Ali
… a pretty broad brush, but I hear you.

Kevin Sabet
But tha- that was the one brush. That was the one brush the (laughs) FDA had to look at, so again, if we’re looking at the FDA study… If we’re looking at the non-FDA, and you’re looking, talking, like you mentioned before, Ismail, with the other drugs, um, but you know, I, I, what I’m saying is, it’s, it’s a very new area, and I feel like there are a lot of people with preconceived notions that sort of want to sweep a lot of these adverse effects under the rug, ’cause I see it with the esketamine research.

Ismail Ali
I think that was true 20 years ago, but I think now it’s become professionalized. There’s a massive, massive group of people across fields, across universities, all over the country and world. I think the idea that the fact that there were studies that were not kind of informed by 2024’s context that started 10, 20 years ago, uh, doesn’t mean that the studies today aren’t [inaudible

]-

Kevin Sabet
What are people doing to make sure that the doctor that was prescribing Matty Perry ketamine… Um, how do we prevent that from happening?

Ismail Ali
I love this example, actually, because that theoretically existed in a semi-gray area context where you have off-label use of ketamine, where there isn’t yet that opening for full, uh, regulation and oversight of that case. And I think anyone who’s looked at that case, who’s read the articles, who’s seen the text messages, no one s- would say that that occurred in, like, a legitimate setting. Of course, there were kind of semblances of that, but anyone who looks at those details would see that that was happening even outside of the regulatory context.

Kevin Sabet
What I’m arguing, though, is that as we legitimize, as we put the cart before the horse, we’re gonna have more of those bad actors, not less of those bad actors.

Ismail Ali
Well, there’s no standard, there’s no standard of care, or there’s limited standards of care in ketamine prescription, and more visibility would allow for that to happen. Those are still being developed within even the realm of ketamine, which is a legal drug, which is used off label for mental health indications.

Kevin Sabet
I just say it’s too early.

John Donvan
We’re gonna come up to a break, but one more time, Kevin. When you portray the, uh, community of researchers doing this work as being part of a cult, there’s just no question that that is, um, a disparaging remark, and I’d like you to slow down on that and detail why you say it’s cult-like, and then allow Ismail to respond to it.

Kevin Sabet
I will slow down and back up in case it was misconstrued. I’m not saying that the entire community of researchers is a cult, if you’re at all interested in these studies. What I’m saying is that we’ve seen cult-like behavior, blind following, of a few big people in this field, uh, who, uh, uh, many of whom are not, by the way, publishing papers all the time, or maybe they used to, but instead, they’re out there raising hundreds of millions, if not billions of dollars from, um, activists to promote a political agenda to allow for the full legalization of these drugs. So that, that’s, that’s what I’m saying.

Ismail Ali
I’ll say this is kind of like saying that nutritionists who ask people to eat well are a cult because they also eat well. Uh, the fact that people are interested in the research, I think alone does not mean it’s illegitimate, and I think it’s worth looking past that, especially now where we have a huge range of professionals across universities everywhere that are looking at, into this at the same time.

John Donvan
Okay, we’re gonna take a break now, and when we come back, we’re gonna be continuing the conversation around this question, psychedelic for mental health, help or hype? And in that conversation, we’re gonna be inviting in some other voices to bring more questions to our debaters. We’ll be right back. I’m John Donvan. This is Open to Debate.

Welcome back to Open to Debate. We’re taking on the question, psychedelics for mental health, help or hype? I’m John Donvan, and I’m joined by Ismail Ali, the director of policy and advocacy at the Multidisciplinary Association of Psychedelic Studies, and Kevin Sabet, a former three-time White House Office of National Drug Control Policy. Now I’d like to jump to, uh, we’ve asked a number of people to listen to the conversation so far and to join in with a question based on their expertise. And these are people who write and study about the issue, and first up, I wanna say hello to Emily Witt. Emily is a staff writer at The New Yorker. Um, Emily, you’ve also written the books Future Sex, and more recently, Health and Safety: A Breakdown, uh, which looks at some of your experiences of using psychedelic drugs. So Emily, welcome to the program, and you’ve been listening. What question do you have for our debaters?

Emily Witt
Yeah. Thanks so much for having me, and thanks for the fascinating debate. Um, one pathway to psychedelic legalization has been, um, religion and freedom of religion. Um, millions of Americans have also taken psychedelics in underground settings. My question is whether emphasizing the therapeutic potential of these drugs is really the best way to legitimize them, or is it simply the most promising path to commodifying them? And I wonder if therapy, for Kevin, is not the best way, if there’s any model under which the u- uh, the use of psychedelics would be acceptable to you. Um, you know, you mentioned your concern for psychosis and schizophrenia. I don’t know that that concern is best addressed under the existing paradigm. So I’m, I’m curious whether therapy is really the best way forward.

John Donvan
Uh, why don’t you go first with that, Ismail? Thanks, Emily.

Ismail Ali
Sure. I’ll speak briefly to the religious piece, ’cause it’s a really good question, and in the United States, we have this paradigm where either you’re medical or you’re religious. And I think doctors and spiritual people across the, across the country are realizing that that line is a little bit more blurred than we’ve seen so far. So it makes sense that religious figures and religious environments can’t make medical claims, and it makes sense that the medical environment is one in which spirituality is a little bit at arm’s length. But for a lot of people, spiritual healing and physical healing are inter- intermixed, and I would say that with the rising awareness of psychosomatic and other kinds of disorders that have this kind of psychological and physical relationship, um, it’s an interesting spectrum.

And I think that the types of regulation, the types of oversight, and, um, kind of limitations of practice that exist in a religious context or spiritual context are different than the ones that might exist in a medical context, primarily because of the claims. You might not make a claim that religious use of something can treat something, whereas you’re allowed to do that in a medical context. So I don’t think it’s an either-or. I think that they’re different, and I think that they have different frameworks, and I think we’re actually seeing that with the increase of visibility, and regulation, and accountability within both of those systems simultaneously.

John Donvan
And your s- take on that, Kevin?

Kevin Sabet
Sure. Look, I think, uh, you know, my concerns around, uh, mental illness, uh, and especially severe mental illness, and the re- again, this study that just came out of Ontario, which I think is very concerning. Um, uh, you know, to me, um, j- uh, yes, it’s actually preferable to not have these drugs widely available, uh, if they are increasing these adverse events. Insofar as they can be helpful for different kinds of conditions, um, you know, helpful maybe as an adjunct or, you know, uh, again, in combination with something else or whatever, or even on their own. Um, I, I would rather there be some clinical guidelines. I actually do think the therapeutic paradigm is best.

What I… What worries me is what we, what we see when, like what we’ve seen with the marijuana issue, where someth- s- you know, the proponents say we, “I promise, we only want it for medical use. It’s only for cancer patients,” and then the next year, it’s for anyone with a pain, and then the next year, it’s for headaches, and then, then now, it’s for anybody who says that they have anything which, in which it provides relief. There’s zero standards in any of these states, really. There’s like 50 kinds of, uh, conditions. Uh, um, everybody has at least one of these conditions.

Um, and then it becomes sort of a mockery, and then it g- from there, the next step is, “Well, actually, we should just legalize it, because that’s gonna be the best way to regulate it. So it shouldn’t just be medicalized. It should also be legalized.” So my concern is that a lot of the advocates on the psychedelic side, especially those that h- are spending money, tens of millions of dollars in different states, to legalize them, that they’re following this kind of pattern, the same pattern we’ve seen with marijuana. Whereas I’d rather see a truly therapeutic paradigm, where you have oversight, regulation, uh, and you’re actually able to sort of have some rules that could be enforced around the use of these drugs.

Uh, my worry is that by legitimizing them, legalizing them, just like we’ve seen with, with, with marijuana, alcohol, tobacco, that it’s very hard to enforce the rules when you have so many different actors out there, and you have a government that might be indifferent and have other kinds of priorities.

John Donvan
Okay, thank you for that, Kevin, and Emily, thank you very much for your question. Um, I’d like to next, uh, bring in, uh, Dr. Javier Muniz, who is a retired associate director for therapeutic review at the Food and Drug Administration, um, and also a founding consultant at Muniz PsyNova Solutions. Javier, thanks so much for joining us, and please come on in with your question.

Javier Muniz
Thank you for having me, and thank you for the debate, uh, to both Kevin and Ismail. I, I, uh, my question is revolving around, uh, what’s called Breakthrough Therapy designation. I’ll m- m- briefly mention what it is. It’s when the FDA determines that a treatment, uh, i- offers early evidence of substantial improvement over existing therapies for a serious or life-threatening condition. That’s basically what that is. So the FDA has given the designation for Breakthrough Therapy desi- uh, therapy, to various compounds in this class. Uh, for example, LSD for generalized anxiety disorder, uh, psilocybin for treatment-resistant depression, MDMA for PTSD. So, Kevin, when, when you were, uh, talking about the existing evidence and things like that, what do you, what do you think this means, uh, the Breakthrough Therapy designation, and the FDA saying, “Yes, we, we, we think this offers, potentially, improvements over existing therapies”? What, what do you think about that?

John Donvan
So, so Javier, I think what you’re saying is it, it sounds like there’s some- that the FDA at least thinks there’s something there, and you’re asking if the FDA thinks there’s something there, you know, what, what do you, what do you make of that fact? So yeah, please take that on.

Kevin Sabet
Yeah, no. It means we should study it, which I think we should. It means we should study it properly. It means that we should make sure there isn’t misconduct. It means we should make sure that there aren’t conflicts, uh, with, with companies and folks that are intertwined in the research design and protocol. It means that we should make sure that there are safety guardr- guardrails, uh, that all participants can feel safe. Uh, but of course, uh, um, w- we want the FDA to be giving all kinds of drugs, uh, if they deserve it, Breakthrough designation. That’s a good thing. I’m not… I don’t think that’s a bad thing. That’s a good thing. But again, I think we need to be responsible, we need to do it right, and clearly, this first go at it wasn’t done correctly. It wasn’t done up to the standards, uh, despite the Breakthrough designation, so it actually shows that Breakthrough designation certainly doesn’t mean a slam dunk in terms of medication approval if it shows anything. But um, of course it shows that there, this has potential to study, and I think we should.

John Donvan
Okay. Javier, thank you so much for joining us with your question, and also, we really appreciated your, your expertise in explaining what Breakthrough means for us as well. Really appreciate it. I want, now wanna i- invite Rachel Nuwer into the conversation, and Rachel is a freelance science journalist and author of I Feel Love: MDMA and the Quest for Connection in a Fractured World. Rachel, welcome to the program, and please come in with your question.

Rachel Nuwer
Thank you so much for having me. Um, so it seems to me that psychedelic medicine was really over-hyped in the media for a couple of years back, and now we seem to be entering into a period of almost anti-hype against psychedelics. In the, some cases, this anti-hype is equally overblown and misinformed as the original hype. So, I decided to ask this specific question because I’ve seen evidence of that anti-hype in this conversation through several instances of misinformation that’s been cited as fact. So, I wanna state for the record that what’s happened is well, one well-known instance in the Lykos trials of an egregious sexual misconduct issue in an early Phase 2 trial that was reported to authorities and public a- publicly addressed. Since then, however, there’s been no other evidence of sexual misconduct in the clinical trials of MDMA. Kevin cited is actually of naturalistic users, which means people who are illegally seeking out this treatment in the underground. They’re not controlled. It’s not conducted by professionals. It could literally just be, like, some guy that you know.

Um, so the allegations that there’s been rampant sexual misconduct, that it runs deep and broad, that Lykos and MAPS is a religious cult, this general air of, you know, nefarious activity, I think what people aren’t realizing is that this has actually been an agenda pushed by members of a specific radical leftist group that has had the long-term goal of destroying MAPS and Lykos. These allegations have just been uncritically accepted because they have been tapping into stigma surrounding these drugs and created a sort of satanic panic type hysteria in the media and the public.

John Donvan
Hey, Rachel. Uh, R-

Rachel Nuwer
Yeah.

John Donvan
Rachel, I, I, I’m jumping in for two reasons. One is that we’re now limited for time-

Rachel Nuwer
Okay.

John Donvan
… and-

Rachel Nuwer
Well, I have a, I do have a question if-

John Donvan
So let’s hear the question, and then, what, but we’re gonna have to give Kevin a chance to respond as well.

Rachel Nuwer
Okay, sure. Um, so the question is do you think the media whiplash from, you know, positive hype to negative hype has shaped public understanding of psychedelic medicine, and how might we might have a more sensible and fact-based discussion about potential benefits, limitations, and harms of these treatments?

Kevin Sabet
I don’t think the public’s paying much attention, no offense to anybody, including myself, who does (laughs) drug policy, to any of this, to be honest with you, number one. So I’m not sure there’s some widespread public change, and public’s paying attention to 50 other issues, that psychedelic medicine just, I gotta be honest with you, same as with marijuana policy, frankly, is just not a main one, uh, number one. Number two, uh, if you look at the overall coverage of psychedelics, um, it, while maybe there’s more balance, and, or you could call it balance in the recent year or two, the vast majority, I would say, would be much more positive coverage, about the, the, you know, f- f- with veteran stories, with heart-wrenching stories that we’ve been reading about.

John Donvan
Uh, Kevin, you said the public’s not listening. I’m not so sure about that, but if the public is listening at all, w- where, where do you th- where do you think, what do you think the public understands about this issue right now? Ismail, I’ll let you go first. Like, where, where is the public’s thinking on this? You know, we know that in Massachusetts, they were just given the opportunity to legalize certain, um, drugs for medical use, and the public turned it down. That just happened in the, in the recent vote.

Ismail Ali
Right.

John Donvan
So where do you think the public is on this?

Ismail Ali
Well, I’ll just say two quick things. One, I totally agree we’re in a pendulum swing. I think that that is, uh, a natural, uh, uh, place to be for an environment where we have a highly desperate population really seeking solutions, and first, we had, like, this idea, like I said earlier, that psychedelics are a silver bullet. It’s very-

Kevin Sabet
Mm-hmm.

Ismail Ali
… clear, and I think it’s becoming clearer that they’re not, which I think-

Kevin Sabet
Mm-hmm.

Ismail Ali
… is a good thing, because it’s bringing more nuance to the conversation. And I think the public is receiving a lot of different conflicting pieces at the same time, and they’re sorting out what was the norm that they had, you know, the kind of post-war on drugs hysteria, and what’s, like, the reality. We’re, so we’re sort of finding, I think, the, the legitimate as- like water level, you might say. We’re finding the appropriate water level for what information we have and don’t have about that right now.

John Donvan
Kevin, your take on that?

Kevin Sabet
Well, we’ve done some internal, uh, focus groups and things, and I think that one of the things we’ve seen is that, um, uh, uh, people still have… It’s not so much drug war hysteria. It’s like, “My friend jumped off of a tree when he was high on LSD, so I’m not sure these things (laughs) are that good.” I mean, there’s still some of that, because these are what people experienced, and you can’t, you know, you can’t, um, b- judge someone else’s actual experience. Interestingly, I, I didn’t… Like, if you were to ask me this question before the vote, uh, in Massachusetts, I really had no idea how it was gonna go. Um, you know, you have a very, very blue state in Massachusetts, overwhelmingly f- passed marijuana legalization, medical marijuana as well, overwhelmingly, you know, sort of the, again, when you look at Harvard, it’s, it’s where Timothy Leary and others are from. So, you know, if anything, I, I thought eight $8 million to 100,000 that it was gonna vote in favor. I was actually slightly surprised on election night, I, honestly, to see the, the, the por- the, how it, how the vote went, 57-or-so percent no, so it’s interesting that that’s where the public is at least in that one state, but I th- I, I don’t think this is a high-salience issue for most American voters.

John Donvan
Okay. We’re gonna wrap it up there. Rachel, thanks so much for joining us on the program. And now we move on to our closing statements. Um, in our closing statements, we’ll give each of our, uh, debaters their chance to, uh, get in their last word on this. And Ismail, you are up first. Um, you get to make your closing statement first, to tell us one last time why you believe psychedelics will help when it comes to mental health.

Ismail Ali
So I’ll say that mental health is a proxy for something bigger. It’s a crisis of isolation, runaway economic equality, injustice that causes and maintains poverty and cuts off opportunities, and maybe even some form of spiritual abandonment that severs us from our place in the larger ecosystem. This isn’t woo-woo. This is the wisdom that we hear from people in traditions across the globe and throughout history. Clinical data from the last two decades has begun to paint a picture that there was in fact insufficient evidence to make the case for the status quo in the first place, and information coming in from states like Oregon, which has a legal regulated program, has shown new data that over fi- within over 5,000 people that have gone through the program over the last year, it’s only resulted in a single-digit number of emergency calls, I think five, which shows that with proper scaffolding, which is only possible through legalization, we can in fact reduce the risks that Kevin and others have been talking about, which again, are legitimate, but are better controlled in a regulated environment.

Psychedelics impact things like nature relatedness, introspection, and when done intentionally, relational and community connection, all of which are prosocial elements and behaviors, whether or not they directly acu- respond to acute systems. So again, the concerns about the risks are real. They exist, and they are harder to manage in illicit environments and more manageable with regulation. We’ve seen how cultural and regulatory mechanisms can be used to improve our public health. Kevin mentioned smoking and alcohol, which is true. Those are both taxed. Those are regulated, but are both also examples of where public health, uh, interventions have improved. Messaging and taxing smoking has reduced deaths. Education has reduced instances of drunk driving, for example. And we’ve seen how the lack of nuance through blanket criminalization has failed on nearly every metric.

So with this topic today, the details are complex. There are rabbit holes in every direction, it’s true. But the reality is simple: psychedelic therapy works. It should be made legal. We’re in a crisis. FDA reviews do not signal rejection, but requests for further data. The momentum continues, and while current mental health treatments are not novel or sufficiently as- effective, this modality has moved in the direction of safety, cost effectiveness, efficacy, and as the stakes are high, people are suffering, we should take that seriously and responsibly regulate. Thank you.

John Donvan
Thanks so much, Ismail. And Kevin, you literally get the last word. Um, your closing statement, please, to tell us again why you feel psychedelic use in mental health is all hype.

Kevin Sabet
Thank you. Uh, and thanks for this opportunity. You know, I think there is potential for all kinds of classes of drugs, including psychedelics, but right now, we are, we are far from there, being there. Uh, I think that n- it’s understandable for people for g- to grasp for solutions and want silver bullets, and want other solutions that are not traditional, uh, during this mental health crisis that we have. Uh, but I am here to say that we need to look at the large body, especially of recent data, sh- uh, that actually gives us pause, that gives us pause because we see negative side effects as a result of psychedelics. We’re seeing, uh, like we did last week, uh, a h- uh, an increasing 21-fold, uh, risk increase of schizophrenia among users, among over nine million users. We’re seeing case reports of PTSD and suicidality, uh, immediately following folks that participate in some of these psychedelic studies.

Um, and so I think there, psychedelic therapy carries significant risks, uh, you know, due to the patient’s very vulnerable state. Um, that doesn’t mean that there isn’t a place for this. I think we need to properly study, um, not have advocates lead the way, not have people who regularly are using the drug lead the way, um, but those that actually w- are looking at this objectively, which there are researchers that are doing that, there are universities doing this research right now, and wait, and reserve judgment for that to happen. Right now, there is a well-financed, very well-organized, extremely well on the PR side, uh, group of some researchers, but mainly advocates, that are pushing for the legitimization, uh, both for people with, you know, a psychiatric illness, but also, um, those without, for more general use, to legitimize, and normalize, and popularize the use of psychedelics.

Um, I agree with the American Psychiatric Association, uh, that says that, uh, uh, right now, there is inadequate, uh, research, uh, for, uh, endorsing psychedelics to treat psychiatric disorders, so I think we need to wait and see what the science actually says before making a judgment based on some anecdotes.

John Donvan
Thanks very much, Kevin, and that is a wrap on this debate, and I wanna thank both of our debaters for, for agreeing to show up, and at least to have the conversations with somebody they disagree with. So thank you to both of you, Ismail Ali and Kevin Sabet. Thanks so much for joining us on the program.

Ismail Ali
Thank you so much, Kevin. Thank you, John.

Kevin Sabet
Thanks, Ismail. Thanks, John. Appreciate it.

John Donvan
And I also wanna thank, uh, our journalists and experts who came in with questions, Emily, Javier, and Rachel, and I wanna thank all of you who were tuning into this episode of Open to Debate, um, and for yourselves also being open to debate, to hearing two sides of an issue. You know, as a nonprofit working to combat extreme polarization through what we do, which is civil debate, our work is made possible by the centers like you, by the Rosenkranz Foundation, and by supporters of Open to Debate.

Robert Rosenkranz is our chairman. Our CEO is Clea Conner. Lia Matthow is our chief content officer. Elizabeth Kitzenberg is our chief advancement officer. This episode was produced by Marlette Sandoval and Jessica Glazer. Editorial and research by Gabriella Mayer and Andrew Foote. Andrew Lipson and Max Fulton provided production support. The Open to Debate team also includes Gabrielle Iannucelli, Annalisa Cochrane, Rachel Kemp, Eric Rose, Mary Regis, Savion Jackson, and Linda Lee. Damon Whittemore mixed this episode. Our theme music is by Alex Clement, and I’m John Donvan. We’ll see you next time on Open to Debate. Thanks so much for joining us.