In the @COMPASSPathway trial the 25mg vs 1mg (=placebo) #Psilocybin difference is not only significant statistically, but also clinically. On the MADRS the 'minimal important difference' is ~3-6 points (tinyurl.com/5apzv8h8), the 25mg dose meets this criteria (more context 👇)
The 'minimal important difference' sounds like a low bar to cross, but actually most #antidepressants fail to do so relative to #placebo, tinyurl.com/yut6xyhd - thank you @PloederlM for your work on this, would love to hear your take on this trial!
Lack of blinding remains an issue, but the dose-response relationship should alleviate this concern. As I argued before, #psychedelics macrodose trials most likely will always lack blinding due to obvious drug effects, it is the nature of the intervention.
Given the seemingly impressive effect size, i was surprised by the low remission/response rates (context: tinyurl.com/3n6p4cae)
• • •
Missing some Tweet in this thread? You can try to
force a refresh
Now that #psychedelic trial's lack of blinding is hot again, lets remind ourselves that for most treatments blinding doesn't even work as a concept, eg. mindfulness, psychotherapy, lifestyle interventions etc. Lack of blinding is the rule rather than the exception, a short 🧵
Blinding as a concept only works for pharmacological treatments, but there are many more interventions where 'blinding' does not even work conceptually (see 👆). Nobody is upset that blinding quality is not measured and blinding integrity is not maintained in an exercise trial.
The tension:
-psychedelics are pharmacological (lets set aside therapy for a sec), so blinding should work
-blinding obviously does not work due to strong subjective drug effects
Its an 'unblindable' pharma treatment (at least by conventional methods), which is strange at first
The recent #psilocybin vs. alcoholism trial used an active placebo (diphenhydramine). Despite this ~94% correctly guessed their treatment, showing that blinding didn't work. IMO this shows that active placebos likely wont solve the blinding issue of #psychedelic trials, a 🧵
Active placebos may have perceivable effects, but these wont confuse most patients, because psychedelics have very specific subjective effects. When a patient experiences drug effects, in most cases its easy to decipher whether its due to a psychedelic or some other drug.
Even if someone is unfamiliar with psychedelic effects going into a trial, modern ethical research standards require doctors to discuss likely effects with patients, making blind breaking that much easier
Their two conclusions:
-p1: "meta-analysis suggested that blinding was unsuccessful among participants and investigators."
-p2: "patients or assessors were unlikely to judge which treatment the patients were on."
Despite the importance of #blinding in medical research, most trials don't assess blinding integrity, partially because there is no method to adjust trial results for blinding integrity... until now! New preprint with implications for #microdose and #psychedelic research 🧪🧵👇
First, we define activated expectancy bias (AEB), which is an uneven distribution of expectancy effects between treatment arms due to patients recognizing their treatment allocation. AEB can be viewed as residual expectancy bias not eliminated by the trial’s blinding procedure.
The main idea behind AEB is that if treatment allocation can be deduced by participants, then, treatment expectancy can bias the outcomes in the same manner as it biases non-blinded trials, for example as in open-label trials.