Thread by @psybalazs

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

We need balance where #psychedelics do not get a free pass on the lack of blinding, but its not a reason to completely dismiss trials either.
#meditation can not be blinded either, but that doesn't mean meditation trials are worthless, they just have a risk of bias.

Blinding is supposed to neutralize expectancy biases, in cases where blinding works imperfectly there are alternatives strategies, eg. pre-treatment expectancy manipulations and clever stats... stay tuned for more (intentional and admittedly cheap paper in the pipeline teaser)!

(as a clarification I have macrodose in mind for this thread, not microdosing, where blinding is hard, but probably achievable - depending on how exactly MD is defined)

would love to hear feedback on this 👆 perspective @EikoFried @eturnermd1 @vincepsy @RCarhartHarris @FlamelingJop @m_wall @MattBurkeMD @MichielElk @ehaijen