Who is blind in psychedelic research? Letter to the editor regarding: blinding and expectancy confounds in psychedelic randomized controlled trials
Expert Review of Clinical Pharmacology July 6, 2021 E. Schenberg
A letter commends a review on unblinding in psychedelic clinical trials but critically questions whether the proposed solutions are pragmatic, ethical, and conceptually sound. The author notes that suggested multi-arm designs increase patient numbers and costs, may face ethical issues such as patient deception, and could violate clinical equipoise. The letter argues that isolating pharmacological effects from placebo, therapeutic alliance, and expectancy may be impossible in principle, as psychiatric drugs target subjective experience and patients becoming aware of changes may be inherent to therapeutic action. The author questions whether maintaining blinding would indicate a drug had no useful effect.