We are overmedicated. How can we use psychedelics to heal not just individuals, but entire systems?

Set up to fail

“It’s the ultimate money-maker.”

My friend, Gary, was referring to the GLP-1 agonists or latest weight-loss drugs which I’ve been writing about and prescribing to patients. Ozempic, Wegovy, and Mounjaro have hit our society like a tidal wave. It seems like everyone is either on one of these medications or knows someone who is.

Gary pointed out that humans in the modern world are largely set up to fail. Technology has processed food to keep it shelf-stable and easy to consume at any time, but as a result, every bite contains an incredible number of calories and dubious ingredients which could lead to bad or unknown outcomes. Brands have advanced marketing and branding expertise in a race against competitors to get at our wallets, with the health of customers — individuals eating the food — as collateral damage.

Tied up in all of this is a lack of awareness or education in the face of overwhelming stimuli. No one has the time to deliberately research and understand everything they eat. Junk food producers have hijacked our taste buds and our attention to trigger unhealthy eating habits. Not to mention, most people cannot spare the time or money to find healthy alternatives. Even doctors and scientists don’t have the bandwidth to study the effects of our modern nutritional habits in such a complicated, fast-paced world. We have a high-level sense that we eat too many calories and too many processed foods. We tell patients to get whole foods and watch what they eat, but we don’t have the time to hold their hands through the process.

Unfortunately, none of this preaching has worked for the vast majority of the population. Instead, we had an increase of obesity from 30.5% to a shocking 41.9% of the US population over the last two decades.

The solution, for patients who even choose to tackle this serious problem, is to turn to diets and medications. And for what it’s worth, GLP-1 agonists and similar drugs are really excellent options. They actually do help patients lose a dramatic amount of weight with few or no serious side effects. I prescribe them quite often to my obese and overweight patients because of their great outcomes and favorable safety profile. Many of my patients on GLP-1 agonists lose 8–12 lbs a month, with one of them even losing 125 lbs over the course of a year.

But the problem is that, once you stop these appetite-suppressing injections, your appetite comes back and many patients regain their weight. This is why Gary says they’re the “ultimate money-maker.” We live in a world which tempts us constantly to fail at our healthy lifestyles, so businesses make money from us overeating, and other businesses make money from us taking medications to fix the resulting obesity.

Our minds are at risk

The same story plays out for our mental health. We live in a world that sets us up for failure. Social media platforms encourage us to compare ourselves to others, leading to high rates of unhappiness and even depression and anxiety. Advertisers bombard us with messages that we are missing something and if we buy this or that product, our lives would be so much better. News headlines have become increasingly negative in order to grab our attention and get our clicks.

There are also countless other factors, like increased cost of living, increased rates of isolation, and increased social and economic inequality, which have resulted in a general worsening of humanity’s mood. The problem is similar to the obesity one: many of us don’t have the resources and bandwidth to handle the fast-paced nature of this onslaught through deliberate means like lifestyle change.

So, we turn to medications like Prozac, Wellbutrin, and Seroquel. These are the ultimate money-makers because most of us simply cannot fight the tsunami of external forces that turn our minds into ruminating thought loops of anxiety and insecurity.

The fear I have is that psychedelics will be no different. We already see this with some companies and groups that are pushing for regular, extended use of psychedelics. There is a danger that people will gain a dependence on yet another medication rather than fulfilling the potential of such a transformative class of drugs.

Trapped in a trance

In zoos around the world, people have noticed elephants swaying back and forth, as if in a trance. Monkeys have taken to compulsive grooming to the point of baldness.

The solution zoos have taken has been to medicate these animals with the same psychiatric drugs used on humans. This happens with dogs at home, too, who act too hyper and are literally diagnosed with ADHD, just as a misbehaving child might be. Elephants on Prozac and dogs on Adderall are becoming commonplace in the modern world.

Dr. Nicholas Dodman, renowned animal psychiatrist, says that the medications are a band-aid. They help an animal tolerate their environment in the zoo, which is so far removed from their natural habitat that they actually lose their minds. The “real” solution would be to allow animals to live in nature rather than in zoos, or to let domesticated dogs run, bark, and play all day rather than be cooped up indoors.

It is the same for us humans. We are putting band-aids on our mental health issues with the daily medications produced to numb our pain. The world we live in pushes our addictive buttons until we spiral down into mental illness. Our cultural habits stifle our emotional healing and growth. Like giving the dog free rein to run dozens of miles rather than a quick walk around the block, or an elephant a giant treadmill to enable their natural day-long walks, we humans need to redesign our lifestyles to better our health.

Holistic treatment is key

The approach of treating a person by considering their life context is called holistic treatment. This means looking carefully at what factors — biological, spiritual, psychological, relational, etc. — are impacting the person and addressing the condition while taking all these factors into account. I’ll be honest — coming from an ultra scientific background, it is tempting for me to reduce any medical intervention down to the one ingredient that makes all the difference. It is a major mindset shift to accept that sometimes it takes a package of ingredients that can flex to a specific person’s unique needs.

Practically speaking for obesity, it means that every time we prescribe GLP-1 agonists, we have to pair it with education and coaching. (It would be even more fantastic if we could also change the world around the patient so they wouldn’t be so tempted, or directly send them healthy food choices, but we’re trying to stay somewhat realistic here.) In a 15-minute visit, I usually spend five minutes learning about a patient’s current life context and how they got to their weight, five minutes coaching them through healthy life habits they should strive for, and five minutes prescribing the actual medication and teaching them about side effects and logistics of usage. I am lucky to work with health coaches who can also add to the accountability and education of these patients. This is very different from the majority of doctors, who have even less time and bandwidth for their patients and thus usually spend just the five minutes they have for prescribing the medication.

For mental health, we need to spend even more time understanding a patient’s life context. In nearly every case, there are a dozen factors that result in a patient’s depression or other mental health condition. Even if there was a triggering event, like the death of a loved one or the loss of a job, depression and similar conditions result from a lifetime of learning thought patterns and conditioning emotional responses from a million experiences and events.

The incentives are all wrong

“But we can’t bill for that!”

The problem is, we have a healthcare system that rewards tangible actions like procedures. A quick procedure, such as cutting out a mole, pays more than a long chat to teach a patient about how to work on their negative thought patterns. Our fee-for-service system incentivizes doctors and health systems to have shorter and shorter clinic visits with more and more quick fixes. This, practically speaking, results in pill pushing. It’s much easier for a psychiatrist to hand over a stimulant prescription than to go through a patient’s life and understand everything that is contributing to their ADHD. Patients also are incentivized by their high healthcare bills and long wait times to demand tangible solutions, like pills.

So the pills make everyone happy, right? Wrong. Every drug has some side effect or risk, and long-term, frequently used drugs have cumulative risks. Even supplements and herbs have risks, though these are even less well-understood due to their lack of regulation and testing. But we all continue to demand the supplements and the prescription medications because we live in a culture which teaches us that pills solve problems, and they solve them fast.

It is a complex discussion to go into why value-based care has essentially never worked at a large scale in the US, and so I’ll save that big topic for another post. Needless to say, the incentives are wrong in healthcare and we are all suffering for it. What we need is a way to pay providers for offering care which is both cost-effective and does not promote the epidemic of overmedication.

We need to treat the system

Contrary to perhaps popular belief, when we treat a patient with psychedelics at Curio, we try to make every session as effective as possible so they can get off ketamine treatment as soon as possible. Investors may have some questions about that, but we have a strong mission to help people feel happy and fulfilled rather than chronically sick and thus dependent on drugs.

(The way we are making money long-term is by building technology and clinical services to help push the field toward lower costs and improved outcomes, in case any investors are actually wondering.)

We make every session as valuable as possible by providing preparation education before, guidance during, and integration coaching after our sessions. That is oversimplifying the explanation of our services, but covers the highest level of what we do. There are also elements of evidence-based rigor, constant research and data analysis, plus fidelity technology for optimizing quality.

The reason we conduct care so differently from others is because psychedelic treatments are so novel and experiential. Never before has a treatment modality required attention to experience design. Never before have we had an opportunity to change the system to accommodate such holistic care.

So let’s not waste this opportunity. Let’s make psychedelics the solution that finally changes how we care for our patients to be more holistic, accessible, affordable, and effective.

References

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