The media coverage of the MDMA Clinical trial result stinks

July 24, 2010

I am disappointed in the mainstream, and not so mainstream, media coverage of the Mithoefer et al, 2010 paper on MDMA-assisted therapy for Post-Traumatic Stress Disorder. I had been holding off reading any of it because I suspected it might distract me from actually discussing the paper.
After writing up my thoughts on the paper, I went strolling around the Google News hits for MDMA to see what had been written about this paper. There was a whole lot of of really bad journalism. Sure, for the most part they got the basic facts right, but I noticed a consistent issue having to do (I assume) with journalism’s penchant for selling a story they’d like to tell over the story that exists.
Let us start with the more venerable news organizations.
ABC News Ecstasy may help traumatised veterans
See the title? Pretty common to see something abut veterans or combat PTSD in the title as well as in the article body.

found that the drug seems to improve the effects of therapy in military veterans

No, there was one combat stress case. I noted that this stuck out as odd in my post on the paper. Well, now you can see why the authors might have been so keen to include this single warfighter subject. They enjoyed much wider press and nobody called them out for this scientific distraction
(This part of the ABC report caused me to laugh though:

The researchers, led by Dr Rick Doblin of the Multidisciplinary Association for Psychedelic Studies

Of course this is true, the driving force behind getting these studies rolling is the recreational legalization Trojan outfit MAPS. It looks better though, if you ask me, when they credit the therapist Mithoefer as being the leader of the project and MAPS as only providing support and assistance. )

CBS News by David S. Morgan Ecstasy Helps Treat PTSD Patients, Trial Finds
My problem on this one was the subheader “83% of Patients with Post-Traumatic Stress Disorder Showed No Symptoms After Combination Psychotherapy and Drug
I didn’t read the results as “no symptoms”, rather as improved symptoms and no longer meeting diagnostic criteria for the disorder. Not quite the same as “no symptoms” I fear.
Fox News (attributed to NewsCore) Study: Ecstasy Can Help Traumatized Soldiers
Apart from this observation

The trial only studied 20 patients but the U.S. team has gained approval to complete a larger study in military veterans.

and the title, the Fox bit refers only to “patients”. So it definitely leaves the impression that the paper is about combat PTSD.
TIME Ecstasy Shows Promise in Relieving PTSD
This piece quotes stats on PTSD in service members from the paper’s Introduction but never mentions the index trauma of the participating subjects, most of which were not combat PTSD. This article also says “the most rigorous scientific methods” were used and specifically mentions blinding and the problem of placebo response in individuals who knew the study drug was MDMA. Yet somehow they fail to mention that the double blinding of the study failed spectacularly. You don’t get points for trying, only for achieving believable double blinding!
Many of the less mainstream pieces I was able to find on the Google search also chose to lead their stories with the potential for treatment of combat PTSD in warfighters.
Is Ecstasy the Answer for Veterans With PTSD?
This bit mentions veterans but never points out that the vast majority of the subjects were not combat trauma cases of PTSD.
Ecstasy Helps Treat Traumatized Soldiers

During the research and experimentation phase, researches gathered 20 patients with PTSD and exposed twelve of the patients to ecstasy and the rest with placebo pills. The soldiers then proceeds to their regular therapy treatments.

Yeah, they got the subject pool entirely wrong. But they also had this extra little boo-boo. Really, this article is not strong stuff.

Ecstasy is composed of methamphetamine or amphetamine and hallucinogen (usually mescaline).

Stars and Stripes by Leo Shane III New treatment for PTSD? Dropping some Ecstasy

..a group of researchers with the Multidisciplinary Association for Psychedelic Studies in California are suggesting that 3,4-methylenedioxymethamphetamine (better known as Ecstasy) could prove valuable in helping combat vets in dealing with post-traumatic stress disorder. The study, which tracked only 20 patients, found veterans using Ecstasy were more receptive to counseling sessions than those on a placebo.

No mention that only a single combat PTSD case was included, of course. This seems to be a publication focused on the military so it is somewhat understandable that they would pick up on the combat PTSD angle. But no excuse for failing to pick up on the fact this paper has essentially no information other than anecdote about combat PTSD.

Coverage was not exclusively horrible. I did find a couple that avoided making big mistakes or at least managed to get some of the right focus included.
The WebMD article does a bang up job.
NewScientist by Arran Food Ecstasy may help trauma victims
This one gets it right! Good job.

[the researchers]..gave either MDMA or a placebo to 20 patients with PTSD, mostly female victims of sexual abuse, who had not responded to conventional drugs.

US News & World Report HealthDay bit (also appearing here)
This one also does pretty well. Although it doesn’t specify the patient index trauma at all, at least it doesn’t mention soldiers or combat trauma. It also gets points because it quotes Mithoefer on the failed-blinding limitation and quotes another PTSD researcher cautioning about neurotoxic effects of MDMA.
There was a modest boo-boo in

The phase 2 study, the second of three phases of research required by the federal government before approving a drug for a specific use

This was barely the size of a normal Phase I and would never be sufficient for a Phase II on the way to regulatory approval. The authors even call it a “pilot” Phase II in the introduction so there is really no excuse for missing this.
AOL News Surge Desk by Katie Drummond Ecstasy Shows Promise as PTSD Treatment
This bit also manages to avoid the warfighter trap when describing the results so I’m giving a thumbs up for that. However this piece does end with

The study sample was small, but big enough for the Food and Drug Administration to take note. The agency has approved a study of 40 military veterans from Iraq, Afghanistan and Vietnam, to be performed by the same research team.
It’s a move that signals a new willingness among federal health agencies to consider every option, from yoga to acupuncture, in addressing the massive number of troops returning from war with post-traumatic stress.

Given that this one doesn’t mention the majority index traumas, it does tend to leave an impression that the study was about combat PTSD.
CNN Health blogs Can Ecstasy ease post-traumatic stress disorder?
Not too bad overall as they start with:

The study, which appears in the Journal of Psychopharmacology, included 20 people with PTSD stemming from traumas such as sexual assault and combat stress.

I suspect most readers would assume there was more than one combat stress patient but at this point I’m looking for bright lights. If the article so much as mentions sexual assault it is (sadly; more on this later) batting above the average. I do like the fact that this CNN piece ends with the following because it tends to push the reader back on track by suggesting the present study did not involve combat veterans.

Mithoefer and his team are now gearing up for a similar study involving combat veterans, which is scheduled to begin later this year.

4 Responses to “The media coverage of the MDMA Clinical trial result stinks”

  1. What is particularly problematic for me (at least, based on your summaries and critiques, having not read all the original news reports) is the assumption that PTSD (and probably any other mental illness) exists along a binary distribution – you have it or you don’t, or you have it and then you’re cured – and fails to account for the possibility that PTSD exists along a normal distribution with a few people having no symptoms, a few people having lots of symptoms, and most people somewhere in between. This particular issue drives me crazy, as it has the potential effect of delegitimizing the complaints of individuals who are perhaps just shy of reaching diagnostic criteria.


  2. DrugMonkey Says:

    In their partial defense, this IS a very preliminary trial. In fact it really was a Phase I trial jumped up to try to see if they got any effective outcome. “Pilot” Phase II isn’t really anything.
    and in any research you have to balance the options of going for specificity (to gain higher confidence of interpreting what is going on) against generality (to avoid missing something that may be there because you first assumption was wrong).
    Actually the majority of their sample being women with sexual assault trauma is pretty decent specificity. They just muddied it up with the warfighter subject. Because that is their next trial….


  3. Neil Says:

    Although I agree that there are misleading insinuations in the media reports regarding these trials, I still think it’s important that the information be made public. Just because of PTSD in non-combat related doesn’t make it any less traumatic, and it could be argued that a case of violent sexual assault is more distressing than combat scenarios (although that is certainly subjective). As with any drug, dosages should be meted our carefully, and side-effects should be well examined and clearly noted, but I don’t think that a drug should be ignored simply because it is used recreationally. Certainly this is the case for many pain killers that, when used properly, provide necessarily relief for those who would otherwise be in agony.


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