editorial comment most high school kids know this already.....

For some, the diagnosis comes out of the blue. For others, it arrives after a long battle. Either way, the news that death is just a few months away poses a daunting challenge for both doctor and patient.

Drugs can ease pain and reduce anxiety, but what about the more profound issues that come with impending death? The wish to resolve lingering conflicts with family members. The longing to know, before it's too late what it means to love, or what it meant to live.


This month, in a little-noted administrative decision, the Food and Drug Administration gave the green light to a Harvard proposal to test the benefits of the illegal street drug known as Ecstasy in patients diagnosed with severe anxiety related to advanced cancer.

The drug, also known as 3,4-methylenedioxymethamphetamine, or MDMA, has been referred to by psychiatrists as an "empathogen," a drug especially good at putting people in touch with their emotions. Some believe it could help patients come to terms with the biggest emotional challenge of all: the end of life.

Milestone for FDA

The FDA's approval puts the study on track to become the first test of a psychedelic substance since 1963, when Timothy Leary and a colleague lost their teaching privileges at Harvard after using students in experiments with LSD and other hallucinogens.

It also marks a milestone for a small movement favoring a more open-minded attitude toward the therapeutic potential of psychedelic drugs.

Already, MDMA is being tested for its ability to reduce symptoms of post-traumatic stress disorder. And two U.S. studies are looking at the usefulness of psilocybin - the active ingredient in "magic mushrooms" - in terminally ill cancer patients and in people with obsessive-compulsive disorder.

In the coming year, advocates also hope to submit to the FDA an application to test psilocybin and LSD as treatments for a debilitating syndrome known as cluster headaches.

That would be a fitting birthday present for Albert Hofmann, the chemist who discovered both compounds while working for the Swiss drug company Sandoz and who turns 99 next week, said Rick Doblin, president of the Multidisciplinary Association for Psychedelic Studies. The Sarasota, Fla.-based nonprofit has organized and funded much of the new research.

Hofmann has referred to LSD as his "problem child" - a reference to his belief that despite its widespread abuse, the mind-altering drug has the potential to help some people.

Effects on serotonin

Although they vary in their chemical structures and specific effects, many psychedelic drugs work on the parts of the brain that regulate serotonin - the same brain chemical that is the target of many FDA-approved antidepressants. That does not indicate that the drugs are necessarily safe; indeed, they all carry medical and psychiatric risk.

Yet even scientists who have been vocal about those risks have expressed at least guarded support for the idea that, in the company of a therapist and with proper medical monitoring, moderate doses might benefit some people.

"When taken under adverse circumstances by ill-prepared individuals, there are substantial psychological risks," said Charles Grob, a psychiatrist at Harbor-UCLA Medical Center in Los Angeles. "But when taken in the context of carefully structured and approved research protocols and facilitated by individuals with expertise, adverse effects can be contained to a minimum."

Grob is leading an FDA-approved study in which terminally ill cancer patients are being given psilocybin to see whether it can help them sort through emotional and spiritual issues. He said the patients take a "modest" dose of synthetic psilocybin, equivalent to two or three illicit mushrooms. They spend the next six hours or so in a comfortable setting with a psychiatrist.

"So far they have had very impressive results in terms of amelioration of anxiety, improvement of mood, improved rapport with close family and friends and, interestingly, significant and lasting reductions in pain," Grob said of the first few patients to enroll.

'Religious experiences'

"These are extraordinary compounds that seem to have an uncanny ability to reliably induce spiritual or religious experiences when taken in the right conditions."

With the FDA's Dec. 17 approval of the Harvard MDMA protocol, the only remaining hurdle is getting a special license from the Drug Enforcement Administration. A dozen subjects with less than 12 months to live will get either low or moderate doses during two sessions a few weeks apart, along with counseling and psychological tests before and after treatment.

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