When Joe Rogan Is in Charge of Health CarePsychedelics have genuine potential as psychiatric tools, which is why separating them from politics is so important.
IF YOU DON’T LIKE ROBERT F. KENNEDY JR. setting national health policy, how do you feel about Joe Rogan? The question is a serious one that deserves a serious answer, given what transpired when Rogan showed up in the Oval Office a little over a week ago. He was there to watch President Donald Trump sign an executive order promoting psychedelic drugs as a treatment for mental illness, a cause that Rogan has long championed. But it turned out the podcast host wasn’t just another invited guest. He was the one who had prompted Trump to act. “I sent him that information,” Rogan said, revealing he’d texted the president about the ways psychedelics might help with conditions like depression and PTSD (post-traumatic stress disorder). “The text message came back, ‘Sounds great. Do you want FDA approval? Let’s do it.’ It was literally that quick.” This does not appear to be an exaggeration. Mehmet Oz, the celebrity doctor who oversees Medicare and Medicaid programs, told reporters that Rogan’s text set off a frenetic week of internal deliberations that culminated in the executive order. Kennedy played a role too, as Trump recounted in his own remarks. “I said, ‘Bobby, let’s just do it and get Oz involved and it’s going to get done so quickly,’” Trump recounted. “And you guys did a great job.” The executive order calls on the Department of Health and Human Services to make more funds available for research into psychedelics, while telling the Drug Enforcement Agency to update its legal guidelines to allow legitimate academic and therapeutic uses to go forward. Those moves reflect a widespread recognition that psychedelics have real potential as a breakthrough therapy for some patients. And it’s hard to find anybody—even among frequent administration critics—who finds this sort of action beyond the bounds of normal presidential prerogatives. “It’s well within the remit of any administration to decide that research in a given area is a priority for them, and to make it easier for researchers to do that work,” Peter Lurie, president of the Center for Science in the Public Interest, told me.¹ But the executive order also instructs the Food and Drug Administration to give psychedelic manufacturers so-called priority vouchers that expedite reviews. This provision is setting off alarm bells because it suggests the president is doing an end-run around the FDA’s normal scientific processes, quite possibly because he wants to quiet a politically influential podcaster who has been giving him grief over Iran. It also seems possible Trump might be looking to boost companies that stand to profit bigly from psychedelics—companies who count among their investors well-known Trump allies like Peter Thiel. “The optics of the situation are quite concerning,” Rachel Sachs, a Washington University law professor and expert on drug regulation, told me.² “It appears that the president is directing FDA, at the very least, to issue these priority vouchers to these products—and based on his public statements, will be exerting some type of pressure on FDA to ultimately approve the products.” It wouldn’t be the first instance of such meddling: Career FDA staff have told STAT News that they have come under pressure from administration officials seeking priority vouchers for pharmaceutical companies that agree to the prescription drug pricing deals Trump keeps hyping. And it’s not like it takes journalistic sleuthing to establish the connection to Rogan: Trump and several other administration officials came right out and said it exists. None of this means that the FDA will ultimately bend to pressure from top Trump officials, or make ill-considered decisions when it comes to any particular treatments. But the threat itself is enough to damage the agency’s credibility, in ways that could ultimately hurt everybody—including both the companies that want to manufacture psychedelics and the people who might genuinely benefit from them. This kind of reporting and in-depth analysis—so important to the future of our democracy—is made possible by the support of our Bulwark+ members. If you’re not already a member, consider joining today—and get your first two weeks free: MODERN INTEREST IN THE THERAPEUTIC BENEFITS of psychedelics, like so many key episodes in medical history, traces back to an accident in the lab. In 1943, a Swiss chemist named Albert Hofmann was synthesizing a substance he hoped would lead to respiratory stimulants when he inadvertently absorbed a tiny amount. The substance was a version of a compound we know as LSD.³ The LSD altered his vision and perception, and made him feel like he was in a “mystical” state. He decided to try again a few days later, and experienced even more dramatic changes in perception and mental status. Hofmann famously rode his bicycle home while on what we would now call an acid trip, which is why historians (both professional and amateur) call the April 19 anniversary of that ride “bicycle day.” Hofmann worked for a company called Sandoz Laboratories, where he and his colleagues quickly recognized the potential of such a powerful mind-altering drug. Sandoz distributed research samples to psychiatrists, kicking off a wave of promising studies in the 1950s that suggested potential to treat depression, personality disorders, and alcoholism. Publicity around these developments attracted lots of attention, and not just among people with mental illness or those trying to treat it. Counterculture leaders in the ’60s hailed the drugs (still legal for purchase back then) as a way for everybody to alter their state of consciousness. Meanwhile, the CIA experimented with LSD as a way to wage psychological warfare. Both those developments fed a backlash. Researchers stopped studying psychedelics, Sandoz stopped producing LSD, and the National Institutes of Health pulled funding. Eventually the federal government declared psychedelics to be a Schedule I controlled substance, making studies even more difficult to conduct.⁴ That was basically the end of research on psychedelics—until 2000, when scientists at Johns Hopkins University launched a new study on the effects of Psilocybin, the active ingredient in magic mushrooms that indigenous central Americans had long used in religious ceremonies. That project and a series of followups picked up where the studies from the ’50s and ’60s left off, yielding results suggesting psychedelics might work as a treatment for alcoholism, anxiety among people facing life-threatening cancer, and other conditions. Recently some especially influential research has demonstrated that treatment with MDMA, the active ingredient in ecstasy, could help veterans with PTSD who were not responding to more traditional therapies. The potential to reach these veterans and others facing similar struggles has been a big theme of Rogan’s promotion, and got plenty of attention from Trump in the Oval Office last weekend. “Today’s order will ensure that people suffering from debilitating symptoms might finally have a chance to reclaim their lives and lead a happier life,” Trump said while signing the order. Later he asked, jokingly, “Can I have some, please?”
AS WITH ANY DRUG, the challenge with psychedelics lies in demonstrating they can live up to their hype. That means fully studying possible adverse effects, which is no small thing given the potential of some psychedelics to raise blood pressure and the possibility that others could trigger psychosis or worsen symptoms of bipolar disorder. But it’s not just questions about safety that need answering. It’s also questions about efficacy, which for psychedelics can be particularly challenging to assess. The best way to test how well a drug works—and under what conditions—is through “double-blind” experiments in which neither the researchers nor the subjects know who is getting the treatment and who is getting the placebo. But anybody participating in a psychedelic study is going to figure out pretty quickly whether their mental status is changing. That can bias the findings, especially for a drug where results depend so much on how test subjects say they feel rather than measurable physical signs. Researchers will also know who’s really getting the treatment, because they’re going to be watching as it happens. The proper way to administer psychedelics is in lengthy sessions that last many hours, with a therapist guiding the patient through talk therapy while they are in the altered mental state.⁵ That’s how the drugs appear to work: People in that altered state are able to get past mental blockages from past trauma, in order to grapple with underlying causes of depression, substance abuse disorder, and other conditions. Concern over the reliability of data was among the reasons that an FDA panel two years ago voted overwhelmingly against approval of an MDMA-based drug that would have been the first new major PTSD treatment in decades. That disappointed advocates and researchers, some of whom felt FDA was being too rigid. But the FDA has issued guidance on the kind of evidence it would need and—even before last week’s announcement—companies were lining up with new applications they were optimistic would succeed, with plenty of investment money behind them. Now Trump has gotten in the middle of things, creating several potential hazards. Probably the most obvious is the possibility that his order pushes the FDA to rush the review process, in ways that make it more likely scientists overlook warning signs about safety problems. “The speed of review here that they contemplate is very, very rapid,” said Lurie, who noted that psychedelics were already eligible for the quicker of two review tracks at the FDA. Expediting reviews of psychedelics could also force the FDA to slow down reviews of more promising therapies, especially when the agency is operating with fewer personnel thanks to DOGE-ordered layoffs and DOGE-induced departures. “We stand a risk of FDA scarce resources being devoted to things that are actually less important from a public health point of view,” Lurie said, “in which case patients suffer.” Some enthusiasts of psychedelics might not worry so much about what happens to other drugs. But, as Sachs pointed out to me, the stigma and controversial history of psychedelics mean their manufacturers are especially dependent on collective trust that any approval was based purely on scientific merit. “If there is a perception that a podcaster texted the president, and that’s why these products were approved, that’s a problem for these companies,” Sachs said. TRUMP’S ORDER BY NO MEANS represents the first time officials in the executive branch have interfered with FDA decision-making. In the early 2000s, the Bush administration famously blocked over-the-counter sales of emergency contraception to minors. A few years later, the Obama administration just as famously did the same thing, despite an explicit promise to let science—not politics—dictate agency decision-making. But those were isolated incidents, confined to one particularly controversial type of drug. “We cite these specific examples because it was a rare occurrence,” Sachs said, “and it was often criticized quite strongly when it did occur.”⁶ Under Trump, by contrast, interference with decision-making has become common across health care agencies—whether it’s canceling funding for projects simply because their abstracts contain keywords that sound like DEI, or dispensing with normal CDC procedures to pull back on support for vaccination. “Those [previous controversies] felt like exceptions to the rule; now it’s not even clear what the rules are,” Lurie said. FDA arguably has held up against Trumpian political influence better than some other scientific agencies. But the pressure has taken a toll. And Lurie worries it’s only a matter of time before the agency loses the independence and credibility that is the foundation for the pharmaceutical ecosystem, and upon which the well-being of so many people depends. “You can get to a place with the FDA where people assume they only approved a particular drug—or didn’t approve it, as the case may be—because it was politically useful,” Lurie said. “At that point, patients don’t know what to do, doctors don’t know what to do, insurers don’t know what to do, because they simply can’t trust what’s coming out of the government. And it’s very difficult to really advance patient care under circumstances like that.”
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Lurie added that it is worrisome “that the particular products that they are selecting for attention seem to be selected on the whims of the secretary, or on the whims of the president. It doesn’t feel like the most rigorous way of identifying what the priorities for research ought to be. But they are within their rights to select them.”
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In the interests of disclosure, Sachs made sure to let me know that she serves on the steering committee for a Washington University research center studying psychedelics, and that she gets no special compensation for that work.
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The full name is lysergic acid diethylamide; the initialism LSD comes from the German Lysergsäurediethylamid.
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Adding to the difficulty, all of this was happening in a period when the FDA was already making the approval process for all drugs tougher, following the worldwide outrage over thalidomide, a drug for treating nausea in pregnant women that turned out to cause severe birth defects. The FDA had largely spared Americans from the effects by refusing to approve the drug. But it was only thanks to the heroic, nearly singledhanded effort of an independent-minded scientist named Frances Oldham Kelsey. The brush with much greater disaster in the United States prompted Congress to put in place new systems and tougher rules.
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These sessions are supposed to be preceded by therapy sessions without the drugs, and then be tracked in followup meetings. Figuring out how to review drugs whose efficacy depends in part on such therapy, and not just the drug itself, is among the challenges the FDA faces.
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Another famous episode of political pressure on FDA was in the late 1980s and early 1990s, when AIDS activists pushed the agency to review and approve potential treatments more quickly. You’re a free subscriber to The Bulwark—the largest pro-democracy news and analysis bundle on Substack. For unfettered access to all our newsletters and to access ad-free and member-only shows, become a paying subscriber.We’re going to send you a lot of content—newsletters and alerts for shows so you can read and watch on your schedule. Don’t care for so much email? You can update your personal email preferences as often as you like. To update the list of newsletters or alerts you received from The Bulwark, click here. Having trouble with something related to your account? Check out our constantly-updated FAQ, which likely has an answer for you.
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