AI Summary
5 min readA woman under anesthesia for hand surgery relives the knife attack that brought her to the operating room. But instead of jolting awake in terror, she stays in a dream state long enough to move past the assault — she dreams of going to the emergency room, into surgery, and then home, running errands with her repaired hand. She wakes up without nightmares, and a year later, she still has none. The drug that made this possible was not a psychedelic. It was propofol, a standard anesthetic, carefully titrated by an anesthesiologist watching her brain waves.
This case is at the center of a provocative argument from Dr. Boris Heifets, an anesthesiologist and researcher at Stanford. The dominant question organizing his work is whether the therapeutic power of psychedelics comes from the molecule itself or from the psychological experience it enables. His answer, supported by a series of careful experiments, leans heavily toward the experience — and that has major implications for how we think about psychedelic medicine, placebo effects, and the nature of transformative change.
The problem with psychedelic trials
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What you'll learn
- 1 (00:00) **Episode Introduction & Guest Background** - Hosts Heather Berlin and Christoph Koch introduce the theme of psychedelics and dream states in anesthesiology with Dr. Boris Heifets.
- 2 (02:53) **Why Anesthesiology and Psychedelics** - Heifets explains his path from PhD neuroscience to anesthesiology, drawn by the applied study of consciousness.
- 3 (08:09) **How Psychedelics Work Therapeutically** - Heifets defines the broad class of psychedelics and their shared therapeutic properties.
- 4 (11:02) **The Central Debate: Drug vs. Trip** - Heifets frames the fundamental challenge of separating drug-specific effects from psychological experience in psychedelic research.
- 5 (14:45) **The Placebo Problem in Psychedelic Trials** - Heifets explains why randomized placebo-controlled trials are uniquely difficult for psychedelics.
- 6 (18:00) **Innovative Approaches to Isolate Drug Effects** - Heifets describes strategies to separate the drug's biochemical action from the psychological experience.
- 7 (19:30) **The Ketamine Under Anesthesia Study Design** - Heifets details how his team ran a psychiatry trial in the operating room.
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Show Notes
Can psychedelics under anesthesia heal trauma? What is the latest research around ketamine, MDMA, and psilocybin? That’s part of what we explore this week on Science of Perception Box. Stanford anesthesiologist Dr. Boris Heifets joins Dr. Heather Berlin and Dr. Christoph Koch to discuss the latest research on the first double-blind study on Ketamine, the placebo effect, and the therapeutic value of anesthesia-induced dreams.
Dr. Boris Heifets, MD, PhD, is a board certified anesthesiologist who specializes in providing anesthesia for neurological surgery. He has practiced at Stanford since 2010. After completing residency training at Stanford, Dr. Heifets completed fellowship training in neuroanesthesiology, also at Stanford. In addition to treating patients, Dr. Heifets directs both clinical research and basic neuroscience. His research group studies how new rapid-acting psychiatric therapies like ketamine, MDMA, and psilocybin produce lasting changes in nervous system function, behavior, and therapeutic outcomes.
Dr. Heather Berlin is a neuroscientist, clinical psychologist, and Professor of Psychiatry and Neuroscience at the Icahn School of Medicine at Mount Sinai in New York City.
Dr. Christof Koch is Chief Scientist for the Tiny Blue Dot Foundation and the current Meritorious Investigator and former President of the Allen Institute for Brain Science.
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Episode Chapters:
(00:00) - Introduction
(01:34) - Exploring Psychedelics and Anesthesiology
(02:53) - Dr. Boris Heifetz's Background
(04:32) - Understanding Anesthesia and Consciousness
(07:56) - The Therapeutic Potential of Psychedelics
(10:48) - Challenges in Psychedelic Research
(18:00) - Innovative Approaches in Psychedelic Medicine
(24:35) - Introduction to the Study and Consent Process
(24:50) - Patient Interviews and Priming for Ketamine
(25:33) - Surgical Anesthesia and Placebo Effect
(26:28) - Unexpected Placebo Findings
(26:45) - Implications for Psychedelic Studies
(27:32) - Harnessing the Placebo Effect
(31:47) - Dream States and Anesthesia
(38:22) - Transformative Experiences in Clinical Care
(42:53) - Personal Reflections and Gratitude
(47:07) - Conclusion and Final Thoughts
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