["Until God says 'yes or no', but here, in my home": autonomy and end-of-life care for rural older adults in the Los Lagos Region, Chile].

Clinical and research interest in psychedelic treatment and psychedelic-assisted psychotherapy for posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) has increased rapidly in recent years. Following the War on Drugs and tighter regulation of pharmaceutical research in the 60s and 70s, psychedelic research was largely halted. Recently, the FDA has allowed psychedelic research to resume, granting MDMA breakthrough therapy status for PTSD in 2017 and psilocybin breakthrough therapy status for MDD in 2018. Enthusiasm for novel treatments is expected given the high rates of disability and mortality associated with MDD and PTSD, as well as the relatively low clinical response rate to antidepressant medication. This surge in research has resulted in increased media coverage from newspapers, magazines, podcasts, and more. Some of this increased media coverage has been attributed to the popularity of Michael Pollan’s book, “How to Change Your Mind”, resulting in what researchers have coined the “Pollan Effect”. In this work, ‘hype’ is defined as heightened positive expectations regarding psychedelic treatments and ‘media hype’ is defined as the reflection of this hype in media outlets. Media hype involves a process of amplification and magnification of effects by the media, often through selective emphasis or repetition, without necessarily including exaggeration or distortion. The characteristics of media coverage of psychedelic treatment have not been well studied. Researchers have noted that “modern psychiatry has had a pattern of hope, hype, and crash, where new treatments were hailed as answer, only to fall short”. However, the impression that there is media “hype” regarding psychedelic-assisted therapy has not yet been quantified and is based on anecdotal reports from clinicians, patients, and community members. Some examples of this referenced “hype” include Volkow and colleagues’ (2023) expressed concern that “the hype has gotten ahead of the science”, reflecting a cautious perspective held by many engaged in the broader scientific discussion about psychedelic treatments. When considering previous treatments such as stem cell interventions, cannabis for anxiety or Parkinson’s disease, and melatonin for sleep that have also received widespread, largely positive, media attention, clinicians have reported concern that overly positive medical information in the media will impact patients’ requests for or expectations regarding treatment. While the impact of patients’ expectations for treatment is starting to be studied, it is still unclear whether media reporting on psychedelic treatments is hyped. It is vital to explore media hype regarding psychedelic treatment because it may impact patient enrollment in clinical trials as well as their expectations, attitudes, and adherence with treatment, all of which may affect patient outcomes. Media hype could also lead to high rates of placebo and nocebo effects in clinical trials, underestimation of treatment risks, and, potentially, future limitations on research. Media hype regarding psychedelic treatments is uniquely problematic because it may also lead to increases in self-medication with psychedelic substances, which remain Schedule I drugs in the United States. In August of 2024, the Food and Drug Administration (FDA) rejected an application from Lykos Therapeutics for the approval of MDMA for PTSD, citing “protocol deviations amounting to unethical conduct”. The rejection followed a negative appraisal from the Institute for Clinical and Economic Review (ICER) Panel, citing insufficient clinical evidence and study design flaws. The FDA rejection was controversial and surprised advocates for psychedelics and appears inconsistent with the media representation of the efficacy of MDMA.