Set, Setting, and Clinical Trials: Colonial Technologies and Psychedelics

Abstract

This chapter critically engages with the model of evidence-based medicine (EBM) by analysing the tensions besieging randomised controlled trials (RCTs) as they encompass phenomena that challenge their capacity for universalisation, standardisation, and metrification. We bring together ethnographic work on technologies of healing and associated modes of knowing deployed in RCTs and psychedelic clinical trials, and ceremonial uses of the Amazonian herbal brew ayahuasca in urban Brazil. Building on a review of anthropological work on clinical trials, we argue that RCTs, even psychedelic ones, have been captured by the pharmaceutical industry in its quest to grow profits rather than reduce illness. Drawing on feminist and decolonial work, we question the use of technology as a category for thinking about health, recognising with la paperson (2017, p. 17) that as they mutate, they become 'technologies of alienation, separation, conversion of land into property and of people into targets of subjection'.We do not engage with anthropology of technology literature that distinguishes 'non-industrialised' indigenous practices from Euro-American ones as

How the context of reception affects the meaning of RCT evidence

“…There may be potential for generalisation to other specialities where there are distinct influential groups and approaches to the application of RCT results to clinical practice. Social science research on RCTs has examined the local construction of epistemological considerations such as efficacy, plausibility and placebo (Dumit and Sanabira, 2022;Lakoff, 2007;Wahlberg, 2008), and there are doubtless many factors which can contribute to the variations in these constructions. From the contribution of this paper, one factor among these which might explain systematic differences in interpretive frames of meaning is the concept proposed, situationally-specific habitus, which is associated with the routine work, contexts and collaborative networks of participants.…”

“…collections edited by Wahlberg and McGoey (2007), Will and Moreira (2010) and Brives et al (2016)). Researchers have problematised the presumed epistemological foundations of RCTs, such as the meanings of placebo (Lakoff, 2007), efficacy (Dumit and Sanabira, 2022) and the plausibility of mechanisms of pharmacological effect (Wahlberg, 2008). Furthermore, researchers have drawn attention to the contingencies of geographical contexts (Dumit and Sanabria, 2022), patient selection (Lakoff, 2007), regulative regimes (Abraham, 2007) and dissemination practices (Wahlberg, 2008;Will, 2010).…”

Minorities’ diminished psychedelic returns

“…While the clinical perspective views everyone through the same therapeutic lens whereby users can be positively manipulated to create unified positive outcomes (Dummit and Sanabria, 2022), the cultural position states that set and setting do not exist independently of culture (Hartogsohn, 2017). According to Hartogsohn (2016), the individual level where the psychedelic is consumed sits "atop of a more fundamental collective level, which frames and gives shape" to set and setting available to the (Hartogsohn, 2016: 2).…”

Psychedelics and workplace harm

“…And secondly, does employment status impact the effectiveness of psychedelics from a clinical perspective? The role of sociocultural conditions in shaping the set-and-setting of psychedelic experiences has been suggested as a crucial factor (27)(28)(29)(30)(31)(32)(33)(34). Setting refers to the physical and social environment where psychedelics are consumed.…”