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I've noticed the skeptics here like to raise this argument on every article related to psychedelic research. As if they've found a gaping hole that somehow casts "doubts" on the methodology of decades worth of clinical trials.

Unfortunately this line of thinking doesn't hold up to scrutiny, and completely misses the forest for the trees. Mainly because the only implied alternative is to not blind subjects at all! How exactly would that reduce bias or otherwise improve the clinical trial design...?

> I imagine people guess correctly >90% of the time.

Yes in some cases you're right. Here's a paper from last year that does exactly what you asked [0]. They note that "Placebo could be distinguished well from active substance and correctly identified in 96% of the sessions." The placebos were ethanol and mannitol, for LSD and Psilocybin respectively.

The important takeaway is that subjects still had to guess. They didn't know their group assignment with certainty. And that is key to reducing bias.

I'd really like to see someone articulate a coherent alternative to subject blinding in psychedelic research.

[0] https://www.nature.com/articles/s41386-022-01297-2

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Yours is my favorite comment, and this type of thinking is why I bother to raise this question from time to time. I don't think this invalidates the entire line of research, but I do think it's less than fully transparent to present psychedelic research as if it were double-blind. I imagine the guess rate for a drug like atorvastatin (Liptor) is much closer to 50%. This false double-blind isn't unique to psychedelic research either. I think it's a wider fault of medical science to treat double-blind as a ritualistic silver bullet that controls for placebo instead of considering if it's applicable to all experiment designs.

Here are two ideas that I think are better than subject blinding for psychedelic research. I think the first one is the preferred method, but I think the second option is still better than using a placebo group or active placebo group.

* Have one group receive an established treatment and another group receive the psychedelic treatment. For psychedelic assisted therapy the comparison could be traditional therapies. I'm sure there are methods in the literature that promote increased creativity in subjects that could be used for this study.

* Double the treatment group. If you don't need to divide the subjects into multiple groups then you can put more subjects into the treatment group.