The Heretical Dr. X

Mark Ehrman, a Los Angeles-based freelance writer, is a frequent contributor to the magazine.

A four-person panel convenes in a swank Los Feliz lounge in conjunction with the Silver Lake Film Festival. The topic: illicit substances in American culture. Sitting around the table are the kind of indie/alternative types one would associate with a festival such as this: an LA Weekly writer, a documentary filmmaker and the playwright who adapted the cult documentary "Reefer Madness" to the stage. They dress casually and make intimate references to drug use.

Not so the final participant. With a white shirt, dress slacks and his boyish face topped by graying hair, 52-year-old Charles Grob appears to be the odd man out. His tone and frame of reference are clinical. "Bumming out" is an "extreme negative reaction," for example, and an "epiphany" is "a positive transpersonal experience."

As director of the division of child and adolescent psychiatry at Harbor-UCLA Medical Center in Torrance, Grob (rhymes with "globe") oversees the clinic's patient load of some 450 children and adolescents a year, trains the psychiatry residents and fellows, and teaches in the medical school. His cred at this gathering derives from having been the first researcher to legally administer 3,4-methylenedioxymethamphetamine (MDMA) to human subjects since the drug, also known as Ecstasy or X, was outlawed in 1986. He also has been a vocal critic of research sponsored by the National Institute on Drug Abuse on the dangers of Ecstasy and a proponent of the idea that certain hallucinogens may--for the right patients and under the right conditions--be good medicine. He recently edited a book called "Hallucinogens: A Reader," a collection of essays and articles (written primarily by doctors and academics, including many by Grob himself) that emphasizes the benevolent aspects of the psychedelic experience.

Grob sets the tone for 30 minutes of discourse on the wrongheadedness of the U.S. government's war on drugs and how the objectivity of science has been polluted in the name of politics. Unfortunately, the event's organizers botch the planning and not a single member of the public shows up. "Just one of those things," says Grob, who has driven from his Irvine home.

Perhaps he is able to shrug it off so easily because the experience is a familiar one. This isn't the first time he's found that nobody is listening.

Ever since Galileo argued that earth orbits the sun, scientists have run afoul of prevailing political realities. Grob also sees himself swimming against a powerful tide. "In the 1950s and '60s, hallucinogenic treatment was thought to be the cutting edge of psychiatry," he says. "There was great promise that we had potential treatments, even for alcoholism and drug abuse, that did not respond well to conventional therapies. But the problem is that these treatment models have been entirely ignored for [nearly] 30 years."

During the late 1970s, a new therapeutic tool made the rounds of West Coast psychotherapists. At first it was called ADAM, then Empathy because of its tendency to create that ability in its user. Bootleggers cast about for something catchier. They called their product Ecstasy, which, according to Grob and others, is less disorienting than LSD, mescaline (found in peyote) or psilocybin (the active ingredient in hallucinogenic mushrooms). At the time it also was legal.

"What MDMA does psychologically is remove the fear of a perceived emotional threat," says clinical psychiatrist George Greer, an early proponent of its psychotherapeutic use.

As a public-health professional, Grob believed it would be unconscionable not to revive the investigation into the potential benefits of hallucinogenic drugs. He asked for and received government approval to study MDMA's effects on humans in the early 1990s. That limited initial study preceded by several years the rise of all-night raves, where teenagers and young adults often use the drug. At about the same time, studies sponsored by the drug abuse institute warned that Ecstasy causes brain damage. The wind had shifted, and Grob couldn't get approval for further studies.

Grob has complained that the government studies were "seriously flawed," and in March 2001 he told the U.S. Sentencing Commission on MDMA that the tests were "an egregious example of the politicization of science, which not only clouds our understanding of the effects of MDMA, but also undermines the credibility and integrity of the scientific process." Last year he publicly criticized research funded by the drug abuse institute claiming that a common recreational dose of Ecstasy can cause permanent brain damage and linking the drug to an increased risk of Parkinson's disease.

He continues to push an agenda that puts him squarely on the other side of the U.S. government's zero-tolerance line, believing that Ecstasy can help curb compulsive behavior in alcoholics and ease anxieties in post-traumatic stress disorder sufferers and end-stage cancer patients.

Grob wages his lonely battle from a Harbor-UCLA office in a spread of World War II-era barracks adjacent to the hospital. He works amid the clutter of photocopied research papers, psychiatric journals and books in what little time a teacher and administrator in the budget-challenged county health system has to spare. Milton Miller, chairman of the Department of Psychiatry at Harbor-UCLA, calls Grob "one of our most appreciated teachers" and says he has no problem with the subjects Grob chooses to study because "the tradition of university is you look for what's true."

While Grob's efforts bring to mind an obvious comparison to the late Harvard psychologist and outspoken '60s-era LSD guru Timothy Leary, in many ways Grob is the anti-Leary. He does not advocate recreational drug use, and whenever he makes any reference to administering hallucinogens, he often follows it with some variation of, "Of course, under sanctioned medical conditions.

"As a psychiatrist, I'm always talking about the dangers of Ecstasy," Grob says, noting that half of the Ecstasy tested in clubs contains substances other than MDMA. Even pure MDMA is problematic. One of the more serious effects is hyperthermia, a rapid and possibly fatal rise in body temperature that makes a crowded rave the worst place to take it.

"I've consulted on several fatalities from Ecstasy use, including a couple of kids who had fatal cardiac arrhythmias," says Grob. But he also believes that scaring kids with bad information is less effective than knowing facts and telling the truth, something he says he practices both as a psychiatrist and as a parent of a 16-year-old daughter.

Grob believes that Leary and other recreational users ultimately hurt the cause by inciting reckless drug use. That led to casualties and, Grob feels, an escalation of the war on drugs. "Leary was a very impressive intellect," says Grob, adding that Leary, in interviews near the end of his life, "acknowledged the unfortunate role he had in the demise of hallucinogen research."

Unlike Leary, Grob's public profile barely registers. He doesn't issue press releases or maintain a Web site. "I'm more into speaking to physicians, mental health professionals and policymakers," he says. "I'm very conservative, to the point of being boring." In the three-bedroom Irvine house where Grob lives with his wife and daughter, there is a drawing of Jerry Garcia on an office wall. Grob says his wife, Anne, gave it to him as a joke.

There's no shortage of people who find the idea of testing Ecstasy for its potential benefits too radical. Alan Leshner, the drug abuse institute's director between 1994 and 2001 and currently CEO of the American Assn. for the Advancement of Science, says that the risks of MDMA are well-documented. Using it, he says, "is like playing Russian roulette with your brain."

Leshner asks for proof that any hallucinogen has beneficial uses, saying that clinical reports in which alcoholics, end-stage cancer patients and post-traumatic stress disorder victims claim their conditions improved after using MDMA do not constitute a proper study. A sign in his office reads: "The plural of anecdote is not evidence."

The institute supports 85% of all research into the health aspects of drug abuse and addiction, and the researcher who has earned much of its largess is Johns Hopkins University associate professor of neurology George Ricaurte. His studies form the scientific justification of the institute's multimillion-dollar public-service campaign against the drug.

Grob, by contrast, finds himself allied with alternative types such as those who appeared with him at the Silver Lake Film Festival and drug liberalization activists of all stripes. His closest affiliation is with a psychedelic research community of a few dozen prominent figures who do the bulk of the testifying, researching and critiquing. Most of them are inspired by the work of a Czech scientist named Stanislav Grof.

In the late '50s and '60s, Grof studied LSD's effects on anxiety and depression among terminal cancer patients, breaking new ground in neurology. As with Albert Hofmann, who in 1943 first discovered the properties of LSD by accidentally inhaling its vapors and then intentionally dosing himself, Grof and many of those who followed him also have conducted their most extensive "experiments" on themselves. Those include a chemist named Alexander Shulgin, who is the first person to ingest MDMA and report his finding in a scientific journal, and Greer, the early proponent of MDMA psychotherapy and currently the medical director of Heffter Research Institute, a Santa Fe, N.M., organization that Grob co-founded. It consists of scientists and mental-health professionals who are dedicated to raising funds and promoting scholarly research into hallucinogenic drugs.

Another big player is Rick Doblin, president and founder of the Multidisciplinary Assn. for Psychedelic Studies. Doblin spent seven years in the 1970s conducting a personal investigation of hallucinogens. He says that the association began as a research organization but has evolved into a "nonprofit psychedelic and medical marijuana pharmaceutical company" that engages in activism. It also hopes to develop a line of psychedelic drugs for psychiatric uses. The association helped fund Grob's 1992 MDMA study.

Grob seems sensitive about questions concerning his personal experiences, insisting his views about helpful hallucinogens came from scholarly journals. "Don't call me a hippie," he says with rare irritation, after revealing that his Oberlin College years between 1968 and 1971 included antiwar protests. He dropped out in 1971 for medical reasons and worked on a kibbutz.

"He was very clean-cut in those days," recalls Stanley Krippner, for whom Grob was a research assistant during a 1972 dream research project at Maimonides Medical Center in Brooklyn, N.Y. But, he adds, "It was deceptive. He was certainly a free thinker." It was during that period that Grob availed himself of Kripp- ner's library and first discovered Grof's research.

"I told my father this is what I wanted to do with my life," Grob says. "He said, 'Unless you have credentials, nobody will listen to you.' "

Having credentials is no guarantee either. Grob eventually finished his undergraduate degree at Columbia University, then enrolled in Downstate Medical School in Brooklyn. In 1975, he presented a report on Grof's LSD research to his class, hoping to stimulate a discussion. "There was complete silence," he recalls. But he persevered, increasingly concerned about the lack of new research into the therapeutic potential of hallucinogens.

He received his medical degree in 1979, completed his child psychiatry fellowship and then began teaching at Johns Hopkins University Hospital in 1984. But nearly two decades later, Grob still feels like he's waiting to be heard.

The main reason is that by the early 1980s, MDMA was turning up in clubs in Los Angeles, San Francisco and, particularly, Austin, Texas. In 1984, as Grob began practicing psychiatry, then-Texas Sen. Lloyd Bentsen asked the federal Drug Enforcement Administration to criminalize MDMA. The following year, the agency declared the drug illegal on a temporary basis as hearings began. In 1986, despite a judge's recommendation that MDMA be allowed for medical applications, the DEA lumped MDMA with other hallucinogens--as well as heroin, cocaine and methamphetamine--on the Schedule 1 list: against the law, no medical applications.

Doblin, who had returned to Harvard and earned his doctorate in public policy, knew his way around the federal bureaucracy. The best tactic for reversing that decision, he decided, was "medicalization"--getting the Food and Drug Administration to approve MDMA as an experimental drug. To do that, he needed someone with a university affiliation who knew how to put together a proper research proposal and run a study. So in 1990 he formed what he calls "the most important and best partnership" in the association's history after meeting a very earnest psychiatry professor named Charles Grob, who was teaching and practicing at UC Irvine.

By 1992 the FDA had accepted the argument that hallucinogens represented no greater safety threat than pharmaceuticals that were already being tested. Although Grob's proposal called for studying MDMA's effects on existential anxiety in dying cancer patients (the group with the most to gain and the least to lose with untried medications), the agency first demanded a "Phase 1 Safety Study," in which healthy subjects are given varying doses of MDMA to gauge fluctuations in blood pressure and heart rate. In March 1994, shortly after Grob moved to Harbor-UCLA, he gave the first FDA-sanctioned doses of MDMA to 18 volunteers.

Coincidentally, 1992 also marked the beginning of the nation's largest spike in illegal recreational use of Ecstasy. Its use rose 500% between 1993 and 1998, according to the DEA. By the end of the millennium, the drug abuse institute says that the drug had been tried at least once by 11% of all high school seniors in this country and was used most heavily by 18- to 25-year-olds, with an estimated 1.4 million young adults using the drug regularly. Politicians, parents and public-health officials were alarmed, and the FDA wouldn't approve Grob's follow-up studies. "The drumbeat of neurotoxicity" was intensifying outside the scientific community, says Doblin.

There were personality issues too. Doblin favored activism; Grob simply wanted to do science. With mounting responsibilities at Harbor-UCLA, Grob abandoned MDMA research in favor of less-controversial substances while still lending his good name to Doblin's campaign. In late 1993, he traveled to Brazil to research ayahuasca, a plant preparation used in religious ceremonies in the Amazon, and which Grob believes can help ease addictions such as alcoholism. He recently received FDA approval to study how psilocybin, the active ingredient in hallucinogenic mushrooms, can help ease symptoms of existential anxiety in terminal cancer patients. Neither of those substances, he says, "come with the controversial baggage of MDMA."

Doblin continued to push for follow-up MDMA studies. In 2001, his association teamed with husband-and-wife researchers Michael and Annie Mithoefer in South Carolina, who had received FDA approval to test Ecstasy's effect on people diagnosed with post-traumatic stress disorder, raising the possibility of the first federally approved MDMA trials since Grob's 1994 study.

For more than two decades, George Ricaurte's career has been spent showing how and why amphetamines (MDMA and methamphetamine in particular) are bad for your brain. Indeed, Ricaurte's brain imaging scan of monkeys on Ecstasy--a splotchy multicolored image indicating where the damaged cells are--has been reproduced on postcards by the drug abuse institute for its nationwide campaign against club drugs. Ricaurte's studies at Johns Hopkins rely on animals and on humans who have admitted to recreational Ecstasy use, but Grob criticizes how Ricaurte conducted his "flawed and misleading" studies going back to 1989. Grob also vigorously challenges Ricaurte's definition in a 2002 study of a "common recreational dose," which Grob believes is more toxic than any recreational user would ingest.

Ricaurte, who for several months did not respond to The Times' inquiries about Grob's specific charges, says he is only vaguely aware of Grob's persistent criticism during the past decade and also wary about discussing the issue with the media. "There are a certain number of complexities, but reporters don't seem to like the 'ifs'--and those are the qualifications that are critical to make," he says. Of Grob's specific criticisms, he asks: "What is the point in raising questions about these old studies when they have been supported by subsequent studies? The one thing that has been observed repeatedly in at least six different, independent studies . . . is some form of memory impairment" in MDMA users. Ricaurte says his conclusions are sound and that the drug's impact on human brains likely would be similar to its impact on monkey brains--a conclusion that Grob also challenges.

The turnout is more robust at Grob's next speaking engagement. About 400 people, mostly college students, have come from all over the country to the Anaheim Hilton for a dual convention by Students for Sensible Drug Policy and the Marijuana Policy Project. The keynote speaker is former U.S. Surgeon Gen. Jocelyn Elders. Grob has brought his daughter, Stephanie, and takes her around like a dad at a carnival--at one point buying her a shirt made from hemp fibers.

Stephanie can recite her father's criticism of the Ricaurte neurotoxicity data. She insists that she has no interest in going to a rave and taking MDMA, and has never tried pot. Dob- lin, who like Grob is scheduled to appear on a panel, needles Stephanie about trying Ecstasy. Grob gets irritated, tolerating Doblin's zeal as one might tolerate a goofy uncle.

The attendees are articulate, committed and polite--"a nice bunch of kids," Grob says. The biggest applause goes to a panelist who informs the group of a specific chemical transmitter in the brain that's sensitive to the active ingredient in marijuana, proving, he says, that "God programmed us to get stoned."

Meanwhile, the wrangling continues among MDMA adversaries. Another Johns Hopkins academic recently expressed concern about the drug's dangers to the safety board looking into Doblin's post-traumatic stress disorder study, causing the board to withhold approval. (The questions came from Una McCann, an associate professor of psychiatry who is married to Ricaurte.) "Rick's a bit too outspoken and he might have shot himself in the foot," says Grob.

A recent study by two Parkinson's disease experts at the University of Manchester in England suggested that MDMA can have positive effects on Parkinson's sufferers. The British study showed that MDMA reduced the uncontrollable movement of the arms and legs of nonhuman primates exhibiting side effects from a traditional Parkinson's treatment.

That study contrasts with the Ricaurte study that claimed MDMA damaged monkey's brains in some of the same ways that Parkinson's does. The inspiration for the British study came from an anecdotal case history, and Grob claims that reinforces his argument that anecdotal evidence should at least be considered in decisions about whether to pursue more rigorous scientific analysis.

Grob says he's making progress, pointing out that the mainstream media are paying more attention to both sides of the MDMA issue. Many are even quoting him. Although they're quoting Ricaurte six times as often, Grob says, "it's better than six to nothing, because that's how it used to be."

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Researcher Rachel Uslan contributed to this story.

For The Record Los Angeles Times Thursday March 06, 2003 Home Edition Main News Part A Page 2 National Desk 1 inches; 41 words Type of Material: Correction Surgeon general's name -- In a Los Angeles Times Magazine article on Harbor-UCLA psychiatrist Charles Grob ("The Heretical Dr. X," March 2), the first name of former U.S. Surgeon Gen. Joycelyn Elders was misspelled as Jocelyn. For The Record Los Angeles Times Sunday March 23, 2003 Home Edition Los Angeles Times Magazine Part I Page 6 Metro Desk 0 inches; 28 words Type of Material: Correction In the article on Harbor-UCLA psychiatrist Charles Grob ("The Heretical Dr. X," March 2), the first name of former U.S. Surgeon Gen. Joycelyn Elders was misspelled as Jocelyn.
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