What happened in this episode?
Clinical psychologist Richard Louis Miller returns to Third Wave’s podcast to argue that the psychedelic “renaissance” needs to confront adverse effects and patient-selection blind spots, not only potential benefits. He says pharmaceutical companies have historically obscured harms, and he frames his new book as a push for fuller disclosure so patients can make informed risk–reward decisions. Miller points to potential cardiovascular impacts at standard psychedelic doses — including elevated heart rate and blood pressure — and says those risks should matter for people with pre-existing heart issues.
He also stresses uncertainty for people with serious pre-existing psychiatric conditions, arguing that many trials exclude higher-risk participants and therefore leave gaps in evidence for groups such as those with schizophrenia, bipolar disorder, OCD, or borderline personality disorder. Miller distinguishes these questions from microdosing, which he portrays as having fewer adverse effects, while adding a personal account of the “paranoia” he felt when psychedelic use was illegal and threatened professional consequences.
The conversation turns to major pharma’s entry into the field, including Eli Lilly’s move into 5-MeO-DMT; Miller questions whether ultra-fast experiences are well-suited to psychotherapy and raises concerns about pricing and access. He suggests the current one-to-one guided model is expensive and argues group formats and peer-guiding may be more scalable. In the final section, Miller previews a forthcoming ageing book and criticises longevity “trends”, supplements, and commercialised wellness, advocating instead for exercise, real food, sleep, and social connection as long-term maintenance practices.
