EPISODE 433

An Approach to Psychedelic Therapy Inspired by Indigenous Traditions - Dr. Jeeshan Chowdhury, Founder and CEO of Journey Colab

11-21-2023

Subscribe

Download

Transcript

Shiv Gaglani: Hi, I'm Shiv Gaglani, welcoming you to Raise the Line with Osmosis from Elsevier, an ongoing exploration about how to improve health and healthcare. 

 

Our in-depth look at the potential use of psychedelic compounds in mental health treatment continues today with a focus on the role they may play in helping people overcome substance use disorders. My guest is Dr. Jeeshan Chowdhury, whose own mental health journey led him to found Journey Colab in partnership with OpenAI CEO, Sam Altman. Journey Colab's mission is to combat addiction through psychedelic care, employing a unique stakeholder model that includes Indigenous communities in ownership. 

 

Dr. Chowdhury has been a creative force in the health space for many years, co-founding several organizations, including Hacking Health, a nonprofit that facilitates collaboration between frontline clinicians and tech experts. He has won numerous national research awards, edited two medical exam preparation textbooks, and participated in a life sciences research project at the NASA Astrobiology Academy that will ultimately be carried out in space. 

 

Dr. Chowdhury is an MD and doctor of philosophy who studied at Oxford as a Rhodes Scholar and has continued his educational pursuits at the California Institute for Integral Studies Center for Psychedelic Therapies and Research. I had the opportunity to first meet him at the Psychedelic Science Conference in June in Denver. I've been looking forward to this conversation. So welcome to the podcast, Jeeshan.

 

Dr. Jeeshan Chowdhury: Thanks for having me, Shiv.

 

Shiv: So, you obviously have a super impressive background, one that I think many of our audience can aspire to being mostly medical students or healthcare professional students or providers. Can you, in your own words, give us your background? What got you interested in pursuing a career in medicine and then ultimately technology?

 

Dr. Chowdhury: There are a couple of input inputs into that. I always was a very nerdy kid growing up, very into my biology classes, my science classes. I was also a very bullied kid. I was not one that was good on the sports field. I was typically like first in class, last in the playground and on the pitch and so those forces combined really to push me towards becoming very academically oriented. Like many people in medicine, I come from an immigrant family where the push for a secure profession, a stable profession, was a strong influence as well, and I always thought I would be a scientist. 

 

I guess what came together was this passion for biology, this push to come into a stable profession and then being very much a people person. Even though I was very bullied growing up, I didn't want to talk to test tubes my whole life. That that drove me to medicine as like a stable base to be able to explore more and I was very fortunate as I got into medicine, I was able to see other areas outside of just clinical medicine. I did an internship at the NASA Academy that you mentioned that opened my eyes to the applications outside of just clinical medicine. That's what pushed me to do a PhD. I was very fortunate to get a Rhodes Scholarship, as you mentioned, and got to see more. 

 

So, I just went from this very directed base of medicine and then started pushing out from there. I'm very grateful to have done medical training. I ultimately did not pursue clinical practice, but it was a base for me to then push the envelope of my life.

 

Shiv: Yeah, absolutely. Very relatable as well. I’m an immigrant myself and we know the drill about a stable profession. Education is certainly how our parents got to the US, or most likely, and so education is what will help us and many of our listeners have that stable base. So, you push into all these different areas. 

 

Can you tell us a bit about your time at Oxford? Like, what did you do your DPhil in and what were some seminal experiences you had that ultimately got you into what you're doing now, which is psychedelics and mental health?

 

Dr. Chowdhury: Yeah, I mean, I actually got to Oxford with a plan to work in a research lab -- like to be on the bench wearing a white coat -- and very quickly realized that that did not fit my personality. I made so many mistakes in pipetting and what I really enjoyed was the human interaction, the questions around science. 

 

The other thing that was really frustrating was -- and I think things are accelerating -- but from bench to bedside was just so much time, and so it was out of an impatience and wanting to interact more on the front line that I moved eventually from wet work to hardware to software because the cycles were just much faster. So, by working in technology broadly, but then moving more into the digital space, I was able to get closer to implementation, closer to seeing how it actually affected practice and that's why I got into informatics, which then led me to then going into Y Combinator to launch my first company. It was taking the experience I had around how like studying how this technology and the flow of information affect medicine to then thinking, “OK, well, there's a lot of broken spots here.” 

 

My journey to Y Combinator was very much through my personal experience. I was on my rotations and I had my paper list ready for the weekend. I remember this really well. Actually, I went down to get a coffee to prepare for the weekend, went back upstairs to the call room and I couldn't find my list. And I'm like, I am totally screwed this weekend because I had the perfect list with all the notes, what to do, and it was all gone. I'm like, I can't find this in the chart because this is not how we work...it is not captured in the system of record. That was the nucleus for my first company, Listrunner, which essentially was just a handoff application. It was very much based on that experience and what I had learned in my Ph.D. around informatics.

 

Shiv: Wow, that's awesome and obviously, again, relatable because that's one of the reasons I've returned to med school myself. I wrote a Forbes article about this and give a talk about what I call the “two F” framework, where one of the F's is fear. It kind of sucks to go from running a company to being bottom of the totem pole, a student being told what to do all the time and doing scut work. But that fear is what leads to growth. The other one is frustration, right? When you are frustrated by that experience that you just shared or by how inefficient lectures are in med schools or a whole host of a million things to get frustrated about, rather than just being mad or frustrated, you know, if it's a compelling enough and recurring frustration that can turn into an opportunity then you can innovate as you did with Listrunner. 

 

So, maybe walk us through that company, how did it go, how was the Y Combinator experience and then what eventually led to you starting Journey Colab? I would love the origin story of the new venture.

 

Dr. Chowdhury: Sure. Yeah. I finished my graduate training at Oxford, come back to internship or clerkship, as we call it in Canada, had that experience of, ‘Hey, there's a lot of things broken here. We're doing a lot of things inefficiently.’ Our first logo at Listrunner was actually “Don't be a scut monkey,” which only spoke to residents and interns but like, people got it. What was important for me is l was trying it out. I met a co-founder through Hacking Healthcare, where we were doing hackathons in hospitals. We were getting some traction, raised a little bit of money from some physicians who wanted to do angel investing. But YC was very important in my journey because I had spent, at that point, twelve years in my training, had gotten into residency and I needed some external validation to be able to step outside of that. 

 

But more importantly -- and I think those who come from an immigrant perspective will understand this -- I needed some validation for my family. The idea of saying I'm going to step out of residency and take this risk was challenging enough. But actually being able to say we got into YC, we have some seed funding that's real, but more importantly, there's this validation and my brother, who's an ICU and ENT doc, was actually able to convince my parents, very classic immigrant parents, like, no, this is actually a real thing to be able to do it was crucial for me.

 

A lot of people talk about accelerators in terms of what's the value? You can do it on your own. You certainly can. But for me, in my family situation, in my personal history, that external validation was really important to be able to go through. And it was certainly helpful. Despite all my training, I hadn't done an MBA and I had never run a business before. It was like this boot camp. I remember one of the first things that they did at YC in a couple of weeks was running a pipeline. I'm like, “I'm not an oil and gas company.” No, it's like a sales pipeline...very simple things that most people would understand but that like I was able to take my medical training, my PhD training and actually apply it into the real world.

 

Another thing that I remember from YC that was really critical is that Paul Graham was still involved at the time and he came in to do just one talk and he was like, “You know, a lot of you have been very successful in school because you know how to follow an assignment, or have been successful in the company because you know how to placate your boss or look good to your manager. But in a startup, there's none of that. There's no faking it there.” It's you in the market. It's like, that raw. Do you have something that people want enough that they will buy it from you enough that they will give you your time? 

 

I actually got super scared in that moment because I'm like, wait a minute...everything I've done so far has been convincing somebody at a proxy level that, ‘Hey, I have something of value to contribute.” Now I really have to do it and so that shift was just massive for me and I think it was a very big part of my journey.

 

Eventually, we did get acquired, spent some time in the acquiring company, and then if you transition to the question of how I got to psychedelics, it was very much my own personal mental health journey. Many people listening can relate to this, if they're in medical school...I had been chasing achievement to fill a personal gap in myself, and I think that happens to a lot of us especially that have an immigrant experience or an outsider experience. We seek after these external validations and I did a lot of that in med school. I did Oxford. I did YC. 

 

But the surprising thing was that it was after I sold my first company and I achieved the safety and security that I had been struggling for my whole life that I got to this crisis point. I should say, you know, I'd struggled with my mental health. I tried what we had available, from antidepressants to talk therapy. Those things do work. They don't work as well as I think they could for a lot of people. Wellbutrin actually got me through the last two years of medical school. But it always just felt like I was drowning in my mental health and the Wellbutrin or the coach or the therapist or whatever was like someone threw me a life preserver and I could hold my head and keep it above water. 

 

But it was something about selling my company that I got to this point of desperation where even though I got the safety and security I wanted, I still had this feeling of drowning and wanting to let go. Quite frankly, I got to this very desperate part of my life which was what gave me the, I guess, courage or bravery to try something new. Fortunately, I was able to meet a safe psychedelic therapist because I've been in San Francisco and there are people who are not only just trained clinicians, but have done additional training on top of that, as well as people who --and I didn't know this at the time -- had spent some time learning from traditional and Indigenous communities about how these medicines have been used, because while they're new to us, they're not new to humanity. 

 

That’s all to say I found somebody safe and the way I like to describe it is that in that psychedelic state of consciousness, in that safe, therapeutic clinical container, for the first time in my life, the muddy waters I had been drowning in cleared up and I could see what was holding me down. It was from, you know, the experience of being bullied, the experience of internalizing racism and the experience of growing up in a very homophobic time and place and for the first time, knowing myself and accepting myself and getting a glimpse of that. And it wasn't done after that. It was just like, ‘here's the path to how you accept and know yourself and that changed my life completely. 

 

Like many people, I asked the question, “Well, why is this not more available?” I started doing more research into it. That's how I got reconnected with Sam, who's asking some similar questions. At the time he was still president of YC and running this group called YC Research that was looking into psychedelics and he very quickly was just like, ‘Jeeshan, you should start a company in the space. I'll write you a check.” And I'm like, “Sam, I'm a brown immigrant in America. The war on drugs looks at me very differently than it looks at other people.” I quite frankly talk about fear. I was scared of starting a psychedelic company. I know it's all the rage now. I'm just like, “I don't know if this is the right fit for me. If things go wrong, I know who they will go after first -- someone who looks like me.”

 

But the more I spent time in it, I was convinced that from the perspective of a physician, from a scientist, from the perspective of an entrepreneur, this needs to happen and I was very fortunate that Sam believed in me even before I believed in myself. The moment I was ready to make that switch happened at the start of the pandemic, where many people were asking the question, what am I doing with my life? I did that. Sam wrote me a check that day and we got started.

 

Shiv: Wow, that's incredible background. There's so much to unpack in that response. I fully agree with you about the validation and the whole journey, and I think what a lot of our audience will relate to is trying to fill that gap in themselves from whatever -- they may be aware of the cause or they may not -- by chasing these external benchmarks. 

 

The founding story of Journey Colab is fantastic and thank you for being so open and vulnerable about your own mental health journey, because I think part of the movement is trying to validate and normalize the vulnerability. Obviously, people like Brene Brown have done a great job of turning vulnerability to strength and it informs your own very successful career. But I think it's important for us to talk openly about this. My hope in bringing all this psychedelic coverage to our audience is I think a lot of people in our audience could benefit from similar things, whether or not they have a clinical diagnosis. I think when we met, we were at the same event with David Yaden, who was on our podcast, and David is the Roland Griffiths Professor at Hopkins. A lot of his research endeavors are about human flourishing and creativity and whatnot. 

 

So, let's go into Journey Colab. Sam writes you a check, you start building it. What are you building? What's the scale of the organization? And I also mentioned in the introduction that it's a unique stakeholder model, including Indigenous communities in ownership. So, maybe you can dive into that as well. 

 

Dr. Chowdhury: Yeah, I mean, a lot to unpack there. Like with many startups, I think the important thing is that it's nimble and it's able to find its way. In my first company, we were going to office hours with Sam, and I'm like, ‘Hey, we've got this initial traction, but we've hit some roadblocks. We're not converting to enterprise contracts. We get a max growth of around a couple dozen users and then we stop.  We were very frustrated and I remember looking at him being like, you know, what do we do? And he's like, you can give up. I was like, if you want to keep doing it, he was very kind of blunt about it. And even though it's almost ten years ago, I remember it very clearly. He was just kind of looking like, well, you can either stop or you keep experimenting and try and figure out what will work. He's like, “Other than Instagram, I can't think of a single startup that hit it on the nail with their first idea.”

 

I think for a lot of people in medicine where it's like this very defined path to go through -- you do your MCATs and then you go through your preclinical and it's very clear -- taking this uncertain path and being able to fail is really, really hard. I think it discourages a lot of otherwise very smart and creative people in medicine to try something, because without that defined path, it is very tough. 

 

So, at Journey, we started off looking at a couple of things. We knew that addiction would be the place that we wanted to work because it was under underserved. We wanted to do the company in a different way through this stakeholder model. This was just around the time that OpenAI had moved from a nonprofit to a cap profit, so we were able to work with Brad Lightcap, the CFO there, looking at different type of models and this was super important for me to what I was saying earlier about being afraid to work in psychedelics, because I didn't want to end up like what we have seen repeatedly over and over again when you take a very powerful psychoactive substance and apply traditional corporate and governance models.

 

We saw that with the opioid crisis and just the aftermath of that. There's more recent coverage of that around stimulants and these startups that end up becoming pill mills. We could have probably made a lot of money in the short term by being a pill mill, but I just didn't want to do that, which is one of the reasons we stayed out of ketamine very early, despite the opposition of a lot of people saying, “Hey, you could make a short-term buck here.”

 

So, that's why the stakeholder model is really important. We have put 10% of the founding equity of the company into an irrevocable purpose trust so that the land, the traditions and the people that our medicines and our work are inspired from can benefit from it. This is different than saying what a lot of organizations do, which is we'll donate like 1% of our profits or 10% of profits. Like, that's impossible to account for. Our founding shares -- the same shares that I have -- are in this trust. We can't take them back. Future investors can't take them back. It's fixed there and eventually you want that to be led by stakeholders, including from Indigenous communities, so that they can benefit. We're all aligned in growing the shares in value in a way that is sustainable. 

 

That's made a big difference for us, and that's led us to where we are today in addiction, which is focusing with another stakeholder, which is rehab centers where the majority of people go for care for addiction. It's a mixed industry, like many, but there are very poor outcomes, unfortunately. But when we think about what is needed for psychedelic care -- and I think a number of your other guests talked about this -- is that it's not just the experience, unfortunately. If it was, everybody who went to a festival who took a high dose would come back cured or come back with durable results. But we see it's only transient when it's in that setting. There’s a lot of talk about set and setting, but what we're really talking about is a program where we integrate this into care, where we meet patients where they are. 

 

Where Journey is today is working with rehab center partners to integrate psychedelic care with them initially through clinical trials within an intent to create an integrated treatment program. So, this is one tool that is available where patients are today.

 

Shiv: Wow, that's fantastic. I mean, I really love the focus on the stakeholders and aligning incentives. So, what are some of the wins you've had so far? How big is the company? And what do you see as kind of the next three to five years? How would that play out in your ideal world?

 

Dr. Chowdhury: Yeah. I'll say one thing...when you talk about having different stakeholders, there's a lot of reasons to do it. It's the right thing to do, but it's also practically the right way to build a product and service that's going to actually work and reach as many people as possible. The lean startup refrain is talk to your customers, gather your room, and it just becomes this slogan. But I think particularly what Silicon Valley and YC does well is getting close to your user, understanding who they are, and we're doing that through the stakeholder model. As a founder in psychedelics, I would be negligent in not talking to the people who are the only ones who have mastered this technology at scale, which are traditional communities that are only ones who have successfully integrated it. 

 

When we look at their use, it is always done in the context of an expert healer, what we would call a shaman -- someone who has a lot of training -- and it's done as part of a very well-honed protocol or program, what was otherwise called a ceremony and always done in the context of a larger community. So, that informs how we look at psychedelics. I actually look at psychedelics, not as even assisted therapy, but as an interventional psychiatric procedure, and just like you’d have with a surgery, you have pre, intra and post-operative care. We bring the same rigor to treating our population in recovery with what's called preparation, the journey or the integration. That's part of a larger program. That's why we work with rehab centers. So, that's where we are today. 

 

One of our big wins has been...well, I say it's a big win, but it's been kind of controversial not to say, “Hey, we're going to eliminate the therapy. We're going to go for shorter type of experiences.” Like, the reductionist view in psychedelics has come fast and quick and is the predominant one. But we have stayed in this more integrative view of psychedelics where the experience matters, timing that experience matters, that all the wraparound care is vital to it. You can't distill it away and we need to work with stakeholders to make that actually practically effective. 

 

So, one of our big wins has been working with a group called All Points North in Colorado. They’re a leading addiction treatment center. We will be for the first time since I think Henry Osmond in the 1950s in Weyburn in Saskatchewan -- close to where I was born and raised -- bringing psychedelic treatment and clinical research into a rehab setting. We'll be launching our first clinical trial with MDMA and psilocybin in the coming year for alcohol use disorder and this will be the first time to actually show that we can integrate this treatment to where patients are today and expand that model to the many other treatment centers where patients are currently, and show that there's a new model to be able to bring this care. Rather than trying to build centers from the ground up, we can work with incumbents.

 

I think this is where your listeners can provide a lot of value in that in a lot of Silicon Valley approaches, it's about building something new. It's about taking people out. But this is where doctors and institutions can make such a big difference because, you know, for good or bad, it's hard to take out the incumbent. You need to be where patients are today. You need to be where providers are today and this is where you could go start a startup, but you could also work with a startup, too. You could be like, ‘Hey, I'm going to be the innovative one inside the system that's going to partner with a startup and bring it in.’

 

So, there's these multiple paths. But I think where clinicians and providers and centers have a really important part to play as stakeholders is that, you know, it's such an entrenched system that without having this being part of it, the innovation is going to be slower. It's not going to happen, and so there's a vital role for us to be involved.

 

Shiv: Yeah, that's definitely a common theme on this podcast, too. The companies that wind up succeeding and achieve distribution, very rarely do you go from zero to one and create a whole new model, like an Uber or Airbnb. In those models, you're bucking regulation and have great outcomes. But in healthcare, I think most health care systems would not be as supportive of that kind of thing, because, again, the risk is so high. These are patients’ lives. 

 

Dr. Chowdhury: Yeah, I mean, the annoying thing when I first got to Silicon Valley almost ten years ago now was everyone was like, “We want to eliminate doctors. We want to eliminate the nurse.” I'm like, why? Why would you want to do that? I understand that there's costs there. It's expensive. But I think the companies that have been most successful have not been the ones who have tried to say, okay, we're gonna try to replace the doctor with an automated system or, you know, something else. It's the ones that said, these people are vital to what we're trying to do. They're a trusted source. They have expertise, obviously. We're going to augment them. We're going to make them more efficient. We're going to make them be able to reach more people. Like, Augmedix is a great example of that. This is where they started with Google Glass as a virtual scribe, then moved to other tools with AI. But they never said, ‘Hey, we're going to eliminate the doctor.’ They're like, ‘We want to work with doctors.’ 

 

I think that's a crucial point here in the innovation cycle in healthcare is that doctors, medical students, residents...the new technologies that are coming out need us to be able to distribute and get out, and that's a vital role that we can play.

 

Shiv: Totally. Yeah, that's great. You preempted some advice as well. But speaking of new technologies, when we spoke a couple months ago, we talked a little bit about AI, which has obviously captured the public's attention. You know it well with Sam on your board at OpenAI and even referencing the CFO at OpenAI helping you build your financial model.

 

What is your view right now on how AI could be useful to what you're building at Journey Colab or in general healthcare?

 

Dr. Chowdhury: So, going back to what I was saying, there's a lot of talk about creating an AI therapist. I'm not sure how useful that's going to be. Perhaps I'm biased in that I think the human connection really matters, but I think that we can use tools to augment those therapists. One thing is about adherence to training modules and ensuring people have the right supervision. You could very easily imagine with the patient's consent that there's an agent that is listening in on the conversation and giving the therapist real time feedback about adhering to the therapy manual or giving them supervision in real time. Or, say, if there's a journal or some support being provided to the patient, like summarizing all that. 

 

You know, a therapist can't read all the journals of their patients, but they could certainly get a summary or and have patients flagged that are having suicide ideation or going down. I think those type of augmenting tools are really interesting, particularly around supporting therapists, making therapists more effective, being able to give them a more personalized touch to a wider set of patients. That's what I'm really excited about. 

 

Broadly in healthcare, there are just so many inefficiencies that this new technology can help with. There's the obvious example that we're going to get to an arms race on both sides of the coding issue where there's gonna be coding agents that try and upscale and then payers that are going to use it to try and fight back and I think people can make money there. But what's more exciting is, again, this idea of augmenting physicians so that you could read scans early and flag them early for, say, stroke or for other pieces. Anything around being able to increase the reach of physicians, I think, is going to be pretty exciting.

 

Shiv: Yeah. 

 

Dr. Chowdhury: And documentation actually is one. There's a lot of companies working in the space that's going to require like specific training data to be able to do this. But if you could just have an agent in the room, have your interaction, eliminate screens completely -- the note is done, not just for billing purposes, but actually for clinical care -- hat's super exciting.

 

 

Shiv: Yeah, and hopefully, we'll help our providers stay in practice longer by reducing that administrative burden as well. That tends to be a reason a lot of our colleagues have left medicine. I'm curious, one thing we discussed a couple months ago that I'd love your take on is about the flourishing aspect. You're a tech entrepreneur whose been very successful and you’ve shared your mental health journey. So, there’s one thing of getting people from “abnormal” -- however you want to define that -- to normal mental health and then normal to flourishing. You know, maybe a tech entrepreneur whose even more creative, ore socially conscious because of the psychedelic experience. Or, a healthcare provider who just flourishes and loves their job even more than before.  What’s your take on that spectrum and would Journey Colab ever play a role on the flourishing side? Are you supportive of it? We had the NIMH director on the podcast, Dr. Joshua Gordon, and his mandate is very much abnormal to normal, not so much normal to flourishing.

 

Dr. Chowdhury: The lens I would look at through is getting back to the traditions and the cultures and the peoples that have successfully integrated these very powerful tools into their societies in a way that was not what we did in the 1960’s with bringing psychedelics back into the Western world. And when I look at those traditions, there is the use of psychedelics for healing, in terms of like a physical ailment, or even what would we call mental health ailment, but there's also very much the ritual of using it at the transitions of life. Across many different cultures, when we examine it closely, there are some parts of life where a ceremony has been used -- whether that's the coming of age in adolescence to adulthood, the birth of a first child, the death of a parent, some sort of change -- and the one constant that we have in our lives is change. 

 

What's interesting is when we marry that with the new science that's coming around with psychedelics, particularly Gul Dolen’s work out of Johns Hopkins, where we talk about this as plasticity. That really is not specific enough or nuanced enough of an understanding. Her work is really interesting and I'll summarize it very quickly. Psychedelics, in her framework, seem to open up what's called a critical period in the human brain. And we know about these developmental critical periods, like learning a new language when you're young, or like the socialization in adolescence where you are more sensitive to your environment, where you have a faster rate of learning so you can adapt. Psychedelics seem to have the ability to introduce, temporarily, that critical period again, particularly on social reward circuits.

 

So, when you talk about flourishing, what I think about is that the only constant that we have is change and that often when people struggle, it's in those moments of change that either happen externally to them, or as they're progressing through their lives. We know that these traditional communities have, in the context of ceremony and with expert healers in the community, helped people to get through them and we do not have that anymore. And that's very intentional, like from the burning of the library in Alexandria, to the war on drugs today, Western culture has systematically destroyed and eliminated that culture and that knowledge of plant medicine.

 

I think what you're asking is, well, this can help in specific ailments, but can this be helpful just in the course of our lives? And I think everything that we know about traditional use says, yes, we absolutely can. How we can have a framework of that outside of the medical system, I think, is something that we need to build. We just don't have that anymore. Unfortunately, it's not just about saying these are available now because without those expert healers and guides, without that culture around the appropriate use of when and where and how, I think we'll end up with what happened just a few decades ago, where we lose them again.

 

 

Shiv: Yeah, that's a super valid point and something that aligns really well with what Matt Johnson said on this podcast, too, of the cycles we go through of rediscovering, learning about these tools, and then banning them. It was sort of like Prometheus with fire. With any tool -- fire, psychedelics, AI -- there's obviously positives and negatives, it's just how you apply them. 

 

I'm respectful of your time so I have just two other questions for you. The first is, any advice? I mean, you've been doing this for a long time. You went through med school, you went through PhD, you’re a tech entrepreneur. What advice would you give to our audience about approaching their careers?

 

Dr. Chowdhury: That's a good question. I think understanding your risk tolerance is very important. It is absolutely okay to say I have at a period of time in your life more risk tolerance and less risk tolerance and understanding that that is going to be an evolving thing. In addition to risk tolerance, the other thing that comes through is opportunity cost. So, earlier in your career you may have less risk tolerance, because perhaps you come from an immigrant background or you come from a place where I really need to pay the bills, but at that time in your life, your opportunity cost is low. Go on later in your life -- and I see this happening to a lot of physicians later in their life -- where they're like, okay, I have higher risk tolerance, because I've established myself in my career, I have a good practice, but the problem is, now your opportunity cost has gone through the roof. Now for you to step away, even from a day of clinic, in real dollars is a lot of money, in addition to the fact that you may have kids now, you may have a mortgage.

 

And so the way I try to map it out to people is that you have to look at these two dimensions in your career and understand when can you take on more risk and when do you have the opportunity cost to be able to do that? And they are often conflicting. You have to make a choice on that. I've seen some people step out early where the risk tolerance is high, but the opportunity cost is low and they've done different things. Like they've been, you know, they may be able to make it work either going into a traditional corporate job in pharma, coming back to medicine, like, it's easier. In some cases, it's easier to do that when you're younger and earlier in career. But then I've also seen people who really wanted to be more creative in their career later on, but they're trapped because the opportunity cost is just so high. 

 

So, I'm not giving people an answer there, but I think those are the two dimensions that I like to tell to people is, like, where are you? Where do you see that to be? And where are you going to get an opportunity where they line up where you can take different choices based on those two dimensions?

 

Shiv: Yeah, that's incredible advice. And just more broadly, self-awareness, right? Just getting to a point of self-awareness, where you understand what your values are, what your risk tolerance is, as you're saying. Are you someone who subscribes to the “sunk cost fallacy?” You know, “I did this much time, so I’ve got to keep going. How can I give up a medical career, because I spent already 10 years training in it.” So, yeah, I'm sure you're a big fan of decision-making frameworks and books. Definitely recommend that to all of all of our learners and your advice is well taken. 

 

Last question for you: is there anything else you want to tell our audience about you, about psychedelics, about Journey Colab? Open mic.

 

Dr. Chowdhury: Yeah, I think my message is that psychedelics are a very, very powerful tool and that while there are different applications for it -- say ceremonial, recreationally, in the clinical space -- we need to treat them with an immense amount of respect and rigor, like they have always been in traditional communities. That gives us a role as clinicians and physicians to step into that. 

 

Now, I'm not saying those are the only people that can be involved in how we're bringing this into our culture and society. But we have a very important role, I think, as clinicians, to help the people who are most vulnerable, who can also benefit the most, ensure that there is a safe place for them to be able to access this and that they are treated with respect, with safety and with accountability.

 

So, I'm very excited for clinicians to have this role in making sure that this very powerful tool is able to help the people who need it the most. And I encourage clinicians, wherever you are on spectrum to look into it and see because I think for so long, mental health and psychiatry, behavioral, clinical was stuck. We just didn't have tools and we are coming back to a tool that we have used throughout our evolution as a species and bringing them back. And while I think there are these other areas that they certainly need to be looked at, we have a very important role to make sure that for the people who need it the most, we can ensure that this tool is wielded in a responsible way and help the people who need it the most.

 

Shiv: Well, that's a really inspirational message to end on. I'm really glad that you and your team at Journey are working on this. We've had a lot of academics on the podcast who are amazing. They're doing the groundbreaking work upon which companies like yours are built. But I feel very strongly, like you, that bench to bedside...there's so many things we know work or are working really well but there just needs to be scalable models, things that align incentives -- like what you're doing with stakeholder ownership -- that gets to the people who need it the most. 

 

So, Jeeshan, I'd really like to thank you for the time you've taken to be with us on the Raise the Linepodcast, but more importantly, for the work you and your team are doing at Journey to hopefully tackle this addiction crisis we all know about.

 

Dr. Chowdhury: Thanks for having me.

 

 

Shiv: And with that, I'm Shiv Gaglani. Thank you to our audience for checking out today's show and remember to do your part to raise line and strengthen our healthcare system. We're all in this together. Take care.