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Today, though, speaker after speaker questions the neurotoxicity conclusions. "The difference between a medicine and a poison is the dose and context," Grob points out, challenging whether Ricaurte's doses in monkeys stand up to the scrutiny of interspecies scaling. An audience member asks if the pruning is damaging brain cells or, as when he prunes his garden, just reworking their growth. The question underlying his questionhow we might distinguish brain damage from brain change, perhaps linked to the kind of psychological breakthroughs some MDMA users reportgoes unanswered. "The so-called neurotoxicity phenomenon may be a prelude to a neuroplasticity response," Grob says later. "We don't know."
What about the studies finding functional impairment in humans? Here, too, Grob and others find that the studies raise as many questions as they answer. The "MDMA users" had in fact used street Ecstasy and other drugs, often repeatedly. Was the impairment the result of Ecstasy alone, or some other more toxic drugketamine, for example? Given widespread reports of bunk sold as Ecstasy, how do we know the users had even taken MDMA? Why did studies on cognitive function match polydrug-using hard partiers against a control group of squeaky-clean college students?
A reporter asks Ricaurte why, rather than looking retrospectively, he has never done the "prospective" trials scientists usually prefer: dividing two groups of MDMA-naive individuals, administering MDMA to one and a placebo to the other, and charting cognitive or other effects. Ricaurte pauses. Ethically, he says, "Any study has to be conducted with an eye toward risk versus benefit. I can't point to one study showing the therapeutic benefit of MDMA."
"Of course you can't," says Grob, "because to date, none have been permitted."
As sponsor of more than 85 percent of the world's research on the health effects of drug use, NIDA has funded only three research centers to test MDMA in humans, and none to look at therapeutic use of the drug or how the context in which it is used might change the risks. Like the government's DARE program, which claims to help kids with drug decision making and then says the only choice is to "say no," NIDA's Ecstasy research purports to be driven by science but offers an anemic range of options. "There are pockets of honest research," says Lindesmith executive director Ethan Nadelmann, "together with an overlay that is profoundly politicized and corrupting of the research. Certain questions are not to be asked."
Studies on the therapeutic use of MDMA are under way in Switzerland, Spain, and Israel. The U.S., meanwhile, is hammering its science into armaments for the drug war. In the last year, NIDA has used every opportunity to get out the message that "even one MDMA dose is toxic," distributing 330,000 Brain on Ecstasy cards, issuing mailings and alerts to 250,000 health professionals, and launching a PR blitz. Predictably, sensational media coverage has followed: On a recent 48 Hours, a doctor showed an Ecstasy-abusing teen and her concerned mother a computer model of her brain and declared it "almost moth-eaten."
The number of MDMA users in Americacustoms seizures, arrests, and scare campaigns notwithstandingcontinues to rise. "Right now," says Grob, "the only ones being controlled are the researchers."