#459: George Goldsmith on Improving Mental Health

George Goldsmith is the co-founder and Executive Chairman of COMPASS Pathways, which aims to treat depression through psychedelic mushrooms. In this conversation, we discuss mental health, depression, psychedelics, psilocybin therapy, and regulation. ======================= Choice is a new self-directed IRA product that I'm really excited about. If you are listening to this, you are likely part of the 7.1 million bitcoin owners who have retirement accounts with dollars in them, but not bitcoin. I was in that situation too. Now you can actually buy real Bitcoin in your retirement account. I'm talking about owning your private keys and using tax-advantaged dollars to do it too. Absolute game changer. https://www.retirewithchoice.com/pomp ======================= Want to sell your wonderful internet business? Tiny partners with founders to give them quick, straightforward exits that protect their team and culture. We’ll make an offer within a week, close the deal within a month, and keep your business operating for the long term. Get in touch at tinycapital.com, and we’ll let you know within a couple of days. https://www.tinycapital.com/

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:02Anthony Pompliano?

  What's up everyone? This is Anthony Pompliano. Most of you know me as Pomp. You're listening to the Pomp Podcast, simply the best podcast out there. Let's kick this thing off. George Goldsmith is the co-founder and executive chairman of Compass Pathways, which aims to treat depression through psychedelic mushrooms. In this conversation, we discuss mental health, depression, psychedelics, psilocybin therapy, and regulation. I really enjoyed this conversation with George, and I hope you do as well. Before we get into this episode, though, I want to quickly talk about our sponsors. First up is BlockFi. They provide financial products for crypto investors. Those products include a high-yield interest account where you can earn up to 8.6%

• 0:44Anthony Pompliano?

  interest in that interest-bearing account. They also provide a US dollar loan against your crypto collateral, and they have a crypto exchange where you can buy and sell cryptocurrencies. On top of that, they are now going to come out with a Bitcoin Rewards credit card. That's right, it'll be a credit card that you use, just like your normal credit card, but you earn Bitcoin back rather than dollars or airline miles. So, go check out BlockFi's high-yield interest account, US dollar loans against your crypto collateral, or a no-fee crypto exchange, and then that credit card will be coming out soon. Go check them out at blockfi.com/pomp. I'm an investor, I sit on the board, I'm a very happy user,

• 1:26Anthony Pompliano?

  and you will be too, if you go get an account, blockfi.com/pomp. Next up is Choice, a new self-directed IRA product that I'm really excited about. If you're listening to this, you are likely part of the 7.1 million Bitcoin owners who have retirement accounts with dollars in them, but not Bitcoin. I used to be in that situation too. Now you can actually buy real Bitcoin in your retirement account. I'm talking about owning your private keys and using tax-advantaged dollars to do it too. It's an absolute game changer, a self-directed IRA product where you buy Bitcoin, you hold your private keys, and you use your tax-advantaged dollars to do it. Go check them out at retirewithchoice.com/pomp. Again, retirewithchoice.com/pomp.

• 2:10Anthony Pompliano?

  I have a big, big portion of my retirement account with them. They've helped me get a Bitcoin exposure. 100% of my retirement funds is in Bitcoin exposure. So go get that self-directed IRA product with Choice. RetireWithChoice.com/pomp. Lastly, is Tiny. I've had Andrew Wilkinson, one of the founders of Tiny, on the podcast multiple times. I'm a really big fan. He's super thoughtful and he just gets it. So if you want to sell your wonderful internet business, you have to go talk to Tiny. It's gotta be your first stop. Tiny partners with founders to give them quick, straightforward exits that protect their team and their culture. They'll make you an offer within a week. They'll close the deal within a month and they'll keep your business operating for the long term.

• 2:55Anthony Pompliano?

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• 3:28Speaker 01

  Anthony Pompliano is a partner at Morgan Creek Digital. All opinions expressed by Pomp or his guests on this podcast are solely their opinions and do not reflect the opinions of Morgan Creek Digital or Morgan Creek Capital Management. You should not treat any opinion expressed by Pomp as a specific inducement to make a particular investment or follow a particular strategy, but only as an expression of his opinion. This podcast is for informational purposes only.

• 4:00Anthony Pompliano?

  All right, guys. Bang, bang. I've got George here. Super excited to have this conversation. Thank you so much for doing this, sir.

• 4:06Speaker 02

  You're welcome. It's really exciting to be on the Pomp Show.

• 4:11Anthony Pompliano?

  For sure. Let's just start with your background. You're obviously doing a bunch of really interesting and incredible things today in the psychedelic space. But let's first start just kind of where did you grow up and how did you start in your business career?

• 4:24Speaker 02

  Oh, sure. I grew up outside of Philadelphia, Pennsylvania. I was born in fifty-five. I'm actually adopted also, which is, you know, really grateful to the people who adopted me and grew up in that environment. I then went off to school, went to preparatory school in outside of Philadelphia called the Haverford School and had a great education there, went off to university. And all along the way, I was sort of interested in a combination of technology, which was just getting started then. This was really early days of computers. So I was really

• 5:04Speaker 02

  intrigued in doing computer programming and so forth. So I was a bit of a geek as a teenager. And one of the things I found actually really interesting was some of the work that was being done in psychedelics at that time, this is late sixties, early seventies with cancer patients. And obviously, that's a theme that's continued. I was also really interested in psychology. And so I brought those things together in university and graduate school as working in cognitive science, looking at attention and consciousness. Then I got some clinical training. I was really interested in clinical psychology. But I realized kind of toward the end of my training that I didn't want to work one person at a time. There are people who love that, who get great meaning for

• 5:47Speaker 02

  it, but I really wanted to look at how we could work at a system level. And so that really started to point me more toward business, away from academia, away from research. And my first company was something called the Human Interface Group, which was in eighty-five I created it. It was really to help people who were going through large-scale technology change with influx of computer-grade manufacturing. This was really going on in the mid-eighties. I was really interested in the human side. How do jobs change? How do people change, etc.? And that really started a long career that focused on different aspects of collaboration. And so for me, I've always been interested in that. I built businesses around it, sold

• 6:29Speaker 02

  one to Bodis, one that was a software development to support collaboration, then went on and focused on collaboration across businesses that really took place in the early days of the internet. Another organization called Tomorrow Lab and then joint forces with McKinsey and Company and did a bunch of work there. And the most interesting thing that I started to get curious about was the interaction between governments and business and collaboration there because this was right around the time of the major scandal. Some of your folks may have heard of Enron and so forth, but this is when public trust in large companies started to go away and for very good reason. And I became really interested in what is the role of the regulator and how does he

• 7:14Speaker 02

  actually, that function of regulation affects society? And I created a bit of a wonky business called Tapestry Networks, which really was to bring people who were kind of at the leading edge of good ethics in companies, audit committee chairman, to actually start looking and sharing best practices, learning from worst practices, and starting to engage with, you know, people like the SEC just to learn how to implement Sarbanes-Oxley, which was going on at the time. So, you know, very, very focused in terms of how do we look at the responsibility we have as business leaders to operate ethically, effectively, and how do we work with regulators

• 7:59Speaker 02

  to make sure that we discharge duties appropriately? Then lastly, that took me down the stream to do some work in healthcare and similar issues, similar regulated industry, looking at how do we get the right medicines to the right patients at the right time? And here's a really important bit, at a cost society could afford, right? So not only do we have to worry about safety and efficacy, but the really big thing is if we have something that works, it better be accessible for as many people as possible at a rate society could afford. And that led me to move to the UK where healthcare is actually a right, not a privilege. And so it's available for everyone.

• 8:40Speaker 02

  And I think that, you know, working on this issue across Europe has really helped inform some of my work that was also, you know, involving the US as well. So that was kind of what I, my career arc, always about collaboration, always about getting to a better answer, usually with together and usually with a real focus on improving the quality of people's lives.

• 9:02Anthony Pompliano?

  I love that life mission. One of the things that has come to the forefront, especially during this pandemic where governments have forced people to sit inside is mental health. And obviously, it's much easier to kind of measure the people who get sick, the people who die. But there's definitely a rise in mental health issues, depression, and it feels like maybe over the last five to 10 years, that has come to the forefront in general, but it was really, really accelerated by COVID and kind of all of the government mandated shutdowns. Can you talk to me a little bit just about that problem in general, how you view it,

• 9:41Anthony Pompliano?

  and maybe what some of the effective or non-effective types of treatments historically have been there?

• 9:50Speaker 02

  Yeah, it's a pretty big question, Pomp, but you're renowned for that. So I think first and foremost, we were a mental health care company. You mentioned psychedelics, but I think we just see that as a really interesting, important tool that has a long history, a long, lot of learning to be built upon. But we have an opportunity now to look at it as a tool to really improve and transform mental health. And why is that important specifically today? Well, as you mentioned,

• 10:26Speaker 02

  you know, just looking at depression, just one whole area of mental ill health, if you will, it is almost bigger in terms of its impact on society and patients and cancer and diabetes together. It's huge. It is just, you know, the people who have said that they are depressed or in treatments, about over 300 million people worldwide. It's estimated that one in five, one in six people will experience that sometime in their life. And, you know, we've been really making good progress in the late eighties around some new treatments, kind of the traditional antidepressants for that.

• 11:09Speaker 02

  But when you look at it hard, you see that about thirty percent of people aren't helped by traditional antidepressants. When you use that as a multiplier on that over three hundred million, you quickly get to over a hundred million suffering with depression, being disconnected from their lives, disconnected from their loved ones, disconnected from a sense of purpose. Really kind of in a deep inner kind of conversation often and and removed from the life that they want to live quite often. And to have a hundred million people suffering from that, and it actually has to be more because of the stigma that you talked about still exists around the world. It's a big problem.

• 11:50Speaker 02

  And while we're making some progress historically, we have a huge opportunity with that many people who are suffering and perhaps suffering unnecessarily. And so COVID, actually, I think the intersection of COVID and the intersection of a demographic, I think, is changing things. And the demographic are people who are part of the first medicated generation with psych meds. And this started in the late nineties with children on both sides of the Atlantic, which are areas that we focus in on, but more in America. And I think people became very much more comfortable talking about this, much more

• 12:32Speaker 02

  familiar with kind of the use of medicines even as children. And I think this kind of openness has reduced stigma. I think parents who use these tools have reduced stigma. And I think COVID has just said, look, this is a huge problem. We're all feeling it, no matter whether we've had a history of this or not. It's hard kind of talking to, you know, these little squares on screens and calling that contact and relationships. So I think we're seeing a confluence of things in terms of reduction of stigma broadly around mental health, reduction of stigma around people are looking at these new substances like psychedelics as a possible approach we could take, at least we need to look at

• 13:16Speaker 02

  it, and a reduc-, you know, kind of this huge unmet need that's bubbling up all around us. So I think it's the right time to have this conversation, and more importantly, the right time to do the really hard work ahead, to see if these are good tools to transform mental health for all those people who aren't helped.

• 13:35Anthony Pompliano?

  Yeah. And talk a little bit about kind of the founding of Compass and kind of what the impetus for the idea was and where you guys started.

• 13:46Speaker 02

  Well, so I was busy doing this work I had mentioned on health systems also, you know, working continually in corporate governance and how to have effective governance. And so that was going on. I had the wonderful event in my life of meeting someone amazing who I got married to, Katja, my wife, my co-founder, a doctor, someone who is just incredibly committed to making a difference for patients. That's been her life work. And someone who also had a research background. And she brought her, you know, her son was 16 when we got married. He was going off to university, incredibly smart, talented, high-energy person.

• 14:32Speaker 02

  They're really interesting to be around. He went to university and then started really suffering with depression and OCD and anxiety. And, you know, we thought, well, how difficult could this be? We, you know, we're therapists. Thank God, we live in the United States. We do have some access to care. You know, we're so much more fortunate than so many others are. This shouldn't be difficult. And so that started a journey to help him. And he just became worse and worse with all the medicines. He was in that 30% that aren't helped. And, you know, with combinations of things, it just turned into trial and error where it was more error. And it just didn't work. And that led Katya on her sleepless nights as a mom to start

• 15:16Speaker 02

  doing research. It led her to become board certified in integrative and holistic medicine. She was an internist, so it helped her understand this world of psychiatry. If she were here, she'd say, you know, she prescribed antidepressants for patients who were suffering, but she wasn't a psychiatrist. And this really started our journey of how to help him. And in that journey, we found psilocybin research. She found psilocybin research with OCD, studied by Moreno. And that really kind of excited her because it showed promise in something that was just so kind of lots of dead ends in the past. So that led us to get, try to get smart as we do, try to meet the people who are doing the work, incredibly brave, thoughtful researchers,

• 16:00Speaker 02

  working at the leading edge of looking at these substances, which have been, you know, just really vilified and not looked at. So they took a lot of personal risk, you know, teams like Johns Hopkins, Bolt Griffiths, Matt Johnson, Steve Ross, his team up at NYU, Robin Card Harris, David Nutt at Imperial, Franz Volenweer, Charlie Grove at UCLA. And these are incredibly important pioneering studies they did. And we became really intrigued by that. We spent time, we provided some financial resources along the way to help them as donors to get started. And the more we saw, the more we realized that, given the work I had been doing,

• 16:44Speaker 02

  and given what we were seeing, that there was kind of a missing step to get this to patients. And that was large scale, well-funded studies that were done to the highest standards globally, because it's a global problem. It's not a US problem, but it is a US problem, but it is a global problem, too. And so, you know, if we had promise, why not try to do this at that scale? Going back to my earliest days that I referred to, which is one to one is beautiful work. Scaling is where you can create opportunities for lots of that one to one. So that's kind of our focus. And that took us into kind of a thought experiment about, well, how do we do this?

• 17:26Speaker 02

  And so the first port of call was talking to regulators with whom I'd had the benefit of working in the past and just sharing some of the early signals that excited us and it excited them. And then we decided, well, it's time to see what we can do to contribute.

• 17:43Anthony Pompliano?

  And so when you first start going down kind of this path, if you will, talk at kind of a high level about psychedelics and some of the, you know, understandings that we do have and some of the understandings that we don't have as an industry and how you view this, is this just a medicinal type activity? Is this something that you think will eventually become recreational? And how you see, you know, really using this on the front of mental health, you know, given that you're building one of the leading companies in the space? Like, just how do you view psychedelics in general before we get into some of the specific things you guys are doing?

• 18:24Speaker 02

  Well, again, I've got to maybe helicopter up a bit and say, how do we review mental health? And then how do we view psychedelics? So, mental health is a huge spectrum of life experiences. And we call mental health when people aren't suffering from the way they experience life. We call mental illness where they are really suffering significantly or disconnected, debilitated, unable to participate in their life and worse from there. There's a large gray area in that, that we don't really fully understand what the boundaries are.

• 19:05Speaker 02

  When you develop a medicine, it's always working in the area of the greatest unmet need first, because that's where we we know that whatever risk of treatment there is, even if there's benefit, the benefit, a small benefit for someone who's really suffering is really a good thing. For someone who's kind of having bad days here and there and you take on more risk, then it's harder to say where the benefit and risk boundary should be. And so this is really the core aspect of regulation. It's the core aspect of how we provide care to people in in a medical environment is understanding this balance of risk and benefit and for whom. So if Katya were here, she would say, you know, we know a lot about mental illness.

• 19:50Speaker 02

  There are books written about it, you know, they have the DSM, Diagnostic and Statistical Manual, and there's hundreds of pages describing everything about mental illness. It's much harder to find a book on mental health. And so we have this really well-defined territory, and that's really where the medical area is focused. And the reason we're focused in in our areas, we didn't try to be clairvoyant. As I said, you know, one of the problems that pharmaceutical companies have had in the past is they develop things and then they try to convince people that they're worthwhile. And we, what I learned in all my work with regulators and payers and health systems

• 20:32Speaker 02

  is that if we start the other way around and say, where's the need and how might we help? That's a really important place to start, and that's what how we started Compass. We went to regulators and health systems, insurers, and said, where is your biggest problem where this might help? And they kept coming back with this notion of treatment-resistant depression. And that's a weird title, treatment-resistant depression, right? It's a weird construct, because depression isn't resisting, and the patients that we've met who've suffered with this aren't resisting. It's really a convenient way to say, we don't know what to do right now to help you.

• 21:14Speaker 02

  And the traditional medicines don't work, so we'll try a bunch of things. And yes, the treatment seems not to be working. And but these people, I don't know, no one's that we've met is resisting treatment. What they're doing is really trying to find something that works for them. And that's really the opportunity that's measured in, you know, 100 million people. And that's where we're starting to focus. Now, when we look at psychedelics, I think one of the things that happens is we have to think about, well, what is depression? And there are lots of different views and perspective on this. But one thing that's really been interesting, kind of in most recent work on depression, kind of leading edge work,

• 21:56Speaker 02

  is looking at depression as an issue of cognition, the way we think, not the way we feel. The feeling kind of is a cascade. But the way we think, the scientists often talk about what's called negative attentional bias. You can think of negative attentional bias as people who wear a different colored glass than rose colored. People who tend to see things in a negative fashion. They tend to expect the worst, not the best. They tend to operate sometimes from a feeling of scarcity rather than abundance. And not because there's anything wrong with them, it's how they've learned, it's how they've processed information, it's the environment. And sometimes people get very captivated by these thoughts.

• 22:42Speaker 02

  And they start thinking more and more, and they become ruminating. They kind of, you know, turn things over again and again and again in their mind. And the more you look at it, the kind of the worse it gets. The worse it gets, the more internally focused you become, the less engaged you are with your life, maybe the less fun you are to hang out with. You know, all of these things contribute to kind of a falling in and on ourselves and our thoughts.

• 23:08Speaker 02

  I think that one of the things that's really important is that psilocybin, and based on some very recent research in the last 10 years, that we just didn't understand before, we didn't know before, that the last 10 years, we, there's actually a circuit of activity in our brain that connects different parts of our brain and helps us explain and make sense of the inputs. And you can also kind of think of that as yourself. That's sort of my, how I process information. What we know with psilocybin is it can provide in many people at the right dose, with the right support and preparation,

• 23:45Speaker 02

  the right, a kind of reset of that network. And, and so, this notion of rumination and playing over things, it applies in, it's a characteristic of a number of things broadly in kind of the mental illness area of depression, anxiety, OCD, eating disorders, where people have these very kind of well-worn routines of thinking. And psilocybin seems to help reset those.

• 24:17Anthony Pompliano?

  And so when you talk, when you talk about this therapy, walk me through how exactly it works, right, from like an execution standpoint. So I have a treatment-resistant depression. I go and I interact with, whether it is a doctor or a psychologist, at some point, I get to the point where I say, hey, I think that this may be the best path forward. Is this something where I get a prescription and I basically am doing this at home? Am I going into a controlled environment with like set and setting? Like, walk me through kind of just how actually the actual therapy works?

• 24:56Speaker 02

  Sure. And I'll be very clear. Right now, you can't do any of those things because this is in clinic, legally at least, because this is now in clinical trials. So maybe what I'll do is talk about how our clinical trials work, because that's real and happening today. And we'll give you a view into that in the real world. So the first thing we have to do, because a lot of clinical trials are

• 25:20Speaker 02

  Difficult to assess because they have lots of different types of patients. It's called heterogeneity. And so the first thing we have to do is make sure we're kind of working on the same type of thing for patients. So the very first thing that happens in their studies is we have to make sure you have quote-unquote treatment-resistant depression. That means we need medical records to demonstrate that you've had at least two different antidepressants, traditional antidepressants, and you're still depressed in the same episode. So the first thing we have to do is make sure you're the right kind of patient so that the data we present actually reflects a reality, right? If you give somebody, you don't know what you're giving them, you don't know what they're suffering with, and you get great results, what does that tell you? So how do you do it for the next person?

• 26:05Speaker 02

  How do you know who helps and who doesn't help? So first thing, make sure you have the right patient. In our case, it's two to four prior failures with an antidepressant. And you still have a high level, a medium to high level of depression. So you're still suffering. That is measured by questionnaires and interviews. And if you have all that and you don't have a prior history of schizophrenia, certain kinds of uncontrolled high blood pressure, you then can come into our study. Now, a lot of people who have taken antidepressants and find that they don't work, still take them. And that's, they take them because it's almost like an insurance policy. If I stop taking them, maybe I'll even feel worse, but I'm still depressed and I'm taking them.

• 26:47Speaker 02

  So the very first step for us is to help people taper and then get off of the traditional antidepressants because they are thought to counteract the effects of psilocybin. So the first thing we have to do is what's called a therapeutic washout. And that takes a couple of weeks. It's done under the supervision of a psychiatrist, and we do that in our studies, and that's going to happen in the real world. It's a couple of weeks. Most people can do it without a lot of difficulty. Some people suffer flu-like symptoms, and some people actually get worsening depression. And about the same number of people, according to prior studies, actually aren't depressed anymore when they stop their medication. And they don't qualify for the studies anymore.

• 27:27Speaker 02

  Because the depression goes away, for some reason, we don't know if you're not assessing causality, we're just assessing correlation. So they come off the antidepressants. And then we start talking to them a little bit to understand their narrative. Because what's really powerful in depression is kind of how I see that world, that's that train of thinking I mentioned. And to start understanding their story. And everyone has a story, everyone has a story about their life, how it's unfolded, what it's been, I told my story, you have your story, we all have our stories. Sometimes those stories no longer serve us. And so we try to understand a bit in the therapy about what the narrative is, what's the quality of that narrative for the person. And start disconnecting them from the narrative.

• 28:11Speaker 02

  It's to help them when they feel anxiety, to pay attention to where the anxiety feels in their body, not the story about when the anxiety first happened and all that. But just pay attention to the thought, or the feeling, not the thought. Disconnect them. And we train people how to do that, we train people how to manage anxiety through breathing exercises. And we give them a sense of what it's like to have a psilocybin experience by showing them a little animation we've made to educate patients, to talk about it. We answer any questions they might have. We're only using 10% of people who've had, only 10% of people who participate in our trials have had prior psychedelic experiences.

• 28:51Speaker 02

  Because a lot of the other trials have always focused on people who've, a greater proportion of people have had these experiences. But if we're making this as a medicine to the whole world, we have to really make sure that it reflects the real world. And that's about no more than 10% of people. So we go through all this preparation. Then the day of the actual session, they come in in the morning, they're instructed to eat a light breakfast. And they come into a pretty chilled out environment, you know, it's a couch or a bed, it's soft lighting, um, there's two therapist chairs, one's a therapist, one is a person who's assisting that therapist, that's the way we train new therapists.

• 29:32Speaker 02

  And they're basically invited to take the medicine, uh, which is five capsules, five milligrams each, or two capsules, or one active capsule, we're doing one, ten and twenty-five in our trials to see, is the ten significantly better than the one, is the twenty-five even better, do you have more or less side effects with each, this is a critical aspect of creating a medicine, what's the dose, right, and what's, so you've got to do that, right, this is kind of basic, basic stuff, um, so they're doing that, and so we give people the psilocybin, but it might be a high, medium, or low dose, then we invite them, based on what we, how we prepare them, to just relax, they might look at art books, they might just listen

• 30:14Speaker 02

  to music, we then give them a soundtrack that we have, that's seven hours, and it's basically the soundtrack for the session, we also invite them to put on eye shades, because the difference between recreational and therapeutic use is really is it in an inner or an outer experience, and we're very much about an inner experience, a deep inner experience that's supported by others, the therapists are there to help people deal with any anxiety they might have, or things they want to talk about, or help them, you know, go to the restroom, but it's not an active therapy session, it's a therapist there to provide exquisite just-in-time support to a person, whatever they might need.

• 30:56Speaker 02

  And the psilocybin session starts about twenty to forty minutes after, people start having a sense of a little shift in the way the music sounds perhaps, maybe some patterned images when their eyes are closed. And then that builds and then they may start having memories and thoughts of their past life, you know, things have happened in the past. And this emerges, it grows. The music kind of is a little bit of a carrier wave to support that over the course of the time. Music has different levels of, you know, different types of emotion. It's all instrumental

• 31:34Speaker 02

  largely until the very end. And it it provides a base note for the experience of internal exploration. And we ask people just to, you know, let emerge what emerges. Don't fight it. Go with it. Be curious about it. But there's always someone there to keep you safe. Keep your body safe.

• 31:55Anthony Pompliano?

  It it sounds

• 31:57Speaker 02

  When it's over about six or eight hours later, they go home and then we come back and do a debrief the next day. Sorry for such long answers.

• 32:05Anthony Pompliano?

  Uh, listen, I I love this. This is, I think, giving people a crash course in terms of, uh, you know, not only, one, your philosophical view of of mental health and kind of what you guys are seeing, uh, as the opportunity and really what a potential solution looks like, but also, uh, two, how this, uh, kind of plays out from an execution standpoint. Talk to me a little bit about, um, kind of the regulatory environment. And I'm much more familiar with kind of the US environment than than elsewhere. Um, there's kind of this balance between, uh, decriminalization, legalization, and then obviously medicinal versus recreational. How do you look at regulation? And is there like a specific framework or milestones that you're looking for, uh, as we kind of push forward with a lot of

• 32:50Anthony Pompliano?

  the scientific research that's going on?

• 32:51Speaker 02

  Yeah. So, um, you know, regulation is something that seems very scary and like going to the principal's office for many people, right?

• 33:04Speaker 02

  If I think about what regulation really is, regulation grew up and has evolved simply because the animal spirits of capitalism just can't stop promoting things that might not be true. And when it comes to healthcare and you get overselling, people can get hurt because you have a vulnerable population. So, regulation came out to really say, if in fact you're going to make a claim about something to a vulnerable population, you better have data. You better know who it works for, who it doesn't work for, and what the risks are. Because these people are vulnerable. And that's really the core of regulation. It's how do we make sure that we are not making claims that take people who have hopes for a better life

• 33:49Speaker 02

  and somehow take advantage of them for our own good. That's why regulation exists. And it's evolved to be, you know, very, very complex because this is a complicated topic, right? And making sure that the same medicine is the same everywhere on the planet. And then when you take 10 milligrams of it in Beijing, it's going to be the same as when you take it in Boise. And, you know, that it's to the highest quality standards. We know what to do. You know, we know how to assess that. There are huge branches of science to do this. So, regulation is about ensuring you have a quality product. You know who will benefit, you know who won't benefit, and you have data to back it all up. And a drug

• 34:35Speaker 02

  is essentially a substance that doesn't have that. A medicine is a drug plus all the evidence that you have, that it's a quality drug that to the highest standards possible, that it continuously improves through the manufacturing process, that you have something that doesn't harm people. And it actually has a benefit that's greater than the potential harm. And you can identify who will benefit from it, who it won't. So that's what regulation is. It's a fundamental aspect of public health and responsible development of substances for human beings. Now, we see three areas. We see the recreational. We see an emerging area that we kind of tongue in cheek call the sector recreational.

• 35:20Speaker 02

  It's people who, you know, have a sense that something could be just a little better in their lives. Or maybe if I had a different viewpoint, or it's sort of like personal development on steroids. And that seems to be an emerging sector. I think that's where some of the things like Oregon and others are looking at this. I think someone refers to the betterment of well people, Bob Jesse, as a kind of a way to define the recreational sector. Then you have vulnerable people who are struggling to get out of their bedrooms, struggling to make it to work on assistance, desperate. I mean, every 40 seconds, someone commits suicide, someone on the planet, someone dies from suicide.

• 36:02Speaker 02

  So, and 20 people try every 40 seconds. This is a huge problem. And so that's where we're focused, given the urgency and the need. That intersection is the medical side, and that's where regulation really comes through. Now, I'll just leave this kind of for your next question. But the, the really interesting question is, when are the tools of regulation identifying benefit and risk, identifying safety, identifying the quality of the product? When do we throw them out the window?

• 36:42Speaker 02

  I kind of think it's important. I think you'll see a lot of the work that went into the Oregon legislation is to, to try to answer some of those questions. So it isn't, hey, try this, good luck with that.

• 36:56Speaker 02

  So I think there's a really important set of questions here. We're focused on doing it the most rigorous medical way because that's really the highest standard. And if we can set that standard, then we can learn from it.

• 37:08Anthony Pompliano?

  And as you're kind of building the company, one of the things that really stuck out to me as I looked more and more into what you guys are doing is that kind of the company values that you guys embody. And so this idea of collaboration, of being transparent with the progress that you make, the combination of both the medicinal drugs, but also some of the, what I'll call softer therapy type approach as well. Where do a lot of those kind of company values come from and why are those so important to you? Given that, you know, as a publicly traded company, there's this idea of just, hey, we're capitalists and we're going to go make as much money as we can.

• 37:47Anthony Pompliano?

  There's other things in there that maybe aren't, you know, counterintuitive to that, but, but definitely I think would, uh, would surprise people if they were reading some of the, the ways that you guys think about the business.

• 37:59Speaker 02

  Well, I think the way everyone thinks about business is changing. And, you know, you can see some of the largest corporations of moving to a focus on stakeholders in it as a broader view than just shareholders. So I think this change is taking place. We see it with emergence of ESG goals, environment, social and governance goals for business, required reporting from financial regulators and the people who oversee us. So the world is changing and I think that's for the better, frankly. I think that we need to take our responsibility, particularly working with vulnerable populations incredibly seriously. As you know, and many of the people listening to this know, it's not easy to take a company public.

• 38:45Speaker 02

  And one of the core things about doing that for us was being transparent. So we have to have, and doing it to the highest standards. So the SEC, the US is kind of the highest standard for disclosures. And so when you read our 300-page document about what our plans are, you know exactly what our plans are. You know exactly what the 100 pages of risks are. You know, all of that is laid out so that people can choose to participate or not. And it's our game plan and it's a game plan that we are. Viewing is how do we do the most, not the least? Because if we do the most, we then can confidently look to

• 39:27Speaker 02

  health systems and patients everywhere on the planet to say, look, we've done the hard work. Now let's actually look at how we can help at scale. And this is a huge problem and it needs really highly competent, effective approach. Now. Values are pretty important, right? Because that's how you actually have a company that performs and delivers. And we have four sets of values and we like the kind of tensions and the creative tension between them. It's compassionate. That's where we start, right? It's even reflected in our name. People are suffering. We have to get that. We've been on the front lines. You know, I had my ex-wife who sadly has passed away, struggled with alcohol and died from that.

• 40:09Speaker 02

  So I think many of us, everyone has a story like this somewhere in their life of what that struggle looks like and feels like. So compassion is where it all has to start. But we also can't be, because of the size of the problem, we have to be really bold at the solution level. That's another kind of, you know, value for us is to be bold, think big. You know, and you know, really look at what could we do? And be imaginative. And hopefully we'll get a chance to talk a little bit about how technology plays into all this, how therapy plays into all of this, how music plays into all of this. You know, it's a beautiful creative experience to bring this,

• 40:49Speaker 02

  but we have to be bold in our vision because too many people are suffering from incremental solutions. So boldness is important. The next thing that's super important to us is rigor, right? If you're bold without being rigorous, bad stuff can happen. Um, so you know, we don't want to be bold and not have a good safety profile of our medicine or really understand who it helps and who it doesn't and who it might even harm. These are all things that we have to do with the highest level of rigor and do it kind of better than in some cases, the industry that's developed medicines in the past has done. So we set a high bar. It's helped informed by boldness and compassion. Lastly, we have to be inclusive. And this is super important, right? It's great if you know

• 41:33Speaker 02

  you're in a recreational setting and can afford to drop somewhere 2,500, $5,000 for an experience in a workshop in Amsterdam or wherever. That's not a person who's been unemployed for two years and struggling and on food stamps in the US and trying to get therapy through Medicaid. That's not that. And so inclusive means access. It means how do we think about reimbursable? It takes me back to my prior work in affordable, a funny word to use with healthcare, but better be used to make it accessible. So you know, we're doing a wonderful project right now on the inclusion side, a couple of them. But one of them that we're really excited about is a project with the Grady Trauma

• 42:17Speaker 02

  Center in, you know, disadvantaged communities outside of Atlanta, trying to understand how will they adopt this? You know, what are the attitudes to people who are that population of vulnerable suffering? We have people who are suffering across all social strata, but to really pay attention to access for those people, that's really important to us. So inclusion is also an important value. So this is sort of the way we, you know, weave our company together is to make sure we're focused on these values. Even internally, we recognize people about how they embody the values every month.

• 42:57Anthony Pompliano?

  And so, George-

• 42:58Speaker 02

  Has to be a living.

• 42:59Anthony Pompliano?

  Yeah. When you think about kind of bringing all of this together, right? What is the ultimate vision for what you're building? Is this something where there's the clinical trials and there are kind of biotechnology or science-based advancements and ultimately kind of final products that get approved and can be used by people? There's the technology component in terms of the way that you manage care and help actually people who need it. And then also what I'll call kind of the therapeutic experience. So whether that's music, the setting, et cetera, is really kind of the vision to bring those

• 43:41Anthony Pompliano?

  three things together into a unified kind of front to end experience and product and service that ultimately drives at solving at least a part of that mental health issue. Is that fair to say?

• 43:58Speaker 02

  It's fair to say, and maybe I'll kind of play it back in some of the way we think about it.

• 44:04Anthony Pompliano?

  Okay.

• 44:05Speaker 02

  So, vision. The vision is a world of mental wellbeing for as many people as possible. Full stop. By the way, wellbeing doesn't mean you don't have down days. Wellbeing means that you don't kind of just have down days. That you have a full on personal experience that goes from the emotional ups downs, that you live a full human life. And that's what we mean by wellbeing. That you actually participate in your life and have the relationships you want and the life you wish. Now, how do we get there? One of the things that is our major goal is looking at how we do things that are really required to help get there for people who are suffering.

• 44:47Speaker 02

  That's summarized by developing a personalized approach, meaning it might be different for you than for me because we're different. So how do we think about personalizing therapy? Understanding doses? How do people respond? Who responds to what? So personalized is really important. Doing research to help inform how we personalize something because we're all different. Our life experiences are different. Our stories are different. Our suffering is different. The next thing is to be able to actually provide something that is a fast and durable, single episodic, single treatment. And that's why we're so excited about the work we're doing in psilocybin therapy and also with other psychedelics that we're

• 45:29Speaker 02

  doing earlier stage research with. It's to be able to create for a majority, not everyone. This is not a cure. That's so important to your stress, you know. But for many people to create this immediate and durable experience of a different way of looking at things, a way of being less depressed, that's important. Now that's where the work starts, not where it ends, Paul. And I think this is important, right? Because then what happens is how do you keep people there? How do you enable people to have this sense of well-being? More good days, being present for bad days, but not viewing them as a life sentence. You know, this idea of staying in a well-being zone.

• 46:13Speaker 02

  And some people relapse, right? The thought patterns pick up again, life experience, something might happen, et cetera. So we need to be able to predict relapse, and then we need to prevent it. So four Ps, well, actually three. First, personalize, predict, and prevent. And our goal is to create the tools and information to enable health systems to do that. The tools might be things like psilocybin, as we're developing to the highest global standard, our COMP 360. It might be how to use that effectively with different patient populations, different therapies, different doses. And it's to understand how long it lasts for whom, and who benefits and who may not.

• 46:58Speaker 02

  And to then really be able to be a compass for health systems and individuals of where are they relative to their true north of personal well-being? Where is a population doing? So depressed patients, are they doing better as a whole or not? If I'm a payer, or if I'm an insurer? Do they have less or fewer other kinds of diseases? You know, a lot of people do self-soothing when they're depressed. There's metabolic disease, cardiovascular disease that emerges, addictions. You know, all these things that kind of go part and parcel with depression. Do we make a difference in those? Do people have richer, fuller lives?

• 47:40Speaker 02

  So, understanding that, understanding the impact of this, not just on depression, but on one's life. I think this becomes really important and then that leads us to be, how do you be a responsible participant in a system like that? Well, you don't charge for therapy and you don't charge for pills, right? You actually become a partner with systems to say, we'll improve outcomes and we'll do that over time. And if we're doing that, we should get paid through some of the savings. If we don't do that, we shouldn't get paid because our job is to be identifying and doing the research, understand who will benefit. So this is happening in oncology, so it's not a wacky idea, it's not crazy. It's just hasn't really been applied here.

• 48:22Speaker 02

  And so what happens is you have therapy, you have medicine, you have technology to help support people, provide feedback, you have data. All those things need to come together into a rich tapestry of information for people so that they can personalize, predict, and ultimately prevent relapse. So I feel sometimes I give two big answers or too long, but our vision is really to help people who are deeply suffering, starting with treatment-resistant depression, so-called, and then to expand into other areas, always following data, always doing it in the highest responsible way from our point of view, and opening to share that, those data, to help inform people to deliver service.

• 49:07Speaker 02

  Our view is not, we don't want to be delivering care, we want to make the care that's delivered as best as we possibly can.

• 49:13Anthony Pompliano?

  I love this vision. I think you guys are well on your way to accomplishing it, so I am cheering you on. Before I let you go, I always, I always ask the same two questions to everyone, and then you'll get to ask me one to finish up. The first is just, what is the most important book that you've ever read?

• 49:31Speaker 02

  That's a really, really hard one. I would probably say today, Zen and the Art of Motorcycle Maintenance.

• 49:44Speaker 02

  And why is that? Well, it was someone who is really struggling with these these issues of how to think about the world, how to participate in the world.

• 49:55Speaker 02

  And also someone who is deeply involved in the pursuit of the ideal of quality. What is quality? And I think that those two things, understanding the human experience of someone really struggling and to really understand what does quality mean? How do we deliver it in the most responsible way? It was really formative for me to just think about those things. I could give you a bunch of other books, but right now that was the answer for today.

• 50:21Anthony Pompliano?

  I love that answer. It's a great one. Uh, second question is more fun. Aliens, are you a believer or a non-believer?

• 50:30Speaker 02

  You didn't ask if I was one.

• 50:34Speaker 02

  Gotta work on these questions, Paul.

• 50:38Speaker 02

  Look, I think that it's hard for me to shah them, that we're here alone. So aliens, you know, are there other cultures, other things and other places beyond our knowledge? I'd be hard pressed to say I have evidence if there aren't.

• 50:54Anthony Pompliano?

  I tend to agree with you on that one.

• 51:00Anthony Pompliano?

  All right. You could ask me one question to finish up. What do you got for me?

• 51:05Speaker 02

  What's driving your interest and commitment to talk to people like me in this area at this time?

• 51:11Anthony Pompliano?

  Yeah, look, just learning. I think that, uh, you know, I'm in a very fortunate position where I get to spend all day just finding and talking to the most interesting and successful people in the world. And so sometimes that's through investing, sometimes that's through things like the podcast. But to me, it's just learning. It literally is an intellectual curiosity and kind of a commitment to lifelong learning. And so, you know, even our conversation today, I walk away with multiple things that I learned that I have to now go think about and ponder about. Um, and it's personally rewarding for me because obviously I'm extracting a ton of value. Uh, but at the same time, I think that doing it in this format, rather than just having private conversations, but recording them.

• 51:56Speaker 02

  And kind of sharing them. It allows for other people to learn alongside me, which I think people appreciate. And also it gives the guest a platform to kind of spend an hour of their time or so and really get their message and kind of their learnings out to as many people as possible. And so it's one of those rare cases in life where you can kind of align, you know, a win-win-win for multiple groups. And so it's fun and I'll, I'll keep doing this until, you know, one day I'll just wake up and say, hey, that's it. It's a fun ride. I'll see you guys later.

• 52:30Speaker 02

  I guess at some point we all do that.

• 52:35Speaker 02

  I really appreciate your time and your interest in this. At some point I'd love to come back and share what we're learning as we get more data over the course of the year. And I think I'm really grateful for your dedication to this and helping get this message out. We don't have to suffer in the way that we have in the past. Absolutely. Where can we send people to find either you on the internet or find out more about Compass? I'm kind of busy, so I actually don't do a lot of social media, but you can learn everything about our company at compasspathways.com. And yeah, we're, we're heads down, great team, working hard.

• 53:17Speaker 02

  So you'll see, probably follow us on our website. It's probably the easiest way to do that. We have a section of news and you can see what we're up to at all times. Awesome. Well, George, listen, thank you so much for your time today. I think people really learned a lot from this as I did and we'll have to do it again in the future.

• 53:36Speaker 02

  Lovely. Thanks, Paul. Be well.