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Can a Trip-Free Psychedelic Still Help People With Depression?

A patient with depression once described their condition as “being enclosed in the most narrow confined space imaginable, it was like a sack over my head.” Another said it was as if he was locked in a metal cage “from the shoulders up,” or in a “mental prison.” During and after taking a high dose…



Can a Trip-Free Psychedelic Still Help People With Depression?

A patient with depression once described their condition as “being enclosed in the most narrow confined space imaginable, it was like a sack over my head.” Another said it was as if he was locked in a metal cage “from the shoulders up,” or in a “mental prison.”

During and after taking a high dose of psilocybin, the active ingredient in magic mushrooms, something changed. “It was like being on holiday away from the prison of my brain,” one person said. “I was a ball of energy bouncing around the planet, I felt carefree, re-energized.”

These testimonies came from a clinical trial for treatment-resistant depression at Imperial College London in 2016. As soon as one week after taking psilocybin—and for as long as three months after—the subjects’ depressive symptoms were “markedly reduced,” a paper on the results said. Since then, psilocybin and other psychedelics have been hailed as powerful and much-needed interventions for mental illness. Psychedelic research centers have been formed at Imperial College, and more recently at Johns Hopkins University in Baltimore, Maryland. In October 2018, psilocybin received Breakthrough Therapy designation from the Food and Drug Administration, recognizing it as a promising treatment for hard-to-treat depression, and potentially expediting the process for its approval as a legal medication. (Psilocybin is currently illegal at the federal level in the U.S. and the U.K.)

As scientists strive to understand exactly how these drugs lead to such dramatic outcomes, there’s a growing desire to tease apart the experience of psychedelics from the drugs’ other effects. Can the hallucinogenic trips that psychedelics induce be separated from other interactions the drugs might be having on the brain?

The experiences people have on psychedelics can be profound, emotional, painful, blissful, and seemingly transformative. One patient in an Imperial College study reported that they “had an encounter with a being, with a strong feeling that that was myself, telling me it’s alright, I don’t need to be sorry for all the things I’ve done. I had an experience of tenderness towards myself. During that experience, there was a feeling of true compassion I had never felt before.”

But what if this “trip” is just smoke and mirrors? A window dressing on a neurobiological process happening elsewhere that itself is reducing depression symptoms? Psychedelic drugs interact with receptors in the brain that cause the trip itself, but there are many other effects that are distinct from the hallucinogenic journeys people go through. For instance, they can create an increase in the connections among regions of the brain, and disruptions in other brain circuitry. Yet, up until this point, many experts have considered the entire psychedelic experience one single thing.

“Psychedelics produce profound experiences,” said Chuck Raison, a professor at the School of Human Ecology at University of Wisconsin-Madison. “Psychedelics have an antidepressant effect. They do both at the same time, so they get mythically linked, because the human brain works like that. It sees causation where there’s association.”

Researchers are now attempting an uncoupling: What, exactly, is responsible for the positive mental health outcomes? Which components of a psychedelic treatment are required, and could any be removed? Initiatives from academia, government, and the biotech industry are beginning to dissect psychedelics to see if they can be tweaked, optimized, or even stripped of the psychedelic experience altogether—and still be an effective treatment.

This area of study raises the question: What would a non-hallucinogenic psychedelic be like? It might be less subjectively spiritual or profound, and it very possibly would not work at all. But if it did work for depression, some experts say the arrival of a non-hallucinogenic (or somehow modified) psychedelic is inevitable. This kind of drug would be more scalable, marketable, and profitable than one that causes trips. It could also be more accessible than current frameworks for psilocybin treatment for depression—treatments that take hours at a time—providing the most large-scale benefit to those who desperately need more options for treating mental illness.

“Unless psychedelic effects are the mechanism by which these drugs work, sooner or later, these drugs will not have psychedelic effects,” Raison said.

After the depression studies at Imperial College thrust psilocybin’s potential medical benefits into the spotlight, clinicians have started to see that, for some patients, the effects can wear off after a few months—even in people who initially showed massive improvement.

“That suggests that it’s not just a change in your perspective of the world from an experience that benefits you,” Raison said. If an incredibly powerful experience fundamentally shifted your worldview, why would that benefit start to fade? “That there’s some kind of physiological something along with it.”

He’s in the process of recruiting participants for a study that will attempt to answer part of this basic science question regarding psychedelics: What is the role that conscious experience plays during a trip? To do this, he’ll have people trip on psilocybin, and then prevent their brains from making memories of the experience.

If someone took psychedelics while unconscious or asleep, and it still led to an antidepressant effect, it would suggest that the “trip” isn’t necessary for the clinical outcome. But Raison’s study is an even subtler investigation.

He’s assessing the importance of something called access consciousness. If you take shrooms, you’ll have an immediate experience of your trip, or phenomenal consciousness. But later, you’ll access the experience again, remembering what happened—reflecting and integrating whatever your experiences were.

“We prefer to try to peel the onion and start with that outer layer of consciousness, which is the memory of the event,” Raison said.

They plan to use a sedative drug called midazolam, which has been shown in studies to produce a kind of amnesia that can temporarily prevent people from forming new memories. At certain doses, a subject could remain awake and have a psychedelic experience—but not remember it. “This is like going on a bender,” Raison said. “You’re dancing, you’re screaming, you’re kissing people, but you don’t remember.”

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They’ll first test what doses of midazolam puts healthy volunteers in this state. Then, they’ll repeat the process with a group of people who have depression and compare those who take psilocybin and remember it to those who don’t. If both groups have equal benefit from the psilocybin, it would suggest that you don’t actually need the memory of the experience for it to be used for depression.

“You might still need the phenomenal conscious experience,” or the awareness of the trip actually happening, Raison said. If psilocybin still works with a memory erase, the next step would be to do it again with unconscious participants. On the other hand, if erasing people’s memories of a trip with midazolam does lead to a dulled effect on their depression symptoms, it indicates that the memory and reflection of the event is an important component.

Raison thinks that even with the results from the existing trials, we won’t really know how to treat a disease like depression unless we fully understand what the psychedelics are doing. His study could be a portal into that.

“We can begin to ask: what’s the difference in the brain between people who are getting psilocybin by itself versus psilocybin plus midazolam?” Raison said. “Then you’re beginning to identify pathways that are specifically associated with a sort of antidepressant effect.”

A non-hallucinogenic psychedelic already exists and there is another medical context where it’s been shown to have benefit: headaches.

Emmanuelle Schindler, a neurologist at Yale School of Medicine, treats cluster headaches, which have acquired the sinister nickname “suicide headaches” from the frequent and excruciating pain they cause.

Schindler heard anecdotally about people using traditional psychedelics to improve their cluster headaches, and from a 2010 study that surveyed people’s use of something called 2-bromo-LSD, or BOL, for their headache disorders.

BOL differs from LSD by just a single atom, and is non-hallucinogenic. When a chemical compound called bromide is attached to LSD, it removes its psychedelic effects. BOL was created by Albert Hoffman, who also invented LSD. (When Hoffman first made LSD, he was actually looking for new medications for migraine headaches.)

In interviews with a group of headache patients named Cluster Busters, Harvard Medical School psychiatrist John Halpern found that 41 percent of them had less painful or less frequent headaches when they took a variety of psychedelics, and for 52 percent of them, their cluster cycles stopped completely. A survey on BOL use found it can provide similar relief for cluster headaches.

“Those who got their hands on [BOL] or those who took part in that small study have said that when they use it in the same way that they would use psilocybin or LSD, it had similar effects on their headaches,” Schindler said.

It’s still unknown how BOL—or LSD or psilocybin, for that matter—ease cluster headache symptoms. One clue is that both the psychedelics, whether hallucinogenic or not, chemically resemble a lot of other headache medications.

Psilocybin’s chemical structure is very similar to sumatriptan (brand name Imitrex), a medication used to treat one headache at a time. It’s also similar to melatonin, a hormone that helps regulate our sleep cycles but can also help treat headache disorders, too. LSD is similar to methysergide, a headache medication that isn’t available anymore, and dihydroergotamine, which is used to treat headaches and, when taken over the course of several days, can help to prevent future headaches.

But psilocybin, LSD, and BOL differ from those drugs in a big way: They can lead to long-term relief even after a few doses, similar to what researchers are seeing in the trials with treatment-resistant depression. Other headache medications don’t do that, Schindler said.

BOL is not officially being used to treat any headache disorders, but it’s still an intriguing example in which the hallucinogenic piece of the puzzle isn’t necessary. BOL can have similar effects as psilocybin and LSD, Schindler said, and so patients aren’t required to go on a psychedelic trip to find relief.

A more customizable psychedelic therapy like that is appealing to many—both patients who might not want the trip, as well as private companies and governmental groups tinkering with these drugs to make better versions of them, or using psychedelics’ interactions with the brain as a launch point to make something entirely new.

One such effort is a new AI-enabled psychedelics lab called Entheogenix Biosciences, launched by two companies, ATAI Life Sciences and Cyclica. Srini Rao, the Chief Scientific Officer of ATAI and the CEO of Entheogenix, agreed that there are intersecting, and sometimes competing, theories of how psychedelics help people—experientially or biologically. Depending on which holds true, it will likely influence the ways psychedelic drugs are brought to market.

Entheogenix will be studying several psychedelics—ketamine and DMT as well as psilocybin—and evaluate which parts of their chemical structures are associated with mental health benefits. “Then we can start taking out those pieces associated with hallucinations, for example,” Rao said. “We can design new compounds that presumably don’t hit those pieces but maybe maintain some of the other pieces of pharmacology that are critical, particularly those around neuroplasticity.”

They’re not only seeking out non-hallucinogenic psychedelics (after all, the hallucination bit might be crucial) but also analyzing different chemical versions of psilocybin that could “improve” on the original model. These versions might retain the psychedelic element, but at much shorter durations. Instead of the normal six to eight hours, it could be condensed to 30 to 45 minutes. They could also potentially fix other issues with the drug, like one with another serotonin receptor that is associated with damage to the heart.

“If you’re going to design new molecules, you might as well make those as pristine as possible,” Rao said.

It’s an approach that The Defense Advanced Research Projects Agency (DARPA), the U.S. military’s research branch, will be attempting their own version of, too. In September, DARPA announced the launch of the Focused Pharma program which will develop new “neuropsychiatric” drugs loosely inspired by the results from various clinical trials of psychedelics. The goal of DARPA’s program is to develop treatment for service members and veterans with PTSD, depression, and substance abuse.

The project is explicitly not investigating psychedelics themselves, a spokesman for DARPA said, but the existence of psychedelic research had an influence on the group’s work—it showed it’s possible for a drug to have such immediate effects on depression, as well as interact with the brain in complex ways, said Tristan McClure-Begley, the program director of Focused Pharma.

McClure-Begley said that even if psychedelics as they exist now were approved for such a purpose, their use would be limited given their side effects. He doesn’t see how psilocybin could realistically be implemented for veterans and other populations on a wide scale given that as the treatment exists now, a person needs hours of preparation, hours for their trip (or two trips), and then hours of follow-up. There are two trained, and therefore expensive, clinicians with them during the trips, and others to facilitate the prep and integration sessions.

“This is costly, it’s hard to bring to scale,” Raison said. If the experience of tripping isn’t tied to the mechanism in psychedelics that has a positive effect on depression, then “it’s hard to see why, if you’re trying to treat a disease, you’d insist on people having them. Tons of people are going to be working to try to find a way to optimize these molecules and make their delivery as simple as possible.”

It might not be so easy to draw a line in the sand between biology and experience, said Chris Timmermann, a neuroscientist at the Psychedelic Research Group at Imperial College. All drugs have an experiential component to them, even those that aren’t psychedelic. If you take an antidepressant and it makes you feel better through “biological” means, you’re still going to have healing experiences from engaging with other people, again, or your work, family, and finding more pleasure in life.

“There’s a huge interplay between contextual factors and the experience people have, and there seems to be a very strong relationship with the quality of people’s experiences and the psychological outcome, from a clinical perspective,” Timmermann said.

He thinks that from a scientific standpoint, it is important to dissect the psychedelic experience from its biological impact. But he hopes that the push to analyze the experience leads to more attention paid to experience overall—no matter what the research ends up finding.

Let’s suppose that Raison’s study finds the psychedelic experience is, in fact, necessary for depression relief. Timmermann doesn’t think we should stop there, and continue to treat “experience” as one event, rather than a combination of many.

Timmermann has been studying DMT, the psychedelic compound found in ayahuasca, and said that in reports of what people experience, they often bring up similar themes or visions, as with psilocybin. “Like, ‘I went to a different dimension’ or ‘I saw these entities or beings,’ and so on,” he said. “We have good evidence that experience is a crucial factor for people to get better. But it’s also very valid to try to make sure why this is the case.”

Many of what people say are the most meaningful pieces of the experience are ones they have a hard time describing. We could be missing out on understanding those breakthrough moments. “It’s almost like it’s uncharted territory,” Timmermann said. “Science hasn’t veered in the direction of phenomenology of experience. It’s like we have no language for it.”

Not only do the fuzzy lines between experience and biology need to be scrutinized, but the very experience itself needs to be dissected and analyzed too, he said. Perhaps experience is important, but certain types at certain times are more or less so. In a study forthcoming in Scientific Reports, Timmernmann and his co-authors broke down the experience of a DMT trip, showing what people felt at different time points after taking DMT, the associated intensity, and the associated brain activity.

This kind of discipline and rigor may seem like an unconventional way to approach a psychedelic trip, but if we’re seriously going to use these drugs as medicines, that will be necessary, Raison said. Since psychedelics can produce intensely profound feelings, it can seem wrong to strip psychedelics for their parts, categorize the mystical, taxonomize the spiritual, or come up with psychedelic-inspired meds that will be produced and sold by big pharma at astonishing profit.

Raison said if he’s honest with himself, his gut feeling is that the conscious experience of the trip is a factor. He thinks many clinicians who witness the profound and life-changing experiences their patients go through would agree. But the point is we don’t know for sure, and he doesn’t think researchers in this field should gravitate to either extreme—one assuming it’s all biological, and getting rid of all the woo-woo psychedelic stuff; the other treating psychedelics like they’re so sacred that they shouldn’t be tampered with.

“I’m personally rooting for consciousness,” he said. “But as a mentor once told me, ‘If you’re afraid of the truth, you should get out of science.’ You never know, right?”

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Stressed Students, Bridesmaids Drama, And More: An Advice Column From A Total Amateur

Hi! A while ago I asked the BuzzFeed Community to tell me a problem they’re having, so that I — a person with absolutely zero professional qualifications to help anyone — could give them advice. So, here are the results! NBC 1. “Dear Andy,I have NO idea where I should go to school… I’m applying…



Stressed Students, Bridesmaids Drama, And More: An Advice Column From A Total Amateur

Hi! A while ago I asked the BuzzFeed Community to tell me a problem they’re having, so that I — a person with absolutely zero professional qualifications to help anyone — could give them advice. So, here are the results!



“Dear Andy,

I have NO idea where I should go to school… I’m applying to 12 schools, 10 on the west coast and two in BC. I’m a high achieving student (I’m in five AP classes, president of two clubs, volunteering and a job, etc.) and I don’t want to go somewhere that’s all about the pressure, but I still want a high quality education. I’m so lost, help!”

—The Overwhelmed Student

Dear Overwhelmed,

You posted this just to dunk on all of us academically, didn’t you?

Kidding. In all seriousness, you can get a very good education at a bunch of different schools. And when you’re done, you’ll have a degree that probably nobody will ever verify! In my completely amateur opinion, the only reason people think the “Ivy League” schools are better is because a lot of wealthy, well-connected people go there (and have gone there), and therefore when you graduate from one, you’re more likely to get in at some fancy law firm or whatever because of your connections. So if you aren’t planning on being like, IDK, the CFO of Waystar Royco or something, just pick the school that you really want to go to. Where are you going to be happy living? Is one of the schools in a city you already want to move to and/or the city that has jobs in your future profession? Is it important for you to be close to home? How many Wendy’s are there on campus, and do they carry Spicy Nuggets? These are the questions you should be asking.

Oh, wait, actually…forget all that. Go to the school that will cost the least when you factor in tuition, room & board, and any scholarships you might get. Student loans are a curse and you want as little of them as possible. In the end, you might not even end up doing the thing you studied in college. Wanna know what degree I have? A BFA in Theater Performance. An acting degree. And now here I am, writing for a website. You’ll be fine.



“Dear Andy,

I got married this summer, and I decided to choose only family to be my bridesmaids. For me this included three female cousins and my (now) sister-in-law. My husband, on the other hand, decided to do a mix of family as well as friends from high school for his groomsmen. I had no problem with this at all.

I had a few friends who I knew would expect to be bridesmaids, so I made it clear to them from the very beginning that I would be choosing family only as to not have a huge wedding party, but I told them they were not any less important to me and that I still wanted them to be involved in the wedding as much as they felt comfortable with. Most of the friends I had this conversation with were very understanding, however one straight up told me that she was disappointed (this was two years before the wedding).

Now it’s been a few months since I got married and this friend (a friend from childhood) started talking about the wedding. She told me she felt left out of the wedding since she wasn’t part of the wedding party. It particularly bothered her that my husband included friends and I didn’t. She then proceeded to tell me that it was difficult for her to be there the day of my wedding because of these feelings. AT MY WEDDING. She also included the fact that she didn’t want to upset me and that it doesn’t change our friendship. But if that is the case then why say anything in the first place? I’ve already said one too many times the reason for my bridesmaid choices and how important she is to me regardless. And she says she understands. I just wish she would let it go. Ever since this conversation I feel like I’ve been seeing her in a whole new light.

I do care about her feelings, but I stick by my decision and I don’t regret anything. I feel like I’ve done everything I can to make her feel better.”

—The Besieged Bride

[TL;DR: Bride had only family as bridesmaids, groom had some friends in the mix, bride’s childhood friend felt left out and complained about it a few months after the wedding.]

Dear Besieged,

Question one: How drunk was your friend when she brought this up to you? If she was like, a 6 or more out of 10, I say let’s give it a pass and hope she got it out of her system.

Question two: Has your friend had a wedding of her own yet? If yes, then she should’ve understood the situation, because wedding planning is a special kind of hell and inevitably you have to make difficult decisions like this one that might hurt people’s feelings. So if you’ve planned your own wedding, you know the deal and you’re able to say to yourself, “It’s their wedding, I’m just going to be supportive and have fun.” If she hasn’t gotten married yet, she’ll realize later that it was totally inappropriate to complain about this to you. Hopefully.



“Dear Andy,

I have been taking so many of the relationship quizzes on BuzzFeed but they all say I’m single. The major problem is I have an S.O. Is she just faking or am I?? Help me!! Is my girlfriend not actually mine or are we real?”

—The Quizzical Quiz-Taker

Dear Quizzical,

You’re not real. This is all a simulation.

—Andy (or am I?)


“Dear Andy,

I’m not sure where to live. I live in Milwaukee, WI, right now. Moved here three years ago for school, but that fell through because Milwaukee is friggin expensive. My family wants me to move back to the other side of the state, towards Minneapolis/St. Paul. What should I do?”

—Meandering the Midwest

Dear Midwest,

Get the fuck out of there, it’s so cold! Listen, I used to live in Michigan, and it was depressing because it was grey and miserable nine months out of the year. Now I live in Southern California, it’s sunny and beautiful and my vitamin D levels are through the roof. Migrate south, seriously.

But if you HAVE to stay, I will say that everybody who lives in Minneapolis seems to LOVE Minneapolis for some reason.



“Dear Andy,

My problem is that I struggle with feeling attractive. I started taking birth control when my boyfriend and I started dating (six years ago). I started gaining the weight right after. I’m now a size 12 and my boyfriend is a slender guy. I haven’t felt attractive in the last year. I gained so much weight at one point I was a size 16. I’m back to a 12 and trying to lose weight again. I don’t feel sexy or beautiful in any way. I prefer to keep my shirt on during sex now. I don’t know why my boyfriend still finds me attractive. I have a tummy, I have rolls when I sit down, I just don’t know what he sees anymore. Any advice you could give me would be much appreciated.”

—Struggling With Size

Dear Struggling,

First off, don’t worry about your boyfriend. Clearly he finds you attractive, and when you actually care about someone, the size tags on their clothes don’t matter to you at all. Appreciate that fact and find some security there.

Now, consider the possibility that if your boyfriend finds you attractive at any size, you can too! It’s not easy. It requires shedding every bit of toxic influence that the media and our society overall has thrown at you for your entire life. That takes time and work.

But if you are worried about your physical health at all, consult a doctor. There are many different types of birth control and like 40 different pills, and everyone reacts to each one differently. It can take time to find the right one, and not every doctor is going to be helpful about it. Advocate for yourself if you’re unhappy with your medication. You may have done all of this already and I’m just sitting here mansplaining BC to you, but if so at least you can cross that off your Mansplaining Bingo Card.


That’s it for this week. But if you’re having a problem that you need advice about, let me know! It could be anything: petty arguments that you need a judge to decide who was right and who was wrong, help making life decisions, relationship issues — I’m your completely unqualified man. Email (for total anonymity) or leave a comment here!

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Doctors Can Already Refuse To Prescribe The Pill. The Religious Discrimination Bill Could Make That Easier.

The Australian government is pushing ahead with its proposed religious discrimination laws, and doctors and lawyers are concerned the legislation could allow practitioners to deny or delay medical care when it comes to reproductive health.But as signs in GP’s offices provided to BuzzFeed News show, doctors are already refusing reproductive healthcare under the current guidelines,…



Doctors Can Already Refuse To Prescribe The Pill. The Religious Discrimination Bill Could Make That Easier.

The Australian government is pushing ahead with its proposed religious discrimination laws, and doctors and lawyers are concerned the legislation could allow practitioners to deny or delay medical care when it comes to reproductive health.

But as signs in GP’s offices provided to BuzzFeed News show, doctors are already refusing reproductive healthcare under the current guidelines, before a patient has even walked into an appointment.

Laura — who asked to use a pseudonym to protect her privacy — saw this sign in the waiting room for her GP’s office in Sydney’s north. It makes clear the doctor will not prescribe any kind of contraception or referrals for sterilisation or in-vitro fertilisation.

“I just felt really angry that you can basically say ‘I’m not interested in seeing women aged between 15 or 16 and 50’, and that a bulk billing doctor receiving Commonwealth funding refuses to see certain people,” she told BuzzFeed News. “It is within the law to go to the doctor and ask for contraception so I don’t feel like it should be the right of the doctor to refuse it.”

Laura said it was “really alienating” and she was shocked that the sign was allowed under current guidelines.

“It seems to contravene a woman’s right to access healthcare and it sends a really negative message to young women who might be sitting in the waiting room,” she said.

The doctor can be booked online and Laura worries that some patients might not see this sign and then be refused care.

A Melbourne midwife saw this sign in her GP’s surgery making clear the doctor would not give referrals for abortion and featuring the Badge of the Immaculate Heart of Mary, a Catholic devotional article.

The sign itself does not breach Victorian law, nor professional guidelines governing abortion, as a termination has not yet been requested by — and therefore hasn’t been denied to — the patient. If a patient was to request a termination, the law dictates that they must be referred to someone who will provide it.

“According to the legislation, a patient who requests an abortion must be referred to another practitioner — we expect this law to be upheld by all clinicians,” a Victorian Department of Health and Human Services spokesperson told BuzzFeed News.

Chair of the Australian Medical Association Ethics and Medico-Legal Committee, Dr Chris Moy, said the religious discrimination bill was, to some degree, “a solution searching for a problem”.

“With respect to abortion every [jurisdiction] pretty much allows people to conscientiously object,” Moy told BuzzFeed News. “Most people accept at this moment in time that there can be conscientious objection, but the biggest controversies have always been about your obligations after that and the impact of a delay in treatment should be considered by doctors.”

Australian Government

Religious Discrimination Bill explanatory notes.

The association’s position statement on conscientious objection for any treatment says the impact of a delay in treatment, and whether it might constitute a significant

impediment, should be considered by a doctor if they conscientiously object: “For example, termination of pregnancy services are time critical.”

Moy said doctors need to consider not only their own needs but those of the wider community.

“We as doctors have a right to conscientious objection if we have deeply held beliefs but we cannot walk away from patients and we owe a responsibility to patients in urgent situations,” he said.

Equality Australia chief executive and lawyer Anna Brown said the government’s religious discrimination bill gives additional rights to health professionals who wish to refuse treatment to patients based on personal religious beliefs.

She said it makes it difficult for any health organisation — hospitals, pharmacies, clinics — to enforce standards requiring medical staff to provide “judgement-free treatment, or even treatment at all, regardless of any personal religious views”.

“Because you will not be able to ask current or prospective employees about their religious objections, employers will not — and cannot — know whether someone is willing to do the job until it’s too late,” she said.

“[If the bill passes] a health centre cannot ask its GP whether he objects to prescribing the pill before a patient seeking access books in for an appointment. This will make it very difficult for hospitals, clinics and practices to take steps to ensure continuity of care for their patients.”

Australian Government

Religious Discrimination Bill explanatory notes.

Brown said the bill would “expressly authorise adverse impacts on patient health” to accomodate the religious objections of a health professional, which could have serious implications for patients, particularly those outside major cities.

“If a pharmacist in a small town refuses to dispense a script, how far should the nearest pharmacy be, and how much should it cost to get there, before the law will protect the patient?” she said. “This law doesn’t provide an answer.”

Brown predicted the law would allow “religious judgement” to interfere with the relationship between health professionals and patients.

“Patients will have less protection if a health worker makes certain discriminatory statements during a consultation on the basis of their religious belief,” she said. “For example, women may lose existing discrimination protections if they are told they should ‘pray for forgiveness’ for having sex outside of marriage, falling pregnant outside of wedlock, or sleeping with other women.”

A spokesperson for the Medical Board of Australia told BuzzFeed News that its code states doctors have the right to “not provide or directly participate in treatments if they conscientiously object”.

“However, they must inform patients and colleagues, and not impede patients’ access to treatment,” the spokesperson said.

The code is “not a substitute” for the law.

“If there is any conflict between the code and the law, the law takes precedence,” the spokesperson said. “Anyone who has concerns about the actions of a registered health practitioner, such as a medical practitioner, is encouraged to report this to AHPRA so the concerns can be investigated.”

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists president Vijay Roach said the college’s response to the bill is consistent with its position on conscientious objection, the right of patients to access health care and the duty of a medical practitioner to ensure that a woman can access the health care she needs.

“RANZCOG respects the personal position of all of our members, and recognises the right to conscientious objection in relation to provision of certain aspects of healthcare,” Roach told BuzzFeed News.

“However, the college emphasises that health practitioners owe a duty of care and must refer the patient to other health practitioners or health services where a woman is able to receive the health care she needs.”

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The Sick Refugees Held In Island Camps Have Become A Defining Political Issue For Australia

The health of the hundreds of asylum seekers and refugees held on island nations in the Pacific has become a defining political issue for Australia. World Vision / PR IMAGE A Sri Lankan asylum seeker looks out to sea on Manus Island in 2017. More than seven years have passed since Australia reopened its offshore…



The Sick Refugees Held In Island Camps Have Become A Defining Political Issue For Australia

The health of the hundreds of asylum seekers and refugees held on island nations in the Pacific has become a defining political issue for Australia.

World Vision / PR IMAGE

A Sri Lankan asylum seeker looks out to sea on Manus Island in 2017.

More than seven years have passed since Australia reopened its offshore detention centre on the Pacific island of Nauru. There, and in Papua New Guinea, refugees and asylum seekers were sent to wait in limbo for years, the human collateral of a harsh policy. Many got sick, both physically and mentally.

Fast forward to today. The government desperately wants to repeal the “medevac” law, which, by giving doctors a greater say, makes it easier for the hundreds still in island detention to access medical treatment in Australia.

The issue has become a defining one, and debate on the medevac repeal is likely to feature in Australia’s final political sitting week of 2019.

But how did we get here?

When Kevin Rudd unseated Julia Gillard to return as prime minister in 2013, he made a surprise announcement: nobody who came to Australia by boat in the future would ever be settled in Australia.

Australian Government

Gillard, who led a centre-left government, had reopened detention centres on Nauru and Papua New Guinea’s Manus Island for offshore processing in 2012, as thousands of people tried to make it to Australia by boat. But Rudd’s ban on ever being re-settled in Australia was new.

The policy was justified as an attempt to discourage people from taking the treacherous boat journey to Australia and halt the people smuggling trade in its tracks.

When the conservative Coalition won the election in September 2013, they doubled down on Rudd’s pledge and introduced Operation Sovereign Borders — a military-led operation that includes intercepting boats before they arrive in Australian waters and turning them back to where they came from.

The numbers of potential refugees in the detention centres on Nauru and Manus Island escalated, starting from Rudd’s declaration.

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Asylum seekers at the Manus Island detention centre in 2014.

By June 2014, there were more than 2,500 asylum seekers in offshore detention: 1,198 men on Manus Island, and 1,268 people on Nauru — including women and children.

24-year-old Iranian asylum seeker Hamid Khazaei, who was held on Manus Island, died from a leg infection in September 2014.

Refugee Action Coalition / PR IMAGE

After Khazaei contracted the leg infection, he developed flu-like symptoms. After three days, the Australian government approved his transfer to Port Moresby. He had a series of cardiac arrests. He was transferred to Brisbane, Australia, but he died a week later. A coroner would later find that Khazaei could have lived if he had received appropriate medical care when his condition first deteriorated. He found that Khazaei would have survived if he had been evacuated to Australia for medical treatment earlier.

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Khazaei was the third man to die in offshore detention. Earlier in 2014, Reza Berati was murdered by security guards at the Manus Island regional processing centre, and Sayed Ibrahim Hussein drowned.

Meanwhile the number of people needing medical treatment for serious and complex complex in Australia was escalating. But in mid-2015, the government put on the brakes, deciding transfers to Australia should become “increasingly rare”.


In 2013, 92 people were transferred to Australia. The following year that number went up to 362. The first half of 2015 saw similarly high numbers of transfers.

But in May 2015, after a review of the number and purpose of medical transfers, the government decided they should become “increasingly rare”. According to a directive issued by immigration department secretary Michael Pezzullo, a patient would need to be in a “life and death” situation, or one “involving the risk of life-time injury or disability”, to come to Australia. He said he expected at least half the asylum-seekers temporarily in Australia for medical treatment to be returned within a month.

Previously, family members of a patient were automatically transferred with them. After the review, the immigration department would decide on a case-by-case basis.

The review also led the government to invest in more medical facilities and expertise on Nauru and Manus.

A failed legal challenge to offshore detention saw people take to the streets for the Let Them Stay campaign at the start of 2016.

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A Let Them Stay rally in Sydney in February 2016.

On Feb. 3, 2016 the High Court rejected a claim from a refugee that Australia’s system of offshore detention was illegal.

In the wake of the case, refugee advocates launched the Let Them Stay campaign, demanding that 267 people in Australia for medical treatment (including 37 babies and more than 50 children) not be sent back to Nauru and Manus Island. The campaign achieved widespread support, with churches offering to provide sanctuary, and the 267 people were able to stay in Australia.

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Demonstrators in Sydney in February 2016.

While the government largely stopped returning people to offshore detention, transfer numbers dropped dramatically.

Supplied: Department of Home Affairs.

In the calendar year 2016, just 73 people came to Australia from offshore detention. The number fell to 37 in 2017.

Although it is not government policy to keep sick refugees from offshore detention in Australia, since the Let Them Stay campaign very few people have been returned, even if they are not granted a visa. The last person went back to Nauru voluntarily in April 2018.

In the middle of 2016, two more refugees aged in their 20s died.

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A vigil for Omid Masoumali outside the inquest into his death in February 2019.

Omid Masoumali, 26, set himself on fire on Nauru on April 29, 2016. More than 24 hours later, he was flown to Brisbane, where he died several days later. Just two weeks later, Rakib Khan died at 26 from a suspected overdose.

A groundbreaking case in May 2016 laid the foundations for a legal campaign to get sick refugees to Australia.

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The National Justice Project’s George Newhouse, who represented the woman.

A young woman refugee who became pregnant after a sexual assault on Nauru, and wanted an abortion, brought the case in the Federal Court. The Australian government wanted to take her to Papua New Guinea for the abortion, but the court found she could not receive a safe or legal termination there. The government gave evidence that they did not bring her to Australia because her case was not “exceptional” enough to comply with their strict policy.

In a landmark ruling, Justice Mordecai Bromberg found that the Australian government had a duty of care to the people it holds offshore.

In November 2016, the United States agreed to resettle refugees from Nauru and Manus Island.

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Prime minister Malcolm Turnbull and president Donald Trump meet in the Oval Office in February 2018.

After a famously heated phone call, US president Donald Trump agreed to continue the arrangement, which prime minister Malcolm Turnbull had negotiated with the Obama administration. The first refugees left for the US in September 2017.

In the face of the “unique and complex” medical problems facing refugees on Nauru and Manus Island, the government convened a taskforce of bureaucrats to decide who would come to Australia.

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Home affairs department secretary Michael Pezzullo.

The transitory persons committee, established in mid-2016, sat without a doctor among its members for nine months. Meeting records obtained by BuzzFeed News showed the committee discussed the department’s reputation and the likelihood of litigation when considering what to recommend. Until the medevac law, the secretive committee was the forum where transfer decisions were made.

The memo setting up the transitory persons committee noted that the government continued to see “unique and complex” cases, involving a combination of physical health, mental health and child protection issues. It said the committee’s purpose was to consider the “medical, legal, diplomatic, policy and financial implications” of medical transfers to Australia.

After reading the minutes, a former doctor on Nauru, Nick Martin, told BuzzFeed News: “They’re coming at it from the position of, what can we do to keep this person out of Australia? That a dangerous point to start off from.”

Taiwan and Australia secretly reached a deal in September 2017, allowing sick refugees to receive high-quality care for complex medical conditions — without being brought to Australia.

Solomon203 / Wikimedia

The first transfers happened in January 2018. At least 33 people have gone from Nauru to Taiwan for treatment, but many have refused to go.

Between August 2016 and November 2017, five more detainees died. Four had been held on Manus Island, and one on Nauru.

Building on the May 2016 decision, a flood of cases seeking medical transfers from offshore detention hit the Federal Court throughout 2018.

Refugee Action Coalition / PR IMAGE

A group of men protest in the Manus Island detention centre in November 2017.

Some of the cases were brought on behalf of children on Nauru suffering from serious psychiatric problems.

All up, lawyers brought 48 court cases between December 2017 and February 2019 to have clients transferred for treatment. They won every case.

Lawyers who fought the cases have said the government routinely ignored requests to evacuate desperately ill refugees, forcing lawyers to front court on weekends and in the middle of the night.

In the midst of the legal onslaught, the Department of Home Affairs formalised its hardline policy: nobody would come to Australia unless there were “exceptional” circumstances.

Supplied: Department of Home Affairs.

The policy, from June 2018, stated that transfer requests would only be considered if a patient had a “critical and complex” medical condition that would result in their death or “permanent, significant disability” if they were not transferred to Australia.

The transitory persons committee would later discuss whether there was “room for compassion” in the policy.

A health crisis was building. Evidence grew that the environment of offshore detention not only made it more difficult to access medical treatment, but was causing health problems in the first place.

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MSF doctors addressing the media in Sydney in October 2018.

By mid-2018, health contractor International Health and Medical Services had started regularly reporting that the environment on Nauru was a factor causing ill health among refugees and asylum seekers.

International medical charity Médecins Sans Frontières agreed. “Living under a policy of indefinite processing creates a perpetual state of despair, making it impossible for asylum seekers and refugees to recover,” said the organisation’s Australian president in December 2018. After spending 11 months working on Nauru, MSF was expelled by the Nauruan government. MSF described the mental health situation on Nauru as “disastrous”.

“In fact the mental health situation and suffering is amongst the most severe that MSF has seen around the world, including in projects providing care for victims of torture,” president Stewart Condon said.

In mid-2018, two more asylum seekers died.

Children on Nauru developed Resignation Syndrome, a rare psychological illness where they withdrew from the world.

Mike Leyral / Getty Images

A 12-year-old Iranian refugee girl, who had attempted to self-immolate with petrol, on Nauru in September 2018.

BuzzFeed News reported, and MSF later confirmed, that a number of children held on Nauru had developed the condition, which doctors liken to “going into hibernation”. Children with the condition withdraw from the world, cease eating, drinking, speaking, and using the toilet, and fall into a seemingly comatose state.

Revelations in the media and the courts meant the Kids Off Nauru campaign gathered pace in the last months of 2018.

News Corp

The front page of the Sunday Telegraph on October 28, 2018.

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A billboard outside parliament in November 2018.

This is big. Page 2 of today’s @dailytelegraph, which is a Murdoch newspaper. #KidsOffNauru

This is big. Page 2 of today’s @dailytelegraph, which is a Murdoch newspaper. #KidsOffNauru

Meanwhile in Canberra, home affairs minister Peter Dutton launched a leadership challenge against prime minister Malcolm Turnbull.


Dutton announcing his challenge on August 23, 2018.

Dutton was unsuccessful in the first spill, but over the course of a chaotic parliamentary week, Turnbull lost the numbers and resigned as leader.

A second spill saw Scott Morrison emerge victorious and be sworn in as prime minister in August 2018.

During her campaign, Phelps had spoken out about the treatment of refugees in offshore detention.

Her victory, together with the resignation of MP Julia Banks from the Liberal party because of her disgust with the leadership spill, left the Coalition with less than half of the seats in the lower house of parliament.

In February 2019, Phelps and the combined forces of Labor, the Greens and other independents succeeded in getting the medevac law through parliament.

Lukas Coch / AAPIMAGE

It was the first time a government had lost a substantive vote on the floor of the House of Representatives in 78 years. The government stridently opposed the changes, which gave doctors a greater role in deciding who would be transferred. The government claimed it would lead to a flood of people smuggler boats making a dangerous sea voyage to Australia.

The first people transferred under medevac came to Australia on March 29, after the law commenced at the start of March.

Meanwhile, the health crisis in detention was worsening. In the first three months of 2019, 43 detainees were admitted to Nauru’s Regional Processing Centre Medical Centre (RPCMC), for stays between 1 and 44 days. The majority of admissions were for mental health treatment and some of the 43 were admitted more than once, with 73 admissions in total. There were 359 detainees in total on Nauru at the end of March.

Although the minority government could not repeal medevac, it fought the law in the courts, but lost in the Federal Court and the Full Federal Court. It has also tried to argue the courts cannot order refugees to be transferred from offshore, but was unsuccessful in the Full Federal Court. It wants to appeal the judgment in the High Court.

In February 2019, the last four children left Nauru, boarding a plane for settlement in the US.

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A woman and her daughter protest in Canberra in November 2018.

The Morrison government was returned in the May election, this time with a majority.

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Morrison’s victory speech.

But that election also brought back Tasmanian senator Jacqui Lambie.

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Lambie returns to parliament in July 2019.

With its newfound parliamentary majority, the government passed a bill to repeal medevac through the lower house in July. But it needs Lambie’s vote to secure a victory in the Senate before it is passed into law and medevac is gone.

Meanwhile, medevac has continued to operate.

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Doctors call for medevac to be saved, at parliament house this week.

Under the first six months of the medevac regime, 127 people were approved to come to Australia. Since medevac became law, there have been no deaths in offshore detention. The independent panel which reviews government vetos of medical transfers has agreed with the government most of the time.

With one week left for the government get it done before the end of the year, all eyes are on Jacqui Lambie. She’s said she’ll vote to repeal medevac, on one condition…

Lukas Coch / AAPIMAGE

…but has refused to reveal the condition, citing national security. Nine newspapers reported that she wants the government to secure third-country resettlement for the people remaining on Nauru and Manus, perhaps by taking up New Zealand’s offer.

What happens next? We’ll find out this week.

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