Live from Web Summit: An Affordable Internet & Pharmaceutical Psychedelics

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Emma Varvaloucas (EV): Welcome to a bonus episode of What Could Go Right? I’m Emma Varvaloucas, executive director of The Progress Network. This is the second part of our two-part episode that we recorded at Web Summit, a conference that brought together 30,000 people and startups of all sizes to Lisbon, Portugal. While we were there, we sat down to talk with a few people for the podcast whose companies and work are trying to make the future better. They’re game changers in their respective fields, and all of them are aiming to impact society positively.

Our next conversation is with Sonia Jorge, the executive director for Alliance for Affordable Internet [A4AI] and the head of digital inclusion program at the Web Foundation. As an expert in the confluence of development and communications policy, Sonia talked with us about how the organization brings affordable internet to countries worldwide, and what works and what doesn’t work during that process.

ZK: So we’re here with Sonia talking about digital divides and internet access at the Web Summit. Sonia, you’ve been addressing these issues for quite some time and they have remained quite some issues. So other than every government in the world deciding to invest several trillion dollars to hyper-connect everyone and lay fiber optics and invest in 5G and give everyone devices, what can we do about making sure that what’s increasingly a utility, like water and closing heat and electricity, how can we make sure that everybody has access to the wonderful and sometimes not so wonderful world of the web?

Sonia Jorge (SJ): Right. It’s actually not very difficult to do a couple of things. It’s about political will, right? But two things that I like to highlight that are really easy to do and make a huge difference. One is if countries had very clear national broadband plans, with clear targets, clear project and programs to address these issues, it would be very easy to actually address and solve the problem. We know what to do. We know exactly how it can be done, and it’s about just having the will to put it in practice. So that’s one. The other thing is to support that, again, because we work on policy, especially in low- and middle-income countries, one of the things that we focus on in our work is helping governments have also clarity from a policy perspective. Is the digital development space in their country one that is conducive to not just the investment in the infrastructure, as you were saying, but also in supporting all the other compliments that make a digital society possible, like are people digital citizens? Do they understand how to use technology? Do they have the skills? Do they have the knowledge? Do they benefit from the content that is online? Do they know what it means to be an active digital citizen recognizing their rights but also their duties when they engage with technology? And I think those two actions from a policy side to support that, this idea of digital citizenship as well as very strong clarity around broadband planning, and when I say broadband, it’s to make sure that people have access to… access that is also of high quality—that would do a lot.

ZK: So does the impending rollout globally of 5G technology… One of the things that happened, for instance, in Sub-Saharan Africa, is that because there wasn’t as much embedded energy infrastructure, it’s a little easier to have micro-solar projects and solar because you’re not competing with an embedded industry. Does 5G offer a better prospect at a less cost than having to lay lots of cable?

SJ: The telecom sector is similar to the other sectors also in Sub-Saharan Africa. So you have dominant players, you have, you know, in some markets really excellent, healthy competition. In others, you don’t. And so, it’s similar. Now, should internet access also be, as you were asking earlier, and some people like to say, a human right, a public utility? I would argue for it. Absolutely. It would solve a lot of problems because you would have a mandate to do things in a different way. But can competition and can policy also help us get in the, you know, kind of going in that trajectory? I think it can as well. The thing is that for that to happen, we need to make sure that we have strong regulation, right? Really strong policy to allow competition to be healthy and really result in good pricing and good options for people. If it doesn’t, we need to do something different, and we haven’t done enough of that.

And I think many countries feel very… maybe not confident to actually take the kinds of actions that are required to turn around what competition can do for the markets, and recognize what cannot be done, and compensate that with strong partnerships, with strong public and universal access type of programming that in some countries has proven to be really successful. And so embracing that, you know, the ability of understanding that there’s not just one way of doing it. Sometimes part of the equation is understanding all the pieces to it, right? It’s like a puzzle. You can work really well with one piece of the puzzle or another, but if you don’t do, if you don’t work on another piece, the whole puzzle together is going to fall apart. And so you have to work on all of these pieces together.

ZK: One flip side is, do you worry sometimes about the ways in which many governments have used increased broadband access for increased control? I mean, the hope was that, like, all this would be a liberating, connecting, economically beneficial, which it is, and it can be, but there’s also the downside to it.

SJ: The threats, the abuses, absolutely. This is why I like to use the concept of digital citizenship, because I think it’s really important that everyone understands that by coming online—and those of us that also work on enabling connectivity, we also are just as responsible to make sure that that connectivity is safe, is private, that our personal data is protected. And so I think that the concept of digital citizenship really encapsulates that. It’s about not just what we as users and consumers have the rights to, to that opportunity, but also our duty to behave in a way, and to learn to behave in a way that allows us to be who we want to be in the digital space. And I think that’s really important. That’s especially important for women, as you know. Not only do they remain mostly excluded, but when they’re not excluded and come online, they are abused at a much higher rate, and it’s a very ugly environment.

And if you don’t have that very strong sense of both right and duty and understanding, you cannot benefit from it, you cannot reap the opportunities that you can actually, you know, reap from these kinds of digital environments. So it is important. We don’t want an unsafe internet. We don’t want an internet that is not private. But how many people spend the time learning to use? I mean, there’s a bunch of hackers here that I’m sure are probably trying to check all of our phones, and it’s so easy to do, and people are still not using VPNs. And this is the Web Summit. I’m sure some of that can go on [inaudible]. So anyway, that’s just a comment on the side.

EV: I was wondering if you could tell us a success story. You mentioned that there are some countries who have gone in and had increased access and hopefully avoided these pitfalls that we’re talking about now. But are there a few examples you can give us, which ones and how it happened?

SJ: Yeah, I mean, I would say the countries that we actually have been supporting since A4AI started as an initiative, in Ghana, Nigeria, and Mozambique in Africa, and in Latin America; the Dominican Republic is one that I’m so proud of, especially now. These are countries that were not in very good shape when it came to connectivity, especially affordable and high quality, what we call “meaningful connectivity,” and through a lot of really good work, focusing on good policy and really focusing on solutions to make it happen, have made incredible strides.

There’s a lot more to be done, no doubt. And there’s many more new things that we have to be more aware of, but they’ve made incredible strides. And not only that, they’ve proven that when they plan well, and then when they plan with everyone at the table, things actually can happen, because it’s not just about the government’s interests or just private interests separate. It’s about all of our vested interests together as a collective. And so in those countries, not only has there been a lot of progress, but really good progress. In Ghana, not just about, you know, say, infrastructure or broadband in general, in the aggregate for the country, but it’s targeted projects for rural areas, targeted projects for women and girls, and all of these kinds of things that together really create a good positive solution.

EV: And how much of it is, like, best practices as far as, you’ve done this before in certain countries, and you’ve seen what works, and so you can go in and say, “look, this is the experience that we’ve had,” and how much of it is every country is completely different, and it needs a targeted approach, or it needs something new?

SJ: Well, that’s a good question, Emma. That’s very smart, and I’ll tell you, we always base so much of our advice on good practices. But good practices are only as good as the evidence that they can share, right? Often, a good practice is good in a particular environment, like you were alluding to, and it doesn’t work in another environment. Part of what’s important, what we have to be responsible for is understanding it’s not so much, “it was a good practice,” but what were the conditions that made it possible to be a good practice? And if you know those conditions, then you can tweak and work to see so that you can make that happen. And you can also accept the fact that a particularly good practice in one area does not work elsewhere. And you need to basically reimagine, rethink a particular process in a new place. And that’s okay. We don’t have to all be the same. In fact, that’s what makes us more interesting.

ZK: Well, thank you, Sonia. And thank you for the conversation, and thank you for the work.

SJ: Of course. Thank you.

EV: Thank you, Sonia Jorge, for the work you’re doing.

How do you feel about the healing potential of psychedelics? Today, we’re playing our conversation with Robert Barrow, the CEO of MindMed, a company that researches and develops psychedelic-inspired medicine that they hope will be able to treat mental illness and addiction.

Zachary Karabell (ZK): So we caught up with Rob Barrow, CEO of MindMed at Web Summit, and we’re having a conversation about what for many people is a secret passion, but there’s increasingly a public debate about “what do we do about a variety of substances that society has deemed illegal,” from psilocybin to LSD to MDMA to, in certain parts of the world still, cannabis that also could have profoundly constructive therapeutic effects and the ability to do a lot of good in the world, even though the cultural and social and legal framework says that they only do harm. So how does one square that circle? You know, you come along and you say, “Hey, wait a minute. No.” But what about that whole narrative of these are bad things that do bad things to good people?

Robert Barrow (RB): I think that’s really a social story that’s been told with politically motivated reasons for many, many years, and that certainly has changed in recent years.

Ultimately, what we need to do is have definitive research to prove the benefits of these drugs. If we can show that, if we can show that it benefits patients, I think the world will change its mind about the applications. No one really looks at psychostimulants and says, “oh, these are just bad drugs,” right? Our kids are getting Adderall and Ritalin regularly, and these obviously have psychoactive effects, and they have relations to other controlled substances. The same is true here. I’m not saying it’s the same story as the ADHD treatments. But it is really important to just recognize that until we have definitive clinical data to say these drugs are safe and effective, it’s open to a political narrative. And we prove it, the books closed. It will be proven once and for all. And we’ll have a really well-defined path forward.

ZK: I mean, it’s definitely true, like, I have this debate constantly with my teenage son—not really a debate because I happen to agree with this—but a discussion of the arbitrary lines that we have socially drawn between extremely powerful drugs like Ritalin, um, like Prozac, I mean these are mood altering, targeted substances that were designed for purposes, but unequivocally have a significant effect on one’s psyche on one’s physicality, you name it, and we’ve decided, okay, those are, those are acceptable and legal. And then we have a whole series of other drugs, also powerful, also potentially destructive or constructive, that we’ve just decided are off the table and off the spectrum. So how do you, I mean, how do you navigate the legal challenges of a lot of what you are looking into and researching? You know, most of these substances are illegal to buy and illegal to use.

RB: Yeah, I think it has everything to do… in the psychedelic world, a commonly discussed terminology is set and setting. And really, if you zoom out and take a more standard medical approach, the real question is “how are patients observed and how is safety managed per treatment?” So it’s a very different thing to, say, have someone just go take LSD at a concert or on the street, very different safety and efficacy profile compared to coming into a controlled clinical setting with experienced medical professionals. Those are two very different applications. And so, as we think about how these can be most effectively used, we see it as a pharmaceutical product. One that can be rolled out into our mental health infrastructure that exists currently and that individuals can access. I think about my family from rural North Carolina, none of them are going out and doing LSD or psilocybin to benefit themselves.

ZK: That you know of.

RB: That we know of. Well said. But if one day they become approved therapies and one of them has depression or anxiety, and we see that there is a huge therapeutic benefit with a relatively low risk, I envision a world one day where those individuals in particular are going out and being prescribed these therapies and having a sort of life-altering experience and treatment session that puts them on a new trajectory and that changes the course of [inaudible].

ZK: So do you think the story of what’s kind of happened with cannabis over the past 10 to 20 years, where multiple countries from Canada to I guess now nearly 20 states in the United States and a few countries in Europe from the Netherlands to Switzerland—I don’t know the recent… I think France as well now—is it a similar pathway toward greater social acceptance for cannabis that then leads to more, “Huh, maybe we should reconsider what these substances are, what they do.” Because you have this long period, right, where medical marijuana was acceptable, but not recreational use, or is it very different do you think?

RB: I think it’s very different. I think it’s night and day compared to cannabis. We are developing, and other companies in the psychedelic space are developing, these as pharmaceutical products. So they’re going through the FDA [Food and Drug Administration] and AMA [American Medical Association] approval processes. That takes longer; it’s an expensive, labor-intensive effort to get these across the finish line. But once they are, they will be prescription drugs that you’ll get prescribed by a physician in the US. You go to your doctor and they’ll say, “You have anxiety,” let’s say. “This is a treatment option you could consider.” I think that is a total sea change from a state-by-state, extralegal policy legalization process. We have no direct interest in altering the course of the legality of it. It’s like, no, we want to see these approved as drugs. And ultimately, I think that’s going to lead to broader adoption, or more social acceptance, and more permanent acceptance.

To me, this is the thing: If you leave open to the political winds the accessibility of a drug or not, the tide can turn right? I mean, it can be that we decide this decade that psilocybin should be illegal, and then in 20 years, “oh, actually it’s a bad thing; we don’t want it anymore.” I don’t want to risk that. I want to see these drugs get approved, be prescribed, get on the market, and hopefully get out the patients that need them. That’s the ultimate mission here.

EV: Given that this future rests—like you said at the beginning—on the proof, you know, “does this really work or not,” where are we on the proof? What does the research tell you?

RB: An enormous body of academic data that dates back to the 1950s and 60s on LSD, and to some extent on psilocybin—there’s been a lot of recent research into those two molecules in particular. Our friends at MAPS had a positive Phase 3 study of MDMA in treating post-traumatic stress disorder. Colleagues at Compass Pathways are going to have a Phase 2 read-out of psilocybin and treatment-resistant depression later this year.

And there’s a number of other studies that are happening at leading research universities around the world that’ll be coming out in the next six to 12 months, including some that we have a direct involvement with on LSD and anxiety disorders. The evidence is substantial historically, certainly on the efficacy side. On the safety side of the equation, there was just an enormous body of data from well-controlled research, and dating back decades, showing that these substances when administered in controlled settings are enormously safe. We have to prove it to the FDA. They don’t meet the FDA or AMA standards as of yet. But I think we can take an enormous degree of comfort in the opportunity we have based on the historical data. So it hasn’t been definitively proven yet, but I think about it as a drug developer. It’s very rare that you come into a development program, you have safety in a thousand patients, and we see signals in hundreds of thousands of patients.

Most of the time you’re developing new drugs and you don’t know if it it’s ever been in humans before. And you don’t know if it’s going to have some severe toxicity after a single dose. We have a lot of optimism with the psychedelics. I think there’s a very, very clear path forward to getting them onto the market. It’s just a matter of making the right investments, choosing the right indications and putting our heads down and hopefully doing it.

ZK: So final question on this: Is this like the positive, brave new world story, where we have a much greater capacity with much more subtlety, right? Because a lot of the drugs that are legal, like Ritalin and some of the others, are pretty blunt instruments, or at least the way they’re administered, they can be more like a sledgehammer to a nail. Do these create the possibility of more sort of tailor-limited dosage for a whole slew of things that right now are not so receptive to the drugs that we have?

RB: I think everything is on the table, and all we’ve seen to date is that the applications span far broader than just POP indications with psychiatric depression, anxiety. There are applications in pain, there’s applications in cluster headache that we’ve seen. There’s applications in, for instance, phantom limb pain, things that are just intractable. And we’re just in the early innings of understanding exactly where this could ultimately go. I think inherently as well, at least in psychiatric indications, the leading thought about the mechanism of action is that it’s at least some, in some part psychological, right? That there’s some therapeutic element of it. That inherently has a tail that will grow, right? What you need out of a treatment session is going to be different than what I need or what someone else needs. So inherently you’re going in with an individual therapist, you’re going in with your own set of intentions and needs based on your condition. It’s going to be a more direct process than just pure pharmacotherapy where it’s, “take one of these forever, and I hope you get better.”

ZK: Cool. Thanks, Rob.

RB: Yeah. Pleasure.

EV: Thanks so much to Robert Barrow, and maybe we’ll all be tripping together soon on an episode of What Could Go Right? And thank you, What Could Go Right? listeners, for coming along to Web Summit with us. We hope you enjoyed it.

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