Strategic Social Change in Cancer and Psychedelics: Lessons from Dr Tony Back

I was terrified to start Healing Cancer Journeys.

Not because I doubted the mission. I was terrified because starting HCJ meant coming out publicly about my own psychedelic use.

Would my family shun me as a drug user? Would my employer fire me? Would the cancer community judge me harshly for discussing illegal substances?

But I also knew that staying silent perpetuated the exact stigma I wanted to fight. If people living with cancer never spoke openly about how psychedelic medicines helped us, these medicines would remain forever associated with outdated hysteria rather than legitimate healing.

So I came out. I started talking publicly about my experiences with psychedelic medicines. I was being intentional about putting a human face on psychedelics. I wanted to be strategic in creating social change to increase safe access to healing medicines for people living with cancer. 

And then I met Dr Tony Back and realized I was a complete amateur. During our recent podcast episode, Tony and I explore how he has spent many decades strategically changing systems. First in cancer care communication. Now in psychedelic medicine access. He has helped countless patients. But goes beyond individual patients to identify systemic problems and create systemic solutions that transform entire fields.

This is what strategic social change looks like. And as the cancer community advocates for our right to determine which medicines to use in our healing journeys, we learn from Tony’s example.

Finding the Pattern Early

Tony's orientation toward systemic change began long before psychedelics when he recognized the challenges of difficult conversations between doctors and patients.

As a college sophomore, he spoke with his mother's oncologist about her blood cancer complication. Tony described that the oncologist "talked to me all about her spleen. Just massive details about the spleen. But didn't really talk about the big picture."

In that formative experience, Tony recognized that many oncologists are trained to discuss specific organs, but simply aren’t equipped to have difficult conversations about life and death.

Years later in medical school, Tony watched famous doctors interact with patients and thought: "Does anyone really know how to do this?"

He described a patient who had died unexpectedly. The attending physician said, "Well, she was an old trout." And everyone followed him around the corner "like a school of fish." Tony thought: "Why doesn't someone say something about this?"

As he progressed through training, Tony noticed attending physicians would avoid difficult conversations and "give them to the most junior person on the team."

So Tony didn't just get better at having those conversations himself. He helped to create VitalTalk and OncoTalk, training programs that have taught thousands of clinicians how to communicate with seriously ill patients.

His key insight in these training programs: "If I'm different, they will be different.” Tony saw that if doctors show up differently in conversations, the entire dynamic shifts. Patients respond to emotional presence. They need both facts and empathy.

This established Tony's approach to social change: identify a systemic problem and create a systemic solution. Don't just work around broken systems. Change the systems themselves.

Strategic Disclosure as Activism

In 2018, Tony made a calculated decision. He would publish an article in the Journal of Palliative Medicine titled "What Psilocybin Taught Me About Dying."

The article described his personal experience using psilocybin. An illegal Schedule I substance. Published in a respected medical journal.

Tony drew inspiration from LGBTQ+ activism. Tony shared that came of age as a gay man in the 1980s during the AIDS crisis. He'd heard activists say: "Until everybody comes out, this is not gonna change." Tony reflected, "I was kind of skeptical at the time, but later I realized they were totally right." 

When he got into psychedelic research, Tony recognized the same dynamic. Patients talking about wanting access created one conversation. But doctors publicly stating they had used these medicines and found them valuable? That created a different conversation entirely.

Tony was characteristically humble in describing how he calculated the risk: he said had stature in the medical community and stability in his career. And despite his humility, I see this as a courageous act - to share his personal experiences and risk his medical reputation.

While I see his decision as courage, Tony describes it as strategic. "My wanting to be public about that, even though it was an illegal activity, that was very intentional," Tony said.

Intentional. Strategic. Creating permission through visibility. Making space for other doctors and researchers to explore these medicines without fear of professional consequences.

Research as Advocacy

Tony's current psychedelic research continues this strategic approach to systemic change.

When he designed a study offering psilocybin to healthcare clinicians with depression from frontline COVID work, he received 2,200 applications for 30 slots. 

Seventy healthcare workers applied for every single spot. Think about what that reveals. Not just individual suffering. Systemic crisis. Healthcare workers are drowning. Our healthcare system is being pushed to its breaking point. 

Tony told me about one emergency room doctor who said: "I feel more disposable than a used COVID swab."

These weren't recreational psychonauts. These were nurses and doctors at the breaking point.

And after the study: 70% of participants made substantial work changes. Some reduced hours. Some changed specialties. Some left institutions that didn’t respect them. This is not just a reduction in depression. This is significant behavioral change to address the root causes of depression. 

Tony views these career changes as healthy. "All of us get to these turning points in our lives. All of a sudden we go: whoa, is this the right path for me right now?"

Psilocybin didn't fix their burnout symptoms. It catalyzed awakening. It helped them ask: "What is my work as a healer really about?"

But here's the strategic brilliance: those 30 healthcare workers didn't just heal individually. They became advocates. Living examples. People who could tell their colleagues: I tried this. It helped.

Tony designed the study not just to gather data but to create ripples. When healers wake up, they tell other healers. Research participants become agents of cultural change.

The Long Game

Tony reminded me of Margaret Mead's observation: "Never doubt that a small group of thoughtful, committed citizens can change the world."

Tony has spent three decades being that committed citizen. Finding systemic problems in how we care for people with serious illness. Creating systemic solutions. Not waiting for permission. Creating permission through strategic action.

The cancer community benefits from his long game. The communication training he developed helps our oncologists have better conversations with us. The research he conducts creates pathways toward legal access to psychedelic medicines. The personal disclosure he modeled gives other doctors permission to explore these medicines.

My own act of coming out about my use of psychedelic medicines feels less terrifying when I see Tony's example. He did it much earlier. At much greater professional risk. 

And his strategic approach offers a model for how the cancer community can become agents of change. Not just receiving better care. Creating better systems. Not just advocating for individual access. Transforming cultural conversations.

Patient voices are powerful. Doctor voices are powerful too. Both together? Even more powerful.

We can learn from Tony's example. Identify systemic problems. Create systemic solutions. Use privilege strategically. Don't wait for permission. Create permission through action.

Let's journey together.