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The issue is you can't do a double blind study on psychedelics.
Indeed, very difficult to surmount that obstacle. Makes me a little less confident in all the positive studies I've read over the years about MDMA efficacy for PTSD, which is a real bummer because it's very exciting to think MDMA can fill the gap in pharmaceutical treatments for PTSD (with therapy of course)
However I think that even if the FDA decides no in August, it just means a few more years of more rigorous studies are needed to get approval. That's would make sense since there is also some mention of other issues with the current studies.
I think MDMA for PTSD is too historically monumental to be hastily researched and approved. I think it's critical to have rock solid evidence of efficacy so that we can obliterate the demonization of psychedelics and wear down the crotchety stigma around what are really valuable and beneficial substances IMO