Authors of nonrandomized studies of people who have used ecstasy (an illicit drug typically consisting of (+/−)-3,4-methylenedioxymethamphetamine, MDMA) often claim that any small difference between users and non-users is evidence of neurotoxic damage, while ignoring the possibility of pre-existing confounding factors (such as impulsivity or childhood adversity) that might mediate both increased drug use and physiological or neurocognitive differences (Krebs et al, 2009). The recent cross-sectional fMRI study of BOLD signal activation in response to visual stimuli by Bauernfeind et al (2011) is not an exception.

Bauernfeind et al report that increasing ecstasy use was correlated with increased cortical excitability, and they suggest that this is most likely related to the damage caused to serotonin transporters. In a press release, principal investigator RL Cowan compared the ecstasy users with people with early Alzheimer's disease (www.mc.vanderbilt.edu/news/releases.php?release=2109).

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