Arch
Arch', just some thoughts, which are not really disputing your main points.
There is a clinical trial of the effects of psilo on CH taking place now, at Yale Medical School (thanks to ClusterBusters). https://clinicaltrials.gov/ct2/show/NCT02981173
There might be some errors in what I'm about to "report" about BOL after the initial trials, but it is basically accurate. Around 2010, a US company, Entheogen, patented BOL for CH and purchased the temporary rights to it (it's owned by a university, Harvard I think, if I have the facts right) for a specified period of time (5 years?). Then Entheogen tried to raise the many millions of dollars it would need to do real clinical trials of BOL and bring it to market. I think their main strategy for trying to do that was to partner with a established pharma companies. (The first trial of BOL -- also sponsored by ClusterBusters -- was very important, but it was far from being a true clinical trial of the type required to license a drug.) We were often told that Entheogen was on the verge of raising the money, but it never happened, and then its license on BOL expired. The cost of clinical trials is staggering in itself, and add to that the possibility that they might not be approved because of the LSD content of BOL. So, technically, it's true that the pharma companies didn't see how they could ultimately profit enough from BOL to pursue it. I guess it's important to remember the extent to which CH is "under the radar" in the medical world, because I suspect part of the issue would have been, even if BOL got accepted by the FDA, you'd then have to get doctors to correctly diagnose CH in the first place and then know to prescribe the BOL. When you think of how few doctors even seem to know to prescribe oxygen, that seems like it could be a big issue requiring a very costly campaign to educate the doctors about a condition they very rarely see (plus, you would have, like it or not, the problem of doctors not wanting to prescribe something with LSD in it). I feel like all the combined factors led pharma companies away from wanting to develop a treatment for CH.
I have a long-time friend, my golf buddy of 20 years, who developed a miraculous drug to combat depression. It works when it is first administered, has no side effects, and treats even the worst depression. It has been in clinical trials for more than six years now, at a cost of hundreds of millions of dollars. And that is even after the FDA gave the drug "fast track" status because the early clinical trials were so impressive. My friend's company was bought by a very big pharma company, Allergan, for about 850 million dollars, and Allergan is now trying to bring the drug to market. Expected to be available in 2021! (The drug is called rapastinel. You can look it up. Here's one recent quote about it from a news story: >>Saunders described Rapastinel, which is under development for the rapid onset action for the treatment of depression, as one of his "personal favorites." The company expects Rapastinel to launch in 2021 with $1 billion to $2 billion in peak sales.<< ) So it's a darn tough road to get a drug to market. (Final thought about rapastinel: It works on the same receptors that ketamine works on, but without ketamine side effects. I am vaguely hoping that since ketamine treats CH, maybe rapstinel will, too.)