I've never done it, but I have a strong sense that pharmahuasca would be cold, sterile, and missing some of the je ne sais quoi that the "shaman piss" [1] experience offers. I'm sure it would still be a valuable experience, and one I'd be open to exploring, but drinking trees works well enough for me, thanks.
I mean, sure you can puke (I often do, sometimes several times in the course of a night), and it tastes horrible, and your sweat smells like tree bark at the end of the night — let alone the end of the week. That's just the process, though, and "optimizing" it out would probably also remove many of the things that are actually among the most valuable (for me, and everyone else who does this more than once with whom I've spoken) aspects.
EDIT: footnote added.
[1] Interestingly, in one of the earliest-documented shamanic traditions, tribes on the Siberian steppe would use amanita muscaria mushrooms, which are visionary, but also mildly toxic. The shaman would take a shaman-sized dose, and journey, then collect his urine (which still contains threshold doses of psychoactive metabolites), and serve that to his "patients".
I agree about set and setting. The "clinics" I picture are probably not what that word normally conjures up.
I'd be fascinated to know then if certain underlying themes and insights would remain similar or not. So far the western experience with psychedelics does show some commonality with that of indigenous peoples-- it's common for people to report a kind of cosmic oneness experience, insights about their character, etc. But there are also unique cultural twists. Ours have a flavor reminiscent of Greek and Roman Dionysian and Bacchanalian ceremonies, and then there is stuff like:
http://www.matrixmasters.net/salon/2006/06/podcast-042-–-“us...
Somewhat off topic question but I'd like to ask anyway - How exactly do you know its thousands of years old ?
I'm not saying it isn't, but how do you know for sure ?
But you know what? Those are the exceptions. I've taken ayahuasca dozens of times, and am booked for another trip to Peru next month. I've been fortunate only to work with reputable people, and have consistently only met others in my travels that have also worked with reputable people.
Please don't judge a tradition that's thousands of years old, and actually remarkably safe — with a few caveats, that the reputable folks will screen for — on the basis of a couple of cretins who look at the plants and the gringo tourists and just see dollar signs.