November 19, 2009

Help from an Unexpected Quarter

Although it’s long been clear to me that genetics play an important role in human behavior, I hadn’t expected much help from that quarter because I regarded my investigation as an opportunistic chance to study drug use as a reflection of “nurture,” rather than “nature.” Wrong. An article by David Dobbs in this month’s Atlantic focuses on an easily recognizable sub-set of the population I’d also become attracted to through their illegal self-medication with cannabinoids. In fact, I hadn’t finished the first paragraph before I could have supplied the names of at least two famously troubled children indistinguishable from those Dobbs’ article is about: one for her controversial death at the age of four, the other from a detailed case report I’d first heard presented at a national meeting of cannabis reformers in 2004.

Although the initial focal point of his article is a celebrated researcher at the University of Leiden in the Netherlands, Dobbs makes clear that support for the controversial notion summarized by the catch phrase “orchid children” comes from many respected academics in several nations. The basic notion seems to be that gene variants already known to be associated with serotonin transport are not only associated with early development of problematic behavior in toddlers and pre-school children, but there is solid evidence that improving the way mothers deal with those children can modify their problematic behavior in positive ways. Beyond that, and even more exciting: the same heredity that impels similar troubled behavior, when properly nourished at home, may unlock expression of unusual talent.

What my own work has suggested to me is that when vulnerable adolescents have been fortunate enough to begin self-medicating with a drug that, although illegal, allows them to control certain destructive impulses, a vulnerable few will blossom as “orchids,” while the majority who represent the more common (and hardy) “dandelions,” also benefit from the protection cannabis confers against excessive use of two legal alternatives they are still being pushed into using by an ignorant society.

Perhaps we can wake up in time to save ourselves.

Doctor Tom

Posted by tjeffo at 06:04 PM | Comments (0)

November 18, 2009

Different Responses To Similar Information

We live in a constantly changing world ; one in which taking things for granted can have disastrous consequences, as was dramatically demonstrated in Minneapolis on August 1, 2007 when a relatively modern bridge collapsed during rush hour, killing 13, injuring over fifty, and shutting down a vital traffic artery for 18 months. In the aftermath, it was revealed that the bridge, in company with many others that are routinely inspected at intervals, had been known to have serious problems for years, but for one reason or another, hadn’t been either retrofitted or replaced, a non-decision that implicitly assumed there would be time to do one or the other before a collapse. We also know there are many similar bridges in daily use. The term commonly used for such avoidance is “calculated risk.”

A different type of calculated risk is involved in the recommendation announced on Monday by the U. S. Preventive Services Task Force, an official- but little known government agency, recommended changing long-accepted guidelines for performing routine mammography, a decision that, when implemented, would affect not only a large number of women, but the reimbursement of large numbers of health care providers.

The response was predictably rapid and intense. Given my interest in another controversial Public Health issue, I can't help comparing the open "debate" over mammography, which is legal, to the non-debate that frustrates users of "medical marijuana" (cannabis) my study clearly shows to be treating themselves safely and effectively for conditions that are otherwise far more damaging to both them and society when treated with pot's legal alternatives: alcohol and tobacco.

In fact, given the amazing responses, in California and elsewhere, in terms of the gray markets created by medical cannabis laws, one could reasonably claim that the adverse Public Health consequences of keeping cannabis illegal may be much greater than is presently either realized or imagined.

Doctor Tom

Posted by tjeffo at 04:25 PM | Comments (0)

November 14, 2009

Credibility and Cognitive Dissonance; testing the limits

Over the past several months, even as officials in the Obama administration were announcing there would be fewer raids on cannabis dispensaries, the LA City Council was preparing to crack down on them; thus it appeared that the level of cognitive dissonance might, after thirteen years, finally be reaching a level that could not be sustained. In the background, the usual glut of conflicting claims and counterclaims could be found in the media and on the internet. However. I also remembered feeling the same degree of frustration on several other occasions, especially after starting to publicize the admittedly unexpected findings of a study of the applicant population to an obviously indifferent world.

I’m now glad I discussed them here to the degree I did in a generally careful, (albeit tedious) style, because I understood, almost from the beginning, that objective and reasonably complete medical records might be essential some day if the Medical Board of California (MBC) should ever elect to punish me for "recommending" the medical use of marijuana on behalf of thousands of patients over the past eight years.

In that same connection, it’s long been clear that “pot docs” had little to fear from zealous DAs, or even from the DEA itself; our greatest threat has always been from California’s medical licensing authority. I had watched in horror in 2004 as the MBC persecuted (there is no other word) the late Dr. Tod Mikuriya and then twisted the knife by making him foot the bill for their grossly unfair “investigation.”

I'm also glad I had chosen to attend an MBC quarterly meeting in 2005 and formally provided them with timely notice of the study I had become engaged in, but hadn’t yet published in peer-reviewed literature.

To cut to the chase, a new regulatory watershed may just have been reached; first there were rumors that Hany Assad MD had lost his license; then, those rumors were confirmed on Friday evening, when a Google search turned up Fred Gardner’s meticulous description in CounterPunch. Just as important from my perspective, was the text of the actual decision posted on a spiteful, anonymous site mocking not only Assad, but other pot docs who had chosen to defend him and Dr. Alfonso Jimenez, a peripatetic Hawaii/San Diego osteopath recently unfrocked by the Board of Osteopathy. The same anonymous source posted a similar attempt to smear Dr David Bearman, a Santa Barbara physician who’d testified on Jimenez’s behalf and Phil Denney MD a veteran pot doc, the current president of Mikuriya’s old organization , and a witness for Assad.


Typical of many authoritarian abuses of bureaucratic power, the cases brought by the MBC against both Drs. Mikuriya and Assad relied on the unsupported judgment of professionally incompetent judges to define reality in ways that are clearly at odds with both Science and competent professional observation, in this case my findings, which weren't available in time for Mikuriya's defense and weren't cited in Assad's. Over the past four years, the study's findings have been published or cited in a variety of locations.

To summarize only the most important points: the charges brought against "pot docs" by the MBC were based on invalid assumptions mede by the MBC and accepted by thr physicians it was prosecuting. For example, the key issue in the "medical marijuana" controversy is arguably the safety and efficacy of an herbal remedy that had been rendered illegal by legislative fiat in 1937 and remained relatively unknown to the public for another thirty years before becoming explosively popular with youthful initiates in the mid-Sixties.

In an interesting parallel, the current medical gray market that began developing thirteen years ago under the aegis of California's disputed initiative, has grown erratically, but its product is now surprisingly popular for reasons that have yet to be either questioned or examined (except in this blog).

I now think the available records would provide me with a powerful defense should the MBC choose to "investigate" my practice as cannabis specialist/investigator recommending its use within the intention of the initiative, in a manner consistent with data accumulated under its protection, from the user population encouraged by the amnesty implied by its passage to provide it. I have been advising all applicants of what I've learned and urge them to manage their own use accordingly.

In Science, the proper response to unexpected new data is not to reject them out of hand, but to consider them in light of what had been known from earlier studies. Unfortunately, the historical record wiht respect to cannabis fails to reveal that any unbiased studies of its inhaled form were ever done prior to 1937, or in the wake of the CSA in 1970, despite a specific official recommendation to do so in 1972.

Doctor Tom

Posted by tjeffo at 06:58 PM | Comments (0)

November 12, 2009

Good News, Bad News

An item in yesterday’s LA Times caused me a bit of surprise; the good news was that the AMA finally saw fit to endorse reclassification of “marijuana” thirty years after a federal Administrative Law judge working for the DEA had formally declared pot to be both safe and effective (before being summarily overruled by his administrative superior). The bad news is that a careful reading of the whole article shows how far the AMA remains behind the reality curve by clinging to the notion that “recreational” use can be accurately differentiated from medical use through casual observation by the medically untrained, and by implication, that it warrants arrest.

It’s difficult to fault the AMA for that belief, however; my own acquaintance with the usual suspects listed as applauding their decision confirms that they all share both the AMA's poor judgment and the lack of clinical experience required to have arrived at it.

Ironically, in defending their recommendation, the AMA also invoked the prescient 1937 warning of Dr. William Woodward to the effect that future research might show that cannabis offers considerable medical benefits, thus the Congressional Committee then discussing a bill that would preclude such research should think twice before recommending it.

The official record shows that the good doctor was then scolded by the committee chairman for his impertinence.

Doctor Tom

Posted by tjeffo at 07:21 PM | Comments (0)

November 11, 2009

How Should a Victorious Candidate lose a War?

In recent weeks, several of the issues I’ve struggled with since starting this blog have come together in ways that are both new and internally consistent with the different view of human nature forced on me since I started treating cannabis applicants like patients and research subjects in 2001. For one thing, I’ve had to seek answers in several disparate disciplines, something that shouldn’t be surprising because the drugs we humans self-medicate with reflect the same cognitive conflicts driving all our behaviors. In that respect, my education, training, and past experience were very helpful in some areas and left me at a disadvantage in others.

Before considering those areas in detail, (and future entries) I’d like to advance one of the key concepts that just came into focus: whether he realizes it or not, our rookie President is now struggling with a problem faced by several other national leaders since the end of World War Two: how does one lose a war gracefully; especially when the enemy won’t agree to a cease fire?

Starting with Viet Nam, several solutions have been tried unsuccessfully; Lyndon Johnson turned his back on the Democratic nomination in 1968, thus giving Richard Nixon a close victory. Nixon compounded the losing war in Viet Nam by attempting to shift the onus of defeat to the corrupt regime we’d agreed to prop up under Eisenhower and continued supporting under Kennedy. Unfortunately, Nixon also opted to punish his political enemies with what has ballooned into a global “War on Drugs,” in which surrender is also unthinkable to those charged with "winning" it.

Currently, Obama is pondering his limited options in two other losing wars in which the risks were seriously underestimated and “victory” was not defined by those who started them, exactly the same problems faced by Eisenhower, Kennedy, Johnson, and Nixon in Viet Nam and Bush-Cheney in Iraq and Afghanistan.

Doctor Tom

Posted by tjeffo at 06:12 PM | Comments (0)

November 09, 2009

I Told You So...

Every once in a while, it's nice to savor a small triumph, especially when one has pretty good evidence their main message isn't being received as well as they had hoped. Such was the case yesterday when I learned that Obama's new drug czar couldn't explain when, let alone why, pot had became so popular, something I'd have thought any drug czar would know. Hoping to rub it in a bit, I searched the archives and quickly found an item I'd posted three years ago:

October 27, 2006

Children of the Sixties; behind pot’s appeal to youth...

Analysis of the interviews of California pot applicants I’ve been conducting over the past five years (and, hopefully, soon to be reported in detail) confirms that pot smoking, as a youthful phenomenon, is comparatively recent, one which didn’t begin on a large scale until the mid Sixties, when youthful baby boomers who had fallen under the influence of Fifties "Beat" writers began using it. What happened next (and largely out of sight) was the rapid  expansion of an illegal cottage industry until it had literally saturated most American high schools with marijuana, an event that took several years to become complete nationally. It was most overt from the start on both coasts, where pot was associated with several events that still resonate powerfully: Monterey Pop, the Haight Ashbury, the Summer of Love, Woodstock, Altamont, psychedelic drugs, Bill Graham’s Winterland & Fillmore East, and the Stonewall riots. In the Seventies came Kent State, the premature drug-related deaths of several Rock icons, and a somewhat muted spill-over of anti-war protests and social unrest from the Sixties.

The tumultuous era ended with Watergate.”

Even as I was completing that task, I came across an interesting reference to an article relating PTSD and cannabinoids that had been published in Time last week. It seems that the PTSD like behavior of rodents conditioned to fear the dark could be improved by a THC agonist injected directly into their brains. Wow! Imagine that! If only those researchers had read my blog of November 17, 2006, they'd have had clinical confirmation from a human study; Time (pun intended) to go back to the archives; all of which brings up another point about the the CSA: by arbitrarily defining certain drugs as too dangerous and habit forming to be permitted, the framers of the CSA were unwittingly creating a natural experiment with the potential to shed important light of human behavior years into the future.

Not only did Proposition 215 permit the unwarranted assumptions made about each drug by the framers of the CSA to be tested; they also made their central idea- that prohibition works- to be tested as well.

Doctor Tom

Posted by tjeffo at 11:38 PM | Comments (0)

November 08, 2009

A Revealing Interview with Obama’s Drug Czar

On Tuesday, November 3, Rebecca Roberts of NPR conducted a thirty-minute soft-ball interview of current drug czar, Gil Kerlikowske, on Talk of the Nation. Kerlikowske, who has maintained a far lower profile than John Walters, his stridently uninformed predecessor, revealed that he is just as ignorant of many key details of marijuana use; thus I wouldn't look for much change in current federal “prohibition lite” (fewer DEA raids). What will be most interesting in the near future will be the official excuses offered for those that are carried out (you can bet there will be some).

Roberts’ interview, despite her failure to ask several painfully obvious questions, wasn't altogether useless, precisely because her subject was so much more affable than John Walters would ever have been. Thus Kerlikowske unwittingly revealed what he doesn’t know rather than simply repeating tedious drug war propaganda everyone has learned to tune out. A quick example was provided by a call from a female listener ("Kris") about 25 minutes into the program.

From the transcript:ROBERTS: Let's hear from Kris(ph) in Lincolnton, Georgia. Kris, welcome to TALK OF THE NATION. KRIS (Caller): Thank you. I was wondering - I'm 62 years old, and when I was in high school, I didn't even know what marijuana was. And I'm wondering why is it so rampant now, and it never used to be?

ROBERTS: You're listening to TALK OF THE NATION from NPR News.

Mr. KERLIKOWSKE: Well, I wish I had a good answer for that, Rachel. I am - I actually just about two years younger than you are, and so I'm afraid I would put myself in exactly the same mindset. But I think that marijuana is popularized on television shows. It is popularized in media. There is only one antidrug media message out there, and that's the one that the Office of the National Drug Control Policy actually funds, and that - the antidrug.com. There's an awful lot of information about drugs, and it's put forward in a very matter-of-fact and straightforward way that's very helpful to people. So I would tell you that there's more information available there.

My analysis: this is right in line with what I've come to recognize as the Generational Ignorance to which all humans seem prone: we tend to be blind to the social conditions that existed as few as fifteen years before we were born, primarily because our childhood memories are far more emotional than intellectual. Abstract thought doesn't begin in most children until around the age of twelve and is usually focused on local conditions in school and at home at first, although that may vary considerably, depending on intelligence and many other complex variables. In any event, both Kris and Kerlikowske were leading edge Baby Boomers who came of age in the early Sixties when pot first began appearing in American High Schools. I've consistently encountered the same ignorance among the pot smokers I've been interviewing for past eight years. When I tell them there was NO POT in American High Schools during my high school days ('45- '49). In fact, appreciation of that generational ignorance is key to any understanding of the genesis of today's enormous pot market; beyond that, the appeal pot had for boomer teens is critical to understanding its sudden surge in popularity from 1966 on, a surge that was clearly badly missed by the First Nixon Administration as it was hastily rewriting our drug laws without any scientific or medical inpupt at exactly the same time.

Since I know from painful experience that a number of "reform" luninaries share the same ignorance, I shouldn't be surprised when the drug czar admits he's just as ignorant of essential reality as the leadership of NORML and MPP (and, I suspect, as the Gang of Four, who are all of similar age).

Doctor Tom

Posted by tjeffo at 07:43 PM | Comments (0)

November 06, 2009

American Drug Policy; what ever happened to Skepticism?

I’ve long subscribed to Scientific American and often read its monthly columns, not because I necessarily agree with the columnists, but because they often make me think. One such is Michael Shermer, an academic from Southern California whose column is known simply as Skeptic. Shermer has literally made a career of skepticism, not only has he written extensively about it, he's also founded an organization dedicated to it, and publishes a magazine focused on it.

I recently caught up with his July column, and became intrigued with the esoteric concept of the Null Hypothesis, which, upon first reading, seemed to have some promise as a model for what had become a personal holy grail: the perfect argument for dispatching the drug policy monster once and for all in a way that would leave little doubt about its fundamentally evil and irrational nature.

After considerable time spent going back and forth between various Null Hypothesis explanations summoned by Google, I realized that holy grail, if it exists at all, is still out there waiting to be discovered and that Michael Shermer will probably always have work trying to explain the nature of truth to skeptics of all stripes.

On the other hand, the short essays I'd just posted do reveal how deeply rooted our drug policy is in two deceptive laws which, when taken together, reveal how faithfully it reflects the ambient ignorance of two bygone eras. That raises an important question: how could such limited views of drug use and addiction have remained almost unchanged over so long an interval?

The answer is that drug policy "science" was easily discouraged during the Anslinger era when Pharmacology was relatively primitive. Following Harry's departure, it was replaced by Nixon's CSA, which gave rise to two in-house agencies, the DEA and NIDA, that have protected their policy from scrutiny far more successfully than their policy has protected civilization from the evils of the global criminal drug markets it has sponsored.

In that respect, they have been aided to no small degree by an essential human weakness: that of denial. I expect that over the next few days we will see plenty of denial as our government and news agencies attempt to minimize and confine the obvious PTSD that is now afflicting an increasing percentage of our military, which, in turn, is being assiduously drug tested to detect the agent my study has revealed to be most effective in treating it.

Doctor Tom

Posted by tjeffo at 05:43 AM | Comments (0)