October 30, 2005
Blame it on the BrainOur species, Homo sapiens, may have just reached a critical watershed moment in our tenure on planet Earth: the biggest current threat to our collective survival seems our inability, as a species, to control our destructive behavior. Although 500 years might not seem very long compared to the time required for Evolution to produce the human brain; that organ- when coupled with Science- has greatly accelerated our impact on both own species, and our planetary environment as well. Not everyone agrees, however. Despite an abundance of evidence that global warming is a viable hypothesis, it is perhaps the most striking example of human disagreement about a contentious issue with significant existential implications. If the hypothesis is "true" (accurate) failure to act could have huge consequences down the road; and in not very much time. certainly as early as 2050; which is the main reason I now regard the doctrinaire Republican position on that issue as the height of political irresponsibility.
Today's greatest irony may be that Republicans generally see global warming as political, a Democratic notion- almost certainly not true and one that must be opposed in any event.
Our brains have allowed our species to dominate its global environment like no other, but they also may be seriously flawed. The even greater irony is that although recognition of that flaw should now be possible via to the same cognitive processes that produced quantum theory, space exploration, genetic engineering and organ transplantation, both the historical record and the events being reported by our daily news media show us headed in the wrong direction: directly away from the critical understanding that an effective solution would require.
It would seem self-evident that in order to solve a problem, one must first understand it and to do that, one must be able to discuss it freely and honestly.
In that context, humanity's "drug problem," became a dominant issue right after Richard Nixon's Controlled Substances Act was passed in 1970, a law still enforced as the law of the land and as UN policy. 'solution' as ever, becomes an excellent example of- and a metaphor for understanding- the cognitive frailty I'm referring to.
Our species doesn't yet seem capable of even realizing its long term survival is now in the balance; thus it will require some critical changes in both thinking and collective behavior to avert looming catastrophes. Indeed; I can be reasonably certain that the majority of humans with enough interest to read these words would probably disagree; some violently- even to the point of wanting to punish me for having said them them. That reality simply makes my point: the tragic flaw we have yet to deal with is the impact pur feelings ("emotions") on our beilefs. It's so profound that we have yet to be able to even study our own emotions objectively. Quite the opposite; all the nations in the "civilized" world are now bound by a UN treaty to arrest and punish anyone found transporting certain designated agents (drugs) with the ability to modify human emotions directly. Even worse, the same signatory nations have erected barriers against any unbiased evaluation of either the policy itself or its impact on society.
A final irony is that the nation most responsible for demanding- and later promulgating and enforcing- that policy has done so on patently spurious grounds; the policy itself has been responsible for an unparalleled corruption of scientific thought- and yet it has received the tacit endorsement of most of the very scientific institutions which should be leading the charge against it.
The above "heresy"- expressed in about 500 words- was enabled by a relatively simple ad-hoc clinical study of admitted drug users that began in November 2001 and is still ongoing (although reduced by my health problems). The overall purpose of this blog has been to connect the dots between the heresy (with modifications as required) and the findings which that rise to it. It is only fair to acknowledge that the study has yet to be well received by many- save for the applicants whose pot use was explored by the interview developed to study it- and, of necessity, only those examined after a certain stage in its development. Indeed; understanding the resistance manifested by avowed supporters of "medical marijuana" to the realities disclosed by pot applicants has been as important to my own understanding as the data itself.
It appears that both the need (desire) of certain humans to use drugs- and of others to repress and/or punish that use- are not only closely related phenomena, but also important manifestations of an intrinsic human cognitive weakness.
October 22, 2005
A Stupid Editorial-- and the Reply Reform Can't Offer
Reform's present disarray is-- as usual-- expressed by an omission.
Earlier today, Dale Gieringer posted Debra Saunders' entire column
from the SF Chronicle as further evidence that a rabid Bush apologist
is undergoing a slow, irregular and highly improbable epiphany on
medical use; but he only tangentially referred to the smug, terribly
uninformed editorial on the opposite page. Within the current context
of law enforcement's vicious campaign against medical use throughout
California, San Francisco's ill-advised restrictions will be a huge
setback to the cause. It's nothing less than the triumphant
culmination of the campaign featuring the "Able Bodied Young Men"
canard which began with the "Oaksterdam" flap of 2004 and has spread
from one community to another throughout the state.
My reply; -- too long for an LTE , but which I soon hope to expand
into an Op-Ed:
What have the Chronicle's editorial writers been smoking?
As a physician who supported Proposition 215 in theory long before
November, 1996, and began interviewing applicants for the required
'recommendations,' at local buyers' clubs 5 years later, I've had a
unique perspective on the law's complex nine year evolution. The
most important thing I've learned is that nearly everyone involved in
the process remains as confused now as they were then. A closely
related phenomenon is how stubbornly humans tend to cling to
uninformed political beliefs.
Space restrictions limit me to pointing out a single critical error
at the beginning of your editorial and then pointing out the
absurdity of the assumptions underpinning the platitudes in its last
Californians didn't vote "in favor of the palliative use of marijuana
as a painkiller" in 1996. Pot's ability to control nausea in AIDS
and cancer victims was its most cited benefit during the campaign.
Its use as a chronic pain reliever wasn't widely reported until
police throughout the state began arresting disproportionate numbers
of the relatively few people receiving recommendations from the
relatively fewer physicians willing to even talk to them. That was
the situation I encountered when I began interviewing applicants at a
busy Oakland club in November 2001. Suffice it to say that since
then, it has changed dramatically as fierce law enforcement
opposition has continued unabated, Supreme Courts at both state and
federal levels have muddied the water with cowardly non-decisions,
and the ranks of "pot docs" were augmented by a few very prolific
"scrip docs" who then blanketed the state and thus produced a rapid
rise in the number of people with recommendations.
What I would gradually discover over ensuing months was that all
parties- including most of the applicants themselves, were-and still
are- confused about who uses pot and why. That's a conclusion which
is inescapable from now-voluminous clinical evidence which no one
with firmly held political beliefs on the subject seems willing to
even look at.
As for the hopeful beliefs expressed in your last paragraph: given
the public record of cruel prosecution of obviously sick people at
the hands of both state and federal systems of "justice" over the
entire history of medical marijuana in California since 1996, how
could you possibly think such an embattled concept "will get a fair
chance to work" if the City most responsible its very survival past
infancy passes restrictive regulations in response to a fundamentally
dishonest political campaign?
Another (clueless, yet popular) way to ask that question might be:
what have you guys been smoking?
Tom O'Connell MD
October 17, 2005
Suppressed Testimony 18 Months Later
At least one California physician besides myself has been seeking out evidence of psychotropic use in the applicants she screens for "marijuana" recommendations. Dr Claudia Jensen, a Southern California pediatrician specializing in adolescent medicine was summarily subpoenaed to appear before Congressman Mark Souder's subcommittee in April of 2004. It was clear that Souder had intended to make an example of her by trumpeting what he regarded as her irresponsible advocacy of cannabis for symptoms of ADD, however, it's also clear that once he and his advisers went over her courageous and well-documented testimony, they thought better of it.
I had the privilege of working briefly with Claudia at a cannabis club in Oakland in the Spring of 2002 when we were both 'rookies' learning from applicants and developing our own concepts on the self-medication phenomenon we were both encountering clinically for the first time. I know we shared similar opinions then and that our thinking has subsequently evolved along similar lines. She stopped coming to Oakland on week-ends as her practice in Ventura developed, but we have remained in loose contact. She informs me that she has hundreds of clinical records which should be available for review whenever we have the time and resources .
There was almost no news coverage of Claudia's testimony. I was told by observers that she acquitted herself admirably under fire and that there were few hostile questions. The major political lesson here (so far not heeded by "reform") is that well informed clinicians who advocate intelligently for their patients have little to fear from uninformed politicians. A little thought should allow them to understand that political opponents of cannabis like Souder won't attack well informed doctors; if for no other reasons than it opens their own absurd views to scrutiny.
That's not to say that advocates for the other side won't try to spin the truth when they are unopposed; again, the best antidote is clinical evidence, competently delivered.
Hopefully, the surge of interest generated by current laboratory reports of pot's anxiolytic properties will finally provoke the open discussion of psychotropic use that fearful "reformers' have been desperately trying to to avoid.
Dr. Tom O'Connell
October 16, 2005
While it shouldn't have been assumed that Proposition 215, California's unique voter-approved experiment with "medical marijuana," would be without controversy, the original intent of that legislation is being almost completely frustrated by an amalgam of fear and hostility which literally defies description. Sadly, opposition has been so sustained and effective that prosecution of activists within the state is more virulent than ever and one community after another is considering measures that would deny business licenses to any outlet intending to distribute cannabis to qualified patients.
The hostility of various federal and local police agencies might have been anticipated for a while; but that it would be sustained for nearly ten years is both amazing- and almost certainly a consequence of the failure of either state or federal judiciaries to protect law abiding citizens from malevolent prosecution. Ditto the failure of the press to report accurately or coherently on the issues. Ditto the clueless response of either academic "drug policy analysts" or medical institutions at any level to take an intelligent interest in a problem that should have commanded their attention from the start.
Finally- and most inexplicable of all- has been the rejection of my attempts to interest self-styled supporters of medical marijuana in the results of clinical research aimed at clarifying core 'medical' issues by systematic collection of data from applicants. These are sweeping charges- some of which I've been reluctant to make publicly- my primary reason for doing so now is the simultaneous appearance of two articles in current medical literature which offer hope that the situation may be somewhat less dire than it seemed a few days ago, and may also be closer to reversal.
As noted earlier this blog is centered on a clinical study which began in late 2001. It has been carried out continuously since then with little support beyond the medical fees paid by applicants themselves. Quite apart from its political symbolism, the potential value of cannabis as a therapeutic agent was clearly a reasonable subject for research when 215 first passed in 1996, and remains even more so today. As anyone even moderately familiar with current medical literature should be aware, several studies both abroad- and more recently in the United States- have recognized that cannabinoids as potentially offering an exciting array of therapeutic benefits to an extremely broad range of clinical conditions.
In stark contrast to the glittering promise from laboratories has been the dearth of clinical research involving cannabinoids and human subjects. In only one instance I'm aware of- GW Pharmaceutical's study of Sativex, an unusual proprietary product- have any clinical studies been conducted. Given the remarkable- and virtually unchallenged- safety record of cannabis, it's clear the reason for this absence of clinical data relates directly to the status of "marijuana" as an illegal drug.
In previous blog entries, I've focused on NIDA as the federal agency most culpable for its opposition to cannabis- primarily because of its distortion of science on behalf of an obviously political message. However NIDA is merely the most vocal; all federal medical agencies have been reluctant to say anything positive about cannabinoids. And NIDA is an agency within the NIH; in that connection, it's amazing that this week's New England Journal would feature a plea from the head of the NIH for precisely the kind of "clinical-translational" research my study represents.
In another remarkable coincidence, a second prestigious journal (The Journal of Clinical Investigation) just published an exciting animal study; one which explicitly supports the idea that cannabinioids are not only anxiolytic and antidepressant, but also active in brain areas that control emotions, and- most amazing of all- seem to provoke neurogenesis, a unique and presumably helpful type of cell proliferation in those same areas. Although I question the need to study human cognition in animals with far less complex cognitive function, these observations do support my clinical observations in humans; observations I have been contending for over two years merit the interest and support of anyone interested in the truth- especially those claiming also to favor medical use of cannabis.
As a final incongruity, both journals have taken a rare step in making these unusual articles freely available for downloaded by the general public. Hopefully, that's an omen- one which will also be of some help in provoking long overdue support for a unique study.
Dr. Tom O'Connell
October 15, 2005
Drug Policy 102: How Nixon's Drug War has expanded a prohibition into a repression.
The "war" on drugs launched by Richard Nixon's "Operation Intercept" in September 1969 suddenly and dramatically expanded national resources which America had long been committing to a bad idea- one that had already been failing miserably in the case of "drugs for over fifty years," and had flamed out in spectacular fashion a mere fourteen years it was applied to alcohol in 1920. That idea was prohibition- the belief that a specific human behavior, when opposed by a majority on "moral" (religious) grounds, can be either "controlled" or eliminated simply by passing laws against it.
The idea that prohibition works is, of course, still alive and well in the form of our "war on drugs," even though the preferred modern euphemism is "control."
The essential reason for prohibition's inevitable historical failure is not difficult to grasp: it's human greed. It has never taken long for a lucrative criminal market supplying any banned item to develop and flourish- whether for alcohol, "drugs," gambling, sex- or even nuclear weapons. The history of such illegal markets is that they quickly gain enough wealth to corrupt many of society's important institutions- a process which has now gone on so long in America that we seem unable to recognize- or even discuss- it openly.
In the thirty-six years which have elapsed since Nixon's malign initiative- and thanks to the increasingly brutal and dishonest efforts of the American federal bureaucracy he was then creating to enforce it- the flawed idea or drug prohibition has, paradoxically, both failed and succeeded on a massive scale. Its failure is measured by the perennial inability of enforcers to accomplish even one claimed goal; its success is measured by its continued acceptance as an essential policy with budget and influence to match. The drug war has now seriously unbalanced American society- thanks to its ability concentrate wealth and power in the hands some of our wealthiest, greediest and most repressive citizens- and most recently- even with the unwitting assistance of organizations like NORML. which represent its targeted victims.
One the more troublesome aspects of American drug prohibition is that, thanks to its cloning by UN treaty in 1961, it is now also an "essential" policy in every member nation. Although differing considerably in the style and intensity of its enforcement within various nations, the policy's global acceptance- together with the mischief created by the international criminal markets it enables- now pose a threat to our entire species by making eventual reversal of the culprit policy all the more difficult.
A question which had long puzzled me was just how such an obviously flawed and destructive national policy could be tolerated within a country claiming to be the world's most active proponent of 'human rights.' The answer turns out to be quite simple: the same all-too-human emotions of fear and greed which have allowed every successful repression in history to gain enough tacit acceptance to be enforced over a significant interval. In terms of simple duration, the drug war- when measured since it first emerged as a coherent national policy in 1914- is now the most enduring modern repression since the Inquisition.
Over the next few days, I hope to cite some recent examples of the policy's continued malign dominance of American politics- together with some hopeful evidence that its ultimate unmasking as a breathtaking scientific fraud may be a bit closer than we now realize.
As before, those insights will all refer back to my study of California pot users which inspired this blog in the first place.
Dr. Tom O'Connell