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November 26, 2005

More Connections -- and more Dots

Recently, I called attention to Claude Shannon, whose mid-Twentieth Century work on communication theory had both anticipated and greatly facilitated what we now know as 'information technology' (IT). Another entry promised to connect several 'dots' between the serendipitous study of pot users which originally inspired this blog and how several of its implications clearly point to major weaknesses in current drug policy.

Perhaps my study's most important revelation was that virtually all those applying for a cannabis recommendation in California were already experienced chronic users who had first tried it during adolescence. Two additional revelations were that most (95%) had been born after 1945, and nearly all had first tried (initiated) pot in close temporal conjunction with similar trials of alcohol and tobacco. The same characteristics had been noted by the first behavioral scientists ever to study the then-new phenomenon of youthful pot use in the mid-Seventies. Those observations  eventually led to a 'Gateway' "theory" which-- despite its subsequent inability to earn validation--  is  a major rhetorical argument used by federal policy makers who remain insistent  that harsh punishment for possession of arbitrarily designated 'drugs of abuse' is an essential element of drug policy.

Important differences between mid-Seventies observations cited by Kandel and my more recent ones is that, as the American cannabis market has grown dramatically in size over time , and  pot has become even more available to adolescents , the  average age of  its youthful initiates-- at least, those who eventually apply  for  medical  recommendations-- has declined. The most recent analysis by cohort shows that alcohol, tobacco and cannabis were all tried at the same average age (14.9 years) by those applicants born between 1976 and 1985.

It is to be stressed that although data entry is  incomplete,  demographic data from over half of the approximately 3000 individuals seen during the past four years has been entered.  It's thus quite unlikely that  average ages at initiation will change significantly.

Another  implication,  strongly supported  by  both the demographic data and the aggressive initiation patterns  for  several  other  illegal drugs exhibited by this  population over the same time interval is that their drug initiations are far more likely to represent inchoate youthful attempts at palliating symptoms of emotional origin than reflecting irresponsible youthful hedonism.

Human emotions were not recognized as phenomena worthy of serious consideration by scholars until  the Renaissance;  despite considerable subsequent attention from philosophers, they weren't thought of as producing symptoms requiring pharmaceutical intervention for another 350 years; yet it's quite likely that the humans who left  Africa in the series of migrations completed some 13000 years ago-- and who were the antecedents of all modern humans-- possessed brains which were structurally and physiologically indistinguishable from our own.  Thus, any behavioral differences between them and ourselves almost certainly  results from phenomena we are just now beginning to study seriously under the rubric of cultural evolution.
Given the current planetary ecology  and the doctrinal divisions which continue to plague our rapidly expanding species, the importance of a global drug policy based on honestly gathered evidence which has then been accurately interpreted can't be overstated.  That current policy is clearly derived from religious beliefs which are being dishonestly portrayed as Public Health is as obvious as the reticence of the 'scientific community' to object out of fear or feigned disinterest.

The  apparent willingness of so many scientists to tacitly accept such overt perversion of their profession's most essential attribute out of fear is an ominous omen.

Tom O'Connell, MD

Posted by tjeffo at 06:13 AM | Comments (0)

November 21, 2005

Historical Background

California's "medical marijuana" initiative just celebrated its Ninth birthday; it was passed in November 1996-- nearly sixty years after cannabis ("marijuana") was first banned by the feds, and twenty-five years after then-President Nixon summarily rejected the cautious recommendations of his own "blue ribbon"  (Shafer) Commission) to decriminalize it and study its potential medical benefits. As we now know, Nixon opted instead for a disastrous war on drugs which soon began a series of dire changes in American society, the most obvious of which has been a steadily growing prison population which is disproportionately poor and dark-skinned. Parallel developments have  been real declines in state educational and health care budgets, a noticeable drop in the performance of American primary and secondary students in public schools, and- more recently- an  obesity epidemic affecting all age groups; especially children and adolescents.

  That the medical marijuana initiative was supported by 56% of  Californians over  strongly voiced opposition from sitting and former federal politicians and bureaucrats-- plus law enforcement bureaucracies at both state and federal levels-- evoked some surprise; but hardly the political soul-searching that might have attended a similar voter rejection of almost any other policy item. The entire federal bureaucracy then closed ranks in declaring  the vote a "mistake" and continued to oppose any implementation of the new law. Thus encouraged, state and local police blatantly denied their obligation to uphold California's constitution as they began harassing and prosecuting the first 'medical' users to be 'certified' by those few physicians then willing to defy federal threats and process applicants as the new law allowed.

In general, the media has continued to treat drug war topics as quirky; especially if they deal with cannabis- it has continued to emphasize word play over fact and give the default to the federal position that 'marijuana' deserves  criminal sanctions because of its presumed danger to youth.

Primarily because the Ninth Circuit upheld the First Amendment and a few communities-- mostly in the Bay Area-- provided a modicum of critical support for the new law (virtually abandoned by the Legislature and vigorously undermined by then- AG Dan Lungren), several pot clubs  survived in the Bay Area. They soon became hubs where patients from other parts of the state could be directed to compliant physicians, obtain more reliable cannabis with a greater variety of cannabis products, and network with other medical users. It was at that point (late 2002) that I began seeing a steady stream of applicants at a popular Oakland club and, soon after, at two smaller clubs; one in San Francisco and another in Marin County.

I soon gained a fairly straightforward insight: perhaps the most greatest potential benefit of the new law had been the (unanticipated) opportunity it provided for physicians to systematically examine a population of chronic pot users which had been previously "hidden" from view by threats arrest/exposure. All that was required would be a willingness to ask them the right questions, a technique that could look past their own excuses for using pot- and a way to elicit whatever other conditions most of them (seemed) to be self-medicating.

Although patient denial-- particularly by males-- that they use pot for emotional reasons is almost universal, a sympathetic approach, plus a demonstration of sincere interest-- when coupled with a "structured" interview have allowed me to elicit  a credible 'profile' of pot smokers. One of several bonuses has been a coherent explanation of the illegal market which had been launched on its present pattern of inexorable growth at about the same time Nixon launched a "war on drugs during his first administration.

That these and other issues have had little appeal to the self-appointed gurus of 'reform' has engendered a lonelier and more intense evaluation of what I've learned from applicants/patients over the past four years. Indeed, as
I've had the opportunity to see a growing number of 'renewals,' the dimension supplied by people newly educated to their own lifetime pot use has only added to my conviction that an opportunity to carry out unbiased clinical evaluations of drug users has been the (critical) missing ingredient which has allowed our feckless and uninformed drug policy to gain such undeserved power.

I look forward to sharing more insights from this ongoing study of pot use as they become available.

Dr. Tom O'Connell

Posted by tjeffo at 04:21 AM | Comments (0)

November 18, 2005

More Dots

When I first tumbled to the fact that passage of California's 1996 medical marijuana initiative had provided a serendipitous opportunity for a clinical study of chronic pot use, I was actually embarrassed that it had taken me so long to come to that realization (it was then about mid-March 2002, and I'd been seeing twenty or thirty applicants each  week from mid-November of 2001).
What has since become more than a bit frustrating have been my vain attempts to get self-proclaimed drug policy 'reformers' to  even recognize that such an opportunity exists- along with the stubborn quality of their denial. In fact; my need to understand that denial became a major preoccupation for the simple reason that as the scope of the study has grown, the effort required to complete it has expanded to a point where it now exceeds the resources, time, and technical expertise one individual can bring to bear. Thus, without some key help, further data acquisition may have to either be stopped or severely curtailed.

A limited evaluation of what's already been learned from standardized interviews of cannabis users suggests very strongly that an accurate and unbiased clinical analysis of the appeal cannabis has for humans may well offer the single most effective route to understanding both our urge to use all psychotropic agents and the parallel urge governments have to 'control' such use.

 A long article in today's New York Times on the increasingly sophisticated and aggressive polypharmacy being practiced by a set of educated, computer literate twenty-somethings is both timely and helpful in making my point: the mix of symptoms they are addressing is almost identical to those treated (often unwittingly ) by the pot smokers I have been interviewing. Beyond that, the medications are the same mood stabilizers and psychotropic agents many of my candidates have already had prescribed for them; not surprisingly, many are increasingly being directly advertised to the public  in Big Pharma's "ask your doctor" TV ads.

Although the full text of the Times article may require a (free) sign-up for those not already registered, the effort is worth while. I plan refer to this article in future posts aimed at 'connecting the dots' as promised on November 7.

Dr. Tom O'Connell

Posted by tjeffo at 09:47 AM | Comments (0)

November 14, 2005

Communication Problems

One of the  standard reasons cited by drug czars for continuing to prosecute medical marijuana users is that failure to do so would send the "wrong message" to 'kids.' What the demographics of cannabis applicants in California demonstrate so convincingly is that America's 'kids' have been tuning out the federal message for thirty-five years.

When Claude Shannon, a mathematician/engineer at Bell labs, propounded his 'Theory of Communication,' in 1948,  it  seemed overly simplistic to some;  yet it has since had such applicability and utility that he is now regarded by many insiders as the father of Information Technology. Thus, the work of Shannon, who seems to have been the first to grasp the significance  of the binary digit, both anticipated and facilitated the digital revolution.

A non-mathematical articulation of Shannon's theory holds that messages are bits of encoded data which are understood (decoded) by properly tuned receivers. The transmission of any message involves three elements; a source to encode it, a compatible channel through which it is sent, and a compatible receiver to decode it. Although the accuracy of the message itself is irrelevant to the theory; communication is demonstrated when a message has meaning (elicits  a response) at the receiver end. Impaired message quality (static, interference, noise, distortion) can be traced to one or more of the elements; for example, 'static' garbling radio transmissions can be due to a poorly tuned receiver or to cosmic rays (sun spots) distorting the channel.

The universality of Shannon's theory is exemplified by its applicability to biological systems; which are now understood to involve complex signaling mechanisms  that function and interact throughout life. In essence, death can be defined as the  irreversible loss of an organism's ability  to communicate, both internally and externally

Most biological communication falls under the rubric of physiology; it involves both internal and external communication, and--  in sentient organisms--  most of it takes place below the conscious level. Genes are turned on, immune responses mobilized, hormones elaborated, muscles contract, and nerve impulses are transmitted without either awareness or conscious direction. The brain-- the essential substrate for all behavior-- has been shown by  the relatively new multi-specialty discipline of 'Neuroscience'  to function primarily through complex neuro-humeral 'signaling' at the molecular level. Certain specialized structures of the mid brain  and cortex have been found to play  important roles in mood, emotional tone, and behavioral response. In a sense, the old 'mind-body' duality might now be considerably better understood-- were it not for the doctrinaire confusion sown by an inflexible and unscientific policy of drug prohibition for the past thirty years.  The war on drugs has not only destroyed countless lives; it has significantly skewed research and retarded medical progress

The tie-in between Shannon's work and drug war  fraud is best illustrated by the large number of NIDA-supported studies  being carried out on the Endocannabinoid Systems  (ECS) of laboratory animals-- even as humans in California are being arrested and imprisoned for legally attempting to relieve the same symptoms targeted by animal researchers searching for patentable molecules.

One is also forced to wonder just why the media and so many of the involved scientists  have continued to support a cruel and unscientific public policy with their silence once there was so much evidence that it is completely at odds with both known facts and what is most likely to prove true.

*The links supplied in this entry are, of necessity, limited. Interested readers are urged to explore on their own:
at:    http://www.ncbi.nlm.nih.gov/.

Dr. Tom O'Connell

Posted by tjeffo at 09:53 AM | Comments (0)

November 07, 2005

Defining "Medical"

One fundamental problem in the 'debate' over medical marijuana  is that no coherent definition of  'medical' has been accepted by all parties. Indeed, those with opinions seem to have chosen arbitrary positions for which they  then advocate without first coherently defining . Thus it's no wonder that  attempts at scientific 'debate' quickly become political arguments over who is ' "sick" enough to be exempted from the usual criminal penalties. When one considers the contentious history of cannabis prohibition, the earliest realization  that California's Proposition 215 had created an opportunity to study pot use clinically should have provoked far more curiosity than it has, especially from reformers-- to say nothing of academics  affiliated with the various endowed schools of 'Public Policy' at major universities; all of  which have been claiming to favor 'evidence based' policies since  about the same time the drug war was launched.

An indirect  example of this controversy appeared recently in the Orange County Register; it has since been picked up by several other newspapers. What is unusual about it is that one of the more prolific evaluating physicians revealed his own position, albeit indirectly. That allows me point out just why I take issue with him-- and all who tacitly agree with him.

I should  also point out that I consider allowing a reporter's presence at such evaluations poor judgment at best- perhaps even unethical at worst; not only are those medical exams highly unusual, they almost always involve an admission of illegal drug use. This isn't the first politically slanted article by a medically untrained reporter to be facilitated by this particular physician; a similar piece by Carol Mithers appeared in the LA Weekly in May 2004.

The reporter first describes two two young skate-boarders ("skater dudes") in terms that clearly indicate his own prejudice. He then agrees with the physician's summary rejection of the first one's insomnia as a valid reason  for pot use- an opinion first expressed by Barry McCaffrey in 1996. None of the three: McCaffrey, the physician nor the reporter,  seem even remotely aware that chronic insomnia is considered by modern Psychiatry to be a cardinal symptom of depression. Nor could they possibly know that its very effective palliation by cannabis is easily elicited from 90% of those I take histories from.

The reporter also shares the physician's sympathetic attitude toward the second skater, who is said to have "aggressive metastatic bone cancer" despite looking exactly like the first. I have no disagreement with that decision, but I do have a very different perspective on the clinical evaluations described. Primarily, I disapprove of what appears to be a politically correct rejection based on mere inspection and the eliciting of a 'chief complaint;' that's not how clinical medicine should  be practiced. I also know, with considerable certainty, that both applicants were almost certainly treating the same underlying emotional symptoms with cannabis well before the second one developed what is, very likely,  an osteogenic sarcoma.

In addition, when the same the same physician  practiced in Northern California, he was one of the few then recommending pot for large numbers of applicants; thus many of his former patients saw me for "renewals" when I began screening applicants toward the end of  2001.  In fact, I still  occasionally see some. I can thus say unequivocally that more than a few resemble the first "skater dude," right down to the tattoos and the chief complaint of insomnia.

To be more specific, I have screened hundreds of applicants who obtained recommendations from other physicians- some considered stalwarts of the medical marijuana movement, and  others regarded sneeringly as 'scrip docs.' What I can say unequivocally is that there are no discernible differences in their patients and the ones who have sought me out primarily. In other words, chronic pot users applying for recommendations seem to have remarkably uniform medical and social histories. Their pot use also seems to have been far more beneficial to their health than the many other drugs most of them tried- whether prescribed by physicians, or used on their own initiative.

Finally, this physician's age and his own history of discovering pot while a teen-aged Naval enlisted man during the Viet Nam war places him in the exactly the right place at the right time: he fits the same profile as many others I have seen who were inclined to see  their own use as as "recreational"  until closely questioned about certain important details.

Such is the nature of denial.

Tom O'Connell MD

Posted by tjeffo at 04:21 AM | Comments (0)

November 02, 2005

Connecting the Dots, Part 1

In the most recent entry, I said our species "may have arrived at a critical watershed in its tenure on planet Earth;" however, I didn't specify either the basis for that alarmist statement or just what the specific danger might be. Since I also promised to connect the dots between a four year study of pot users and its most controversial implications, perhaps the best way to begin would be by specifying what I think our biggest problem is and explaining how it's reflected in contemporary American attitudes toward cannabis.

Our species' biggest existential threat- largely self-created, and yet peculiarly beyond discussion- is the accelerating growth in our own numbers. Human population, which peaked at just over six billion near the end of the Twentieth Century, may already be beyond our ability to either sustain or control. This is a vexing problem; one which is at the same time both simple and complex. From the time of Malthus, concern about human overpopulation has periodically evoked sparks of interest which then typically receded after one or another technologic advance seemed to 'solve' the problem.

A good example is the original Malthusian alarm over the possibility that humans could outgrow their ability to feed themselves. Although death from starvation has continued to plague some parts of the planet, it has become almost axiomatic that starvation is never a result of inadequate food production, but rather of its inadequate distribution, usually for political reasons. It's also true that mass starvation is almost inevitably associated with greed, war, and poverty.

Meanwhile, as one limitation of the planet's carrying capacity after another were apparently 'solved' by technology throughout the last century, the number of humans living on earth has continued to grow. Fears of inadequate food production were replaced by fears over energy supplies. Those fears, in turn were allayed by discovery of new oil reserves, supplies of natural gas, and the promise offered by 'renewable' energy in the form of wind, direct solar energy and even ocean tides.

As oil and food distribution fears were allayed by bigger tankers, automated ports, and container ships, other vexing problems of the unequal distribution and consumption of wealth and resources were seen as eventually soluble by 'development.' A breakthrough of sorts occurred when the Cold War ended without nuclear winter in 1989 and it was widely assumed that more developed nations, acting through the UN, could eventually lead to a more peaceful and stable world. Those hopes were soon dashed by a bewildering array of seemingly intractable regional conflicts rooted in an amalgam of racial, tribal, or religious differences. When such local wars became large enough- and especially if they impacted the economies of 'developed' nations- some sort of intervention would occur and a 'peacekeeping' force would be left behind. In more densely populated and poorer parts of the globe- especially those with less direct impact on Western economies- such 'solutions' were slower, less enthusiastic, and usually attended by enormous mass suffering which typically evoked relatively little interest from Western media.

Towards the end of the century, new fears that the planet's ever-increasing use of energy could provoke or accelerate changes in climate were scoffed at as 'unproven;' even as global temperatures (measured reliably and consistently for less than two centuries) began to rise and regional weather patterns became more extreme.

As if that weren't enough, what had been considered a regional conflict in the Middle East was shockingly escalated by an attack so dramatic and successful that it has cast a huge shadow over the world ever since and now seems to be widening into a wholly unfamiliar pattern of World War in which loosely affiliated networks take out their resentments on the developed world by indiscriminate terrorist attacks.

Clearly; if such a scenario doesn't convince us that our emotions play a dominant role in our decision making, perhaps nothing will. At least, not in time to recognize the threat those emotions pose to our survival.

The tie-in to cannabis- and our nation's doggedly unsuccessful attempts to control its use- is that it's perhaps the one psychotropic agent offering the most expeditious approach to a rational understanding of how our emotions interact with our cognition- and why those who see their primary role as 'control' of the behavior of others are so firmly and uniformly in denial of that reality.

In other words, the inability of world 'leaders' to get beyond their ideological bias against "drugs" may both illustrate, and also play a role, in their manifest inability to deal realistically with the growing threats posed by overpopulation, turbulent human behavior and unruly weather.

Doctor Tom

Posted by tjeffo at 06:31 AM | Comments (0)