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July 30, 2006

Politically Correct Pot

An interesting aspect of NIDA’s defense of pot prohibition has been a slow shift from reflex denial of any possible therapeutic benefits to claims that other agents can treat the same conditions just as effectively without any need to be ‘smoked’ and without ‘unwanted’ cognitive effects. In other words, the same theme with which Barry McCaffrey greeted the IOM report in 1999: the disadvantages of cannabinoids that limit their medical benefits will also discourage investor interest in developing ‘crude’ or ‘raw’ ‘marijuana’ extracts as  commercial products.

As a recent article in Wired,  and Fred Gardner’s report of the 2006 European IACM meetings in CounterPunch suggest, nuance is all important.  What one quickly understands from a little further reading, is that our real problems with pot policy may have more to do with trying to cover up the mistaken beliefs originally cited  as reasons to ban it.  One dilemma is that it may not be possible to obtain the desired clinical benefits from products in which all cognitive effects have been "successfully" blocked.

I’m betting that won’t be possible; in any event, the politicians responsible should never live down all the human misery their arrogance has already caused.

Posted by tjeffo at 12:10 AM | Comments (0)

July 27, 2006

An Impertinent Question

The first of several  lessons I've learned from my immersion in the medical marijuana issue for the past four years is that American drug policy has been an even more dishonest and destructive fraud than I’d ever imagined. What allows me to say that is data I've acquired from chronic users; data medical marijuana 'activists' simply refuse to either acknowledge or discuss; with a degree of unanimity that is itself very revealing

The second is that there seem to be at least two important reasons why the drug war has become such a widely supported global policy despite its multiple obvious failures (indeed it has NO lasting ‘successes’). One is that such a policy seems ideally suited to the secret desires of most governments to snoop on their citizens while maintaining well funded police and intelligence services; the other is that the political opponents of drug prohibition are at least as clueless and ideological in their own thinking as the most doctrinaire drug warriors–– and they have a lot less money to spend.

The third–– and from an existential point of view, perhaps most important–– lesson is that the highly evolved brain which has allowed humans  to establish mastery over the rest of the planet seems deeply flawed in  at least one critical respect: its singular inability to study our own behavior with anything like the same objectivity that allowed our recently discovered scientific method to ‘solve’ the 'problems' once constraining human population growth. The dirty little secret, which can't even be discussed at the moment, is that our sheer numbers may have already trapped us aboard a planet which is simultaneously undergoing sudden climate change while we are forced to deal with the possibility that the international 'rule of law' that facilitated the concentration of so much wealth in the hands of so few may not be enforceable for much longer.

Once one considers the cascade of possible catastrophes that could be lurkng around the next corner and realizes how little we seem able to control the raw emotions now so evident on the nightly news, it's difficult to believe that 'business as usual' will persist for long.

Again; the obvious connection to cannabis is that it's clearly being used by a majority of its chronic users to deal with the dysphoria of everyday life. One relevant question then becomes why do the chronic cannabis users I've been questioning for the past four years seem to know so little about the organizations claiming to represent both them and 'medical' use?

Posted by tjeffo at 03:04 AM | Comments (0)

July 23, 2006

A Note of Alarm

Sometimes I'm forced by current events to tear myself away from considering the medical uses of pot, which, I admit,  has become somewhat of an obsession over the past four-and-a-half years. The current deterioration of conditions in the Middle East is one such occasion.

A few entries ago,  I compared the American war on drugs with the phenomenon of Nazism which, after gaining total political control of Germany in 1933, had transformed that nation into the strongest military power in Europe by September 1, 1939; only to lead it into a helpless state of unconditional surrender and near-total devastation by April 1945.

In the headlong dash toward their own destruction, the Nazis combined several barbaric practices which, although not exactly new, added a new dimension to both slavery and political murder while inspiring two new names for such practices: holocaust and genocide.

Historians were quick to apply genocide to an earlier Twentieth Century Turkish repression of Armenians;  now anyone so inclined can find multiple credible examples of attempted genocide in our post World War Two 'modern' world despite a strong UN resolution firmly condemning it.

In fact, Wikipedia's discussion of what constitutes genocide is could easily apply to the treatment of people identified as 'drug abusers' in America. While it's obvious that drug warriors would object, anyone with a capacity for ordinary logic and a modicum of historical knowledge should be able to see that American drug policy is less concerned with 'Public Health' and than it is about justifying a 'need' to  identify and punish consumers of certain arbitrarily designated 'drugs of abuse.'

In parallel, the modern world's posturing over how best to resolve political differences in the Middle East is not encouraging; we are clearly still hung up over the same old issues: assigning blame and then using military power to punish 'terrorists' without any recognition that imposing the 'rule of law' on people trapped in an onerous status quo will always be seen by them as terrorism and simply inspire more behavior of the type being punished. Is the 'legal' killing of innocent children with high tech weaponry (collateral damage) any less reprehensible than when carried out by a suicide bomber or a Hezbollah rocket?

Certainly the evidence is that all such killings are not only reprehensible; but at odds with the goals of any sustainable policy.

The closer one gets to the official 'thinking' of the various governments now thrust into the Mid-East crisis, the less practical recognition there seems to be that all current responses will be futile. The only thing more disconcerting is our stubborn human tendency to ignore the dangers of 'business as usual' while hoping for the best.

Two related questions remain: how much resilience does the modern world still possess; will it be sufficient to permit 'recovery' from yet another mismanaged crisis?  By now, one would think the fundamentally emotional nature of the resentments which precipitated them should be apparent to all...telling people they 'shouldn't' feel the way they do is like telling them they don't count. It has never worked as policy; there's certainly no reason to expect that to change in an era when the same TV images are being seen around the world in real time.

Oh, yes. The pot connection. That's easy; it's stress and 'depression.' Most chronic use of cannabis has clearly been generated by the same symptoms that have made Prozac and other antidepressants runaway best sellers since the Eighties. The dirty little secret is that pot probably has a (much) bigger market share.

Doctor Tom

Posted by tjeffo at 12:25 AM | Comments (0)

July 16, 2006

Listening to cannabis

The title was chosen to highlight one of the first things I learned about cannabis and its users after agreeing to screen candidates for 'pot recommendations' at an Oakland  Buyers' Club (not the OCBC) in late 2001. I had seen several references to Kramer's book after it was published in 1993 and may have even read a review or two, but had no more than passing interest in Prozac or any of the other SSRIs at the time because I was then a chest surgeon, who had yet to discover drug policy issues and hadn't ever been actively involved with treatment of  "depression." Besides, I'd gone semi retired in '94 and wasn't writing many prescriptions.

Today, when I read a review of Kramer's book by someone even more committed to regressive psychoanalysis than he apparently was, I quickly caught a sense of both his (and Kramer's) disapproval of Prozac's potential for obviating so much of what Psychiatry is/was all about. Yet, Kramer had obviously been so impressed with Prozac's therapeutic benefits that the reviewer faithfully reported that fact before adding a note of disapproval so mild that it would be easily missed by a casual reader.

That review made me eager to read the book, but I was completely frustrated by the impenetrability of my old sources at Amazon.com; thus I started Googling 'cannabis, Prozac' and soon found an item by Phillip Dawdy which had appeared both in the Seattle weekly and on the Alternet in August 2004.

Dawdy's article was enlightening in a number of ways:

1) A lot of what I had been somewhat surprised to learn from and about patients had already been suspected in 2004. Nevertheless, my work goes a lot further than those suspicions because it's based on longitudinal data supplied by real people who now are organized as a registry.

2) The drug policy reform 'movement' which claims to speak for medical users has missed the most important way in which pot is being used as 'medicine.' That includes Lester Grinspoon whose quoted complaint about IRBs is very weak tea; compared to the stir that would be caused by endorsement/replication of my work by those (relatively few) California physicians in a position to do so. So far, that hasn't happened; for reasons neither they nor reform will discuss with me.

3) The links supplied by the Alternet Drug Reporter are contemporary; in other words, the people who wrote articles on behalf of DPA, MPP, and ASA are clearly way behind where Phil Dawdy was in 2004.

Doctor Tom

Posted by tjeffo at 02:45 AM | Comments (0)

July 14, 2006

Cognition, Science, and the Emotions

Through modern Archeology and Antropology, we have accumulated detailed knowledge of several hitherto unknown 'civilizations' that flourished for sigificant periods of time, only to eventually fail for a variety of reasons such as climate change, deforestation and political implosion.

In the last entry, I suggested that the emergence of scientific thought in the middle of the last millennium radically changed the world.  That's because Western Europe, was soon encouraged by its superior weapons and deep water navigation capabilities to 'explore' (and pillage) a world previously inaccessible to them. That quickly led to an orgy of exploitative colonization which is still going on and has often been justified by notions of  cultural, 'racial'  or religious superiority.

The process of forced cultural diffusion gradually 'opened up' not only the Americas, but the entire world; it was soon accompanied by sustained growth of the human population despite two 'world wars' during the Twentieth Century. Significantly; the only war with the potential to arrest population growth–– a nuclear World War Three–– was narrowly averted in 1962. Nevertheless, the detonation of a third nuclear weapon in anger now seems more likely than at any time since then.

  In fact, all modern wars, including those now either in progress, threatened, or smoldering around the world, are clearly related to colonial and post-colonial resentments, a judgement still not acknowledged by 'world' leaders, who can't seem to admit that the  intensity of those resentments and the manifest impossibility of ever addressing them within the context of the global economy has never been more apparent.

We can also see in retrospect that the  avarice and cruelty of European colonizers toward those they exploited was nearly universal; yet, the same behavior  quickly  became the norm for the leaders of former colonies who came to power after World War Two. Like earlier imperial expansions, the pivotal one enabled by European science also delivered a measure of economic 'progress' to those it exploited; however, unlike them, the economic expansion launched from Europe in the the Fifteenth century never collapsed of its own weight;  probably because it also marked the beginning of today's  competitive global economy.   Human population growth has been sustained through the plethora of scientific advances (many of them unexpected) generated by economic and military competition. That a global economy can thrive on greed, fear, and dishonesty has remained evident despite the nearly constant background of wasteful open warfare somewhere on the planet.

Unfortunately, the rigorous intellectual honesty required for success in science and technology has not spilled over into the political domain. World leaders have continued, to retain enough tacit approval from the people they govern to cling to the same time-honored political rhetoric employed throughout history.
As noted earlier, the consequences of such intellectual schizophrenia can be seen all around us. Cognitive dissonance is openly embraced as national policy with no sense of shame; Indeed, it's brandished; with little evidence that those doing so are even aware of the ignorance they are admitting to; nor do 'responsible' scientists who should certainly know better ever speak out.

American drug policy, is simply one of the world's oldest, most irrational, cruel, and counter-productive policies. it survives only because it has become too politically correct to challenge; however, it's not the only such example.

Also, because a unique study of recalcitrant cannabis users was  (unexpectedly) enabled by passage of a fiercely resisted state initiative, it is both distressing  and revealing that those with the most reason to be curious about the phenomenon of pot use have solidly committed themselves  to embracing many of the same irrational assumptions of their political opponents.

Doctror Tom

Posted by tjeffo at 08:38 AM | Comments (0)

July 12, 2006

March of Folly

The title was borrowed from the late Barbara Tuchman, it refers to her insight that governments often work against the best interests of own their people for extended periods. She also described some of the mechanisms by which they do so.

Never before have the follies of human existence been more evident; nor has the denial of their absurdity by world ‘leaders’  been greater. However, because we are also learning that nothing in "nature" remains constant, it’s very likely that next week– or next year- both phenomena will have become measurably worse.

Admittedly, that’s a profoundly pessimistic assessment of the world’s future; unfortunately, the evidence favoring it is all around us. Everywhere we look on the international scene, we find evidence of festering disagreements between rival groups that have been violent for years and are further from resolution than ever. No longer is violence confined to relatively orderly wars between readily identifiable nations; modern wars are increasingly waged between belief systems commanding constantly changing sectarian allegiances of the sort found both within and between nations; the important divisions are more often economic, religious or racial than purely national.

When we attempt to trace the present global chaos to its origins, we are soon left with only one culprit: human cognition. In other words, the agency which allows us to be informed with lightnig speed of the latest deadly car or railway bombing half a world away is the same one that enabled our species to create the mess which both generates the carnage and makes restoration of "order" unlikely.

Cognition, the modern in term for thinking, involves several functions we humans share with other species, but possess in greater abundance and with a considerably greater degree of integration. The organ integrating and controlling cognition, the brain, is also possessed by other animals; but in demonstrably less complex form. That the modern human brain has been produced by a gradually adaptive process (evolution) was first separately intuited by Darwin and Wallace in the mid-Nineteenth Century and is still hotly disputed. However, its accuracy is also very obvious to anyone possessing sufficient background in Science and the ideological freedom to think independently.

Which brings us to a watershed understanding: based on certain pre-existing beliefs, all humans seem to have a variable capacity for accepting  certain ideas as "true." If we return to the notion that the cognitive abilities which created the present global mess are also rendering its solution difficult, we can see the connection. It’s difficult to imagine any phenomenon but Science that might have allowed the acceleration in human population growth over the past six hundred years. Although we have ample historical and anthropological evidence that agriculture facilitated the emergence of many complex civilizations in various parts of the world,  it wasn’t until the first clear-cut technologic advances produced by empirical science in Western Europe produced a cascade of technologic advantages; and Europeans attempted, with considerable ‘success,’ to extend their hegemony to the rest of the world, that ‘modern times’ really began.

What's the connection between the above thoughts and the study of pot smokers which impelled me to start  blogging? It's actually fairly direct; once one realizes that the most obvious conclusion of that study is that our cognitive abilities are impacted to a considerable degree by the same emotions which are– all at the same time– the source of our noblest ideas, the root of all evil, and inescapable physiological manifestations of human brain function.

 That's a combination which  makes their "control" a sort of Holy Grail that both government and religion can't seem to resist attempting.

Doctor Tom

Posted by tjeffo at 07:14 PM | Comments (0)

July 10, 2006

An Important Case History

An Important Case History An  enduring theme of our highly evolved 'war' on drugs is the notion that 'kids' shouldn't use 'drugs.' So politically correct has that taboo become, most 'anti-drug' laws now provide for enhanced penalties for violations occurring within some arbitrarily fixed distance from a school.

The 'kid' taboo has also made most physicians, including (or perhaps, especially) 'pot docs,' reluctant to use 'kids' and 'drugs' in the same sentence; let alone 'recommend'  that a 'kid' use pot. On the other hand, my routinely taken histories confirm that most adults  'initiate' all the psychotropic drugs they will ever try by age 25 (the obvious exceptions are usually prescribed by physicians; more on that subject later).

Because his patient's remarkable history contains so many of the themes encountered in milder form in many of my own applicants,  I'm urging anyone with an serious interest in medical pot to read the history of Alex P in the current CounterPunch (courtesy of Tod Mikuriya, MD & Fred Gardner).

Doctor Tom

Posted by tjeffo at 05:02 PM | Comments (0)

Interesting Developments

As Proposition 215's tenth anniversary approaches, a recent spate of  coordinated moves by the DEA and California police have made it painfully clear that neither side of the medical marijuana 'debate' has learned much about youthful pot use, the distinctive historical phenomenon which had so clearly induced Richard Nixon to start a 'war' on drugs 37 years ago and then later forced him to ignore the unexpected recommendation of his own Presidential Commission that pot be decriminalized so its medical uses could be studied.

Because the drug war's survival as policy as has always depended on protecting it from objective evaluation,  federal disinterest was to be expected; however, the same shouldn't have been true of reformers, who- nevertheless- continue to reject data that could help them salvage some of the the promise implicit in Prop. 215 when it passed in 1996.

But don't hold your breath...

Some day, there may be an attempt to account for the lives destroyed and misery produced by Nixon's two critical drug policy decisions, but because he couldn't possibly have known the extent of the carnage, we probably shouldn't be too tough on him. However, what about the legions of 'true believers' and cravenly complicit functionaries who have allowed an improbable policy that was failing miserably at such high human and social cost, to avoid scrutiny year after year?

As if that weren't enough, the gyrations of the drug policy 'reform' movement in response to recent federal provocations suggest they are as clueless as ever. I've been monitoring their e-mail discussion lists since they were surprised by a series of raids coordinated with a  media campaign in San Diego last week.  I'm more amazed than ever at how little they gleaned from carefully worded posts in which I'd suggested that a federally inspired campaign  focused on youthful male users (ABYM) had been signalled by the rash of negative reports from 'Oaksterdam' two years ago; and how that campaign had since evolved into an effort to deny business licenses to 'dispensaries' all over the state.

There's a lot going on,  the dust is still settling, and there's at least some hope that recent government moves may hint at some federal insecurity in the background. For example; the otherwise  inexplicable 'historical' report by Professor Burnham of a June 17 dinner honoring six former drug czars at which they also claimed the war on drugs had been 'won.'  Why was there only one write up (in Burnham's home town newslaper on June 30)? Why no immedate interest from mainstream media? Who had gone to all the trouble to plan such an elaborate event and then let it pass almost unnoticed?

For that matter, why re the feds being so aggressive in San Diego? Do they simply assume the Medical Board of California will go along with their  demands that physicians be disciplined fot recommending pot? Don't they realize that following the Board's punishment of Dr. Mikuriya, such a strategy could involve risks for them?

What is most clear to me is that the feds have been forced to concoct a myth to justify their aggressive pot prohibition. As new information appears, the myth has required subtle amendments, which–– over time–– have made it considrably less than coherent. Reform has developed its own myth, which because it agrees with the main points of the federal fairy tale, has been a major factor in their own perennial failure to change policy.

Since it's also very clear is that neither side knows the truth about our modern pot market,  both may be terribly embarrassed if the public were to find out before they do...

Doctor Tom

Posted by tjeffo at 05:46 AM | Comments (0)

July 07, 2006

Another Federal Riposte

Another Federal Riposte The Hinchey-Rohrabacher  Amendment, little known to those who aren't drug policy 'reform' insiders, has become an annually recurring  example of their blindness. It began as a well meaning bipartisan plea from two California Congressmen with personal reasons for endorsing the 'traditional' notion of 'medical marijuana' as a reason to grant very ill or dying patients the privilege of  smoking pot. That this year's (predictable) defeat in the House was so quickly followed by a crisp federal riposte has served to confirm at least two of my suspicions. The first is that aside from their opponents in government, the reform movement is relatively unknown to the great mass of Americans.

The second suspicion is that the feds working assiduously to protect current drug policy DO pay a lot of attention to reformers and have carefully crafted their anti-marijuana campaign in California to take full advantage of their ignorance. California's law, by far the nation's liberal pot law, has allowed the largest numbers of ordinary pot smokers to think of themselves as potential 'patients.' What I learned shortly after starting to examine them in 2001, was that virtually all those who would usually be dismissed as 'recreational' users are actually self-medicating, with benefit, for very common emotional symptoms which most people,especally young males, are usually loathe to admit.

That concept had been a tough sell, especially to the generationally blind, pot-smoking reform community which clings stubbornly to the original 'seriously ill' model their opponents are now using so skillfully to hoist them on their own petards.

Yesterday's escalation of a state-wide federal and local police campaign was a case in point;  San Diego is the biggest city with a strident anti-pot tradition and the carefully timed busts plus the accompanying publicity involved all the elements of the recent 'moratrium' campaign and added a new one: a renewed attempt to threaten physicians who write recommendations with punishment by the Medical Board of California.

Whether it will succeed in provoking the Board to resume its harassment of physicians remains to be seen...

Doctor Tom

Posted by tjeffo at 04:13 PM | Comments (0)

July 04, 2006

Human Frailty

Working with chronic cannabis users has led me to believe the question we should really be asking about American drug policy is one often asked about Nazism shortly after World War Two: how could such an inhumane doctrine have become so credible? Its corollary was: how could an 'advanced' nation have fallen for such an obvious fraud?

The answer to both questions begins with the realization that such aberrations are enabled whenever a nation's supreme legal authority is either persuaded or forced to endorse egregious scientific error. Failure to recognize the critical difference between scientific and legal standards of 'truth’ not only allows the imposition of a ‘pet’ policy in a doctrinaire manner, it encourages it.

Nazism and the War on Drugs can thus be seen as extreme examples of the same phenomenon in two different settings. Hitler, who was chosen to lead the government of a demoralized nation in 1933, seized power immediately on the  promise of restoring self-respect to a dispirited, angry populace. He was then able to convert Germany into the strongest military power in Europe in six short years.

Our war on drugs represents similar doctrinaire thinking, but has been forced to proceed far more slowly; literally one institution at a time. The Drug War grew from a presidential directive which suddenly expanded an already erroneous policy; but the policy already included several key characteristics which facilitated its implementation as a 'war:'  it, too, was based on doctrinaire assumptions and control of 'narcotics' had long been usurped from Medicine before much was known about either 'addiction' or the relevant physiology.  Also, Harry Anslinger, the FBN's chief bureaucrat, had efficiently discouraged any interest from Psychiatry or the  Behavioral sciences in addiction or addicts for over thirty years.

Two distinct generic fears are important to public acceptance of  repressions like Nazism and the Drug War: one is fear of those accused of representing whatever new 'threat' they are focused on; the second, and more realistic for those not targeted, is the fear of ordinary citizens that they could find themselves on the wrong side of a fiercely enforced policy.

More than a bit disquieting is the realization that all such aberrations ultimately depend on the tolerance of the populace they are imposed upon; all that would have been required was the courage needed to overthrow them; a fact as true of Saddam as it was of Hitler, Stalin, and Mao. Thus, the critical corollary is that outside  'help' from other nations or sources has nearly always been required to overthrow them; and there is always the risk a new repressive ideology may replace the first.

Our capacity for repeatedly experiencing such follies without ever seeming to learn from them is not very encouraging. The pointless circular debates over drug policy are shocking for their confused ‘science’ and stand in stark contrast to the remarkable ability of scientists in other disciplines to accurately study an unprecedented ‘natural’ disaster like the recent tsunami, in which human behavioral anomalies clearly weren’t causative. Lest we think there’s some IQ difference between them and ‘behavioral’ scientists, we should recall that they, too, have NEVER criticized the shockingly unscientific behavior of NIDA;  nor was any objection voiced when Alan Leshner, its former director, was chosen to head the prestigious AAAP.

Doctor Tom

Posted by tjeffo at 06:42 AM | Comments (0)

July 01, 2006


Drug War Revisionism When I belatedly discovered the war on drugs as a political cause in 1995, it had already compiled a long and complicated history. Although the selection any such date is always arbitrary, the most obvious starting place for any history of federal drug policy had always seemed the Harrison Narcotic Act (HNA) of December 1914. In most considerations of Harrison, the 1906 Pure Food and Drug Act (PFDA) had often been held up as an example of its opposite: a ‘wise’ regulatory measure that had actually done some ‘good' by reducing inadvertent opium addiction among the nation’s housewives by requiring patent medicine labels to list ingredients.

Thus, it was with some mild surprise that I recently (and belatedly) discovered a movement afoot to consider the PFDA as the historical origin of current US 'drug control’ policy; however the more I think about it, the less that should have surprised me. The ‘other side’ in this uneven propaganda contest has enormous advantages of money and time; however, they must also be aware of their policy’s vulnerabiity: most Americans consider the drug war  a hopeless failure. With that in mind, a campaign to parley the FDA’s Centennial and the public’s generally  higher regard for it to brighten the the drug war's image is, at least, logical. What is staggereing, however, is the absolute contempt for truth with which the campaign is being orchestrated.

Such a campaign would also explain the FDA’s ridiculous 4/20 ‘statement’  explaining why “Medical Marijuana” will never be approved (it has to be smoked!). Even more blatant was a gathering of ex-drug czars held on June 17  to commemorate the ‘appointment’ of psychiatrist Jerome Jaffe to be the first such functionary (although he was called a Presidential  ‘Advisor at the time and Dan Baum's 1996 'Smoke and Mirrors' succinctly explained the panic behind his appointment).

A just-published report by John Burnham, its quasi-official ‘historian’ on the gathering, with much emphasis on its significance (a celebration the drug war's ‘victory') just appeared in yesterday's Columbus Dispatch. It  makes for fascinating reading but, so far, has provoked little notice from reformers. Are they out to lunch? Whatever the explanation, their failure to note- and respond- to such blatant revisionism, cannot be regarded as a sign of political strength.

Doctor Tom

Posted by tjeffo at 09:46 PM | Comments (0)