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January 10, 2007


My last entry ended with a link to an Op-Ed authored by the two political managers of the successful 1996 campaign for Proposition 215 and my promise to discuss it as an illustration of the costly failure of reform to take advantage of the huge opportunity that had been created by its passage.

That they began by taking credit for success of 215 and ‘similar success in six other states,’ confirms that they remain unaware of the critical importance of the phrase, ‘for any other illness’... which has set California apart from every other state with a medical cannabis law. That key phrase was already there when they took over the campaign, and from what I clearly remember from views expressed during later campaigns, if they had been in control of 215 from the outset, that wording would never have made it.  Certainly, no other successful pot initiative has allowed anything close to the unbiased clinical evaluation of everyday users permitted in California.

In effect, they are still championing the uninformed view of ‘medical’ use which dominated most advocates' thinking in 1996; their opinions haven’t changed a bit. The intiative was enabled by anecdotal evidence that pot's effectiveness against nausea and vomiting was permitting some patients to complete life-saving new therapy for AIDS and cancer. Given the pervasive misconceptions and ignorance about the use of cannabis that existed then, that was a perfectly reasonable formulation; in fact, because of my age, I was far more ignorant of ‘pot culture,’ than most; yet I was in full agreement with the notion that 'medical marijuana's' greatest benefit would be to AIDS and cancer patients.

My ignorance extended to how Proposition 215 was being implemented; it lasted until late 2001 when I was recruited to evaluate applicants seeking a doctor’s recommendation. It really wasn’t until then that I realized how little I actually knew about either cannabis or its chronic users. In a real sense, that recognition of my own ignorance was a blessing, because it forced me to learn directly from the patients I was interviewing. That becomes a critical point to appreciate, because one of the next things I had to learn was that most chronic users, although clearly self-medicating, were under the impression that their (inevitable) early use had been ‘recreational.’

In other words, my unique opportunity, as an experienced surgeon, to obtain clinical data from over 4000 pot smokers of all ages over the past five years has gradually but completely changed my profoundly mistaken early opinions about the chronic use of cannabis. That's why it's so distressng to read that two presumably knowledgeable activists who remain in the forefront of political advocacy for medical use openly display their  preoccupation with the uninformed opposition rhetoric of another century.


A note on Gladwell: After receiving two prompt criticisms of my praise for Malcolm Gladwell’s New Yorker article on Enron, I must point out that my praise was really for the very useful distinction between ‘puzzles and mysteries,’ for which Gladwell (accurately) credited Rand security analyst Gregory Treverton. I must also admit that I should have been more clear and at least mentioned  Treverton.  For the record, I did not intend praise for Gladwell’s earlier writing on pharmaceutical issues, nor a defense of either Enron or Jeff Skilling.

Doctor Tom

Posted by tjeffo at January 10, 2007 07:17 PM