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January 31, 2007

Correction !

Woodruff should obviously have been 'Woodward.' I thought he correction had already been made in the html version; but obviously, the error slipped through. In my current state of knowledge, it's safer for me to post this correction than delete the earlier entry and revise it.

My apologies.

Doctor Tom

Posted by tjeffo at 05:16 PM | Comments (0)

Questions never asked...

The facts are simple and beyond dispute: cannabis which had been introduced to Western Medicine in 1839 and then used to treat a variety of  illnesses over the ensuing 98 years, was summarily made illegal by the Marijuana Tax Act of 1937. Two things become clear from reading transcripts of the sketchy hearings held prior to Congressional action on the bill,  the first is that  they were shockingly political, and the second is that few of those in attendance knew anything about cannabis. When the  lone AMA representative questioned the need a ban, he was treated as a hostile witness by a Congressman who would later become a Chief Justice of the Supreme Court.  It is also clear from the statements of those favoring the bill that its target was cannabis in its smoked (inhaled) form at a time when the bulk of medicinal use was oral or topical. In other words, a legitimate medical market was to be sacrificed, together with the then-undeveloped market for industrial hemp, to a law that would give the federal government total control of all current and future uses of a plant that has since proven a veritable cornucopia of useful products.

To date, the federal government has not relinquished that control and spends billions of tax dollars each year on dishonest propaganda to justify it. Meanwhile, both political parties and most of our  institutions cravenly look the other way. Some, usually with an easily identifiable vested interest, openly support the fraud

When one considers that the first effect of the MTA would have been to immediately discourage all research into cannabinoid pharmacology at a time when America's pharmaceutical industry was in its scientific infancy, the cost of the MTA is compounded. When one also realizes that the fear generated by adolescent use of cannabis in the Sixties is what stampeded Congress into passing the even more repressive CSA in 1970,  and thus providing the weaponry for Nixon's drug war, the MTA can be seen as one of the most destructive pieces of legislation ever passed. That cannabis is still illegal and generating three quarters of a million felony arrests a year is nothing less than a national disgrace.

In that regard, the statement of Dr. Woodruff of the AMA was prophetic: "To say, however, as has been proposed here, that the use of the drug should be prevented by a prohibitive tax, loses sight of the fact that future investigation may show that there are substantial medical uses for Cannabis."
In any event, very few people seemed to care when cannabis was was made illegal by voice vote a few months later. All medical use, which had been declining, disappeared without a trace while the small, relatively obscure market for inhaled cannabis ('reefer'), remained largely undisturbed and invisible to a majority of Americans for the next thirty years. The ripples of tabloid excitement which attended the arrests of (white) entertainers Gene Krupa in 1943, and Robert Mitchum in 1948, are really testaments to the relatively tiny size of the  'reefer' market between 1937 and the enthusiastic discovery of 'pot' by white adolescents in the late Sixties.

When one further realizes that today's enormous illegal pot market had already been growing for at least five years by the time the drug war was launched, and that it has continued growing steadily ever since, two logical questions come to mind. The first is why did the market for a drug made illegal in the Thirties not start to fluorish for thirty years? The second is what critical factors have allowed that same market to grow steadily each year since the drug war began, depite the increasingly punitive and expensive efforts of our federal bureaucracy to destroy it?

Doctor Tom

Posted by tjeffo at 04:49 PM | Comments (0)

January 21, 2007

More of the Same; plus an appeal...

'The more things change, the more they stay the same,' could apply equally well to America's current wars  against 'drugs' and 'terror.' While the common denominators generating both are the pervasive human emotions of fear and greed, I've reluctantly come to the opinion that  although it's also failing, has been going on ten times as long, and causes avoidable human misery on similar a scale, the war on drugs will  be not be questioned politically until long after the one on terror has been abandoned.

In fact, it's already starting to happen.

I've been off-line for several days, but a quick review of pertinent news items discloses that the feds, even while taking unaccustomed lumps over Iraq and Afghanistan, have continued their campaign against medical pot in California.

The first of many examples: only a 'White House' confident of the drug war's popularity would honor those prosecuting medical pot dispensaries in California as 'heroes.' Also notice the story's Washington by-line.

Another example highlighted the most recent ploy for circumventing border seizures by  growing pot within the US; although Mexican cartels have financed large grows in California's National Forests for several years, use of Central Valley tract houses for indoor grows is a more recent tactic favored by ethnic Asians, many operating from Canada. As to the profits from either operation, one has to infer that so long as a tactic is used, it must be working; at least for the money men.

Which brings me to the issue of a different kind of 'surge,' one assiduously ignored by virtually every drug policy 'expert' who might have raised it as a logical question for the last thirty years or so: how does one explain the amazing commercial success of illegal 'marijuana' from the mid-Sixties onward?  That success was already underway by 1965 and well established by March,1972 when Nixon chose to  pursue his drug war instead of the timid recommendations of Ray Shafer's Committee.

That Nixon's judgement was expedient and has turned out to be 'politically correct' is a no-brainer. It's equally clear that the question about pot's popularity has been asked in the past. The best example I'm aware is  Andrew Morral's study, published in November 2002, which also provided  theoretical  'proof' of some other explanation beyond the long discredited 'gateway' concept.

Ironically; Morral's study was published at about the same time I was beginning to analyze previously unavailable market data gathered as clinical histories from some of the customers responsible for that commercial success at a time when, as adult pot smokers, they were seeking to have their own chronic use recognized as 'medical.'

If anyone can provide some logical reasons why their data should not have been gathered, or- once gathered- should be ignored, I'll be happy to read them. In the same spirit, if you think the results of such a study should be of interest to those implementing  American drug policy, please let me know that also.

Doctor Tom

Posted by tjeffo at 08:59 PM | Comments (0)

January 12, 2007

Market Mysteries

A recent study provided evidence that pot is now America’s largest cash crop. Although the econometrics of illegal markets are elusive, the thirty-five billion dollar estimate by Jon Gettman seems to be in the ballpark; especially given our rather steady three quarters of a million felony pot busts per year and the increasing number of  plants being grown by aliens on federal land in California as a way of avoiding seizures at the border.  Not that cross-border smuggling is a thing of the past, as illustrated by repeated discovery of high-volume tunnels at odd intervals.

Not to mention Canada...

My interviews of cannabis applicants have raised several related, but seldom–asked, questions as mysteries of the type referred to in a recent entry. For example:  why was there a three decade delay between pot becoming illegal in 1937 and the initiation of a of a thriving black market? Another: how did that market grow? A third is to what extent does current adult usage reflect the pervasive pattern of adolescent initiations faithfully recorded by annual Monitoring the Future (MTF) surveys since 1975?

In essence, database analysis of the demographics and drug initiation data provided by interviews of the applicant population conducted since November 2001 provide answers to those questions which are not only very consistent with known events, but also cast considerable doubt on certain key assumptions about drug use which have become widely shared by nearly all interested observers.

Many of the scientific breakthroughs of the last two hundred years, were the result of new observations which challenged old beliefs. In the case of drug using behavior by humans, that dearth of accurate observations was not a result of technical inadequacy, but rather of a federal embargo on clinical research which was effectively imposed and held in place by the policy itself.

Hopefully, some day soon, the passage of Proposition 215 in 1996 will come to be seen as the first step in repudiating a thoroughly unscientific substance prohibition that had been permitted to masquerade as responsible public policy throughout most of the 20th Century.

Until that happens, our future as a democratic nation will remain in considerable doubt.

Doctor Tom

Posted by tjeffo at 03:50 PM | Comments (0)

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 07:17 PM | Comments (0)

January 08, 2007

Puzzles and Mysteries

Readers of this blog quickly learn that although I'm a supporter of medical pot on both clinical and political grounds, I have  problems with what I regard as the failure of drug policy reform to take full advantage of the opportunities Proposition 215 created ten years ago; in fact, I've gone so far as to accuse them of the same blind adherence to dogma that typifies their opponents in the DEA, ONDCP, and NIDA.

In essence, I have spent five years  attempting to solve several mysteries. Before identifying them, I should first call attention  to Malcom Gladwell's brilliant elucidation  of the differences between puzzles and mysteries in this week's New Yorker: he contends that the former are quite specific and can be solved by relatively small amounts of one-of-a-knd information; however, solution of the latter generally require a large number of accurately classified observations (data). Gladwell's example of a puzzle is the precise location of Osama bin Laden, which US intelligence has been unable to come up with for over five years. His example of a mystery is the collapse of Enron; he had been able to identify several astute observers who had been tracking (and profiting from) public information about the reckless business practices and worsening earnings of the energy giant for several months; even while the conventional wisdom of the market still considered it a stock to buy and hold,

The first important mystery to surface in my early experience with pot applicants was one that neither government prohibitionists nor drug policy reformers have ever shown any interest in: how did an herbal substance–– which has been a recognized  medicine from 1839 to 1937, and then been summarliy banned without generating much market interest –– suddenly become popular enough with the adolescents of the Sixties to provoke a newly-elected President Nixon into declaring a destructive  drug war ?  A closely related mystery was how that banned product has achieved its spectacular market success (it has been the most valuable cash crop in America for several years) despite a relentless propaganda campaign against it and a repressive enforcement policy that has generated three quarters of a million arrests annually; also for several years?

But the ultimate mystery I still had to solve was why neither prohibition nor reform have been at all interested in those mysteries, let alone in their solutions. As it turns out, the unbiased clinical examination of those Californians induced to apply to use pot medically, when compiled in enough detail, not only provides solutions, but also discloses some previously unsuspected destructive effects of our forty year drug war.

The major residual problem is the mistaken mind-set about pot use which  reform continues to share with the general public; thankfully, a just-published Op-Ed by 215's 1996 political managers, written to celebrate the Proposition's tenth anniversary, provides an opportunity to point out that mind set and show how it has worked against the initiative

It's an issue I promise to return to very soon...

Doctor Tom

Posted by tjeffo at 12:46 AM | Comments (0)

January 04, 2007

The Curse of Half Measures

Fred Gardner used the hoopla over the departure of Gerald Ford and some recently released transcripts of secret Oval Office tapes to call attention to  a maundering monologue by the very man who appointed Ford President and was later pardoned by him. Whether history will continue to see Ford, whose own appointment legacy includes not only Cheney and Rumsfeld, but also drug advisor Robert DuPont (later appointed NIDA's first director), as the quiet hero and 'healer' being gushed over during this past week is another matter, but one thing becomes painfully clear from Gardner's analysis: a series of politically correct compromises made by its leaders while the fledgling drug policy reform movement was still in its infancy has kept it mired in an unequal struggle for nearly four decades.

During that same interval, a cruelly inhumane and intellectually improbable drug war has become so powerfully intrenched  that its repudiation as policy any time soon seems very unlikely to most observers. Sadly, and ironically, many of the same reform leaders are still around and their preferred tactic of politically correct compromise with the concept of prohibition continues to dominate the movement they founded.

So successful was Nixon at burying the  March,1972, report of the Shafer Commission that few modern reformers even know who Ray Shafer was, let alone the consequences of the crippling compromises made to soft-pedal his Commissions's report before its release; however the transcript of the conversation between a (probably drunken) Nixon and a very quiet Art Linkletter really amounts to a monologue in which Nixon dramatically reveals his own prejudices against Jews, psychiatrists, homosexuals, and Catholics,  as well as a deep distrust of anyone whose drug of choice is not alcohol. It's also important to realize that this monologue was delivered long before Watergate and the '72 Presidential campaign. Although Nixon was still consolidating power and only being discomfited by young ant-war demonstraters, his paranoia is starkly revealed.

The key to the significance of Gardner's piece is his succinct statement, "decriminalization' is a one-word lie;." That's because so long as power remains in the hands of police and prosecutors; they get to decide how much, and how rapidly to allow any softening of a repressive policy. Thus 215 only gave California in 1996 what the Shafer Commission had recommended for the entire nation in 1972; even then, the modern pro-pot lobby has failed to either understand or take advantage of the opportunities offered by the irregular development of a huge 'gray market' within the state in response to the initiative.

Thanks to their lack of response, those gray market outlets are now being shut down and distribution increasingly forced back to the street where market perticipants will be more vulnerable to arrest. The next step will almost certainly be to make the required physician's endorsement more expensive and less valuable by adding onerous administrative requirements to the highly imperfect SB 420.

Doctor Tom

Posted by tjeffo at 08:37 PM | Comments (0)