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February 27, 2007

A Psychiatrist's Analysis of George W. Bush

George Bush's "irrational"consideration of a "surge" in the wake of the Iraq Study Group report -- which apparently defies all credible counsel -- has begun to generate speculation regarding his sanity. References to Bush's "delusions" have appeared in the mainstream media and throughout the blogosphere.

As a psychiatrist, I understandably get concerned when I see clinical terminology bandied about in political discourse, and thought it might be of interest to share a professional perspective on this question.  I have adistinct clinical impression that I think explains much of Mr. Bush's visible pathology.  First and foremost, George W. Bush has a Narcissistic Personality Disorder.

What this means, is that he has rather desperate insecurities about himself, and compensates by constructing a grandiose self-image.  Most of his relationships are either mirroring relationships -- people who flatter him and reinforce his grandiosity -- or idealized self-objects -- people that he himself thinks a lot of, and hence feels flattered by his association with them.  Some likely perform both functions.  Hence his weakness for sycophants like Harriet Miers, and powerful personalities like Dick Cheney. Even as a narcissist, Bush knows he isn't a great intellect, and compensates by dismissing the value of intellect altogether.  Hence his disses of Gore's bookishness, and any other intellectual who isn't flattering him.  Bush knows that his greatest personal strength is projecting personal affability, and tries to utilize it even in the most inappropriate settings.

That's why he gives impromptu backrubs to the German Chancellor in a diplomatic meeting  -- he's insecure intellectually, and tries to make everyone into a "buddy" so he can feel more secure. The most disturbing aspect about narcissists, however, is their pathological inability to empathize with others, with the exception of those who either mirror them, or whom they idealize.  Hence Bush's horrifying insensitivity to the Katrina victims, his callous jokes when visiting grievously injured soldiers, and numerous other instances.  He simply has no capacity to feel for others in that way.  When LBJ was losing Vietnam, he developed a haunted expression that anybody could recognize as indicative of underlying anguish. For all his faults, you just knew he was losing sleep over it. 

By the same token, we know just as well that Bush isn't losing any sleep over dead American soldiers, to say nothing of dead Iraqis.  He didn't exhibit any sign of significant concern until his own political popularity was sliding --  because THAT'S something he CAN feel. Which brings us to his recent "delusion."  To be blunt, I don't see any indication that Bush has any sort of psychotic disorder whatsoever.  The lapses in reality-testing that he exhibits are the sort that can be readily explained by his characterological
insensitivity to the feelings and perceptions of others, due to his persistently self-centered frame of reference.  Mr. Bush knows that things aren't going his way in Iraq, and he knows that this is damaging him politically.  He also sees that it is likely to get
worse no matter what he does, and in fact it may be a lost cause.  However, he recognizes that if he follows the recommendations of the Iraq Study Group, Iraq will almost certainly evolve into a puppet state of Iran, and given his treatment of Iran he will completely lose control of the situation -- and he will be politically discredited for this outcome.

The ONLY chance that he has to avoid this political disaster, and save his political skin, is to hope against hope for "victory" in Iraq.  Advancing the "surge" idea offers Bush two political advantages over following the ISG recommendations.  One is that if it is implemented, maybe, just maybe, he can pull out some sort of nominal "victory" out of the situation.  The chances are exceedingly slim, granted, but slim is better to him than thealternative -- none.  Alternately, if the "surge" is politically rejected, he gains some political cover, so when things inevitably go bad, he can say "I told you so" and blame the "surrender monkeys" for the outcome. Most people probably won't buy it, but some (his core base) will.  Now, I know what many of you are thinking -- is George Bush willing to risk the lives of hundreds, maybe thousands more American soldiers, on an outside chance to save his political skin, in a half-baked plan that even he knows probably won't work at all?  Yes, he is.  Because George Bush is that narcissistic, that desperate, and yes, that sociopathic as well.

Especially interesting about Mr. Bush, but quite common, Narcissistic Personality Disorder is frequently associated with alcoholism.  The insufferable "holier than thou" attitude associated with "Dry Drunk" Syndrome" is indicative of underlying narcissism.  Also, the way that Bush embraces Christianity is characteristically narcissistic.  Rather than incorporating the lessons of humility and empathy modeled by Jesus, Bush uses his Christian faith to reinforce his grandiosity.  Jesus is his powerful ally, his idealized "buddy" who gives a rubber stamp to anything he thinks.  Finally -- and this will sound VERYfamiliar to many readers -- those persons with NPD are notoriously unable to say they're sorry.

Admitting error is fundamentally incompatible with their precarious efforts to maintain their sense of order.  Anyone having this particular characterflaw almost certainly has NPD.

This perspective on President Bush's public behavior by Dr. Paul Minot, a psychiatrist in Waterville, Maine, was sent to me in an e-mail from a physician I've known for a long time; I don't know where (or even if) it was originally published and I've never met Doctor Minot; however, googling  his name satisfies me he does exist and probably wrote it. Although I agree with much of what it says and admire its concise, well constructed prose, I'm in profound disagreement with the Psychiatric nosology (system of classification) the evaluation is based on. Sometime soon, I will post a similar evaluation based almost entirely on what I have learned from five years of interviewing people who use cannabis on a regular basis as a way of illustrating where I believe Psychiatry and the Behavioral Sciences have been led astray, with no small assistance from the war on drugs.

Doctor Tom

Posted by tjeffo at 04:33 PM | Comments (0)

February 26, 2007

A Plea that Failed

This  letter was written at the invitation of Dustin Costa's federal defender; I don't know if the judge ever read it; certainly, he gave no sign of recognition while listening impassively to a much shorter oral version delivered in Court on the day after the Super Bowl. There were several other pleas for mercy before the judge launched into a wandering dissertation that confirmed his entirely different interpretation of the case he'd just presided over. I don't remember any of those remarks; only that they fully prepared me for the gross miscarriage of justice they led up to: fifteen years in a federal prison

Dear Judge Ishii,

 I am indeed grateful for this opportunity to address the Court before sentence is passed on my friend and colleague, Dustin Costa, because I see it as an opportunity to call attention to information which was not brought out at his trial and also justifies a very specific request: that he be sentenced to time already served in the Fresno County Jail.

It has been a matter of great regret that although I was called as a witness at his November 2006 trial, I had no opportunity to disclose to the jury material which will be presented in this letter; material which, with one important exception, I would also have been prepared to give as testimony in a trial held under the jurisdiction in which Mr. Costa was originally charged, Superior Court of the State of California. The ‘important exception’ referred to above was the precipitous and unprecedented change in jurisdiction signaled by six California peace officers serving a federal arrest warrant at gunpoint on August 10, 2005.

The federal jury that convicted him was not only prevented from learning of that abrupt, secret, and fundamentally unfair change in jurisdiction; the event itself prevented them from hearing other important pieces of evidence which might have been exculpatory under a California law (The Compassionate Use Act), which has survived multiple reviews by both the California and US Supreme Courts since its passage in1996.

I met Mr. Costa when he saw me as a patient on October 31, 2002, and then again in December 2003, for renewal of the physician’s recommendation to use cannabis required by the Compassionate Use Act. Mr. Costa’s previous recommendations had been provided by Doctor Eugene Schoenfeld of Sausalito, one of the few California physicians then willing to discuss use of cannabis with patients. Mr. Costa came to me after I began providing the same services in Oakland; only because my location was considerably closer to his Central Valley home.

In terms of his medical history, Mr. Costa, who suffers from both diabetes and psoriasis, easily qualified as a medical user. In addition, he had also been a significant long-term abuser of alcohol and had learned from Dr. Schoenfeld that cannabis could help him control his problem drinking. In fact, Mr. Costa, who weighed well over 300 pounds when he first saw Schoenfeld, credits that advice with saving is life.

At the time of our first consultation, I had been screening a steady stream of cannabis applicants for nearly a year and was beginning to recognize the first of several commonly held misconceptions which the unique opportunity to study a large population of admitted long term users was beginning to disclose.

Those early realizations have since been pursued in an ongoing clinical research project. One of several subsequent disclosures has been that Mr. Costa’s age, family experiences and adult history mark him as an archetypal early cannabis user of the type that ultimately gave rise to the enormous, and still growing, illegal market that exists today.

That market, first enabled by the Marijuana Tax Act of 1937, did not begin growing until a critical development took place in the mid-Sixties: hundreds of thousands of adolescents and young adults of Mr. Costa’s generation had to unwittingly discover the anxiolytic properties of inhaled cannabis. The suddenly developing popularity of ‘marijuana’ among youthful users over a decade of tumultuous social change soon generated a powerful response: the Controlled Substances Act of 1970, which has since sustained an increasingly rigorous policy of cannabis prohibition as the mainstay of a ‘war’ on drugs.  According to policy advocates, the still-growing numbers of chronic cannabis users should be considered either addicts or willful hedonists deserving of harsh punishment for continued use.

What my research suggests, however, is a quite different interpretation: the stubborn popularity of cannabis among youthful initiates is related to its efficacy in relieving symptoms of juvenile angst for which alcohol and tobacco had long been the entry-level self-medications of choice. Not only does cannabis relieve those symptoms more safely and effectively, it diminishes subsequent use of the other two agents, particularly alcohol. Also, the persistence of symptoms in an unknown fraction of those youthful initiates is almost certainly what has sustained the still-growing illegal market among otherwise law-abiding adults.

In other words, rather than a gateway into ‘hard’ drugs, cannabis has been quietly functioning as a healthier alternative to alcohol, tobacco, and other drugs for vulnerable adolescents. Without question, Mr. Costa has been unique among the medically untrained people I know in his ability to grasp the significance of those findings and how they might be applied. Following his arrest by local authorities in Merced, our mutual needs led us to cooperate in developing those concepts from the early summer of 2004 onward.

At this point it may be appropriate to interject that rather than something to be frustrated, constrained, or thwarted by the existing power structure, a more positive response to the passage of Proposition 215 would have been to regard it as an opportunity to learn precisely why a vexing illegal market had been prospering for over three decades in the face of repressive federal and state efforts to destroy it.

 Mr. Costa’s need to defend himself had already led him to start a cooperative (The Merced Patient Group) as a model that might ultimately qualify for legal distribution of cannabis under the Compassionate Use Act. He was also working on community service projects that could take advantage of the powerful rehabilitative potential of cannabis identified by our data.

My own needs, generated by constantly changing political pressures on cannabis retail outlets, were for a continuing flow of patients in a venue where they could be seen at fees they could afford. Our mutual needs led us to conduct a series of clinics in Merced from August 2004 until his incarceration in August 2005. Since then, he has contributed several valuable (anonymous) histories gathered from fellow prisoners which have enhanced my own understanding of the impact of drug use on behavior, as well as how a more enlightened policy might help solve those problems.

Some findings of this five year experience with chronic cannabis users are summarized in a blog and on other web sites. It is to be emphasized that while neither final nor definitive, this work strongly suggests that federal drug policy is both grievously mistaken and unnecessarily destructive; primarily because it is being enforced in the absence of any unbiased evaluation of its results. In that context, I can only see the federal trial and conviction of Mr. Costa as profoundly unjust.

Thank you for allowing me to offer this statement on the occasion of his sentencing.


This gross injustice is, sadly, only one out of the many now competing for space in our media, which is the main reason I'm chronicling it here today. At some point, it will have to stop, but experience also teaches that we have no way of knowing how or when that will finally happen.

Doctor Tom

Posted by tjeffo at 04:37 PM | Comments (0)

February 22, 2007

Paradigm Shifting can be Lonely Work

Despite its somewhat checkered history, the term paradigm, which is now encountered far less often than in the Nineties, remains a useful generic term for the unwritten rules observed by a majority of discussants in a specialized field. In that sense, one can understand that American drug policy is surviving its unbroken record of failure largely because of the restrictive paradigm in which it has long been ‘debated’ by the ‘experts’ on what are erroneously presumed to be both sides of the issue.

Because a majority of those experts are actually within the same ‘box’ and either actively or passively resist efforts at thinking outside it, the paradigm shift required for significant change in American drug policy has been made far more difficult.

What has also been made clear to me by the (unexpected) oportunity to do unbiased clinical research among actual drug users is that our national drug policy is best understood as a gigantic and destructive conceptual error which evolved erratically into repressive dogma over almost a century, despite its near total lack of scientific validation at every phase of that evolution.

The drug policy emperor indeed wears no clothes, and the degree to which his illusory raiment has been accepted as real is a major part of the problem of deposing him. There are now a host of vested interests which would have enormous difficulty acknowledging such a mistake; to say nothing of having to deal with the economic consequences. In the meantime, I occupy a lonely position, because a detailed understanding of the errors underpinning pot prohibition turns out to be a kind of Rosetta Stone for deciphering many of the generic human cognitive aberrations it exemplifies.

In other words, the more familiar one is with my findings, the easier it is to translate the rhetoric with which we fear-driven humans tend to deal with each other, whether in commerce, politics, diplomacy, or religion. Because we have impusively plunged ahead in using science to serve the usual fear driven goals, we may have already painted ourselves into a corner from which escape is far from guaranteed.

While I’m not claiming drug policy is responsible, it has certainly helped; and it also serves as an excellent illustration of how the problem was created.

Doctor Tom

Posted by tjeffo at 05:28 AM | Comments (0)

February 18, 2007

Human Emotions and Historical Analysis

The facile observation that, "Those who cannot remember the past are condemned to repeat it," has remained one of the more famous aphorisms of our time ever since George Santayana made it (Reason in Common Sense) near the turn of the last century. Sadly, it’s likely to remains so. That’s because we humans seem to have a built-in tendency to disagree, often violently, over what we will allow ourselves to believe;  both as groups and as individuals. In other words, what is regarded as ‘true’ at any one moment has always been both a matter of belief, and subject to great disagreement. A critical corollary of Santayana’s truism is that the critical influence of our emotions on our political and religious beliefs has tended to be denied; even as they were being manipulated by those seeking to exert control over human society.  That history also confirms that our  beliefs have produced violence along a spectrum ranging from fist fights through formally declared wars between nations to barbarous acts of terrorism by loosely affiliated groups does not auger well in a modern world increasingly understood to be but a speck in a vast cosmos and constantly stressed by recent ‘explosions’ of its human population and the information available to that population.

Is it any wonder then, that stress, anxiety, and their various named surrogates: insomnia, depression, PTSD, and ADD, have become a major focus of the television advertising purchased by our increasingly competitive and lucrative Pharmaceutical Industry? When one also considers that it takes only a few searching questions to reveal that nearly all the Californians seeking my ‘medical’ endorsement of their  continued use of inhaled cannabis have clearly been self-medicating with it since adolescence, is it any wonder that such illegal use has been  steadily increasing among those who tried it during adolescence and are now being punished ever more severely by a central government clearly committed to protecting its current drug policy?

That seems like enough rhetorical questions for now; more later.

Doctor Tom

Posted by tjeffo at 07:31 PM | Comments (0)

February 17, 2007

'Progress' in a Glacial Debate

In addition to DEA Administrative Judge Mary Ellen Bittner's non-binding recommendation that Professor Lyle Craker be allowed to grow cannabis for research purposes, a second cannabis-related medical milestone was reached this week: a paper from the University of California Medical School in San Francisco reporting that inhaled cannabis significantly reduced AIDS-related neuropathic pain in a small, but carefully controlled series of human subjects, was published in the peer-reviewed journal, Neurology. Of the two events, the latter seems more likely to have both immediate and lasting impact on drug policy. There is also a decent possibility that the almost simultaneous announcement of the two events might have a synergistic effect by deterring Bittner’s DEA superiors from rejecting her recommendation as they would otherwise be certain to do.

My optimism stems from the historical impact of an earlier peer reviewed paper which ‘officially’ established a medical benefit from cannabis that could not be easily dismissed. It’s significant that by the time Proposition 215 made it to the ballot in 1996, federal rhetoric had shifted from the dogmatic assertion that, as a schedule one drug, pot couldn’t possible have ‘medical utility’ to the significantly different position that other medications worked ‘better,’ and without the ‘undesireable’ (code for immoral) effects of ‘crude’ marijuana. It was also certainly more than coincidence that Marinol, a semisynthetic form of THC,  was developed for oral use by Unimed during the protracted DEA hearings that led to Judge Francis Young's famous opinion and then approved for schedule two the same year.

More recently, the rhetorical argument with which Barry McCaffrey, following cues within the report itself, minimized the impact of the  1999 IOM report by stating that anything 'smoked’ couldn't be 'medicine, was adopted by the FDA this past year as the main reason it would never be approved for therapeutic use. Just coincidentally, vaporization, the technique that the cannabis Professor Craker hopes to grow would be used to study, is of interest primarily because it would obviate most of the theoretical danger from inhaling the products of plant combustion, a danger recent studies have unexpectedly failed to confirm. Such is the glacial progress of the arcane, largely rhetorical, and completely dishonest 'debate' that's been raging between the feds and reform since 'medical use' was first raised as an issue in the early Eighties.  Sadly, that debate has been neither understood nor accurately reported by the media and what my own experience underscores is the enormous advantage the government has always enjoyed from being able to use the criminal code to place millions of self-medicating humans off limits for clinical research.

Of course, the insistence by most lobbyists for medical use that it's only valid for the 'seriously' ill, and that their lifetime use has been strictly 'recreational' hasn't helped to either clarify a murky situation or advance their  cause. Quite the opposite; it has tended to validate the exaggerated Cheech and Chong image of the Seventies.  In that way, opinionated reformers have been more than a little like the Congressional Democrats who painted themselves into a corner by voting for a feckless war in Iraq.

Incidentally, neuropathic pain is a well known, but poorly understood, medical problem which also tends to be under treated; the fact that cannabis can do so effectively wasn't news to me because I'd been enlightened by several patients seeking recommendations; unfortunately, that still isn’t ‘official,’ because it has yet to be published in a peer reviewed journal.

But I'm working on it...

Doctor Tom

Posted by tjeffo at 04:42 PM | Comments (0)

February 15, 2007

Lou Dobbs, Reform and the American Dilemma

Readers may have noticed my impatience with drug policy 'reform,' a movement I first discovered in 1995, through attending the ninth annual meeting of the Drug Policy Foundation in Santa Monica. Upon returning home, I  became involved, in short order, with personal computing, the internet, and political activism. Those were heady days, indeed. As an almost retired Bay Area surgeon with some unacustomed time on his hands, I soon found myself at the center of the campaign for Proposition 215. Although a pot novice, my age  allowed me to join a famous Market Street Buyers' club where I just happened to make a purchase  late one Saturday evening,  hours before a surprise morning raid by state narcs produced headlines around the world and almost certainly guaranteed passage of an initiative that had been struggling for public awareness.

Lungren's raid also helped inspire creation of Media Awareness Project, which together with its newsletter, would provide me with five years of largely uncompensated employment, as well as an intense education in drug policy history and theory. What I wouild also learn, however, soon after being recruited to screen cannabis applicants at a new Oakland club in November 2001, was that I knew almost nothing of the cannabis culture that had sprung up among American Youth twenty years after I left High School in the Forties. Ironically, it was precisely that naivete that led me to realize that the requirement that I examine a steady stream of pot smokers was also a unique opportunity for clinical research, while, at the same time, convincing the reform veterans I tried to share my (unexpected) findings with that I didn't know what I was talking about.

After all, weren't they all pot using reform veterans who had been immersed in the political campaign for medical marijuana while I had been completely unaware of the movement? Hadn't I been steeped in ignorance while they were developing not only a modicum of rare medical knowledge about pot use, but also a raison d'tre, a strategic agenda and a professional career? How could I possibly have learned anything they didn't already know?

What I would also learn was that the complex evolution of medical marijuana as an orphaned initiative, hated by many bureaucrats and unabe to generate the usual protective 'enabling legislation, had created a political vacuum; one influenced by a number of conflicting interests,  highly variable legal and law enfoercement opinions, and a great deal of uncertainty during its first five years of existence. Ultimately it would also be influenced by the interaction of several new factors, including the number of MDs willing to write recommendations, the number and location of clubs that opened to sell pot to those possessing them, and the response of both local and federal law enforcement agencies to both public opinion and the timid non-decisions of the California and US Supreme Courts. Without going into detail, I would venture that the huge variation in numbers of Californians who had seen a doctor and paid for a recommendatiom has been the best indicator that a lot of interest in pot exists in California. Also; whether one regards its use as 'medical' or recreational' is largely a function of one's political beliefs.

In keeping with my virtual ostracism from the local reform community, I now rarely contribute opinions to the two reform e-mail lists I still subscribe to, but I continue to read them for the news. Recently there has been a surge of outrage toward Lou Dobbs of CNN for his opportunistic criticism of those he considers responsible for the influx of both  illegal drugs and illegal aliens across our Mexican Border. Reform's annoyance with Dobbs has approached that generated by the latest federal proaganda from John Walters or  NIDA, but I have seen Dobbs' uninformed blather very differently: rather than something to complain about, I've seen it as another missed opportunity for reformers to have pointed out just how silly and unworkable our drug policy really is.

If one considers that our inabiity to 'control' both the illegal drugs and illegal immigrants smuggled across our southern border has been documented in numbing detail, the absurdity of our drug policy becomes inescapable. In fact, the failure of CNN, Dobbs' natural enemies in the media and just about every other interested party to answer his bleatings with that response can be seen as a manifestation of the systemic malaise that has allowed our drug policy to become a heavily protected sacred cow, despite the obvious social damage it inflicts on our most important institutions.

The similar failure of reform to take advantage of the dramatic unraveling of the Dubya/Cheney war in Iraq by pointing out its obvious parallels with the drug war is another such omen. I'm not at all sure of the origin of all these omens, but I don't see any of them them as promising for either an effective change in drug policy or for our national future...

Doctor Tom

Posted by tjeffo at 03:46 AM | Comments (0)

February 13, 2007

A Little Known Case

Yesterday, a celebratory press release from an organization relatively few people have ever heard of announced a favorable decision by an unknown DEA Administrative Law Judge named Mary Ellen Bittner in a contentious case that has been dragging on for years. At issue  was whether a University of Massachussetts professor should be permitted to grow cannabis (‘marijuana’) at the behest of a private organization for a straightforward study intended as a first step in exploring its possible use as an FDA approved therapeutic agent. In other words,the need to conform to the provisions of the Controlled Substances Act of 1970 had required that the first step of what promises to be an arduous journey be taken within the enemy camp.  

This is not the first time a DEA administrative law judge has made a favorable ruling on behalf of ‘medical marijuana.’ A far more sweeping decision, that cannabis is indeed medicine, had been made by DEA Judge Francis Young in 1988 in response to a NORML petition to reschedule cannabis as permitted by the CSA. He was soon peremptorily overruled by his administrative superior, in accordance with the one-sided provisions of the CSA. In essence,that pair of decisions, soon followed by credible evidence that some frustrated oncologists were recommending use of ‘marijuana’ to their patients is what eventually led to initiatives allowing  the contested medical use now permitted in some states.

Whether Judge Bittner’s decision will be overruled or allowed to stand is now the burning issue for medical marijuana reformers. Past experience, plus the fanatical intransigence of drug war supporters within the federal government, do not auger well. If the current decision is allowed it stand, it could represent a sea change in the direction of American drug policy.

I’m not counting on it...

Doctor Tom

Posted by tjeffo at 03:39 PM | Comments (0)

February 12, 2007

A Typical Example of Medical Use

Michael Goldstein’s clever, but misleading, piece in yesterday’s LA Times Magazine will probably be used by critics of medical marijuana as an example of ‘cheating.’ It also unwittingly illustrates several of the more popular misconceptions of pot advocates so well that I can’t resist pointing a few out.

Right off the bat, his choice of the word ‘medicate’ confirms that the present controversy involves doubts raised by medically untrained ‘experts’ about pot smokers with recommendations: are they toking for ‘valid’ reasons? Also, his chosen examples, Xanax, Prozac, and Vicodin, cover most of the symptoms a majority of chronic pot smokers self-medicate for. Anyone reading the entire article will also learn from the last paragraph that Goldstein himself remains somewhat confused: “I learned a lot during my months as a medical marijuana user and came to three conclusions: My tolerance is low; pot should be legal as a pain reliever; the distribution system in place right now has room for improvement. But it's like Winston Churchill said about democracy—it's the worst form of government, except for all the others.”

What’s unusual about Goldstien is his inclusion of key autobiographical details: that he’s been a minimal user for thirty years since living on the East Coast in the Seventies, that his use has intensified in the six months he’s had his recommendation, and that he’d also been prescribed Vioxx for arthritic pain, but had been afraid to take it.

Those details go along way toward placing him solidly within the ‘patient’ population I’ve been gathering data from for the past five years. If I had more time, I could go into even greater detail;  but if you’re not a drug warrior or a member of NORML, you may already be able to get what I’ve been driving at...

Doctor Tom

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

February 11, 2007

More Drug Policy 'Science'

As I’ve emphasized since starting this blog, my now-five year old study of pot smokers has been opportunistic from the beginning, thus it couldn’t have been designed in advance. Rather, it had to take direction from whatever
characteristics might be exhibited by whatever candidate population was motivated by the (unexpected) passage of California’s initiative in1996 to seek a ‘recommendation.’ It would also be a function of whatever information could be obtained from them under whatever circumstances might prevail when they were seen.

An important corollary turned out to be that those exhibited characteristics would also depend both on how pot smokers perceived themselves, and how their perceptions had been nfluenced by prevailing beliefs. Thus, whatever I could learn from them would be a mixture of truth, drug war propaganda, their take on that propaganda, and my own ability to discover, record, and analyze what they knew.

The most basic consideration of all may be that recent expensive federal anti-marijuana campaigns could not have been based on lies, because one can’t lie if one doesn’t know the truth, and the most obvious conclusion that can be drawn from my data is that critical elements of the truth have been successfully hidden from nearly everyone by the drug war since it was declared nearly forty years ago.

On the other hand, since its rhetoric is nearrly always intended to shore up yet another improbable belief rooted in speculation, recent federal campaigns in defense of the drug war have had to be increasingly improbable just to deal with the slowly accumulating mountain of evidence that cannabis is safe and effective medicine— especially for anxiety disorders.

A good example was just published; the fact that cannabinoid agonists do hold great promise in the treatment of several diseases (Parkinson’s in this case) raises questions that should properly have  been asked long ago in any rational society:
1) Why did it take so long to identify cannabinoids and an endocannabinoid system in the first place?

2) How can the ‘scientists’ studying cannabinoid agonists in rodent models  spout such doctrinaire nonsense  in defense of a policy that’s kept  research confined to blind alleys for years?

3) In a setting in which millions of Americans have been self-medicating with cannabinoids for nearly four decades, why should that experience be rejected on the grounds that their self-medication was once foolishly made illegal or is now seen as insufficiently 'precise' on spurious a priori graounds?

4) Just how stupid can one society be?

Doctor Tom

Posted by tjeffo at 06:40 PM | Comments (0)

Science and Policy

The Manhattan Project, which produced the world’s first three nuclear bombs, is also the prototypical example of a publicly funded, goal-directed scientific project that quickly grew into a massive bureaucracy; yet, unlike most such structures, eventually succeed in accomplishing its original goal. Conceived on the eve of Word War Two out of the combined insights of two émigré European physicists and their fears that Nazi scientists were aware of, and perhaps already exploring the weapons potential peculiar to their esoteric area of expertise: nuclear chain reactions.  The project started modestly with a letter one of them had written and then persuaded Albert Einstien to send to President Roosevelt just before the invasion of Poland in September, 1939.

The rest is history

My purpose here is neither a detailed history of the Manhattan Project nor continuing the endless debate over how those three original weapons should have been used; rather it’s to call attention to the project as prototype for similar publicly-funded, goal-directed scientific projects that have eventually produced a series of brilliant successes for the US space program under the control of NASA, an organization which, like the Manhattan Project, was born out of a similar fear: that  Russia, then our sworn Cold War enemy, would gain dominance over the US by being first to develop the lethal potential of an emerging technology.

Beyond that, I’d also like to invite a comparison with the  quite different role of drug policy ‘science’ under the control of NIDA since its creation in 1975.

NASA’s first prodigious feat was fulfilling President Kennedy’s 1961 promise of a safe round trip to the Moon before 1970. Again, this is not to defend or debate the political wisdom of manned space flight; but simply to point out that the series of investigations required to accomplish that goal, although cloaked in a degree of military secrecy appropriate to the Cold War, were logical, systematic, and public to the degree possible. Since our manned space missions have always been conduted publicly, the managers of NASA have always had to face the possibilty of failing publicly. Compare their approach and results with the tactics and results of a drug policy that has always insisted that the major problem represented by drugs is ‘addiction,’ as conceived in 1914, and the only acceptable policy must be universal total abstinence from certain agents and the grudging  use of others under tight medical supervision. Also, that the arrest and criminal prosecution of violaters is the only way to secure compliance.

That that this policy has failed disastrously is an open secret to all but those with a vested interest in defending it; that the role played by science quickly shifted from studying drug use to justifying current policy should be clear to anyone with a modicum of medical knowledge and the ability to read; yet the drug war is being more ardently prosecuted than ever— especially in California and against the medical use of marijuana.

Unbiased clinical studies of illegal users are all but impossible to perform under NIDA control and any that are done are nearly impossible to publish in peer-reviewed journals.

Ironically, the success of our witless drug policy can now be seen as purely a propaganda victory based on fear and greed; entirely analogous to the initial success of the Nazis in gaining control of Germany during  the Thirties— or the success of the Bush Administration in using those same emotions to stampede this nation into an unwinnable war in the Middle East.

Doctor Tom

Posted by tjeffo at 12:31 AM | Comments (0)

February 06, 2007

  American Justice

On Super Bowl Sunday, my wife and I drove down to Fresno for the sentencing of my friend Dustin Costa, shamefully victimized by our federal government when subjected to a double-jeopardy federal arrest in August, 2005 for exactly the same charges of growing medical cannabis he was then defending himself against at the state level.  The unprecedented second arrest was carried out soon after the June '05 Raich decision that bore little discernible relationship to the key point those filing the case had hoped to establish: the legitimacy of Proposition 215. In their wisdom, the Supremes, whose individual comments documented how little they understand the issues, left the two laws standing in opposition; but gave a key enforcement boost to those favoring federal supremacy.

Too bad the sponsors of Raich neglected to frame their challenge in a way that might have also forced a review of the witless MTA. That omission allowed the Supremes to pretend that the Constitutional issue was simply the legitimacy of the Interstate Commerece clause, and not the practice of Medicine by unqualified federal bureaucrats.

Better yet if they had simply left well enough alone; their implicit assumption that Supreme Court Justices are both wise and above politics proved naive in the extreme. Thus much of the ground painfully gained during the erratic nine year evolution of Proposition 215 within California was lost through an unwise legal gambit.  There is no doubt  the thriving illegal cannabis market in California will survive, but growing and distribution for medical use have become far more problematic and the public is more confused than ever.

In essence, Costa's sentencing proved every bit as grotesque as his federal arrest and truncated trial following 15 months of punitive incarceration in the Fresno County Jail. The same judge, Anthony Ishii, who had made a series of rulings recognizing a dubious search and keeping the jury from hearing the most important details of the case,  then presided over a truncated trial in November. He completed his farcical judicial hat-trick yesterday by sentencing Costa to near the maximum requested by a relentlessly malevolent prosecution.

When Costa was led in to be sentenced in the same chains that had been objected to and removed during his trial, I had a sense of what Ishii's long awaited sentence would be. Thus I wasn't surprised when, after listening impassively to a series of articulate pleas for leniency, he dithered incomprehensibly for what seemed like an eternity before agreeing with the prosecution on all but one minor point.

Compare that with Ed Rosenthal's sentence of time served. Thus, a 60 year old diabetic, who is clearly not a criminal, and arguably thought he was in compliance with a state initiative left standing by both the California and US Supreme Courts, was sentenced to thirteen years in federal prison for the 'crime' of challenging a policy that has been failing egregiously for nearly four decades. The judge's voice, which had been hesitant and uncertain while considering the various confusing alternatives open to him,  strengthened noticeably  as soon as he began reading the prolonged, formulaic sentence specifying details Costa will have to comply with, if still alive, after thirteen years of federal imprisonment.

Perhaps as balm for his conscience, Ishii also punted to the Ninth Circuit. In the words of ASA's  Kris Hermes: 'Judge Ishii, however, also commented that, because Costa was caught between conflicting state and federal laws, he would make special note of these circumstances for the purpose of his appeal. Costa fully intends to file an appeal and will likely seek release on bail pending that appeal.'

Thus does 'reform' seek to make a silk purse from a sow's ear.  I, for one, am nearly as disgusted by their dishonest timidity as by the feds' dishonest arrogance.

 A pox on both.

Doctor Tom

Posted by tjeffo at 05:01 PM | Comments (0)

February 03, 2007

Blowing Smoke

 The last entry on smoking made two important points which I'd gleaned from data supplied by cannabis applicants: the first, and historically more important, was that the rapidly developing popularity of cannabis with adolescent and young adult baby boomers in the mid Sixties was what had frightened a majority of Americans then over thirty into accepting Richard Nixon's invidious war on drugs.

 The second point was that it was the rapid onset of pot's anxiolytic properties that occurs only when it is inhaled, which had made it so popular with that era's young people who, until that time, had only alcohol and tobacco as readily available psychotherapeutic agents with which to self-medicate.

 Those two concepts are basic; they also raise several other implications which challenge critical assumptions accepted on behalf of the drug war over the past forty years, assumptions which can now be seen as reflecting the blatant bias of a policy that has always placed a higher value on self-defense than on truth.

The first such assumption was a lame, never-validated ‘gateway’ idea which has never even passed muster as a hypothesis, but nevertheless has been trumpeted as a 'theory' by both the relentlessly self-interested  Robert DuPont and the lay press. It has also been sucking up large amounts of NIDA research money for policy- compliant behavioral 'scientists since 1975.

Significantly; a NIDA-sponsored  summation of those studies, which unwittingly also reveals their emptiness, was published in 2002, the same year a seminal theoretical analysis by Morral, et al demonstrated that some as yet unknown ‘common factor’ could offer a more coherent explanation.

In the next entry, I’ll discuss how the (probable) nature of that common factor can also be gleaned from data supplied by California pot smokers...

Doctor Tom

Posted by tjeffo at 07:03 PM | Comments (0)

February 01, 2007


Timing is important. Yesterday's entry was intended to set the stage for advancing a number of related and somewhat complex ideas  about how the huge modern illegal market got started only after large numbers of baby boomers discovered the benefits of  inhaling pot in the mid-Sixties.

Even after posting that entry, I wasn't quite sure how to proceed until I opened my e-mail and found an item posted to a drug policy discussion forum that solved the problem: it seems a Bay Area pharmaceutical company is developing a drug delivery system for inhaling pain medication that's intended to take advantage of the same type of rapid brain processing that made cannabis an overnight success with American youth in the Sixties. Thus they not only neutralized the drug war's latest rhetorical argument against medical use of cannabis ('who ever heard of a medicine that's smoked?'), they simplified my job as well.

Now all I have to do is cut, paste, and edit last evening's hasty e-mail response to the discussion group: the key to understanding why  pot became such an over night sensation with adolescents in the mid Sixties is that they were the first American teens exposed in large numbers to its inhaled form, thus allowing its powerful anxiolytic properties to be more rapidly experienced and precisely controlled.   Because smoked cannabis is processed by the brain in real time, an experienced user controls dose by simply ceasing to toke after reaching a desired level.

Orally ingesting pot as an 'edible' is how most medicinal use took place before the MTA,  it makes dose much trickier for a user to regulate and also makes cannabis a much less satisfactory anxiolytic, although it may work quite well as an antinocioceptive (pain reliever) either alone, or in combination with an opioid.

In Viet Nam, young draftees discovered pot was effective self-medication for the stresses of a tour in a combat zone and many who returned with the condition later identified as PTSD discovered that inhaled cannabis was effective treatment for that as well.

Once pot became well established in American High Schools (by 1975) there was no stopping it;  the adolescent market has continued to grow despite the displeasure of Congress, as manifested by targeting young users with enhanced penalties. The least well-known market demographic from my study is that over 30% of California applicants for a medical recommendation are now between 40 and 60. Some in their generation have been self medicating with it for thirty to forty years.

 Ironically, all of this came about because American youth finally discovered 'reefer' after a thirty year latent period (1937-1967). The youngest ten year cohort in my applicant population, those born between 1976 and 1985,  first tried (initiated) pot at 14.9 years: the same average age they also tried alcohol and tobacco.

Now that boomers are reaching retirement age, they may be more receptive to the truth about their own pot use, as opposed to the nonsense the feds have been slandering them with recently.

Doctor Tom

Posted by tjeffo at 04:35 PM | Comments (0)