April 28, 2007
Yesterday, I wrote that when I had more time I’d explain why I don’t think Bob Barr’s recent endorsement of medical marijuana, improbable as it probably struck most people when they first heard about it, signaled any fundamental change in his core beliefs; in other words, that the leopard had not changed his spots.
One of the things I’ve learned from recent experience is that logical arguments go only so far in convincing those who start out with contrary opinions; therefore rather than a tedious deconstruction of Barr’s rant, I think the points I want to make would be best illustrated by inviting serious readers to compare it with the far more responsible look Arianna Huffington took at the same issues, namely school shootings, and the potential role of psychotropic medications in their genesis.
I thnk such a comparison would persuade most reasonable people that Barr is still a moralistic and punitive prosecutor at heart; one with a very conservative social agenda and not above stretching the truth to make a point.
The various complex issues related to the ‘Ambien Defense’ are still of great interest to me, but I don’t think we yet know enough about the details of Seung-Hui Cho’s personal and medical history (including post mortem drug levels) to come to any responsible conclusions.
April 27, 2007
Still a Strange Bedfellow
It wasn't that long ago that ex-Georgia Republican Bob Barr was viewed by drug policy reformers as an arch fiend for his implacable opposition to any use of cannabis whatsoever. In fact, it was Barr who cobbled together a bill that successfully delayed the official ballot count when the District of Columbia passed its own medical marijuana legislation. Lately however, Barr, defeated in his last re-election bid by developments unrelated to the drug war, has undergone a change of heart and become a lobbyist on behalf of the demon weed, at least so far as its 'legitimate' medical use is concerned. The reason I know his endorsement is limited is that he signed up as an advisor to MPP, which, in its own medical wisdom, has chosen to support only the 'serious illness' notion of allowable medical use. The ironies of Barr's conversion are well covered by a recent piece in the Austin Chronicle.
What impelled me to write this entry despite being pushed for time, was the Barr Op-Ed in this morning's Chronicle; after my own reference to Ambien yesterday, I found his citation of an 'Ambien Defense' irresistible. For reasons I don't have time to go into right now, it was a relief to discover that my hunch about Bob Barr was correct: the leopard has not changed his spots.
More on that thought, and the reasons behind it, as soon as I have a bit of spare time...
April 26, 2007
A Warning in the Mail
The other day, I received a ‘Dear Healthcare Professional’ letter from Sanofi-Aventis, makers of Ambien (zolpidem tartrate), a sedative/hypnotic drug heavily advertised in ‘Ask Your Doctor’ TV spots as an effective 'sleep aid' and claimed less problematic than old style sleeping pills. However, the letter from Sanofi-Aventis was a warning to prescribers that Ambien isn’t as safe as once believed. I was intrigued because my five year experience with cannabis applicants has made me very aware of insomnia; in fact, when specifically asked, ninety percent of my patients agree that cannabis helps them sleep and about 10% will cite it as the main benefit they derive from pot.
Among the several things I learned from the advisory letter is that insomnia, a symptom once ridiculed by Drug Czar McCaffrey as an indication for pot use, ‘may be the presenting manifestation of a physical and/or psychiatric disorder.’ Also, that Ambien, when combined with alcohol or other drugs may cause ‘abnormal behavior,’ so care should be taken not to use it with other therapeutic agents or alcohol. Patients should also only ingest it right before sleep, and even then, be alert to possible problems the next day (!).
All of which made me grateful my practice now deals only with the medical use of pot. For one thing, I have the peace of mind of knowing that all my patients are familiar with how it affects them; in fact most have been regular users for years. Additionally, pot has a unique safety record and its LD 50 has yet to be established. For the pharmacologically unintiated, the LD stands for ‘lethal dose’ and 50 is the percent of whatever experimental animal population one is working with. An LD 50 for mice would be the dose, expressed in grams or milligrams, of an agent required to kill half the mice in a colony of statistically significant size.
In other words, it’s been impossible to kill experimental animals with pot.
Nor have human human deaths from acute toxicity ever been reported; all of which renders the pejorative and highly speculative comments NIDA Director Nora Volkow offered in the wake of another of one of those now-famililiar ‘this is stronger than your father’s pot’ reports completely irrelevant. Besides, what I have learned beyond any reasonable doubt by directly questioning admitted users is that they prefer inhaling cannabis over eating it because it allows such precise control of its cognitive effects. I have also learned that once beyond their late teens, most minimized their consumption of both pot and alcohol.
April 25, 2007
A Quick Confirmation and a Strategy Unmasked
On April 23, I opined that the next step in making abortion illegal at a national level would be when 'the five men now in firm control of the abortion issue at the highest level of judicial review do what comes naturally to them: restrict the scope of abortion in the US by redefining how it can be restricted by criminal prosecution;' in other words, by simply extending the process of criminalization on a case by case basis, and thus redefining federal authority over the practice of Medicine. Little did I realize that the process was being impatiently advocated, even before those words had been written. Katherine Parker's screed, which didn't appear as an Op-Ed in the SF Chronicle until Monday, had already been published on a right wing website on Friday.
The impatience of anti-abortion forces to get into high gear betokens their long and successful practice of a simple generic technique they've used so successfully over the years to confound their liberal opposition: first define the moral high ground you plan to seize, and then claim it. Once a moral beach head has been occupied and controlled, preferably by an agency of the federal government, it can be expanded into a moral imperative as circumstances permit. 'Partial birth abortion' is a medically grotesque construction which most surgeons (other than right-to-lifers) would find both ludicrous and offensive, yet Parker adeptly turns the tables on their reality (and authority) by portraying standard medical terminology the same way.
It's a technique as old as the hills; consider the history of 'addiction' as a concept; always, a bit shameful and long considered a weakess, it had yet to be either studied or precisely defined by Medicine before it was successfully turned into a loathesome 'disease' with abstinence as only one acceptable outcome of treatment by SCOTUS decisions rendered on behalf of the Harrison Act prior to 1920. Amazingly, the Supreme's 'thinking' on addiction has not only stood the test of time; it has actually been greatly strengthened by drug war funding which has turned several federal agencies into tax-supported lobbyists for both criminal drug markets and the police deputized to 'uproot' them.
In the most grotesque development of all, the expensive failure of any police agency to ever do so in lasting fashion is cited as 'proof' that a failing policy is essential: 'Just think of how bad things would under legalization!'
And so on...
April 24, 2007
An Overdue Special that Doesn't Quite Cut It
I haven't had many good things to say about the San Francisco Chronicle’s coverage of medical marijuana because I think the dominant newspaper in a region that has remained the epicenter of the medical marijuana movement should have demonstrated more understanding of the issue itself; that's been especially true since the Chronicle was bought by the rival Hearst Corporation in a controversial deal in 2000. From an historical point of view, the Hearst name has a lot to live down, and when it comes to 'medical marijuana,' the newly emergent Chronicle just hasn't been up to the job.
On April 22, it apparently tried to make amends by devoting much of its Sunday Magazine, complete with the obligatory marijuana leaf on a green cover, to medical pot. The first of three featured articles, by Katherine Seligman, dealt dealt with the intricacies of modern cannabis lore from the standpoint of afficianados. Her reports on the activities of growers and other assorted devotees were rendered in the same detached fly-on-the-wall style a non-oenophile might have used to describe vintners, winemakers and other serious wine lovers; however, the major difference is huge: some had asked her to omit last names and other specifics out of concern that she was describing activities regarded as crimes by the DEA. So successful was Seligman’s detachment that I was unable to guess her age; let alone if she had ever tried pot herself. I can, however, vouch for the accuracy of her descriptions of growers, because I've met several who are clearly motivated by love of their art, much the same as some gardeners who grow only roses, orchids, or tulips. It was also interesting for me to learn that Dale Gieringer, California NORML's most visible member, has little appreciation for 'pot ‘lore’ as it relates to strains, aromas, and other distinguishing qualities. Although I share his ignorance, I also realize that, over the years, talented growers have made enough improvements in the baseline quality of the product reaching the public that we can take certain effects for granted in the majority of users.
The second article, ‘Getting Carded’ is David Rubien’s account of the process of obtaining a recommendation and how, after finally doing so, he had experiences at a number of ‘dispensaries,’ some visited as a reporter, and others as a patient. While the author freely admitted his own prior use, as well as partaking while legal, he gave no background on the present confusing mess: why are there so many clubs in San Francisco? Why is the recommendation process now in such a state of flux? What has been the background of the Board of Supervisors' belated involvement? To say that Rubien might have done a better job of setting the stage for his report is gross understatement.
The deep policy divisions at the root of the controversy were unwittingly underscored in the third article by Joe Garofoli: ‘Parenting Through the Haze.’ From my perspective, it's the most informative of the three; but only because it allows a comparison of the widely divergent beliefs held by both federal officials and their opponents in ‘reform.' His article simply confirmed what I'd had to learn long before reading it: neither side will even look at evidence that threatens their staked-out positions. For example, Bertha Madras, identified by Garofoli as a professor of psychiatry on leave from Harvard to work for the drug czar, is quoted as claiming that a glass of wine is a legitimate 'relaxant,' but that 'when people smoke marijuana, they are experiencing 'a whole range of distorted perceptions and distorted behaviors,' which she presumably thinks justify treating them as felons.
Dr. Mitch Earleywine is another professor (PhD in Psychology), with a opposing opinion. Now 43, he told Garafoli he he's been using pot since age 15. Earleywine authored a book in 2002 called 'Understanding Marijuana, A New Look at the Scientific Evidence' and is currently writing another called 'A Parents Guide to Marijuana,' I read the first one a few years back, but couldn't get him to look at my patient data, even after we'd been introduced by e-mail. His opinions about medical use may lack a clinical foundation, but they are classic 'harm reduction,' the strategy endorsed by an overwhelming majority of reformers.
The irony I’ve been focused on lately has been reform's squandering of the political advantage it had gained by 2003 before the Oakland City Council responded to a clueless expose in the Chronicle (where else?) by moving to 'crack down' on what were then called 'clubs.' For the past three years, the reform movement has had no response to an orchestrated chorus of criticism from local police that the young people seen in dispensaries are 'cheating.' Is the movement's refusal to consider evidence of another explanation because its 'leaders' are unwilling to accept that their own chronic use may have been impelled by the same factors as the patients I've been seeing?
April 23, 2007
Abortion Ban is 'Partial,' at Least for Now
Those hoping to impose a national ban on abortion seem to have learned from the political success of our perennially failing drug policy to be patient and disguise their true intentions; the recent SCOTUS blessing of a 2003 federal ban on a specific surgical procedure was a critical second step in what had already been a long process. The first had been stacking the Supreme Court with four more devout Roman Catholic male justices following Reagan's appointment of Antonin Scalia in 1986. The second had been passage of the legislation itself while Congress was under rare GOP control in 2003. The third will be when the five men now in firm control of the abortion issue at the highest level of judicial review do what comes naturally to them: restrict the scope of abortion in the US by redefining how it can be restricted by criminal prosecution.
For my colleagues in the medical marijuana movement who have yet to notice, that's quite similar to what's been happening in California since the Raich decision: federal and local law enforcement, aided by a medically uninformed and policy-compliant media, have been offering the same simplistic, pejorative 'explanation' of recent, highly visible fluctuations in the numbers of pot docs, certified patients, and dispensaries: medical use may be legitimate for a few sick and dying people, but for the majority with stay-out-of-jail cards, it's a scam. As a consequence, the distribution of medical pot is being pushed back out onto the street where distributors and patients alike face greater risk of arrest; even as the initiative itself is left intact.
Nor is this the first time the Supremes went into medical practice; sponsors of the 1914 Harrison Act hadn't sought a ban on heroin or cocaine; only the power to regulate them to comply with treaty obligations flowing from a series of international conferences sponsored by, you guessed it, the United States. Armed with a tax measure enforceable via the criminal code, the bureaucracy created by the new law soon began arresting those physicians prescribing most flagrantly for 'addicts' (but in compliance with the statute). Two subsequent 5-4, Supreme Court rulings had a decisive effect by endorsing a moralistic view of addiction and limiting how physicians could treat both it and various complex pain syndromes yet unknown.
The eventual result was to freeze medical knowledge of several poorly understood phenomena at the 1914 level, long before they could ever be studied by modern techniques in an unbiased setting. Even today, long after the policy was expanded into a perennially failing 'drug war' under the aegis of the 1970 Controlled Substances Act, NIDA retains tight control of most 'research' into 'drugs of abuse' and Psychiatry has developed a drug-war-friendly schema for classifying emotional 'illness.' If my profession has even noticed that its right to make patient care decisions has once again been usurped by all three branches of the federal government, its leaders have yet to say so.
April 19, 2007
The Significance of Weeds
The story line of Weeds is simple enough: "This new series is a single-camera comedy about a single mother who makes ends meet by selling marijuana in the fictional suburb of Agrestic, California. The series exposes the dirty little secrets that lie behind the pristine lawns and shiny closed doors...Mary Louise Parker stars as the suburban mom who resorts to selling weed to support her family after her husband unexpectedly dies." In other words, sort of a stoner version of Desparate Housewives. I also just found out it became a success, having won some awards and been nominated for others; more importantly, a third season is in production
I remember catching parts of one or two of the episodes that aired shortly after the pilot in the Summer of '05 and being offended by the show's shallow, one dimensional point of view; however, I was too busy with other things to follow up. Because I never watched it and the reform e-mail discussion lists never mention it, I forgot about it until someone, or something, clued me about last week's episode. It turned out to be a vicious, but remotely plausible spoof of the medical marijuana 'scene' that's been flowering in LA recently. The very speed with which art has imitated life in this instance is mute testimony to the disaster that has befallen the medical marijuana movement since the Summer of 2005. It's also quite telling that its leaders don't discuss Weeds; especially since the plot of the last episode wouldn't have been at all plausible until the spate of recent publicity about all the 'pot docs' setting up shop in Southern California and how 'dispensaries' been popping up in their wake like so many mushrooms; only to be raided by the DEA with help from local police.
Weeds is to the current medical pot scene what Reefer Madness was to the Thirties and Cheech & Chong were to the Seventies. If the show isn't being financed by John Walters, it should be, because it's doing more to scare anxious parents and convince conservative city council members in California that medical marijuana really IS a scam. It's thus a better deal for ONDCP than the clueless commercials it's been purchasing from Madison Avenue at taxpayer expense.
April 15, 2007
Time to Organize?
Over the past three years, as I’ve accumulated an increasing amount of information from chronic pot users, I’ve become progressively more confident in my belief that American drug policy has been a tragic mistake from its earliest legislative emergence as the 1914 Harrison Act. I’ve also become considerably more specific in my criticisms of a drug policy ‘reform’ movement that still refuses to take full advantage of the brilliant political victory it won by adding Proposition 215 to the 1996 California ballot.
The reason I’ve become so confident is knowledge: first, what I'm still learning from pot users and, just as importantly, what I later learned from from (relatively) unsuccessful efforts to share their data with reform leadership. It soon became clear that reform's response to unwelcome new information was denial, the same way most of us respond to it (there’s perhaps no better illustration than George Bush’s reluctance to give up on the invasion of Iraq).
Along the way, I’ve been forced to learn several other things; fortunately, learning has always been a pleasure, and access to information (culture), has never been greater and is increasing by the week. Then too, there’s the ability of people like myself to publish their opinions in blogs they hope will be discovered by search engines. That brings me to the point of this entry.
Now seems a reasonable time to organize the blog into an arbitrary hierarchy of the topics emerging from the welter of observations and opinions I've been exposed to since late 2001. I also think I’ve had enough time to integrate that new material with my past experiences as a child of the Thirties who became a physician in the Fifties and has since been privileged to interact with thousands of patients in a variety of complex dramas; what we doctors refer to collectively as our ‘clinical experience.' The blog will continue to focus on my most recent clinical experiences, those gathered from the pot smokers I'm still seeing.
I will simply be trying improve coherence by organizing them within a limited number of recurring categories...only time will tell how helpful that effort will be.
April 14, 2007
A Tale of Two Prosecutions
The farcical federal prosecution of Ed Rosenthal, 62, which began with his February 2002 arrest for growing medical marijuana, just hit a new low with an announcement that the Department of ‘Justice’ plans to retry him on the same charges despite rulings from both the trial judge and the Ninth Circuit Court of Appeals, that another guity verdict could not add time to his original sentence of the one day he spent in in custody following his arrest.
In sharp contrast is the federal prosecution of another 60 year old medical marijuana grower, Dustin Costa of Merced, who was arrested by his local sheriff two years after Rosenthal in February 2004 and charged under California law with growing an equivalent number of plants. The feds didn’t get into the act until after the execrable Raich decision of June 2005. Two months later, on August 5, Costa's bail was summarily canceled by a tranfer of jurisdiction for his case from state to federal authorities that has yet to be explained by either side. He then remained in federal custody at a county jail until tried and convicted in Federal Court in Fresno. In February, he was sentenced to thirteen years, which he just began serving last week after a harrowing series of secret tranfers to a prison in Texas. With credit for time already served, his projected release date is September 5, 2018.
Aside from the glaring injustice of one man spending a day in jail for the same offense that will cost another thirteen years of his life, there is the inexplicable failure of the medical marijuana community to pay more than passing attention to Costa, while rallying massive support for Rosenthal. Beyond that, there is the failure of the press in California to comment on the huge discrepancies between two federal prosecutions conducted a few hundred miles apart in their home state.
Drug policy activists have long complained, to no avail, of a 'drug war exception' to the Bill of Rights. The ludicrous behavior of our federal bureacracy in these cases, while perhaps a new low, was not that surprising. What is more distressing is that the 'exception,' which seems (still) tacitly endorsed by the media, may have been accepted by the reform movement as well
April 13, 2007
Dustin Costa follow-up
To summarize the treatment a sixty year old ailing ex-marine has received at the hands of a vindictive federal government: Dustin had been charged by his local DA in Merced with growing marijuana in February 2003 and was released on bail. By August 2005, he’d made 18 court appearances, yet no trial date had been set; after the Raich decision in June, 2005, he was summarily rearrested on a federal warrant and held without bond at the Fresno County Jail for 18 months until being tried in Federal Court in late November, 2006. He was convicted on the day before Thanksgiving by a jury that had been prevented from hearing testimony that his activities were in compliance with California's ten year old medical marijuana law.
He then remained in the Fresno County Jail until February, when he was sentenced to 15 years and summarily transferred to the Kern County Jail in Bakersfield to await transfer to a federal prison. On March 31, he was again moved without notice and disappeared until yesterday when he was able to call me from a federal correctional institution (FCI) in Big Spring Texas, near Midland/Odessa. He describes it as a low security facility with barely passable food, but possessed of several amenities that were lacking in county jails in California: recreational facilities, ink pens to write with (even a typewriter, but no internet access).
I received two letters later in the afternoon which I’ll report on later, but I did want to post his new address and that he welcomes mail from all who care to write. He is allowed to receive soft covered books mailed by individuals or from any book store; hard covered books can only be sent directly from the publisher.
Dustin R. Costa 62406097
FCI Big Spring
Federal Correctional Institution
1900 Simler Ave
Big Spring, Tx 79720
April 12, 2007
Further Update on Dustin Costa
The last I'd heard of Dustin's whereabouts was ten days ago, right after he was summarily removed from the Kern County Jail in Bakersfield and transported to an 'undisclosed location' within the Federal Bureau of Prisons. Over the week-end, I used their locator; it informed me he was at a Federal Transfer Center (FTC) near the Oklahoma City Airport. When another search last night came up with the same info, I addressed a short note to that location, but before I could go out to mail it this morning, he called to tell me he has been in Texas for a week, at a prison somewhere near Midland and that I should receive a letter from him today or tomorrow. The good news is that it is not a high security facility and his physical surroundings and the amenities available to him have improved a great deal over the county jails he'd been confined to in California; the bad news is that he is in Texas, far away from friends and family. We didn't have long to talk, but he said that now that he has received telephone approval, he will have reasonable access to a phone and will call me again in a few days. He would also welcome mail from any who care to write, so as soon as I have a reliable mailing address, I'll post it here (the BOP locator still has him in Oklahoma and didn't list 'Midland' as a location).
April 11, 2007
Biological versus Cultural Evolution and its Challenge to Human Survival
In its most basic form, the concept of evolution refers to changes occurring over time in response to a changing environment that ultimately become of sufficient magnitude to reshape the evolving entity while (paradoxically) allowing its survival. While the environmental changes provoking evolution may be abrupt, those thought of as evolutionary were generally considered more gradual. However, it's now well recognized that several cataclysmic changes have shaped biological evolution on Planet Earth by producing mass extinctions.
In terms of evolution's general definition, the evolving entity might be something as abstract as an idea or as concrete as a living species. As any evolutionary process unfolds over time, one conceptual difficulty becomes separation of provocative environmental changes which were purely external from others that may have been part of the initial adaptation and later became counterproductive or, in the parlance of modern Psychiatry, 'maladaptive.' An easy example is the dentition of saber tooth cats that allowed them to kill much larger mammals, but later became an impediment when their prey adapted to a changing climate by becoming smaller and swifter.
Another, and more profound, conceptual difficulty arises from the implication that 'evolution' has 'survival' as its goal; did the saber tooth cat go extinct or 'survive' as a modern Puma? While the non living members of a species that failed to meet the challenge of environmental change may exist as inanimate fossils for a while, they will eventually be recycled by 'nature.' However unsuccessful ideas stubbornly refuse to go away and are continually cropping up in new guises to sabotage cognitive progress. 'Dead' languages which are no longer spoken may have become fossils, but enough failed ideas seem to have persisted long enough in 'living' languages to preclude the indefinite survival of our species.
'Evolution' acquired a more specific and controversial meaning with reference to Biology after Charles Darwin published 'On the Origin of Species' in 1859. It has, if anything, become even more controversial today, despite widespread agreement among scientists that, as a theory, it has provided at least as much useful structure to the Biological Sciences as the Periodic Table has to Chemistry and Newton's theory of Gravity to Physics.
Just as Newtonian Physics required some enhancement from Einstein and others Darwin's original theory has undergone amplification; first through Mendelian Genetics and later through elucidation of DNA's molecular structure and the subsequent mapping of genomes. A measure of biology's greater degree of complexity than more 'basic' sciences is that RNA is required for gene expression, and we still don't understand just how that happens or how genes are turned 'on' and 'off' at various times.
As mentioned above, the concept of biological evolution was quickly followed by the attractive assumption that a parallel 'cultural' evolution is also taking place. Unfortunately, that assumption eventually breaks down because 'culture' is a purely human endeavor and, as such, subject to the same intrinsic limitations as our cognitive processes, while biological evolution is a response to the impersonal forces of Nature which so easily defy human control.
An analogous comparison is the one I've been making between the parallel classifications now being used for somatic disease on the one hand, and emotional 'illnesses' on the other: one is based on the (relatively) objective criteria of Pathology, while the other is based on the far more subjective criteria now being catalogued by Psychiatry for eventual debut as DSM-V.
It's now clear that cognition is both a biological process and the means by which our highly evolved brains have reshaped the planet in ways we only began to understand in the second half of the Twentieth Century. The impact of that cognitive activity is still being emotionally debated in a setting in which a majority of educated humans still profess belief in a Creator and reliance on military establishments for 'security,' despite the manifestly erratic and uncontrollable dissemination of the nuclear weapons technology that dominates international relations nearly three decades after end of the Cold War.
As if that weren't discouraging enough, the 'civilized' world, as represented by the United Nations, is manifestly unable to impose the rule of law in areas of admitted genocide and continues to subscribe by treaty to a failed domestic American drug policy without any scientific basis. That policy has been judged an abject failure by 3/4 of at the American public for years and is credited with generating the four-fold expansion of its prison population since 1970, yet it's staunchly defended by the federal bureaucracy as both necessary and 'successful.' (Many other examples of comparable intellectual dishonesty abound; drug policy is merely the one I've become most familiar with).
Against that background, one should be able to understand the uncertainty generated by realizing that the same concept (evolution) can describe both the process that produced our marvelous brains AND the intrinsic emotional qualities by which they are responsible for the violent differences in belief frustrating our species' feeble attempts to deal with its most pressing existential problems.
Again, the key to understanding this cascade of existential opinions is the simple recognition, stubbornly denied by a majority of humans, that most psychotropic drug use, whether prescribed or not, is simply a manifestation of the uncertainty we now call 'anxiety.'
April 08, 2007
A Gloomy Easter Thesis
Man, although long the planet’s cognitively dominant species (at least in terms of our ability to determine time from a scientifically informed perspective), really didn’t start affecting the survival of other species on a mass scale until roughly five hundred years ago; first we had to achieve leisure and literacy; then we had to accumulate enough culture to stumble onto empirical science, a development that took place in Western Europe between Gutenberg and Newton and included Copernicus and Galileo (collectively, from 1398 to 1727).
Developments flowing from that brief interval quickly led to scientific ‘progress’ which, through its ability to generate wealth, started the human species on a road it has been uncritically following ever since: a vicious cycle in which unforeseen problems are created by enabling population growth and then ‘solved’ when newer technology created by further scientific progress leads to even more wealth and further expansion of the human population.
We are now bumping up against the reality that our planetary ecology will not sustain its current burden of 6.6 billion humans; particularly when they are as polarized, as is now the case, by disputes over the distribution of wealth and non-renewable resources. Ironically, we are just beginning to understand there are calamities beyond mere depletion of scarce resources threatening our welfare: accelerated climate change, unrecognized mass extinctions, and pandemics of ‘new’ diseases are just some that have recently competed for our attention; there may well be others. In any event, the sheer inertia of a global economy that has evolved around the unchecked pursuit of economic ‘growth’ can also be seen as a major problem, albeit one we are still unwilling to recognize as a species and even less equipped to deal with.
How do these dire thoughts relate to use of Cannabis? That’s easily understood, once one appreciates that the dominant lesson to be derived from interviewing those who became its chronic users is the degree to which human emotions influence— and have have always influenced— human behavior.
April 07, 2007
A Coincidence...and an Insight
An article by Dr. Jerome Groopman on Bipolar Disorder appearing in the latest (April 9) New Yorker immediately caught my eye; it had arrived right after I’d posted my latest rant on the shortcomings of the DSM. It was therefore no surprise that it supported my contention that the system of classification that has been uncritically embraced by modern Psychiatry is both confusing and misleading. However, I wasn’t prepared for the fresh insight it (unwittingly) provided as to why the DSM misses the mark and how the conditions it attempts to classify might be more usefully considered.
Dr. Groopman is both articulate and prolific; he’s been the New Yorker’s medical writer since 1998 and somehow finds time for a day job as distinguished Harvard educator and researcher. Also of interest: he’s just published a book on the cognitive process in Medicine, one I’ve yet to read but have seen described as a critique of traditional medical thinking and a plea for clinicians to question certain commonly held assumptions. Ironically, the fact that he didn’t follow that advice in the bipolar article is what may have provided me with the insight needed to more precisely describe the DSM flaw I’ve always been troubled by.
Groopman’s article is focused on a specific controversy that surfaced within Psychiatry during the Nineties: does an entity once known as ‘Manic Depressive Psychosis’ occur in children? Before it was renamed ‘Bipolar Disorder,’ Manic Depressive Psychosis had been thought to affect only adolescents and adults. The intramural dispute over the question of pediatric involvement apparently didn’t surface until after promulgation of the bipolar label and specific criteria for its diagnosis by DSM-IV (1994). Since then, and very much in keeping with our present era’s internet advocacy, an ‘explosion’ of interest has occurred. A Google search of just the term, ‘bipolar,’ generated over twenty one million hits, with the vast majority found on the first ten pages clearly aimed at potential ‘patients.’
To return to Dr. Groopman’s New Yorker article, it’s based mostly on his extended conversations with a number of recognized experts in academic Psychiatry. Although their quoted comments reveal an ambient confusion over the precise diagnosis of Bipolar Disorder and are, at least implicitly, critical of the role played by an ascendant DSM as reigning diagnostic authority, all those quoted clearly accept the idea that’s also implicit in the DSM itself: the classified entities can be as accurately pigeon-holed as the diseases described by pathologists. There is a further critical implication that those entities, once described (discovered?), will all behave like somatic diseases; in other words, they will persist and tend to progress in some characteristic fashion unless ‘effectively’ treated.
To return to the Google exercise, what one can recognize quite clearly is an attempt to advertise both a new ‘disorder’ and its treatment. As is pointed out in one description of Bipolar Disorder after another, the 'symptoms' of elation and depression are characteristic of emotions manifested, to some extent, by all of us at various times. In other words, there is nothing about them as absolutely characteristic (pathognomonic) as the histological characteristics which allow pathologists to separate most physical diseases from each other with complete confidence. The implications of that statement are of great significance for the following reasons.
The diseases that have been systematically studied anatomically, histologically, and biochemically by pathologists from the time of Virchow can be analyzed with considerable confidence as separate entities with reference to cause (etiology), clinical course (pathogenesis), outcome, and response to treatment. None of those assessments are possible in conditions for which no objective diagnostic standard exists, which is an apt description of all the entities classified in the DSM. Isn’t it just as possible that the psychiatric 'symptoms' upon which DSM nosology is based reflect variable emotional tendencies that are both inherited on a genetic basis and expressed in variable fashion in response to the plethora of widely varying environmental influences that affect all humans?
That latter description is a far more accurate picture of the behavioral ‘reality’ disclosed thus far by systematic questioning of the population of cannabis users I’ve been both studying and attempting to describe.
April 04, 2007
More on Pot Docs
It's no secret that when it comes to 'Medical Marijuana,' San Diego is California's most unfriendly big city and its Union-Tribune it's most consistently unfriendly newspaper. How else does one explain a law suit demanding that the initiative process, which neither the Californa nor Federal Supreme Court would tamper with, be struck down?
Nevertheless, there seems no shortage of San Diegans wishing to receive recommendations to use pot. As I've described in another post, not all pot docs have the same background or motivation, yet district attorneys and others who dislike marijuana users feel free to vilify them and seek to entrap them by sending in snitches posing as patients. These same DAs also seem to think they are knowledgable enough about medical practice to decide what constitutes an appropriate screeening examination for compliance with the (admittedly vague) guidelines of Proposition 215. The real reason for 215's vagueness was the ignorance and confusion with which thirty years of mindless prohibition had surrounded pot use between 1937 and 1967, and which was then followed by another two decades of inexcusable pseudo scientific drug war propaganda from the DEA and NIDA before Proposition 215 was elected as a political ploy by its ultimate sponsors.
What no one seems to have noticed in the intervening ten years is that the proposition has provided access to at least some of the customers who have propelled cannabis into its undisputed position as the nation's leading cash crop. One would think that opportunity would not be so completely lost on those on either side with a burning interest (pun intended), but one would be wrong.
To return to the issue of pot docs, it appears that the Medical Board of California, which can itself make no claim of clinical expertise relating to cannabinoid use, is again bowing to police pressure by investigating physicians at the behest of San Diego law enforcement officials.
I wish I could report Krueger's lengthy U-T report was just an April Fool hoax, but it seems to be for real...
April 02, 2007
What About ADD?
ADD is the acronym for ‘attention deficit disorder,’ a condition I learned was associated with use of marijuana only after I started screening people seeking pot ‘recommendations’ in 2001. Those calling attention to ADD were usually males under twenty-five who’d either been treated with Ritalin in school or had it recommended to their parents following a medical evaluation which had typically been suggested by the principal at the urging of a teacher.
However, the applicants themselves rarely mentioned their ADD history; quite the opposite, they tended to base their desire to use pot on common musculoskeletal conditions: sore backs, trick knees, or dislocating shoulders. Among computer users, tendonitis and carpal tunnel syndrome were frequent. However, a common problem with those scenarios was that a careful history often revealed that the pain hadn’t started until well after the pot use had become chronic.
I’ve since learned that there are different patterns by which ‘ADD’ may become manifest and all are very likely expressions of anxiety in children, adolescents, or adults. I should also say that at this point, I don’t think of ADD as a ‘disease,’ but rather a behavioral pattern which, if intense, can easily become problematic for both those displaying it and those around them, particularly family and loved ones.
Fortunately, it can usually be improved by a combination of understanding and anxiolytic therapy; but optimization of such therapy on a large scale will require a more intelligent understanding by those attempting to treat it than is now the case
Although the behavior had been recognized as a discrete entity in Europe as long ago as the Nineteenth Century, its modern diagnosis and empirical treatment with stimulants were not introduced until the early Nineteen Seventies, when Paul Wender popularized it as ‘Attention Deficit Disorder’ and reported that the academic performances of a majority of children treated with Ritalin were improved. Unfortunately, ‘attention deficit’ has proven as much a misnomer as his suggested etiology, ‘minimal brain damage’ (MBD) was mistaken. In essence, no coherent theory addressing all of the syndrome's common features has been advanced.
Nevertheless, there was a steady increase in cases being treated with Ritalin and other stimulants until the late Nineties, when they were estimated to have been prescribed for somewhere between three and six percent of primary school children in some districts. Not surprisingly, critics began alleging overtreatment, while defenders were claiming that ADD is still being under treated.
What I find particularly disturbing is that the lack of recognition of any possible medical benefits from cannabis in ADD is so clearly influenced by a drug policy dogma which is also obscuring the anxiolytic benefits inhaled cannabis has been providing to a now-accessible poulation of chronic users who seem to be more of an embarrassment to political supporters of medical use than potentially powerful evidence of the folly of an absurd policy.
April 01, 2007
Update on Dustin Costa
This morning, I received a voicemail message from a stranger who was calling through the same commercial 'service' that's been transmitting the telephone calls I'd been receiving from my friend Dustin Costa ever since his abrupt post-sentencing transfer from the Fresno County Jail to the Kern County Jail in Bakersfield to await definitive assignment to the federal prison where he will begin serving the balance of a 15 year sentence for growing medical marijuana. I understand the foregoing sentence involves several complicated ideas, each of which might require an explanation, but will defer them all to report one simple fact: Dustin was transferred in the middle of the night without being told where he was going. The message from the strange voice also said he would write me from wherever he was sent as soon as he could.Thus does our government trifle with the emotions of those in its care,a travesty confirmed by censored media reports about detainees in known locations like Guantanamo, as well as in an unknown number of 'undisclosed locations.'
Later this afternoon, I received a letter from Dustin, written on March 26th, which he asked me to consider posting on this blog. I certainly will do so as soon as I'm able; primarily because it has great merit as an original idea, but also because it is convincing evidence that he simply does not belong in prison.
Dustin is a political prisoner who is being unjustly punished for daring to question America's fraudulent drug policy.