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November 14, 2009

Credibility and Cognitive Dissonance; testing the limits

Over the past several months, even as officials in the Obama administration were announcing there would be fewer raids on cannabis dispensaries, the LA City Council was preparing to crack down on them; thus it appeared that the level of cognitive dissonance might, after thirteen years, finally be reaching a level that could not be sustained. In the background, the usual glut of conflicting claims and counterclaims could be found in the media and on the internet. However. I also remembered feeling the same degree of frustration on several other occasions, especially after starting to publicize the admittedly unexpected findings of a study of the applicant population to an obviously indifferent world.

I’m now glad I have discussed them here in a generally careful, (albeit tedious) style, because I understood, almost from the beginning, that objective and reasonably complete medical records might be my best defense if the Medical Board of California (MBC) should ever elect to punish me for "recommending" the use of marijuana on behalf of thousands of patients.

In that same connection, it’s long been clear that “pot docs” had little to fear from zealous DAs, or even from the DEA itself; our greatest threat has always been from California’s medical licensing authority. I had watched in horror in 2004 as the MBC persecuted (there is no other word) the late Dr. Tod Mikuriya and then twisted the knife by making him foot the bill for their grossly unfair “investigation.”

I'm also glad I had chosen to attend an MBC quarterly meeting in 2005 and formally provided them with timely notice of the study I had become engaged in, but hadn’t yet published in peer-reviewed literature.

To cut to the chase, a new regulatory watershed may just have been reached; first there were rumors that Hany Assad MD had lost his license; then, those rumors were confirmed on Friday evening, when a Google search turned up Fred Gardner’s meticulous description in CounterPunch. Just as important from my perspective, was the text of the actual decision posted on a spiteful, anonymous site mocking not only Assad, but other pot docs who had chosen to defend him and Dr. Alfonso Jimenez, a peripatetic Hawaii/San Diego osteopath recently unfrocked by the Board of Osteopathy. The same anonymous source posted a similar attempt to smear Dr David Bearman, a Santa Barbara physician who’d testified on Jimenez’s behalf and Phil Denney MD a veteran pot doc, the current president of Mikuriya’s old organization , and a witness for Assad.

Typical of many authoritarian abuses of bureaucratic power, the cases brought by the MBC against both Drs. Mikuriya and Assad relied on the unsupported judgment of professionally incompetent judges to define reality in ways that are clearly at odds with both Science and competent professional observation, in this case my findings, which weren't available in time for Mikuriya's defense and weren't cited in Assad's. Over the past four years, the study's findings have been published or cited in a variety of locations.

To summarize only the most important points: the charges brought against "pot docs" by the MBC were based on invalid assumptions mede by the MBC and accepted by thr physicians it was prosecuting. For example, the key issue in the "medical marijuana" controversy is arguably the safety and efficacy of an herbal remedy that had been rendered illegal by legislative fiat in 1937 and remained relatively unknown to the public for another thirty years before becoming explosively popular with youthful initiates in the mid-Sixties.

In an interesting parallel, the current medical gray market that began developing thirteen years ago under the aegis of California's disputed initiative, has grown erratically, but its product is now surprisingly popular for reasons that have yet to be either questioned or examined (except in this blog).

I now think the available records would provide me with a powerful defense should the MBC choose to "investigate" my practice as cannabis specialist/investigator recommending its use within the intention of the initiative, in a manner consistent with data accumulated under its protection, from the user population encouraged by the amnesty implied by its passage to provide it. I have been advising all applicants of what I've learned and urge them to manage their own use accordingly.

In Science, the proper response to unexpected new data is not to reject them out of hand, but to consider them in light of what had been known from earlier studies. Unfortunately, the historical record with respect to cannabis fails to reveal that any unbiased studies of its inhaled form were ever done prior to 1937, or in the wake of the CSA in 1970, despite a specific official recommendation to do so in 1972.

Doctor Tom

Posted by tjeffo at November 14, 2009 06:58 PM