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May 31, 2010

How Logical Assumptions evolve into Major Mistakes

The question asked near the beginning of an article in The Scientist caught my attention: “Was it possible that stress affected young brains and older brains differently, in ways that researchers and clinicians had overlooked? ... Do adolescents and adults undergo a similar neuroendocrine response when stressed?”

The reason I’d been searching for information on Dr. Russell Romeo was the youthful researcher's growing reputation for investigating the impact of emotional stress on young animals, in his case, rat pups. Also, we had arrived at a similar key understanding, albeit by very different routes: namely that the amygdala and limbic system are critical loci for sensing, integrating, and responding to emotional stress. Finally; I had become interested in learning more about whatever neuroendocrine mechanisms he might be proposing as explanations.

What I soon learned was (typically) equivocal. I knew, of course, that because his research is further into the academic mainstream than mine, it had also to be more compliant with the official (but ludicrous) NIDA position on “addiction." Nevertheless, Romeo's focus on youth gave me some reason to believe his studies might be congruent enough with my clinical data from humans to be seen as supporting similar conclusions.

The reasons are more complicated than complex; my interest in Romeo had originally been piqued after encountering his name in a search for material on Stanford’s Robert Sapolsky, another ex-Rockefeller University fellow who had also worked and published with Bruce McEwen while in New York.

That all three investigators had become focused on stress in youthful animal models simply added to the hope their work would lend support to my most obvious, yet controversial, finding: namely, that the large scale initiation of cannabis by American adolescents in the Sixties had clearly been the key to its paradoxical (and never questioned) commercial success thirty years after being banned for obviously spurious reasons.

All that's necessary to explain that success is a realization that the safety and efficacy of inhaled cannabis in relieving the adolescent angst of baby boomers was why "marijuana" had, over time, become the most valuable crop harvested in the US and is now, also paradoxically, the most valuable and frequently intercepted illegal drug along our border with Mexico.

Another key to the increasingly complicated puzzle is yet another simple understanding: the drug war's only major success has been its placement of human populations of illegal drug users off limits as "legitimate" research subjects by continuing to insist that such use can't possibly be "medical."

Doctor Tom

Posted by tjeffo at 10:28 PM | Comments (0)

May 30, 2010

Unpleasant Memorial Day Thoughts

Watching that disastrous geyser of crude oil erupt into the Gulf of Mexico on TV news for the past few weeks has been almost as surreal as following the denial of reality that's long been standard practice for both the US and Mexico with respect to their vexing issues of illegal immigration and illegal drugs. What the three unwelcome intrusions: oil, drugs, and illegal aliens, have in common is that all are uncontrollable, almost impossible to measure precisely, and expose the penchant for dishonesty that may be the most tragic flaw in humanity's otherwise glorious cognitive ability.

If so, it would be tragic indeed, for it is that same cognitive ability that has been allowing Science to unravel secrets of the universe we inhabit at an ever-increasing rate over the past several hundred years. Unfortunately, thoughtless exploitation of new scientific technology, our innate dishonesty, and an underlying emotional vulnerability seem to have combined to produce the multiple problems we now find themselves embroiled in and from which we may have considerable difficulty escaping; primarily because there are now so many of us and we have become so adept at avoiding unpleasant reality.

I'm only too aware that I've been harping on the same unpleasant themes a lot recently; but it's difficult to imagine solutions for problems that can't be acknowledged.

Doctor Tom

Posted by tjeffo at 05:33 PM | Comments (0)

May 28, 2010

The Lessons of History

It’s not impossible for the ecologic disaster now evolving in the Gulf of Mexico to become the deep sea equivalent of the “Dust Bowl” that added so much to the woes of the Great Depression.

As someone who grew up in the East and was only four years old in 1936, I never appreciated the degree to which mismanagement of America’s grasslands had added to the miseries of an era I had lived through, but not experienced directly.

However, just reading that history now is all it takes to see that the same hubris and impatience for profit that allowed Midwestern topsoil to be blown away in the Thirties have also been responsible for whatever economic blight will follow the release of millions of gallons of crude oil into the Gulf of Mexico.

Even so, the world doesn’t seem to be paying much attention...

Doctor Tom

Posted by tjeffo at 04:22 PM | Comments (0)

May 23, 2010

Border Unreality; a sign of the times

The last entry referred to the formal state visit then in progress between Presidents Obama and Calderon. Given the gravity of the immigration, crime, and economic problems facing their two nations, the public statements of the two leaders were a travesty, as was media coverage of their meeting.

To appreciate the enormous gap between reality at the border and what was not said in Washington, one has only to compare current murder rates in the neighboring cities of El Paso and Juarez. The Texas city, which has been becoming steadily more “Mexican” in terms of its inhabitants, is still a very safe place to live, while just across the Rio Grande, Juarez is now the murder capital of the entire world.

One does not have to look far for the reason. It’s the drug war; or more precisely, America’s feckless war on “marijuana,” which has been growing more futile and incoherent every year, as illustrated by our cable TV coverage. On any given evening, one is liable to encounter a police reality show featuring bully-boy detectives with shaved heads celebrating a big bust because it took large amounts of “narcotics” “off the street,” and led to the arrest of a gaggle of low-level “bad guys.” On an adjacent channel, one is just as likely to find one of the innumerable re-runs of “Marijuana Nation” documenting the unexpected success of California’s medical gray market.

One the fastest growing demographics in my registry of cannabis applicants has been the cohort born between 1982 and 1992; all of whom would have been much too young to qualify for a "recommendation" when Proposition 215 passed in 1996. Once one appreciates that long term chronic use has been based on the anxiolytic appeal of inhaled cannabis for the latest crop of adolescents to enter our junior high schools since about 1965, and that nearly all have been trying alcohol and tobacco at nearly the same average age (14.9 years) since 1971, one can readily understand the failure of a federal policy based on keeping "kids" from trying all three. It never had even a remote chance of success for exactly the same reasons parents have classically been unable to keep their adolescent "kids" from doing the same things they did.

The answer to the logical question raised by our national dilemma is two more questions: how do we get the federal government to admit a huge, costly mistake? After we do that, how do we induce some of its most powerful bureaucracies to either commit suicide or radically re-think their mission?

Doctor Tom

Posted by tjeffo at 06:03 PM | Comments (0)

May 20, 2010

Putting it All Together

I began this blog in a effort to explain what I've been learning about the human use of cannabis and other drugs by taking advantage of the opportunity California’s version of “medical marijuana” had provided licensed physicians to interview pot users. Because recognition of that opportunity had, of necessity, been a function of my own naivete, I have also gradually come to see the blog as a record of my own loss of innocence, at least with respect to modern pot culture, which only began in 1946. To have been a true insider, I'd have had to be born at least a dozen years later. Another of several lessons learned along the way is that because our unique brains are able to accumulate and analyze information (create culture) to an unparalleled degree, the circumstances of any individual human's birth have a greater impact on their ultimate development than on any other mammal. Thus a felicitous combination of circumstances is all it takes for a Darwin, or an Einstein to emerge. Newton once said: "I have stood on the shoulders of giants." Given the right circumstances, any moderately intelligent human can become a giant.

The ramifications of that concept are staggering: as our species has been gradually adapting to its discovery of Science as an efficient new tool for deciphering its environment, it has been unwittingly contriving to use scientific technology as a mechanism for converting its home planet into an overpopulated and almost unmanageable prison. The flaw responsible for this sad state of affairs may well be the parallel evolutionary development of our brain’s emotional and cognitive centers in such a way that emotions ultimately control our most important choices, whether as individuals or groups. We also have related abilities: one is secretly acting out destructive fantasies as individuals; another is forming intense emotional bonds with various groups throughout life. The former predisposes to serial murder by individuals; the latter to wars motivated by racial and religious hatred.

Ironically, the best available evidence for these conclusions is to be found in our popular media which, as a result of the digital revolution, have enhanced the ability of individual humans to expose their cognitive skills and emotional flaws as never before. A convenient current example is media coverage of the series of ceremonial meetings now taking place in Washington between Presidents Obama of the US and Calderon of Mexico.

A cursory review of only a few of the news articles written so far confirms the reporters' reluctance to explore the incredible cognitive dissonance on display in the public statements of both men. Even more discouraging are the heated comments posted in response to various news items.

Doctor Tom

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

May 18, 2010

More on the Critical Distinction between "Clinical" and "Legal"

The often misunderstood term clinical implies interaction between a physician and a patient, a relationship similar to other protected professional relationships; those between investigative reporters and their sources or lawyers and their clients for example. Historically, government representatives, particularly in law enforcement, have tended to see such protections as interfering with their jobs. Although nominally required to obtain search warrants, they sometimes resort to illegal searches, which, if discovered, can have far-reaching consequences.

Two famous recent examples have been the Watergate break-in and the one that preceded it, an equally illegal search of the office of the psychiatrist who treated Daniel Ellsberg following his unauthorized 1971 release of the Pentagon Papers. The purpose of both warrantless searches was the same: to look for material that would discredit perceived political enemies of a sitting president, at that time one of the most powerful men in the world

Perhaps the most ironic aspect of the unlikely chain of events is that it began with what was unquestionably a crime and ended in the expulsion of Richard Nixon from the White House, a result neither Ellsberg nor Anthony Russo, his Rand Corporation associate could possibly have have predicted while they were laboriously xeroxing some 7600 pages of classified documents in 1971. Both men clearly understood the risks; they also believed they had a moral obligation to disclose the truths they had uncovered: how the malfeasance of four separate US administrations had involved the nation in an Asian quagmire.

Ironically, it was the decision of Nixon’s “plumbers,” many of them ex-law enforcement agents, to break into the office of Ellsberg’s psychiatrist in an effort to smear him, that ultimately led to Nixon's downfall.

Additional ironies, from my point of view, are legion. Most importantly, the modern drug war, as articulated by the First Nixon Administration, is still not only the law of the land in the United States, but also World’s drug policy. It’s also the lineal descendant of judicial decisions authorizing the police to arrest physicians they disagreed with, and were later expanded- also without scientific evidence- to permit arrest of any citizen for mere possession of forbidden drugs as defined by the spurious criteria listed in the Controlled Substances Act.

In essence,legal has trumped clinical through a series of judicial fiats issued since 1914. Until those errors are recognized and corrected, the world will continue to be burdened with a policy of proven failure, the consequences of which are increasingly difficult to recognize and have long been beyond correction for a majority of its victims.

Doctor Tom

Posted by tjeffo at 04:44 PM | Comments (0)

May 17, 2010

Medical Marijuana; arriving at a clinical definition.

As California’s contentious initiative nears its fourteenth birthday, the original concept has succeeded to the point where another such initiative, one legalizing possession and use by adults for any purpose, is on the November ballot. Once upon a time, such a development might have been considered “progress;” however in today’s bizarre world, similar divisive arguments are rarely settled for long, thus new points of contention have already been created. However, lack of agreement doesn’t mean the unique opportunity for clinical research provided by 215 was wasted. Although disputed and stymied to the extent possible by courts, police agencies, and other other non-clinical entities, it has been possible to gather and preserve previously unavailable and uniquely valuable patient data.

As one who has been accumulating such data for over eight years, I’ve always believed I had a duty to share it to the extent possible. Fortunately, near the beginning of my patient (“applicant”) experience, I realized they were a source of unique information and focused on discovering what they had to teach me. After coming to some tentative conclusions I attempted to share with presumed Reform colleagues, I was surprised at the degree to which patient evidence was discounted; either because of observer bias by non-clinicians or by clinicians with a limited view of the opportunity presented in California. By then, both my own data and its internal consistency were such that I realized the importance of preserving and sharing them, so I began this blog in the Summer of 2005.

Over the past year or so, I’ve started deliberately sharing what I’ve learned with both new patients and “renewals,” some being seen for the fifth time, thus expanding all patient encounters into opportunities to both educate them and to test the validity of certain concepts by seeking their disagreement and whatever exceptions to my general impressions their own experience might provide. It's important to interject at this point that clinicians should never think they know everything a patient has to teach them.

I now believe I’m ready to pull together a medically coherent and historically accurate clinical overview of "Medical Marijuana," the bitterly disputed legal entity created when California voters surprised the world by approving Proposition 215 in 1996.

Doctor Tom

Posted by tjeffo at 05:35 PM | Comments (0)

May 12, 2010

Forgotten; but not Gone: leftovers from the age of coal.

When the Industrial Revolution began in earnest around 1800, its first cheap fuel was coal and its first important products were textiles. Soon coal mines and mills had become sources of great wealth, but each had its own victims. In America they were the slaves who suddenly became indispensable to cotton agriculture; in England it was the poor, especially children, who came to be preferred for mining coal and working in mills.

Each population of victims provoked a humanitarian backlash; abolition movements in England and North America, and literary protests against slavery and brutal labor conditions from Harriet Beecher Stowe, Karl Marx and Charles Dickens. All eventually played roles leading to the increasingly dangerous conflicts of the late Nineteenth and Twentieth Centuries and are still factors influencing the new struggles of the Twenty-first.

One of many apparent differences was the shift in major energy sources to oil and natural gas; however, both are also products of the Carboniferous Period, simply regarded as “cleaner” and more adaptable to the expanding needs of a growing human population. Inevitably, there’s also a catch: the usual desire to exploit new technology for profit, as exemplified by yesterday’s exercise in finger pointing over a deep-water oil well polluting the Gulf of Mexico, even as the media seems impatient to get on with the latest scandal.

It reminded me of an eerie scene I’d witnessed while driving through Pennsylvania about thirty years ago: smoke pouring out of holes in the ground, left-overs from the days of coal and now, according to Wikipedia, still polluting the environment all over the world, but with little fanfare. I guess, as they say in business, their environmental damage is already "in the market."

I wonder how much more the environment can take and still nourish our species- or if the global Economy will recover from the chaos it may be about to enter.

Doctor Tom

Posted by tjeffo at 05:46 PM | Comments (0)

May 11, 2010

The More Things Change...

An item in today's NYT reminded me of an NPR interview I'd heard while driving home from Oakland in 2008. I was so impressed that I googled the epidemiologist being interviewed and ended up exchanging e-mails with her as well as blogging about how impressed I had been by her courage and forthright style.

Sadly, today's piece in the times suggests she also had an accurate crystal ball; the global financial crisis, then just a dark cloud on the horizon, seems to have made matters worse by drying up the money that was then doing some good by paying for treatment. Unfortunately, the ignorance driving spread of the disease persists.

Doctor Tom

Posted by tjeffo at 12:08 AM | Comments (0)

May 08, 2010

Empiricism & Belief; Emotions & Dishonesty: the evolitionary flaws that drive our behavior.

Although still disputed, one of the more reliable estimates of how long humans have been a separate species is about two hundred thousand years. In that connection, we now have some long-awaited evidence that humans share DNA with Neanderthals, their older relatives on the evolutionary tree foreshadowed by Darwin's prescient leap of intuition. Although one of the more useful scientific theories ever developed, the very idea of Evolution is still hotly disputed by creationists. Likewise empirical Science, which only dates back to events surrounding Galileo's questioning of Papal authority in the Seventeenth Century.

All of which allows consideration of a critical point: the same intellectual battle between empiricism (science) and dogmatism (religious faith) that began with Galileo and Urban VIII remains unresolved. In one guise or another, it lurks within most of the intractable disputes now dividing our planet. Furthermore, although top-down religious thinking has been far less productive in terms of reliable results, it remains the default for policy makers the world over

That's because authoritarian dogmatists have managed to control the trajectory of human culture, with the ultimate result that we now face a cascade of serious problems, many of which are unprecedented. The Industrial Revolution, rooted in technology, has been a cornucopia of new products for which humans quickly developed insatiable appetites, even as their largely "faith-based" national governments remained unequal to the tasks of regulating commerce equitably or settling international disputes amicably. Indeed; arms production for "defense" is now an important branch of global commerce.

Meanwhile, technology was also facilitating an enormous increase in the human population which may already be beyond the planet's capacity to sustain. However as the current Climate Change debate demonstrates, global response to such crises is variable, signaling that we can expect even more debate before a mitigation strategy is adopted. Finally, Climate Change may be merely one of several crises in our intermediate future.

Many readers may already be put off by this sobering assessment; yet, my interpretation of both human nature and current events has been shaped by the unique opportunity I've had to study the human use cannabis as it's been evolving over the past 40 years.

The first thing I learned was that cannabinoids are safe and very effective against several common emotional disorders. The second is that nearly all of pot's considerable medical benefits have been obscured by drug war propaganda. Finally, that the failure of the US (and world's) drug policy is now so obvious that the prolonged refusal of those who enforce it to accept even minor criticism brings both their intellectual honesty and the legitimacy of their policy into serious question. In fact, the progressive cognitive dissonance of the drug war makes it a superb metaphor for a disaster that can be neither admitted, nor "controlled."

The current oil leak into the Gulf of Mexico and the erratic eruptions of an Icelandic volcano, are examples. Once one becomes cognizant of the extreme reluctance of governments and corporations to admit past mistakes, the basically irrational nature of typical partisanship becomes more apparent.

Given the modern panoply of (predominantly) human disasters, it would behoove us to recognize how dangerous the split between scientific and religious thinking has become; also the degree to which the religious variety has become society's default. Just imagine how unlikely it would be for a declared atheist to be nominated for the Presidency by either major party.

Doctor Tom

Posted by tjeffo at 05:55 PM | Comments (0)

May 05, 2010

Behind the Headlines, and a Useful Concept

In 1952, I was a senior in college and Dinah Shore was belting out TV commercials for Chevrolet. Harry Truman was in the White House and the idea of a huge oil slick bearing down on New Orleans would have seemed utterly improbable. Nevertheless, there was still a lot to worry about: an unexpected "police action" in Korea had raised the first-ever threat of nuclear war after Russia’s 1949 nuclear test obviated comforting predictions by western scientists that it would take them at least fifteen years. The “loss” of China to Communism, also in 1949, plus revelations that Russia's nuclear program had been assisted by espionage only added to McCarthyism and the national paranoia it engendered.

What the Chevy commercial did foreshadow was a reality that couldn’t have been anticipated in 1952: that burgeoning technology, cheap energy, and explosive population growth could lead so quickly to today’s related dilemmas of rapid climate change and looming shortages of oil and fresh water.

The process by which such interconnected problems might have evolved is increasingly referred to as Path Dependence, a relatively new term which, although still unfamiliar to most laymen, is the subject of turf battles within academia, particularly the disciplines of Economics, Sociology and History.

When broadly interpreted, the concept becomes very useful for the component-by-component analysis of any directional change. In that context, the greater our planet’s human population, the more likely it is to become trapped in its (our) past and the more difficult change becomes.

To that outline must be added a simple caveat: policy mistakes are made by humans; because our emotions render such admissions difficult, particularly by the agencies responsible for them, correction becomes difficult and is inevitably delayed.

Thus does the uphill struggle to "reform" a failing, destructive drug policy based on nearly a century of fear and false assumptions become readily understandable.

Doctor Tom

Posted by tjeffo at 03:23 PM | Comments (0)

May 02, 2010

Parsing Mexico, 3

The last entry ended on the suggestion that trade in “marijuana,” an illegal drug almost unknown to most Americans when JFK was elected has, since then, become important enough to threaten economic and political stability in both Mexico and the United States. Further, that the two governments' mutual reluctance to acknowledge such obvious problems suggests they may be even more serious than is being reported.

The evidence for those startling claims is relatively straightforward: marijuana use, essentially unchronicled before the 1937 Marijuana Tax Act, remained rare throughout the Forties and Fifties. That the few celebrity "busts” that did occur received so much publicity (Gene Krupa in 1943 and Robert Mitchum in 1948) only emphasizes their rarity. The relative insignificance of whatever market there was for marijuana between 1937 and the early Seventies is further confirmed by the explosion in arrests that began in conjunction with passage of the Controlled Substances Act in 1970 and has been sustained into the present as successive waves of adolescents have continued trying "pot," between ages 12 and 18, a phenomenon amply confirmed by Monitoring the Future surveys since 1975.

What Accounts for the Timing of Pot's Popularity?

The first literary interest in marijuana was by "beat" authors . As the first whites to use it and write about it approvingly, they were clearly an important influence on the emergent “counterculture” that developed when Baby Boomers born right after World War Two began coming of age in the Sixties. Drug experimentation and use soon became one of their hallmarks. Because they were so new and unfamiliar to boomers' parents, the drugs their children were trying: marijuana, LSD, and other “psychedelics,” were all the more frightening, a circumstance that clearly played a key role in Richard Nixon's 1968 political comeback, which in turn, enabled his dubious legacy: Watergate, diplomatic recognition of China, extension of the Viet Nam war to Laos and Cambodia, and the “War on Drugs."

Just as the 1914 Harrison Act was bereft of science that could justify its assumptions about “addiction,” there have never been pharmacolgic studies that would support the assumptions by which the Controlled Substances Act's Schedule 1, gives medically untrained lawyers (US Attorneys General) the power to prohibit drugs they literally can't understand for what amount to moral or religious reasons.

Anyone with the necessary medical knowledge should be able to recognize there now exists an enormous amount of medical literature refuting the CSA's Schedule 1 assertion that cannabis and other listed agents lack “redeeming” medical benefits. That assertion was absurd in 1970 and is now ridiculously out-of date. A critical question then becomes: why is such an absurd, obsolete assumption still the basis of a UN treaty that subjects any international traveler to arrest for mere "possession?"

Whether we are at more risk from an uncontrolled oil rig in the Gulf of Mexico or equally uncontrollable political instability on dry land may be a moot point.

Doctor Tom

Posted by tjeffo at 05:59 PM | Comments (0)

May 01, 2010

Parsing Mexico, 2

Although I’d spent five years in El Paso, one in an Army dispensary at Fort Bliss and the next four across the highway as a surgical resident at William Beaumont Hospital, I hadn’t been back there since August, 1963. Thus I’d found it difficult to reconcile descriptions of violence and mass murder now emanating from El Paso with the peaceful memories I still have of that interval in my life. One source that's helped has been Charles Bowden, an author I’ve yet to read in detail, but, thanks to Google, one who has already filled in several blanks in my understanding of how crime and corruption have changed that part of the border. it's important to note that Bowden probably has more than a nodding acquaintance with drugs, but he's clearly not a reform activist.

I didn’t visit Mexico again until 1975 when we spent a week in Mazatlan on vacation from a burgeoning civilian practice. There followed, at intervals, similar weeks in Cabo San Lucas and Puerto Vallarta: the last in the mid-Nineties. By that time we’d settled on Puerto Vallarta as a favorite destination, partly because it was so easily reached on a Alaska Airlines. Perhaps providentially, a growing interest in drug policy had radically changed our travel destinations from 1995 on.

Another thing I recall from our visits to Mexico is how surprised I was to learn of the relative value of its petroleum reserves, a hot topic of conversation in the Eighties. What Bowden’s essays also brought home is that same industry’s relative decline because of aging infrastructure and depleted reserves, not to mention the growing global demand. In other words, Mexican and US petroleum are in the same quandary. Quite apart from global warming, there's a looming oil crisis. The only questions are when, and how violently it will become manifest. Ditto water, for that matter.

All of which helps focus on the factors mentioned in yesterday’s entry. Although "foreign," Mexico and the Gulf are near neighbors, yet we seem to have trouble thinking about their current problems; perhaps because there are no easy solutions. However those problems are approaching crisis levels, thanks to prolonged neglect (denial).

I haven’t even mentioned “marijuana,” a contrived name for a product long associated with Mexico, but one that didn’t begin to become an important economic engine in both nations until it’s anxiolytic properties were discovered by American "kids" over forty years ago.

Just how that happened and the socio-economic significance of pot's illegal market will be topics for another day.

Doctor Tom

Posted by tjeffo at 08:10 PM | Comments (0)