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July 30, 2011

Another Take on the Debt Crisis

Thursday night, I happened to catch a remark by Wall Street Journal columnist Peggy Noonan, in which she gleefully reported that she had labeled President Obama a “loser" in her Friday column. Given the potentially dire context of our looming financial crisis, I considered such a personal attack on our president irresponsible at best. Sure enough, there it was in Friday’s WSJ. In fact, the whole column was even more scurrilous than her flip remarks on TV had suggested. What Noonan's arch analysis missed completely is that if we default, the federal government would be incapable of prioritizing which recipients to pay and which to stiff; let alone improvising how to get checks or bank credits out to the lucky ones. The ripple effect of unpaid obligations throughout a nation in which millions of individuals and small businesses are hovering on the brink of bankruptcy seems not to have occurred to Ms Noonan or the Tea Party morons she attempts to cast as modern heroes.

It's becoming increasingly clear as the debt ceiling deadline approaches that those who hate Obama for whatever reason are so determined to defeat him on a major issue they will take extraordinary risks to do so. It's also clear they have so comprehension of what those risks are, or even how much their financial brinksmanship may have already cost the nation (or the world).

What's also clear is that Tea Party extremists are so focused on the 2012 general election and their goal of limiting the Obama Presidency to one term, they have chosen the financial equivalent of a nuclear weapon. That they may have succeeded in exposing Obama's innate timidity seems likely, but the cost of that "victory" may be the long-term eclipse of their own party.

Given the abysmal quality of their presidential candidates and Congressional "leadership," let us devoutly hope so.

Doctor Tom

Posted by tjeffo at 04:29 PM | Comments (0)

July 28, 2011

Is denial humanity's' most dangerous characteristc?

Homo sapiens, as we have come to call ourselves, could be at a tipping point in terms of popular belief about both our origins and ultimate destination as a species. I say that because we seem particularly blind to the threat represented by America's debt crisis, a global event that has been building for years, if not decades or even centuries. Yet at the eleventh hour, those with the authority- some would say responsibility- to resolve it seemed peculiarly incapable of doing so.

Given the unprecedented increase in human numbers that occurred in the 20th century (and yet seems of such little concern to modern politicians and world leaders) the very complex global economy that has been both the enabler and a consequence of that population explosion should be an entity responsible leaders would seek to protect at all costs. However, as anyone reading American newspapers or watching cable news knows very well; such is not the case. With less than five days remaining before default, a workable solution seems further off than ever.

As someone who remembers the bombing of Hiroshima and Nagasaki in real time (it was the Summer between 8th and 9th grades) I am only too mindful of the fact that scientists involved in the Trinity test carried out less than 3 weeks before the actual bombing of Hiroshima were divided as to what might happen; some thought it could be a dud and a few feared a runaway chain reaction with catastrophic consequences. The similarity of the uncertainty of nuclear experts in 1945 and the extreme range of possibilities anticipated by economists resulting from our unresolved debt crisis next Tuesday could hardly be more ironic.

Assuming that neither extreme is realized, the overwhelming weight of responsible predictions seems to be that Americans will be hurt financially in the short term by (avoidable) loss of global confidence in our ability to pay our debts; yet that logic seems lost on the Tea Party minority in the House. Such behavior is not unusual for humans harboring powerful resentments. Indeed, responsible group behavior in the face of potentially dire consequences may the exception rather than the rule. One can make the argument that if we humans really did learn from our mistakes, there wouldn't be as many as history has recorded. On the other hand, we're still here...

In a similar vein, because I have acquired specific knowledge of how destructive our policy of drug prohibition has been with respect to cannabis, and how blind both American and International political leaders have remained to its shortcomings, I've also been forced to understand just how such anomalous circumstance could have come about.

The best answer at present seems to be our (human) capacity for denial, seems to be keeping pace with our equally strong capacity for self-destructive behavior. So far, at least, we've stopped short of total destruction. Let's hope that record continues; at least long enough to come up with an exit strategy.

Doctor Tom

Posted by tjeffo at 11:42 PM | Comments (0)

July 23, 2011

The Drug War's Origins

The American government's concern over "addiction" began early in the 20th century with the (TR) Roosevelt Administration's participation in two international conferences on the opium trade. Our acquisition of the Philippines, following the Spanish-American war played a key role because Episcopal Bishop Charles Henry Brent, a respected missionary, came to believe that opium from China had become both a serious problem in the islands and an American responsibility through conquest. He was able to make that case effectively through his friendship with newly appointed US Administrator for the Philippines (and future President) William Howard Taft,aboard ship as they traveled to the islands after the war.

Closer to home, Heroin, a morphine derivative patented by Bayer in 1898 amidst claims it was non-addictive, proved to be just the opposite, becoming a favorite of addicts and raising the public's fear of “addiction” to new heights. It was in that context that Hamilton Wright MD, one of the more energetic members of the Roosevelt Administration began lobbying Francis Burton Harrison, a Brooklyn Congressman with close ties to the Philippines and his own aversion to addiction. Wright's ultimate success was the Harrison Narcotic Act of 1914, which Woodrow Wilson signed into law in December. Harrison eventually became the vehicle that established a policy of de facto drug prohibition until it was replaced by the even more devious and repressive Controlled Substances Act in 1970.

Whether those who had used deceptive transfer taxes as cover for Harrison and the Marijuana Tax Act of 1937 fully intended a policy that would mature into harsh, criminal prohibition can't be determined with certainty, but that's exactly what happened after Attorney General John Mitchell replaced both with the Controlled Substances Act he drafted almost single-handedly in 1969. His party then passed the CSA with little debate (and even less medical input) in 1970. Given the adverse changes in American education, incarceration, and healthcare that have occurred since, one would have to admit that the CSA's unintended consequences have been severe.

Doctor Tom

Posted by tjeffo at 03:12 AM | Comments (0)

July 14, 2011

Obama’s Drift to the Right; and some notes on getting high.

Wouldn't it be ironic if Barack Obama, the first nominally black American president were also the first real Manchurian candidate in history? In the last entry, I was decidedly critical of his presidency; and that was before his offer to put cuts in Medicare on the table. Before going any further I should admit there is no precise definition of " Manchurian Candidate," a character appearing in Richard Condon's 1959 novel, and first brought to the screen in a film made in 1962, but not released for several years because of the political scruples of one of its stars. For those interested in more detail, the lengthy review by Roger Ebert is a good place to start. Briefly stated, a Manchurian candidate is a "sleeper"programmed to gain political office and then lead the country in an entirely different direction than his supporters expected. The general idea has been brought to the screen twice, once in 1962 and again in 2004 by talented directors and very different casts of talented actors.

In any event I'm using the term because I cannot conceive of any more improbable turnaround for an American President than the one Obama seems to be in the midst of. Given the intellectual dishonesty and irresponsibility of his political enemies on the other side of the aisle, his latest ploy has outraged many loyal supporters and left some stunned. In retrospect however, given the laundry list of earlier improbabilities starting with the DEA raid on pot clubs in January 2009, this latest move could be seen more as further progression in a coherent plan to betray all the principles candidate Obama once claimed to stand for.

There is another possibility; It could still turn out that Obama is simply taking a leaf from Clinton's'94 playbook in which he snookered the Republicans into shutting down the government over their “Contract with America,” much to the disadvantage of then-Speaker Gingrich, who has yet to recover and is now spinning his wheels as a minor presidential candidate.

This particular political theater is distressing to me personally because of my interest in medical cannabis and the witless war on drugs. Obama was the first candidate to ever admit his own adolescent initiation of cannabis and cocaine and also the first to admit inhaling and getting high. Beyond that, his remark, “that was the point,” in response to a reporter's question led me to hope that he might be the first politician capable of (publicly) understanding the appeal of cannabis to adolescents.

It may be progress of a sort for our third Boomer president just to admit trying illegal drugs and actually getting high. One of several bits of generally unknown cannabis culture I've picked up from my extensive profiling of applicants is that not all got high the first time they tried pot; indeed the failure rate may be over 50%. It's a phenomenon fairly well known to the cognoscenti that has been well described by Lester Grinspoon.

Why it happens is generally unknown; in essence, inhaled cannabis is the only illegal drug which gives prospective users a test to see if they qualify to use it; I can’t imagine anyone who had been unable to get high ever seeking a recommendation. Pot is also used as an “edible,” but the two routes of administration produce notoriously different effects, and as a practical matter, virtually every prospective initiate tries it by inhalation the first time.

Which bring up another bit of lore: the "body high" produced by edibles is so different than the "head high" produced by inhalation that they may as well be different drugs. Almost every user learns that sooner or later but almost none know the reason, which is that when inhaled as smoke, the active agents are delivered to he brain almost immediately and experienced almost in real time. In essence, each toke is an incremental increase in the dose, allowing the user to "titrate," its effect from memory and thus avoid overdose.

Edibles, on the other hand, belong to the gastrointestinal tract when swallowed and thus are digested, a totally different process. The digestion products then gain access to the Hepatic Portal Circulation and are processed a second time by the liver. Thus what the brain "sees" after an edible is very different than smoke; also significantly different from simple decarboxylation, which is the standard explanation. Furthermore, the details of what happens in the liver have never been studied, or- if they have- have yet to be published.

The silence of the literature on this key difference speaks volumes about the enforced ignorance of both the policy and the policy makers, who still insist that all legal cannabis for research must come from the Federal Marijuana farm in Mississippi and approved by the DEA (which always says no). It's another catch 22 in John Mitchell's maddening Controlled Substances Act.

The edible "high" is dramatically different; it lasts a minimum of three hours, sometimes longer. It is associated with a feeling or weakness in the arms and legs which is pleasant, but rules out hard work or a visit to the gym after eating a brownie. The bonus is markedly enhanced antinociception (pain relief) which is especially welcome to patients with severe pain syndromes. The such as sciatica, traumatic arthritis or various neuropathies. the relief also lasts the whole three hours. Unfortunately, unlike smoke, the potency of edibles can't be easily titrated, thus unintentional overdose is common However, most have learned to cope with that problem by either making their own or by cautious testing of each new batch from a known vendor.

That one can't find these phenomena described in the literature speaks volumes about a policy of enforced ignorance based on the imaginings of medically ignorant policeman, judges and lawyers.

What it says about clinically ignorant activists I will simply leave to the imagination. It's important because it points out the importance of clinical inquiry in determining what questions need to be asked and answered- the difference between science in search of truth or in defense of empty dogma.

Doctor Tom

Posted by tjeffo at 05:34 PM | Comments (0)

July 07, 2011

Change you Can’t Believe In; in a world having problems with reality

I‘d only been screening applicants hoping to use “marijuana” legally for a few months before their clinical histories convinced me that many time-honored beliefs about cannabis are simply either untrue or based on serious misconceptions. After nearly ten years spent studying that heretofore hidden population, I think I've gained an understanding of how it has been evolving for the past 40 years and how America's drug war had been damaging both our own society and those of other nations well before that.

The best place to begin may be with the Harrison Narcotic Act of 1914, a law prompted by developing awareness of drug problems falling under the rubric of “addiction” in the late 19th Century, especially the injection of heroin. Preceded by New York Times specials earlier that year and reflecting ambient racist fears, Harrison was an early attempt to establish “control” over a targeted drug by means of a transfer tax. The new law quickly led to several test cases generated by the arrests of physicians for prescribing drugs (as it required). Through a series of narrow (5 to 4) decisions, the Supreme Court ruled that prescribing for addicts in amounts not in accord with federal policy was illegal. Thus did an ignorant Congress, with a critical assist from an equally ignorant Supreme Court, define “addiction” and specify its optimal treatment long before Medicine had been able to study the phenomenon clinically- or even to describe it coherently.

By establishing rigid rules specifying what the goal of treatment must be (abstinence), also by authorizing criminal punishment for recidivism, a manifestly ignorant Court enabled a policy that would ultimately give America the dubious honor of leading the world in the incarceration of its own citizens.

Yet for some reason, the “drug war” has become a sacred cow; even mild public criticism of our drug policy courts strident denunciation and risks political destruction of the critic. Now globally enforced by UN treaty, the Drug War has the potential to become one of our species’ epic mistakes. A good example was a recent memo from the Obama Justice Department threatening criminal prosecution of officials in states with medical marijuana laws for daring to comply with them.

That memo reinforces the ambivalence Obama's Administration has been exhibiting toward the issue since January 2009. It has also oscillated in other key areas: it bailed out the same banks that helped create our economic collapse, it's now using Predator drones to kill suspected terrorists in Pakistan and Afghanistan. Also our rejoicing at the assassination of a notorious terrorist being protected there, reminds us that Pakistan had also been sheltering one of its citizens who had grown rich from the delivery of nuclear technology to them, and probably shopping it to rogue nations around the world.

Given the shaky US economy, our crumbling infrastructure, the cascade of weather disasters like Joplin and the record heat and flooding now being experienced in parts of the US. Also, given the international failure to plan for the increasing probability of adverse climate change, the new Obama Administration may be better suited for life with the hypocritical world we humans have created than we realized.

If anyone has a more optimistic description of our present prospects, I’d be happy to listen.

Doctor Tom

Posted by tjeffo at 01:27 AM | Comments (0)