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July 31, 2012

American Irony: “Gun Control” or “Drug Control?”

More than a week later, the mass shootings at an Aurora, CO theater are still attracting the attention of a world that was already overflowing with bad news. As more information about James Eagan Holmes trickles in, he seems even more a typical schizophrenic of the type housed in state mental hospitals by the thousands in the Fifties.

Well before Ronald Reagan became Governor of California in the Sixties, the state had started reducing the state hospital system that was caring for thousands of inpatients considered too unstable to be managed at home. To single out Reagan for all the changes that transpired before and after his tenure would be to oversimplify some very complex issues: both the state's population and the number of patients in state hospitals were increasing rapidly; pressure to "de-institutionalize" mental patients for both humane and fiscal reasons had actually begun with the availability of Phenothiazines, the first “tranquilizers.”

I would argue that a more critical factor has been (and still is) Psychiatry's lack of a coherent classification for the conditions it has been attempting to treat from the late Nineteenth Century on. The problem is readily understandable: emotional and behavioral problems simply do not lend themselves to the type of objective analysis Pathology provides so readily for the rest of clinical Medicine.

What I do hold Psychiatry and its affiliated disciplines responsible for is their delusion that the highly conjectural DSM system of classification which has been expanding since the Fifties, allows the objective clinical management similar to that provided by medical disciplines.

The results of relying on an imprecise nosology have been chaos; especially once the DSM began to evolve into a mental illness “bible” for non-clinicians: police, judges, social workers, teachers and counselors who do have legitimate professional interests in the same general population, but tend to lack the clinical focus physicians are traditionally expected to emphasize. Unfortunately, punishment has been emphasized at the expense of prevention and treatment which have also been forced by prevailing dogma to conform to a punitive model.

One result is the controversy now swirling around James Eagan Holmes: people of varying backgrounds heatedly arguing over how an obvious schizophrenic should be managed within the Criminal Justice System. At the same time, there is meager discussion of the incredible ease with which disturbed people can purchase guns legally in the United States, which has the dubious honor of leading the world in gun ownership, gunshot deaths, and levels of incarceration.

On a related subject, we passed a Prohibition Amendment to our Constitution in 1918; after it failed to produce the utopian benefits predicted, we repealed it, but failed to notice that it had provided criminal gangs with a successful business model, one that could be readily adapted to other illegal markets, such as the one for "narcotics" created by the Harrison Act of 1914. In 1937, we created a criminal market for smoked "marijuana" (“reefer”) for devious reasons almost as an after thought. When it suddenly expanded for no apparent reason in the Sixties, the problem was "fixed" with new legislation (The Controlled Substances Act) proposed by an Attorney General. Almost immediately, global criminal organizations were able to develop multiple illegal drug markets for the drugs the CSA prohibited (“controlled”). Forty years later, they are still expanding. The sheer number of “controlled” substances increases almost weekly and Marijuana, the most lucrative crop harvested in North America for over a decade, is also being smuggled in massive amounts across our Southern border.

Instead of questioning why those phenomena have occurred, right wing politicians demand more cops and bigger prisons, while their more timid opponents in “reform” damn “recreational” use without understanding that most chronic users (themselves included) were troubled adolescents who had tried "weed" before the age of 18 and have benefited substantially from its anxiolytic effects, which are far safer than those of other drugs, especially its 2 legal alternatives.

All of which prompts me to wonder if there is any hope for the survival of the smartest of mammalian species, the only one with the scientific skills to have allowed them to overpopulate the only planet available for the foreseeable future.

The stage now seems to be set for the most gripping human melodrama of all time: how will we deal with the global climate change we are producing? Unfortunately, before we can start correcting that problem, we will have to understand another: our own behavior.

Doctor Tom

Posted by tjeffo at 03:10 AM | Comments (0)

July 24, 2012

Stop the Presses! He’s a Schizophrenic, not a Mass Murderer!

I found myself screaming that at the TV as I watched the blank, disinterested face of James Egan Holmes while he sat in a Colorado Courtroom with his red-dyed hair listening to, but clearly not comprehending, the monotonous drone of court functionaries scheduling his next hearing at which he is expected to be charged with murder! I wondered, “has it really come to this?” Have we as a society become so confused that we've consigned nearly all of what was once Psychiatry to the Criminal Justice System? Doesn’t anyone realize that back in the Fifties, Holmes would almost certainly have been recognized as a schizophrenic long before he started spending the grant money he’d been awarded to pursue a PhD in “neuroscience” at a leading Medical School to purchase the guns and ammunition used shoot seventy-odd fellow humans in a spasm of uncomprehending rage?

Not that schizophrenia was that well understood in the Fifties. Nor is it understood any better today; rather, it's largely ignored until or unless, a schizophrenic commits a "crime;" which may help explain why our jail and prison system has expanded four-fold since 1970, even as the once huge state hospital system we built for the "mentally ill" has all but disappeared.

Telling the story of our nation's descent into Drug War Madness won't be easy; it involves far more than drugs and the vague concept of "mental illness" (for which Medicine still lacks a coherent system of classification). Among other things, it will require an understanding of America's fixation on guns and killing, a trait that has made us the most over-gunned society on Earth by a wide margin and imposes a penalty of thousands of extra deaths from homicides, suicides, and accidental shootings. Just how many is a matter of "debate" because the NRA is also one of the most powerful and dishonest lobbies on Earth.

Another critical element in the early history of drug plicy has to do with President McKinley's assassination in 1901 because it propelled Teddy Roosevelt into the White House. Among many far-reaching decisions, TR elevated a medical bureaucrat named Hamilton Wright MD to a position that allowed him to pursue his obsession legal prohibition of as the best way to prevent "addiction." Wright's concept meshed with that of Francis Burton Harrison, who helped write the deceptive Harrison act that would eventually give our federal bureaucracy the power to both define "addiction" and decree its treatment; a powers it has never relinquished and which enable the drug war to use its enormous legal, political and economic clout with such abandon.

This seems like a good place to stop for now. I hope soon to resume this narrative; in the meantime, I'm willing to predict that until very recently, James Holmes was what his record suggested, bright, albeit shy; a good student with no significant red flags in his family or behavioral background.

Doctor Tom

Posted by tjeffo at 04:24 PM | Comments (0)

July 21, 2012

Mistakes Too Big to be Admitted

It has become increasingly obvious to those with an interest in cannabis ("marijuana") policy that either the Obama Administration can’t control its bureaucracy, or the President and his AG were just blowing smoke when they said shortly after the 2008 election they would take it easy on states with medical marijuana laws. Nor, could their message have ever reached Melinda Haag, Holder's US Attorney for California's Northern District (and a 2010 Obama appointee!).

After Haag's October 2011 press conference, in which she reaffirmed total federal rejection of any possibility that "marijuana" could be considered "medicine," DEA raids on dispensaries ceased (they were, in any event, becoming sources of local hostility and anti-government resentment). Instead, dispensary landlords began receiving letters from Haag's office threatening them with forfeiture if they continued renting to violators of federal drug law.

The new tactics are working; a record number of dispensaries have been evicted by landlords who chose not to risk loss of valuable property to the government. The down side has been a lot of unnecessary suffering by "legitimate" patients. Unfortunately; because government propaganda has convinced most "straights" that much of "medical" use is simply "recreational," the cannabis-naive public doesn't realize the importance of the relief it provides, nor the needless cruelty of making it nearly impossible to obtain by someone who has come to depend on it.

However, change may be in the air; recent high-profile forfeiture actions brought by US Attorney Haag against Harborside, the entity that operates dispensaries in Oakland and San Jose that have been targeted, will bear watching. The Harborside organization has emerged as an important player in the shadowy world of "medical marijuana" beyond California. It has also been the subject of widely seen and generally favorable documentary videos stressing its professionalism and commitment to both cannabis science and to product quality. Harborside is clearly "not your nephew's pot club," to paraphrase an obnoxiously overworked item of federal propaganda. Harborside's brain trust has promised a stout defense of its record-keeping practices and compliance with existing law.

Prosecutor Haag, on the other hand, revealed that her suspicions regarding Harborside's culpability had been whetted by her belief that any operation doing that well must be doing something illegal!

Thus do the advocates of arbitrary medical practice unwittingly reveal their ignorance and prejudice, even as they presume to enforce a law rooted in similar errant beliefs against patients who were often the victims of careless or dysfunctional upbringing.

History is replete with similar examples: poorly conceived policies that were rigorously enforced for long intervals despite the obvious social damage they were producing.

So has the ultimate replacement of such policies often been needlessly difficult, especially if long delayed by denial or stubborn defense of the policy's essential doctrine. The American Civil War, qualifies in both respects and the depth of "Dixie's" intrinsic racism, though lessening, cannot be denied.

Also, one has only to mention Tiberias, Caligula, or Nero to appreciate that history has a long memory for bad behavior. In the modern era, just as Hitler's name is inextricably linked to Nuremberg, so will Nixon and Mitchell likely be associated with Watergate and the Controlled Substances Act.

Ms Haag would be well advised to read more history before marching destructively through California's Medical marijuana experiment.

Perhaps she should also ask herself why a drug that was attacked by two disgraced lawyers with no expertise in Pharmacology has remained America's most frequently tried and commonly used illegal drug since the original Monitoring the Future surveys began in 1975.

Finally; one of the more consistent scenarios exposed in the wake of embarrassing political failures (like the drug war will inevitably become) is misplaced confidence in the false assumptions on which it depends.

In the case of the drug war, the key assumption that underpin the Controlled Substances Act in 1970 are more thread bare than ever: what they really add up to is that cannabis can't possibly be medicine because John Mitchell (who died in 1988) and Richard Nixon (ditto 1994) said so.

Isn't it time we freed ourselves from the ghosts of Watergate? Doctor Tom

Posted by tjeffo at 08:04 AM | Comments (0)

July 12, 2012

A Draft from the Past- and a new clinical correlation

I don't post every entry I compose. Some are saved as drafts for possible later use or because something else caught my eye before I got around to posting it. The following was composed in July, 2012, but never posted. Just this past month, I somewhat belatedly realized that an unusually high percentage of the patients I've been taking histories from for over ten years were self-medicating for autoimmune disorders. The July 12, 2012 entry noted, "An exciting recent insight requiring further investigation is that it (cannabis) may also relieve a wide variety of symptoms of autoimmune disorders." Today, I Googled that same issue and was rewarded by an exciting hit. This is a rare case of old clinical correlations being confirmed by new research.

Text from July 2102: I just became aware of NIH grants that have been supporting research at the University of South Carolina Medical School for over five years. The Doctors Nagarkati, both PhDs, appear to be husband and wife. although limited to animals and tissue culture, their work clearly indicates that both cannabinoids and endocannabinoids possess enormous potential benefits for human patients- even as the DEA and local police continue to raid California dispensaries asserting that marijuana is still "illegal under federal law," (one based on the unfounded assumptions in Schedule One of the Controlled Substances Act of 1970).

Aren’t the FDA, the DEA, NIDA, and the NIH part of a federal bureaucracy nominally controlled by President Obama? Is it possible to embarrass either them, or Obama for their continuing observance of the scientifically baseless and intellectually bankrupt Controlled Substances Act passed over 40 years ago at the behest of two lawyers forced out of office for dishonesty? Given the circumstances, isn’t it time to rethink our destructive “War” on drugs?

My own interest has been sustained by an ongoing study of the benefits to (now over seven thousand) Californians seeking protection from arrest under the aegis of Proposition 215.

Doctor Tom

Posted by tjeffo at 10:46 PM | Comments (0)

July 10, 2012

Geo-Climatology and Politics

Weather is to climate as daily news is to history: both tend to occur in patterns that have facilitated important human activities- agriculture is perhaps the best example because it clearly allowed the first civilizations to develop.

However, science also discloses that long established patterns are occasionally punctuated by one-off events that would have been unpredictable. Perhaps the most familiar example is the extinction of the dinosaurs as first proposed in 1980 by the father and son team of Luis and Walter Alvarez, both UC Berkeley professors. They were led to predict such an event because of a thin layer of iridium found at the same geologic stratum (K-T Boundary) all over the world.

Their prediction was dramatically confirmed within a few years by the discovery of a crater near the tip of the Yucatan peninsula. It is now widely accepted that an asteroid the size of Manhattan struck near the present-day Mexican village of Chicxulub roughly sixty-five million years ago and among that event’s many consequences was the survival of a clade of mammals that was then able to evolve; thus do we modern humans owe our existence to a remote event that has become so well accepted that astronomers maintain a watch on the most likely sources of such missiles so as to anticipate not only arrival dates, but those that may graze Earth's atmosphere.

While there could have been no human observers to record the Chicxulub event, the accumulated evidence adds up to one of the best vindications of modern science one could imagine: the existence of such an impact site had been predicted by the global presence of a thin layer of iridium that corresponded to the time dinosaurs were suspected to have gone extinct.

Nevertheless, nay-sayers (usually fundamentalist defenders of the tenets of traditional "Desert" religions on rhetorical or theoretical grounds) abound. They may not have even heard of the dinosaur extinction hypothesis, but would, in any event, be required by their faith to oppose it.

What characterizes such rhetorical arguments is an ignorance that requires essential facts to be either ignored or misrepresented. Thus does ignorance support further ignorance; a rhetorical technique that essentially cancels out logic and science.

Thus is it likely that current scientific evidence casting doubt on belief in an anthropomorphic creator is either ignored or doubted by a majority of our species.

I can't think of a better reason to support an admittedly wishy-washy incumbent in November. His challenger is an unabashed fundamentalist, almost a cultist. Not only does Romney have the advantage of obscene amounts of money and the backing of four doctrinaire Catholics on the Supreme Court, he would, if elected, be able to appoint one or more assistant justices and thus guarantee both the drug war's survival and the continued implosion of our species.

As it is, the recent (and somewhat surprising) defeat of the fundamentalist wing of the Supreme Court by its Chief Justice may have been both a reprieve for Obama and a chance for me point out the drug war's largely unsuspected contributions to the decline of American health care.

Doctor Tom

Posted by tjeffo at 07:42 PM | Comments (0)