October 29, 2012
Annals of DenialWhat follows is an admittedly gloomy analysis of the drug war's largely unrecognized adverse effects on our species and the bleak prospects for their early mitigation. The most appropriate current analogy may be the slow motion progress of Hurricane Sandy as it bears down on the US East Coast. Record breaking storm surges are expected and TV’s Weather Channel experts are predicting unprecedented flooding in an area that's home to nearly a third of the US population. Nevertheless, recently written articles denouncing global climate change as a “hoax” are still easy to find.
With respect to the drug war, we have been victims of a hundred year policy error, the magnitude of which has been exacerbated by the fact that its principal architects were largely unknown to each other, lived during three different political eras, and were connected primarily by their desire to protect the early federal hegemony over "drugs" that had been arrogated by the policy's earliest proponents, men who could not possibly have predicted how their largely invalid assumptions about "addiction" would have eventually matured in today’s overpopulated, competitive, and dangerous modern world.
The next entry is planned as a simple narrative describing that evolution and suggesting the magnitude of the modern world's self-imposed drug problem. I certainly wouldn't expect it to find immediate favor; in fact, quite the opposite. That the drug war is a necessity is still one of the modern world's most cherished myths (but one starting to show signs of age). I'm also e-mailing the text to people I have good reason to believe will not reject it out of hand; but might even read and discuss it (revolutions have to start somewhere).
As time permits, I hope to offer specific evidence on key points that reinforce the idea that the drug war began as an understandable mistake that has evolved into a tragedy. Predictably, one of the first obstacles it will face is denial a human characteristic by used increasingly to avoid the need to even think about bad news, especially that with dire existential implications: financial melt downs, threats of nuclear war, and weather disasters like Sandy, for example.
As for me, I'm going to watch Sandy's development on on the Weather Channel and be grateful that I ended up in the Bay Area by opting to intern at San Francisco General Hospital after medical school graduation in 1957. Had it not been for that decision (and a slew of other unpredictable events) I wouldn't have had the chance to study pot use in California, learn why the drug war is such a disaster, and have an opportunity to tell the world news it would prefer not to hear about the real "Hoax of the Century."
October 27, 2012
Annals of Cognition (the Impact of Emotions on our Decisions)That Man is a cognitive mammal and the brain our organ of cognition should be evident to any educated human in the Twenty-First Century, yet there is much disagreement over the details which, as it turns out, become important; if only because differences of opinion over key details may prompt humans- acting either as individuals or in groups- to disagree with lethal consequences. When one person kills another in such a disagreement, it’s called “murder” and in most countries considered a matter for the criminal justice system to decide. However, as is also quite evident, applicable law has varied considerably from nation to nation and era to era, with the result that murder in one culture can be considered an honor killing in another. One has only to recall the plot of Romeo and Juliet to get the point. Closer to modern times, it's clear that honor killings are still an intrinsic part of many cultures, as is demonstrated by simply Googling the phrase.
In that context, we can see that one of the important ways that have allowed the anomalous American “war on drugs” to become a respected concept in the modern world is that its advocates have succeeded in making the concept of being “high on drugs” such a shameful state that it must be discouraged, not only by families, but by society's institutions; also that if persistent beyond a certain age, being "high" on certain drugs becomes grounds for formal punishment by the criminal justice system in UN member nations. This is especially true with respect to “marijuana,” which once led to the arrest of an American billionaire while on a trip to New Zealand to watch the Americas Cup.
So much for hypocrisy and “equal justice under the law.” On another tack, we have Hurricane (or is it a Tropical Depression?) Sandy now bearing down on the East Coast of the US. Both Sandy’s dimensions and wind velocity are uncertain at this point, but what seems accepted by all weather experts is that it’s a huge storm carrying immense amounts of water and that it will have enormous impact on the Eastern US. Also, that its after-effects will probably last through Halloween, games three and four of the World Series, and Election day. In fact Sandy could even affect the outcome.
Talk about unintended consequences! I have long been troubled by the human tendency to deny obvious reality in favor of cherished irrational beliefs (one of which is that criminal prohibition of drug use is a viable national policy). In that respect I would hope that the arrival of Sandy and its after effects might prompt some second thoughts about Al Gore who, as soon as he was cheated out of the Presidency by a Supreme Court packed by Republican Presidents, lost all respect among the same Democrats who let it happen by not voting for him (or voting for Ralph Nader). Perhaps the post-Sandy soggy basements of Democrats living in the Northeast will remind them of how much the eight year reign of the Bush- Cheney "greed and idiocy" Administration have cost us, not only in terms of the economic disaster they and their oil patch cronies allowed, but also the time lost by a world that eight years of more effective US leadership might have accomplished.
If that sounds bitter, the effect is intended. I learned long ago as a practicing surgeon that failure to make a timely diagnosis of a surgically curable condition risks not only an uncomplicated recovery, but also the life of the patient. In this situation, humans are not just the doctors, they are also the likely causes of an iatrogenic planetary illness, one from which recovery is uncertain.
October 24, 2012
Annals of Human Belief 1One indicator of humanity's unique position atop the cognition pinnacle is the intensity of our beliefs; we are the only species that commits murder or suicide over issues ranging from transient personal frustrations to deeply held religious and political convictions. Although not the only cognitive mammals, we are the only surviving hominids and our greater cognitive abilities are clearly what differentiated us from those who went extinct. Yet ominously, we now find ourselves in a particularly dangerous predicament because we have developed the power to influence our planetary environment to a degree that is both unprecedented and a threat to our survival.
Unfortunately, we don’t seem even remotely capable of modifying the behaviors that have placed us in that position; even worse, we seem strangely indifferent their dangers even though it only requires a modicum of scientific knowledge to appreciate their serious implications. The first indisputable example of existential human risk was the Cuban missile crisis 50 years ago this week. Fortunately, because both Kennedy and Krushchev rejected the advice of their generals, we still don’t know if Nuclear Winter would have followed a nuclear missile exchange, but it would have been a disaster for the US and Russia, to say nothing of Cuba. There were undoubtedly other close calls, Able Archer, for one.
One of the more specific modern dangers, for which a plethora of suggestive evidence already exists, is global climate change, which became a cause for Al Gore after he was snookered out of the Presidency in 2000. Surely both the Presidential candidates, who just concluded their third “debate” without mentioning the subject, were aware of Gore and his issue; yet neither mentioned it or was even questioned about it, which is precisely why I think we should all be worried.
Such existential thoughts were definitely not my main interest when I accepted the invitation of on Oakland cannabis club owner to screen prospective customers seeking to take advantage of California’s medical marijuana initiative in November 2001. Although I’d been an outspoken opponent of US drug policy since 1995 and an advocate of “medical marijuana’ since 1996, my knowledge of both was largely theoretical.
The club owner in question was seeking to protect himself by ensuring that his customers would be in compliance with the letter of California’s new “Medical Marijuana” law; I was seeking to learn about how it was functioning after five years of disputed existence. As it turned out, although our business relationship may have played some role in the sudden expansion of pot’s then-fledgling retail distribution system that took place in 2003, we were both unaware of how implacably the federal government was opposed to any “medical” use. We were also unaware of the the extent of basic human dishonesty, or of the likelihood of “friends” might steal from, or turn on former allies.
My early experiences with those I labeled “cannabis applicants” in the peer reviewed paper published five years ago (but have always thought of as “patients”) quickly told me my original beliefs on the subject were mistaken. I was very aware that inhaled pot’s ability to relieve nausea and prevent vomiting were what had generated the public awareness that put 215 on the California ballot, but I was completely unprepared for the most common complaints I'd be hearing from those seeking to use it medically: a majority of the men were emphasizing chronic pain and though many would also allude to "stress" and "insomnia," women were far more open about emotional symptoms. Somewhere along the line I began asking everyone about their prior use of alcohol and tobacco and it quickly dawned on me that most had tried both as aggressively as I had. I thus realized that if pot had been as available to me when I was in High School, I would probably have tried it and my whole life might have been very different. Shortly after that, I consciously embarked on what has become a 10 year study of pot use that has convinced me the the modern “drug war” has been America’s greatest mistake since our revered founders buried Slavery within the Constitution in 1787, an opinion I know many might bristle at, but am very; sure is accurate.
To be continued.
October 21, 2012
The Drug War's Watergate Connection & Why Marijuana Prohibition is a War CrimeThe Presidential debate scheduled for Monday reminds me that Watergate was not the only disaster caused by Richard Nixon, not even the worst. Two others that were much worse were the bombings of Laos and Cambodia, which left behind thousands of bomblets that are still maiming children forty years later; also the evil, dishonest Controlled Substances Act which has no basis in science, but depends entirely on bogus assumptions for the "scheduling" of drugs that are laughably simplistic and entirely without foundation. That the same assumptions are still cited (by a police agency) as the reasons "Marijuana" must remain illegal is both a national and a species disgrace.
A review of the sequence of events that led to that culprit legislation is straightforward enough to grasp the flagrant nature of the dishonesty it was based on. The first event was the 1969 Supreme Court decision to nullify the 1937 Marijuana Tax Act in a case involving Timothy Leary, a development that was both unexpected and a significant problem for Richard Nixon, who was then being assailed by young people outside the White House protesting those illegal bombings of Laos and Cammbodia, as well as the Vietnam war in general. The Court's action required that the deceptive MTA be replaced forthwith; another problem for Nixon.
Attorney General John Mitchell's solution to Nixon's problem was a clever, but dishonest rhetorical exercise: the creation of a simplistic "scheduling" algorithm by which to rate drugs ("substances") on the basis of their "danger," "habit forming" potential, and "acceptance in American Medical practice" (as if any AG would be qualified to judge those nebulous criteria). Another problem with Mitchell's schema was his total lack of knowledge of Pharmacology. Although no self-respecting pharmacologist would have taken his schedules seriously, none were given that chance. nor were, there any data offered to support Mitchell's assumptions; nevertheless, Congress passed the Controlled Substances Act, incorporating all of them, and tragically; policemen around the world have used them to make millions of felony arrests and destroy countless lives for forty years.
Even worse, the CSA contains another provision that allows the US Attorney General to place new drugs on schedule one as he deems necessary. With each new addition, a lucrative, and potentially violent, illegal market has been created.
Since 2001, I have been using the access to chronic cannabis users provided by California's medical marijuana initiative to interview over 6800 applicants seeking to take advantage of's Proposition 215 to profile them and investigate their histories of use. Their data reveals a profile of chronic cannabis use which is overwhelmingly at odds with the uninformed and generally incoherent DEA propaganda used to counter the generally valid information published by reform organizations.
In that connection, "reform has consistently been snookered by its tendency to take ignorant DEA claims at face value and then base their own arguments on the benefits of cannabis as medicine without realizing that their opponents are so deeply committed to a bogus policy, they will simply not be moved by contradictory data.
Suffice it to say that a careful comparison of my data with federal claims reveals that the dug war is even more egregiously mistaken and cruel than could have been imagined
Beyond that, cannabis is uniquely complex and treats a wide variety of psychotropic and somatic ailments very safely and effectively. For example, it's excellent treatment for common "Autism Spectrum" syndromes ranging from dyslexia, and ADD to Bipolar disorder. It's also a well tolerated anticonvulsant. When ingested as an edible in proper dosage (which can be tricky to establish) it provides surprisingly effective pain relief from severe neuropathic and arthritic pain. An exciting recent insight requiring further investigation is that it may also relieve a wide variety of symptoms of autoimmune disorders.
A final thought: The CSA was cleverly supported when the DEA and NIDA were created by Nixon's Executive Order in 1973 and 1974 respectively. That also provided plenty of money, mostly to psychiatrists and psychologists, for writing policy-friendly papers with which to stuff peer reviewed literature. What all the early papers missed is that thousands, perhaps millions, of adolescent baby boomers who began trying "marijuana" in the Sixties were susceptible to the anxiolytic properties of inhaled weed. That was a phenomenon that turned the relatively small market that had existed in Anslnger's day into the monster that scared parents in the Sixties.
That seems like quite enough for one day; I'll have a lot more later.
October 11, 2012
Annals of Human FollyAlthough humans can take some justifiable pride in being the only species to exhibit our advanced cognitive abilities, there are so many examples, even within my own profession, of humanity's amazing ignorance and willful stupidity- that it probably behooves all of us to restrain whatever impulse we have for the kind of self-congratulatory rhetoric typically heard during political campaigns.
Two glaring examples of human fallibility in the realm of Medicine illustrate that point. The first was that of James Lind, an Eighteenth Century Scottish physician who correctly observed that the consumption of lemons and limes prevented scurvy, a dreaded condition afflicting sailors on the long sea voyages that had become common following discovery of the Americas. Given the role of the its navy in both protecting England from attack and enlarging its empire, scurvy represented a particularly serious problem for the British. The good news was that Lind wasn’t persecuted for his unconventional views on scurvy; he was simply ignored; a development that prompted him to design what is now considered by many to be the first example of clinical research and earned him an honored place in history.
About a hundred years later, a Hungarian-born physician was far less fortunate. Although Medicine was still deeply mired in relative therapeutic ignorance, there had been advances in overall understanding and physicians were enjoying some increase in prestige. A junior instructor at the more highly regarded of two Obstetrical clinics in Vienna named Ignaz Semmelweis noted a clinical phenomenon, which like the one noted by Lind, had also been observed by others: after being examined by professors, young women in childbirth often came down with child bed fever, a dreaded condition with a high mortality. Long before bacteria would be discovered by Pasteur, Semmelweis correctly surmised that the professors were spreading child bed fever from patient to patient with their hands and made his own students wash theirs between different patients, a practice that dramatically reduced its incidence, but offended his senior physicians because it was interpreted as impugning them and contradicting existing beliefs. To make a long story short, Semmelweis, who turned his observations into a campaign, was never taken seriously during his lifetime, even after he left Vienna, moved to London, and published his results.
The continued skepticism of colleagues in two nations ultimately drove Semmelweis into an asylum where he died- ironically of septicemia- at the age of 47. Although possibly mentally unstable in an era when mental problems were poorly understood, the serial collegial rejection of his clinical truth in two nations must have played a major role in what must be regarded as a personal and professional tragedy.
To an uncanny degree, the current American and global folly aka the “War on Drugs” is orders of magnitude worse than either of the examples just cited. Not only does a global Drug War affect millions and promote violence everywhere, it is based on rhetorical nonsense promulgated by two notorious, medically ignorant liars. Even worse, the alleged medical harms of cannabis were easily refuted by clinical histories taken from long term users. Beyond that, wannabe doctors in the cannabis reform movement, have, so far been cool to the idea that their own repetitive use as adolescents was occasioned by the anxiolytic effects of cannabis when it is inhaled.
Thus troubled patients who have been effectively self-medicating serious symptoms, are still being arrested and prosecuted as criminals in the US and around the world, while the planet's political leaders have yet to notice.
Is it any wonder the same leaders are equally unable to deal with two far more serious problems: the closely related threats of rapid climate change and the energy demands of a human population that has grown spectacularly to seven billion since 1800; roughly about the same time the United States became a nation and the Industrial Revolution started in earnest?
October 07, 2012
The Worst National Disgrace since SlaveryThat America's Controlled Substances Act is the perfect trifecta: a national, international and species disgrace, perhaps the worst bit of public policy since American chattel slavery led the nation into a near-fatal Civil War in 1860. There is simply no excuse in 2012, to take its central prohibition of Marijuana seriously. Yet the federal agency created by Nixon in 1973 as his personal drug police force is such a colossal failure at “controlling” any of the illegal markets it aspires to shut down, the DEA should have zero legitimacy (are they just stealing the money?). Yet the "heroic" agency continues to wreck young lives and spew incoherent propaganda to the diminishing number of people who take it seriously.The DEA's most noticeable failing is that it can't articulate a coherent theory of drug use for any "drug of abuse." They are stuck with Mitchell's mandate, but they have no clinical research of their own, just the usual vague incoherent garbage they've been spouting ad nauseam since 1973. Their ignorance should be embarrassing, but it isn't because they simply don't know how ignorant they are.
Almost as bad, although it has been taking a lower profile since the odious Alan Leshner moved over to the AAAS (!) is NIDA- another agency Nixon created via Executive Order; not to arrest people but to shill for a policy they are literally paid to block all honest research into, misrepresent data from, and never say anything good about. That they can claim to support "evidence based" policy boggles the mind.
The list of drug policy dupes and knaves is as long as it is dishonorable. My particular villains are the wannabe docs who have decided, on the basis of zero medical training or clinical experience that they can recognize "legitimate" pot users from across the street because they aren't wearing a cast, limping, or appear to be dying.
Before closing, I should probably explain why I am so exercised. It's because another general election appears to be slipping by without any discussion of either the drug war or medical cannabis. Given their history and social implications, I don't understand the disinterest. Also,given Obama's paternal history, for him to dodge the issue is as puzzling as his earlier silence on DEA raids and the aggressive new campaign his "Justice" Department dragon lady is waging against dispensary landlords. As a physician who has taken careful histories from thousands of patients, I know there are many who are placed at real financial, time, or personal safety disadvantages by Ms Haag's malicious dispensary closures.
October 04, 2012
An Overview of (Recent) Human HistoryUntil the landmark Seventeenth Century discoveries of Galileo in Astronomy and Newton in Physics, the cognitive tools of modern Science had been generally unknown to other Western thinkers pondering complex natural phenomena; but without the success enjoyed by the two Renaissance giants. In retrospect, the two had also- and almost simultaneously- discovered new investigative principles that would shape future research, and were rooted in the importance of a disciplined and rigorously honest approach to the study of natural phenomena. They are the same principles that dominate what is now referred to as the Scientific Method.
What is also now clear from our modern perspective is that Galileo and Newton, whose lives almost overlapped, were at least as important for the investigative principles they demonstrated as for their monumental findings. That those findings ultimately challenged long accepted religious beliefs would, of necessity, bring the methods that enabled them to the attention of other "naturalists."
Shortly before Galileo and Newton, there had been Columbus, another pioneer, but of a different stripe, whose adventures changed the then-known world in totally unpredictable ways that would soon dovetail with scientific "progress" by adding two new continents and 6000 miles of ocean to the (then) "known world" as areas to be both exploited and understood (in that order).
When we consider how recently the discoveries of Columbus, Galileo, and Newton took place in the context of time as is now understood by the scientifically literate, perhaps we can gain a better understanding of how important human cognition has been to what now- since Darwin- can also be seen as the cultural Evolution our species has been experiencing through use of its cognitive powers, as critically assisted by our unique curiosity.
To return this short essay to this blog's customary focus on cannabis, our contemporary world is now overpopulated, divided by murderous competition, and being uniquely threatened in ways we refuse to address. None of those conditions could possibly exist without our marvelous brains, which are not only uniquely cognitive, but also prey to debilitating anxiety.