June 11, 2011

On Foxes Guarding Henhouses & Classifications as Guides to the Future

Alan Leshner, who earned a Phd in Physiological Psychology from Rutgers in 1969, has been one of the most visible representatives of American Science since 1994 when he was appointed Director of NIDA. In that capacity, he soon became a well known proponent of the idea that "Addiction" is a "Brain Disease," which just happens to be the mantra of the War on on Drugs; also an essential doctrine of both US and UN policy. In 2001, some five years into California's Proposition 215, Leshner left NIDA to become CEO of the Prestigious AAAS.

Although Leshner may have toned down his strident support for dug prohibition and the idea that cannabis use should be firmly suppressed, there is no reason to believe he's changed his opinion on the basic issue, which he expressed succinctly in a 1997 JAMA interview: " I am ferociously against polarizing the debate. I think that's one of the terrible problems we've made with this issue (addiction). People say that it's either a public health or a public safety issue. The truth is, it's both. And it begins with a voluntary behavior: people choose to use drugs. I don't call it morality, but I call it voluntary. And there's no question it's a medical illness and once you have it, it mandates treatment. It's a myth that millions of people get better by themselves.”

That statement reveals Leshner’s own bias; it's also an unwitting admission of his ignorance of a critical bit of medical history. He is so convinced that “Addiction” must be a “disease,” that he doesn’t bother to question how “diseases” have been defined and classified in the modern era, nor how important accurate systems of classification have become to Science. Until Rudolph Virchow began acting on his brilliant insight that microscopic changes in cellular structure were critical and near-universal reflections of physical disease, the profession lacked a basic vocabulary for rational discussion of its core subject material. In that respect, Virchow’s stroke of intuition did for Medicine what Darwin’s did for Biology as a whole: provided a remarkably useful and accurate skeleton to which could be added as-yet undiscovered "muscles" in the form of new data. To pursue the skeleton/muscle metaphor a bit further: the dynamics of those relationships are also often suggested by new findings.

There are many good examples: Mendel and Darwin never met; its even likely that neither man ever read the others' work; however, the role of Mendelian Genetics in clarifying the mechanism by which Evolution might function was prescient and did nothing to hinder the ultimate discovery of the molecular structure through which genes exert their effects. Even today, as much as we have learned by decoding the human genome; what we have learned about the complexities of genetic expression simply compounds the multiple problems still requiring solutions.

Another example of serendipity: Von Wegener's observation that South America and Africa resemble pieces of a jigsaw puzzle and the subsequent emergence of a coherent Tectonic Plate theory in less than a century is, by now familiar to most. Nevertheless; we are also reminded on a daily basis that plausible explanations of natural phenomena that cast doubt on the existence of an omnipotent deity still face tough sledding in our (not-so) modern world.

Doctor Tom

Posted by tjeffo at 05:27 PM | Comments (0)

March 25, 2011

Annals of Confusion

The war in Libya and the nuclear crisis in Japan remain atop the global news and even further from a satisfactory resolution. On a short trip to the supermarket I heard a snippet on CNN describing how rolling blackouts in the wake of the Japanese nuclear accident are hampering resumption of full production by Japanese industry and could thus have a prolonged ripple effect on the economies of both the United States and Japan. The reason is Japan's incompatible standards for electric power frequency: the Eastern part is on 50 Hz (220-240V) while the West is on the American standard of 60 Hz (110-120V). There are only three facilities for safely transferring power in the whole country; they are complicated and expensive to build, a situation that threatens to greatly increase the economic consequences of the March 11 tsunami at a time when the world can least afford it.

The situation in Libya is also confusing and uncertain, with mixed signals emanating from NATO. Apparently all member nations are on board with a no-fly zone, but some balk at what could be called offensive air operations. However the retired generals working for the various networks as consultants are unanimous that a single unified command will eventually be necessary, however the mission is eventually defined. Further, it will almost certainly become an American operation because we have the largest and most capable military; notwithstanding our continuing involvement in Iraq and Afghanistan.

All of which makes it clear that had President Obama not taken the time and trouble to obtain Arab League and UN support before committing American forces to Libya, the calls for his scalp would now be deafening. Yet, majority opinion also seems to be that Gadaffi's forces were poised to murder thousands, an outcome most would have found intolerable, even though his reign in Libya may still be a long way from over.

Finally; as far as the safety of nuclear energy is concerned, Fred Gardner, in his usual role of informed contrarian, reminds us that the health risks of gamma irradiation were being minimized even before our urgent development of nuclear weapons to hasten the end of World War Two, yet another reminder that humans have typically rushed to exploit the latest technology before its risks were fully understood.

Even though the major reason for our haste since 1946 has been runaway human population growth rather than global war, we remain armed to the teeth, intensely competitive, and just as oblivious to our own cognitive frailty as ever.

Doctor Tom

Posted by tjeffo at 03:39 AM | Comments (0)

January 13, 2011

Questions Answered: #1

The first question listed as needing an answer in yesterday's entry was:

How did such an intrinsically stupid policy ever get started?

The answer begins with the Harrison Act of 1914 and the Supreme Court of that era. By upholding it in a series of narrow decisions rendered between 1917 and 1919, the Court unwittingly opened the door to what it should have seen as an unconstitutional intrusion by government into individual liberty. That error was facilitated by several factors: the then-recent prominence of drug addiction as a new social problem and the (uninformed) beliefs by the Court that addiction is a “disease.” Also that physicians could not be trusted to treat it properly. Essentially, the law they upheld assumed that federal agents with police powers would be more reliable than physicians in the treatment of “addiction.” They thus voted to uphold Harrison in both the Jin Fuey Moy (1917) and Webb (1919) cases.

Ironically, the Court later reversed itself completely in the Linder case (1925) but, unfortunately, no challenge to Harrison ever materialized. Thus for all practical purposes, Harrison remained both law and policy under Harry Anslinger’s reign over the FBN until his Marijuana Tax Act was also declared unconstitutional in 1969.

Thus, in 1970, the sweeping Controlled Substances Act drafted by the Nixon Administration replaced both Harrison and the MTA, perpetuating not one but two, unconstitutional invasions of individual rights under cover of Public Health and the need to regulate interstate commerce. Nevertheless our present Supreme Court chose to rule narrowly on the Raich case on the basis of a (totally unrelated) World War Two case. Thus once again, has an errant policy escaped meaningful judicial review while continuing to inflict great harm on innumerable individuals and the social fabric of both American and global society.

Equally ironically, when unbiased medical scrutiny of that policy was finally enabled by passage of Proposition 215 some 82 years after Harrison, most full-time "reformers" (many of whom had been using cannabis illegally since adolescence) rejected compelling clinical evidence that inhaled cannabis is actually safer and more effective anxiolytic therapy than any of the legal medicines produced for that purpose by Big Pharma.

Doctor Tom

Posted by tjeffo at 06:48 PM | Comments (0)

December 27, 2010

Prohibition and Addiction: 1

In 1918, the United States ratified the 18th Amendment to its Constitution, a step intended to reduce alcohol consumption. Although known ever since then as Prohibition, it did not make consumption of alcohol by an individual citizen illegal; only its commercial production and sale. Even so, the new policy represented a radical social change its supporters justified by claiming it would induce the working-class men then frequenting saloons and spending their wages on alcohol to bring them home for the benefit of their families. Thus the new policy represented a risky experiment in utopianism based on an amalgam of Morality, Public Health, and some novel assumptions about respect for the Law. The tactic of choosing a Constitutional Amendment was equally simplistic: similar laws had been passed at the state level; not once but several times in the mid Nineteenth Century, but had always failed because of a combination of smuggling across state lines and prompt replacement of the legislators who had passed them.

After formation of the Anti-Saloon League in Ohio, the strategy shifted because it was assumed an Amendment would be too difficult to repeal and that smuggling across international borders could be more readily controlled. It was also assumed that having a national law would somehow ensure its observance; thus the cost of arresting and punishing law breakers would shrink after the first few years. When the “bad apples” were weeded out (it was claimed) the cost of enforcement would be drastically reduced. The policy's most enthusiastic advocates really oversold it egregiously as an essential step toward utopia that was guaranteed to succeed.

We know what happened instead; even as Prohibition was going into effect on January 16, 1920, the first illegal stills were running full blast. Alcohol consumption had simply been too important a part of the American experience from the earliest Colonial days to expect it to be “controlled” by voluntary compliance with a simplistic law. That the "Noble Experiment" lasted fourteen years is both amazing and a sad commentary on the intelligence of the American polity; that we have yet to learn- or even admit- that our failing "Drug Control" policy is really one of prohibition that has been failing for the same reasons as the Eighteenth Amendment raises even more serious questions about "human nature;" particularly in terms of intelligence, honesty, and our vaunted cognitive ability.

Finally; that our domestic drug policy failure became global through a UN treaty raises exactly the same doubts about our species, which is the major reason I see global acceptance of marijuana prohibition as both an important litmus test and an urgent problem.

I'm very aware that raising such questions two days after Christmas is unwelcome; however time seems to be running out on us in other cognitive areas as well, so I see no reason to soft pedal the bad news.

We'll either wake up in time to save ourselves or we won't.

Doctor Tom

Posted by tjeffo at 07:57 PM | Comments (0)

August 22, 2010

Delusional Thinking is Alive & Well in California

The magazine section in today's San Francisco Chronicle featured 2 very different op-ed pieces, but each opposed the "legalization" initiative that will be considered by voters in November. That the Chronicle would do so didn't surprise me because its editors have never exhibited clear thinking on pot issues. Even though they are at the epicenter of the "Medical Marijuana" movement, they have yet to cover it intelligently. The following will be sent to them later today, but I'll be surprised if it's published...

For nearly fourteen years after Proposition 215 passed in 1996, we have had a form of marijuana legalization: any resident over 18 able to acquire a signed “recommendation” from a licensed physician could become a “medical” user and receive a (disputed) measure of protection against arrest and prosecution under state law. Although fiercely resisted by all state law enforcement agencies and most politicians after qualifying for the '96 ballot, Proposition 215 passed handily and ultimately thrived despite the best efforts of its opponents and the manifest inability of its supporters to define “medical” use coherently.

“Pot docs” willing to sign recommendations were notably few and far between in early years, but now they compete blatantly on the internet and retail outlets ("dispensaries") selling “medical” marijuana now blanket the state despite the risk of raids by both local and federal police who often confiscate cash, product and equipment. Difficult to measure precisely, the medical gray market created by the proposition continues to grow; indeed, it was that growth, and the prospect of tax revenue replacing enforcement expenses that has helped place a “legalization” initiative (Proposition 19) on the November ballot.

As a physician who has been collecting data from an unselected stream of medical applicants for nearly nine years, I was not surprised by the very different, but equally meretricious arguments advanced by Dr. Cermak and Chief Manheimer in support of the status quo. Indeed, I have been reading similar arguments ever since discovering that both marijuana partisans and opponents share a preference for blind belief over informed skepticism.

My individual patients have not known how other applicants were answering the questions I’ve been asking as part of the standardized intake interview all undergo. Those “renewing” with me (some as often as five times) tend to understand why cannabis has been so helpful and are particularly good sources of information for that reason. I know its reliable because I’m the only one able to compare all answers. Although I have published my data statistically (to protect confidentiality) any other pot doc would be free to ask similar questions and publish their results; that’s how Science is supposed to work.

The never-verified assumptions of Doctor Cermak and Chef Manheimer are those of the drug war as adjusted to the preferences of their professional organizations.

The brand-new specialty of "Addiction Medicine" is entirely dependent on the drug war for its existence and for a definition of the entity it treats; there's no objective standard for “addiction.” It may exist, but cannot be identified precisely enough to justify the coercive abstinence-only methods insisted upon. Also, the historical record of every criminal prohibition policy is one of abysmal failure. The most useful approach would be to look at all drug use as a characteristic human behavior that should first be understood before being subjected to one-size-fits all "treatment."

Perhaps Dr. Cermak should ask himself just why "marijuana" became so popular with adolescents in the Sixties and why its illegal market continues to grow inexorably despite the best efforts of Chief Manheimer and others.

Doctor Tom

Posted by tjeffo at 05:45 PM | Comments (0)

April 20, 2005

About Dr. Tom's Web Log

Dr. Tom O'Connell, Cannabis Researcher.
Medical School: NEW YORK MED COLL, NYC 1957

Certification: General Surgery 1964
Thoracic Surgery 1969

Training: Internship San Francisco General Hospital 1957-'58
General Surgery: William Beaumont General Hospital,
El Paso Texas 1959-1963
Thoracic & Cardiovascular Surgery: Letterman General
Hospital, San Francisco CA 1967-69

Tom O'Connell tjeffo@comcast.net

I hope to provide this space as both a a blog and a forum
for discussion. please e-mail your comments
to the address above.

This BLOG is arranged with the most current entry at the top of the
page so for a history of discussions scroll to the end
of this page, start there and work your way back up.

Thanks to Michael Krawitz, Matt Elrod and DrugSense for their help in
producing this Web Log.

Posted by tjeffo at 04:20 AM | Comments (0)