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April 30, 2010

Parsing Mexico; initial thoughts

Within the past several days, Arizona’s passage of a state immigration law that merely reinforces several provisions of existing federal law has captured center stage at a time when two other contentious issues: an oil rig disaster just off New Orleans and a political shift that will affect coming Florida elections aren’t fading. The two elements that all three controversies have in common are Mexico, our immediate southern neighbor, and the illegal cross border drug trade that’s been growing since Nixon’s election over forty years ago but has never been honestly addressed and is now being avoided more carefully than ever.

Another key element left out of all discussions is that the four biggest sources of revenue for Mexico’s struggling economy have become illegal drugs, illegal immigration, petroleum, and tourism. That the first two are being increasingly curtailed by the US and the last two are declining is both a major conundrum and a reason that the two nations struggle to find common ground.

As must be clear to all thoughtful parties by now, the current situation is threatening political stability in Mexico and anarchy there must surely affect political stability here.

More later, as time permits.

Doctor Tom

Posted by tjeffo at 04:21 PM | Comments (0)

April 25, 2010

Annals of Duplicity

The first item in the current Issue of the New England Journal of Medicine is a completely one-sided Perspective on 'Medical Marijuana” written by two legal scholars with unspecified connections to the University of Maryland Law School.

At first glance such prominent consideration of a controversial topic in what many consider the nation's premier medical journal might seem to auger well for "reform;" especially in light of the opportunity Californians will have a little over six months from now to vote for full “legalization.”

Sadly, my now-extensive clinical experience with admitted users of the forbidden herb leads to a very different conclusion: the piece is subtle confirmation of two related facts: first, those with a vested interest in protecting the drug war from honest scrutiny are finally beginning to realize that the steadily expanding illegal “marijuana” market they have been so blind to for forty years is finally big enough to threaten their policy. Nevertheless, because they still have the law on their side and enough support from the usual sycophants to believe their “war” is still salvageable, many supporters are not ready to quit. In fact, total collapse of the world's drug policy may have become so unthinkable as to render its failure literally “too big to admit.”

The NEJM Perspective does represent some good news, but only by implication, and it's accompanied by a daunting implied challenge. Although the authors (and publishers) have unwittingly facilitated exposure of several intrinsic drug war errors and various ways its supporters have been distorting evidence in its defense, the ultimate political challenge is to force Congress to admit defeat by repealing the CSA. Thus the major value of poorly coordinated state laws is that they permit the illegal market that has developed under the auspices of federal policy to be studied.

However well intended they may have been, recent recommendations by both the American College of Physicians and the AMA are of little value because they embrace the same restrictions on "research" as those insisted upon by the (medically ignorant) authors of federal drug policy.

Future entires will deal with the many inconsistencies brought to light by the NEJM; whether the various parties "get it" or not remains an open question, but the overwhelming evidence is that someone is lying.

Doctor Tom

Posted by tjeffo at 09:22 PM | Comments (0)

April 20, 2010

Blindsided by a Volcano

As this is written, it's still too early to tell whether the eruption of an Icelandic volcano with an unpronounceable name is merely a warning of our extreme vulnerability to forces beyond human control or if it actually marks the beginning of the end of the world as we know it. It's still early in my day on the West coast, but none of the “mainstream” news sources on the internet are considering the worst-case scenario that's been implicit in the eruption of Eyjafjallajokull since it began a few days ago: we may all soon be trapped on a contentious, overcrowded planet where the most universal rule of all, the power of wealth, no longer applies and we are the only species critically dependent on an economy for survival.

The supreme irony is that we were recently treated to an imaginative TV series based on the premise that somehow, all humans could disappear at once. I found it mildly interesting, but because it offered no realistic explanation of how that might happen and I've been preoccupied with other matters, I lost interest fairly quickly.

Now we have a chilling example; a phenomenon with the potential to produce, within a fairly short time, a meltdown of the global economy and the greatest challenge to human existence our species has ever faced.

Just think about it; how quickly and smoothly could we adapt to a world without money? We may soon find out.

Doctor Tom

Posted by tjeffo at 03:52 PM | Comments (0)

April 19, 2010

Global Interdependence (and the need to admit error)

The eruption of a volcano in Iceland and its unprecedented impact on both air travel and the global economy call attention to a point I've recently become aware of and blogged about only yesterday. Science can be a two-edged sword. Not only is it showering us with previously undreamed of wealth, it has allowed our numbers to grow almost exponentially and thus created risks we are often unprepared for. The hazards posed to jet engines by volcanic ash, weren't even discovered until incidents in the Eighties called them to the attention of aviation safety experts. Others involved the near-miraculous survival of commercial aircraft despite ruined engines, which immediately raises questions about how many earlier crashes might have been caused when the similar rare phenomena weren't recognized.

The most famous such event occurred in Southeast Asia where volcanic eruptions are more common and airspace less densely traveled. The present one reverses both characteristics and emphasizes how little is known about key details of the hazard, to say nothing about the ripple effect of mass cancellations; not only on air travel, but on commerce in general. That those effects could suddenly threaten the survival of solvent businesses in a global economy suddenly made fragile by an unexpected increase in debt should also be sobering.

For me, it also emphasizes how vulnerable we have all been made by our species' tendency to exploit new technologies for the wealth they produce without fully considering what additional risks might be involved. Rather than ban all air travel, it clearly makes more sense to examine past mistakes and try to learn from them.

It's especially difficult to correct mistakes we still can't admit: the drug war, for example.

Doctor Tom

Posted by tjeffo at 04:01 PM | Comments (0)

April 18, 2010

A Shift in Emphasis

Yesterday I attended the Hemp Expo at San Francisco's venerable Cow Palace. More properly it was in Daly City, the next town south on the Peninsula separating “The City,” as most Bay Area residents still call it, from San Jose, upstart home of the computer industry and more populous than The City for many years. Change isn't always recognized when it occurs.

That could be a metaphor for things learned at the Expo, some of which confirmed impressions I've been gathering from my interviews of pot users since 2001; others more recent. The most important go a big step beyond my most recent insights, namely the enormous size of the illegal “marijuana” market and its gradual expansion to critical mass under the very noses of the DEA and NIDA, both before and after the creation of both agencies in the mid Seventies. Also why they've been so blind to that market growth and what it signals: their ultimate down-grading and/or absorption by the federal bureaucracy in the relatively near future.

Almost no one believes the drug war has ever worked as originally intended; someone merely suggesting that (John Walters is a good example) risks being considered ridiculously out of touch. Indeed, few of the policy's most ardent defenders make such claims any more. Their arguments in favor of retaining it are increasingly defensive and lean heavily on necessity. For example “we know from the scourge of illegal drugs and the damage caused by alcohol and tobacco what terrible things would happen following legalization.” That such irrational claims still resonate with enough with the voting public to sustain a failing policy is, by itself, an indication of our national problem. It also tends to validate what has become my main thesis: humans weren't an existential threat to their own welfare until the discovery of empirical Science in Europe about five hundred years ago. The rapid success of Science, progressively compounded by the new technologies it produces, has allowed exploitation of “nature” in ways that were unpredictable just a few years before their appearance. A good example is how the Twentieth Century acceleration of both communication and transportation technology has helped reshape the global economy. The century also saw a four-fold increase in the Earth's human population despite two historically lethal “world” wars and the 1918 Influenza Pandemic.
Even more ominously, the same scientific “progress” may have uncovered an evolutionary design flaw lurking within our otherwise marvelous brains. The window on history allowing that startling deduction has been the war on drugs. More specifically, it's been the failure of the federal government's “marijuana” policy as elucidated by a study of the policy's victims made possible after California passed Proposition 215 in 1996, thus marking the nation's first successful voter rebellion against a questionable policy. To a degree I still have difficulty believing, responses to the initiative by both proponents and opponents, have helped reveal the serious brain flaw alluded to above and previously described by neurologist casino truc tuyen w88Paul MacLean. I feel some sense of urgency in describing it as coherently as possible because I've also become aware of how much denial is abroad in the world. Also that our biggest problem is not the war on drugs, which is simply a convenient example of the problem.
There are multiple other more urgent and serious problems facing us. In the short term, the most dangerous may be the planet's dangerously swollen human population, driven by their unruly emotions into making making terrible decisions like 9/11, even as others cling angrily to an unsustainable status quo.

Doctor Tom

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April 14, 2010

Debunking Anslinger

The evidence Harry Anslinger presented on behalf of his Marijuana Tax Act in 1937 was such gross exaggeration of a few sensational cases and he himself so obviously lacking in appropriate training and experience, that current “marijuana” policy can only be seen as a daring fraud sustained well beyond any reasonable belief in its validity or a shocking example of government duplicity. There’s simply no middle ground; the policy’s fraudulent nature can no longer be hidden and “marijuana” possession is still punished by arrest at virtually every US or international port of entry.

On a personal level, I still remember Anslinger as a pompously self-important bureaucrat from a government training film screened as part of Public Health during my third-year in medical school (1956), thus I favor the first explanation. Seated behind a huge desk, unfailingly referred to in the voice-over as “the honorable” Harry Anslinger, he menacingly warned of the dangers to physicians and nurses resulting from their access to "narcotics" and promised swift punishment to any caught abusing those privileges.

Despite that improbable air of omnipotence, Anslinger could not possibly have anticipated the array of arguments and counter augmentations that would be required to support his lie once he left office and "kids" began to discover the appeal of "reefer" in the mid Sixties. Starting with Nixon's "war" on drugs and extending through each subsequent presidency, plus all their drug czars, both the policy's budget and the needless human damage it produces have been forced to keep pace with its hyperbole.

In reality, the policy Anslinger is remembered for is a sad commentary on human nature, a judgment now well supported by history. The drug war should eventually be remembered among the worst repressions of history: the Inquisition, American Chattel Slavery, and the Holocaust, to mention but a few.

When I first appreciated what pot smokers could tell me, I became naively optimistic that simply repeating their histories to the "movement" would begin to turn US drug policy around. Little did I realize how quickly the same sectarian divisions that afflict all human organizations would surface. I now realize that “truth” has as many variants as colors have hues; thus every pot smoker (not to mention those who have never been high) has their own definition of “medical” vs “recreational” use.

What it adds up to is simply another variant of “truth:” In addition to Al Gore’s “inconvenient” variety. I’m thus forced to be patient with the “incremental" variant. The good news is that we can be reasonably sure that the thread-bare nature of federal dogma is now so obvious that pot prohibition shouldn’t be the law of the land for very much longer.

I hope to have more to say about this a few days from now when I'll be discussing how badly the drug war has muddled the complex pharmacology of the marijuana “high,” and what their ignorance reveals about their policy.

Doctor Tom

Posted by tjeffo at 05:25 PM | Comments (0)

April 11, 2010

The Marijuana “High:” therapy or a criminal act?

Our long-term study of Californians hoping to have their use of marijuana recognized as "medical" under the terms of a disputed state initiative may be as significant for what it reveals about bureaucracies as for the light it sheds on pot use. Whatever demand existed in 1937, the actual market for inhaled cannabis (“reefer”) must have been very small, based on the percentage of applicants who were born before the Baby Boom began in 1946 (3.92%). Probably of equal significance, their average age at initiation was significantly higher: over 30 for those born before 1935 and over twenty-five for those born between 1936 and 1945. In fact, the two most important bits of information from our study may be demographic evidence suggesting why the drug war has failed to discourage teen aged “marijuana” initiation, as well as troubling evidence of the lengths government bureaucracies will go to avoid owning up to big mistakes.

One example of the latter: the importance of the Baby Boom to current American history is well recognized but that era is clearly being seen very differently by drug policy enforcers and individual boomers who might have sampled “drugs of abuse” as adolescents. To enforcers the era was an evil to be denounced, rather than an important historical event to be studied or understood. Also, it doesn’t require extraordinary powers of deduction to realize that the Boomers themselves were not only younger than the “reefer” smokers who preceded them, they were a lot more numerous and could well have shared generational experiences that shaped their drug use and other behaviors very differently (exactly what happened). In the same vein, the study also demonstrates how far government bureaucracies will go to resist suggestions their policy may be failing, let alone that they should search for ways to correct it.

Ironically, a Rand study published in November 2002 had reached conclusions very similar to ours but has never been linked to it by others. Nor did it provoke the discussion it should have when first published. Finally, in a brief reassessment published in 2003, the authors actually strengthened their criticism of the "Gateway" hypothesis but explicitly disavowed any support for marijuana “legalization*”

Later this week, I hope to spell out how a clinical dissection of the marijuana “high” as a poorly understood therapeutic and cultural phenomenon that has been vilified for forty years can begin to resolve current contradictions and hopefully, facilitate a more rational discussion.

Doctor Tom

* "Conclusions Marijuana gateway effects may exist. Our results demonstrate, however, that the phenomena used to motivate belief in such an effect are consistent with an alternative simple, plausible common-factor model. No gateway effect is required to explain them. The common-factor model has implications for evaluating marijuana control policies that differ significantly from those supported by the gateway model...However, the study does not argue that marijuana should be legalized or decriminalized."

Go Figure...

Posted by tjeffo at 08:01 PM | Comments (0)

April 06, 2010

Convincing Evidence of Federal Ignorance

The science of Pharmacology was relatively undeveloped when the Marijuana Tax Act was introduced by Harry Anslinger in 1937, thus the phenomenon of getting “high” on “reefer” was relatively unknown and easily demonized. Not only was repetitive (chronic) use of cannabis by inhalation relatively unknown, the public he was misinforming about its dangers had no basis for disbelief and the federal policy he was enforcing had arrogated its authority on the basis of overblown fears of "addiction."

Not much has changed since 1937. As MTF and SAMSHA’s repetitive studies of adolescent drug initiation have confirmed, about half of of all American teens have been trying to get high by inhaling “marijuana” since 1975, thus also confirming that despite rigorous enforcement and ever-increasing felony arrests, trying marijuana remains an adolescent rite of passage on a par with trying alcohol and cigarettes. My data also confirm that not everyone who tries marijuana is able to get high the first time (some required three or four attempts). Yet everyone seeking a recommendation eventually succeeded and now expects to get high each time because, although never defined in clinical terms before, the "high" is clearly an essential element in the self-medication process.

As is evident from the current drug czar's most recent statements, federal opposition to any use whatsoever may be softening. Moreover, most of the millions of living Americans who have succeeded in getting high on "weed" since 1965 know from their own experience that it's not a phenomenon that could possibly be understood by the (approximately half) of other citizens whose drug initiations had included alcohol intoxication and the "head rush" of a cigarette, but excluded the marijuana high.

That long history of federal opposition to pot use, along with the opportunity provided by Proposition 215 to interview thousands of chronic users has provided me with enough evidence to be confident that dedicated defenders of the drug war are either woefully ignorant of cannabis basics or extremely dishonest.

One of the more convincing demonstrations of that ignorance is the complex history of Marinol, developed at considerable federal expense, only after oncologists began suggesting that severely nauseated chemotherapy patients try marijuana. That revelation is further strengthened by my low-tech clinical research among self-medicating pot users revealing some well-known differences between the effects of edible and inhaled cannabinoids that have never been elucidated or seriously investigated by either the Pharmaceutical Industry or academic pharmacologists.

Given the great potential benefits of legal cannabis, the past forty years of enforced ignorance in support of unscientific nonsense was a high price to pay; one further compounded by millions of destructive felony arrests over the same interval.

Doctor Tom

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

April 03, 2010

Getting it (All) Wrong

The single most important fact revealed by the lonely study of cannabis applicants I’ve been engaged in for over eight years is a no brainer: today’s enormous demand for “marijuana” began rather abruptly when the Baby Boomers who started appearing suddenly after World War Two began coming of age in the Sixties.

The factual basis for that statement is just as obvious: the basic demographics every “pot doc” dealing with California’s slowly emerging applicant population should have been collecting; their dates of birth and the age at which they first tried to get “high” by inhaling cannabis. For two such basic items to have not been gathered (or deliberately ignored) by the hundreds (thousands?) of “pot docs” now writing recommendations for a growing applicant population is painfully apparent to me from their silence. Nor have the self-appointed medically untrained gurus presuming to speak for various reform organizations deigned to comment. Their silence on questions I've raised about marijuana’s sudden popularity in the Sixties has been almost as deafening as that of their arch rivals in the federal government.

In fact,it was that stubborn silence on the part of both parties that led me to understand that denial is one of our species’ most characteristic flaws. Like so many other easily overlooked entities: dishonest advertising, rampant obesity, the increasing incidence of autism and a host of others; once one becomes aware of them, they are nearly impossible to ignore.

To return to the Baby Boom, I just happened to catch Tom Brokaw’s special last evening and was even more disappointed than expected; but hardly surprised. Obviously basking in the success of his praise for the “Greatest Generation” and convinced that he has just become a generational expert, Brokaw comes across as knowingly judgmental while completely missing several important points. Even the Daily News TV critic caught his deficiencies.

Hopefully, I’ll have time to return to the Baby Boom in coming months as California prepares to vote on the most important national issue in the coming November election.

Doctor Tom

Posted by tjeffo at 03:01 PM | Comments (0)

April 01, 2010

California’s Legalization Initiative in Historical Context

As the last quarter of the Eighteenth Century began in 1776, an improbably successful rebellion was launched on a flourish of rhetoric promising government based on equal treatment of all citizens. The ensuing Revolutionary War not only led to a new nation that soon attracted freedom-seeking immigrants from all over the world, it also marked the beginning of the end of absolute political power based on heredity at a time when the flowering of scientific technology was about to produce a cornucopia of agricultural production and consumer goods that eventually became known as the Industrial Revolution.

Unfortunately, the Constitution adopted just eleven years following America’s Declaration of Independence betrayed its lofty ideals by secretly protecting the institution of chattel slavery, a decision that would critically shape the new nation’s early development and eventually lead to a corrosive Civil War. Slavery was ended, but American federal power was enhanced to a degree that soon encouraged imperialist expansion based on military power. In essence, the nation that represented the planet’s first potentially viable attempt at Democracy has instead played a pivotal role in enabling its present volatile state of overpopulation, unsustainable consumption of resources, and violent political instability.

Within that context, America’s war on drugs is also UN policy. Although not a prime cause of our species' current malaise, it can easily be seen as both metaphorical and contributory. In a narrower context, the coming ballot initiative to legalize cannabis in America’s most populous and progressive state can also be seen as an important indicator. Simply stated, a global policy of arresting and incarcerating people for self medicating with “marijuana” betokens a degree of hypocrisy, ignorance, and denial incompatible with long term solution of our species' most pressing problems.

Doctor Tom

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