No scientist
wishes to wake up in the morning to discover he has been had and worse he has
been had by his peers who accepted money to slant the research findings. Yet that is the bottom line for USA based
research on marijuana.
Thus the
inevitable review leads to the inevitable retraction and a direct cost in
wasted effort brought on by the deliberate fraud of others. Yet this is now the daily pattern of our so
called pharmaceutical industry. Our
only defense is the rapid expansion of medical research outside theses
financial cartels that is now taking place.
Do you know that
China has and maintains rigorously the best clinical trial protocols in the
world today? It became profoundly
transparent a few years back when the head decision maker was found guilty of
accepting a bribe and received the tradition Chinese sentence of execution
forthwith with a bullet to the back of the head. Somehow they have less sense of humor than we
do.
Anyway it is
nice to see Dr. Sanjay Gupta on board and that he has actually read some of the
literature. I will admit that I
dismissed him after he came out with that original article regarding weed. It appears that I can now go back to reading
his stuff as a trustworthy informant.
Why I changed my
mind on weed
By Dr. Sanjay Gupta, CNN Chief Medical
Correspondent
updated 8:44 PM EDT, Thu August 8, 2013
Watch Dr. Sanjay Gupta's groundbreaking documentary
"WEED" at 8 p.m. ET August 11 on CNN.
(CNN) -- Over the last year, I have been
working on a new documentary called "Weed." The title
"Weed" may sound cavalier, but the content is not.
I traveled around the world to interview medical
leaders, experts, growers and patients. I spoke candidly to them, asking tough
questions. What I found was stunning.
Long before I began this project, I had steadily
reviewed the scientific literature on medical marijuana from the United States
and thought it was fairly unimpressive. Reading these papers five years ago, it
was hard to make a case for medicinal marijuana. I even wrote about this in a
TIME magazine article, back in 2009, titled "Why I would Vote No on Pot."
Well, I am here to apologize.
I apologize because I didn't look hard enough, until
now. I didn't look far enough. I didn't review papers from smaller labs in
other countries doing some remarkable research, and I was too dismissive of the
loud chorus of legitimate patients whose symptoms improved on cannabis.
Instead, I lumped them with the high-visibility
malingerers, just looking to get high. I mistakenly believed the Drug
Enforcement Agency listed marijuana as a schedule 1 substance because of sound scientific proof. Surely,
they must have quality reasoning as to why marijuana is in the category of the
most dangerous drugs that have "no accepted medicinal use and a high
potential for abuse."
They didn't have the science to support that claim,
and I now know that when it comes to marijuana neither of those things are
true. It doesn't have a high potential for abuse, and there are very legitimate
medical applications. In fact, sometimes marijuana is the only thing that
works. Take the case ofCharlotte Figi,
who I met in Colorado. She started having seizures soon after birth. By age 3,
she was having 300 a week, despite being on seven different medications. Medical
marijuana has calmed her brain, limiting her seizures to 2 or 3 per month.
I have seen more patients like Charlotte first hand,
spent time with them and come to the realization that it is irresponsible not
to provide the best care we can as a medical community, care that could involve
marijuana.
We have been terribly and systematically misled for
nearly 70 years in the United States, and I apologize for my own role in that.
I hope this article and upcoming documentary will
help set the record straight.
On August 14, 1970, the Assistant Secretary of
Health, Dr. Roger O. Egeberg wrote a letter recommending the plant, marijuana,
be classified as a schedule 1 substance, and it has remained that way for
nearly 45 years. My research started with a careful reading of that decades old
letter. What I found was unsettling. Egeberg had carefully chosen his words:
"Since there is still a considerable void in
our knowledge of the plant and effects of the active drug contained in it, our
recommendation is that marijuana be retained within schedule 1 at least until
the completion of certain studies now underway to resolve the issue."
Not because of sound science, but because of its
absence, marijuana was classified as a schedule 1 substance. Again, the year
was 1970. Egeberg mentions studies that are underway, but many were never
completed. As my investigation continued, however, I realized Egeberg did in
fact have important research already available to him, some of it from more
than 25 years earlier.
High risk of abuse
In 1944, New York Mayor Fiorello LaGuardia commissioned research to be performed by the New York Academy of
Science. Among their conclusions: they found marijuana did not lead to
significant addiction in the medical sense of the word. They also did not find
any evidence marijuana led to morphine, heroin or cocaine addiction.
We now know that while estimates vary, marijuana
leads to dependence in around 9 to 10% of its adult users. By comparison,
cocaine, a schedule 2 substance "with less abuse potential than schedule
1 drugs" hooks 20% of those who use it. Around 25% of heroin users become
addicted.
The worst is tobacco, where the number is closer to
30% of smokers, many of whom go on to die because of their addiction.
There is clear evidence that in some people
marijuana use can lead to withdrawal symptoms, including insomnia, anxiety and
nausea. Even considering this, it is hard to make a case that it has a high
potential for abuse. The physical symptoms of marijuana addiction are nothing
like those of the other drugs I've mentioned. I have seen the withdrawal from
alcohol, and it can be life threatening.
I do want to mention a concern that I think about as
a father. Young, developing brains are likely more susceptible to harm from
marijuana than adult brains. Some recent studies suggest that regular use in
teenage years leads to a permanent decrease in IQ. Other research hints at a
possible heightened risk of developing psychosis.
Much in the same way I wouldn't let my own children
drink alcohol, I wouldn't permit marijuana until they are adults. If they are
adamant about trying marijuana, I will urge them to wait until they're in their
mid-20s when their brains are fully developed.
Medical benefit
While investigating, I realized something else quite
important. Medical marijuana is not new, and the medical community has been writing
about it for a long time. There were in fact hundreds of journal articles,
mostly documenting the benefits. Most of those papers, however, were written
between the years 1840 and 1930. The papers described the use of medical
marijuana to treat "neuralgia, convulsive disorders, emaciation,"
among other things.
A search through the U.S. National Library of
Medicine this past year pulled up nearly 20,000 more recent papers. But the majority were research into the harm of
marijuana, such as "Bad trip due to anticholinergic effect of cannabis," or "Cannabis induced pancreatitits" and "Marijuana use and risk of lung cancer."
In my quick running of the numbers, I calculated
about 6% of the current U.S. marijuana studies investigate the benefits of
medical marijuana. The rest are designed to investigate harm. That imbalance
paints a highly distorted picture.
The challenges of marijuana research
To do studies on marijuana in the United States
today, you need two important things.
First of all, you need marijuana. And marijuana is
illegal. You see the problem. Scientists can get research marijuana from a
special farm in Mississippi, which is astonishingly located in the middle of
the Ole Miss campus, but it is challenging. When I visited this year, there was
no marijuana being grown.
The second thing you need is approval, and the
scientists I interviewed kept reminding me how tedious that can be. While a
cancer study may first be evaluated by the National Cancer Institute, or a pain
study may go through the National Institute for Neurological Disorders, there
is one more approval required for marijuana: NIDA, the National Institute on
Drug Abuse. It is an organization that has a core mission of studying drug abuse,
as opposed to benefit.
Stuck in the middle are the legitimate patients who
depend on marijuana as a medicine, oftentimes as their only good option.
Keep in mind that up until 1943, marijuana was part
of the United States drug pharmacopeia. One of the conditions for which it was
prescribed was neuropathic pain. It is a miserable pain that's tough to treat. My
own patients have described it as "lancinating, burning and a barrage of
pins and needles." While marijuana has long been documented to be effective for this awful pain, the most common medications prescribed today come
from the poppy plant, including morphine, oxycodone and dilaudid.
Here is the problem. Most of these medications don't
work very well for this kind of pain, and tolerance is a real problem.
Most frightening to me is that someone dies in the
United Statesevery 19 minutes from a prescription drug overdose, mostly accidental. Every 19 minutes. It is a
horrifying statistic. As much as I searched, I could not find a documented case
of death from marijuana overdose.
It is perhaps no surprise then that 76% of
physicians recentlysurveyed said they would approve the use of marijuana
to help ease a woman's pain from breast cancer.
When marijuana became a schedule 1 substance, there
was a request to fill a "void in our knowledge." In the United
States, that has been challenging because of the infrastructure surrounding the
study of an illegal substance, with a drug abuse organization at the heart of
the approval process. And yet, despite the hurdles, we have made considerable
progress that continues today.
Looking forward, I am especially intrigued by
studies like those in Spain and Israel looking at the anti-cancer effects of marijuana and its components. I'm intrigued by the
neuro-protective study by Lev Meschoulam in Israel, and research in Israel and
the United States on whether the drug might help alleviate symptoms of PTSD. I promise to do my part to help, genuinely and
honestly, fill the remaining void in our knowledge.
Citizens in 20 states and the District of Columbia
have now voted to approve marijuana for medical applications, and more states
will be making that choice soon. As for Dr. Roger Egeberg, who wrote that
letter in 1970, he passed away 16 years ago.
I wonder what he would think if he were alive today.
No comments:
Post a Comment