CounterPunch
Weekend Edition
February 23, 2008

Pot Shots
American College of Physicians Takes Pro-Cannabis Stand (Mostly)
By FRED GARDNER

One-and-a-half cheers for the American College of Physicians, which
has issued a statement "Supporting Research into the Therapeutic Role
of Marijuana." The ACP is the nation's largest medical specialty group
-124,000 internists- and is widely respected. "There are no more
prestigious letters to have after your name," says Philip A. Denney,
MD (president of the Society of Cannabis Clinicians), "than FACP -
standing for Fellow of the American College of Physicians."

The statement commits the ACP to five positions:

1. ACP supports programs and funding for rigorous scientific
evaluation of the potential therapeutic benefits of medical marijuana
and the publication of such findings.
1a. ACP supports increased research for conditions where the efficacy
of marijuana has been established to determine optimal dosage and
route of delivery.
1b: Medical marijuana research should not only focus on determining
drug efficacy and safety but also on determining efficacy in
comparison with other available treatments.

2. ACP encourages the use of nonsmoked forms of THC that have proven
therapeutic value.

3. ACP supports the current process for obtaining federal research-
grade cannabis.

4. ACP urges review of marijuana's status as a schedule 1 controlled
substance and its reclassification into a more appropriate schedule,
given the scientific evidence regarding marijuana's safety and
efficacy in some clinical conditions.

5. ACP strongly supports exemption from federal criminal prosecution;
civil liability; or professional sanctioning, such as loss of
licensure or credentialing, for physicians who prescribe or dispense
medical marijuana in accordance with state law. Similarly, ACP
strongly urges protection from criminal or civil penalties for
patients who use medical marijuana as permitted under state laws.

From the perspective of pro-cannabis doctors and patients in
California, Position 5 is the best and bravest aspect of the ACP
statement. The support for physicians who "prescribe and dispense
medical marijuana under state law" could have been written with Marian
Fry, MD, in mind. Fry and her husband, attorney Dale Schafer, were
convicted under federal law for cultivation for sale (to her patients)
and are soon to be sentenced.

Position 4 is long overdue. Marijuana was categorized as a Schedule 1
drug -as if it had no medical use and a high potential for abuse- by
the federal Controlled Substance Act of 1970. In 1999 dependence on
marijuana was deemed "relatively rare and... less severe than
dependence on other drugs" by the Institute of Medicine in a report
commissioned by the Drug Czar's office. The medical utility of
marijuana has been confirmed in numerous ways and settings, including
the IOM report and a recent study published in a prestigious peer-
reviewed journal ("Cannabis in painful HIV-asssociated sensory
neuropathy," by Abrams et al, Neurology, Feb 13, 2007).

Position 2 singles out the Volcano vaporizer as an efficient delivery
system (right on, right on).

Position 3 seems to undermine the rest of the position paper. Why open
wide the valves on the research pipeline while leaving the main closed
and allowing only the slightest trickle? At present the would-be
researcher must get an Investigational New Drug Application approved
by the FDA and a Schedule I license from the DEA to receive marijuana
grown by a NIDA-funded contractor at the University of Mississippi and
processed into cigarettes at the Research Triangle Institute in North
Carolina. The DEA can choke off research, the FDA can choke off
research, NIDA can choke off research. Over the years they have taken
turns doing so, working a four-cornered stall (the NIH and the Drug
Czar's office get involved as needed) as if diagrammed by the
Tarheels' legendary basketball coach, Dean Smith himself.

Botanist Lyle Craker of UMass Amherst applied in 2001 for a DEA
license to grow marijuana for privately funded research. There was an
extensive hearing in 2005. In February, 2007, an Administrative Law
Judge recommended that Craker's application be approved. The DEA
Administrator keeps sitting on it, of course, and is not bloody likely
to give Craker a license. This is the system the ACP endorses
sanctimoniously: "Obtaining research-grade cannabis is critical to
conducting well-designed clinical trials on the safety and efficacy of
marijuana and its cannabinoids. In addition, because of the drug's
widespread general use and high potential for abuse, it is imperative
that the federal process is followed for obtaining research-grade
marijuana and conducting clinical trials."

Note that the trials being contemplated in the argument for Position 3
-and Position 1b- involve "safety and efficacy." Why the former? The
safety of cannabis has been established by countless NIDA studies
seeking to establish its harmfulness (not to mention the data
collected by California doctors as published in O'Shaughnessy's Winter/
Spring 2007).

"More research is needed" is a lie when applied to safety, and
spending money on more safety studies is a way of delaying the much-
needed efficacy studies. It's almost as if a Prohibitionist within the
ACP committee that drafted the position paper asserted him or herself
at key points. The ACP statement includes the following re adverse
effects: "Chronic use of smoked marijuana is associated with increased
risk of cancer, lung damage, bacterial pneumonia, and poor pregnancy
outcomes." A footnote cites the IOM Report (no pages specified) to
back these assertions. But chronic use of marijuana does NOT cause
cancer of the lung, upper airways, or esophagus, according to the
definitive study reported to the American Thoracic Society in June
2006 by Donald Tashkin and colleagues from the UCLA School of
Medicine. Although tars in cannabis damage bronchial tissue, the
damaged cells, for some unknown reason, don't become malignant.
Evidently something in cannabis is exerting an anti-cancer effect!
This is an area that truly warrants more research.

The ACP's assertion of "poor pregnancy outcomes" is based on the IOM
Report, which is based on a NIDA-funded project -the Ottawa Prenatal
Prospective Study- led by a man named Peter Fried, who determined that
the children of mothers who had smoked marijuana during pregnancy
showed impaired "executive function." Fried measured "executive
function" by having the kids press a clicker whenever they heard a
musical tone. The tone consisted of two quick beeps, one emphatic, one
a sort of echo. The kids whose moms had smoked pot tended to make two
quick clicks in response. The other kids tended to make one click,
which Fried -well aware of what his NIDA funders wanted- defined as
superior executive function!! (He might have defined it more logically
as a sign of laziness, bad hearing, or even a form of cheating.) When
the kids whose moms had smoked pot were found to have higher IQs and
more friends in school, Fried attributed it to what he called "the
earth-mother effect." He claimed that the same women who had harmed
their babies in the womb by smoking pot, gave them ample attention and
good nutrition when they emerged, so they turned out quite well on the
whole.

Peter Fried's far-from-rigorous finding of "impaired executive
function" underlies the ACP's assertion of "poor pregnancy outcomes"
and the medical establishment's line that pregnant women should not
smoke marijuana. Once the results of a study get published in "the
literature" they can be cited as if they were proven fact -as if the
process of peer-review guaranteed the publication of Incontrovertible
Truth. This reverent attitude towards "the literature" belongs in the
realm of religion, not science.

Quotable Quotes

Eric Bailey got some quotes worth quoting for a Feb. 14 Los Angeles
Times article about the ACP statement.

"We felt the time had come to speak up about this," said ACP president
David Dale. The implication being: 'We've known the truth about this
for years, but were afraid to make a peep." California voters passed
Prop 215 in 1996 with the ACP on the sidelines. The Institute of
Medicine Report was published in 1999. What took the ACP so long to
say that the government ought to act on it?

Bailey quotes Bruce Mirken of the Marijuana Policy Project describing
the ACP statement as "an earthquake that's going to rattle the whole
medical-marijuana debate." Isn't it amazing how many tipping-point
victories we've won over the years? Reform bureaucrats need "wins" to
impress their backers and keep the money coming in. By unreservedly
praising a flawed document like the ACP statement, Bruce Mirken et al
confer undeserved credibility on it. And these things sometimes come
back to bite the movement in the butt. The DEA could very well cite
the ACP's Position 3 as grounds for denying Prof. Craker a license in
the period ahead.

Bailey elicited this verbal gem from Bertha Madras, deputy director
for demand reduction at the Drug Czar's office (the White House Office
of National Drug Control Policy): "'What this would do is drag us back
to 14th-century medicine,' said Madras. 'It's so arcane.'"

Since "arcane" means "hidden," we infer that the Czarette meant to
say, "it's so archaic." People who misuse fancy words are pretentious.
Since pretense is what the Drug Czar's office is all about, we can
also infer that Ms. Madras is perfectly suited to her job at Demand
Reduction HQ.

Fred Gardner edits O'Shaughnessy's, the journal of Cannabis in
Clinical Practice. Reach him at fred@plebesite.com

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