Pompo

Sanjay Gupta: What the Next Surgeon General Doesn't Know About Pot
The next surgeon general needs to stop putting politics before science. Gupta may not be ready for that.
1/8/09|AlterNet| by Russ Belville, NORML


If Dr. Sanjay Gupta is picked for the post of surgeon general, he would become the nation's leading medical advocate. His experience in the media would be beneficial in bringing the Surgeon General's office back to the prominence it held when C. Everett Koop was successfully battling tobacco smoking.

But is Gupta ready to deliver the Obama administration's promised end to the politicization of science and medicine? More specifically, will Gupta toe the federal line that cannabis is lacking in any medical value, or will he recognize what 13 states and the past 12 years of research prove -- that cannabis is a beneficial medicine for some people and an intoxicant far less harmful than alcohol for others?

In 2002, Gupta was more than willing to echo the outrageous claims that smoking pot would lead to psychosis, depression and schizophrenia:

---But the three studies you are talking about talk specifically about schizophrenia and depression, and the fact that marijuana use earlier in life actually may lead to an increased -- 30 percent increase -- in schizophrenia later in life.---

---Depression, also a very big diagnosis -- roughly 18.8 million in this country have it. Again, they looked this time at 1,600 high school students and followed them over about seven years. This is in Australia, not in the United States. But they actually found that all of these boys and girls, particularly girls, were more vulnerable to the symptoms of depression later on in life, again if they were frequent or even daily marijuana users.---

I hope that the next surgeon general has been following the research on cannabis and mental health since 2002. This year, Dr. Mikkel Arendt of Aarhus University in Risskov, Denmark, said that people treated for a so-called cannabis-induced psychosis "…would have developed schizophrenia whether or not they used cannabis."

I hope that Gupta has kept up with the journal Schizophrenia Research and the research published there last year by the London's Institute of Psychiatry, which found no statistically significant "differences in symptomatology between schizophrenic patients who were or were not cannabis users," found no "evidence that cannabis users with schizophrenia were more likely to have a family member with the disorder" and that these findings "argue against a distinct schizophrenic-like psychosis caused by cannabis," authors concluded.

Regarding depression, in 2006, researchers at Johns Hopkins University's Bloomberg School of Public Health in Baltimore found "that the associations observed between marijuana use and subsequent depression status may be attributable not to continued marijuana use, per se, but to third (common) factors associated with both the decision to use marijuana and to depression." In fact, the year prior, researchers at USC had found among cannabis smokers, "those who used once per week or less had less depressed mood, more positive affect and fewer somatic (physical) complaints than non-users," and that "[d]aily users [also] reported less depressed mood and more positive affect than non-users."

Or we could just ask the incoming surgeon general to apply some common sense. If smoking cannabis is a strong predictor of future depression or schizophrenia, then shouldn't there be a spike in the reporting of those conditions around 1978, when 37 percent of high school seniors reported past-month cannabis use, and a decline in depression and schizophrenia around 1992, when the modern low of 12 percent was reported? Instead, what we find is that about 1 percent of the population develops schizophrenia, and that figure stays relatively steady even as cannabis use rises and falls.

In 2006, Gupta was penning the article "Why I Would Vote No on Pot" for Time magazine as Colorado and Nevada had non-medical-cannabis-regulation ballot measures pending. It doesn't seem like he's been following the past two decades of research:

---I'm constantly amazed that after all these years -- and all the wars on drugs and all the public-service announcements -- nearly 15 million Americans still use marijuana at least once a month.---

---Frequent marijuana use can seriously affect your short-term memory. It can impair your cognitive ability (why do you think people call it dope?) and lead to long-lasting depression or anxiety. While many people smoke marijuana to relax, it can have the opposite effect on frequent users. And smoking anything, whether it's tobacco or marijuana, can seriously damage your lung tissue.---

---But I'm here to tell you, as a doctor, that despite all the talk about the medical benefits of marijuana, smoking the stuff is not going to do your health any good. And if you get high before climbing behind the wheel of a car, you will be putting yourself and those around you in danger.---

First, I'm wondering what Gupta is amazed about -- that 15 million Americans trust their own experiences with cannabis over government anti-drug propaganda and hyperbole? The anti-drug PSAs he mentions have been proven to not reduce teen cannabis use and may actually increase it. The Annenberg Public Policy Center at the University of Pennsylvania was commissioned by the National Institute on Drug Abuse to study the effect of government anti-cannabis ad campaigns over four years and found, "Youth who were more exposed to Campaign messages are no more likely to hold favorable beliefs or intentions about marijuana than are youth less exposed to those messages, both during the Marijuana Initiative period and over the entire course of the Campaign."

Gupta claims that smoking cannabis will impair your cognitive ability, and again, I fear he's parroting politics rather than following the research. Just this November, the journal Neuropsychopharmacology published data from Columbia University that reported "the finding that accuracy [on cognitive testing] was unaffected by smoked marijuana indicates that heavy, daily marijuana smokers will not fulfill the DSM-IV [Diagnostic and Statistical Manual of Mental Disorders, 4th edition] criterion for marijuana intoxication that requires impairment of complex cognitive functioning," This is on the heels of a Harvard study published in the Archives of General Psychiatry that determined that long-term marijuana smokers who abstain from the drug for one week or more perform identically on cognition tests as non-users, and a previous study on marijuana and cognition by researchers at Johns Hopkins that found "no significant differences in cognitive decline between heavy users, light users and non-users of cannabis" over a 15-year period in a cohort of 1,318 subjects.

Gupta also makes the mistake of comparing tobacco smoke to cannabis smoke. While it is true that long-term cannabis smoking can lead to wheezing, cough and bronchitis, investigators writing last year in the journal Thorax did not find a positive association between smoking cannabis and the development of emphysema (overinflation of the air sacs in the lungs). Of course, all the pulmonary harms of smoking cannabis can be alleviated through eating it or through cannabis vaporization. Investigators at San Francisco General Hospital reported last year in the journal Clinical Pharmacology & Therapeutics that the "vaporization of marijuana does not result in exposure to combustion gases." A previous clinical trial, published in 2006 in the Journal of Pharmaceutical Sciences, reported that vaporization is a "safe and effective" cannabinoid delivery system that "avoid[s] the respiratory disadvantages of smoking."

In 1997, Dr. Donald Tashkin's research at the UCLA Medical Center found that, "Neither the continuing nor the intermittent marijuana smokers exhibited any significantly different rates of decline in [lung function]" as compared with those individuals who never smoked marijuana. "No differences were noted between even quite heavy marijuana smoking and nonsmoking of marijuana." These findings starkly contrasted those experienced by tobacco-only smokers who suffered a significant rate of decline in lung function.

By 2006, the Washington Post reported on Tashkin's latest research on cannabis use and cancer. Tashkin said, "We hypothesized that there would be a positive association between marijuana use and lung cancer, and that the association would be more positive with heavier use. What we found instead was no association at all, and even a suggestion of some protective effect."

As for driving, nobody here at NORML suggests that people smoke cannabis and then drive a car. But someone's potential irresponsible use of cannabis is not an argument for the danger of cannabis itself. In fact, researchers at Britain's Transport Research Laboratory found in September that text messaging and alcohol are far more dangerous on the road than cannabis. "The reaction times of people texting as they drove fell by 35 percent, while those who had consumed the legal limit of alcohol, or taken cannabis, fell by 21 percent and 12 percent respectively."

To be fair, in his 2006 Time article, Gupta does seem to begrudgingly admit some of cannabis' vast medicinal uses:

---Several recent studies, including a new one from the Scripps Research Institute, show that THC, the chemical in marijuana responsible for the high, can help slow the progress of Alzheimer's disease. (In fact, it seems to block the formation of disease-causing plaques better than several mainstream drugs.) Other studies have shown THC to be a very effective anti-nausea treatment for people -- cancer patients undergoing chemotherapy, for example -- for whom conventional medications aren't working. And medical cannabis has shown promise relieving pain in patients with multiple sclerosis and reducing intraocular pressure in glaucoma patients.---

But back in 2002, even when he gives in on the most recognized medical uses of cannabis, he still recites the government line that there are other drugs that can be used instead of cannabis:

---There are some benefits to marijuana use. It can make cancer chemotherapy patients hungrier -- also in HIV and AIDS patients. … And marijuana can offer some of those things, especially when it comes to reducing nausea and vomiting, not advocating that necessarily myself. I think there are other ways to do that besides marijuana.---

This is the mind-set I call "marijuana as medicine of last resort." It's the concept that any time a medical benefit to cannabis is absolutely undeniable, then it can be somewhat accepted, but only if no other medicine will suffice. This "medicine of last resort" idea is the notion that if both OxyContin and cannabis will relieve pain, you should take OxyContin because it is legal, despite the fact that OxyContin is addictive and has severe side effects. It's the notion that if you're vomiting from severe nausea, you should first try to swallow a synthetic THC pill called Marinol that won't work for 45 minutes rather than smoking an illegal doobie that works immediately. Even when cannabis is the superior medicine for a symptom or condition, the drug-war mentality that there are "good" drugs and "bad" drugs kicks in, and the doctors will recommend a less-effective "good" drug over the more-effective "bad" one.

In a weekly radio address to the nation, President-elect Barack Obama offered his view of science and public policy:

---Because the truth is that promoting science isn't just about providing resources -- it's about protecting free and open inquiry. It's about ensuring that facts and evidence are never twisted or obscured by politics or ideology. It's about listening to what our scientists have to say, even when it's inconvenient -- especially when it's inconvenient. Because the highest purpose of science is the search for knowledge, truth and a greater understanding of the world around us. That will be my goal as president of the United States [News Admin note : We've waited a long time to hear this from our government, Mr. Obama. Don't let us down!!! ] -- and I could not have a better team to guide me in this work.---[News Admin note : Time will be the judge of that ]

If your team is going to ensure the science behind medical cannabis isn't twisted by ideology, we'd invite you and Gupta to meet with us here at NORML so we can show you all the inconvenient truths about cannabis that have been discovered over the past 12 years. Thirteen states and millions of medical users are depending on you to support the truth, not the politics, Dr. Gupta. Will you have the courage of another surgeon general, Dr. Joycelyn Elders, who testified in support of medical marijuana in Rhode Island, saying:

---The evidence is overwhelming that marijuana can relieve certain types of pain, nausea, vomiting and other symptoms caused by such illnesses as multiple sclerosis, cancer and AIDS -- or by the harsh drugs sometimes used to treat them. And it can do so with remarkable safety. Indeed, marijuana is less toxic than many of the drugs that physicians prescribe every day. It is simply wrong for the sick and suffering to be casualties in the war on drugs. Let's get rid of the myths and institute sound public-health policy.---

Sound public health policy free from drug war mythology? President-elect Obama, Dr. Gupta, that is the kind of change we can believe in.

SpiralArchitect

Yeah, my opinion is this guy looks like a total shmuck.

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marcusJay

Just a TV doctor. Kind of makes you wonder why Obama would pick him.

Buzzby

He's a practicing neurosurgeon and was an advisor to the Clinton White House on medical issues. He's not a actor from ER.

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SpiralArchitect

He may be a neurosurgeon and white house adviser, but he still has his facts about marijuana backwards. That is ignorance, not science.

Vicki

I've been watching him on CNN for a while now. I actually liked him, and I listened to what he had to say.

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marcusJay

I know he's not an actor. Whether or not, he's still operating on people is a different story. Frankly, I wouldn't pick him as my doctor because he is not focused on actually practicing medicine. He's concentrating on "other" things.
And I forgot to cheer for another Clinton person coming into the administration.

benjammin21

man, when i read through this article it just amazes me once again how alcohol is legal. alcohol has so many more short term and long term harmful effects yet its still legal and marijuana isnt decriminalized. i just finished my first semester at college and party atleast 3 nights of the week. already ive seen horrible things that alcohol can do. a member of my fraternity has almost died (hadta take him to hospital for alcohol poisoning), i cant even count the piss drunk girls who ive had to take care of, and ive had my own share...

alcohol has way higher potential for disaster than marijuana.

and hes preaching to us about how it damages our lungs... obviously! eating a cheeseburger doesn't keep you healthy either but you do it because it tastes good. you drink because it makes you feel different, you smoke/chew tobacco because it gives you a buzz, and you smoke marijuana because it gets you high. id really like to see the numbers of people that die to liver cancer/alcohol poisoning in relation to the numbers that die from lung cancer/damage caused by marijuana smoke.

also i think its important to note that most people dont smoke herb for their whole life (unlike the addictive cigarette or alcohol). its also much easier to quit smokin bud cold turkey.

dirtbomb

John Conyers is leading the fight against Gupta's confirmation.
Give 'em hell, Johnny!
Avoiding evidence that's right in front of your face, is the M.O. of Doctors too lazy or arrogant to re-think their position.
I've "fired" a few of these nincompoops and gone off to M.D.s with a mind, not merely a brain.

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Pompo

Here's the original article from Time Magazine that Dr. Sanjay Gupta quotes were taken from and an article that is linked to in his original article. Maybe I should post them seperately, maybe not, but seeing how they are so intertwined I thought I'd just throw them up in here for everyone to read

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Why I Would Vote No On Pot
1/8/09|Time Magazine| by Sanjay Gupta

Maybe it's because I was born a couple of months after Woodstock and wasn't around when marijuana was as common as iPods are today, but I'm constantly amazed that after all these years--and all the wars on drugs and all the public-service announcements--nearly 15 million Americans still use marijuana at least once a month. California and 10 other states have already decriminalized marijuana for medical use. Now two of those states--Colorado and Nevada--are considering ballot initiatives that would legalize up to an ounce of pot for personal use by people 21 and older, whether or not there is a medical need.

What do voters need to know before going to the polls?

The first is that marijuana isn't really very good for you. True, there are health benefits for some patients. Several recent studies, including a new one from the Scripps Research Institute, show that THC, the chemical in marijuana responsible for the high, can help slow the progress of Alzheimer's disease. (In fact, it seems to block the formation of disease-causing plaques better than several mainstream drugs.) Other studies have shown THC to be a very effective antinausea treatment for people--cancer patients undergoing chemotherapy, for example--for whom conventional medications aren't working. And medical cannabis has shown promise relieving pain in patients with multiple sclerosis and reducing intraocular pressure in glaucoma patients. See Sanjay Gupta's column Fit Nation.

But I suspect that most of the people eager to vote yes on the new ballot measures aren't suffering from glaucoma, Alzheimer's or chemo-induced nausea. Many of them just want to get stoned legally. That's why I, like many other doctors, am unimpressed with the proposed legislation, which would legalize marijuana irrespective of any medical condition.

Why do I care? As Dr. Nora Volkow, director of the National Institute on Drug Abuse, puts it, "Numerous deleterious health consequences are associated with [marijuana's] short- and long-term use, including the possibility of becoming addicted."

What are other health consequences? Frequent marijuana use can seriously affect your short-term memory. It can impair your cognitive ability (why do you think people call it dope?) and lead to long-lasting depression or anxiety. While many people smoke marijuana to relax, it can have the opposite effect on frequent users. And smoking anything, whether it's tobacco or marijuana, can seriously damage your lung tissue.

The Nevada and Colorado marijuana initiatives have gained support from unlikely places. More than 33 religious leaders in Nevada have endorsed the measure, arguing that permissive legalization, accompanied by stringent regulations and penalties, can cut down on illegal drug trafficking and make communities safer.

Perhaps. But I'm here to tell you, as a doctor, that despite all the talk about the medical benefits of marijuana, smoking the stuff is not going to do your health any good. And if you get high before climbing behind the wheel of a car, you will be putting yourself and those around you in danger.


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Why I'm Not Against, Like, Oh Wow Man, Pot
11/30/06|Time Magazine| by Dr. Scott Hiag

We don't really know how many people smoke it. Some sources say 10 million Americans, others say 35 million. But a lot of people smoke pot and they don't seem very sick. Marijuana just won't go away. Everybody talks about it—many quite fondly. About everyone I know under 55 has smoked it. And they're all right. A few have that pothead "oh wow" personality, but so what? I don't know of one case of serious marijuana-related disease among my friends, family and acquaintances.

At work I have to report the same thing. I've been in hospitals and around sick people for 26 years now. I've admitted plenty of patients who have owned up to using pot. I think I can often tell by how they act. But do the health effects of pot seem very serious? As dangerous as those of alcohol, tobacco, overworking, fashion magazines or overeating? Nope. In fact, the health effects of pot are not nearly as dangerous as the jail they throw you in for possessing it. Not even close. I'm not an oncologist, but I haven't seen a case of lung cancer clearly related to dope smoking. Memory loss, depression, anxiety? Could it be as bad as turning 50? As for it being a gateway drug — how about beer?

There are some reasonable medical uses for cannabis. One patient I knew could get relief from her chemotherapy-induced nausea from nothing other than smoking joints. She was dying in the Massachusetts General Hospital from Ewing's sarcoma at 19, so no one was going to stop her. The word on our oncology floors is that pot's a pretty good appetite stimulant and anti-emetic. A few patients have asked me for it in connection with this. But no, I have never actually written an outpatient prescription for Cannabinol, THC or marijuana leaf (and I have no idea where they could get one filled anyway).

The chief dangers of marijuana, practically, seem to spring from only one of its features: it's illegal. People get beat up, shot up and locked up because of the great amount of money that rides on selling the stuff, stuff that would be about as expensive as lettuce if it weren't against the law. I have treated people seriously hurt by the illegality of pot.

Do I recommend using it? No way. Never used it, even in the bad old days, and I hope that none of my kids ever do. There's something repulsive about the half-closed, red eyes — something that's selfish and irresponsible. The biggest reason I didn't smoke it in the '70s, when everybody I knew was trying "to get me high," was that I wanted to be able to tell my kids that I didn't so that they wouldn't. I feel strongly about it—it's really not my bag. But that's who I am. I also feel pretty strongly that nearly every child should study Latin—really—but I don't think we should lock them up if they don't.

For me, it's similar to the speed-reading phenomenon. In the '70s and '80s there were all sorts of advertisements for this great system that would help you read the whole Sunday Times in 15 minutes "with complete comprehension and recall." I almost sent away for it. I still wonder about it but am now pretty sure it doesn't work. Here's how I know: I have never met a single person who could do it. Hanging around with many big readers for the past 35 years I should have bumped into at least one who took the course and could actually read that fast. I can't help but think it's the same with pot. Hanging around with all sorts of big dope-smokers for the same 35 years I should have bumped into at least one or two with those "serious health effects". The fact is I haven't. But I would listen to any docs out there who have actually seen or treated diseases truly caused by pot.

Another undeniable is that pot has cachet among teens. Some kids between 13 and 19 are clearly willing to risk everything to smoke the stuff — they know how much trouble they can get in. The "smoker" label seems as important a part of their personae as their tastes in music and clothing — maybe more so because it's illegal. It's as defining for them as it was for my pothead friends in the '70s. Maybe they'll become investment bankers too.

An important "art of medicine" issue is sensitivity to the individual's right to self-determination. We work hard to respect patient choice. Lots of explaining, rebutting and cleaning up messes. And as the government should, we draw a line. I won't prescribe cyanide for a patient in pain, even if he asks for it, and the government shouldn't permit home nuclear bomb experiments, even for garage-inventors who promise to be careful.

But some people love cannabis and they're going to get it anyway. Good doctors do learn to persuade and cajole to gently make what we think is the right choice into the patient's choice. ("The girls in therapy really seem to get a kick out of you. Are you sure you don't want to go anymore?") The government equivalent of this is called "drug education" and it's fine. But when you try to change certain things by force, things close to the core about what folks love and hate, about their personalities, you just run into trouble. It doesn't work. You might knock down but you will never build up. This is why the government is better off out of the marijuana business.
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