Tuesday, October 28, 2008

Drug Commercials Scare Me

If you watch any TV at all, you’ve undoubtedly seen one or more commercials for drugs, the medicinal kind that is. If you’re like me, you probably either ignore these commercials or start flipping channels. Well, the other night I actually watched one from beginning to end. And I paid attention. If you’ve done the same yourself, you know that a typical pharmaceutical company’s drug commercial spends about 5-10 percent of its time telling you what the drug is good for and the rest telling you about its contraindications (i.e., when you shouldn’t take it) and/or its side effects.

A great example is a commercial I saw the other night for Humira. It can be used to treat certain types of arthritis, Crohn’s disease, and psoriasis. An interesting combination, and a very short list, of uses. But what about the contraindications? Don’t take Humira if you have any kind of infection, including tuberculosis or hepatitis, or are around anyone with such infections, or even if you tend to get a lot of infections. You should also tell your doctor if you have any numbness or tingling, or have a disease that affects your nervous system such as multiple sclerosis or Guillian-BarrĂ© syndrome, have heart failure or other heart conditions, are scheduled for major surgery, are pregnant, become pregnant, plan to become pregnant or are breastfeeding. You should also be careful if you’ve recently received any vaccines or are planning to get a vaccination.

OK, so let’s say you are infection free, don’t have any of the listed conditions, and are not with child. What can you expect in the way of undesirable side effects? Let’s start with serious infections, including tuberculosis, and infections caused by viruses, fungi, and bacteria. You might also increase your risk for getting certain types of cancer such as lymphoma or skin cancer. (Don’t worry though, the kind of skin cancer caused by Humira is not life threatening if treated, or so they say.) Then there are the possible allergic reactions, which may cause rashes, swelling, and trouble breathing. From there we move on to the nervous system problems that may include numbness or tingling, problems with your vision, weakness in your arms or legs, and dizziness. And the blood problems with symptoms that include a fever that does not go away, bruising or bleeding very easily, or looking very pale. And let’s not forget heart failure and immune reactions, including a lupus-like syndrome. Symptoms you might expect include chest discomfort or pain that does not go away, shortness of breath, joint pain, or a rash on your cheeks or arms that gets worse in the sun.

So I think you can see what I’m talking about regarding the amount of time spent extolling the virtues of a drug versus the grave warnings about its dangers. Makes me wonder why anybody would willingly, or knowingly, take such a drug. As a contrast, I’d like to see a commercial for medicinal marijuana.

First of all, the effects of medical marijuana and the conditions it can be used to treat: the control of appetite and energy metabolism (useful in the treatment of cancer and AIDS patients, as well as anorexia), the relief of pain and inflammation (useful in the treatment of a wide variety of conditions), protection from neurotoxicity and neurotrauma (useful in the treatment of traumatic brain and spinal cord injury, stroke, epilepsy, multiple sclerosis, Parkinson’s disease, Huntington’s disease, and Alzheimer’s disease, to name a few), control of mental disorders (such as schizophrenia, anxiety, and depression), regulation of sleep (useful in the treatment of insomnia), the regulation of addictive disorders (such as the alcohol, cocaine, or opiate addiction), cardiovascular and respiratory effects (useful in the treatment of hypertension, atherosclerosis, and asthma), eye disorders such as glaucoma and retinopathy, and finally as an agent that can directly inhibit cancer growth. And this is only a partial list.

So we’ve already got a pretty long commercial. What about the dangers of cannabis and its side effects? Well, there is one possible side effect (singular): You may experience a sudden increase in appetite or a craving for a particular food (which is only a side effect if it is not being used as an appetite stimulant). If this condition persists for more than 4 minutes, have a snack, relax, maybe listen to some music. I’d suggest some Hendrix, The Doors, or maybe some Bob Marley. But don’t worry, you’re not going to find out 6 months or a year down the line that cannabis was suddenly pulled off the market because of fatalities or serious health problems caused by its use. Rest assured that cannabis has been in use therapeutically since the dawn of time, and in the approximately 20,000 – 30,000 years of its use no one has ever died from a cannabis overdose. How many other “medicines” can make that claim?

Tuesday, October 21, 2008

The Federal Government’s Medical Marijuana Program

According to the U.S. government, marijuana currently has no accepted medical use in the U.S. If you visit the DEA’s web site, you will find numerous references to that effect. And if you read what the DEA tells you (and don’t check out their references too carefully), it would appear to be true. Obviously, they fail to mention the dozen states that currently accept the medical use of marijuana. After all, this is the federal government, and what the states do is not relevant. When they say “no,” as in “no accepted medical use,” they mean it in a federal, legal, legislative sort of way, clearly not in the way that you or I would mean it. But one little fact that never seems to get mentioned with respect to accepted medical use of marijuana is that the U.S. government currently has a medical marijuana program of its very own.

What, you didn’t know that the U.S. government has a medical marijuana program? It’s true. And notice I said “has,” not “had.” The Compassionate Investigational New Drug (IND) Study program began in 1978 in response to a lawsuit brought against the FDA, DEA, and other federal agencies. The case, Randall v. U.S., sought to prevent the government from denying a patient legal medical marijuana that had been found by a federal judge in a previous case (U.S. v. Randall) to be a medical necessity. The program was originally intended to provide patients with legal marijuana and other non-FDA-approved drugs. Eventually AIDS was added to the list of marijuana-responsive ailments, and the program expanded in the 1980s. At that point, the number of patients trying to join the program got a little too large for the government’s comfort, and so the Bush administration closed it down in 1991. There were never more than 30 active patients in the program. When it was shut down, the current, active patients were grandfathered in and continued to receive their medicine legally. Today there are still seven surviving members who receive marijuana from the federal government under the IND program. The other thousands of medical marijuana users in the U.S. are subject to arrest, prosecution, and imprisonment.

So I guess that begs the question, what exactly does the phrase “no currently accepted medical use in treatment in the United States” mean? And it is a very important phrase indeed, since it is one of the three criteria used to classify a drug as a Schedule I substance. To me, being a native English speaker and not a lawyer, “no” means “no.” And I would consider the 12 states that accept marijuana as a medical treatment to be “in the United States.” It therefore is quite obvious, to me anyway, that marijuana does have accepted medical uses, both at the federal and state level. So perhaps someone could explain to me how marijuana continues to be a Schedule I substance. Some might point out that the federal government ended its program 17 years ago because they discovered that marijuana should not be used medicinally after all. OK. But then why let those seven people continue to receive their medicine? If it has no medicinal value and in reality is causing those people grave harm, then why not cut them off when the program ended? After all, isn’t the war on drugs all about protecting people from themselves? You can’t have it both ways (unless of course you are the U.S. government).

But there’s another issue that the federal government’s medical marijuana program raises that may be of even greater importance in the long run. We have a population of federally-sanctioned medical marijuana users that have been taking their medication for 17 years or more. Talk about a great research opportunity. Why aren’t these people being studied? (Although they are willing, none have been involved in any medical marijuana research studies.) Although the sample is small, it is a rare population of patients that could have been participating in a longitudinal study that might have provided valuable information about the true potential for medical marijuana. But I think you know the answer to this question as well as I do. The war on drugs is in no way based on facts. Actual scientific knowledge of the medical value of marijuana would only confuse the issue. And that brings us back to the heart of the matter—what kind of message would legalizing a substance that could potentially help thousands, if not millions, of sick people send to our children?

Tuesday, October 14, 2008

Cruel and Unusual Punishment?

I happened to run across some information that I found quite interesting. And pretty frightening. What I’m referring to is a table of sentences imposed on cases that were decided in U.S. District Courts. By crime, they list the percentage of convictions that were sentenced to incarceration (i.e., jail time) versus probation and/or fines. They also list the average length of the sentences. So I thought it would be interesting to see how drug offenses compare to other crimes with respect to sentencing. I figure that should give us an idea of how serious the criminal justice system thinks drug offenses are, relatively speaking. Because in a fair and just system, the punishment should fit the crime. Shouldn’t it?

First, let’s look at the number of people sentenced to incarceration: They classify drug offenses in two categories, trafficking and possession/other. Unfortunately, they do not separate these offenses by the controlled substance involved. And I can only assume that these are non-violent crimes, since the various violent crimes have their own categories. Of the offenders convicted of trafficking, 92% received jail time, and of the offenders convicted of possession/other, 90% received jail time. This statistic alone surprised me. But in comparison to other crimes, it is downright shocking. The only other crime that even comes close is sexual abuse, for which 90% of convicted offenders went to jail. After that, we have murder—89%, burglary—88%, arson—86%, kidnapping—79%, racketeering and extortion, 78%, assault—76%, perjury—66%, counterfeiting—61%, and tax fraud—56%. At the other extreme, only 17% of those convicted of misdemeanors and petty offenses went to jail.

Based on the proportion of convicted offenders that go to jail, it would appear that drug offenses are right up there with murder and sexual abuse. And of course it is clearly a more serious crime than burglary, arson, kidnapping, and even counterfeiting. I don’t know about you, but this is a bit hard for me to even comprehend. You’re as likely to go to jail for a victimless, non-violent crime as you are for murder! And more likely to go to jail for a drug offense than most other crimes of violence and theft.

Next, let’s look at the length of sentences: Of the offenders convicted of trafficking, the average jail sentence was 74 months, and of the offenders convicted of possession/other, the average sentence was 79 months. Not a big difference, and probably not statistically significant, but even so it would appear that possession is at least as serious as trafficking in the eyes of the criminal justice system. At least with this statistic, there are crimes which receive longer sentences. Those convicted of sexual abuse or kidnapping receive average sentences of 88 months. The average sentence for murder was 85 months, and for racketeering and extortion, 74 months. After that we have the sentences shorter than for drug offenses: assault—38 months, perjury—34 months, tax fraud—22 months, counterfeiting— 21 months, and embezzlement—16 months. Misdemeanors and petty offenses resulted in an average sentence of 10 months.

Based on this statistic, it would also appear that drug offenses are serious indeed. Drug offense sentences are less severe only than those of the most serious violent crimes. Again it must be concluded that you will spend more time in jail for a victimless, non-violent crime than you would for all but the most violent of offenses.

I’d like to believe that the severity of the punishments for drug offenses relative to other offenses that I, and I think most people, would consider much more serious is just a coincidence. I’d like to, but I can’t. These statistics strongly imply that our government views using drugs as the most serious of crimes. Its seriousness is equaled and/or exceeded only by murder, kidnapping, and sexual assault.

And I really hate to ask, but what kind of message is this sending to our children? I have a few ideas. For one, it’s telling them that their government really doesn’t want them to use drugs. And it’s telling them that if they are caught, they are viewed by their government as some of the worst, most violent, sociopathic criminals in our society. It also tells them that if they are going to commit a crime and get caught, they’d be better off if that crime involved cheating, stealing, or beating somebody up. Finally, it’s telling them that to the government, it is more important to protect people from themselves than it is to protect them from others. Don’t you just love our criminal justice system?

Tuesday, October 7, 2008

Applying the Government’s Logic

Our government has its own sort of “logic” that it applies to the war on drugs. I’ve been analyzing it and trying to make sense of it in previous pieces. In case you haven’t read any of my earlier work, I’ll sum up my conclusion simply: It’s twisted.

So I started wondering, what if the government started applying that logic to other aspects of our lives? How insane would that be? OK, probably not as insane as the war on drugs. But still.

The other day I listened to a podcast featuring David Murray, senior policy analyst at the White House Office of National Drug Control Policy. Dr. Murray made what I thought was a good analogy between medical marijuana and aspirin. Aspirin contains a synthesized version of a chemical found in willow bark. Since the stone age, people have been taking willow-bark potions to relieve pain. However we recently discovered the active chemical in willow bark and have been able to synthesize it. It’s a wonder of modern science that allows us to take this age-old remedy in pure form in controlled doses. Dr. Murray indicated that the only way the FDA would approve any cannabis-derived drugs would be if they too were isolated and synthesized like aspirin. (And that sounded like a big “if” to me.) OK, fair enough. If that’s possible, I’m sure patients would be happy to take their medicine in some form other than smoking it.

But it may not be that simple. Unlike willow bark, there are many active substances in cannabis that have a wide variety of beneficial effects. Isolating one or a few of these chemicals might not have the same effect as consuming the natural plant. In fact, this will probably turn out to be true, as some synthetic cannabis derivatives already in use are being shown to be much less effective than the real thing. To me, this is not surprising. Can you get the same benefits by taking your vitamins in pill form that you get by eating fruits and vegetables? Hardly. There are still a few things that mother nature does that humans still can’t really reproduce. (Ever hear of a thing called “artificial intelligence”?) Some may prefer taking pills, but many prefer to eat natural foods. Happily, at this point in time, we have that choice.

But I’m not a physician. And besides, what worries me more are the implications of this kind of logic. That’s right, you’re way ahead of me on this one. I’m anticipating that any day now willow trees will be added to the list of controlled substances. I mean, what if people started making their own willow bark tea whenever they had a headache. Even worse, what if willow bark proved to be more effective, and people stopped buying aspirin? It makes no difference that people have been using this remedy since the beginning of time. Today, in the good ol’ U.S. of A., people can’t be permitted to administer natural, home-made remedies to themselves. It would be chaos. Dogs and cats living together. And what kind of message would it send the kids?

The only reasonable and logical thing to do is to make it illegal to possess any part of a willow tree. If you are found with a willow tree on your property or some willow bark on your person, you need to be sent to jail as soon as possible for as long as it takes to teach you a good lesson. Of course if you’re found with a whole grove of willow trees (or whatever you call a group of them), that would probably take the rest of your life. Just think how much safer John Q. Public will feel knowing that people who think they have the unalienable right to use home remedies and harm no one by doing so are safely behind bars. I know I’ll sleep a lot better. Especially after I finish cutting down all my willow trees. And make myself a nice cup of tea.