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December 25, 2009

The Silent Crescendo of Denial

Two of the more important lessons I’ve learned through taking histories from cannabis applicants have little directly to do with pot pharmacology; rather, they relate to overall human behavior. The first is that fathers are far more important to the self-esteem of their children than is commonly realized; the second is that humans are so averse to admitting mistakes they will carry denial to ridiculous lengths to avoid any admission that they might have been wrong.

To start with what are, for me at least, the most recent and obvious examples of pernicious denial on a global scale: last week, both the US and Mexican governments trumpeted the death of drug lord Arturo Beltran Leyva in a gun battle with the Mexican military as an important "victory” in the drug war. However, I saw it as just the opposite: an indication that America’s drug policy has been an even bigger failure than our disastrous attempt to "prohibit" alcohol between 1920 and 1933; it shouldn't be that difficult to understand that there’s essentially no difference between Leyva’s killing in 2009 and the Saint Valentine’s Day massacre of the Bugs Moran gang in 1929; yet there were no op-eds or editorials making that point immediately after the "victory" was announced.

Even more astonishing, from my point of view: after the family of the Mexican Marine who was both the official "hero" and the only “good guy” killed in the shoot-out was brutally murdered in an obvious act of revenge, I could find no editorial mention of drug war futility. It’s a subject that seems to have become such a global sacred cow that it’s now safely above criticism.

How does one fix a problem one can't acknowledge? Can this species be saved from itself?

Doctor Tom

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December 20, 2009

Message from Copenhagen: Let them eat cake.

The failure of one hundred ninety-odd sovereign nations meeting in Copenhagen to deal effectively with the climate crisis last week should not have been surprising, given the ambient disagreement over whether Planet Earth even has a climate problem. The US, although flat broke at the moment (blame it on Obama!), is still arguably among the more advanced and powerful nations “on the planet,” yet one does not have to look far to find “climate deniers;” they are even more common this year than Holocaust deniers and 9/11 deniers were in the past. In general they tend to be like those other naysayers: conservative religious fundamentalists who view coercion as the preferred solution to human problems. Beyond that, the main reason for the rest of us to worry about our future may be that a majority of scientists are climate change worriers.

Of course, scientists also have problems of their own, one of which is bickering over details; but fundamentalist non-scientists are used to that. Aren’t those pointy-headed scientists also notorious for flip-flopping?

Given the track record of the modern world for aggressive commercial and military exploitation of the latest scientific discoveries while also restricting their benefits on the basis of ability to pay, the prospects of finding a climate solution that won’t also leave a significant fraction of living humans scrambling to survive appear dim. All of which reminds me: denial has become as common as it is because we humans have never liked being bummed out by bad news.

Doctor Tom

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December 19, 2009

The Ubiquity of Denial

My experience with cannabis users convinces me that denial is not only a serious human cognitive flaw, but has become so pervasive and widespread that it can prevent our species from recognizing its serious problems until they are almost beyond solving. Thus we now find ourselves unable to deal effectively with a panoply of unprecedented disasters looming on the global horizon. It's precisely because a large fraction of living humans is either incapable of understanding them or acknowledging their existence. Lest anyone think the frailties of cannabis users are what led me to those conclusions, I hasten to point out that it was the overwhelming dishonesty of both America's drug war bureaucracy and the multiple national and global institutions it has intimidated so successfully. Individual pot smokers are refreshingly honest when treated with respect and the same degree understanding accorded to other patients.

Three current items in the news illustrate our national veracity problems as abetted by the essential contributory role of denial; two relate to medical marijuana, the controversial subject I've become most familiar with; however, there are innumerable others in the news on any given day.

With respect to pot prohibition: although Wisconsin will likely be joining the growing list of states allowing medical use of "marijuana," one looks in vain for any admission from the federal government that its rigidly enforced policy has been a counterproductive failure. Another example in the news is the most recent horror story about Mexican cartels. As for the attendant denial, one is equally hard pressed to find any hint from either the Mexican Government or the UN drug enforcement bureaucracy that their efforts are expensive failures. Ironically, as I was composing this entry last evening, I watched a DEA functionary named Strang try to convince a skeptical Michael Ware on CNN that Leyva's death was a "victory" for both the US and Mexico!

Finally, another report heard on NPR Friday morning while on my way to Oakland predicted the inevitable failure of the Copenhagen climate change summit, while an update on its immediate aftermath that same evening showed improbable video images of an exhausted American President trying to spin it as a partial victory before heading back to a Washington DC being buffeted by a huge snowstorm produced by an unseasonably warm Atlantic Ocean.

Oh, yes, I almost forgot: while driving back from Oakland Friday evening, I spent 5 minutes, or the duration of my tolerance, listening to a Right Wing jackass braying on AM radio (the Bay Area variety is as virulent as any other). He was bemoaning the "fraud" in Copenhagen and implying that it was just a Democratic Party conspiracy to give away American tax dollars.

Doctor Tom

Posted by tjeffo at 03:41 PM | Comments (0)

December 17, 2009

Mexican Standoffs

In a more rational world, California’s hotly disputed Proposition 215 might have been seen as an opportunity to settle what had become a protracted argument between the US federal government and supporters of drug policy reform: does cannabis (“marijuana”) have “legitimate” medical use? That essentially no agreement has been possible in the thirteen years since the initiative’s passage is but one of multiple ironies as we approach the anniversary of some of the initiative's early landmarks.

Another is that the Mexican Border has become the scene of an increasingly bloody turf war between criminal cartels competing to smuggle low grade Mexican marijuana into the United States. In striking parallel, news and opinion articles describing the burgeoning market for “medical” cannabis (“marijuana”) have been keeping pace with lurid descriptions of the increasing violence at the border. As if that weren't irony enough, there is an incongruous reluctance on the part of mainstream media to even notice the obvious connections between those phenomena; it's as if they were occurring in parallel universes rather than neighboring countries with a mutual history as long as the border between them.

In the meantime, delegates to the long awaited Conference on climate change in Copenhagen will undoubtedly agree to meet again, despite the opinion of many that climate change is a chimera and of others that the current effort has already collapsed.

Such widespread cognitive dissonance in a dangerously swollen human population that has already escaped several self-induced disasters and could not have grown to its present size without its recently developed capacity for spectacular scientific achievements should probably give us pause; at least long enough to ask: how much longer will it be possible to engage in fundamentally irrational denial, now that we are so imperiled by our own cleverness?

Doctor Tom

Posted by tjeffo at 05:17 PM | Comments (0)

December 15, 2009

California’s Booming Recommendation Industry

Although it's been more than thirteen years since California passed Proposition 215, there’s still a tendency to call the doctor’s statement patients require to use cannabis legally a “prescription,” rather than a “recommendation.” That the distinction was important is seen by the fate of Arizona’s Proposition 200, which has been in limbo for thirteen years, despite having received an even greater majority than Proposition 215 the same year.

Just as President Nixon’s 1972 rejection of the Shafer Commission's recommendation was the key to enabling today's booming illegal cannabis (“marijuana”) market to go forward, so was Drug Czar McCaffrey’s 1996 threat against physicians who dared to discuss its use with patients (applicants?) the key to creation of a new medical specialty of cannabis consultant, or “pot doc.” I do not claim to have been among the very first of such specialists, but I may have been one of the first to meet applicants at cannabis retail outlets, then known as “pot clubs” but now referred under the more medically respectable rubric of “dispensary.”

To return to the question of how the required physician's statement should be referred to, Arizona's experience suggests that terminology is crucial, a notion clearly anticipated in the pre-election analysis of California's initiative. Be that as it may, one of the consequences of General McCaffrey's 1996 threat was to scare most practicing physicians away from the recommendation process, thus leaving it to a relatively small number of activists, the most prominent of whom was the late Tod Mikuriya, a psychiatrist who had been championing its use since a brief stint at the NIMH in the late Sixties.

Tod was off and running as soon as the Ninth Circuit blocked McCaffrey's threat with an injunction. Therapeutic use of cannabis had been his passion for much of his professional life, thus he was already well prepared intellectually to hold clinics, evaluate applicants, and sign recommendations in multiple locations; thus provoking a blizzard of complaints from law enforcement to the Medical Board. They were accompanied by demands that the MBC conduct an investigation of Mikuriya. Although it was reluctant at first because complaints against physicians traditionally emanate from patients or their families, their delay did not signify approval of Mikuriya's practice; only that entrenched bureaucracies move slowly in dealing with unusual new problems.

Although the MBC's eventual solution was tardy, it was also grossly unfair, and obscenely hypocritical: an "investigation" that blighted what would prove to be the last ball rolling game iphonefew years of Doctor Mikuriya's life. However, it failed completely at its intended effect, which was clearly to frighten the other California physicians licensed by the MBC out of the recommendation business.

Quite the contrary; even as the daily press and TV were becoming glutted with articles and documentaries trumpeting the increased visibility of the medical marijuana industry and bemoaning the ease with which "patients" could obtain the required doctors' "recommendation," they neglected key questions they should have been asking: who are these doctors and what have they been learning from their encounters with people that have been punished with increasing severity by the drug war for the past four decades?

The alarming answers to those questions, if pursued logically, would lead directly to the same conclusions I have been both forced to consider and hinting at with increasing specificity for five years: our species has been pursuing a progressive course of delusional thinking from which there seems very little prospect of escape in time to avoid some catastrophic consequences.

Even as a small minority is now attempting to address the problems we face as a species, the great majority is either denying their existence or proposing partial solutions that would benefit only a limited percentage of the global population, while allowing the rest to survive as best they could.

Our underlying problems, greatly exacerbated by technology since the emergence of Empirical Science, have been overpopulation of the planet and unwise exploitation of its resources; unfortunately, our need to deny them seems to exactly parallel their severity.

Doctor Tom

Posted by tjeffo at 04:03 AM | Comments (0)

December 12, 2009

Annals of Denial

Denial is something we humans have become experts at. One of its most distinctive features is stubborn refusal to acknowledge an error long after it has become obvious to all except those with a vested interest in the status quo. A classic example from History is the Roman Catholic Hierarchy’s treatment of Galileo: after finally subjecting him to house arrest for heresy in the 17th Century, the Catholic Church didn’t get around to acknowledging its error until 1992, long after Science had radically influenced the world in ways the Church still has trouble accepting. One hopes it won’t take the federal government 360 years to take cannabis off Schedule 1, a move that would be unacceptable at any time to a DEA that would face drastic reduction in size and prestige if cannabis were merely legalized, and complete dissolution if all US drug prohibitions were to end for any reason.

Given those considerations, it's likely the drug enforcement bureaucracy created nearly four decades ago following Nixon's unexpected election is being stressed in ways that could not have been anticipated before the unexpected size and vigor of California’s medical gray market were revealed, however erratically, over the last thirteen years that Proposition 215 has been (disputed) state law. Even so, denial is still the order of the day as evidenced by the failure of both my “pot doc” colleagues and mainstream media to ask two obvious questions: how did "weed" become so popular? and why was the steady growth of its illegal market missed completely by those with a vested interest in tracking it?

Instead of dealing with such fundamental issues, dueling opinion pieces still focus on “medical” versus “recreational" arguments, even as news items report the inability of law enforcement to keep track of new retail outlets, let alone shut them down; not to mention the bloody disputes that market is inspiring South of the Border

There have also been significant shifts within the gray market itself that have yet to be seriously discussed. Once its economic potential was demonstrated, primarily in in the Bay Area and Emerald Triangle between 1997 and 2003, it began erratically spreading southward to larger population centers as hundreds of entrepreneurs scrambled to cash in on pot's popularity.

Although my ad-hoc studies of applicants seeking to use pot legally suggested that the distinction between "recreational" and "medical" cannabis is blurred and the modern market didn't begin growing until the first baby boomers started unwittingly medicating various symptoms of adolescent angst with "reefer," the rather profound implications of those observations have been studiously ignored by nearly everyone.

That neither government nor reform sources have opted to address the implications of the data I've been gathering through systematic clinical encounters with a large sample of the huge illegal market created by Nixon only supports my belief that those aggregated histories provide the best evidence yet about how and why today's market has evolved.

That's not to say the story of that evolution is at all complete; my data can't address its inaccessible components: those who still use cannabis without bothering to apply for a recommendation, those who tried it and then gave it up after a variable period of repetitive use, and those who simply tried it a few times and moved on.

On the other hand, just as imitation is the most sincere form of flattery, it may be that inappropriate silence be the most convincing evidence of earlier mistaken beliefs.

Doctor Tom

Posted by tjeffo at 03:34 PM | Comments (0)

December 08, 2009

A Quick Follow-Up & a Sign of Progress

My issue of the need for a lawyer seems to have been resolved; I have decided to take my chances with the judge and simply argue that he is free hear whatever rebuttal witnesses the prosecution wishes to call.

In the course of composing the recent spate of blog entries, I happened to notice an interesting change in the Google Ads with which it’s been festooned: when they first started, most were for drug treatment and rehab facilities, a point that annoyed me no end, because I certainly don’t agree with the basic predicates of what I’ve come to regard as a Treatment Industry.

However, lately (I don't know just when) the selection of ads has changed radically: most are now aimed at the thriving Medical Cannabis Industry, a development that would worry me greatly if I worked for the DEA.

Doctor Tom

Posted by tjeffo at 03:59 PM | Comments (0)

December 07, 2009

Worse Than I Imagined

Over the eight years I've been interviewing cannabis users, I've heard many second and third hand accounts of the unfairness and incompetence of the criminal justice system in its dealings with those suspected or accused of violating California's marijuana laws. My own experience in that area had certainly been frustrating, but also mercifully limited; I'd testified briefly at the disgraceful federal "trial" of Dustin Costa in Fresno three years ago, also at one Superior Court (state) trial in Woodland, near Sacramento.

Last Thursday, my trial experience was expanded in a way I could not have anticipated and am still finding difficult to accept. I traveled to San Jose to testify on behalf of a patient I'd first seen in April, 2002. I remember him particularly well because his history had been one of the first to suggest that cannabis has been used to treat anxiety for years. I'd seen him every year through 2007 for the required "renewals;" during that interval, he'd retired from his city government job in another Bay Area county. I later learned (from his attorney) that he'd been incarcerated for most of 2008 on cultivation charges because bail was originally set at a punitive $100,000. Ironically, he been in Elmwood, same jail where I'd examined another patient.

His attorney had called to ask if I would testify at his trial. I quickly agreed and have since waited out six months of the usual delays for it to actually begin. It's a court (non jury) trial that began with direct testimony intended to establish my eight years of clinical experience with over five thousand individual cannabis applicants. I had also entered a printed copy of the peer reviewed paper published in 2007 into evidence and given one to the prosecutor, who surprised everyone by interrupting my testimony with about five minutes to go with a request that the judge order me to supply all the raw data from that study. I had only about three minutes to point out that because the database is unique, and is in electronic form, his request would involve safeguarding the highly sensitive medical information of thousands of patients. If it were possible at all, it would be time consuming and expensive. It's probably just as well that didn't have time to add that, under the circumstances, his request both absurd and a confession of incredible arrogance.

On Saturday my patient's lawyer called to report that after meeting with both attorneys on Friday, the judge had decided to scale down the prosecution's request to three hundred or so redacted records selected from several different years of the study. I immediately decided that I would resist any such an order and was told I'd have to engage my own lawyer because his representation of my patient creates a conflict of interest

Such is the arcane state of medical marijuana prosecution in the Bay Area, renowned for its "liberal" attitude towards an initiative that's had the force of law for the past thirteen years. I went to court to testify pro bono as a good Samaritan and now must find my own lawyer.

Doctor Tom

Posted by tjeffo at 06:08 AM | Comments (0)

December 05, 2009

Mystery Explained

Although there's considerable discrepancy between the Obama Administration’s widely reported statements that federal raids on pot clubs in states with medical marijuana laws would cease and the occurrence of such raids, there’s been no explanation that I was aware of until interest generated by a somewhat different issue prompted me to Google “prosecutions of medical marijuana violations.” Prominent among the first hits was a recent Justice Department memo from a Deputy Attorney General showing how the federal Bureaucracy hedges its bets; notice the ambiguous escape hatch: "sales to minors," bulleted on the second page.

That's apparently more than enough ambiguity for the DEA to justify any raid it opts to carry out by referring to a federal law that defines 21 as the "legal" age for alcohol for the entire country. Never mind that annual federal statistics confirm that 80-90% of American teens routinely defy that law without being prosecuted as felons; also notice when the states' prerogatives were once again usurped by the feds, It was probably no accident that it was in 1984, on the "Just say no" watch of Nancy Reagan and the Gipper; both of whom expressed inflexible views on a number of social issues.

The final abuse of common sense is that there's abundant evidence that cannabis discourages excessive use of alcohol, particularly by the same youthful demographic that is most at risk from intemperate use of alcohol and operating motor vehicles. Go Figure.

Doctor Tom

Posted by tjeffo at 08:58 PM | Comments (0)

Annals of Coincidence

Although several other mammalian species seem to possess a capacity for cognition similar to ours by entertaining abstract ideas, accumulating knowledge, and thinking ahead, none can compare with how well humans do all those things and much more. Our highly evolved brains are clearly our principal survival organs in the fierce, take-no-prisoners struggle for survival first intuited by the youthful Charles Darwin during a brief stopover in the Galapagos almost two centuries ago and then refined by three decades of obsessive thought before publication. As important as his theory of Evolution has been to our modern understanding of "nature," it is but one of several components of the cultural explosion that began with Gallileo late in the Sixteenth Century and has been accelerating ever since. As it is, billions of the humans who owe their very existence to Science are only vaguely aware of that debt as they struggle for survival in the global economy. Ironically, that same ignorance not only adds to our noxious impact on planetary ecology, it is shared by a substantial fraction of working scientists. Even Albert Einstein seems to have nurtured a belief in "god."

How, one may well ask, does a retired chest surgeon who has spent the last 8 years taking histories from pot smokers dare claim such expertise? The answer, which now makes perfect sense to me, is that the opportunity to take medical histories from people regarded as criminals was a classic "natural experiment" requiring only the willingness to ask pertinent questions of its unwitting subjects. My own willingness to take advantage of that opportunity was more a function of past experience than of intelligence in that my very existence, like that of all others, depended on a long series of events I am unaware of and over which I had no control. Even starting with our birth, our survival of infancy and childhood is by no means guaranteed and the critical choices shaping our lives are far more path dependent than most realize.

To narrow the focus a bit, one of the more logical and erudite practitioners of "neuroscience," (a rubric incautiously applied to some blatantly unscientific nonsense) is William Calvin, an author I discovered in the late Eighties and have since had time to read only sporadically, but always with considerable profit. Little did I realize when I first read Calvin's informed speculations on the seemingly unrelated subjects of language, climate change, and the geology of the Grand Canyon that I would someday develop a heightened interest in the same phenomena, or that the link would be an opportunity to gather information of apparently little interest to few others.

Doctor Tom

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