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HorsesAss.Org » Blog Archive » “There is no Medical Marijuana law in Pierce County”
Given the emphasis Lee has made on "medical marijuana" may I suggest for balance that folks read this excellent summary of the literature by the American College of Physicians?
The key points, if I may summarize the already brief report, are these:
are medical uses of THC, the most important of the known ingredients in marijuana.
THC, however, is already legal.
Legal THC can be given in a number of forms, including an aerosol that is leagal in Canada but not yet in the USA.
2. Smoking weed should not be encouraged because of concerns about purity and evidence that inhaling smoke is bad for you.
3. Research in THC and marijuana in general is merited.
4. Even when it becomes legalized, hopefully we will not encourage people to smoke pot without a lot of evidence that we are not repeating the epidemic of the last three centuries caused by the "filthy habit."
Brownies are probably fine!
******************************************
As for Lee,
He is making a tempest out of a few snow flakes. THC is available as a legal drug.
Unless a patient can not take the legal, oral drug, they have no problem. Of course one reason for taking THC is nausea and that can make an oral drug difficult to take. I supect anybody who needs it can can get the Canadian drug pretty easily and hopefully will soon be able to do buy the aerosol here too. Certaionly I would urge his friend to do that rather than getting herself fucked over by the pot police.
Gieb the profit motic=ve in this society, I would also expect to see injectable and supository forms if the data continue to look good.
Finally, Lee's misrepresenting science is not a good way to convince people that marijuana should be legal. As far as I can find out:
a. ther eis not evidence that reefers have any benefit that is not attributeable to THC asnd THC IS legal now.
b. The report in my link offers ane xcellent summary any lay person can read, inlcuding recommendations that will allow physicians and patients to get the hep they desire wothout braking the law.
c. Lee's reference to an expert who supports his opinion at the UW turns out to be to a medical student who is doing a PhD in the geography of marijuans usuage. Sumil Aggarwal is better read than Lee, but his degree is not in toxicology, psychopharmacology, or biochemistry. While Sunil has read the literature, based on our conversation .. he is not terribly expert in the relevnat biochemistry or pharmacology. Sunil, also seem to beleive in herbal medicine and a number of other ideas that are, to say the least, not in good favor among most scientists. There are, by the way, a number of folks at UW who do have expertise in these areas and I have suggested to lee that he talk with them.
Sunday, July 13, 2008
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11 comments:
Hi, Seattle Jew. The synthetic version of THC, Marinol, doesn't treat conditions as effectively as whole marijuana for many patients. The synthetic version is only one chemical, but the effects of marijuana, especially many of the adjunct benefits, are found in the dozens of other cannabinoids and CBDs that occur in the plant but not present in the pharmaceutical. Many patients also complain that the synthetic version, in pill form, is difficult to regulate dosage. For instance, one pill can make a person very, very stoned, when they only need a bit, or need to maintain a low level effect to stave off nausea. Dried marijuana allows the patient to take incremental quantities, and because it is inhaled rather than ingested, the benefits are felt more quickly. Last, and most significantly, medical marijuana's primary effect is stimulating the appetite and curbing nausea. For reasons that are obvious, ingesting and digesting something to curb nausea is ineffective--they throw it up.
While I understand your concerns about the health impact of smoking anything, keep in mind the amount of smoke inhaled to get an effect of marijuana is about 0.2 grams of pot, less than a quarter of a cigarette, and less than the exhaust of carbon emissions we inhale each day. For the sickest in our society, that's a small trade-off for relief from suffering and managing a serious disease. Really, if it works for people with HIV and cancer, who are we to tell them to suffer without it?
Well, I say, SeattleJew, I do have a BS degree in Chemistry (High Honors, UC Berkeley), and I was a member of the 1997 United States Chemistry Olympiad Team (top score in organic chemistry on the team).
My PhD work was in medical geography, it's true, but that does not mean I don't have knowledge of pharmacology and biochemistry. Check out my dissertation here:
http://sunilaggarwal.net
We just talked about angiogenesis and you claimed to have invented the assays to test for anti-angiogenesis.
Sunil
Sunil ...Posted at SJ
1.I have no idea where you would have gotten the idea that >I< claimed to have invented an antiangiognesisi assay? FWIW, historically, I was one of a small group of folks who did "create" the field of vascular cell and molecular biology. Others who certainly can take equal or gr4ater credit would include Eric Jaffe, Mike Gimbrone, Ted Spaet, Gordon and Julie Campbell, Russel Ross, all of whom were making key contributions in the very ealry 70s.
What you may misremember is a discussion about the role of Judah Folkman. Judah desrves great credit as a driving force, but he really played little role in a actual discoveries in angiogensisi. Key Figures there included Tom Maciag, Denis Gopodarowicz, Ken Thomas, Mike Klagsbrun, and Napoleon Ferraro.
Judah made numerous claims to have discovered anti angiorgenic factors but most of these have remained less than fully convincing. There are some bonafide natural antiangiogens discovered by others, esp thrombospondin, but so far none of these has proven useful clinically.
2, Happy to see your credentiaIs but IU am not sure why? Is this more of Lee's stuff?
AFIK, you and I are in agreement on facts, if we disagree it may be on whether the risk from carcinogens in smoked cannabis is enough to suggest people take caution in getting their THC through smoke.
Actually Lee's hype and tendency to spew vitriol obscures much in the way of a sane discussion and I would NOT want to put in your mouth around his words.
If this impresion is wrong, let me know.
FWIW .
My opinion is that a rational drug policy would rank mj someplace in a part of the spectrum with coffee, tea, chocolate, St; John's wart, tobacco and really not in the class of most other banned substances. I know less about mj's clinical value, but from my reading I do not think there is convincing evidence for an effect that can not be accounted for by THC or similar agonists. While it is possible such effects exist, I think the likelihood that MK smoke is harmful ... as smoke .. is high enough that patients should be encouraged to use THC or to ingest their mj rather than smoking it. The real reason for a MM law, AFIK, is to counterbalance the lack of a real reason for the ban in the first place. One but of illogic making another bit if illogic more illogical!
As to whether there is enough evidence for unproven benefits of mj other than THC, what is enough? I would not invest my dollars in a company going that rout ebut I see no reason that others hould not make such investments if ihey want.
As for the policies I would like to see?
1. I would like to see smoked mj marketed with controls similar to on tobacco. I am not sure controls are needed on toher forms, but if so they should be around the level of alcohal.
2. I think the MM laws are a mistake that can undermine scientific integrity and undermine the move to legalize mj based on all the data that its is a safe and minor drug, Hyping the idea that mj is a miracle drug serves no purpose since most of the claims that mj .. as opposed to THC... is a critical medicine are, to the best of my knowledge, unsubstantiated.
In cases where THC works of course it should be available. If smoked mj works better, someone should find out why.
Smoking mj should only be condoned by medicine IF there is evidence of a benefit that can not be achieved with RHC in some form and that benefit should be sufficient to overcome concerns about respiratory damage due to any smoke,
Dom
Just to be clear, I actually think this is a very small issue. I folks want to smoke marijuana that is fine by me, but I do not make the laws.
I suspect the MM marijuana has a lot more to do with the evangelism of the Pot fokls than it does any great need as seen by medicine. No one I have discussed this with, including folks who do use it, and nothing I have read says that MJ is a terribly important drug. However, the same can be said of a lot of other stuff docs use. The first concern here may be primum non nocere and that applies to prescribing powdered milk if THAT will put a patient at risk of the law.
So, you can see my thoughts on what shold be done above.
Could it be that there are other good things in MJ besides THC. Sure. The same can be said of honey, willow bark, bread mold etc. Generally, we deal with such data by isolating the active ingredients.
If the route of admin is not good, someone should find out why. I gather this may have been done with the formulation now in test in CA.
Until then, if smoked MJ is more effective than marinol, then I see nothing wrong with giving it to folks as a smoke as long as they are already smokers or are told that there is reason to believe that even small amounts of smoke may be harmful. Hpever, given the rest of the controversy, it seems to me that the best way to do all this is to legalize and regulate the sale much as we do tobacco except restrict it (until the law is better written) to patients but restrict growth to registered facilities. This is illogical but it wold address an patient needs.
Sunnil .. I just figured out what you responed to:
c. Lee's reference to an expert who supports his opinion at the UW turns out to be to a medical student who is doing a PhD in the geography of marijuans usuage. Sumil Aggarwal is better read than Lee, but his degree is not in toxicology, psychopharmacology, or biochemistry. While Sunil has read the literature, based on our conversation .. he is not terribly expert in the relevant biochemistry or pharmacology. Sunil, also seems to believe in herbal medicine and a number of other ideas that are, to say the least, not in good favor among most scientists. There are, by the way, a number of folks at UW who do have expertise in these areas and I have suggested to lee that he talk with them..
Sunil this certainly was not meant in any way to dismiss your qualifications but to put them into a sensible context. FWIW,when Lee refers to you as an expert at the UW, he gives an impression that you are a credentialed faculty member in some critical area of MJ research.
Of course, credentials do not mean you are nto absolutely wonderful! I suspect, as I said above, that the only gaps between you and I are those lit by Lee's evangelism for mj as a miracle drug, mj preventing cancer, inhaled mj NOT being carcinogenic, mj havng other ingredients needed b y the patients, etc. If you have references or work of your own that differs from what I have said then teach me .. show me the data you have or refer me to literature that meets the normal standards of any scientific review.
As for your thesis, I am not on your thesis commitee but assume it went well? Congrats! I think I still owe you a dinner!
Yes that what I was responding to. I do have credentials in basic science areas, and have a solid understanding of cannabinoid science. Note the figure on page 25 here:
http://sunilaggarwal.net
and you'll see the size of the literature that you'd have to come up to speed on. Suffice it to say, that there are over 420 compounds in cannabis flowers (aka 'marijuana'), and whether you believe it or not, THC is not the only therapeutically important one. You might be interested in the latest demonstration of this, vis-a-vis methicillin-resistant staph aureus:
http://pubs.acs.org/cgi-bin/abstract.cgi/jnprdf/2008/71/i08/abs/np8002673.html
Yes, all did indeed go well, defense wise. I passed! Yes, i hope to meet you at a future DL gathering. I'm back on the wards, on the OB/GYN service (went to their path conference on Friday).
Thank you for filling me on the vascular biology story. I guess I misunderstood about what you said your contributions were.
By the way, the King County Medical Society has now adopted the ACP position, and is taking it to the WSMA now. Medicine is a logical place to start with rational treatment of cannabis, not matter how botanical-phobic a place it is.
Sunil
With all due respect I have no investment one way or another in whether this particular plant has wonder drugs in it. Other than a pissing match with Lee, why would I care?
I do care that the public not be misinformed. That is why I corrected Lee in re your credentials.
For the same reason that I diss anyone who claims there is evidence of a serious tox issue with marijuana, I also object to anyone who preaches that marijuana is a wonder drug.
Let me comment on some of previous discourse.
First, you want to be seen as an expert in mj. Fine but that does not make you an expert in carcinogenesis, neuropharmacology, etc.
Second, you keep claiming that there is wonderful evidence that supports a wonder drug status for mj. But, when challenged you list your own thesis or long lists of papers. The few specific papers you have cited to me are ether not well done or do not make your points.
Third, you also seem to believe there is some mystical benefit in "natural" medicine and seem to think I am opposed to herbal meds. I call bullshit on both of these. I have a former prof. who is very interested in the medicinal properties of honey ... a common medicine of ancient Egypt. Aside from the chance that this is a good lead for some pharma, the historical impact is worth thinking about! Another friend founded a company to explore Chinese medical lore for useful drugs that meet modern needs. Still others "mine" the Talmud for ancient wisdom about medical care and, in your land of descent, I would be very surprised if there are not efforts to look into traditional medicine of India. In fact, I know a prof at UW who strongly advocates efforts to bring Mahayana Buddhist meditation practices into the modern neurological lab .. a "practice" supported by no less a person than the Dalai Lama. Another friend is revisiting the Lysenko era in Russia because of new evidence that the Soviets may have detected important epigenetic mechanisms. All of this is being done by the existing "orthodox" scientific establishment.
BTW, large phara do have screening programs to look for the sort of drugs you want t descrbe in mj. This even includes efforts to ake soild and plant materials form around the world and use high throughput screening to identify active drugs. . All of this is fine by me, as long as any effort to find better drugs conforms to the scientific standards.
Again, what is YOUR point?
If you actually believe that there is some wonderful anticarcinogenic factor(s) in marijuana then go for it! But do not misuse medicine by assuring the pubic that marijuana smoke is benign.
Don't take my word for it, take the founder and director of the Washington Poison Control Center, Dr. William Robertson (Mr. Yuk), who just testified at the Washington Department of Health hearing on medical cannabis last week that cannabis use--even smoking--was not a major toxic threat.
I don't "believe" that there are anticarcinogenic properties in cannabis, I just read the literature, such as:
Caffarel MM, Sarrió D, Palacios J, Guzmán M, and Sánchez C. 2006. “ 9-
Tetrahydrocannabinol Inhibits Cell Cycle Progression in Human Breast Cancer Cells through Cdc2 Regulation.” Cancer Research 66: 6615-6621.
Carracedo A, Gironella M, Lorente M, Garcia S, Guzmán M, Velasco G, and Iovanna JL.
2006. “Cannabinoids Induce Apoptosis of Pancreatic Tumor Cells via Endoplasmic Reticulum Stress-Related Genes.” Cancer Research 66: 6748-6755.
Ligresti A, Moriello AS, Starowicz K, Matias I, Pisanti S, Petrocellis LD, Laezza C,
Portella G, Bifulco M, Di Marzo V. 2006. “Anti-tumor activity of plant
cannabinoids with emphasis on the effect of cannabidiol on human breast carcinoma.” Journal of Pharmacology and Experimental Therapeutics. Fast Forward. First published on May 25, 2006; DOI: 10.1124/jpet.106.105247.
Online at: http://jpet.aspetjournals.org/cgi/reprint/jpet.106.105247v1.
Guzman M. 2003. “Cannabinoids: Potential Anticancer Agents.” Nature Reviews Cancer 3: 745 -755.
Guzmán M, Duarte MJ, Blázquez C, Ravina J, Rosa MC, Galve-Roperh I, Sánchez C, Velasco G, and González-Feria L. 2006. “A pilot clinical study of 9-
tetrahydrocannabinol in patients with recurrent glioblastoma multiforme.” British
Journal of Cancer 95, 197-203.
Kogan NM. 2005. “Cannabinoids and Cancer.” Mini Reviews in Medicinal Chemistry, Volume 5, Number 10, 941-952(12).
Etc. The review articles might be a good place for you to start reviewing this literature. No, I don't think it is a wonder drug (there is no such thing), but it is definitely wonderful that we now have such great scientific and medical data about cannabinoid science. It should be an option, medically speaking.
I don't really pretend to be an expert on anything, aside from the exact topic that I wrote my PhD dissertation on, "The Medical Geography of Cannabinoid Botanicals in Washington State: Access, Delivery, and Distress" Other info I've picked up along the way is icing on the cake.
I don't think medical authorizations for cannabis undermine standards of medical practice. I think we become a more compassionate and health care providing profession when we expand the number of treatment options we give to patients. I'm predicting we'll have the great State of Michigan come on board with this system of medicine when the vote on it in November, and you'll have Michigan physicians adding their signatures and numbers to the 7,000+ physicians in the US who have already incorporated cannabinoid botanical treatments into their medical practices. PHARMA should be allowed proceed with their cannabinoid developments, but should not have exclusive rights over this naturally occurring botanical.
Don't take my word for it, take the founder and director of the Washington Poison Control Center, Dr. William Robertson (Mr. Yuk), who just testified at the Washington Department of Health hearing on medical cannabis last week that cannabis use--even smoking--was not a major toxic threat.
I have not talked with Bill about this but I suspect he would say the same thing about a few cigarettes. I would and have said the same thing. What is your point?
I don't "believe" that there are anticarcinogenic properties in cannabis, I just read the literature, such as:
WADR, we have been here before. You show me a long lisy of papers. Last ime I I did look though them and read one or more of the reviews reviews. Nothing there provides compelling evidence that inhaled marijuana somehow is preventive of cancer. Saying that this literature does support such a claim suggests we did not do a very good job of teaching or you did a poor job of learning how carcinogenicity is assayed.
If you think otherwise, show me a specific paper and I will be happy to discuss it. As for the idea of the legislature overriding the FDA or the medical profession that is truly frightening. By implication, we should just dump the FDA altgether?
You trust Pharma .. small pharma a lot more than I do.
As for your comments about "botanicals" I have no real idea what you mean. If you think less poure agents should be explored, I guess so but have trouble imagining how tyou would ever ascertain safety and efficacy when you have no real idea od composition. Assuming you do wnat to keep the FDA, how would they regulate mj grown this way?
Would you also replace ASA with willow bark or antibiotics with honey?
Stephen, these are a whole other set of papers. You didn't see these, as I did not share them with you before. I have lots of sets of references for different aspects of this topic. You'll see that the bibliography to my dissertation is over 60 pages long.
The FDA has a whole protocol for botanicals: http://www.fda.gov/CDER/guidance/4592fnl.pdf
Sunil
I can set up a script that dls mj papers too. The issues we have discussed are very clear. If there are papers showing inhaling mj suppresses cancer, does not have other harmful effects, etc, then you are the partisan. read them and pass them on!
On the other issue, it seems to me that the FDA is already doing all that you want except for one thing they can not due due to a bad law you and I agree on.
Personally, in the scale of issues relevant to personal freedom and health care, I do not think MJ should be an issue. There is no evidence that mj has any miraculous effects any more than there is any evidence it is a seriously toxic agent.
FWIW, a far better cause ... in my opinion, is the need for our community, the scientists to insist on rationality. Just imagine how much more fun the mj issue would be if it could start from a scientific perspective! Here is something people want to have, it does little or no harm, so why do we waste money preventing its commercialization?
The the entire issue of MM goes away because a doc can advise a patient to use anything that is not on a proscribed list!
The danger I see in MM is that it places science vs. the law in an untenable way. In effect science is being asked "does mj have enough benefits to overcome the risks that lead to its regulation." Since there are no risks, the question is nuts. OTOH, if science does recommend it even though there may be some risk and even though there are legal alternatives, we are in effect making a de jure judgment that ought not to be in our province.
This reminds me of a discussion I once had with an expert driver about why he had to obey laws that did not make sense at his skill level.
Anyhoo ... issue is till the same. It makes no sense for me to read all the mj lit in case I find something bad. You are the proponent of the mj cause and are young enough to decide where to put your carear efforts.
If you think this is a matter of great medical need and want to convince me, then find substantive papers and I would love to discuss these with you.
BTW, I wonder if you are planning to make this a carear? It seems to em that your choice of thesis is not ideal to create a platform for that process. Have you considered directions for residency and post doc?
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