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.

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 -- and I could
not have a better team to guide me in this work."

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.