From: Counterpunch, Weekend Edition

February 23 / 4, 2008

By FRED GARDNER

One-and-a-half cheers for the American College of Physicians, which has
issued a statement “Supporting Research into the Therapeutic Role of
Marijuana.” The ACP is the nation’s largest medical specialty group

 124,000 internists- and is widely respected. “There are no more
prestigious letters to have after your name,” says Philip A. Denney, MD
(president of the Society of Cannabis Clinicians), “than FACP -standing
for Fellow of the American College of Physicians.”

The statement commits the ACP to five positions:

1. ACP supports programs and funding for rigorous scientific
evaluation of the potential therapeutic benefits of medical marijuana
and the publication of such findings.
1a. ACP supports increased research for conditions where the
efficacy of marijuana has been established to determine optimal dosage
and route of delivery.
1b: Medical marijuana research should not only focus on determining
drug efficacy and safety but also on determining efficacy in comparison
with other available treatments.

2. ACP encourages the use of nonsmoked forms of THC that have proven
therapeutic value.

3. ACP supports the current process for obtaining federal
research-grade cannabis.

4. ACP urges review of marijuana’s status as a schedule 1 controlled
substance and its reclassification into a more appropriate schedule,
given the scientific evidence regarding marijuana’s safety and efficacy
in some clinical conditions.

5. ACP strongly supports exemption from federal criminal
prosecution; civil liability; or professional sanctioning, such as loss
of licensure or credentialing, for physicians who prescribe or dispense
medical marijuana in accordance with state law. Similarly, ACP strongly
urges protection from criminal or civil penalties for patients who use
medical marijuana as permitted under state laws.

From the perspective of pro-cannabis doctors and patients in
California, Position 5 is the best and bravest aspect of the ACP
statement. The support for physicians who “prescribe and dispense
medical marijuana under state law” could have been written with Marian
Fry, MD, in mind. Fry and her husband, attorney Dale Schafer, were
convicted under federal law for cultivation for sale (to her patients)
and are soon to be sentenced.

Position 4 is long overdue. Marijuana was categorized as a Schedule 1
drug -as if it had no medical use and a high potential for abuse- by the
federal Controlled Substance Act of 1970. In 1999 dependence on
marijuana was deemed “relatively rare and… less severe than dependence
on other drugs” by the Institute of Medicine in a report commissioned by
the Drug Czar’s office. The medical utility of marijuana has been
confirmed in numerous ways and settings, including the IOM report and a
recent study published in a prestigious peer-reviewed journal (“Cannabis
in painful HIV-asssociated sensory neuropathy,” by Abrams et al,
Neurology, Feb 13, 2007).

Position 2 singles out the Volcano vaporizer as an efficient delivery
system (right on, right on).

Position 3 seems to undermine the rest of the position paper. Why open
wide the valves on the research pipeline while leaving the main closed
and allowing only the slightest trickle? At present the would-be
researcher must get an Investigational New Drug Application approved by
the FDA and a Schedule I license from the DEA to receive marijuana grown
by a NIDA-funded contractor at the University of Mississippi and
processed into cigarettes at the Research Triangle Institute in North
Carolina. The DEA can choke off research, the FDA can choke off
research, NIDA can choke off research. Over the years they have taken
turns doing so, working a four-cornered stall (the NIH and the Drug
Czar’s office get involved as needed) as if diagrammed by the Tarheels’
legendary basketball coach, Dean Smith himself.

Botanist Lyle Craker of UMass Amherst applied in 2001 for a DEA license
to grow marijuana for privately funded research. There was an extensive
hearing in 2005. In February, 2007, an Administrative Law Judge
recommended that Craker’s application be approved. The DEA Administrator
keeps sitting on it, of course, and is not bloody likely to give Craker
a license. This is the system the ACP endorses sanctimoniously:
“Obtaining research-grade cannabis is critical to conducting
well-designed clinical trials on the safety and efficacy of marijuana
and its cannabinoids. In addition, because of the drug’s widespread
general use and high potential for abuse, it is imperative that the
federal process is followed for obtaining research-grade marijuana and
conducting clinical trials.”

Note that the trials being contemplated in the argument for Position 3

 and Position 1b- involve “safety and efficacy.” Why the former? The
safety of cannabis has been established by countless NIDA studies
seeking to establish its harmfulness (not to mention the data collected
by California doctors as published in O’Shaughnessy’s Winter/Spring 2007).

“More research is needed” is a lie when applied to safety, and spending
money on more safety studies is a way of delaying the much-needed
efficacy studies. It’s almost as if a Prohibitionist within the ACP
committee that drafted the position paper asserted him or herself at key
points. The ACP statement includes the following re adverse effects:
“Chronic use of smoked marijuana is associated with increased risk of
cancer, lung damage, bacterial pneumonia, and poor pregnancy outcomes.”
A footnote cites the IOM Report (no pages specified) to back these
assertions. But chronic use of marijuana does NOT cause cancer of the
lung, upper airways, or esophagus, according to the definitive study
reported to the American Thoracic Society in June 2006 by Donald Tashkin
and colleagues from the UCLA School of Medicine. Although tars in
cannabis damage bronchial tissue, the damaged cells, for some unknown
reason, don’t become malignant. Evidently something in cannabis is
exerting an anti-cancer effect! This is an area that truly warrants more
research.

The ACP’s assertion of “poor pregnancy outcomes” is based on the IOM
Report, which is based on a NIDA-funded project -the Ottawa Prenatal
Prospective Study- led by a man named Peter Fried, who determined that
the children of mothers who had smoked marijuana during pregnancy showed
impaired “executive function.” Fried measured “executive function” by
having the kids press a clicker whenever they heard a musical tone. The
tone consisted of two quick beeps, one emphatic, one a sort of echo. The
kids whose moms had smoked pot tended to make two quick clicks in
response. The other kids tended to make one click, which Fried -well
aware of what his NIDA funders wanted- defined as superior executive
function!! (He might have defined it more logically as a sign of
laziness, bad hearing, or even a form of cheating.) When the kids whose
moms had smoked pot were found to have higher IQs and more friends in
school, Fried attributed it to what he called “the earth-mother effect.”
He claimed that the same women who had harmed their babies in the womb
by smoking pot, gave them ample attention and good nutrition when they
emerged, so they turned out quite well on the whole.

Peter Fried’s far-from-rigorous finding of “impaired executive function”
underlies the ACP’s assertion of “poor pregnancy outcomes” and the
medical establishment’s line that pregnant women should not smoke
marijuana. Once the results of a study get published in “the literature”
they can be cited as if they were proven fact -as if the process of
peer-review guaranteed the publication of Incontrovertible Truth. This
reverent attitude towards “the literature” belongs in the realm of
religion, not science.

Quotable Quotes

Eric Bailey got some quotes worth quoting for a Feb. 14 Los Angeles
Times article about the ACP statement.

“We felt the time had come to speak up about this,” said ACP president
David Dale. The implication being: ‘We’ve known the truth about this for
years, but were afraid to make a peep.” California voters passed Prop
215 in 1996 with the ACP on the sidelines. The Institute of Medicine
Report was published in 1999. What took the ACP so long to say that the
government ought to act on it?

Bailey quotes Bruce Mirken of the Marijuana Policy Project describing
the ACP statement as “an earthquake that’s going to rattle the whole
medical-marijuana debate.” Isn’t it amazing how many tipping-point
victories we’ve won over the years? Reform bureaucrats need “wins” to
impress their backers and keep the money coming in. By unreservedly
praising a flawed document like the ACP statement, Bruce Mirken et al
confer undeserved credibility on it. And these things sometimes come
back to bite the movement in the butt. The DEA could very well cite the
ACP’s Position 3 as grounds for denying Prof. Craker a license in the
period ahead.

Bailey elicited this verbal gem from Bertha Madras, deputy director for
demand reduction at the Drug Czar’s office (the White House Office of
National Drug Control Policy): “‘What this would do is drag us back to
14th-century medicine,’ said Madras. ‘It’s so arcane.'”

Since “arcane” means “hidden,” we infer that the Czarette meant to say,
“it’s so archaic.” People who misuse fancy words are pretentious. Since
pretense is what the Drug Czar’s office is all about, we can also infer
that Ms. Madras is perfectly suited to her job at Demand Reduction HQ.

Fred Gardner edits O’Shaughnessy’s, the journal of Cannabis in Clinical
Practice. Reach him at [fred@plebesite.com->fred@plebesite.com

ACP News

February 2008

Supporting Research into the Therapeutic Role of Marijuana

Marijuana has been smoked for its medicinal properties for centuries.
Preclinical, clinical, and anecdotal reports suggest numerous potential
medical uses for marijuana. Although the indications for some conditions
have been well documented, less information is available about other
potential medical uses.

Additional research is needed to further clarify the therapeutic value
of cannabinoids and determine optimal routes of administration.
Unfortunately, research expansion has been hindered by a complicated
federal approval process, limited availability of research-grade
marijuana, and the debate over legalization. ACP believes the science on
medical marijuana should not be obscured or hindered by the debate
surrounding the legalization of marijuana for general use. In this paper
the College lays out a series of positions on research into, and the use
of, marijuana as medicine.

[Download Full Paper

 >http://www.acponline.org/advocacy/where_we_stand/other_issues/medmarijuana.pdf]

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