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There's a perplexing question associated
with the prohibition of cannabis by Congress in 1937. Why would
U.S. doctors and pharmacists -and we, the people- allow a medically
useful herb to be outlawed? Part of the answer, obviously, is
that the American people are not the ultimate decision-makers,
the government enforces the will of the corporations. But why
wasn't there more resistance from doctors and pharmacists?
A succinct, plausible explanation
can be found in the 1926 edition of the Dispensatory of the United
States of America. We scored a copy of this authoritative 1,792
page compendium for $2 at a garage sale last weekend. The authors
of the article on Cannabis didn't question its medical efficacy.
Doctors were loath to prescribe it and druggists loath to dispense
it due to inconsistent potency.
"Cannabis is used in medicine
to relieve pain, to encourage sleep, and to soothe restlessness.
Its action upon the nerve centers resembles opium, although much
less certain, but it does not have the deleterious effect on
the secretions. As a somnifacient it is rarely sufficient by
itself, but may at times aid the hypnotic effect of other drugs.
For its analgesic action it is used especially in pains of neuralgic
origin, such as migraine, but is occasionally of service in other
types. As a general nerve sedative it is useful in hysteria,
mental depression, neurasthenia, and the like. It has also been
used in other conditions such as tetanus and uterine hemorrhage,
but with less evidence of benefit...
"One of the great hindrances to the wider use of this drug
is its extreme variability. We are inclined to the opinion that
one of the important reasons for the lack of confidence in this
drug has been insufficiency in dosage. Because of the great variability
in the potency of different samples of cannabis it is well nigh
impossible to approximate the proper dose of any individual sample
except by clinical trial. Because of occasional unpleasant symptoms
from unusually potent preparations, physicians have generally
been overcautious in the quantities administered.
"While the inclusion of a physiological assay in the Pharmacopoeia
has somewhat improved the quality of drug upon the market, it
must be remembered that the present method of standardization
is not quantitatively accurate; all that can be hoped from this
assay is the exclusion of inert samples. The only way of determining
the dose of an individual preparation is to give it in ascending
quantities until some effect is produced. The fluid extract is
perhaps as useful a preparation as any; one may start with two
or three minims of this three times a day increasing one minim
every dose until some effect is produced.
The key point is repeated:
"No means have been suggested
for determining, with even approximate accuracy, the relative
potency of different samples of Cannabis indica, the physiological
test simply demonstrating that the drug possesses a certain indefinite
amount of physiological action. The official test is based on
the degree of inco-ordination produced in the dog in comparison
with that produced by a standard preparation."
In other words, in the era
before the active ingredient(s) were identified and assays developed
to determine uniform potency, cannabis products were frequently
too weak or too strong. No wonder doctors were reluctant to prescribe
them. Some patients would get inadequate doses, others would
overdose on unexpectedly strong tinctures. As the Rockefeller
Foundation and the academic medical centers promoted "scientific
medicine," the cannabis plant seemed increasingly crude.
Smoking was not recognized as a proper delivery method except
in the treatment of asthma. Not until the early 1990s, when Tod
Mikuriya, MD, started advocating vaporization as the ideal ingestion
technique in treating a wide range of conditions, was delivery
via the respiratory system appreciated from a clinician's perspective.
Implications
of Pill Splitting
"Scientific medicine"
promotes a myth of precise dosage -as if the curative process
is understood in such detail by doctors that they (and only they)
can prescribe proper treatment. The myth of precise dosage is
exposed by the widespread phenomenon of patients cutting their
prescription meds in half. Insurance companies are now encouraging
the practice. UnitedHealth Group's "Half Tablet Plan"
was described in a May 30 S.F.\ Chronicle article by Victoria
Colliver. "UnitedHealth is taking advantage of the fact
that drug manufacturers typically charge the same amount for,
say, 10-milligram and 20-milligram doses of the same medication.
Patients who need a 10-milligram dose can purchase a 30-day supply
of 20-miligram tablets, cut the pills in half and pay just one
co-payment for a two-month supply."
The V.A. system, according to Colliver, "saved $46.5 million
in 2003 by having eligible patients halve a popular cholesterol-lowering
drug sold under the brand name Zocor. Department researchers
found no difference in cholesterol levels or liver functions
between those who split pills and those who took the equivalent
doses in the form of single pills in a 1999 study of 3,787 patients
in Florida, Puerto Rico and Georgia."
The drug companies don't like pill-splitting, of course. "Healthcare
professionals have noted that this practice can be dangerous,
unsafe, and should not be encouraged," says Ken Johnson
of the Pharmaceutical Research and Manufacturers of America (who
could have split "dangerous" and "unsafe"
without loss of efficacy). But studies have never established
that patients who split their pills suffered adverse effects.
Plaintiffs led by a doctor named Philips sued Kaiser Permanente
in 2000, citing a study showing that patients often split pills
imprecisely. But there was no evidence of resultant har, and
Kaiser prevailed.
Expect the drug companies to start charging more for the higher
doses (even though they cost, at most, pennies more to manufacture).
Garage Scale
Scores
Bruce Anderson once observed
that the minute you walk into a used bookstore you can tell if
it's a good one. The same goes for garage and estate sales. The
nature of the inventory is immediately apparent, and the first
item you price reveals whether the sellers' goal is to make money
or to free up space. The estate sale in Alameda at which I scored
the 1926 Dispensatory was a good one. The owner of the house
had played the organ, and there was a stack of sheet music selling
for $1/per, that included "As Time Goes By," with pictures
of Humphrey Bogart, Ingrid Bergman and Paul Heinreid on the cover.
The words and music were written by Herman Hupfeld. I didn't
know that, and I'm not sure I'd ever heard the lead-in to the
familiar refrain, which goes:
This day and age we're living in
Gives cause for apprehension
With speed and new invention
And things like third dimension
Yet we get a trifle weary
With Mr. Einstein's theory
So we must get down to earth at times,
Relax, relieve the tension.
No matter what the progress,
or what may yet be proved
The simple facts of life are such
They cannot be removed.
You must remember this,
a kiss is still a kiss...
My other scores included "La Cucaracha, The Cockroach Song,
with ukelele, guitar, and special Hawaiian Guitar Chords. Introduced
by Don Pedro and His Orchestra." A photo of a handsome bandleader
in a tux adorns the cover. The lyrics are in Spanish and English
-"American lyrics by Carl Field... Copyright in 1935 by
Calumet Music, Chicago." The famous chorus:
La Cucaracha, La Cucaracha,
ya no puede caminar,
Por que no tiene, por que le falta,
Marijuana que fumar
Is translated thus (with Prohibition looming):
La Cucaracha, La Cucaracha,
Your love's sweetest melody,
La Cucaracha, La Cucaracha,
Soon our wedding march you'll be.
Ugh.
Fred Gardner is the editor of O'Shaughnessy's
Journal of the California Cannabis Research Medical Group. He
can be reached at: fred@plebesite.com
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