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.