• It’s Time for a New Discussion of Marijuana’s Risks

      05/10/2018
      Aaron Carroll

    The following originally appeared on The Upshot (copyright 2018, The New York Times Company). 

    The benefits and harms of medical marijuana can be debated, but more states are legalizing pot, even for recreational use. A new evaluation of marijuana’s risks is overdue.

    Last year, the National Academies of Sciences, Medicine and Engineering released a comprehensive report on cannabis use. At almost 400 pages long, it reviewed both potential benefits and harms. Let’s focus on the harms.

    Cancer

    The greatest concern with tobacco smoking is cancer, so it’s reasonable to start there with pot smoking. A 2005 systematic review in the International Journal of Cancer pooled the results of six case-control studies. No association was found between smoking marijuana and lung cancer. Another 2015 systematic review pooled nine case-control studies and could find no link to head and neck cancers.

    Another meta-analysis of three case-control studies of testicular cancer found a statistically significant link between heavier pot smoking and one type of testicular cancer. But this evidence was judged to be “limited” because of limitations in the research (all of which was from the 1990s).

    There’s no evidence, or not enough to say, of a link between pot use and esophageal cancer, prostate cancer, cervical cancer, non-Hodgkin’s lymphoma, penile cancer or bladder cancer. There’s also no evidence, or not enough to say, that pot has any effect on sperm or eggs that could increase the risk of cancer in any children of pot smokers. (Using marijuana while pregnant does pose other risks, as discussed below.)

    Heart disease

    Another major risk with cigarettes, heart disease, isn’t clearly seen with pot smoking. Only two studies quantified the risk between marijuana use and heart attacks. One found no relationship at all, and the other found that pot smoking may be a trigger for a heart attack in the hour after smoking. But this finding was based on nine patients, and may not be generalizable.

    Lung function

    It also makes sense to think about the risk of respiratory disease. In the short term after smoking pot, a 2007 systematic review found, lung function actually improved. But these benefits were completely overtaken by evidence that lung function may degrade with chronic use. Lung function, however, is a laboratory measure and not necessarily a clinical outcome, and what we really care about is lung disease. Once you control for tobacco use, the links between marijuana and chronic obstructive pulmonary disease appear minimal. Almost no evidence is available to link pot use to asthma.

    Impaired driving

    Driving while impaired is a major cause of injury and death in the United States. Six systematic reviews were considered of fair or good quality by the national academies, and the most recent one pooled three of the others. It contained evidence from 21 studies in 13 countries representing almost 240,000 participants.

    For people who reported marijuana use, or had THC detected through testing, their odds of being involved in a motor vehicle accident increased by 20 to 30 percent, the study found. This is, of course, a relative increase, and shouldn’t be confused with the overall percentage chance of getting in an accident, which is much smaller.

    Regardless, driving while impaired is a terrible idea. Although we have good tests to determine if people are under the influence of alcohol, no such tests are currently available for marijuana, making enforcement more difficult.

    Pregnancy effects

    Babies born to women who smoke pot during pregnancy are more likely to be underweight, delivered premature and admitted to a neonatal intensive care unit, according to a 2016 systematic review. But there were no links seen for changes in birth length, head circumference or congenital malformations. There’s limited evidence for pregnancy complications for mothers, and there’s not enough evidence to comment on much else about babies and their outcomes.

    Memory and concentration

    There’s moderate evidence, from many studies, that learning, memory and attention can be impaired in the 24 hours after marijuana use. There’s limited evidence, however, that this translates into worse outcomes in academic achievement, employment, income or social functioning, or that these effects linger after the pot has “worn off.”

    Mental health

    The possible relationship between marijuana use and mental health is complicated. The most recent meta-analysis found that there’s a significant connection between heavy marijuana use and a diagnosis of psychosis, specifically schizophrenia. This mirrored the findings of previous reviews that sought to cover only high-quality studies. Another systematic review highlighted a potentially small but statistically significant link between marijuana use and the development of bipolar disorder. Heavy users of pot are also more likely to say they have suicidal thoughts.

    What makes this complicated is that it’s hard to establish the arrow of causality. Are people who smoke pot more likely to develop mental health problems? Or are people with mental health problems more likely to smoke pot?

    There’s a similar issue when talking about the relationship between using pot and other substances. Some see marijuana as a “gateway” drug, leading to other substance use or abuse. Others see this as only a correlation in which people who are likely to use or abuse substances are more likely to use pot as well.

    Secondhand smoke

    As states legalize the drug for general use, more cannabis users feel freed from secrecy. They smoke more in public, raising worries about secondhand smoke. A two-year-old study made news recently by arguing that one minute of exposure to pot smoke impaired how vessels responded to blood flow for at least 90 minutes, a greater impairment than from tobacco. This was a study in rats, though, not of humans out in the world. As for risk of a “contact high,” the amount of THC detectable in secondhand smoke is negligible.

    Almost all agree that children should not use pot, but concerns are legitimately raised about whether children might have increased exposure or access after legalization. Although this issue has not been studied widely, it’s possible that pot — the THC and the metabolites from smoke — could have an effect on the developing brains of children. These concerns are more applicable to adolescents who use pot regularly, however, not the accidental ingestion reported in the news once in a while.

    New questions

    Almost all the harms the medical literature focuses on involve smoked cannabis. We know little to nothing about edibles and other means of administration. Nor do we have any consistent manner of measuring the level of exposure.

    Bottom line: Weigh pros and cons

    Many of the harms we’ve discussed are statistically significant, and yet they are of questionable significance. Almost all the increased risks are relative risks. The absolute, or overall, risks are often quite low.

    We haven’t focused on the potential medical benefits here. But many people use pot — even rationally — for benefits they perceive to be greater than the harms we’ve listed.

    We unquestionably need more research, and more evidence of harms may emerge. But it’s important to note that the harms we know about now are practically nil compared with that of many other drugs, and that marijuana’s effects are clearly less harmful than those associated with tobacco or alcohol abuse.

    People who choose to use marijuana — now that it’s easier to do legally — will need to weigh the pros and cons for themselves.

    @aaronecarroll

     
      Health Policy
      benefits, harms, marijuana, pot, Upshot
    item.php

  • Healthcare Triage: Marijuana, Intoxication, DWI, and Breathalyzers

      09/26/2017
      Aaron Carroll

    How do breathalyzers work? And will there ever be a breathalyzer for marijuana? As pot has become legal in several states, law enforcement has sought a method to detect marijuana use in drivers. This is complicated, though. Breathalyzers for alcohol work on principles that don’t necessarily work for pot. And they’ve been extensively researched, which is difficult to do with federal controls on marijuana. There may never be a breathalyzer for pot, but one thing’s is for sure: eating your own feces won’t beat a breathalyzer.

    @aaronecarroll

     
      Health Policy
      breathalyzers, Healthcare Triage, marijuana, pot
    item.php

  • Healthcare Triage: What We Know about Pot in 2017

      02/13/2017
      Aaron Carroll

    Marijuana! You guys always want to know more about pot from Healthcare Triage. It’s also one of the most controversial and complex subjects we cover. And it’s time for an update on what we know, versus what we think, when it comes to the drug.

    That’s the topic of this week’s Healthcare Triage.

    Here’s the study itself.

    @aaronecarroll

     
      Health Policy
      Healthcare Triage, marijuana, pot
    item.php

  • Shut up already. Kids today are better than you.

      12/13/2016
      Aaron Carroll

    One of my biggest eye-rolling topics is the idea that somehow kids today are the worst, or that the kids in the past were better. Shut up, already. I’ve done multiple Healthcare Triage episodes on this topic. Today, Monitoring the Future released their yearly data on trends in substance abuse. Here’s alcohol:

    alcohol

    Sloping ever lower at all age groups. Here’s pot:

    pot

    At worst stable. But still, going down. And this is any use in the LAST YEAR! Here’s heroin:

    heroin

    Granted, never a huge amount, but still – sloping ever downwards. Finally, here’s all drugs other than pot together:

    drugs

    Sloping down, down, down.

    Forever claiming that things are worse, that things used to be better, that somehow the kids these days are anything but awesome is lazy and ignores the evidence. Kids should be telling us to get off their lawn.

    @aaronecarroll

     
      Health Policy
      alcohol, drugs, heroin, kids, marijuana, pot
    item.php

  • Another step towards marijuana research

      08/11/2016
      Aaron Carroll

    I covered the ridiculous barriers to researching marijuana over at Healthcare Triage:

    But now the feds have taken another step towards making this better:

    The Obama administration is planning to remove a major roadblock to marijuana research, officials said Wednesday, potentially spurring broad scientific study of a drug that is being used to treat dozens of diseases in states across the nation despite little rigorous evidence of its effectiveness.

    The new policy is expected to sharply increase the supply of marijuana available to researchers.

    For some time, only the University of Mississippi has been allowed to grow pot for medical studies. It’s been allowed to grow a very small amount. More pot grown means more research that can be done.

    And how can that be bad? If you believe that pot has no real medical use, research might show that. If you believe it’s a wonder drug, research will show that. If the former is correct, then we should stop its medical use. If the latter is correct, we all get a drug that works. What’s the downside?

    Or, we could just go ahead and legalize it:

    And in taking this step, the Obama administration is further relaxing the nation’s stance on marijuana. President Obama has said he views it as no more dangerous than alcohol, and the Justice Department has not stood in the way of states that have legalized the drug.

    Looks like President Obama and I agree. Except I think it’s less dangerous than alcohol.

    @aaronecarroll

     
      Health Policy
      Healthcare Triage, marijuana, pot, Upshot
    item.php

  • How ‘Medical’ Is Marijuana?

      07/24/2015
      Aaron Carroll

    The following originally appeared on The Upshot (copyright 2015, The New York Times Company).

    It is becoming easier to get marijuana, legally. In the last 20 years or so, 23 states, as well as the District of Columbia, have passed laws that make it legal to use marijuana for medical treatments. So have some countries, like Austria, Canada, Finland, Germany, Israel and Spain.

    Advocates believe that this has allowed many with intractable medical problems to receive a safe and effective therapy. Opponents argue that these benefits are overblown, and that advocates ignore the harms of marijuana. Mostly, opponents say that the real objective of medical marijuana is to make it easier for people to obtain it for recreational purposes.

    Both sides have a point. Research exists, however, that can help clarify what we do and don’t know about medical marijuana.

    A recent systematic review published in The Journal of the American Medical Association looked at all randomized controlled trials of cannabis or cannabinoids to treat medical conditions. They found 79 trials involving more than 6,400 participants. A lot of the trials did show some improvements in symptoms, but most of those did not achieve statistical significance. Some did, however.

    Medical marijuana was associated with some pretty impressive improvements in complete resolution of nausea and vomiting due to chemotherapy (47 percent of those using it versus 20 percent of controls). It also increased the number of people who had resolution of pain (37 percent up from 31 percent). It was shown to reduce pain ratings by about half a point on a 10-point scale, and to reduce spasticity in multiple sclerosis or paraplegia in a similar manner.

    Those aren’t insignificant results and they are supported by other studies that have confirmed that marijuana and cannabinoids can help with refractory pain. But most researchers stress that they should be considered only when other therapies have failed.

    There’s a little bit of evidence that marijuana might help with anxiety disorders and with sleep. The trials are at high risk of bias, though, and there are very few of them. The combined trials did not show that it helps with psychosis, glaucoma or depression. Reviews show that trials also failed to support its use for dementia, epilepsy, Tourette’s syndrome or schizophrenia.

    There are also side effects of marijuana to consider. They include dizziness, dry mouth, nausea, fatigue, drowsiness, vomiting, disorientation, confusion, loss of balance and hallucination. There’s also the potential for abuse. Those need to be weighed against any benefits. Let’s be frank: There’s just no way that the Food and Drug Administration would approve any other drug with these side effects and the relatively scant evidence, mostly from small studies, of any health benefits.

    Or course, arguing that no evidence currently exists is not the same as arguing that no evidence could be found. For too long, the federal government has made studying the use of marijuana nearly impossible. The Drug Enforcement Administration has classified marijuana as a Schedule 1 drug, meaning that it has no medical value and a high potential for abuse. Even if researchers jumped through the many hoops to get research approved, it was almost impossible for them to obtain the drug.

    The only place scientists can get marijuana for research in the United States is the University of Mississippi, which has an exclusive contract with the federal government to grow the plant for study. Regardless of how many studies could be done, the university has until recently been allowed to grow only 21 kilograms annually, enough for about 50,000 joints.

    Last year the government raised that quota to 650 kilograms. Research became even easier last month when the federal government removed an extra hurdle of approval researchers needed in order to study marijuana’s medicinal purposes.

    This means that large trials, like those done by pharmaceutical companies, might be possible in the future. These will take years to complete, though. It’s still likely that for the majority of things that marijuana is prescribed for now, evidence will be unavailable for some time.

    Many of the drugs that are approved for chronic pain, such as opioids, don’t have a lot of evidence supporting long-term use. These drugs are also extremely dangerous. Just recently, researchers published a paper that argued that deaths from painkillers are lower in states that have approved medical marijuana.

    Because of that, marijuana’s benefits seem to outweigh the potential harms for people who have intractable nausea and vomiting caused by chemotherapy, or severe and intractable pain from chronic illnesses that won’t respond to other therapies. But people who fall into those categories are not typically the people asking for medical marijuana.

    The vast majority of patients who seek a doctor’s authorization for pot do not have cancer, glaucoma or other serious illnesses. In Oregon, “severe pain” is reported as a condition requiring treatment in 93 percent of patients, while fewer than 6 percent had cancer. Most people are getting prescriptions for conditions where cannabis is not clearly effective, and for symptoms that are very subjective and potentially faked.

    When Prohibition became the law of the land, one of the only ways to get alcohol was to get a prescription from a physician. In 1921, a coalition of brewers, doctors and the public tried to lobby Congress that beer was a “vital medicine.” The American Medical Association disagreed, using the same arguments they use today to argue that marijuana shouldn’t be handed out as therapy. They said it was not proved to work, that it was not a targeted therapy, that most people who asked for it didn’t meet strict criteria and that doctors should not be in the business of doling it out.

    Promising research continues that might support possible use of marijuana in certain areas. For other afflictions, further research would be needed to justify any prescriptions. Should marijuana become legal, however, it’s likely that many of these debates will just go away, as they did for alcohol.

    @aaronecarroll

     
      Health Policy
      marijuana, Upshot
    item.php

  • Healthcare Triage: Kids Should Stay Away from Pot Edibles. And They Mostly Do.

      06/19/2015
      Aaron Carroll

    Just recently, a number of outlets, including the Washington Post, reported on a study about the alarming rise in children who were exposed to parents’ pot edibles. You likely saw a news story on this somewhere or other.

    But, as always, it’s important to view these things in context. We’re going to go that, today on Healthcare Triage News:

    For those of you who want to read more, here you go:

    @aaronecarroll

     
      Health Policy
      edibles, harm, Healthcare Triage, marijuana, pot
    item.php

  • Context, people. Context. (pot edibles edition)

      06/15/2015
      Aaron Carroll

    From the Washington Post:

     

    Between 2000 and 2006, there was no significant change in the number of children who were reported to have been exposed to marijuana. By the end of that period, medical marijuana was legal in 11 states.

    But between 2006 and 2013, the rate of exposure increased by 147.5 percent. Even in states where medical marijuana use isn’t legal, the study found that exposure rates increased, though not as much as in states where it was legal.

    In places such as Colorado, which has legalized both medical and recreational marijuana, this is a persistent problem for legalization advocates. Everyone agrees that drugs — like alcohol — should be kept away from kids, but it is unclear how to make edibles less likely to fall into the wrong hands.

    First of all, I think that it’s fair to say that “everyone” agrees that pot edibles should be kept away from kids, just like alcohol and other drugs. It may be that edibles are more difficult for kids to distinguish from other substances, but no one thinks that we should just leave them “laying around”. No one serious anyway.

    But the main point of this is the huge increase in exposure, especially with legalization. 147% is a big increase. But it’s relative. Let’s go to the study itself:

    This study investigates marijuana exposures among children <6 years old in the United States using data from the National Poison Data System. From 2000 through 2013, there were 1969 marijuana exposures among children <6 years old and an exposure rate of 5.90 per million children. The mean age of an exposed child was 1.81 years (median = 1.58 years). The majority of the children were exposed through ingestion (75.0%), and 18.5% of exposures required admission to a health care facility. The rate of marijuana exposure was significantly (2.82 times) higher in states where its use was legalized prior to 2000 compared with states where its use is not legal. Because more states are likely to pass legislation legalizing medical and recreational use of marijuana, increased efforts to establish child-focused safety requirements regarding packaging of commercially sold marijuana products are needed to help prevent more children from being exposed to this schedule I substance.

    From 2000 through 2013, there were 1969 marijuana exposures in kids five years of age and under reported to the National Poison Data System. This number did increase from just under 100 in 2000 to almost 250 in 2013.* That’s a 147% increase, yes. But that increase is relative.

    Please understand that I’m not minimizing the fact that these numbers are real, and that kids eating pot edibles is a problem. About half of these kids required treatment in a healthcare facility. About 12% were admitted to general hospital wards, and about 7% required hospitalization in a critical care service.

    But what concerns me about all of this is a lack of context. I see many articles hyperventilating about the dangers of pot brownies, but almost none on the dangers of other substances left around the house. In 2013 alone, more than 11,000 calls were made to the National Poison Data System for kids five years of age or under for exposure to alcohol. Three children died.

    I’m not even talking about the more than 45,000 calls for exposure to antihistamines, or the almost 28,000 calls for antimucrobials, or the more than 25,000 calls for cough or cold medicines. Remember – this paper and article are concerned about the almost 250 calls made for pot edibles. Even when we acknowledge that the number for pot brownies could go up as marijuana becomes more and more legal – there’s still a long way to go to reach these other numbers.

    We absolutely should be concerned about kids getting their hands on such things. We should be concerned about kids getting their hands on all things which they shouldn’t, and which could harm them. But if we want to improve the health of children, we should focus on the things that matter – the rate limiting steps – if we really want to make a difference. When I see stories and campaigns that focus on such things, I’ll be a much happier pediatric health services researcher.

    @aaronecarroll

    *This paper seems to report only percentages and rates in the results, so I’m having to read the actual numbers off the charts. If I’m wrong, someone correct me. A cynical person would say that it’s hard to find actual numbers in the papers because they are really still pretty low, and not nearly as flashy as the relative percentage increases.

     
      Health Policy
      children, edibles, harm, marijuana, morbidity, mortlity, poisoning, pot
    item.php

  • Alcohol or Marijuana? A Pediatrician Faces the Question

      03/18/2015
      Aaron Carroll

    The following originally appeared on The Upshot (copyright 2015, The New York Times Company).

    As my children, and my friends’ children, are getting older, a question that comes up again and again from friends is this: Which would I rather my children use — alcohol or marijuana?

    The immediate answer, of course, is “neither.” But no parent accepts that. It’s assumed, and not incorrectly, that the vast majority of adolescents will try one or the other, especially when they go to college. So they press me further.

    The easy answer is to demonize marijuana. It’s illegal, after all. Moreover, its potential downsides are well known. Scans show that marijuana use isassociated with potential changes in the brain. It’s associated with increases in the risk of psychosis. It may be associated with changes in lung function or long-term cancer risk, even though a growing body of evidence says that seems unlikely. It can harm memory, it’s associated with lower academic achievement, and its use is linked to less success later in life.

    But these are all associations, not known causal pathways. It may be, for instance, that people predisposed to psychosis are more likely to use pot. We don’t know. Moreover, all of these potential dangers seem scary only when viewed in isolation. Put them next to alcohol, and everything looks different.

    Because marijuana is illegal, the first thing I think about before answering is crime. In many states, being caught with marijuana is much worse than being caught with alcohol while underage. But ignoring the relationship between alcohol and crime is a big mistake. The National Council on Alcoholism and Drug Dependence reports that alcohol use is a factor in 40 percent of all violent crimes in the United States, including 37 percent of rapes and 27 percent of aggravated assaults.

    No such association has been found among marijuana users. Although there are studies that can link marijuana to crime, it’s almost all centered on its illegal distribution. People who are high are not committing violence.

    People will argue that casual use isn’t the issue; it’s abuse that’s worrisome for crime. They’re right — but for alcohol. A recent study in Pediatricsinvestigated the factors associated with death in delinquent youth. Researchers found that about 19 percent of delinquent males and 11 percent of delinquent females had an alcohol use disorder. Further, they found that even five years after detention, those with an alcohol use disorder had a 4.7 times greater risk of death from external causes, like homicide, than those without an alcohol disorder.

    When I’m debating my answer, I think about health as well. Once again, there’s no comparison. Binge drinking accounted for about half of the more than 80,000 alcohol-related deaths in the United States in 2010, according to a 2012 report by the Centers for Disease Control and Prevention. The economic costs associated with excessive alcohol consumption in the United States were estimated to be about $225 billion. Binge drinking, defined as four or more drinks for women and five or more drinks for men on a single occasion, isn’t rare either. More than 17 percent of all people in the United States are binge drinkers, and more than 28 percent of people age 18 to 24.

    Binge drinking is more common among people with a household income of at least $75,000. This is a solid middle-class problem.

    Marijuana, on the other hand, kills almost no one. The number of deaths attributed to marijuana use is pretty much zero. A study that tracked more than 45,000 Swedes for 15 years found no increase in mortality in those who used marijuana, after controlling for other factors. Another study published in the American Journal of Public Health followed more than 65,000 people in the United States and found that marijuana use had no effect at all on mortality in healthy men and women.

    I think about which is more dangerous when driving. A 2013 case-control study found that marijuana use increased the odds of being in a fatal crash by 83 percent. But adding alcohol to drug use increased the odds of a fatal crash by more than 2,200 percent. A more recent study found that, after controlling for various factors, a detectable amount of THC, the active ingredient in pot, in the blood did not increase the risk of accidents at all. Having a blood alcohol level of at least 0.05 percent, though, increased the odds of being in a crash by 575 percent.

    I think about which substance might put young people at risk for being hurt by others. That’s where things become even more stark. In 1995 alone, college students reported more than 460,000 alcohol-related incidents of violence in the United States. A 2011 prospective study found that mental and physical dating abuse were more common on drinking days among college students. On the other hand, a 2014 study looking at marijuana use and intimate partner violence in the first nine years of marriage found that those who used marijuana had lower rates of such violence. Indeed, the men who used marijuana the most were the least likely to commit violence against a partner.

    Most people come out of college not dependent on the substances they experimented with there. But some do. So I also consider which of the two might lead to abuse. Even there, alcohol fares poorly compared with marijuana. While 9 percent of pot users eventually become dependent, more than 20 percent of alcohol users do.

    An often-quoted, although hotly debated, study in the Lancet ranked many drugs according to their harm score, both to users and to others. Alcohol was clearly in the lead. One could make a case, though, that heroin, crack cocaine and methamphetamine would be worse if they were legal and more commonly used. But it’s hard to see how pot could overtake alcohol even if it were universally legal. Use of marijuana is not rare, even now when it’s widely illegal to buy and use. It’s estimated that almost half of Americans age 18 to 20 have tried it at some point in their lives; more than a third of them have used it in the last year.

    I also can’t ignore what I’ve seen as a pediatrician. I’ve seen young people brought to the emergency room because they’ve consumed too much alcohol and become poisoned. That happens thousands of times a year. Some even die.

    And when my oldest child heads off to college in the not-too-distant future, this is what I will think of: Every year more than 1,800 college students die from alcohol-related accidents. About 600,000 are injured while under alcohol’s influence, almost 700,000 are assaulted, and almost 100,000 are sexually assaulted. About 400,000 have unprotected sex, and 100,000 are too drunk to know if they consented. The numbers for pot aren’t even in the same league.

    I’m a pediatrician, as well as a parent. I can, I suppose, demand that my children, and those I care for in a clinic, never engage in risky behavior. But that doesn’t work. Many will still engage in sexual activity, for instance, no matter how much I preach about the risk of a sexually transmitted infection or pregnancy. Because of that, I have conversations about how to minimize risk by making informed choices. While no sex is preferable to unprotected sex, so is sex with a condom. Talking about the harm reduction from condom use doesn’t mean I’m telling them to have sex.

    Similarly, none of these arguments I’ve presented are “pro pot” in the sense that I’m saying that adolescents should go use marijuana without worrying about consequences. There’s little question that marijuana carries with it risks to people who use it, as well as to the nation. The number of people who will be hurt from it, will hurt others because of it, begin to abuse it, and suffer negative consequences from it are certainly greater than zero. But looking only at those dangers, and refusing to grapple with them in the context of our society’s implicit consent for alcohol use in young adults, is irrational.

    When someone asks me whether I’d rather my children use pot or alcohol, after sifting through all the studies and all the data, I still say “neither.” Usually, I say it more than once. But if I’m forced to make a choice, the answer is “marijuana.”

    @aaronecarroll

     
      Health Policy
      alcohol, harm, marijuana, pot, Upshot
    item.php

  • When real life imitates the West Wing, surgeon general edition

      02/17/2015
      Aaron Carroll

    One of my favorite West Wing episodes is “Ellie”. There are three parts I love. The gist of the episode is that the surgeon general, a personal friend of the President’s family, makes some claims about marijuana on a radio show that are absolutely true, but go against the POT IS EVIL AND NEVER TALK ABOUT IT AND GO TO JAIL FOR IT line that’s often played in DC. The President’s middle daughter, Ellie, says to a reporter that President Bartlet would never fire the surgeon general for that. There are three things I love in this episode. The first is when Bartlet decides not to ask for the surgeon general’s resignation, which prompts this exchange:

    JOSH: You know, it’s going to seem to some people like you did it ’cause your daughter asked you to.

    BARTLET: You know, Josh, I think if you ever have a daughter, you’re going to discover there are worse reasons in the world to do something.

    I didn’t have a daughter then. I do now. And I stand by this.

    The second occurs right at the end. The setup is that earlier in the episode, Ellie, who does not have as close a relationship to her father as her sisters do, declared that she doesn’t know how to make her Dad happy – that’s what Zoey and Elizabeth are good at. But as she and the President are watching a movie together with others as the episode closes, he says quietly to her:

    BARTLET: The only thing you ever had to do to make me happy was come home at the end of the day.

    And then Ellie (and I) start to cry. Hold on… there something in my eye. I’ll be back in a second…

    My final favorite bit is this. When Ellie said her father would never fire the surgeon general for her comments, Bartlet’s response was this:

    BARTLET: But the truth is, it’s the nicest thing she’s ever said about me.

    That’s cause what the surgeon general said was the truth. And we don’t fire people in science and medicine for telling the truth.

    I bring all of this up because our actual surgeon general said things that were true about marijuana last week:

    Dr. Vivek Murthy, the nation’s new surgeon general, says that marijuana “can be helpful” for some medical conditions, and wants science to dictate policy on the federally banned substance.

    “We have some preliminary data that for certain medical conditions and symptoms, that marijuana can be helpful,” Murthy said during a Wednesday interview on “CBS This Morning” in response to a question about his stance on marijuana legalization.

    While Murthy didn’t take the opportunity to endorse legalization of marijuana for medical or recreational purposes, he did add that he believes U.S. marijuana policy should be driven by science and what it reveals about the efficacy of using the plant for medical purposes.

    “I think we’re going to get a lot more data about that,” Murthy said. “I’m very interested to see where that takes us.”

    Did the rest of the administration go crazy? Ask for his resignation? Nope. They pretty much did nothing but support him. Ellie and her father would be proud.

    Also, this:

    @aaronecarroll

     
      Health Policy
      marijuana, pot, surgeon general
    item.php