You can do so by clicking the link below to NORML’s commentary, ‘Let the states decide their own marijuana policies,’ which appears today on TheHill.com’s influential Congress blog and is excerpted below. (The Hill is the paper of record for Washington, DC insiders, members of Congress, and their staff.)

After you have done so, please also join the thousands of other advocates who have e-mailed their US House Congressional Representative here and urged him or her to support ending federal marijuana prohibition. You can also stay up-to-date regarding the latest political developments surrounding HR 2306 via the Ending Federal Marijuana Prohibition Act of 2011 Facebook page here.

Let the states decide their own marijuana policies
via The Hill.com

[excerpt] Lawmakers for the first time have introduced legislation in Congress to end the federal criminalization of the personal use of marijuana.

The bipartisan measure — H.R. 2306, the ‘Ending Federal Marijuana Prohibition Act of 2011′ … prohibits the federal government from prosecuting adults who use or possess personal use amounts of marijuana by removing the plant and its primary psychoactive constituent, THC, from the five schedules of the United States Controlled Substances Act of 1970.

Speaking during an online town hall in January, President Obama acknowledged that the subject of legalizing and regulating marijuana was a “legitimate topic for debate.” Yet last week Rep. Lamar Smith (R-Texas), chairman of the House Committee on Judiciary, boasted that he would not even consider scheduling the measure for a public hearing. On Friday, when NORML requested its members to contact Rep. Smith’s office, the Congressman promptly shut off his DC office phone and later closed down his Facebook page.

It’s obvious why marijuana prohibitionists like Rep. Smith will go to such lengths to try and stifle any public discussion of the matter. Over the past 70+ years, the federal criminalization of marijuana has failed to reduce the public’s demand or access to cannabis, and it has imposed enormous fiscal and human costs upon the American people. Further, this policy promotes disrespect for the law and reinforces ethnic and generational divides between the public and law enforcement.

Since 1970, police have arrested over 20 million American citizens for marijuana offenses — nearly 90 percent of which were prosecuted for the personal possession of marijuana, not marijuana trafficking or sale. Yet today federal surveys indicate that the public, including America’s young people, have greater access to marijuana — including stronger varieties of marijuana — than ever before. It is time to stop ceding control of the marijuana market to unregulated, criminal entrepreneurs and allow states to enact common sense regulations that seek to govern the adult use of marijuana in a fashion similar to alcohol.

After 70 years of failure it is time for an alternative approach. The Ending Federal Marijuana Prohibition Act of 2011 is an ideal first step.

The bipartisan measure, HR 2306 – entitled the ‘Ending Federal Marijuana Prohibition Act of 2011’ and sponsored by Massachusetts Democrat Barney Frank and Texas Republican Ron Paul along with Reps. Cohen (D-TN), Conyers (D-MI), Polis (D-CO), and Lee (D-CA) – prohibits the federal government from prosecuting adults who use or possess marijuana by removing the plant and its primary psychoactive constituent, THC, from the five schedules of the United States Controlled Substances Act of 1970. Under present law, all varieties of the marijuana plant are defined as illicit Schedule I controlled substances, defined as possessing ‘a high potential for abuse,’ and ‘no currently accepted medical use in treatment.’

Said Rep. Frank, “Criminally prosecuting adults for making the choice to smoke marijuana is a waste of law enforcement resources and an intrusion on personal freedom. I do not advocate urging people to smoke marijuana, neither do I urge them to drink alcoholic beverages or smoke tobacco, but in none of these cases do I think prohibition enforced by criminal sanctions is good public policy.”

The ‘Ending Federal Marijuana Prohibition Act’ seeks to federally deregulate the personal possession and use of marijuana by adults. It marks the first time that members of Congress have introduced legislation to eliminate the federal criminalization of marijuana since the passage of the Marihuana Tax Act of 1937.

Language in this Act mimics changes enacted by Congress to repeal the federal prohibition of alcohol. Passage of this measure would remove the existing conflict between federal law and the laws of those sixteen states that allow for the limited use of marijuana under a physicians’ supervision. It would also allow state governments that wish to fully legalize and regulate the responsible use, possession, production, and intrastate distribution of marijuana for all adults to be free to do so without federal interference. (To date, lawmakers in six states have introduced legislation to legalize and regulate the adult use of cannabis, and separate statewide initiative measures are planned for 2012 in several additional states.)

Speaking in support of the measure, NORML Executive Director Allen St. Pierre said, “The federal criminalization of marijuana has failed to reduce the public’s demand or access to cannabis, and it has imposed enormous fiscal and human costs upon the American people. It is time to end this failed public policy and to provide state governments with the freedom to enact alternative strategies — such as medicalization, decriminalization, and/or legalization — without running afoul of the federal law or the whims of the Department of Justice.”

You can read the full text of Allen’s remarks from today’s press conference, which is being reported today by major news outlets nationwide, here.

NORML, along with representatives from the Drug Policy Alliance (DPA), Students for Sensible Drug Policy (SSDP), and the Marijuana Policy Project (MPP), worked closely with members of Congress in drafting the measure.

Additional information regarding this measure is available from NORML’s ‘Take Action Center’ here.

AFTERNOON UPDATE:

Below is video of co-sponsor Steven Cohen (D-TN) speaking on the House floor today in favor of HR 2306: Ending Federal Marijuana Prohibition Act of 2011.

Investigators at the Louisiana State University Health Sciences Center assessed the impact of chronic intramuscular THC administration compared to placebo on immune and metabolic indicators of SIV disease during the initial six-month phase of infection.

Researchers reported, “Contrary to what we expected, … delta-9-THC treatment clearly did not increase disease progression, and indeed resulted in generalized attenuation of classic markers of SIV disease.” Authors also reported that THC administration was associated with “decreased early mortality from SIV infection” and “retention of body mass.”

Investigators concluded, “These results indicate that chronic delta-9-THC does not increase viral load or aggravate morbidity and may actually ameliorate SIV disease progression.”

Clinical trials have previously documented that the short-term inhalation of cannabis does not adversely impact viral loads in HIV patients, and may even improve immune function.

Additional studies documenting the disease modifying potential of marijuana is available in the NORML handbook, Emerging Clinical Applications For Cannabis & Cannabinoids: Fourth Edition, available online here.

Additional information on this suit will appear in this week’s NORML news update. To receive these e-mail updates free, please sign up here.

Project CBD has just sent out its introductory pitch to California dispensaries. ProjectCBD.org is the medical marijuana movement living up to its name,” explains outreach coordinator Sarah Russo, optimistically, as she asks the dispensaries to participate in a “collective research effort.” But what are the chances that the dispensary owners, intent on building their own brands, will support a venture aimed at advancing the movement as a whole?

CBD, in case you’re just joining us, is Cannabidiol —a component of the Cannabis plant known to have anti-inflammatory, anti-tumor and other beneficial medical effects. CBD is not psychoactive and actually counters the psychoactive effects of THC. It is the predominant cannabinoid in hemp —plants grown to produce fiber or growing wild. CBD levels go down and THC levels go up when plants are bred to maximize psychoactive effect, as they have been in the U.S. for many generations of plants and people.

It was widely assumed for a long time that CBD had been almost entirely bred out of the Cannabis being grown in California for medical/commercial purposes. And because no analytic chemistry labs were testing Cannabis samples before the winter of 2008-09, there was no way to assess cannabinoid content. Overseas things were different. For many years researchers have been exploring the medical potential of CBD, and G.W. Pharmaceuticals conducted successful clinical trials and got U.K. government approval to market Sativex, a whole-plant extract with equal amounts of CBD and THC, for use by MS patients. Canada and Spain have also issued approvals for Sativex.

The situation in California changed in 2008 when Steve DeAngelo arranged for a lab to test the Cannabis he was providing at Oakland’s Harborside Health Center. DeAngelo had to fund a start-up to accomplish this. When Harborside opened in 2006 he had phoned every analytic lab in the Bay Area and been turned down when he mentioned the C word. In the spring of ’08 he decided to back two entrepreneurs who were launching a lab —the aptly named “Steep Hill”— and to supply them with a large, steady stream of samples to test for mold and cannabinoid content (THC, CBD and CBN, a breakdown product indicative of freshness). At least eight more labs have started testing Cannabis in California since then, and there are labs in Montana and Colorado. ProjectCBD’s Russo says, “We seem to hear from a new lab every week.”

It turns out that CBD is not all that rare —about one in every 600 samples tested by the labs is found to be high in CBD. Evidently, that’s the rate at which a mutation occurs resulting in an excess of the enzyme that transforms a precursor molecule of CBD and THC into one or the other. More than 25 CBD-rich strains have been identified, and Russo says, “We seem to hear about a new strain every week, too”

The prospect of CBD-rich cannabis becoming available prompted the Society of Cannabis Clinicians to plan a data collection effort. Jeffrey Hergenrather, MD, President of the SCC, had spent years listening to talks about CBD at meetings of the International Cannabinoid Research Society, wishing he could observe its effects on real patients. Hergenrather and co-worker Stacey Kerr, MD have now drafted a survey aimed at documenting patients’ answers to some basic questions about the effects of CBD-rich Cannabis. (For purposes of data collection, “CBD-rich” has been defined as 4% or more CBD, regardless of THC content. The amount of CBD that a given strain contains isn’t the only factor influencing the effects it will exert when ingested. The ratio of CBD to THC may be as or more important. Terpenoid and flavonoid content also appear to be very important.)

Project CBD was launched to publicize and promote the SCC survey(s). Martin A. Lee, the author of Acid Dreams, had been writing about CBD for O’Shaughnessy’s and convinced your correspondent that its re(introduction) into the grassroots supply was going to be a huge, ongoing story and would warrant its own journal of sorts. Over the past year we put a lot of effort into encouraging production by plant breeders and growers who had strains testing high in CBD. Many dispensary owners have been reluctant to stock CBD-rich strains because their present customers are seeking —or are not adverse to— Cannabis that causes euphoria or sedation. In other words, THC content sells, it’s a sure thing. Why should a dispensary spend money and devote shelf space to a type of Cannabis that most medical users haven’t heard of and whose effects are unproven?

Growers, in turn, have to anticipate the wants of dispensary buyers, and are reluctant to devote valuable garden space to plants for which there is no established market. ?Demand at the dispensary level might not take off until effectiveness is established. Which might not happen until significant numbers of patients have tried CBD-rich Cannabis and taken the SCC survey to report their results. Or, as Martin says, “there could be a tsunami of interest any day now.”

ProjectCBD.org provides the whole story to date and a “CBDiary” noting recent developments. The big news as of March 1: for the first time, a California grower has “stabilized” a CBD-rich strain. Lawrence Ringo of the Southern Humboldt Seed Collective is now offering seeds of “Sour Tsunami” that have a one-in-four chance of containing 10-11% CBD (and 6-7% THC).

Read all about it here.

Fred Gardner is the managing editor of O’Shaughnessy’s, the journal of cannabis in clinical practice. His email is fred@plebesite.com.

NORML’s updated primer on existing and potential cannabinoid and cannabis therapies is found here.

Now Dr. Andrew Weil, a best-selling author and world-renowned leader and pioneer in the field of integrative medicine, has lent his powerful voice to this discussion.

Cannabis Rx: Cutting Through the Misinformation
via Huffington Post

[Excerpt below; read the full commentary here.] Research into possible medical uses of cannabis is enjoying a renaissance. In recent years, studies have shown potential for treating nausea, vomiting, premenstrual syndrome, insomnia, migraines, multiple sclerosis, spinal cord injuries, alcohol abuse, collagen-induced arthritis, asthma, atherosclerosis, bipolar disorder, depression, Huntington’s disease, Parkinson’s disease, sickle-cell disease, sleep apnea, Alzheimer’s disease and anorexia nervosa.

But perhaps most exciting, cannabinoids (chemical constituents of Cannabis, the best known being tetrahydrocannabinol or THC) may have a primary role in cancer treatment and prevention. A number of studies have shown that these compounds can inhibit tumor growth in laboratory animal models. In part, this is achieved by inhibiting angiogenesis, the formation of new blood vessels that tumors need in order to grow. What’s more, cannabinoids seem to kill tumor cells without affecting surrounding normal cells. If these findings hold true as research progresses, cannabinoids would demonstrate a huge advantage over conventional chemotherapy agents, which too often destroy normal cells as well as cancer cells.

As long ago as 1975, researchers reported that cannabinoids inhibited the growth of a certain type of lung cancer cell in test tubes and in mice. Since then, laboratory studies have shown that cannabinoids have effects against tumor cells from glioblastoma (a deadly type of brain cancer) as well as those from thyroid cancer¸ leukemia/lymphoma, and skin, uterus, breast, stomach, colorectal, pancreatic and prostate cancers.

… If you want to learn more about this subject, I recommend an excellent documentary film, “What If Cannabis Cured Cancer,” by Len Richmond, which summarizes the remarkable research findings of recent years. Most medical doctors are not aware of this information and its implications for cancer prevention and treatment. The film presents compelling evidence that our current policy on cannabis is counterproductive.

At this past weekend’s national NORML Conference, several panelists — myself included — discussed the use of cannabinoids as selective anti-cancer agents. We also screened Len Richmond’s excellent documentary (in which I’m briefly interviewed) “What If Cannabis Cured Cancer?” (Watch the movie trailer here.)

Fortunately, this important discussion is just now finally making its way into the mainstream. Unfortunately, it’s taken 30+ years to get the MSM to notice.

What possible advancements in the treatment of cancer may have been achieved over the past three decades had U.S. government officials chosen to advance — rather than suppress — clinical research into the anti-cancer effects of cannabis? It’s time for the public and the media to demand an answer.

The administration of THC reduces the tumor growth of metastatic breast cancer and “might constitute a new therapeutic tool for the treatment” of cancerous tumors, according to preclinical data published online in the journal Molecular Cancer.

Investigators from Complutense University in Madrid assessed the anti-tumor potential of THC and JWH-133, a non-psychotropic CB2 receptor-selective agonist, in the treatment of ErbB2-positive breast tumors – a highly aggressive form of breast cancer that is typically unresponsive to standard therapies.

Researchers reported, “[B]oth Delta-9-tetrahydrocannabinol … and JWH-133 …reduce tumor growth [and] tumor number [in mice]. … [T]hese results provide a strong preclinical evidence for the use of cannabinoid-based therapies for the management of ErbB2-positive breast cancer.”

In 2007, investigators at the California Pacific Medical Center Research Institute reported that the administration of the nonpsychoactive cannabinoid CBD limited breast cancer metastasis in a manner that was superior to comparable synthesized agents.

Previous preclinical studies assessing the anticancer properties of cannabinoids have shown that they inhibit the proliferation of a wide range of cancers, including brain cancer, prostate cancer, oral cancers, lung cancer, skin cancer, pancreatic cancer, biliary tract cancers, and lymphoma.

Full text of the study, “Cannabinoids reduce ErbB2-driven breast cancer progression through Akt inhibition,” is available online here.

Neither story particularly breaks any new ground, though the author (who I spoke with extensively prior to the stories publication) does note that investigators are now assessing the use of cannabis for a wide range of disease conditions, including Alzheimer’s disease and the so-called ‘superbug’ MRSA (multi-drug resistant bacterial infections).

Quoted in the story is Columbia University researcher Margaret Haney. I’ve written about Haney’s clinical work with cannabis before. In particular, Haney was the lead author of a 2007 clinical trial concluding that inhaled cannabis increased daily caloric intake and body weight in HIV-positive patients in a manner that was far superior to the effects of oral THC (Marinol aka Dronabinol). The study further reported that subjects’ use of marijuana was well tolerated, and did not impair their cognitive performance.

Yet Haney’s comments in US News and World Report ring tepid at best.

“I am not anti-marijuana, I’m not pro-marijuana. I want to understand it.” Haney expresses frustration at what she considers wrongheaded efforts by states to legalize medical marijuana. There is too much, she says, that scientists do not know.

Haney’s refrain is a common one, and at first glance it appears to make sense. After all, who among us doesn’t want to better understand the interactions between the marijuana plant and the human body? Yet placed in proper context this sentiment appears to be little more than a red herring. Here’s why.

Marijuana is already the most studied plant on Earth, and is arguably one of the most investigated therapeutically active substances known to man. To date, there are now over 20,000 published studies or reviews in the scientific literature pertaining to marijuana and its active compounds. That total includes over 2,700 separate papers published on cannabis in 2009 and another 900 published just this year alone (according to a key word search on the search engine PubMed).

And what have we learned from these 20,000+ studies? Not surprisingly, quite a lot. For starters, we know that cannabis and its active constituents are uniquely safe and effective as therapeutic compounds. Unlike most prescription or over-the-counter medications, cannabinoids are virtually non-toxic to health cells or organs, and they are incapable of causing the user to experience a fatal overdose. Unlike opiates, cannabinoids do not depress the central nervous system, and as a result they possess a virtually unparalleled safety profile. In fact, a 2008 meta-analysis published in the Journal of the Canadian Medical Association (CMAJ) reported that cannabis-based drugs were associated with virtually no serious adverse side effects in over 30 years of investigative use.

We also know that the cannabis plant contains in excess of 60 active compounds that likely possess distinctive therapeutic properties. These include THC, THCV, CBD, THCA, CBC, and CBG, among others. In fact, a recent review by Raphael Mechoulam and colleagues identifies nearly 30 separate therapeutic effects — including anti-cancer properties, anti-diabetic properties, neuroprotection, and anti-stroke properties — in cannabinoids other than THC. Most recently, a review by researchers in Germany reported that since 2005 there have been 37 controlled studies assessing the safety and efficacy of cannabinoids, involved a total of 2,563 subjects. By contrast, most FDA-approved drugs go through far fewer trials involving far fewer subjects.

Finally, we know that Western civilization has been using cannabis as a therapeutic agent or recreational intoxicant for thousands of years with relatively few adverse consequences — either to the individual user or to society. In fact, no less than the World Health Organization commissioned a team of experts to compare the health and societal consequences of marijuana use compared to other drugs, including alcohol, nicotine, and opiates. After quantifying the harms associated with both drugs, the researchers concluded: “Overall, most of these risks (associated with marijuana) are small to moderate in size. In aggregate they are unlikely to produce public health problems comparable in scale to those currently produced by alcohol and tobacco. On existing patterns of use, cannabis poses a much less serious public health problem than is currently posed by alcohol and tobacco in Western societies.”

That, in a nutshell, is what we ‘know’ about cannabis. I’d say that it’s ample enough information to, at the very least, cease the practice arresting people who possess it.  As for what else Dr. Haney and others of a similar mindset would still like to know — and how many additional studies would it take to provide them with that information — well, that’s anybody’s guess.

“You have to start somewhere.” —Willy Notcutt, MD

Fifteen members of the Society of Cannabis Clinicians -the doctors’ group founded by Tod Mikuriya in 1999 and now led by Jeffrey Hergenrather- met in Oakland Dec. 11. UCSF professor Donald Abrams recounted the obstacles he faced in conducting clinical trials with government-issued cannabis and getting his results published in peer-reviewed medical journals. The ensuing discussion focused on how SCC doctors might go about evaluating the effectiveness of high-CBD strains as they become available to patients in the year ahead.

CBD (cannabidiol) is a non-psychoactive cannabinoid. For many generations (of people and plants), cannabis in California and elsewhere has been bred to maximize psychoactivity, which is mainly a function of THC content. (Some  “minor” cannabinoids, terpenes, and flavonoids also affect a plant’s effect.)  Because CBD and THC are in an either/or relationship at the genetic level, breeding for high THC means breeding out CBD. So it was widely assumed that the Cannabis available nowadays in California contains only trace amounts of CBD.

Surprisingly, six strains with buds ranging from 5% to 7% CBD by weight have been detected in the year since Steep Hill analytic lab began testing samples from dispensaries and individual growers.  Only two of these high-CBD strains have been made available to patients -and only intermittently, as the pounds delivered by the growers sell out in a day or two. “Soma A-plus” has been dispensed at Harborside Health Center in Oakland, and “Pineapple Thai” at Herbal Solutions in Long Beach. The other four strains are being grown out as clones and should be available by spring 2010 to collectives wishing to dispense them.

The doctors want, eventually, to test the effectiveness of cannabis with consistent CBD/THC ratios in treating various conditions. One hoped-for advantage of high-CBD strains is reduced psychoactivity, which might enable patients to take larger doses while remaining functional. The California doctors are somewhat enviously and somewhat gratefully tracking the progress of G.W. Pharmaceuticals, the British company that has been growing cannabis and making and testing whole-plant extracts for medical use since 1998 —with government approval and backing from corporate partners Bayer, Almirall, and Otsuka.

G.W.’s flagship product is Sativex, an oral spray that contains about equal amounts of CBD and THC. The rationale for the combination was set forth in “A Tale of Two Cannabinoids,” a 2005 article by doctors Ethan Russo and Geoffrey Guy in the online journal Medical Hypotheses. Here’s a summary:

“CBD is demonstrated to antagonise some undesirable effects of THC including intoxication, sedation and tachycardia, while contributing analgesic, anti-emetic, and anti-carcinogenic properties in its own right. In modern clinical trials, this has permitted the administration of higher doses of THC, providing evidence for clinical efficacy and safety for cannabis based extracts in treatment of spasticity, central pain and lower urinary tract symptoms in multiple sclerosis, as well as sleep disturbances, peripheral neuropathic pain, brachial plexus avulsion symptoms, rheumatoid arthritis and intractable cancer pain. Prospects for future application of whole cannabis extracts in neuroprotection, drug dependency, and neoplastic disorders are further examined. The hypothesis that the combination of THC and CBD increases clinical efficacy while reducing adverse events is supported”

Sativex has been approved by Health Canada for treating neuropathic pain in multiple sclerosis and cancer. It is obtainable by prescription in 22 countries. GW has applied for and is awaiting approval of Sativex as a treatment for MS spasticity in the UK and Spain. The U.S. FDA has given GW approval to conduct a clinical trial in advanced cancer patients whose pain is not adequately controlled by opioids. (GW is close to finishing an extensive study to determine optimum dosages.) The company hopes recruitment of subjects won’t take more than a year. When the results are in, assuming they’re favorable, GW will apply for marketing approval from the FDA

Dr. Notcutt’s Encouraging Input

The researcher who conducted Phase 2 trials on Sativex (to determine basic efficacy and optimum dosage range) back in 1999-2000 is Willy Notcutt, MD, a pain specialist at James Paget Hospital in Great Yarmouth, England. O’Shaughnessy’s recently asked Notcutt whether his approach could be adapted by California physicians and patients seeking to evaluate the efficacy of high-CBD strains. The setting was the International Association of Cannabinoid Medicine in Koln, and Notcutt was speaking for himself, not GW Pharmaceuticals, which expresses official corporate disdain for smoking as a delivery system and “the crude plant” as medicine.

Notcutt:  Indeed… Those were “N of 1″ trials. [In N of 1 trials, data is collected from individuals as their use pattern changes. The number N of patients involved in each study is one, hence the name.]  The advantages of  N-of-1 trials were first described by a chap named Guyatt in Toronto. The fundamental thing is that the patient acts as his own control.

O’S: Is there a standard design?

Notcutt: It’s very flexible, you can design it any which way you want to. Presumably the patients are currently using a high-THC strain. First you establish the baseline: what’s the patient’s [self-reported score on a] pain scale or the sleep line, or whatever parameters you want to measure. Then you start them on the current drug for a week. Then you put them on the new one. Then you switch them back to the current one, and so forth. You can do it as many times as you like until you say…

[Stefan offers to buy beer, thread not picked up]

“It can be done as many times as you want and for any period -one week, two weeks, six weeks. You can leave it open, you can do it single-blinded [not letting the patient know what he's taking], you can do it double-blinded [neither doctor nor patient knowing which strain is being used].  But by far the easiest way to start out is to do a straight observational study: open observation and open label. The patients are going to tell you pretty quickly whether they prefer current drug or new drug. The advantage of going from current drug to new drug is, that is what a clnician actually does. That’s how medicine is practiced. I say ‘try this…’ ‘Not much help.’ ‘Now let’s try you on this new drug…’ ‘Yeah, well I think that drug has helped me…’

“I appreciate that you have a problem with standardization, but a lot of people [medical cannabis users] say, ‘I always get this type, I know how to work it, I fine tune it, if it’s a little weak or strong I smoke a little more or smoke a little less.’ Call that the current drug, which we assume is high-THC, and then compare it with high-CBD. That’s what you’re testing: the comparative efficicacy of high-THC and high-CBD cannabis.

“You’re using the patient as his own control and you plot it out: How many times do they smoke each day? What effects are they getting?  It’s close to what you normally would do as a clinician. That’s how I evaluate a drug anyway. If you define your parameters, and gets reports from 20 patients, you can then get a feel for whether it works.

“I would suggest that it be done completely open-label at first.

“Guyatt’s is not the only paper on N-of-1 trials. I have one from the BMJ [British Medical Journal] from a few years ago sayng that this is the way we should be studying chronic disease. It’s a well-recognized, acceptable clinical approach. But people have gotten so fixated in the last 20 years on the randomized, placebo-controlled trial- (sarcastically) ‘the only way you can do it,’ ‘the gold standard.’

“I think the N-of-1 trial is the only way you study this cohort at this time, because of your problems with standardization. You have people doing it different ways… But your individual patient becomes your study. And then you can aggregate your studies. You can do some simple statistics on it: of 20 patients that started, five found it didn’t work for them at all. Now let’s look at the 15 that reported effect…

“Then you can go on and blind your subjects and not tell them which is which. Or blind the physician. Guyatt wrote about building in a placebo, but you needn’t go to that extent. That’s not how we do medicine. The RCT [randomized, controlled trial] is furthest from normal clinical practice.

“The N-of-1 trial is a good way of generating some data where no data exists. The first two or three GW studies were all N-of-1, until we knew that it worked. If the first nine of ten patients had said, ‘This doesn’t work,’ then you don’t go further.

“You have to start somewhere. An observational study has the force of common sense. It may be best suited when you have a longterm chronic illness and you need some information about whether a drug works…

“Do we give an orthopedic surgeon and an eye surgeon the same tools? No. So should we statistically evaluate every medical problem by the same technique? If we’re evaluating a drug where the blood pressure goes up or down, or the sugar level goes up or down in diabetes, we use one technique. Why use the same technique for a drug that has a completely different spectrum of activity, in an area where you don’t get nice, number data, where you get much softer data, you get subjective opinion. There’s a whole difference in the quality of the data -why use the same statistical tools?

“People are now starting to say that evidence-based medicine is becoming a tyranny that’s killing off research. I’m very interested in this because I’m the lead for research in our district I’m also the lead for research in my own field.  If you start insisting on these big multi-center big studies, all randomized, and you don’t nurture the small studies -the little ones that come along, the N-of-1s that come along where the guy sits down and works on an idea, ‘try this out, try that out’ in a few patients, and generates a little bit more information that then leads to a bit of a better study…

“I still regard as one of the best studies ever, the guy who treated pain after shingles with amtriptyline or nortrypteline. All he did was he found out that when he used the amitriptyline, 60 percent of the patients hated it. When he used nortriptyline only about 30 percent of the patients hated it. A simple trial -but it changed our practice. We stopped using amitriptyline, we use nortriptyline. And now we know the reasons why. That was 10, 15 years ago. I’ve never seen that simple study replicated as a clinical trial of amitriptyline versus nortriptyline because there’s no money it for the drug companies.”

Notcutt offered to review any study design that the SCC docs come up with.

Fred Gardner edits O’Shaughnessy’s, the journal of cannabis in clinical practice, now online at www.pcmd4u.org

On the one hand, I’m thrilled to see that a study documenting the anti-cancer properties of cannabinoids is finally receiving some mainstream media attention.

On the other hand, I’m disappointed that its coverage is limited to a British tabloid that is better known for running anti-pot propaganda like this:

Cannabis killer knifed neighbour 100 times
via Metro.co.uk

A mentally ill man driven to violent frenzies by cannabis was sentenced to life yesterday for stabbing a man 100 times.

… Kashmiri, 50, of Tooting, south London, sexually assaulted the woman at her south London home in June, 2006, and returned five nights later to attack her.

… Kashmiri, whose violent episodes are triggered by cannabis, denied murder but admitted manslaughter due to diminished responsibility.  

Of course, I’m accustomed to reading “Reefer Madness” in the British press.

But I’m less accustomed to reading “Reefer Madness” when it comes from the mouth of an established medi-pot researcher like Dr. Wai Man Liu.

Cannabis may help the war on cancer
via Metro.co.uk

Cannabis could be used to treat many forms of cancer, new research suggests.

The drug contains an ingredient which slows tumour growth and prevents the reproduction of cancer cells, doctors say.

Its effects are seen in all cancers but particularly in those of the lung and brain, and leukaemia, it is claimed.

But scientists warned against smoking the drug, saying the only safe version was that created in the lab.

Researcher Dr Wai Man Liu said: ‘I’m in no way encouraging people to take up smoking the ganja – there would be more harm than good.’

Previous research has shown cannabis-based medicines can help cancer patients as a painkiller, appetite stimulant and in reducing nausea.

The drug has also long been used by multiple sclerosis and arthritis sufferers to reduce pain.

Its medicinal benefits come from the main active ingredient, THC. The latest research, by St George’s University of London, shows that THC can weaken cancer cells to make traditional chemotherapy more effective.

Dr Liu said: ‘It’s another weapon against the armour of cancer. We are quite close but need to jump through certain hoops. I believe it could be used in two to three years.’

Dr Joanna Owens, from Cancer Research UK, said the latest studies were encouraging but needed to be followed up with more trials. She added: ‘Making cancer cells more vulnerable to chemotherapy or radiotherapy is a great concept but it is still early days.’  

Having recently lost friends and family members to cancer, including one to leukemia, I can inform Dr. Liu that such a diagnosis — even when treated with standard radiation and chemotherapy — is a death sentence. For Dr. Liu to advise, with a straight face no less, that these patients would do “more harm than good” by smoking cannabis is a disgrace. Not only can cannabis alleviate cancer patients’ nausea and pain, elevate their mood, and increase their appetite, but also — as Dr. Liu’s own data demonstrates — it may help to alleviate the very disease that’s ravaging their bodies. Nevertheless, I suppose that Dr. Liu would rather have these patients shut up and die than expose the political hypocrisy surrounding criminalizing a plant.

Finally, as for Dr. Liu’s idyllic estimate that his pharmaceutically-approved pot-based anti-cancer drugs will be available in “two to three years,” don’t hold your breath (or, if you already have cancer, try not to die in the interim). I’m sure that these investigators made similar proclamations when they documented pot’s anti-cancer properties — in 1975!

Yet here we are 38 years later and the only ‘progress’ we’ve made on this issue is in the wrong direction — having moved from investigating the plant’s anti-cancer potential in animals to cells in vitro in a petri dish! Thank you Dr. Liu; now kindly get out of my sight.