Yes, Cannabis Is as Safe as We Think: A Rebuttal to Malcom Gladwell & Alex Berenson
Several weeks ago The New Yorker published an article about cannabis by the noted author Malcom Gladwell, “Is Marijuana as safe as we think?” As a lifelong New Yorker reader and current subscriber living at the end of the road in the mountains of the Emerald Triangle, I have come to depend on the magazine to keep me up to date and report the facts, the real stories behind events of the day. It seems to me that this article fell down on both counts. It really should have come under the rubric “Shouts and Murmurs” as it was written in such a smug, snarky thumb-your-nose tone, which poked fun at a presumed multitude of deluded believers and users of the latest snake-oil: cannabis.
At first I was unsure whether the reader was supposed to take this piece seriously.
It soon became obvious the main intent of the piece was to spread doubt and fear via marginal journalism, rather than present a balanced review of the research conducted by the National Science Foundation. The more I read, the more it seemed as if the magazine’s vaunted fact-checking department was on furlough. All in all, the piece fell far short of the standard of excellence and research I have long cherished in the The New Yorker. In a word, it was dishonest. It was “fake news”, exactly what The New Yorker claims to be fighting.
To begin with, the title itself misleads readers. It questions if cannabis’s safety. But both the article and the NSA Report basically focus on evaluating the beneficial effects of cannabis, not on the possible negative effects. Even his use of the word “marijuana” indicates his prejudice. Serious researchers use its scientific name, Cannabis, to avoid the embedded racist stigma in the “M” word. In his colorful prose belittling the therapeutic effects of cannabis, Mr. Gladwell does not mention that, to date, after thousands of years of use, there has not been a single documented death solely from cannabis overdose.
When I first started working on this rebuttal, I focussed only on The New Yorker article, but soon found it referenced an Opinion piece in The New York Times by Alex Berenson, who was flogging his sensationalist new book:Tell Your Children: The Truth about Marijuana, Mental Illness and Violence. Others have called Berenson’s writing “scare mongering” and a replay of the movie Reefer Madness which is the basic tone of his NYT column. Harry Anslinger just sat up in his grave, saying “You called?” Regarding this, the Times fact checkers also slept at the wheel. Both the book and the OP-Ed piece have become quite controversial. Berenson also bases his book on the NSA Cannabis Report, but he totally distorts its conclusions. This has resulted in a social media kerfuffel, where one of the main authors of the NSA report tweeted that Berenson totally misinterpreted their conclusions.
Berenson states baldly that “cannabis causes psychosis; psychosis causes violence; therefore cannabis causes violence”. According to Berenson, cannabis also “causes schizophrenia”. The main violence here is to the scientific method, the reputation of The New Yorker and of the “Paper of Record” (NYT). The ethics of the authors are already questionable. The NSA Report specifically states that there is no basis in the data for causation. Rather it says there is “strong statistical evidence suggesting an association” between cannabis use and psychosis and there is also a suggested association with schizophrenia. Apparently, the writers need to be reminded that “association” or even “co-relation” is not causation. The Report goes on to say that the data is insufficient to determine the directionality of this association, meaning that it is just as likely that psychosis/schizophrenia leads to cannabis use as it is the other way round. Possibly, the subject was desperate for relief and would try anything.
It is important to note that The Report is not a clinical study of patients taking controlled doses in a controlled medical environment. This is a “meta data” analysis, that is “a study of other studies”. It is Social Science not a Medical experiment and the scientists note that there are major problems with combining data from numerous studies looking at different medical problems, employing different methodologies, especially where the data is self-reported.
They also stipulate that isolating the determining effect of cannabis use alone is nearly impossible because there are so many factors to monitor, such as age, gender, socio-economic status, neighborhood, family alcohol and/or tobacco use. In fact, they state that tobacco use is as good a predictor of psychosis, of schizophrenia and even of cannabis use itself, as cannabis use is of predicting tobacco use or mental illness. In other words, the scientists are admitting that they cannot definitively state what influences what, much less what causes these mental conditions.
As for the long history of medicinal cannabis use, those who take the time to read the NSA report will learn that archeologists have found traces of cannabis use in the Holocene era, about 8000 years before the present. The Report notes that there are references to its medical use by the Scythians from 900 BCE, by the famous Greek historian Herodotus. It mentions the the famous Study in the 1840’s by Dr. William O’Shaughnessy, who describes the multi-thousand year traditions of cannabis medicine in India.There was a 3,200 page report published in 1894 by the Indian Hemp Commission, also studying cannabis use in British India. In addition, there are several studies of cannabis use in the United States. In 1860 the Ohio State Medical Society published a compendium of all the known medical uses of cannabis. The Laguardia Report from 1944 and the Shaffer Commission report from 1972, authorized but suppressed by Pres. Nixon, both found no great harm from cannabis consumption and both explicitly stated it was non-addictive and not a gateway drug.
And we shouldn’t forget the stereotype challenging book by Jack Herer: The Emperor Wears No Clothes, in which he provides a list of the medical preparations containing cannabis for which the U.S. Patent Office has granted a patent. He also references Chinese medical formulas using cannabis, that are thousands of years old.
In the National Academy of Science Report referred to, a quick glance at Chapter 4, Therapeutic Effects of Cannabis and Cannabinoids, p. 85, reveals the following statement:
- In adults with chemotherapy-induced nausea and vomiting, oral cannabinoids are effective antiemetics.
- In adults with chronic pain, patients who were treated with cannabis or cannabinoids are more likely to experience a clinically significant reduction in pain symptoms.
- In adults with multiple sclerosis (MS)-related spasticity, short-term use of oral cannabinoids improves patient-reported spasticity symptoms.
- For these conditions the effects of cannabinoids are modest; for all other conditions evaluated there is inadequate information to assess their effects.
This does not seem like a lot of maybes, and even the “maybes” for other conditions are there because of “inadequate information”, not necessarily because cannabis doesn’t do what its beneficiaries claim it does. The usefulness of cannabis is further itemized at the end of the Chapter, on p. 128, where the known medicinal effects are reaffirmed:
There is conclusive or substantial evidence that cannabis or cannabinoids are effective:
- For the treatment of chronic pain in adults (cannabis) (4-1)
- As antiemetics in the treatment of chemotherapy-induced nausea and vomiting (oral cannabinoids) (4-3)
- For improving patient-reported multiple sclerosis spasticity symptoms (oral cannabinoids) (4-7a)
There is moderate evidence that cannabis or cannabinoids are effective for:
- Improving short-term sleep outcomes in individuals with sleep disturbance associated with obstructive sleep apnea syndrome, fibromyalgia, chronic pain, and multiple sclerosis.
In explaining the causes of the inconclusive evidence supporting the beneficial effects of cannabis, the NSA report devotes a whole chapter (18 pages) to the barriers to research and the sources of inaccuracy and inconclusive results. Mr. Gladwell never mentions this.
“p. 127 …there are common themes in the type of study limitations found in this evidence base. The most common are limitations in the study design (e.g., lack of appropriate control groups, a lack of long-term follow-ups), small sample sizes, and research gaps in examining the potential therapeutic benefits of different forms of cannabis (e.g., cannabis plant).
Aside from the problem that it has long been and still is federally illegal, the few approved studies have had such restrictive and elaborate protocols for procedures and security, it discourages researchers from risking funding for other projects. Further, until this NSA report and recent changes in the federal regulations, the government mandate to the National Institutes of Health was to find the negative and harmful effects of cannabis, not its beneficial effects. Let the record show, that after decades of trying to find something negative about cannabis use, the most harm researchers were able to document was from the heat of the smoke drying the mucous membranes, not from the chemistry of cannabis itself.
From the point of view of a cannabis cultivator and a judge in the Emerald Cup, the most problematic feature of government controlled research and probably the core reason for inconclusive results, is the requirement that researchers only use cannabis grown and provided by the “pot” garden at the University of Mississippi. This cannabis crop notoriously tests out at 3% THC or less and there would presumably be only trace amounts of CBD. This stuff would be laughed off the street and rejected at any dispensary, where 20% THC or 20% CBD and high potency concentrates (up to 90% THC) are readily available. Any research using this Ole Miss poor quality material is basically invalid, because it is such low potency and it is not what the public is using.
Further, in the last few years the importance of terpenes to the therapeutic effects of cannabis has become increasingly recognized. Any research ignoring the contribution of terpenes is basically meaningless. Two cultivars may have a similar cannabinoid content, but only one will be therapeutically effective because it has a unique terpene profile. If the experimenter is not using the same cultivar/chemovar used in the previous experiment, they will not get the same results.
Heretofore, the usual argument against cannabis as a medicinal substance was that there were no scientific double blind tests, as required for regular pharmaceuticals. Curiously, the Report mentions the difficulty in finding a placebo that is not obviously a substitute, because those who smoke or ingest the real thing will always know it. Well, duh! That’s because it works.
The repeated argument by the poo-poo-ers and doubters, is that all the evidence for the medical power of cannabis is anecdotal and is therefore unscientific and thus unacceptable. On the contrary, there has been a great deal of conventional scientific experimentation providing evidence for the therapeutic effects of cannabis. This research is being carried out primarily in Israel, but also in Switzerland, England and Germany, where thousands of peer reviewed papers have been published. Almost none of this research was consulted for the NSA Report, as a quick perusal of the Reference Bibliography at the end of each chapter will attest.
Regarding the “anecdotal evidence”, at this point there are literally hundreds of thousands of testimonies, stories, anecdotes (call them what you will) from people all over the U.S. who swear that cannabis saved their life, totally relieved their pain, got them off of opioids or anti-depressants. The problem with these sensational stories in The New Yorker and the NYT is that many people who could be getting relief from their ailments will be scared away by this yellow journalism.
It is curious that one of the conditions for which the NSA Report found very limited or insufficient evidence is pediatric epilepsy. The news stories and videos documenting the dramatic life changing results for epileptic children as soon they began cannabis use have been so numerous it is impossible to ignore them. A number of conservative law abiding families have sold everything and moved to a state with legal medical cannabis in order to obtain this vital medicine for their children. It was the only substance that reduced their child’s epileptic seizures from ten a day to one every ten days or even one every ten weeks.
These people are not lying! They are not making this up! They do not need FDA test reports or clinical trials. They just know they are not nauseous, they don’t feel any pain, they can finally get to sleep, they can deal with PTSD, their son or daughter recovered from their concussion from playing soccer. And they know exactly which strain/cultivar is the one that works. The sales statistics now gathered from the legal retail markets reveal steady growth in nearly all ways of consuming cannabis, especially those particularly designed for therapeutic use. Given the choice, people purchase drugs that work, while having the least damaging, or in this case, the most favorable side effects.
Another weakness to the scientific data assembled in the NSA Report is the use of synthetic forms of cannabinoids, like Marinol and Dronabinol, rather than organic sungrown flowers or whole plant extracts, edibles and tinctures. Very few people actually use these artificial preparations precisely because they don’t work. In cannabis flowers there are more than 530 compounds, including over 90 cannabinoids and 30 terpenes. It is the “Ensemble Effect” of all the constituent molecules working together which brings the healing benefits. Isolating one or two of these compounds in hopes of discovering a “silver bullet,” the one ingredient that makes it happen, defeats the complex nature and power of this magnificent herb by negating the very quality of collective interaction between cannabinoids, terpenes, flavinoids, et. al., that brings the relief or cure.
Additionally, the amazing topicals, edibles and tinctures that are commercially available and bringing relief to thousands, are not being tested. Over the years, backwoods potion makers have been crafting and blending different varietals and chemovars of cannabis with traditional medicinal herbs, oils and other ingredients. These products and preparations harken back to the practices of ancient traditional medicine in Europe and Asia, whose medical texts reveal that cannabis was a go-to remedy and ingredient in nearly all herbal preparations. Something else not mentioned by the NSA or Mr. Gladwell or Mr. Berenson.
Neither the NSA Report nor the two writers mention the work of many doctors who regularly use cannabis in their practice and have witnessed first hand the amazing palliative and healing powers of Cannabis. For a brief review of the historically most important publications on medicinal cannabis see David Bienenstock’s blog on Leafly, “The Most Impactful Cannabis Studies of All Time.” Also Fred Gardiner’s O’Shaughnessy’s, The Journal of Cannabis in Clinical Practice, has the most up to date reports, particularly the work of Dr. Jeffrey Hergenrather and the late Dr. Tod Mirkuriya. I would urge NSA, Mr. Gladwell and Mr. Berenson to read these reports as well, as well as the fact checkers at The New Yorker and the NYT.
The good news is that once federally legal, true research at hundreds of Universities will begin in earnest. Much of this research will focus on delineating specific ratios of THC/CBD/+99 other cannabinoids and the unique terpene profiles that are found to be most effective for numerous medical conditions. Other research will focus on cultivation techniques for predetermining THC/CBD/ et.al., ratios and Terpene profiles for whole plant medicine.
The reason we do not have this information already, the reason that there is “insufficient evidence” for the therapeutic effects of cannabis, is that four score years ago cannabis was categorized as a Schedule One substance, with the lie that it had no medical uses. This is about to change as the World Health Organization is in the process of reevaluating cannabis and recommending that it be removed from the most restrictive category to enable research and access for consumers and patients. Hope Springs Eternal. Soon every human on the planet will have access to the most wondrous, magical, beneficial plant that Mother Nature has provided. That includes Malcolm Gladwell and Alex Berenson.