Pubdate: Sat, 01 Apr 2006
Source: CounterPunch (US Web)
Column: Pot Shots
Copyright: 2006 CounterPunch
Author: Fred Gardner
Note: Fred Gardner is the editor of O'Shaughnessy's Journal of the California Cannabis Research 
Medical Group.
Cited: Marijuana Policy Project
Cited: Tod H. Mikuriya, M.D.
Bookmark: (Cannabis)
Bookmark: (Tod H. Mikuriya, M.D.)
Bookmark: (Marijuana - Medicinal)


"There is no such thing as laziness. Laziness is only lack of incentive."

Norman Reider, MD

A graduate student in the psychology department at the University of 
Southern California, Sara Smucker Barnwell, has conducted a survey to 
assess whether or not cannabis use undermines motivation. She emailed 
a questionnaire to 200 undergraduates who had taken a course on drugs 
and human behavior, and to 100 acquaintances of a co-author, Mitch 
Earleywine, PhD, who in turn were asked to forward it to others. She 
got responses from some 1,300 people. She then analyzed the responses 
of everyday users (244) and those who had never used (243).

Barnwell's questionnaire comprised an "Apathy Evaluation Scale" and a 
"Satisfaction with Life Scale." Apathy was measured by 12 statements 
such as "I don't follow through on my plans" to which respondents 
gave their level of agreement ("Not At All, Slightly, Somewhat, Very 
Much"). Satisfaction was measured by agreement with five statements, 
including "If I could live my life over, I would change almost 
nothing." The mean age of the participants was 33. They were mostly 
Caucasian (79%), with a preponderance of them students. One in three 
frequent cannabis users described their use as medical.

Much of Barnwell et al's paper consists of statistical methodology 
involving "T-distribution," "heteroscedasticity," "controlling for 
unequal variances," "outliers (e.g. data points above/below three 
standard deviations)," "standard transformations (e.g. square 
roots)," "trimmed means," "alternative measures of effect size (the 
estimated measure of the degree of separations between two 
distributions)," "Cohen's delta calculations," "Pearson's 
correlations," "Welch's heteroscedastic means comparison," "Yuen's 
comparison of 20% trimmed means," etc. etc ...

The jargon is almost impenetrable, but it appears that statisticians 
allow themselves to discount "outlier" responses that don't jibe with 
the "central tendency" of the data. Barnwell et al's "robust 
statistical analysis" certainly makes their somewhat fuzzy survey 
seem supremely precise and worthy of publication in a peer-reviewed 
scientific journal.

But why quibble when they're "good on our issue?" Barnwell et al 
conclude: "Participants who used cannabis seven days a week 
demonstrated no difference from non-cannabis users on indices of 
motivation. These findings refute hypothesized associations between 
heavy cannabis use and low motivation ... Daily users reported 
slightly lower median subjective well-being scores (2 points less on 
a 28-point scale) ... Post-hoc tests find that some portion of the 
differences in subjective wellbeing arose from medical users, whose 
illnesses may contribute to low subjective wellbeing more than their 
cannabis use."

The authors acknowledge that their results may have been skewed by 
not taking into account respondents' use of alcohol and other drugs. 
They list some other realistic caveats and counter-caveats: 
"Participant reactivity to questions of motivation may pose an 
additional confound. Despite a lack of empirical evidence supporting 
amotivational syndrome, the popular concept is well known among 
cannabis users. Perhaps cannabis users demonstrate sensitivity to 
questions regarding motivation, exaggerating their own motivation in 
an effort to defy stereotypes. In contrast, users tend to attribute 
low energy and motivation to cannabis even when they use alcohol 
problematically, so there may also be a bias for cannabis users to 
report lower motivation. Further, collecting data via the internet 
may prevent some low education or low income individuals from 
participating. Others may feel uncomfortable reporting drug use 
online. Simultaneously, individuals experiencing low motivation may 
be more likely to participate in internet-based research rather than 
traveling to a laboratory."

Common sense tells us that the main motivator in this society is the 
prospect of remuneration. Millions of Americans, young and old, are 
destined to do unfulfilling work for wages that won't enable them to 
support a family let alone own a home and retire with a sense of 
security. To define our condition in terms of amotivational syndrome 
or apathy is to conflate symptom and cause, to individualize a social 
phenomenon, to medicalize the political. Anti-prohibitionists should 
turn the meaning of amotivational syndrome around and peg it for what 
it obviously is: a manifestation of socioeconomic hopelessness.

Barnwell's paper, "Cannabis, motivation, and life satisfaction in an 
internet sample," co-authored by Rand Wilcox of USC and Mitch 
Earleywine, PhD, of the State University of New York, was published 
in the online journal Substance Abuse Treatment, Prevention, and 
Policy Jan. 12. It was funded by the Marijuana Policy Project.

P.S. Have you seen the Jack-in-the-Box ad with the teenager in a van 
unable to decide what to order? He's all "Uhhhh" A little Jack figure 
on the dashboard comes to life and says, "Dude, why stress? Stick 
with the classics like my tacos ..." And the kid (who looks like a 
diminutive Troy Murphy) asks, "How many should I order?" And Jack 
says, decisively, "Thirty!" Which causes the kid to crack up: "That's 
what I was thinking!!!" Isn't 30 tacos just about what one of those 
teenage boys would think he could handle?

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Mikuriya to CSAM: "I Quit!"

Tod Mikuriya, MD, the prominent pro-cannabis clinician, has sent the 
following letter(s) to the California Society of Addiction Medicine 
and the American Society of Addiction Medicine:


As I contemplated whether or not to renew this year with the not 
unsubstantial dues, I asked myself "Why should I?" Over the years 
since I joined the organization I have tried to raise the possibility 
of a harm-reduction option for the treatment of alcoholism. 
Notwithstanding my repeated and persistent entreaties, I have been 
repeatedly denied any opportunity for a collegial and professional 
forum. I have even offered to make my patients available for 
questioning and review. Nothing. Lame excuses -not ready yet.

Forays into spiritualism with self-styled practitioners responding to 
the "spiritual needs" of addicts was particularly disturbing. Somehow 
I don't remember any training in medical school in theological 
studies. The blurring of boundaries and confusion of identity 
diminishes, attenuates medical leadership, and reduces professional 
credibility to cultism. Medical Review Officers conducting forensic 
examinations are not engaged in a medical activity. Preoccupation 
with urinary metabolites instead of actual fitness for duty further 
diminishes medical leadership and reduces ASAM/CSAM to corporate 
shills and trough feeders. Donald Ian MacDonald of ASAM -Reagan's 
drug czar-promoted piss testing along with Robert DuPont of Paraquat 
fame. The societies support the federal government's irrational 
drug-war policy while prominent addiction specialists seek to 
maximize their share of court referrals.

I officially give up on ASAM/CSAM and any possibility of a magical 
ethical transformation. I have been denied the opportunity to present 
a viable, effective, and medically appropriate intervention: cannabis 
as a substitute for alcohol and other addictive substances.

Retrospectively, I wonder why I waited so long to quit. I can no 
longer maintain my wishful thinking that somehow ASAM/CSAM could be 
fair, objective, professionally and medically correct.

I shall not be renewing my membership. Tod H. Mikuriya, M.D.

Member since 1974 Certified by ASAM 1986 MRO Certified by ASAM 1992

Dr. Mikuriya is feeling a lot better since a stent in his liver 
restored the flow of bile and proper digestion two weeks ago. Also, 
he has been released from "medical house arrest" (his term) imposed 
after a bacillus associated with TB was detected in a washing from 
his lung... He is working on several papers based on his clinical 
findings and observations and his hypotheses re mechanism of action; 
an electronic (and augmented) re-issue of his 1973 anthology, 
Marijuana Medical Papers; and a second volume focusing on what 
California doctors have learned in 10 years of seeing patients. He 
plans to resume seeing patients. April 9 Dennis Peron is throwing a 
party for Dr. Tod this Sunday, April 2, 1-6 p.m., at his house in the 
Castro. Told it was to honor his work, Mikuriya said, "To continue my 
work... a chance to pontificate!" Those wishing to support Dr. 
Mikuriya's various project can contribute to the CCRMG, a 501(c)(3) 
non-profit. The address is p.o. box 9143, Berkeley CA 94709.

Mikuriya strongly suspects that Lipitor, Pfizer's blockbuster statin 
drug, had a deleterious effect on the lining of his biliary tract. He 
was put on Lipitor three years ago to lower his cholesterol following 
coronary bypass surgery. He has had three patients who attribute 
similar adverse effects to Lipitor, including itching, a feeling of 
cold, and digestion problems.

A lawsuit filed last week by a Teamsters health-insurance fund 
charges that Pfizer execs promoted sales of Lipitor for off-label 
uses. The marketers certainly succeeded -since 2001 they've sold $46 
billion worth, including $12.1 million last year, making Lipitor the 
world's best-selling drug. The suit, according to the Wall St. 
Journal, "cites internal Pfizer marketing documents, Pfizer-funded 
studies and physician-education programs that encourage doctors to 
use Lipitor early in treatment, despite the risk of side effects in 
some patients. Pfizer says side effects with Lipitor are generally 
mild, such as stomach upset, but the drug has been associated in rare 
cases with muscle damage and liver problems."

"Rare cases" of a drug taken by millions equate to thousands of 
individual catastrophes. The pharmaceutical manufacturers claim that 
the benefits their compounds confer on many far outweigh the damage 
they cause a few. (The WSJ piece flatly asserts that Lipitor "has 
helped millions of people avoid or manage coronary artery disease, 
including heart attacks and strokes.") The sanctity of the individual 
- -which once received great lip service in this country-couldn't stand 
up to cost-benefit analysis.
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MAP posted-by: Richard Lake