Pubdate: Sun, 26 Jan 2014
Source: Houston Chronicle (TX)
Copyright: 2014 Houston Chronicle Publishing Company Division, Hearst Newspaper
Author: Matthew Poling
Note: Poling, a family practice physician and assistant professor at
Texas A&M Health Science Center in College Station, is the father of three.


On a rare blessed Monday when I arrived home from my medical practice
in time to watch the 5:30 p.m. news with my precocious 13-year-old
daughter, I abruptly found myself engaged in a conversation that, as
an American father, I never expected to have: Explaining to her why
the president of the United States was wrong to tell us that marijuana
use is "no more dangerous" than alcohol "in terms of its impact on the
individual consumer" and "not very different from cigarettes."

No matter what we may have concluded about the policy judgment of our
current president, I think we all believed he demonstrated sound
judgment as a father. But he has called even that into question with
his ambiguous theoretical (or perhaps, actual) advice to his daughters
that marijuana use would be "a waste of time." As if drug use was akin
to downloading an Angry Birds app or a Justin Bieber song.

The medical facts are more clear. Multiple peer-reviewed studies in
the U.S. and the United Kingdom demonstrate increased rates of severe
chronic mental illness like schizophrenia with the relative risk
increase in the 200 percent to 300 percent range, and this increased
risk applies to casual users or "experimenters," as well. While the
absolute risk is small, no such effect on the "individual consumer" is
seen with even chronic use of tobacco or alcohol.

Other less severe but more common psychiatric symptoms such as
anxiety, depression and insomnia are associated with even casual use,
and longer term use adversely affects cognition and memory and is
associated with many lung diseases and physical effects seen with
tobacco smoking.

With the media, celebrity doctors like CNN's Sanjay Gupta and now even
the president either celebrating pot's potential benefits or
minimizing its known risks, one must ask: Why such a disconnect on the
question of risk? I think the answer is bias. In this case, selection

Today's doctors, journalists, presidents and most of their social
circle who may have smoked pot when they came of age in the '60s or
'70s happened not to have suffered the ill effects of drug use
personally and thus assume, based on their small, unscientific sample,
that it must not be so bad. What parent who does their homework could
be anything but mortified by the potential for normalization of
illicit drug use in our society?

The association between marijuana use and social pathologies is well
documented. But, pot apologists claim that association is not
causation, which is true (for example, pot legalization would not be
expected to cause a football team to advance to the Super Bowl, even
though such an association exists) and that troubled people may turn
to drugs in an attempt to "self-medicate," making their condition worse.

Causation is very difficult to prove, a fact that allowed tobacco
companies to claim for decades that there was no "proof" that smoking
caused lung cancer and many smokers live to a ripe old age. But at
some point, associations are so strong that we must acknowledge that
the answer to the "which came first" argument is irrelevant, as the
cause of disease is usually multifactorial.

Drug legalization is first promoted by utilizing the Trojan horse of
"medical marijuana." Such a strategy coupled with heart-rending
anecdotes of human suffering can garner support from the left, right
and center. I might be more sympathetic to this agenda, too, if I had
ever encountered a situation where smoking pot would clearly do more
good than harm. Such clinical scenarios may exist, but after more than
70,000 encounters with patients in all walks of life carrying
diagnoses that span the spectrum of disease, I have yet to see it.
What I have seen is myriad mental health problems triggered or
worsened by pot use.

The mixed message here is of particular concern as the typical
consumer of health information approaches such issues simplistically.
Is Vitamin D good for me or not? Should I be eating oily fish or
avoiding them? This is certainly more true for the adolescent
population where an ambivalent message will do the most harm.
Hippocrates' 2,400-year-old advice still applies: First, do no harm.
Or let's at least be certain we're doing more good than harm. This
principle should be applied not only to the individual patient but to
the public health.

An August Quinnipiac poll of Colorado voters predicts a 40 percent
increase in pot use with legalization. The most recent National
Institutes of Health survey shows that 6.5 percent of high school
seniors smoke marijuana daily, up from 5.1 percent five years ago,
while use of tobacco has declined. Only 44.1 percent see regular use
as harmful, the lowest since 1979. Message received. It is not the
sign of a healthy culture that we have become more concerned with what
goes into children's lungs than what goes into their brains.

Decriminalization also finds support from libertarians who claim that
we have "lost the war on drugs." Except that we don't really know how
much more drug use there would have been without such efforts. We may
eventually find out in the statewide drug legalization experiments
taking place now. Such experimentation might be a worthy scientific
endeavor, were today's youths not the guinea pigs.

Perhaps you've heard that it isn't harmful because it isn't addictive.
First, you will note that it has a remarkably committed following for
a drug that supposedly isn't. Research shows addiction potential with
marijuana. Even if it weren't addictive, it is a misconception that
drugs are harmful only because they are addictive. If that were the
case, caffeine use would be our No. 1 public health concern. Illicit
drugs are harmful because of their effects on the brain.

Fortunately, studies show that when teens rank those who have the most
influence on their decisions, politicians and media personalities
barely register. Parents consistently rank as the most influential
people in their lives and by a wide margin. A clearly communicated
expectation that drug use of any kind should have no place in their
lives is the best protection we can give them.

Unfortunately, it is clear that our culture and leaders will be giving
us little help. While I'd hoped that the after-work topic du jour
would be her new braces or Martin Luther King Jr., I found there was
one more consultation needed and administered a dose of parental love
and preventive medicine. I pray it will be enough. 
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MAP posted-by: Jo-D