Sanjay Gupta’s Mea Culpa
by Fred Gardner, August 20, 2013
Dr. Sanjay Gupta, neurosurgeon and medical advisor to the masses, doesn’t want to be on the wrong side of history. On August 11 Gupta narrated a “Special Report” on CNN that provided dramatic examples of Cannabis exerting beneficial effects. In the days before it aired he made media appearances to apologize for his role in having “systematically misled” the American people about marijuana.
Who can change opinions, prejudices, too — cover them in science in an interview? The Sanjayman! The Sanjayman can. The Sanjayman can ’cause his head is on straight and the world’s gone wrong.
The carefully produced show, entitled “Weed,” included more than a dozen interviews conducted at locations from Colorado to Israel. It opens with Gupta visiting young parents named Matt and Paige Figi, whose 5-year-old daughter Charlotte is afflicted with Dravet Syndrome, a severe form of epilepsy. The parents are totally straight, never used marijuana, he’s an officer in the Army's Special Forces, they live near Fort Carson.
The Figis recount how Charlotte’s condition worsened as every conventional treatment failed. She was having hundreds of seizures per day and the doctors were considering inducing a coma to save her life. Dad, deployed to Afghanistan, researched epilepsy treatments on the web and came across the “WeedWars” segment in which a father reports to Andrew DeAngelo of Harborside Health Center that the CBD-rich herbal extract is working, his son’s seizures have been dramatically reduced!
The Figis buy $800 worth of CBD-rich cannabis at a dispensary and a friend helps them extract the medicine for under-the-tongue application to Charlotte. Her seizures go down to one-a-week and she begins recovering!
As the parents are running out of medicine they are introduced to the Stanley Brothers, six clean-cut young men who look as if their parents gave them a ranch — or six ranches. Gupta tells us the Stanleys grow 600 pounds a year for dispensaries they own. Track with Gupta and Josh Stanley to a large greenhouse full of small cannabis plants beginning to flower. Josh points to one and says, “There’s nothing like this in the world. This plant is 21 percent CBD and less than 1 percent THC.”
Gupta says, admiringly, “It took years of crossbreeding plants to get to this point.” Josh explains, “Instead of breeding up the THC, we’ve bred down the THC and bred up the CBD, and people said, ‘You’re crazy.’ You know, ‘Who is going to smoke that?’”
Who will take a greenhouse, wrap it in a sigh — Soak it in the sun and make a CBD pie? The Sanjayman! The Sanjayman can. The Sanjayman can ’cause he mixes it with facts and makes the truth taste good.
But the truth Gupta told his CNN audience from the Stanleys’ greenhouse was partial and misleading. As Josh modestly accepted credit for introducing CBD-rich cannabis to America, it was as if California had never happened. Did we just dream up those two daredevils in Emeryville in the winter of 2007/08, David Lampach and Addison DeMoura, trying to get the hang of gas chromatography and launch a lab aptly called SteepHill? They were testing samples of herb brought in by growers for Harborside, whose visionary honcho, Steve DeAngelo, was underwriting the lab. They didn’t grasp the significance of the first CBD-rich sample they tested. It had been brought in by an activist, Karen B., who didn’t really know from which plant that “Women’s Collective Stinky Purple” came from.
But by the spring of 2008 all concerned were on the lookout for CBD-rich strains, and SteepHill lab was finding that about one in 700 samples contained more than 4% CBD. Martin Lee and I would contact the growers (some of whom were disappointed that their plants were low in THC) and assure them that there would be great demand for CBD in due course. Of course “In due course” doesn’t pay the rent, which is due in the now.
Nor did Gupta mention the pharmaceutical entrepreneur who was first to grasp the medical and the political significance of CBD: Geoffrey Guy, MD, founder of G.W. Pharmaceuticals, the British company that got Home Office approval in 1998 to produce Cannabis-based extracts containing equal parts CBD and THC. GW’s progress, reported in the AVA for more than a decade, has helped guide U.S. physicians, horticulturists and extract producers. The story of how CBD-rich medicine became available has been told in O’Shaughnessy’s, and the ongoing story is being reported at ProjectCBD.org. The unsung heroes include Rick Pfrommer, Rachael Smajdza, and Caroline Francese of the Harborside purchasing department, and Steve DeAngelo, the enlightened capitalist who didn’t try to monopolize the rare strains.
Gupta and his producers should have known that Cannabis plants with high CBD-to-THC ratios have been bred in California — including a 23:1 CBD-t0-THC “AC-DC” plant that's also been dubbed “Oracle.” Lab tests indicate that the 25-to-1 Charlotte's Web, Oracle, and AC/DC have almost identical terpenoid contents, indicating similar lineage. These plants, according to Allan Frankel, MD, “have zero psychoactivity and are great for initial therapy for seizure disorders and for patients very sensitive to THC. It is very calming and great for anxiety or racing minds. Very little 'cerebral changes,' if any, are noted.” California's Statewide Collective anticipated demand and makes Oracle available as extracts or vaporizer pens. “The CBD-rich vape is great for asthma and other pulmonary conditions,” Frankel has observed. And now back to our show.
Gupta quickly recounts the history of U.S. marijuana prohibition, pegging Harry Anslinger, Commisioner of the Federal Bureau of Narcotics, as the prime villain. Carl Hart, an assistant professor of psychology at Columbia University, says, “This guy saw how he could increase the budget of his department by having this mission, going after marijuana.” No arguing with that — and no time to discuss Anslinger’s ruling-class backers.
Gupta makes clear the connection between marijuana prohibition by the U.S. government and the actual suffering of U.S. citizens. He says, “By 1970 it was a schedule one controlled substance. The government was saying it had no medicinal value and had a high potential for abuse. All reasons why the Figis stayed away from marijuana. Until this…” Cut to the little girl having a seizure. “The seizures start during the first year of life and are unstoppable. Difficult to control and very damaging,” Gupta says. The Figis tried every conventional medication to no avail. Gupta: “Her body was so frail that any seizure could kill her. With no traditional treatment left to try and the clock ticking away, her parents decided to try marijuana.”
Paige explains that in Colorado you need two doctors to approve use by a child. “We were the first young child and they said ‘no.’ Everyone said ‘no, no, no, no.’” Until the Figis found Alan Shackleford, MD, a physician Gupta describes as “Harvard-trained” and “among a handful of doctors in Colorado who give prescriptions for medical marijuana.” During Shackleford’s initial examination, Charlotte had two seizures.
“There were no more options for her,” Shackleford tells Gupta. “Everything had been tried, except cannabis.” There is an implication — probably a result of the editing and not the view of Shackleford — that it’s appropriate for doctors to prescribe and patients to fail on every pharmaceutical on the market before cannabis becomes an option. This is a protocol that doctors in the Society of Cannabis Clinicians have objected to strongly. See Cannabis as a First-Line Treatment for Childhood Mental Disorders by Tod Mikuriya, MD.
Gupta misspeaks when he says, “Marijuana is made up of two ingredients — THC, that’s the psychoactive part that makes you high, and CBD, also called cannibadiol. It is the CBD that scientists think modulates electrical and chemical activity to help quiet the excessive activity in the brain that causes seizures.”
Marijuana is made up of hundreds of compounds. Its active ingredients include terpenoids, flavonoids, and many cannabinoids other than THC and CBD. The effectiveness of CBD may be enhanced by the presence of other compounds found in the plant.
The second patient interviewed by Gupta looks like he was sent by Central Casting in response to a request for a 19-year old stoner/skateboarder. Gupta says, “Meet 19-year-old Chaz Moore. He uses many different strains of marijuana. Many of them high in CBD to treat his rare disorder of the diaphragm.”
Chaz lifts up his shirt to show a two-inch wide band of muscle contracting and releasing. He speaks in staccato words instead of smooth sentences. “My abs will like lock up…”
“It’s called myoclonus diaphragmatic flutter,” says Gupta. The condition becomes painful if it lasts for 15 minutes or more. After convulsing for seven minutes, Chaz draws on a glass pipe. The relief comes in less than a minute, and it’s clearly visible: the muscle that had been fluttering is relaxed and normal. Also, his speech comes in flowing sentences.
Chaz reminds Gupta that when his condition was being treated with pharmaceuticals, he would have been too loaded to take part in an interview. Chaz’s father Sean says, “I’ve watched friends of mine die from taking the same drugs that he took… His quality of life now is a thousand times better than what it was when he was on the pharmaceuticals.”
GUPTA: Sean is not scared of marijuana and neither is Chaz.
CHAZ: This right here, I don’t get sick off of it. I can’t overdose.
GUPTA: And Chaz is right about that. While there are fatal accidental prescription medicine overdoses every 19 minutes in this country, there are virtually no reports of fatal marijuana overdoses.
The Chaz Moore episode is as powerful a consciousness-raiser, in its own way, as the baby with epilepsy. It implicitly reminds viewers that the seemingly able-bodied young man emerging from the dispensary with a baseball cap on backwards might have unseen problems.
Fairness & Balance
After showing that cannabis abates the terrible symptoms of Charlotte and Chaz, Gupta asks “But what was it doing to their brains?” Dr. Julie Holland, author of “The Pot Book,” lists possible adverse effects: “You can you get paranoid, you can have disorganized thinking. You get disoriented. It can be uncomfortable. It can lead to panic attacks or anxiety attacks in people.”
Dr. Carl Hart, an assistant professor of psychology at Columbia, says the effects he has observed include “disruption in memory, disruptions in inhibitory control. They will become slower at cognitive functioning… These effects are temporary, but they’re pretty pronounced.” Gupta asks about the effect on driving. Hart says, “You may prematurely hit your brakes. You may prematurely hit the gas pedal. A wide range of things. You may make a turn without looking more carefully.”
Just when you think they’re heading for a simplistic definition of impairment based on cannabinoid levels in the blood, Gupta and Hart swerve adroitly. Gupta says that the part of the brain most affected by marijuana is the prefrontal cortex.
HART: It’s very important for planning, thinking, coordinating your behaviors. There are tons of marijuana receptors in this region and we think that marijuana, particularly in the novice, can disrupt all of those behaviors… Turns out when you test people who have a lot of experience with cannabis, you don’t see many disruptions, but if you test people who have sort of limited history with cannabis, you can see some clear pronounced disruptions.
GUPTA: Look at this experiment done by CNN affiliate KIRO in Washington state. Subjects smoke marijuana and then drove. One was a daily medical marijuana smoker and another an infrequent weekend smoker… The more the novice user smoked, the more trouble behind the wheel. (Footage of the novice subject driving with a supervisor who says “Watch yourself. Watch yourself.”)
GUPTA: But interestingly, the habitual smoker didn’t have as much trouble… And that’s something I witnessed firsthand driving around with 19-year-old Chaz Moore. The day that I spent with him, he had been smoking all day long. (over footage of them in a car with Chaz at the wheel) Do you feel impaired at all?
Chaz: No, I don’t. I feel normal.
This is an extremely important reality — heavy users tend to be unimpaired by their daily dose — and Gupta demonstrates it vividly.
Gupta travels to McLean’s Hospital, New England headquarters of the Psychiatric Establishment (a wholly owned subsidiary of Big PhRMA), to interview Dr. Staci Gruber, who can’t help batting her eyes at the handsome neurosurgeon. Staci is a PhD, not a medical doctor, and, as director of McLean’s Brain Imaging Center, an expert in the re-emerging field of Phrenology. (Every neuroimaging study on cannabis that claimed some anatomic change has later been refuted. The neuropsychological data show changes in heavy smokers, but with return to normal after 30 days of abstinence.)
GUPTA: She’s using high-tech imaging to see what happens in the brain when you smoke.
GRUBER: What we see is a very big difference in people who begin to smoke prior to the age of 16 and those who smoke after age 16. What we call “early” versus “later onset.”
GUPTA: Gruber’s brain scans show that the white matter — those are the high waves that help the brain communicate from one point to another — are impaired in those who start smoking early.
GRUBER: Maybe that there’s underlying white-matter-conductivity differences.
GUPTA: Those white matter highways are just more disrupted in people who start smoking early.
GRUBER: That’s what we see.
GUPTA: Perhaps not surprising given what we know about the young developing brain.
NYU’s Julie Holland reappears, saying “That’s a very delicate time in brain development, and that’s not a good time to be taking any drugs.”
GUPTA: Preliminary research shows that early-onset smokers are slower at tasks, have lower IQ’s later in life, higher risk of strokes, and increased incidence of psychotic disorders. And while these studies are not conclusive, some scientists are still concerned because in 2012, 35 percent of high school seniors lit up, and that could mean a generation of kids with damaged brains. And many fear something else.
Cut to a teenager identified in the CNN transcript as “Joel Vargas, Addicted to Marijuana.” Joel tells Gupta, “I never really told myself I need help.” We wonder who told him. Probably dear old mom and dad.
GUPTA: A generation of marijuana addicts. When we come back, the truth and the science behind what’s being called a growing epidemic.
That’s a very bold claim, and Gupta does not make good. Dr. Holland defines the problem encountered by some: “There are people who compulsively smoke, who want to stop smoking, but they can’t stop smoking.” This is true — but it conflates those who want to quit because of social pressure and those truly in the grip of an inner compulsion. Gupta defines both subsets as “dependent,” and lumps them together with heroin and cocaine addicts! “In fact,” he says authoritatively, “nine percent of marijuana users will become dependent. Now that’s not as high as other drugs, like heroin — 23 percent of users become addicted — or 17 percent with cocaine, 15 percent with alcohol. But it’s still approximately one out of every 11 marijuana smokers.” This deceptive riff is accompanied by a graphic.
There’s nothing like a specific number to make an assertion seem like a fact. The “9-percent-become-addicted” line has been put out by the National Institute on Drug Abuse since the 1990s. It is supposedly substantiated by the number of people in marijuana treatment programs. But very few people go into treatment because they think they are impaired by marijuana. Most go because they’ve been forced to by a judge, an employer, a school, or a parent. For many so-called marijuana addicts who use the herb for pain or insomnia and go to work unimpaired, the real “problem” is the metabolite level detected in their urine. For depressed teenagers the real problem is the situation and/or environment they find so unbearable that they want to alter their consciousness every day.
Comes now (says the CNN transcript) “Dr. Christian Thurstone, Addiction Expert,” a painfully thin man who looks like he might have compulsivity issues around jogging. He tells Gupta flat-out, “There is no longer any scientific debate that marijuana is not just psychologically addictive, but also physically addictive.” Gupta does not say “How dare you speak in the name of science? There is no rigor whatsoever to your specialty.” Instead there’s a very brief shot of Thurstone with a teenager named Joel V., his Exhibit A.
THURSTONE (to Joel, as if he really cared): So give me an update. How are you doing?
GUPTA (in the foreground): Dr. Christian Thurstone runs one of Colorado’s largest youth substance abuse treatment clinics. The number of marijuana addicts he treats has tripled in the last three years alone.
THURSTONE (to Gupta in another setting): Literally I cried about it. Marijuana is number one on their list of priorities. They have dropped out of life… The prefrontal cortex, which helps people think ahead, control their impulses, that’s not fully developed until age 24. That explains why adolescents are much more vulnerable.
Sanity is restored somewhat when sensible Dr. Holland tells Gupta, “You know, for somebody like Joel, going into rehab is really about learning new behaviors more than it is about sort of treating the physiological dependence or tolerance or withdrawal issues.”
According to Gupta, “When you smoke pot, the feel-good chemicals that make up marijuana called cannibinoids, remember them? They cause your brain to stop producing its own natural cannibinoids. When you stop smoking, you have no feel-good cannibinoids of your own. Until your body kickstarts production, you feel lousy, so many people smoke again to feel better.” This is doubly inaccurate. Not every cannabinoid is a “feel-good” compound. And intake of exogenous THC (by smoking a joint, say) results in some down-regulation of the body’s THC equivalent, but nothing close to total depletion. See John McPartland’s thorough explanation in the Winter/Spring 2013 O’Shaughnessy’s.
Gupta travels to Oxford, Mississippi, to meet our nation’s only legal grower, Mahmoud ElSohly, PHD, who has named one of his several business operations “the Marijuana Potency Project.” ElSohly has a lucrative contract from the DEA to test samples of confiscated weed and another from NIDA to grow marijuana for those few U.S, researchers whose proposals for clinical trials get approved. NIDAwanna also goes to four surviving patients who got grandfathered in when the federal “compassionate” investigational new drug program begun under Jimmy Carter was effectively ended by George H.W. Bush in 1991.
We see ElSohly unlocking the enormously thick door of a vault that contains his aging stash. (Some of it has been in this vault for more than five years.) Gupta sniffs a baggy that ElSohly tells him is 8% THC. Then ElSohly hands him a fresh bud that they both obviously admire:
ELSOHLY: This is 36 percent THC. You can smell it. It has a good aromatic smell.
GUPTA: How much does this worry you — 36 percent THC?
ELSOHLY: Very, very dangerous material. If someone that is not experienced in marijuana smoking takes some of this, they’re going to go into the negative effects of the high — the amount of THC, the psychosis, the irritation, irritability, the paranoia, and all of this.
ElSohly is a scientist, and he should speak precisely. On occasion a novice may find strong marijuana unpleasant, but to say that “psychosis” is something that is “going to” happen to a novice who smokes marijuana is fear-mongering worthy of Harry Anslinger himself.
Gupta says that in 1972 the average potency of marijuana sent by DEA for analysis “was less than 1 percent THC. Now it’s nearly 13 percent.” ElSohly implies that these numbers describe an individual’s use pattern: “They’re starting out with a half a percent and 1 percent, and they get a good high, and then as they continue to use that, it doesn’t give them the same high anymore, so they see — you know, smoking more or high potency material.”
This image of tolerance building up, leading to ever increased craving, is just a bunch of hooey. People smoking marijuana for recreation and certain medical conditions (including pain and depression) want herb with high THC levels. Thus growers want to plant and breeders develop high THC chemovars. It’s obvious why the potency levels have built up over the years, and it’s a good thing if your concern bronchial irritation. High THC levels enable people to use less to achieve the desired effect. High-THC marijuana is not more addictive, it’s more potent.
Gupta didn’t call ElSohly on his duplicitous comment. In fact, he sort of endorsed it by saying “It happened to Joel Vargas. After a couple of years of smoking daily, Joel eventually ended up in rehab where he faced mild withdrawal symptoms like irritability, insomnia, nausea… Joel has been clean now for six months.” We don’t learn if Joel is skateboarding again, or happier.
The tightly scripted show included a visit to Israel, where the Ministry of Health seems to be supportive of — or perhaps even co-opting — the medical marijuana industry. Gupta says, “Here they have pioneered marijuana research. They were the first to isolate THC and CBD decades ago. And now the country’s ministry licensed 10,000 patients to use marijuana medicinally and has approved more than a dozen studies to treat illnesses like PTSD, pain, Crohn’s Disease, even cancer.”
We visit a nursing home where residents are using marijuana for pain, loss of appetite, Parkinson’s Disease, and other conditions. A 78-year old man with Parkinson’s demonstrates how a toke will stop his hand from trembling. The loss of his wife engulfed him in grief, but with marijuana, he tells Gupta, “You fly. You dream.”
Gupta wonders what’s preventing the obviously needed research in the U.S.. Julie Holland tells him, “The FDA has been great at approving studies. But the National Institute of Drug Abuse has been really stonewalling and blocking any studies looking at therapeutic effects of cannabis because that’s not their mandate. Their mandate is to look at the harms of drug use… What’s nice about Israel is that the government is helping the research to happen.”
NIDA director Nora Volkow (who happens to be Leon Trotsky’s granddaughter) won’t take the rap. “It’s very easy to blame an organization,” she tells Gupta. “If you would come up with a grant that says, ‘OK, this is going to be a treatment for drug addiction,’ then it would go to us. But if it’s cancer, it goes to the Cancer Institute. If it is schizophrenia, it goes to NIMH, so the institutes have a mission with certain diseases.”
The show ends back in Colorado, with Matt and Paige Figi sharing their appreciation of what CBD-rich marijuana has done for their Charlotte, and footage of the little girl walking, forming words, having her nails painted by mom, playing with her sister, riding on a pony! Her dad says, “I literally see Charlotte’s brain making connections that haven’t been made in years. It’s almost seeming to build her brain where before it seemed broken.”
Gupta says it straight to the camera, to America: “I can tell you, it was remarkable to see her progress. In the three months since we first met her, we saw a change. She was now talking more.”
The Stanleys have named their CBD-rich strain “Charlotte’s Web.” Gupta says, “More than 41 children are using Charlotte’s Web here in Colorado. All of them are reporting significant seizure reduction, and there are dozens more on a wait list, hoping, praying that a plant could change their lives. Just like it did for Charlotte.”
Fred Gardner is putting back issues of O'Shaughnessy's online at BeyondTHC.com.