The Subprime of Ms. Jane Brody

We are coming up on the 25th anniversary of the Election Day on which California voters legalized marijuana for medical use. Expect a wave of self-congratulation from the activists who went on to legalize the herb for “recreational” and “adult” use in the Golden State and beyond. To these proud reformers, “legalization” is a great advance over “medical use.” They don’t seem to care that for all these years, neo-prohibitionists have managed to severely limit the list of medical conditions for which cannabis is deemed helpful by Capital-M Medicine.

The neoprobes don’t want congratulations, except from the pharmaceutical companies and government agencies that fund them. “Recreational use” is less costly to Big Pharma and Wall Street than “medical use” would have been had it not been severely constrained. If US doctors were routinely recommending cannabis instead of SSRIs like Zoloft, for example, the bottom would have fallen out of the anti-depressant market. Instead, sales continue to soar. According to the CDC, “During 2015–2018, 13.2% of adults aged 18 and over used antidepressant medications in the past 30 days... Use was highest among women aged 60 and over (24.3%).”

Jane Brody provided another example pharmaceutical favoritism in her August 2 column on Irritable Bowel Syndrome (IBS).  Brody has been the New York Times “Personal Health” columnist since 1976. An influencer before they had a word for it, she anchors the Tuesday Science Section with a half-page column on page 7.

Despite the similar initials, Irritable Bowel Syndrome is not an Inflammatory Bowel Disorder. IBDs (like Crohn’s and Ulcerative Colitis) involve physical damage to the gastro-intestinal tract such as swelling or erosions. IBS does not. It is diagnosed by its symptoms, which can include pain, cramping, and —paradoxically— constipation or diarrhea. FDA-approved treatments are pushed tastefully on TV in 30-second dramas with happy endings: a pretty young woman has to leave her friends to find a bathroom. She can’t socialize, she’s very sad. Then she gets relief from Viberzi... (How do they come up with those names?)

Brody touts as “intriguing” research into whether IBS is a food-induced allergic disorder preventable by drugs that mute the allergic response. “Such remedies,” she writes hopefully, “would be a godsend for the 10 to 15 percent of adults in the United States with I.B.S. or other food sensitivities the gut.”

She plugs “a diet favorably alters the population of microbes that live in the intestines, reducing gas-producing bacteria that thrive on fermentable foods.” She informs her readers that “Cognitive behavioral therapy may benefit some patients, and many find it helpful to practice relaxation techniques like positive imagery, progressive muscle relaxation or meditation. Yoga and other types of physical activity may also diminish symptoms of I.B.S. and improve patients’ quality of life... Another soothing technique that can be done anywhere, anytime, to help relieve pain and stress is diaphragmatic breathing, the opposite of sucking in your gut.” 

Brody makes no mention of marijuana providing relief for people with IBS.

It has been 20 years since Ethan Russo, MD, suggested that Irritable Bowel and other treatment-resistant syndromes like Migraine and Fibromyalgia might be associated with an “Endocannabinoid Deficiency Syndrome.” His hypothesis was supported by cannabis clinicians documenting that patients ingesting cannabis reported symptomatic relief. 

Revisiting his hypothesis in 2016, Russo wrote that the endocannabinoid system (ECS) modulates the speed at which food is propelled through the gastro-intestinal system, “providing a rationale for cannabinoids as treatment candidates for IBS.” He noted that “Cannabis was one of the first effective clinical interventions in the 19th century for the intense secretory diarrhea associated with cholera,  a finding which was more recently validated with modern methodology.

“The use, by its sufferers, of cannabis-based agents to treat IBS has eventuated in large part due to the unfortunate fact that conventional treatment with anticholinergics, opioids, and antidepressants has been quite suboptimal.”

Jeffrey Hergenrather, MD, who practices in Sebastopol, has treated approximately a hundred patients diagnosed with Irritable Bowel Syndrome. He reports that “Symptoms of abdominal pain, excessive gas production, bloating and either constipation or diarrhea are all mitigated quite effectively with regular use of cannabis. Although CBD-dominant strains may prove effective, most of my successes have been with high-THC varietals.” (THC activates CB1 receptors in the gut that CBD does not act on directly.)

Icing On The Edible—

Unfortunately, Capital-M Medicine has mastered an amazing trick that can make Hergenrather’s >3,000 patients’ files disappear —even though they continue to exist as succinct case reports in Manila folders that fill a wall’s worth of steel cabinets in his Sebastopol office. Thanks to the amazing trick, their contents become invisible to all who, like Ms Jane Brody, “believe in Science.”  

The amazing trick is to define valid “evidence” so as to exclude patients’ records. In other fields of endeavor, evidence from primary sources —eye-witnesses— is coveted by experts seeking the truth. In Medicine, evidence from primary sources is scorned. The experts insist on filtering the truth until it’s to their liking. 

Earlier this year Brody wrote a column tsk-taking that “The medical marijuana industry lacks randomized controlled clinical trials that can clearly establish benefits and risks.” Her key source was the neoprobe editor of a 554-page tome entitled “Cannabis in Medicine: An Evidence-Based Approach.”