Welcome to a two part look at sloppy science reporting from Australias "premier flagship science programme"; Catalyst. In part one, we examine the falsehood and hype to spring from - of all things - a meta-analysis on cannabis use and psychosis, published in the Lancet in 2007.
In part two, we look at media responses that never made it into the mainstream moral panic presses where it was claimed one off cannabis use increased risk of psychosis by 40%. To make it worse, the moral panic button of increasing the drug classification severity of cannabis had been pushed progressively by UK politicians. The UK Advisory Council on the Misuse of Drugs advised against bending to rhetorical vote herding, citing lack of evidence to justify raising the classification of cannabis. That is their job, after all.
However, the UK public were... well, off their faces on hysteria. It was the Skyhook of illicit drug nightmare, the boogey plant, the alien intelligence... the "addictive killer skunk" whatdunnit. This was later explored by David Blunkett, former Home Secretary who said laws were being "toughened to appease the public". A public I might add that had been subject to tabloid insults on this topic for years. Remember The Independents "apology" of March 2007?
Back in 2008 Dr. Jonica Newby of ABC Catalyst chose to report on the Lancet article as if it really was the "final verdict" she very, very stupidly - for any scientist - promised. In Marijuana Madness Catalyst made a fair hash of the meaning of data - how we interpret science - around cannabis and psychosis. Their confidence was hatched on the back of this media hype in the UK and a growing chorus of old familiar panic merchants here.
Before we move on, I'd like to remind readers I object to naught but bad science, fear greatly that we shall fail heavy cannabis abusers due to false convictions born of bigotry, and in the process condemn thousands to a life of limited choices, social dependence, fruitless coercion/diversion/hospitalisation and prolonged marginalisation. Finally, it is the overstating of an already well known problem by our conservative guardians that has chilling consequences.
Even more final is that evidence rebukes in totality much of the contemporary promotion of panic. Bible propheteers and Young Earth Creationists, Drug Free Australia, recently published a range of fallacious conclusions drawn from a collation of junk science, biased science and obscure findings headed with the eye popping but intellectually repugnant title; "Cannabis - suicide, schizophrenia and other ill effects". Like all topics humans find suitable to the "evangelistic" approach, such biased and blinkered nonsense may well be cathartic for the anal retentive Thought Police amongst us. However to the professional it is evidence only that matters. And as cannabis and synthetic cannabinoid therapy continues to improve the lives of those fighting debilitating disease, it is no surprise to learn DFA have picked up their discriminating against our vulnerable.
Update- June 2009:
Synthetic Delta-9-THC can improve symptoms of schizophrenia. Regular readers may be familiar with the view held in the humble Firesnake Holeplex that the association between cannabis ingestion and psychotic illness is very complex. Specifically the relationship between Cannabidiol [CBD] and its proven role as an anti-psychotic. Could sufferers gravitate toward smoking for relief? Similarly, we know anandamide is lacking in individuals who experience psychotic episodes. ∆ 9-THC imitates anandamide. Again, could smokers gravitate for relief? The paper referenced above supports this view regarding ∆ 9-THC.
This Four Corners article references activity in the UK in late 2001. Despite Australian researchers favouring a cautious approach the facts have been distorted by drug-free proponents. Simply put, 'medicinal cannabis is a covert attempt to legalise cannabis by the back door'. No research, no pilot studies, no bipartisan discourse. A fact sheet here helps place things in context. The NSW cancer council have cautious information here. Ample information may be accessed here at the Medical Cannabis Information Service. In July 2003 Catalyst reported on the issue of medicinal cannabis.
The facts have been distorted quite successfully by the 'drug-free' moral guardians, many of whom stand to benefit financially and politically should we follow their pseudo-science beyond Creationism, miracle cures and adherence to scripture. Suffice it to say, evolution is not the only discipline under threat. Science in general is seen as an evil in dissonance to Gods word.
The Mental Health Council of Australia published Where there's smoke... cannabis and mental health, in 2006. It stressed the paucity of conclusive data. They concluded in part;
However, there is a more relaxed and arguably more common interpretation of the term ‘self medication’ that would strike accord with many consumers, carers and clinicians. This explanation states that people with psychotic illness use cannabis not to relieve the positive symptoms of their illness but to relieve unpleasant feelings or emotions - described in medical parlance as ‘negative symptoms’ - that may be a secondary result of their mental illness. Most people with schizophrenia would admit that cannabis use makes their hallucinations worse but research shows that a high proportion of people with schizophrenia use cannabis to cope with unpleasant feelings such as worry or boredom (Spencer in Castle & Murray, 004; Schofield et al, 006). If you also relax the requirement that the onset of mental illness must precede first cannabis use, the research does in fact support a version of the self medication hypothesis. [6. Motives influencing use of cannabis by people with psychosis: is there evidence for self medication?]
This is not the same as a conclusive "no, cannabis does not cause psychotic illness". Likewise, it isn't conclusive - or a "final verdict" the other way either. Indeed, reading the 1894 Indian Hemp Drugs Commission Report, one is reminded of similar observations heard today. Even when minuscule differences are found, such as a 0.00125% increased risk for cannabis smokers - as the Lancet reported, the Daily Mail screamed, "Smoking just one cannabis joint raises danger of mental illness by 40%". Then Fox, then the NHS, then the BBC.... viral panic over simply absurd fabrications. See below for clairification.
As with media worthy meta-analyses this was presented as "new data" here in Australia, and across the globe. However a meta-analysis can only "find" what it analyses. In this case cannabis and psychosis association. The Lancet published their don't miss it media blurb, Cannabis use and risk of psychosis in later life on Friday, July 27th, 2007. See page one of thirteen,
The most important problems in studying the relation between cannabis use and psychosis are reverse causality and the transitory intoxication effect.
If individuals with imminent psychotic disorder start to use cannabis to alleviate symptoms, the psychosis could be causing the cannabis use, rather than the other way around. In most of the studies included in the present meta-analysis, Theresa Moore and colleagues were able to adjust for the effect of psychotic or imminent psychotic symptoms and they were able to ensure that psychotic outcomes were not due to the transitory effect of intoxication. In observational studies, even the most thorough analysis cannot definitely rule out the possibility that confounding or bias can be responsible
for the association between cannabis exposure and psychotic symptoms. However, in the present paper, the assessment of adjustment for confounding factors and transitory effects of cannabis intoxication is done more thoroughly than in previous reviews, and the odds ratio results for psychosis are more reliable and also more modest than seen in previous publications.
We therefore agree with the authors’ conclusion that there is now sufficient evidence to warn young people that cannabis use will increase their risk of psychosis later in life.
Oh my! The Lancet meta-analysis authors actually wrote the words "could cause...". But we see in the media release; it "will cause...". So er, which authors do they agree with? Technically, none, zip, nada, nill. A mis-trial if ever I saw one. Remember, this sad monotone topped the news releases. A meta-analysis topping media announcements? A false claim circulated to tens of thousands of trash tabloid journalists? Editors dance over submitted works for months but can't proof read their own jottings? Sigh. The future of funding research journals looks set to be complicated.
We can confirm of course the authors own summary. Or if you check page four of thirteen you'll find the original text of the Lancets meta-analysis paper entitled, Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review.
Whether cannabis can cause psychotic or affective symptoms that persist beyond transient intoxication is unclear. We systematically reviewed the evidence pertaining to cannabis use and occurrence of psychotic or affective mental health outcomes.
The evidence is consistent with the view that cannabis increases risk of psychotic outcomes independently of confounding and transient intoxication effects, although evidence for affective outcomes is less strong. The uncertainty about whether cannabis causes psychosis is unlikely to be resolved by further longitudinal studies such as those reviewed here. However, we conclude that there is now sufficient evidence to warn young people that using cannabis could increase their risk of developing a psychotic illness later in life.
So, however impressive the data we cannot ignore the language. "We conclude there's now sufficient evidence to warn young people that using cannabis could increase their risk of developing a psychotic illness later in life". This is a long way from claiming as did Jonica, "the data's in".... "final verdict".... "couldn't find psychosis because we'd been looking in the wrong places...". Compare this hypothetical statement as representative of a "final verdict":
World health authorities, acting upon conclusive data, replicated across the globe, have taken proactive measures to inform all adolescents, their parents, schools... that the use of cannabis will result in a serious case of intractable schizophrenia at a later period in life.
My point is semantic trickery. Observe: "Now there's sufficient [not lots, an abundance or irrefutable] evidence to warn [not act to stop/prevent] ... could [not will, or will if...] increase their risk" [not certainly raise by Y percent], is pretty tame. Apart from young adults laughing in the face of risk it sure isn't saying X Will Be The Case. In fact causality is not ever shown. What else is at play here?
In Will one joint really make you schizoid?, Maia Szalavitz makes a calm, rational case;
Watching the media cover marijuana is fascinating, offering deep insight into conventional wisdom, bias and failure to properly place science in context. The coverage of a new study claiming that marijuana increases the risk of later psychotic illnesses like schizophrenia by 40% displays many of these flaws.
What are the key questions reporters writing about such a study need to ask? First, can the research prove causality? Most of the reporting here, to its credit, establishes at some point that it cannot,though you have to read pretty far down in some of it to understand this.
Over at Bad Science the heading was Blah blah cannabis blah blah blah, hinting at the authors opinion of junk science reporting:
You know when cannabis hits the news you’re in for a bit of fun, and this week’s story about cannabis causing psychosis was no exception. The paper was a systematic review and then a “meta-analysis” of the data which has already been collected, looking at whether people who smoke cannabis are subsequently more likely to have symptoms of “psychosis” or diagnoses of schizophrenia....
So what are we really missing? It's true the crudely labelled "COMT gene" got a mention. The caper here is reasonably basic. Catechol-O-Methyl Transferase is an enzyme that catalyses neurotransmitters such as dopamine, norepinephrine, epinephrine... in fact the catecholamines. In managing the 'building blocks' and blueprint of dopamine, this enzyme must be specific. Humans with a polymorphism [different gene] switch one amino acid in building the enzyme. How do people develop this enzyme? They inherit two recessive gene copies from their parents. Why don't their parents have problems? They [almost exclusively, unless carrying two recessive copies] have a regular gene which is dominant. Upon conception it's the two recessives that make the grade in certain people.
The imperfect blueprint [gene] leads to a subtle difference at the molecular level, issues with psychosis, executive functioning and some subtle neurocognitive effects. Despite the carry on, cannabis ingestion is not certainly going to lead to psychosis. The COMT variant also relates to "being alive" and "length of time being alive" as compounding the onset of psychosis. My guess is if you're alive - indeed the longer you're alive - the greater the chance of smoking cannabis. No, I'm not dismissing it in a frivolous manner, but will not ignore simply existing with the COMT polymorphism is itself a fast-track to psychosis. So, how?
Well, the gene 'blueprint' that builds the Catechol-O-Methyl Transferase enzyme isn't written perfectly in the polymorphism form. In fact it uses the amino acid called valine where it should use methionine. It can still break down dopamine but at four times the rate, leaving the dopaminergic synapses less stimulated. It is this lower or shorter sustained neurodynamic effect in the post synaptic neuron that is associated with cognitive deficits. In the true fashion of neurokinetics and the resultant neurodynamic effect, note here it is less dopamine - not more - that is the problem.
In all "cannabis and psychosis" ranting we are told it is excessive dopamine that is the cause. Then there's the truly concerning fact that we seek to increase with medication, dopamine levels in Parkinsons patients. We give them COMT inhibitors. These drugs "save" dopamine building blocks like Levodopa from being broken down by the COMT enzyme and in all these years, not one episode of induced psychosis has been recorded in these populations. Still, the blinkered view of trouble makers like Cohen - who admits colleagues scream abuse at him - knows no bounds. This - IMHO - may lead to insouciant assumption or generalisations that colour our willingness to be open minded. Viz a viz:
Dr Cohen: This is where dopamine is pumped out into the midbrain. In fact too much dopamine in this area is called the wind of psychotic fire.
Jonica: What a great name.
Dr Cohen: And antipsychotic medications block dopamine in this region and ameliorate psychotic symptoms.
Jonica: OK, so the mechanism is actually really clear, that this is how cannabis causes psychosis.
Dr Cohen: That’s right.
Could it be a case of ill people smoking cannabis to obtain the antipsychotic, CBD, as medicine? Could it be the role of THC in mimicking anandamide - the "bliss molecule"? What of the relationship then of reduced anandamide in psychotically ill humans and the provision of "analogue anandamide" [THC] and anti psychotic CBD only found in cannabis? Despite the junk science behind so called studies into cannabis potency, could it be the documented fact that hydroponic cannabis has an imbalance in the THC/CBD ratio, favouring THC? Could it be ratios of many cannabinoids that mimic endocannabinoids, more than a single molecules concentration at play here?
Surely, we must have an epidemic if as Newby claims, we "haven't been looking in the right places". It turns out Jonica Newby of ABCs Catalyst programme was misleading viewers. The "right place" was actually psychotic patients. My, what a surprise.
And what did we find? This is not a dismissal, but a clarification. According to the Lancet itself the "dose response correction" makes this rather special science. According to reported data, the UKs 6.2 million cannabis smokers presented 800 schizophrenics who would not be thusly afflicted if they never smoked cannabis.
Ergo; 0.00125% of cannabis smokers make up Jonica Newbys "final verdict". Or perhaps cannabis smokers should know that 99.99875% of them will not develop schizophrenia.
In part two we delve deeper into the facts and the reporting of the opposite conclusions.
Related articles here.
Gags,
24 MB. 01.09.18
