‘Reefer Madness’ redux ignites pursuit of victory, not truth
Last week, former reporter Alex Berenson wrote a New York Times op-ed that urged caution on what he calls the “unstoppable march” toward marijuana legalization. Berenson warns about “large studies in peer-reviewed journals showing that marijuana increases the risk of psychosis and schizophrenia,” and goes so far as to claim, without persuasive evidence, that marijuana “appears to lead to an increase in violent crime.” The piece reads like a positive review of “Reefer Madness,” the “notorious 1936 movie that portrays young people descending into insanity and violence after smoking marijuana.” Berenson leans into this comparison: His new book is titled “Tell Your Children: The Truth About Marijuana, Mental Illness, and Violence.” There is nothing wrong with examining the health consequences of ingesting anything––aspirin, coffee, coconut oil––but when the substance is at the forefront of criminal justice reform, it seems irresponsible to conclude that marijuana’s risks are “no less real” than opioids’ risks, when the only thing that everyone agrees about is that far more research is needed before we can conclude anything, a point that Malcolm Gladwell emphasizes in his piece about Berenson’s book in the New Yorker. [Alex Berenson / New York Times]
As this Daily Appeal writer is constantly reminded by her father-in-law, Dr. Paul Marantz, a professor of epidemiology and population health, part of the problem is that correlation does not prove causation. This misconception has led to some “real errors,” he says, like the idea that estrogen given after menopause would decrease the risk of heart disease in women, when randomized trials actually found the opposite. Marantz also faults Berenson for his reliance on anecdotes. He was “really struck” by how Berenson came to the topic, from a conversation he had with his wife, a psychiatrist who specializes in treating, as Gladwell put it, “mentally ill criminals.” Berenson’s wife mentioned that her patients “all” smoke weed. This, according to Marantz, is “not exactly an unbiased source of data from which to make reasonable inferences based on clinical experience”––it is, indeed, almost as far as one can get from a large, randomized study.
The Daily Appeal spoke to Dr. Susanna Curtis, a physician and postdoctoral fellow in the Yale Cancer Center, who researches the effects of marijuana use and medical marijuana certification on people with sickle cell disease, who often suffer from chronic pain. Curtis urges people not to conflate medical marijuana and recreational marijuana. “I tend to think of recreational marijuana like I think about recreational tobacco or alcohol use,” she said. Just as she advises patients against using tobacco or alcohol at rates known to be risky, she suggests that patients who are smoking daily should cut down or quit. Data suggest daily marijuana use doubles the rate of developing schizophrenia, but Curtis notes this would increase the risk from 1 to 2 percent. Compare that to tobacco use: “The lifetime risk of developing lung cancer in a nonsmoker is one percent, but it goes up 15 to 30 times for smokers,” depending on usage. Curtis believes marijuana legalization “should follow the same guidelines we have created for other risky recreational substances. It should be for adults only, there should be strict guidelines on who sells it and what they sell, and research on its health effects should continue.”
For medical marijuana, the calculation is different. Curtis asks whether the medical benefits outweigh any health risks. “I regularly give my patients chemotherapy, which has very severe health risks, but I do it because the possible benefits outweigh those risks,” she said. “Now an important caveat is that chemotherapy is an FDA regulated product which has been extensively studied, has known side effects and drug interactions, and is being used under the supervision of a prescribing doctor. Because medical marijuana is federally illegal it is incredibly difficult to do large studies with it, and as a result there is a lot we don’t know.” Berenson fails to mention in the op-ed that a study he references also found “substantial evidence” that marijuana is effective to treat chronic pain. After Curtis’s center began offering medical marijuana certification, patients who obtained medical marijuana came to the hospital less. “As a doctor, I would prefer if I had an FDA regulated marijuana product which has been extensively studied,” she said, but as of now her only alternatives are weaker pain medications such as Tylenol, and opioids, which are dangerous.
Curtis has a particular concern, because sickle cell disease disproportionately affects people of color. “I could allow my patients to continue to use illicit marijuana instead,” she said, but medical marijuana is safer, even without FDA regulation. It also does not carry the risk of arrest (even in Connecticut, where low-level possession has been decriminalized, it can result in a fine).
In New York Magazine, Jesse Singal critiques Berenson’s article, focusing on his “startling claim” that marijuana use will lead to more violent crime, calling it “a case study in how to misleadingly use statistics to make oversimplified arguments about human behavior and public policy.” Berenson’s “fishiest move is his choice of 2014 as a baseline year,” because according to Mark Kleiman, a drug expert and public-policy professor at New York University who has himself urged caution over marijuana legalization, “Nothing interesting happened with regard to pot in 2014,” but “there was a national uptick in homicide in 2015-2016.” [Jesse Singal / New York Magazine]
One of the most unfortunate parts of this discussion is that people have been forced to choose sides. Berenson laments the “decadeslong lobbying by marijuana legalization advocates and for-profit cannabis companies,” which “shrewdly recast marijuana as a medicine rather than an intoxicant.” He knows he will be vilified by political opponents. But he also goes out of his way to scaremonger about the risk of violent crime, by distorting evidence. Politics forces people to choose sides at the expense of seeking truth. For the people who prefer marijuana to opioids for chronic pain, or the doctors who prescribe it, the issue is personal and professional before it is political. Asking questions earnestly, without stoking fears, is a first step toward reaching any conclusions, and nonpoliticized research is desperately needed in this field and others. Until then, we will all be lumped into pro or con, or, apparently a third category: USA Today, which published an article today entitled “Cannabis food, drinks to be 2019’s hottest dining trend.”