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On bullshit

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Silly season

The "silly season" is almost here. This is the season in which some people talk and act crazy about themselves and public policy. It happens around every two years. Political candidates do everything in their power to win public office. In Arkansas, judicial candidates file as early as December of this year. Democrats and Republicans will start signing up as early as February 2018. Voting for primary elections starts in early May. When the primaries are finished, Arkansas's political government will basically be decided. There is only one viable political party now in Arkansas, the Republicans, and winners of the Republican primary contests will most likely proceed to public office. The general election in November 2018 will simply be a formality for our red state's constitutional officers and most of the legislature. Our governor, attorney general and representatives can plan their agendas now for the next two years.

The silly season is also made simpler by computer voting. Arkansas is quickly switching to the Schouptronic machines provided by the Danahar Control Corp. in Illinois. Paper trails are not available to the silly news media and software engineers will eventually be able to design voting results throughout our state. Maybe someday soon Arkansans will be able to phone text their choices for "Republican Idol." Virtual democracy and a one-party system take a lot of the silliness out of politics.

Gene Mason Jacksonville

On bullshit

I am quoted in Leslie Peacock's article about doctors and medical marijuana. I do not disown any of the things I am quoted as saying, and I commend Peacock on her excellent research and writing. I've enjoyed reading her for at least two decades. But the slant of the article creates a misperception that I am (and many other doctors like me are) cruelly depriving suffering human beings of beneficial treatment. This is not correct. The problem is that there is a lack of scientifically valid evidence that marijuana is helpful for any medical condition that I treat, such as PTSD. Peacock notes on the Psychiatric Associates of Arkansas Facebook page an article reviewing the evidence for using marijuana for PTSD and chronic pain. The article concludes there is no good evidence that marijuana is a beneficial treatment for either of these conditions. The article is published in the prestigious, peer-reviewed journal Annals of Internal Medicine and is summarized in a Reuter's clip. Peacock's article states that my office "voted" not to certify medical marijuana. Voting has nothing to do with this or with determining whether any medical treatment is appropriate. If doctors voted that apple juice cured colon cancer, it would not make it any more effective. I do not object to unusual treatments. If you look on the Facebook page there are also articles about using ketamine (the club drug "special K") as a treatment for depression and MDMA (the club drug "ecstasy") as a treatment for PTSD. If there is evidence a treatment is safe and alleviates human suffering or remediates human disease, then I am all over it. The "evidence" for medical marijuana is testimonial. While testimony is emotionally compelling, it carries no scientific weight. It is not hard to find examples of testimony to just about anything. Even the available testimonial data is not gathered in the systematic scientific way a medical sociologist might do. In my own area of psychiatry there is plenty of evidence that marijuana does harm. For instances it can provoke paranoia and psychosis in people who are predisposed. It can interfere with motivation and memory. I defer to other specialists regarding marijuana as a treatment for seizures, HIV, Alzheimer's disease, etc.

I know that the law only requires that a doctor certify that somebody has one of the listed conditions and does not require the doctor to certify that it is his or her professional opinion that marijuana helps the condition. Think about who this disclaimer lets off the hook: It is not the doctors who provide treatments to patients that are proven to be helpful to them. I will never in my capacity as a doctor advise a patient: "Take this; there is no evidence it works and I don't know whether it does more harm than good — but here you go."

In Peacock's article I am quoted using the word "baloney." I apologize for this word choice. I self-censored to be polite. The word I actually have in mind is "bullshit," in the sense described in the philosopher H.G. Frankfurt's definitive treatise "On Bullshit." Frankfurt argues bullshit is a valuable concept in analyzing human discourse. He states that the difference between bullshit and lying is that the liar is concerned with truth (and wants to obscure or misrepresent it), whereas the bullshitter does not care what the truth is — he is up to something else. For instance, I was out with a friend, and he ordered a bottle of wine and grinned and said "for my heart." I rolled my eyes. Why did he grin and why did I roll my eyes? Because both of us recognized his statement was bullshit. Notice that truth is irrelevant here; wine may or may not be good for his heart, but that is not why he was ordering a bottle of wine. He was ordering a bottle of wine because it is an intoxicating, euphoriant drug, and we both know it. When I say medical marijuana is bullshit, what I mean is that whether or not medical marijuana is helpful for any medical condition, people use it because it is an intoxicating, euphoriant drug. And we all know it. When someone says they use marijuana for their PTSD, they should grin and we should roll our eyes.

Arkansas voters can pass a law legalizing medical marijuana, but they cannot pass a law making marijuana an appropriate treatment for any illness any more than my partners and I can vote that marijuana is not an appropriate treatment for PTSD. The only thing that can establish the utility of marijuana as a treatment is a randomized blocks, placebo-controlled trial comparing marijuana with a plausible placebo and using objective measures and statistical analyses to sort out all the biases that human beings are prone to. In the case of medical marijuana, such evidence is conspicuously absent. Unless there is good scientific evidence, medicine should not be involved with this at all. Also, notice that I am not necessarily against revoking the laws prohibiting marijuana use. I think a good case can be made for repealing all of our vice laws — because their enforcement is too expensive, painful, and ineffective — and then mount public health information campaigns and presume that smart, good, well-informed people will choose to live healthy, happy, productive lives and cultivate good habits rather than bad habits, and they will judiciously use pharmaceuticals that are proven to be helpful to them. That is, we might do better if we treated all vices like we do nicotine use — develop public health and moral solutions rather than punitive, painful legal sanctions. And a debate about this would be honest and not bullshit.

I also worry about doctors monetizing human suffering. The U.S. medical system, which should be devoted to ameliorating disease and easing suffering, is already badly twisted by perverse economic incentives. Obviously, the most self-serving way for me to play the medical marijuana game would be to hand out a checklist with the qualifying diagnoses and their symptoms and have patients check off symptoms and attach a check for $250. I would then provide a signed certificate and a disclaimer that there is no good scientific evidence that marijuana helps any of these conditions. And I could do it all by mail or telemedicine. The patients would buy short-term happiness and I'd be rich. And we could both grin and roll our eyes.

Richard Owings

Psychiatric Associates of Arkansas Little Rock

From the web

In response to Leslie Peacock's Sept. 7 cover story on medical marijuana:

Is hydrocodone "baloney"? Is OxyContin "baloney"? Are fentanyl patches "baloney"? Are the addictions and long-lasting effects on patients' health of the three previous drugs mentioned just "baloney"? I have never met a marijuana addict. I have met plenty of hydrocodone addicts who are now so messed up that they are turning to heroine to ease their physical pain and sadly falling into deeper spirals of addiction.

Artificial Intelligence

Amen. I say give it awhile. After the storm of the early days turns into months and a year or so, the benefits will began to show and start outweighing the negative attitudes on the subjects. The doctors will truly see the good in using it and will begin to come around. You'll see.

Mike Hogan Sr.

Anything that might, I say even might, cut down on the opioid addiction in this country, which leads to heroin, I am all for. Since it is nonaddictive (not to be confused with habit or liking it a lot), I say it is worth a try. Many parts of the country are seeing enormous spikes in opioid addiction deaths in all age groups. No approach seems to be working. For that reason alone, I would be in favor of  legalization of marijuana.

Ark7788

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