116

Book Reviews

New books on medical marijuana

        Medical aspects of Cannabis have gained renewed attention in the last few years. The discovery of cannabinoid/anandamide receptor systems and progress in basic research, a less biased discussion about the potential side-effects of Cannabis, and a rising number of patients, physicians and pharmacologists that demand legal access to the medical use of Cannabis products, have all contributed to this development. This has increased the impact of this topic on the popular literature.
        In 1997, three new American books and one from the British Medical Association were published that deal with the pharmaceutical potential of the Cannabis plant. An additional book published recently deals with 20 myths about Cannabis that relate especially to its possible detrimental potential. Furthermore, the renowned book by Lester Grinspoon and James B. Bakalar was re-published this year in a new revised version. The first five books are reviewed below.

1997. Mathre, M. L. (ed.), McFarland & Co., Jefferson, NC, 239 pages.

        In four segments about "Legal dilemmas of Cannabis prohibition", "Medical characteristics of Cannabis", "Indications for therapeutic use of Cannabis" and "Special considerations", divided in 17 chapters by 17 authors, the reader receives a diversified view on the topic of Cannabis as medicine. Besides a representation of the medical potential of marijuana and the cannabinoids for various medical conditions, which takes the biggest part of the book, legal questions, historical aspects, dosage, practical application and possible side-effects are addressed. This is complemented by a chapter about hemp seed and its oil, an examination of the non-medical potential of the plant as a whole, as well as an appendix with addresses of organizations advocating therapeutic Cannabis, a comprehensive index, and documents such as the well-known resolution, "Access to Therapeutic Marijuana/Cannabis" of the American Public Health Association.
         Noted and also less well-known experts in their fields were included in this project, among others: Michael R. Aldrich (history), Denis J. Petro (neurological disorders), Daniel A. Dansac (anti-emesis), Robert C. Randall (a glaucoma patient´s view), Manley West (Canasol^® in glaucoma), Antonio W. Zuardi and Francisco S. Guimarães (cannabidiol as an anxiolytic), Melanie C. Dreher (Cannabis and pregnancy), Don Wirtschafter (hemp seed and oil), Robert C. Clarke and David W. Pate (economic and environmental potential).
         The weakness of the book follows from its concept, which, in contrast to the well-known 1986 book "Cannabinoids as therapeutic agents", edited by Raphael Mechoulam, apparently did not give the authors any systematic guidelines for creation of the chapters. Hence, overlap in discussions of therapeutic alternatives to Cannabis and presentation of different scientific studies can be found in some chapters, for instance, in the chapter about spasticity and chronic pain. However, other chapters present concrete research results, such as the Lynn Pierson Therapeutic Research Program for the assessment of the antiemetic efficacy of marijuana, without mentioning the place marijuana could have in the therapy of today. The book does not claim completeness in the treatment of all medical topics. Minor ones, such as asthma or menstrual cramps, that were regarded as too insignificant to be treated in an extra chapter, are not mentioned.
         The strength of the book lies in the expert competence of the authors, who deal with their topics in superior style and in thematic depth. The competence is gained either in long-time scientific studies on the presented aspect or in years of experience as a patient using Cannabis and other possible treatments.
         The tenor of the book is generally pleasantly matter of fact and not hysterical. The various authors are not all aligned in their judgments on the medical potential of this plant. For example, in the chapter on application in psychiatry, Cannabis and THC are said to have "at present no place" in clinical psychiatry, although this view can be considered as a bit too pessimistic. Cannabis might not be the right medicament for the treatment of endogenous depression, but its repeatedly documented effects in reactive depression with severe illnesses should have deserved mention. The chapter on addiction and dependence, however, seems in parts to be a bit too uncritical. The claim, that even with ingestion of high doses, there appears no tolerance to its therapeutic effects, appears too optimistic. William B. O´Shaugnessy had already reported as much 150 years ago, drug-tolerance being a well-known phenomenon.
         Numerous references to cited literature allow a further, extensive study of the topic. This book is excellently qualified to give health care professionals a well researched survey of the field. It provides a well supported base of argumentation against viewpoints that don’t afford any medical value to Cannabis. This book is heartily recommended to those who are in search of an intelligible and competent book on this topic and attach less importance to completeness than to accuracy.

1997. Rosenthal, E., Gieringer, D., Mikuriya, T., Quick American Archives, Oakland CA 270 pages.

        In relation to systematics and style as well as contents, this book appears to be divided into two approximately equal parts (of four chapters each), written by different authors. Four chapters, apparently created by medical experts Dale Gieringer and Tod Mikuriya, deal with medical topics such as pharmacological effects, fields of application and possible side effects. Four chapters, obviously by Ed Rosenthal, present advice on the growing of Cannabis, the taking of marijuana (with tips for smoking and cooking recipes), as well as legal and illegal possibilities for access to the drug.
        These chapters are supplemented with a report by epilepsy patient Valerie Corral, an appendix which lists addresses of institutions who deal with medical marijuana or industrial hemp, the wording of both Proposition 200 of Arizona and Proposition 215 of California, a survey of the legal situation in all states of the USA, and a comprehensive and diligent review of human studies on the medical use of marijuana, THC and cannabidiol. Each chapter starts with a one-page Doonsbury cartoon by Garry Trudeau, appropriate to the topic.
        The medical part of the book was created with great competence and care. Neither lapsing into exaggeration of the wanted effects nor minimization of the possible negative effects, the various topics are treated systematically, precisely and as comprehensively as 80 pages allow. Footnotes or references to literature sources are omitted, with the exception of therapeutic studies included in the appendix. This tactic will be regarded as a disadvantage by those who wish references to be given for the authors´ statements, considering the controversial nature of this topic. However, the book contains few and insignificantly minor mistakes. For example, "cannabavarin (THCU)" appears in their listing of cannabinoids, which probably denotes the THC homologue Δ⁹-tetrahydrocannabivarin (THCV). Such trifles do not significantly detract from the good impression this half of the book leaves on the whole.
        In the second part of the book, which is about cultivation and drug administration, the information gets less precise. Statements are often in the realm of speculation, without identifying them as such, e.g., "Sativas are more ‘heady’, inspirational and ‘focused’". Other statements are simply incorrect: "Because 11-hydroxy-THC is not produced when marijuana is smoked...." However the guidelines for the home-growing of marijuana, tips on smoking and other practical hints are useful and will render good service to the user.
         In summary, this is an excellent book for readers that attach more value to comprehensive and differentiated information and practical tips rather than to scientific references.

1997. Conrad, C., Healing Art Press, Rochester, VT 264 pages.

        "Hemp for Health" is an enthusiastic homage to the versatile qualities of the Cannabis plant, an enthusiasm that is reflected in the author’s word choice, choice of topics and overly romanticized descriptions of the use of the plant in medicine, nutrition and agriculture. The style often is a declaration of love rather than a factual discussion: "The two major cannabinoids might be characterized as loving, but competitive sisters. THC and CBD each try to outdo the other. Both are good-hearted nurses for sick and suffering humanity."
         Apart from chapters that deal with the pharmacological effects of Cannabis such as "Eating and Digestion" or "Sight for Sore Eyes", the book also contains rather philosophical chapters that attach to Cannabis an important role as a holistically oriented medicine in such chapters as "Sympathetic Health-Care-Systems" and "Holistic Health and Hemp". Including aspects of fiber and seed oil production, the author even regards hemp as playing an important role in his vision of a better world: "Healing the Earth", "Saving the Trees".
        Each chapter contains a vast number of annotations and source references. Little excursions are repeatedly inserted, for instance, into the function of the cardiovascular system or the pathophysiological cause of glaucoma.
        Chris Conrad attempts the revival of the ancient medical systems that Cannabis fits into, such as Ayurvedic medicine. The discussion of the specific somatic effects of Cannabis and the cannabinoids are interwoven with the holistic experience of Cannabis consumption: "Respectful use of Cannabis within a framework of religion, philosophy and science..." However, in wandering between science and a philosophy of life, the author is often at risk to "lose the thread" of his topic.
         The appendix offers addresses, useful tips on what has to be regarded for administration of Cannabis, a list of illnesses and conditions treatable with Cannabis and a detailed bibliography.
        Unfortunately, the book also contains many mistakes and inaccuracies that can be explained partly by the author´s lack of medical knowledge, and partly from his negligent treatment of sources.
         Some examples: It is claimed that Sallan documented the utility of Cannabis in controlling nausea and vomiting in 1980 (p. 29). However, the cited study (N. Engl. J. Med. 302:135-8; Jan 17,1980) was conducted with pure THC and Conrad simply dropped the second part of the full title: "A randomized comparison of Δ⁹-tetrahydrocannabinol and prochlorperazine". It is claimed that cannabidiol has a positive effect on the symptoms of multiple sclerosis (p. 30). However, the case study of Meinck et al. referred to (J. Neurol. 236:120-2; Feb. 1989), was conducted with marijuana, not with cannabidiol. The author also occasionally draws strange conclusions: "It is conceivable that regular Cannabis smoking could slow the aging process of the lungs themselves" (pgs. 97-98). Misinterpreting the physiological atropine-like effect of THC on the salivary glands of the mouth, he speculates a purely physical explanation: "It is possible that the oily smoke may coat the surface of the mouth with a sticky, resinous film that temporarily prevents saliva from replenishing the surface moisture in the mouth" (p. 102). He also claims that "recent studies also found that Cannabis resin is not the only source of cannabinoids" (p. 152), citing the traces of anandamide recently found in chocolate.
         Unfortunately, this book cannot be recommended. A new edition should be carefully reviewed by the pharmacologically qualified before its re-publication.

1997. Zimmer, L., Morgan, J. P., The Lindesmith Center. New York/San Francisco, 241 pages.

        In 20 chapters, Lynn Zimmer and John P. Morgan discuss controversial aspects of possible benefit and harm resulting from the use of marijuana. They start with a page on which a statement identified as a myth is presented (e.g., "Marijuana is a gateway drug") and then comment using citations of the eighties and, most often, the mid-nineties. Next, there is a 10-line statement by the authors, which carries the headline "Facts". It constitutes a short summary of the following ca. five-page analysis that is supported by extensive references. The thoroughly researched references take about one third of the book by themselves. Topics include addiction, medical value, immune system, pregnancy, amotivational syndrome, highway accidents, deviance and crime, and others. Some touch upon medical applications, while others refer more to recreational use.
         On the back cover of the book, its aim is stated rather immodestly: "This book tells the truth about marijuana." Considering the presented "Myths", the truth - a major "bone-of-contention" in scientific discussions - really does lie more on the side of their statements specified as "Facts". However, some claims made in the "myths-citations" sections are not entirely wrong. For instance, marijuana smoke really does contain more carcinogenic substances than the smoke of a tobacco cigarette, as the citation says. It is true that an average marijuana smoker inhales much less total carcinogenic substances than a tobacco smoker because the number of marijuana cigarettes smoked is substantially less. There are, however, also heavy marijuana smokers. Converse to the above criticism is the observation that other statements in "myths-citations" are only incompletely refuted in the text, for example, the claim that "there are numerous alternative (anti-nausea) drugs...", is incompletely rebutted by merely stating that marijuana has a clinically demonstrated antiemetic effect.
        To the authors’ credit is the collection, as well as the popular and clear presentation, of a great number of study results and scientific findings that confront exaggerated ideas about the potential dangers of Cannabis, which are likely to be used as arguments against the medical use of Cannabis products. The book is a most useful collection of arguments for this purpose. Often though, the differentiated middle-course is nearer to the truth than pointed pros or cons, especially on topics such as marijuana, where our knowledge is still incomplete.

Harwood Academic Publishers. Amsterdam 1997 142 pages.

        The report was prepared under the auspices of the Board of Science and Education of the British Medical Association, edited by David R Morgan and written by C H Ashton. Contributing authors were Anita Holdcroft, Sarah Mars, Tony Moffat, Roger Pertwee and Patrick Wall. It is an excellent and clear reproduction of present scientific knowledge and a well-founded plea for change. "The BMA believes that there should be changes in the law to permit the use of cannabinoids where clinically appropriate under medical super-vision."
         In seven chapters, the topics of legal status, pharmacology, therapeutic uses, adverse effects and recommendations are presented. The largest chapter is on therapeutic uses with 45 pages. A chapter about the history of the medical use of the Cannabis plant is lacking. So, it can easily be forgotten that cannabis has already been accepted as a drug for millenia. The appendix of 25 pages includes a glossary, examples with anecdotal evidence of reports from 11 patients, and clearly arranged summary of research studies. In the therapeutic uses section, different conditions of illness, existing pharmacological treatments, the respective knowledge about cannabis and cannabinoids, needed research and conclusions are systematically presented.
         It is worth noting that anecdotal evidence with marijuana and hashish has been included to help evaluate therapeutic potential. Among other reasons, this is justified by the present strict lawful framework for research: "...the accumulation of scientific evidence has been hampered by regulations restricting the use of cannabinoids to one clinical indication... (p. 77). "It is ironic that the commonest neurological causes of taking illicit cannabis in the USA and UK are MS and spinal cord injury ..., yet only four controlled trials involving more than one patient have been published" (p. 37). The recommendations and conclusions range from demands to ease research restrictions on a national level to demands on the World Health Organisation "to reschedule certain cannabinoids under the United Nations Convention on Psychotropic Substances" (p. 78).
         As careful and convincing as the arguments in the chapter concerning therapeutic uses are, as sophistical and inconclusive is the short argument, regarding single cannabinoids as suitable medicine, but not cannabis. It is stated that the composition of the ingredients varies and one cannot ascertain "which particular agents (or combination of agents) were beneficial" (p. 69). "Even if cannabis ... were shown to have therapeutic benefits ... medical knowledge would not be advanced nor treatment improved." (p. 69). The idea of illustrating cannabis’ therapeutic benefit, without its advancing knowledge nor improving treatment, is not very convincing. It is striking that clinical studies with single cannabinoids, usually follow strong anecdotal or well-documented historical evidence with preparations of the whole plant, and that afterwards, when the evidence has been confirmed, some scientists then take the view that there is no knowledge about the therapeutic potential of the whole plant, but only of the single cannabinoid.
         Editor’s note: The previous five book reviews were written by:

Franjo Grotenhermen
nova-Institut Germany
e-mail: FGrotenhermen@compuserve.com

        Hemp! for Textile Artists. Cheryl Kolander, 1995. "Mama D.O.C." Inc., 5806 North Vancouver Avenue, Portland, OR 97217, Soft cover, spiral bound, 99 pages, US$40.00 plus shipping and handling.

        Hemp, as a fiber, has the feel of linen, the sheen of silk and a versatility beyond compare. The first edition of Hemp! for Textile Artists, printed on hemp blend paper, includes fiber and fabric samples which have great tactile appeal. They are also one reason for the higher price on this inexpensively produced book. For those who are persistent enough to sift through the "hemp propaganda" it contains, there are rewards: detailed information from many sources, gathered together with an obvious passion.
         Beginning with an extensive history and anecdotal information, the book contains a wealth of facts on the plant, its processing and the resulting fiber. Included in the chapter on spinning are detailed instructions on all stages of fiber preparation, and working diagrams of equipment used in the processes. There is excellent information, well illustrated, on spinning and fiber blending. The chapter on dying - "naturally, of course!" is thorough, detailed and most informative. As the author suggests, "Just do it! . . . Have fun." (pg. 61)
         Weaving is not covered as thoroughly, and multiharness weavers and those interested in complex weave structures will be disappointed. In fact, any weaving information is found in Chapter 6, titled "Fabrics" (listed in the Table of Contents as Chapter 7), which deals with commercially woven cloth. The sewing tips apply to any hand-woven fabric and includes seam finishes and ironing. Projects included in Chapter 11 are very simple items illustrated with full scale photographs and would appeal primarily to beginners. Also included in this extremely diverse book is information on the medicinal use of Cannabis, and its commercial uses in paper, food products and building materials. There is an extensive bibliography and a United States suppliers list.
         The book would have benefited from professional proof-reading and the elimination of at least some of the poorly reproduced photographs. In my experience, weavers, spinners and textile artists are a passionate group of people who enthusiastically endorse and promote subjects and materials close to their hearts. Was the author hoping to use this enthusiasm to reach a wider audience? This book would appeal to a more extensive group of textile artists if it allowed hemp, as a fiber, to stand on its own merits without the emphasis on side issues.

Jean Betts
Victoria, B. C., Canada

Hemp Horizons John Roulac 1997. 211 pgs.Chelsea Green Publishing. Soft cover ISBN 0-930031-93-8 $18.95

        This book is aimed at a popular audience who undoubtedly will find it informative. Unfortunately, readers with a more technical back-round, will find not only a lack of depth, but also an unfortunate inclusion of misinformation. Still, this book is highly recomended, especially for those looking for an introduction to the topic of industrial hemp.
         One of the many interesting aspects of the book are the seven thumbnail sketches of presently sucsessfull industrial hemp businesses, one included with each chapter. They clearly illustrate not only the future of industrial hemp dreams, but also the concrete hemp realities. Seven chapters discuss: the world of hemp; the history of hemp; the law, politics and hemp; hemp today; hemp in the marketplace; hemp farming; and finishes with hemp and the substainable future.
         Chapter One "World of hemp" begins with an overview that spells out the differences between industrial hemp and marijuana, and further explains how hemp could once again become an important agricultural crop worldwide. Roulac also discusses the range of products produced from hemp including; long fibers, medium length fibers, short core fibers (hurds), seeds, seed oil, and seed meal. Many of the common hemp myths are addressed such as; hemp will eliminate the cutting of forests to produce paper, hemp seed oil will be appropriate for auto fuel, American-grown hemp will be much cheaper than imports, farmers will get rich growing hemp, and hemp has no agriculture pests. Roulac challenges these myths with clear and realistic responses. A discussion of the many reasons that hemp will return as a mainstream agriculture crop follows. This chapter ends with the author’s vision of a 100% hemp house.
         Despite the thorough debunking of common hemp myths, Hemp Horizons is peppered with its own versions of misinformation about hemp as a crop plant. Roulac over-states the benefits of hemp on farming and soils (pg. 10) and claims that hemp is hardier than cotton, corn and soybeans and can withstand drought and cold snaps (pg. 20). I have never seen any evidence that the quickly established canopy lowers ground temperatures, that hemp develops a deep tap root, or that hemp is any more resistant to drought and frost than other more common field crops.
         Chapter Two "Hemp’s historical prominence" discusses hemp’s historical importance in Asia and Europe and how hemp’s decline began in the late 1800’s and early 1900’s worldwide. Hemp was a victim of cheaper substitute fibers and the large amount of hand labor associated with harvesting and processing hemp. The First and Second World Wars each brought a short resurgence of hemp production for strategic reasons that ended after the wars. Introduced synthetic fibers were the final nail in the coffin that relegated hemp to a minor crop status.
         Chapter Three "Law and politics of hemp" is a thorough rehashing of all the conspiracies and reasons industrial hemp and marijuana were made illegal, possibly to protect wealthy industrialists and their busi-nesses. The inclusion of more international information would have been nice, this chapter includes more info on individual American states where it is illegal to grow hemp, than legislation in new and old European hemp growing countries. Roulac explains that hemp cultivation will pollinate drug Cannabis crops for miles around resulting in seed set that will lower the value of the drug Cannabis. The resulting "fiber X drug" seed would also not be suitable for sowing for drug production, as the resulting crop would be too low in THC to be used for drugs.
         Chapter Four "Around the globe with hemp today" gives a roundup of hemp activities world-wide, and contains a lot of great information.
         Chapter Five "Hemp in the marketplace" reviews businesses including such topics as processing centers, subsidies, manufacturing, marketing, business opportunities, and product versatility, and also discusses other bast fibers.
         Chapter 6 "Farming of hemp" begins with a discussion of hemp seed varieties and how America lost it’s developed varieties. Following is a simple overview of hemp farming from planting to harvest, that potential hemp farmers will find very informative.
        Chapter 7 "Hemp and a substainable future" discusses in depth why hemp is better than cotton or petroleum for a substainable future, suggests that future developers of harvesting and processing equipment should consider these factors, and ends with a timeline through the year 2010 of how the hemp industry could evolve in North America.
         The resources listings for contacts are great! They include Accessories, Apparel, Associations and Organizations, Bodycare, Building materials, Carpets, Catalogs, Consultants, Cordage, Distributors, Food, Footware, Furnishings, Government licensing, Housewares, Internet sites, Machinery, Seed oil, Paper, Plastics, Processors, Publications, Research, Retail, Seeds and Cultivars, Textiles, and Videos. Also included is a good bibliography and a well put together index.
         Readers will notice that the IHA contributed photos for this book.

David Watson
IHA Charman