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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.
Cannabis in medical practice: a legal, historical and pharmacological overview of the therapeutic use of marijuana
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.
Marijuana Medical Handbook
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.
Hemp for Health: the medical and nutritional uses of Cannabis sativa
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.
Marijuana Myths, Marijuana Facts. A review of the scientific evidence
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.
British Medical Association: Therapeutic Uses of Cannabis
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
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
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