The Pharmaceutical Journal
Vol 271 No 7274 p656
8 November 2003

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Cannabis question [more]
Dangerous ethanol [more]
Publishing research [more]
Path to tranquillity [more]

Cannabis question

Assessments of the health hazards posed by the use and abuse of cannabis are notoriously flimsy. Any mention of their dangers in comparison with those posed by other drugs of abuse tends to develop into a pointless argument.

It may be accepted as axiomatic that the consumption of any drug for any reason other than a therapeutic one is to be condemned as unjustified. Since the beginning of civilisation, humans — and sometimes even other animals — have indulged in alcohol in many forms as a means for blurring the impact of unpleasant experiences of everyday living, but it is virtually impossible to make out a defence for getting drunk. And the smoking of tobacco, though of relatively recent date, should be condemned as foolish.

The chewing of coca in the empires of the New World is no less reprehensible, though there is scant evidence that before it was modified to take into account the abuse of extracted cocaine it did much lasting harm. The abuse of opium and its products appears to have far more serious effects.

Now, a comparison of the tobacco habit and the cannabis habit by a clinician in California has been published in the BMJ for 20 September and makes unexpected reading. It concludes that cannabis cannot be judged to have any notable adverse public health impact in terms of mortality. For example, there are no known instances of lethal overdose of cannabis, in contrast to other illegal drugs such as cocaine and legal ones such as alcohol, aspirin or paracetamol. And, unlike users of alcohol and tobacco, most cannabis users discontinue the habit relatively early in adult life. This means that diseases related to long-term cannabis use are unlikely to impinge seriously upon public health.

Whereas a regular cannabis user may smoke no more than one marijuanha cigarette a day, a regular tobacco user smokes 20 or more daily. This means that exposure to harmful smoke ingredients is less with cannabis cigarettes. Moreover, cannabis smoking does not predispose to coronary heart disease as tobacco smoking does. Thus, although cannabis is not harmless, the harm done by tobacco is far more severe in terms of public health and mortality.

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Dangerous ethanol

A disturbing report by Stephen Pincock is published in the 4 October issue of The Lancet. He writes that a government document has recently shown an increase in alcohol consumption linked to a greater incidence of cirrhosis and premature deaths. It claims that on 40 per cent of occasions when men go out to drink they consume at least four pints of beer, equivalent to eight units of ethanol, twice the recommended daily guideline.

The habit of “binge drinking”, by which is meant three or more pints for a woman or four or more for a man, at a session, is a danger to health. And it is calculated that alcohol plays a role in 22,000 premature deaths and costs the United Kingdom economy £20bn every year. The average consumption of ethanol by British drinkers in 2001 was 8.5 litres, increased by 150 per cent since 1951. Young drinkers are apparently inattentive to warnings, since consumption by people younger than 16 is twice that 10 years ago.

Apart from health issues there is an associated increase in nuisances and public disorders. Alcohol-associated crime, assault and disorder costs some £7.3bn a year, while injuries and illnesses cost the National Health Service £1.7bn a year and the annual loss through illness an absence from work may be as high as £6.4bn.

The charity Alcohol Concern suggests that the binge-drinking culture might be tackled if the Government is prepared to invest a sum similar to that invested by promoters of the drink industry, which amounts to some £800m a year. The Royal College of Physicians reported that in 2001 more than one in three men and one in five women in the United Kingdom regularly consumed more alcohol than the suggested limits. It suggested that hospitals should take detailed histories of individuals presenting with signs possibly associated with alcohol abuse, using questionnaires. In acute hospitals alcoholic patients pose serious hazards for risk and resource management, staff satisfaction and quality of care for other patients.

The problem is not confined to the UK alone, but exists in many other countries. Any improvement in the situation in the near future will depend on the pursuit of opportunities to reduce the availability of alcohol to under-age drinkers and the demand for it by young people in general.

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Publishing research

Recent instances of the unreliability of some scientific research papers have prompted the Royal Society to undertake an investigation into the ways in which the evidence unearthed during research is brought into the public domain. A working group that includes academics, industrial scientists, scientific publishers and journalists is to examine the regular practice of peer review, which has long been considered to offer a safeguard against slovenly experiments and faulty conclusions.

The vice-president of the Society, Sir Patrick Bateson, is to chair the working group. He has stated that it is evident that peer review is not an adequate method of protection as it stands today. Some data published in leading scientific journals have later been shown to be either false in fact or poorly interpreted when conclusions are to be drawn. Unfortunately, pieces of research of questionable quality tend to create highly significant publicity that gives science a bad name in the view of the general public and the politicians. Dr Bateson offers as an instance the claims earlier this year concerning the birth of human clones.

Accordingly, the Royal Society group is to consider criticisms of the present process of peer review of papers submitted to journals and will attempt to offer ways by which it might be improved or completely replaced by some other safeguard.

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Path to tranquillity

And yet it is always conducive to tranquility of mind to examine if possible oneself and one's fortunes, but if that is not possible, to observe persons of inferior fortune and not, as most people do, compare with those who are superior
— Plutarch: ‘Moralia’ (ca AD100).

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