This is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page.

Archive 1

Archive 2

Archive 3

Archive 4

Archive 5

Archive 6

exists any study which compares chemotherapy success rate with and without cannabis? recent research indicates, that cannabis itself has anti-cancer properties..so it could theoretically be that chemotherapy does not work at all and the benefits aris from cannabis itself.. does anyone have information on this topic — Preceding unsigned comment added by 82.130.74.143 ( talk • contribs) 11:48, 15 January 2013 (UTC)

There is one clinical study that looked into clinical effects of cannabis in cancer patients. http://www.nature.com/bjc/journal/v95/n2/full/6603236a.html

9 patients with progression of a brain cancer called glioblastoma multiforme was treated. It wasn't a controlled study, so it is unknown if the benefits that were observed was an effect of cannabis or an effect of the natural history of their cancer. The bottom line is, that all nine patients died within a year. Not a single patient was cured.

This could be mentioned in the section on brain cancer. The referenced study (111) used tumour samples from these patients. Jli Anax ( talk) 13:02, 17 November 2013 (UTC)

Please have a look at WP:MEDRS; we don't cite medical content to primary studies or the laypress-- we use secondary reviews. SandyGeorgia ( Talk) 17:18, 4 December 2013 (UTC)

There has been a proposed graphic to recent reclassification of medical cannabis in the United States. Image was located via Wikimedia. Ktownnative ( talk) 20:53, 15 November 2013 (UTC)

These have been tagged for years; I have removed them. SandyGeorgia ( Talk) 00:31, 30 November 2013 (UTC)

• Cannabis is one of the 50 "fundamental" herbs of traditional Chinese medicine, ^[1] and is prescribed for a broad range of indications.

• Patani from Asia are primary natural producers of the diuretic, antiemetic, antiepileptic, anti-inflammatory, pain killing and antipyretic properties of Cannabis sativa, and used it extensively for 'Kopi Kapuganja' and 'Pecel Ganja', as recreation food, drinks and relaxing medication for centuries. ^{citation needed}

• During the 1970s and 1980s, six U.S. states' health departments performed studies on the use of medical cannabis. These are widely considered some of the most useful and pioneering studies on the subject. ^{citation needed}

• In Spain, since the late 1990s and early 2000s, medical cannabis underwent a process of progressive decriminalization and legalisation. The parliament of the region of Catalonia was the first in Spain to have voted unanimously in 2001 legalizing medical marijuana; it was quickly followed by parliaments of Aragon and the Balearic Islands. ^{citation needed} The Spanish Penal Code prohibits the sale of cannabis but it does not prohibit consumption (although consumption on the street is fined). Until early 2000, the Penal Code did not distinguish between therapeutic use of cannabis and recreational use, however, several court decisions show that this distinction is increasingly taken into account by judges. From 2006, the sale of seed is legalized, ^{citation needed}

• Several studies have been conducted to study the effects of cannabis on patients suffering from diseases like cancer, AIDS, multiple sclerosis, seizures or asthma. This research was conducted by various Spanish agencies at the Universidad Complutense de Madrid headed by Manuel Guzman, the hospital of La Laguna in Tenerife led neurosurgeon Luis González Feria or the University of Barcelona. ^{citation needed}

Removing text not sourced correctly, see WP:MEDRS-- much of this article is cited to primary studies. SandyGeorgia ( Talk) 02:21, 30 November 2013 (UTC)

• Medical cannabis relieves some symptoms of multiple sclerosis ^{citation needed} and spinal cord injuries ^{medical citation needed} by exhibiting antispasmodic and muscle-relaxant properties as well as stimulating appetite. ^{medical citation needed}

• alcohol abuse, ^{medical citation needed} collagen-induced arthritis, ^{medical citation needed} asthma, ^{medical citation needed} atherosclerosis, ^{medical citation needed} colorectal cancer, ^{medical citation needed} HIV-associated sensory neuropathy, ^{medical citation needed} depression, ^{medical citation needed} dystonia, ^{medical citation needed} gliomas, ^{medical citation needed} hepatitis C, ^{medical citation needed} leukemia, ^{medical citation needed} skin tumors, ^{medical citation needed} posttraumatic stress disorder (PTSD), ^{medical citation needed} psoriasis, ^{medical citation needed} sickle-cell disease, ^{medical citation needed} sleep apnea, ^{medical citation needed}

Also, full sections discussing primary studies, there are secondary reviews compliant with WP:MEDRS, pls find and use them. See also WP:UNDUE, WP:NOT (News) and WP:RECENTISM.

• ALS: [1]
• Pain relief: [2]
• Brain cancer: [3]

SandyGeorgia ( Talk) 02:21, 30 November 2013 (UTC)

Diabetes

Entire section, WP:UNDUE, WP:NOT (news), WP:MEDRS. SandyGeorgia ( Talk) 02:24, 30 November 2013 (UTC)

A study published on May 16, 2013 in the Journal of American Medicine revealed that regular marijuana use is associated with better glucose control. They found that current marijuana users had significantly lower fasting insulin and were less likely to be insulin resistant, even after excluding patients with a diagnosis of diabetes mellitus. Participants who reported using marijuana in the past month had lower levels of fasting insulin and HOMA-IR and higher levels of high-density lipoprotein cholesterol (HDL-C). These associations were weaker among those who reported using marijuana at least once, but not in the past thirty days, suggesting that the impact of marijuana use on insulin and insulin resistance exists during periods of recent use. The Study there were al ^[2]

Crohn's Disease

A study published on May 6, 2013 in the journal Clinical Gastroenterology and Hepatology revealed that subjects with Crohn's Disease experienced benefits from inhaled cannabis use. At the completion of the study's treatment period, ten out of the eleven patients that received cannabis treatment displayed substantial improvements in disease-related symptoms, while five of these patients experienced complete remission. The study's authors wrote: "... all patients in the study group expressed strong satisfaction with their treatment and improvement in their daily function." The study was small, but was designed as a randomized placebo-controlled clinical trial, the gold standard for a clinical trial. ^{[3] [4]}

Breast cancer

According to a 2007 and a 2010 study at the California Pacific Medical Center Research Institute, cannabidiol (CBD) stops breast cancer from spreading throughout the body by downregulating a gene called ID1. ^{[5] [6]} This may provide a non-toxic alternative to chemotherapy while achieving the same results without the painful and unpleasant side effects. The research team says that CBD works by blocking the activity of a gene called ID1, which is believed to be responsible for a process called metastasis, which is the aggressive spread of cancer cells away from the original tumor site. ^{[5] [6]} According to findings released by the team in 2012, when the particularly aggressive "triple-negative" cells (which contain high levels of ID1 and account for 15% of breast cancers) were exposed to CBD, they "not only stopped acting 'crazy' but also returned to a healthy normal state". Human trial models are currently in development. ^[7] Dr Sean McAllister, study co-leader, commented: ^[8]

"The preclinical trial data is very strong, and there's no toxicity. There's really a lot of research to move ahead with and to get people excited".

Mental disorders

A study by Keele University commissioned by the British government found that between 1996 and 2005 there had been significant reductions in the incidence and prevalence of schizophrenia. From 2000 onwards there were also significant reductions in the prevalence of psychoses. The authors say this data is "not consistent with the hypothesis that increasing cannabis use in earlier decades is associated with increasing schizophrenia or psychoses from the mid-1990s onwards". ^[9]

A 10-year study on 1,923 individuals from the general population in Germany, aged 14–24, concluded that cannabis use is a risk factor for the development of incident psychotic disorder symptoms, and the continued use might increase the risk. ^[10] A study conducted by Thomas F. Denson and Mitchell Earleywine found fewer weekly users with symptoms of depression than those that did not use marijuana. They also reported that used marijuana for medical reasons were found to have been more depressed than recreational users, but reported fewer negative symptomatic issues. ^[11]

However a medical study published in 2009 taken by the Medical Research Council in London, showed there was no significant effect of THC on [11C]-raclopride binding. Thus concluding, recreational cannabis users do not release significant amounts of dopamine from an oral THC dose equivalent to a standard cannabis cigarette. This result challenges current models of striatal dopamine release as the mechanism mediating cannabis as risk factor for schizophrenia. ^[12]

First, it's Tourette syndrome, not Tourette's. I pride myself on attempting to write neutral text, sourced to secondary reviews. This removal of two review sources made the text less neutral. There are positive findings wrt cannibinoids in TS; we need not completely sanitize the article to present evidence-based facts, and Cochrane Reviews are not the only game in town. If we are *only* going to cite the Cochrane review, then we need to go back and say more. Let me know, SandyGeorgia ( Talk) 15:08, 30 November 2013 (UTC)

Sorry, an over-zealous revision on my part: I have restored the section with 3 sources as you had it. Alexbrn ^{talk| contribs| COI} 15:19, 30 November 2013 (UTC)

Thanks, Alexbrn ... I will update those reviews as I come across newer things, but for the next few days, I'm going to be quite busy elsewhere! SandyGeorgia ( Talk) 15:36, 30 November 2013 (UTC)

Per WP:MEDMOS and deleted a lot of popular press / primary sources. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 21:16, 2 December 2013 (UTC)

Why does this rather innocent looking statement require 10 sources? SandyGeorgia ( Talk) 08:15, 3 December 2013 (UTC)

In Canada, marijuana vending machines are planned to be used in centres that cultivate the drug. ^{[13] [14] [15] [16] [17] [18] [19] [20] [21] [22]}

• • BUMP-- could someone please explain? Otherwise, I shall begin deleting. SandyGeorgia ( Talk) 16:45, 4 December 2013 (UTC)

hmmm, no response from anyone, so I trimmed the citations. There is excess detail in the Medical_cannabis#Dispensing machines section, which resulted from the merge from Talk:Marijuana vending machine. I suggest that discussion should be revisited, and the content sent back to Marijuana vending machine. SandyGeorgia ( Talk) 22:15, 4 December 2013 (UTC)

Of course trim. One good ref maybe two is all that is needed. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 22:53, 4 December 2013 (UTC)

Viriditas, Petrarchan47, Dala11a Alexbrn? SandyGeorgia ( Talk) 20:52, 4 December 2013 (UTC)

This article is enormous and working on it is difficult. I propose:

• Create a sub-article, History of medical cannabis
• Cut a good deal of what is now in the Society and culture section to Legal and medical status of cannabis, and summarize it back to here. We already have a sub-article that discusses status in different countries; why are we repeating here country by country? This is ridiculous. I put a merge proposal (which would also incorporate the US section, consolidating the whole thing to about one paragraph, using summary style with a hatnote. SandyGeorgia ( Talk) 16:58, 4 December 2013 (UTC)

Excellent idea. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 17:08, 4 December 2013 (UTC)

Yes, I can go with that too, support♫ SqueakBox talk contribs 20:43, 4 December 2013 (UTC)

My ideas are in flux about how best to organize, but rather than suffer "analysis paralysis" - yes: let's start moving in a sensible direction now (knowing we can adapt if necessary later). Alexbrn ^{talk| contribs| COI} 20:54, 4 December 2013 (UTC)

 Done SandyGeorgia ( Talk) 00:05, 5 December 2013 (UTC)

Text was added to the lead saying:

The alleviating benefits of cannabis has (sic) been shown to outweigh negative effects.

The source is:

• Clark PA, Capuzzi K, Fick C (2011). "Medical marijuana: medical necessity versus political agenda". Med. Sci. Monit. 17 (12): RA249–61. PMC  3628147. PMID  22129912. {{ cite journal}}: Unknown parameter |month= ignored ( help)CS1 maint: multiple names: authors list ( link)

The abstract says (emphasis mine):

These studies state that the alleviating benefits of marijuana outweigh the negative effects of the drug ...

which is not what our text says. Our text states as fact something that the source says is claimed by the studies. Full text of that source is available; which part of it supports the text in our article? SandyGeorgia ( Talk) 21:56, 1 December 2013 (UTC)

Is this article a reliable source in any case? (I think not). The full text does contain: "Scientific research has shown that the benefits of medical marijuana greatly outweigh the burdens." Alexbrn ^{talk| contribs| COI} 22:03, 1 December 2013 (UTC)

Well, sure, Jesuits know all about medicine (they know all about everything :) At any rate, if we're going to use sources, we need to use them correctly. There were two new reviews added to the lead, [4] with neither of them used correctly (one cherry picked, this one misrepresents). I added the missing portions of PMID  23386598. Petrarchan47, when adding new sources, please do not use bare URLs and expect others to do all the cleanup. You can generate a citation template from a PMID by entering it here. Also, if you add a source to the lead (implying it is recent enough and high enough quality to be cited throughout) please make sure you include both sides of the coin as presented by that source. [5] SandyGeorgia ( Talk) 22:12, 1 December 2013 (UTC)

This seems to be resolved; in the interest of space, does anyone object to archiving this section? SandyGeorgia ( Talk) 18:46, 11 December 2013 (UTC)

Cannabis_(drug)#Medical_use is a poor summary of this article, and most of it should be removed, merged here, and rewritten in summary style. SandyGeorgia ( Talk) 22:32, 1 December 2013 (UTC)

Yes agree Doc James ( talk · contribs · email) (if I write on your page reply on mine) 21:15, 2 December 2013 (UTC)

The Cannabis plant has a long history of medicinal use, with evidence dating to the Emperor Shen Nung in 2737 BCE.

This date is not correct, which is why I previously removed it. Why was it added back? Viriditas ( talk) 04:15, 3 December 2013 (UTC)

Well, also, Shen Nung is a mythical or semi-mythical figure, so the word "evidence" is probably too strong. This is pretty much like saying that medical cannabis was pioneered by Romulus and Remus. MastCell  ^Talk 05:09, 3 December 2013 (UTC)

Yep, and the first written evidence wasn't dated until 1-2 CE. New evidence of older medicinal cannabis use is now available. [6] The Chinese claim is from the mid-1970s and is no longer true. Viriditas ( talk) 05:19, 3 December 2013 (UTC)

The basic and definitional aspects of this article are in particularly poor shape, and the flow is off (concepts are introduced before they are defined, and the definitions could be much more comprehensive, as well as more specific to which product is being discussed in which research). The article should

1. Mention that medical cannabis can be smoked, inhaled, or pharmaceutical
2. Discuss the pharmacology
3. Better define and discuss each pharmaceutical product

Now that I have dozens of sources covering this territory, I plan to work on these sections today and tomorrow (some of which involves sub-articles). Lots to do in here, but there is very good information in sources that have been alarmingly untapped in this suite of articles. User:SandyGeorgia/Cannabis sandbox SandyGeorgia ( Talk) 16:51, 7 December 2013 (UTC)

I am going to remove the {{ MEDREF}} tag I placed now, because the article (with the exception of the botanical section) is mostly correctly cited now. I don't know which secondary review from User:SandyGeorgia/Cannabis sandbox is the best for citing that section; if anyone has suggestions, I'll be glad to do the work.

The dispensing machine section is still very out of place in this article, and I don't see good reasons at Talk:Marijuana vending machine for it to have been merged to here (it does meet notability, and the issues being discussed in that section are business-related).

The article is now ready for expansion, there is room for correct expansion, and there is an abundance of secondary reviews upon which expansion can be based. There is more than I can get through in weeks, so anything that I haven't yet added is not for lack of concern or interest, rather for lack of time given the huge amount of good sources available and the amount of material to get through. I will probably next expand the Tourette syndrome section, as I know that area well (although there is little more to say than what is said in the Cochrane review). SandyGeorgia ( Talk) 03:09, 8 December 2013 (UTC)

A merge to medical cannabis has been proposed. I encourage you to weigh in and get it resolved so that we can remove the unsightly template at the top of medical cannabis as soon as possible.

Please see: Talk:Marijuana_vending_machine#This article as a section within another

Many thanks, Anna Frodesiak ( talk) 01:56, 29 October 2013 (UTC)

I see this merge was done, which is frankly ridiculous for an article this size. Could we revisit this logic with a broader audience please? SandyGeorgia ( Talk) 17:21, 4 December 2013 (UTC)

Is anyone working on this article going to respond to this section? If not, I will move the text back to marijuana vending machine; I've been asking for feedback for a week with narry a response. SandyGeorgia ( Talk) 18:44, 11 December 2013 (UTC)

 Done SandyGeorgia ( Talk) 04:50, 13 December 2013 (UTC)

This is discussing a legal and social and cultural aspect [7] thus moved it to that section. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 18:35, 9 December 2013 (UTC)

I have multiple times on this page asked if we can move the way off-topic information about the business goings-on of vending machines back to marijuana vending machine from whence it came; no one has responded. SandyGeorgia ( Talk) 20:12, 9 December 2013 (UTC)

I raised this four times over more than a week, no one responded, so,  Done SandyGeorgia ( Talk) 05:09, 13 December 2013 (UTC)

A thousand pardons. I missed you raising this. I started the article and it got merged here. I'm happy wherever it is, but most happy with it as a standalone. There, it can expand without making a host article go off-topic. Also, one of the machine makers said he'd send me a photo, so that ought to make it even more standalone worthy. Cheers, Anna Frodesiak ( talk) 06:26, 13 December 2013 (UTC)

The fourth paragraph of the Lede states that medical effects of cannabis are disputed, and cites the US DEA and a US medical organization. This is leaving out the rest of the world, and seems more fitting for an article dedicated to Medical cannabis in the US. petrarchan47 t c 03:28, 3 December 2013 (UTC)

I've removed the entire paragraph. It was not cited to a reliable secondary source and was clearly labeled as an advocacy statement on both ends. Viriditas ( talk) 05:09, 3 December 2013 (UTC)

This is the same discussion below under "Recent additions to the lead". SandyGeorgia ( Talk) 09:06, 3 December 2013 (UTC)

We've discussed problems with the lead in three sections, and arrived at an interim solution, pending eventual rewrite. In the interest of space, does anyone object to archiving this section now? SandyGeorgia ( Talk) 18:48, 11 December 2013 (UTC)

The lede does need to contain notable criticism, but the FDA-centric stuff that's there presently probably isn't it as (yes) it is a bit US-centric. Attempting to make it seem otherwise by saying organizations "like" the FDA share its view, are unsourced. I'd favour removing this paragraph and re-visiting this when the article body is in better shape. Alexbrn ^{talk| contribs| COI} 15:54, 30 November 2013 (UTC)

"FDA-centric stuff" is not a correct description. It is a fact that many countries in the western world demand the drugs for medical use must be registered and approved by its own agency. Typically have persons from the medical profession a very strong position in those agencies. Approval of a drug as as medical drug is i those countries demand around 10 years of testing and documentation of the result and a strict quality control of the production and distribution after approval. Dala11a ( talk) 20:37, 30 November 2013 (UTC)

I'm always all in favor of writing the lead last-- after the article has been developed-- because leads should summarize the article. I also don't view content in terms of "criticism" or not, unless we are talking about, for example, literary criticism or criticism of a film or work of art. Content is content, the facts are the facts, and a well written article will not be categorized along the lines of "criticism". See Wikipedia:Criticism. The article should be neither "pro" nor "con", which negates the need to view any part of it as "criticism". It should merely state the facts as supported by the highest quality, most recent sources, for example:

• Gordon AJ, Conley JW, Gordon JM (2013). "Medical consequences of marijuana use: a review of current literature". Curr Psychiatry Rep. 15 (12): 419. doi: 10.1007/s11920-013-0419-7. PMID  24234874. {{ cite journal}}: Unknown parameter |month= ignored ( help)CS1 maint: multiple names: authors list ( link)

SandyGeorgia ( Talk) 21:19, 30 November 2013 (UTC)

The way I see it, criticism is not necessarily adverse criticism; so perhaps "evaluative opinion" might be a better way of putting it. WP:LEDE does guide us include "any prominent controversies", and that might apply here. I'm not sure though, that the FDA stuff does that well - and agree it is better to focus on the body before writing a lede.

Has anybody got access to that new review article, BTW? Alexbrn ^{talk| contribs| COI} 21:47, 30 November 2013 (UTC)

The introduction must give a balanced view of the situation in this matter. The vast majority of doctors do not recommend the smoking of marijuana, it is a very small minority of doctors who write for a very large proportion of all recommendations, most of them are made after a very brief survey, in practice, often only on the grounds that the patient states he needs pain relief. Dala11a ( talk) 01:09, 1 December 2013 (UTC)

I'm definitely in favor of a balanced section on this topic. I would put off using this material in the lead until it is completed. I do want to point out, however, that your argument is fallacious on several levels. You say that the majority of physicians don't recommend it, but you will need to quantify that statement. More to the point, why would the majority of physicians recommend it? Do you understand why some do? Please think your argument through. The majority of people are not sick and in need of cannabis, nor are the majority of patients and doctors in states where it is legal. Also your claim plays around with the concept of a minority. Since only the minority of people are sick, only a minority of physicians would recommend it, especially due to the concerns listed above with laws and regions. The point you are trying to make, however indirectly, is when would it be recommended and when would it not. You should probably look at specific specialists who focus on issues where the drug is shown to work. Viriditas ( talk) 04:04, 5 December 2013 (UTC)

We agreed below on an interim compromise to the lead; is anyone opposed to archiving this section in the interest of space, as we will work more on the lead once the article is written? SandyGeorgia ( Talk) 18:45, 11 December 2013 (UTC)

I have this paper now:

• Gordon AJ, Conley JW, Gordon JM (2013). "Medical consequences of marijuana use: a review of current literature". Curr Psychiatry Rep. 15 (12): 419. doi: 10.1007/s11920-013-0419-7. PMID  24234874. {{ cite journal}}: Unknown parameter |month= ignored ( help)CS1 maint: multiple names: authors list ( link)

Excerpt:

Advocacy, opinion, and politics may cloud perception of the merits of marijuana’s legal use [126]. However, the peer-reviewed literature is the most objective means to examine purported and realized health effects of marijuana exposure. In this review, we examined the recent (since 1998) literature regarding associations of the health effects to marijuana exposure. We found evidence that marijuana seems to have physical health effects in humans aside from mental health, behavioral, and societal morbidity, and there is a biological basis for many of these effects. For example, marijuana use is associated with diseases of the liver (particularly with co-existing hepatitis C), lungs, heart, and vasculature. For clinicians, knowing these associations will enhance their ability to address these incident (or on-going) physical illnesses that may occur secondary to marijuana use.

That is, it deals with the health effects of cannabis, not medical cannabis. It will be useful for updating the cannabis, effects of cannabis and long-term effects of cannabis articles, but less useful here. SandyGeorgia ( Talk) 16:39, 1 December 2013 (UTC)

I'm not convinced. The study makes popular anti-drug claims and the references show studies dated from 23 years ago. I also question the veracity of these claims and find them unbelievable. They seem to be extrapolating long term harm from a single correlated association. Is this even science? I'm familiar with the medical cannabis literature and I've never seen these strange claims before. The references also show a lot of citations to the anti-drug studies. I'm curious who funded this study and if it is taken seriously by the research community. I suspect that it is not. NIDA, the DEA, big pharma, and other groups have expressed an interest in helping publish studies like this. In the 1980s, NIDA even said off the record that they would not publish studies that showed positive outcomes. Viriditas ( talk) 04:20, 5 December 2013 (UTC)

Israel is the leading country in terms of research, and should have its own section.

Here are some sources: NPR Science Daily Fox petrarchan47 t c 08:03, 3 December 2013 (UTC)

There is an Israel section. (I'll note that the bottom of the article is still in bad need of a copyedit, rationalization, and consolidation, but I removed the copyedit tag because the top is in good shape and in the hopes others will take that on willingly.) SandyGeorgia ( Talk) 08:25, 3 December 2013 (UTC)

Great. petrarchan47 t c 08:39, 3 December 2013 (UTC)

This article is too long; I've proposed in another section below that we merge a lot of the country-specific text here about the legal and medical status in various countries to Legal and medical status of cannabis. To whatever extent secondary sources mention the importance of medical research in Israel, that would be included in the Research section, per WP:MEDRS. SandyGeorgia ( Talk) 17:24, 4 December 2013 (UTC)

This was removed in the recent slew of fixes, but the information should be re-added. source petrarchan47 t c 08:05, 3 December 2013 (UTC)

An assessment of cannabis safety is medical content, isn't it? How is an opinion from a judge in 1988 in line with WP:MEDRS? Alexbrn ^{talk| contribs| COI} 08:17, 3 December 2013 (UTC)

Because this edit replaced three journal sources with a laypress news source (!!), I've spent some time searching PubMed on the topic. As an aside, the three journal sources were primary sources that shouldn't have been used to begin with, but replacing them with a laypress source was even worse. From what I can determine in PubMed, it looks to me like we're weasling around the issue by quoting the judge, and we can do better. Someone with full journal access might opine; if you are willing to relax MEDRS to quote a judge in the laypress, then we might also relax MEDRS to quote primary journal sources that discuss documented deaths. SandyGeorgia ( Talk) 08:22, 3 December 2013 (UTC)

Interesting, so these are equally valuable in your view? The DEA judge did a review, for over a year, of all available research at the time. I thought his statement about the therapeutic ratio was especially relevant to this article. This is also history. But really, this isn't about scoring points and it feels as if it has become a game. The POV is obvious by these replies, sorry to say. petrarchan47 t c 08:48, 3 December 2013 (UTC)

I'm talking sources. You're talking motive. Let's talk content. I did not say anything was equally valuable. I said the three primary journal sources shouldn't have been used, but replacing them with lay press was even worse. And we can do better. SandyGeorgia ( Talk) 09:01, 3 December 2013 (UTC)

SandyGeorgia - This source has a section on marijuana-related fatalities (you'll need full access to see page 902). Money quote: "Few reports of marijuana-related fatalities appear in the medical literature; the etiology of those fatalities is not well documented." Cited in support is http://dx.doi.org/10.1037/1064-1297.2.3.244 Alexbrn ^{talk| contribs| COI} 08:52, 3 December 2013 (UTC)

That no one has died from cannabis is not disputed, and was echoed by Sanjay Gupta, in his 2013 CNN documentary called "Weed". He said he spent a year going over all the evidence, and one thing he found was that there exists no documented deaths attributed to cannabis. This isn't fringe theory. Lester Grinspoon is a Harvard doctor who spent 30 years researching the dangers of cannabis for the government. His statements can appear anywhere and constitute RS because of his status. I have to warn you, if you decide to state that people have died from cannabis, you're going to make wikipedia look like an idiot. petrarchan47 t c 09:00, 3 December 2013 (UTC)

Why are we quoting Sanjay Gupta anyway? Petra, please lower the rhetoric. No one is talking about stating that people have died. We are talking about whether to include statements that people "haven't died" from questionable sources. Two different things. SandyGeorgia ( Talk) 09:03, 3 December 2013 (UTC)

@Alexbrn, yes, I understand from PubMed that the etiology of deaths isn't well documented. That is what I find weasly about quoting the judge. SandyGeorgia ( Talk) 09:04, 3 December 2013 (UTC)

I propose either using Barceloux then, or saying nothing at all - this doesn't seem to be a topic covered much in the secondaries, after all. Alexbrn ^{talk| contribs| COI} 09:11, 3 December 2013 (UTC)

Barceloux? Can we get a standard in here for how we refer to studies? You tend to cite DOIs, I cite PMIDs, I don't know who Barceloux is. And readers who come along three days from now are even less likely to know. SandyGeorgia ( Talk) 09:20, 3 December 2013 (UTC)

By "Barceloux" I mean Chapter 60 of Medical Toxicology of Drug Abuse: Synthesized Chemicals and Psychoactive Plants [8] (i.e. the statement about few deaths and poorly documented etiology). For the other journal, I know you like PMIDs and I tried to find one for you, I truly did, but could only see a DOI. Alexbrn ^{talk| contribs| COI} 09:25, 3 December 2013 (UTC)

I guess you mean this 2012 book (which I had to look up in my ISBN finder-- Google book links don't work for everyone). OK, if that's what you mean, then a 2012 source is better than a 1988 statement from a judge, IMO. Next time, please lay out your source more clearly on the first post-- we've got a lot of work to do in here :) SandyGeorgia ( Talk) 09:35, 3 December 2013 (UTC)

Sorry, I had absolutely no idea that Google Books wasn't everywhere! Is there a problem accessing the .co.uk Google Books links from outside the UK? Alexbrn ^{talk| contribs| COI} 09:39, 3 December 2013 (UTC)

I will explain on your talk so as not to fill up this page. SandyGeorgia ( Talk) 10:44, 3 December 2013 (UTC)

Summarizing, I prefer this recent source over a 25-year-old statement from a judge:

• Barceloux, Donald G. (2012). "Chapter 60: Marijuana (Cannabis sativa L.) and synthetic cannabinoids". Medical Toxicology of Drugs Abuse: Synthesized Chemicals and Psychoactive Plants. Wiley. p. 902. Few reports of marijuana-related fatalities appear in the medical literature; the etiology of those fatalities is not well documented. {{ cite book}}: Unknown parameter |ISBN13= ignored ( help)

Can we get a page number?

And why are we quoting Sanjay Gupta, a TV-doc commentator, in an encyclopedia? SandyGeorgia ( Talk) 11:47, 3 December 2013 (UTC)

• Calabria B, Degenhardt L, Hall W, Lynskey M (2010). "Does cannabis use increase the risk of death? Systematic review of epidemiological evidence on adverse effects of cannabis use". Drug Alcohol Rev. 29 (3): 318–30. doi: 10.1111/j.1465-3362.2009.00149.x.. PMID  20565525. {{ cite journal}}: Check |doi= value ( help); Unknown parameter |month= ignored ( help)CS1 maint: multiple names: authors list ( link)

Another source, probably more useful for long-term effects of cannabis, but shows why we should not be using a 25-year-old statement from a judge, when we have updated medical reviews. SandyGeorgia ( Talk) 17:40, 4 December 2013 (UTC)

• I believe many studies have showed that participants have died, but there is no way to correlate that with cannabis. Wang et al., 2008 comes to mind. These kinds of deaths happen in large studies because statistically death cannot be avoided. Viriditas ( talk) 04:25, 5 December 2013 (UTC)

Per the discussion on Petra's talk, I've added {{ recruiting}} to this talk page. SandyGeorgia ( Talk) 19:53, 8 December 2013 (UTC)

And I've removed it. She was talking about forming a workgroup/WikiProject. There are no active teams except for Drug Free Australia, but this is being addressed on WP:ANI. Viriditas ( talk) 20:04, 9 December 2013 (UTC)

There is alredy a Wikipedia:WikiProject Cannabis, and it was notified days ago of this discussion (with no effect). Petra made numerous and clear statements indicative of recruiting; please do not remove maintenance tags without discussion. SandyGeorgia ( Talk) 20:25, 9 December 2013 (UTC)

I discussed it. You misinterpreted numerous clear statements indicative of starting a new workgroup/WikiProject about medical cannabis to mean she was recruiting. She wasn't and she isn't. Viriditas ( talk) 20:37, 9 December 2013 (UTC)

That's settled:

• "...I have a biochemist friend who studies cannabinoids, and who has agreed to join us in working on these articles ... "
• "I am also calling in some scientists/researchers in the field, and as your team also has a doctor, I don't see how this could be viewed as a problem, or as anything but a great benefit to our readers."
• And on MastCell's talk [9]
• And on Petrarchan47's talk [10]

SandyGeorgia ( Talk) 05:07, 13 December 2013 (UTC)

As I mentioned above, User:SandyGeorgia/Cannabis sources is a page where I've begun consolidating secondary reviews in the hopes we will work together to build this article.

• This edit by Petrarchan47 replaced correctly cited and dated text to text that was not verified by any citation. That was correctly removed by CFCF. There are numerous reviews that have free full text listed in the sources sandbox above; it would be helpful if those working on the article would access them to correctly cite text. SandyGeorgia ( Talk) 15:34, 9 December 2013 (UTC)

Sandy, I am going to do this as best I can, and it isnt' going to look exactly as you've requested. I would like to be allowed to ask other editors from Project Cannabis to help, but fear retribution for canvassing. Pending assisstance, I'll just edit and comment and participate as I normally do on any other page. You do not get to dictate how things go on this or any article, it is a group thing.

SOURCE

Updated September 2013

In 1996, California voters passed Proposition 215, making the Golden State the first in the union to allow for the medical use of marijuana. Since then, 19 more states, and the District of Columbia have enacted similar laws, for a total of 20 states and the District of Columbia with public medical marijuana programs.**

Petrarchan47, Wikpedia:WikiProject Cannabis was notified a week ago. SandyGeorgia ( Talk) 20:30, 9 December 2013 (UTC)

• This edit by Petrarchan47 added text to "Medical uses" about a now-closed program ("History") cited to the laypress. We have multiple secondary reviews covering this information, and journal-published secondary reviews tend to be more accurate than the laypress, which is why our medical sourcing guidelines prefer secondary journal reviews over the laypress. I copyedited, corrected the wikilink, and upgraded the citations to a secondary journal review. In this case, the full text of that journal review is available, and could have been used. It is a 2006 review, so shouldn't be used to cite medical fact when there are more recent reviews available, but it is useful for History. I also moved the text to the History section. SandyGeorgia ( Talk) 15:34, 9 December 2013 (UTC)

For goodness sake, this is information about a government program, not a health claim; it doesn't need to be MEDRS compliant. petrarchan47 t c 18:38, 9 December 2013 (UTC)

Whether health claims or not, everywhere on Wikipedia for any kind of text we prefer the highest quality sources over lower quality sources. In this case, we have free full access journal source text available; we can use it. SandyGeorgia ( Talk) 20:23, 9 December 2013 (UTC)

Petrarchan47, you indicated two days ago that time and energy is an issue; I suggest that working together would be a more efficient use of everyone's time and energy. When we have so many recent reviews, it shouldn't be necessary for others to correct inadequately cited text here. Also, having indicated a sources sandbox above (one where we will hopefully all collaborate), I see you have started:

• User:Petrarchan47/sandbox

which should be mentioned here. You have listed secondary reviews there, which is a great improvement over past editing here, but unfortunately some of the reviews you've accessed are quite old, and might not be useful here when we have so many recent secondary reviews. If you could collaborate on sourcing, it would help save time for all of us. We can all move faster in building this article if we don't have to stop and rectify poorly sourced additions. SandyGeorgia ( Talk) 15:35, 9 December 2013 (UTC)

And, reverted; presumably now we will discuss? SandyGeorgia ( Talk) 17:21, 9 December 2013 (UTC)

• With this edit, again we have (as above) the addition of text which is not verified by the citation given, along with incorrect capitalization of Glaucoma (see WP:MSH), incorrect use of numbers vs digits, and by the way, the source used the word marijuana. Petrarchan47, please begin to discuss your edits on talk as that will save time for everyone and avoid duplication of effort. The text you have added is incorrectly written and incorrectly cited. SandyGeorgia ( Talk) 17:35, 9 December 2013 (UTC)

• I have not corrected the errors introduced above; this is too time-consuming, so I will leave that error fixing or tagging to someone else for now. SandyGeorgia ( Talk) 18:23, 9 December 2013 (UTC)

PLEASE tell me you aren't going to nitpick when I have stated my time and energy for this is low. Please take a little gentler approach, I am asking from one human being to another. This article is global in scale, the term "marijuana" is US-centric (much like the first section of this article) and slang. It should not be used in a medical cannabis article except in the US history section. The claim "not verified by the citation given" is misleading - the information I added is included in the corresponding and linked Wikipedia article. Should I have copied refs to this article? I didn't think it was necessary. petrarchan47 t c 18:38, 9 December 2013 (UTC)

You have a misunderstanding of Wikipedia sourcing policies: yes, you must cite text in the article where it occurs. SandyGeorgia ( Talk) 19:48, 9 December 2013 (UTC)

• This edit added outdated text from a six-year old source, even after multiple sections on this talk page discuss the problems with using old sources for this kind of text (for example, see the section on Tourette syndrome), and a sandbox with a multitude of recent secondary reviews has been started. The text was removed as already discussed with newer sources, but next, Petra edit warred without discussion to reinstate the text. Once again, Petrarchan47, please engage the talk page in good faith and discuss your edits. SandyGeorgia ( Talk) 19:48, 9 December 2013 (UTC)

In this version, I have rewritten and expanded the TS section as a sample for discussion. What I've written demonstrates the problems with using older reviews when we have newer reviews available. In the general Tourette syndrome literature, mention of cannabinoids in treatment has completely dropped off, and there is nothing new that can be said based on recent reviews. Basically, there were two controlled studies years ago that promoted cannabinoids for TS treatment (both Muller-Vahl), both on small samples, both with sample bias), and there has been little further interest or mention in the literature. So, do we include the older reviews for balance, or do we only include the 2009 Cochrane review (considered the gold standard) when we have nothing else recent? I am not averse to having the history removed, but I hope we can use this sample first for discussion of how this article should handle old claims and reviews relative to newer information. SandyGeorgia ( Talk) 17:12, 9 December 2013 (UTC)

I think having just Cochrane is best. In general I prefer to see the use of older studies minimized, perhaps by some terse wording after the up-to-date statement ("Earlier studies had suggested foo and bar[ref][ref]"). Alexbrn ^{talk| contribs| COI} 07:46, 12 December 2013 (UTC)

This [11] As we discuss it already using better sources. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 18:58, 9 December 2013 (UTC)

Also there are a lot of more recent sources. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 19:00, 9 December 2013 (UTC)

Have removed it a second time. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 19:12, 9 December 2013 (UTC)

Maybe it's not so much the fact that we have other sources elsewhere, it's the placement, and the clarity that I prefer. Please leave this or replace it with the better, more recent sources you have - but leave the information in this section so that the reader can get a clear, more rounded picture of the medicinal uses, as this seems to be a section where utility is being summarized. This first section seems very slanted toward warnings about one type of administration (smoking) and toward US government views. Please remember this article not the "Medical cannabis in the US" article, and that most patients, from what I understand, eat or vaporize their medicine (this context should be added to the article once a ref is found). petrarchan47 t c 19:13, 9 December 2013 (UTC)

The problem is it's unclear: by mixing up a big list of things which are being treated with things that might be treatable. Also it's a rather dated source (when we have better) and you're quoting from the abstract ... All in all, this is not useful to us. Alexbrn ^{talk| contribs| COI} 19:15, 9 December 2013 (UTC)

It's of use to the reader, and I linked to the full paper, so it's quite irrelevant that I am quoting from the abstract. Anyway, I was addressing Doc James, and I don't think he needs your support in 'handling' me. Aren't you the one who claimed there was no effect on MS, when in fact it is the most well-documented condition? petrarchan47 t c 19:30, 9 December 2013 (UTC)

I said you were quoting from the abstract; not always a good idea in representing the source well. You haven't addressed my point that the source is dated. As to my edits, you are misrepresenting them - and not for the first time, sad to say. Alexbrn ^{talk| contribs| COI} 19:37, 9 December 2013 (UTC)

Tell me specifically how I misrepresented your work on the MS section, if you wouldn't mind. I am also unclear as to what constitutes "outdated" (besides a study being later debunked or contradicted) and which wikipedia editor determines this date. I wonder if editors new to this subject appreciate that laws have created great difficulty in studying the plant for anything besides harmful effects, and that there is a dearth of research, meaning that what we do have is rare and shouldn't not be so readily discarded. petrarchan47 t c 21:45, 9 December 2013 (UTC)

I provided a link to WP:MEDDATE, that will help explain what "outdated" means. As to your misrepresentations, I will set these out on your Talk page so as not to clog up the conversation here. Alexbrn ^{talk| contribs| COI} 21:51, 9 December 2013 (UTC)

Petrarchan47, there are times when we must use sources older than the last three, four or five years (for example, Ben Amar 2006 has good history sections, better than anything newer that I've come across so far), but when a specific example of the problems with older TS data is given on talk, you don't engage, and you instead add text from a six-year-old review on the very same topic, I hope you can see how that makes what is already difficult editing here that much unnecessarily harder. On any medical topic, one can find old reviews that say just about anything; in this topic, we have very good secondary reviews, a number of them, and if we can avoid using older reviews, we'll make much faster progress. That is why I've provided a sandbox with links to all the free full text we can find; if you have other recent secondary reviews, by all means, please bring them forward so that we can all consult them, and work together more efficiently. SandyGeorgia ( Talk) 22:00, 9 December 2013 (UTC)

As discussed in numerous sections above, there is a problem with using a six-year-old source for text that is better sourced today. I also note that Petra has editwarred to retain that text, instead of discussing. This is a time-consuming way to work; Petra, please address the numerous updated secondary reviews (for example, the Tourette syndrome one given above) and explain why we should retain outdated information, much less in more than one place in the article. SandyGeorgia ( Talk) 19:53, 9 December 2013 (UTC)

For the record, the edit history shows edit warring by multiple parties, including Jmh649. Viriditas ( talk) 20:01, 9 December 2013 (UTC)

One needs support to make a controversial change per WP:BRD. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 20:15, 9 December 2013 (UTC)

You didn't seem to need any support when you reverted the schizophrenia material back in. I guess the rules only apply to Petra, then, right? Viriditas ( talk) 20:32, 9 December 2013 (UTC)

Viriditas, I am addressing the specific example of editwarring by Petrarchan47 after discussion was started here and here. Without having engaged either of those discussions, Petra first added and then reinstated outdated text, and text already covered elsewhere in the article by newer sources. SandyGeorgia ( Talk) 20:18, 9 December 2013 (UTC)

Sandy, there is a specific venue for addressing editwarring. Please use Wikipedia:Administrators' noticeboard/Edit warring. Please also remember to report Jmh64 while you are there. Viriditas ( talk) 20:30, 9 December 2013 (UTC)

The medicinal value of cannabis is disputed. The American Society of Addiction Medicine dismisses the concept of medical cannabis because the plant fails to meet its standard requirements for approved medicines. The US Food and Drug Administration (FDA) maintains that cannabis is associated with numerous harmful health effects, and that significant aspects such as content, production, and supply are unregulated. [12] [13]

And editor recently added this content to the lead section. The statement by the ASAM is sourced to a primary advocacy piece while the statement by the FDA is sourced to a government propaganda press release published on a website by the Scholastic Corporation. Both of these statement have been thoroughly debunked in the literature and neither citation meets the reliable secondary source classification. It's funny how WP:MEDRS is invoked when an editor removes positive information about the efficacy of medical cannabis but ignored when editors add negative political propaganda. Viriditas ( talk) 05:02, 3 December 2013 (UTC)

Viriditas, your insinuations are unhelpful; there are many people at work on the article, sometimes editors get crossways with each other with that much work happending; there is much work still to be done; attributing motives is a failure to AGF and doesn't help work advance. There is still a mountain of poorly sourced content in the article that needs to be deleted; that there hasn't been time to get to it yet isn't a reason to attribute motive. I usually work on the lead last and hadn't really looked. And I have no idea if Dala11a has invoked MEDRS for anything. Let's please focus on content and not be attributing motive.

This was the text addition by Dala11 that was subsequently copyedited into much better shape by someone before you removed it. The sentence The medicinal value of cannabis is disputed has been in the article all along, was not added by Dala11, it was merely joined with that information when someone later copyedited (I haven't followed through to see who did that copyedit, but it did improve the prose.)I can't see any reason for deleting that sentence, as it is an accurate, brief, and balanced summary statement.

This removal should be discussed. SandyGeorgia ( Talk) 08:58, 3 December 2013 (UTC)

The medicinal value of cannabis isn't disputed by the Institute of Medicine of the United States National Academies or any other number of established mainstream medical institutions. That sounds like a fringe statement. Do you have a MEDRS-compliant source to support it or just a link to a self-published advocacy website? Viriditas ( talk) 10:23, 3 December 2013 (UTC)

I plowed through more than a dozen journal review yesterday, and have started

• User:SandyGeorgia/Cannabis sources

where we can consolidate a list of sources, indicating which editor has access to the full text of which articles. I've found in particular that we have in general a huge amount of untapped information in secondary reviews, some unnecessary use in the article of extremely old information, and in particular that our entire section Medical cannabis#Pharmacology is extremely poorly sourced while we have an abundance of good information in the reviews that should be covered here and isn't even touched on (this article does a poor job of sorting out which studies and finding pertain to which pharmaceutical product vs. smoked cannabis used medicinally).

Before beginning to rework the text, I've decided to instead focus a bit on organizing the sources. Could anyone who has free full access to any recent secondary review that is behind paywall please indicate so at User talk:SandyGeorgia/Cannabis sources so I can add it to the chart? SandyGeorgia ( Talk) 17:34, 6 December 2013 (UTC)

I believe I've now listed all of the recent secondary reviews in the article or mentioned here on talk, except that I have something about "Chadwick" in my notes, and I'm not locating a Chadwick. Please add to the talk page there if you see anything that needs to be fixed or added. Also please note if you have the full text of anything not having a URL or PMC, so we know who can quote excerpts if needed. SandyGeorgia ( Talk) 20:57, 6 December 2013 (UTC)

I have indicated where I have access (for things which you don't). Alexbrn ^{talk| contribs| COI} 14:36, 7 December 2013 (UTC)

• "Researchers and clinicians remain divided regarding key issues such as whether or not cannabis is an independent cause of psychosis and schizophrenia." http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3796266/

• PMID  24133460 is a recent review. SandyGeorgia ( Talk) 20:17, 4 December 2013 (UTC)

• Lester Grinspoon on Cannabis and schizophrenia
  • Clearing the Smoke: The Science of Cannabis (PBS Doc) http://watch.montanapbs.org/video/1825223761/

From the video (at 15:30): Scientists are unsure whether it causes, or simply correlates. "Dr Grinspoon was a psychiatrist and his expertise was in schizophrenia. He strongly disagrees with critics who say marijuana may trigger [Schizophrenia]. Grinspoon: 'I think that is absurd. The frequency of of schizophrenia - the world over - is about one percent. You would expect that with a drug used as often as it is, you would expect a "blip"' (ie, a rise in rate of Schizophrenia to match increased cannabis use). "It doesn't change a bit. In fact, you can find as much in the literature about how cannabis is useful to Schizophrenic patients as it is harmful" Lester Grinspoon.

• • Summary of the Testimony of Lester Grinspoon, M.D. before the Crime Subcommittee of the Judiciary Committee U.S. House of Representatives On the general use of medical cannabis from Grinspoon's website

• • http://norml.org/pdf_files/brief_bank/AFFIDAVIT_OF_LESTER_GRINSPOON_MD.pdf
    • This is a 2008 affidavit, a primary source. SandyGeorgia ( Talk) 20:17, 4 December 2013 (UTC)

• ecological studies have found little association between the increase in cannabis use over recent decades and incidence of psychotic disorders http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3544397/

• This is PMID  23361397 (unclear whether it is a review, commentary, letter, what) SandyGeorgia ( Talk) 20:17, 4 December 2013 (UTC)

• Of the studies included in the review, 11 reported better cognitive functions among cannabis-using schizophrenia patients compared to non-users, 5 found minimal or no difference between the groups and 3 found poorer cognitive functions among cannabis-using schizophrenia patients compared to non-users. http://www.ncbi.nlm.nih.gov/pubmed/22716156

• PMID  22716156 is a recent review. SandyGeorgia ( Talk) 20:17, 4 December 2013 (UTC)

• Patients with schizophrenia frequently report cannabis use, yet its effects on neurocognitive functioning in this population are still unclear. This meta-analysis was conducted to determine the magnitude of effect of cannabis consumption on cognition in schizophrenia without the confounding effects of other co-morbid substance use disorders. Eight studies met inclusion criteria yielding a total sample of 942. Three hundred and fifty six of these participants were cannabis users with schizophrenia, and 586 were patients with no cannabis use. Neuropsychological tests were grouped into seven domains (general cognitive ability and intelligence; selective, sustained and divided attention; executive abilities; working memory and learning; retrieval and recognition; receptive and expressive language abilities and visuo-spatial and construction abilities). Effect sizes were computed for each cognitive domain between cannabis-using patients and patients with no history of cannabis use. Effect size differences in cognitive performance in the schizophrenia group as a function of cannabis use were in the small to medium range, denoting superior performance in cannabis-using patients. http://www.ncbi.nlm.nih.gov/pubmed/21420282
• PMID  21420282 is a 2011 review and meta-analysis. SandyGeorgia ( Talk) 20:17, 4 December 2013 (UTC)

(Just beginning to leave some notes) petrarchan47 t c 18:59, 4 December 2013 (UTC)

Petra, if you give a PMID followed by a number, we can all see what type of study it is, and a link to the full text. It makes for a much shorter and more navigable talk page. Also, if you minimize markup (bolding and italics) your posts will be more readable.

I've been at work most of the day flagging reviews, will look at these later.

I'm also unclear why you are parking these here, as they appear to be useful for long-term effects of cannabis (which is still in dreadful shape). That we have recent reviews discussing that there are safety concerns related to schizophrenia and relative to medical cannabis is the issue in this article; these reviews will need to be incorporated into the long-term effects article. SandyGeorgia ( Talk) 20:21, 4 December 2013 (UTC)

I left them here to begin a conversation about the new and improved Lede to this article, specifically its "concerns about schizophrenia". I think all of the changes being made to these articles need review. I'm beginning with the Lede to this one. If I had a team like you do, we could work on all of the articles together, but I don't. petrarchan47 t c 20:40, 4 December 2013 (UTC)

[Edit conflict]

Sandy, this list is not directed at you, personally. I am going to try and call in a larger group of editors to help - no article on Wikipedia should be allowed to be controlled by a select group of people, which I see happening across the entire suite of cannabis articles. Experts like David Nutt are being removed, and a systematic sweep is leaving the articles with a focus on the negative by these edits. This is not an easy field to study. Research is hampered by laws, while the USG funds only studies that will look for negative effects. At the Cannabis (drug) article, it took roughly 7 editors (none of them working as a team or who knew each other previously) over a month, maybe two, of hard work just to deal with one section, the Safety section, which was a disgrace before I waved the flag. Few of us agreed, we took our time, added refs, and made our cases. We looked at the totality of the science and other RS on the subject, and formed a consensus as a group. People have very heated opinions about this subject, and this is why we need a good, large mix of folks in here. I am doing the best I can to help. If my refs need fixing, you have my permission to go ahead and do it yourself - but please leave a clickable link. petrarchan47 t c 20:36, 4 December 2013 (UTC)

Yes, I was suggesting that you could shorten your posts by using PMID links, and that this particular list belongs at Talk:Long-term effects of cannabis. I've made a number of proposals above to try to speed up our work (I'm sure we'd all like to get tags removed from articles asap); would you mind responding to those so we can move on? SandyGeorgia ( Talk) 20:50, 4 December 2013 (UTC)

I don't have the time or the energy to go after this like you all are doing. I am working on getting a team together to review all these changes for NPOV. The research takes time, this is a complex subject. For instance, this review shows that some of the conclusions your team has added to the article are not the result of a good review of the literature, with an open mind about the subject:

• PMID  21462790 "Many studies have focused on the long-term effects of cannabis on memory, but their results have been inconclusive. There do not * About fifteen longitudinal cohort studies that examined the influence of cannabis on depressive thoughts or suicidal ideation have yielded conflicting results and are inconclusive. Several longitudinal cohort studies have shown a statistical association between psychotic illness and self-reported cannabis use. However, the results are difficult to interpret due to methodological problems, particularly the unknown reliability of self-reported data. It has not been possible to establish a causal relationship in either direction, because of these methodological limitations..."(etc) petrarchan47 t c 21:10, 7 December 2013 (UTC)

Yes, Petra, writing articles correctly takes a lot of research and time, and that is made even more difficult when faced with an entire suite of articles that has been built incorrectly-- using primary sources and synthesis-- over many years. There is no "my team" or "your team"; there are guidelines for sourcing, and having spent the last week up to my eyeballs in journal articles, I am finding a wealth of secondary reviews so far beyond what I usually encounter for any sort of medical content on any article I've worked on (I'm usually lucky to have half a dozen recent reviews) that it is all the more mystifying that this suite of articles didn't take advantage of the multitude of sources compliant with our guidelines and policies. I have listed those that you have pointed out (indicating which I have access to) at User:SandyGeorgia/Cannabis sources. I do not have access to PMID  21462790; I do have now dozens of secondary reviews that need to be incorporated here. If there are others you feel should be included, please list them on the talk page there. There are so many recent reviews that we should not be relying on decades old primary sources, as this article was doing until a week ago. There is no reason for the stringing together here of primary sources when there are secondary reviews that do a very fine job of presenting all sides of the issues, including the psychosis/schizophrenia one. Please stop advancing the notion of "teams" and personalizing issues (see WP:BATTLEGROUND), and focus instead on content and sources. So far, the article hasn't even begun to be built. SandyGeorgia ( Talk) 22:04, 7 December 2013 (UTC)

This edit took two statements sourced to Borgelt 2013-- one sentence which discussed the benefits, one which discussed safety concerns, that is balanced-- and eliminated the second portion about safety.

1. Cannabis has been used to reduce nausea and vomiting in chemotherapy and people with AIDS, and to treat pain and muscle spasticity. PMID  23386598

2. According to a 2013 review, "Safety concerns regarding cannabis include the increased risk of developing schizophrenia with adolescent use, impairments in memory and cognition, accidental pediatric ingestions, and lack of safety packaging for medical cannabis formulations." PMID  23386598

So, we have safety concerns from our most recent review eliminated, while benefits identified in that same review are retained. What we have left in the article is only that the FDA doesn't consider that safety has been established, which is confusing, since the same can be said from reliable MEDRS-compliant secondary sources. SandyGeorgia ( Talk) 09:18, 3 December 2013 (UTC)

The edit summary said: "Please don't cherry pick abstracts". But was that happening? Alexbrn ^{talk| contribs| COI} 09:19, 3 December 2013 (UTC)

Unhelpful. Please stick to the facts; they usually speak for themselves. SandyGeorgia ( Talk) 09:21, 3 December 2013 (UTC)

I meant it as a factual question, about the abstract of PMID  23386598 - this link doesn't work for me? Alexbrn ^{talk| contribs| COI} 09:30, 3 December 2013 (UTC)

Oops, I found and fixed the error (when I numbered 1 and 2 above, the two got attached-- now fixed). Kinda funny since I just lectured you above about getting your sources straight the first time :) Sorry! Now you can see the article for yourself. Not only do we still have content to remove in here, we still have much content to add-- which is why I always find it strange when people fixate on the lead before working on the article. Whether it's in the lead or elsewhere, we have left out balance from this source. SandyGeorgia ( Talk) 09:44, 3 December 2013 (UTC)

Right, so I think the the concern in the edit summary was that the content ("Safety concerns regarding cannabis include the increased risk of developing schizophrenia with adolescent use, impairments in memory and cognition, accidental pediatric ingestions, and lack of safety packaging for medical cannabis formulations.") was just a mirror of the abstract ("Safety concerns regarding cannabis include the increased risk of developing schizophrenia with adolescent use, impairments in memory and cognition, accidental pediatric ingestions, and lack of safety packaging for medical cannabis formulations"). And indeed this does look problematic to me, not because of cherry picking, but because of plagiarism. Alexbrn ^{talk| contribs| COI} 09:55, 3 December 2013 (UTC)

It was one sentence, fully enclosed in quote marks. [14] Are you familiar with plagiarism? Cherry picking refers to taking only one side of an argument from a particular source. Removing the safety issues while leaving the benefits is, yes, cherry picking. One sentence fully encased in quote marks and attributed to its source is not plagiarism. Or too close paraphrasing. Or copyvio. It's attributing a direct quote. SandyGeorgia ( Talk) 10:06, 3 December 2013 (UTC)

Sorry, yes - you're completely right (I missed the quotes/attribution ... must be getting text-blindness). As for cherry-picking, this was the reason for the removal of the content, but it appears to have no basis since the original content wasn't partial. Alexbrn ^{talk| contribs| COI} 10:12, 3 December 2013 (UTC)

No problem; since we've never worked together before, you probably didn't know that I launched this. SandyGeorgia ( Talk) 10:27, 3 December 2013 (UTC)

There is no clear causal link between cannabis and schizophrenia and adding this to the lead section of medical cannabis is not only undue weight, it is completely off-topic. Were the study participants medical cannabis patients? Viriditas ( talk) 10:17, 3 December 2013 (UTC)

I've mentioned that I usually leave work on the lead for last, after the article is written. I don't care at this point what text goes in the lead, but we can't leave out of the article entirely something all recent high-quality journal secondary reviews say, nor is something covered by multiple reviews undue or off-topic. One of the specific reasons we use recent reviews is because they help us assign due weight. Borgelt 2013 is not a study; it's a review. Wikipedia:Wikipedia Signpost/2008-06-30/Dispatches helps better understand how to apply WP:MEDRS. SandyGeorgia ( Talk) 10:32, 3 December 2013 (UTC)

And yet, the exact opposite is the case. The source was being given undue weight (There is no clear causal link between cannabis and schizophrenia and "there is minimal information available about drug interactions and contraindications with cannabis-derived pharmaceuticals and medical cannabis"). Because the source was being misused, I removed it. Viriditas ( talk) 10:42, 3 December 2013 (UTC)

I note that Borgelt 2013 was a source located by and added by Petra (to the lead), not me. In addition to the now four secondary review sources listed below that discuss schizophrenia, here are exact excerpts from Borgelt (our most recent review, PMID  23386598):

• Safety concerns regarding cannabis include the increased risk of developing schizophrenia with adolescent use, impairments in memory and cognition, accidental pediatric ingestions, and lack of safety packaging for medical cannabis formulations.
• The Canadian product insert for nabiximols states the following contraindications: ... history of schizophrenia or any other psychotic disorder;
• Frequent use of cannabis, especially in adolescence, is associated with the development of schizophrenia, a chronic neurodevelopmental disorder. During adolescence, when schizophrenia typically presents, profound changes occur in the brain, often through synaptic pruning, a process that endocannabinoids help regulate. Using cannabis interferes with adolescent neurodevelopment, and imaging studies associate marijuana use with adverse development of the hippocampus and the cerebellum. Epidemiologic data associate heavy adolescent use of marijuana with both an earlier onset of schizophrenia and a 2-fold increased risk of developing schizophrenia.76 To be clear, the use of cannabis in adolescence does not cause schizophrenia but increases the risk of its onset, suggesting interplay between marijuana use and genetic predisposition for schizophrenia. For people who develop schizophrenia, ongoing use of marijuana is associated with more severe psychosis and impaired performance on tests of attention and impulsivity. Marijuana is a psychoactive substance whose psychiatric complications are known to increase with early onset and regular use.

We have at least four secondary reviews now. We don't need to add an exact quote from one of them to the lead, but we do need to add something. Could we please get busy coming up with text? SandyGeorgia ( Talk) 17:54, 3 December 2013 (UTC)

Nope. that material about schizophrenia did not come from the review of medical cannabis cited by the authors (Wang et al. 2008.) It's a bait and switch cited to a study that has nothing to do with medical cannabis use. It's extremely sneaky because this material is placed between a review of medical cannabis studies, making it look like that medical cannabis use is associated with schizophrenia. It's not, and the paper doesn't show that. Clearly, the abstract is misleading and the paper sensationalizes claims that have no bearing in fact. It's one thing to talk about adverse events from medical cannabis use in a controlled study. That kind of data is relevant to this article and should be encouraged. It's quite another to stick in off-topic adverse events from non-medical cannabis studies in the same paper and talk about "implications". Very sneaky and underhanded. Viriditas ( talk) 04:45, 4 December 2013 (UTC)

Ah yes, ye-olde-cannabis-causes-schizophrenia-canard. That one has been making the rounds for about thirty years and gets trotted out every time a new medical cannabis law is passed. The idea that cannabis increases the risk of developing schizophrenia has no sufficient evidentiary basis nor any causal link and is based on an associative hypothesis. The self-medication hypothesis (schizophrenics use cannabis to help them cope) has not been ruled out, nor have many other competing hypotheses. The Royal College of Psychiatrists has previously said: "In some instances cannabis use may lead to a longer-lasting toxic psychosis involving delusions and hallucinations that can be misdiagnosed as schizophrenic illness...This is transient and clears up within a few days on termination of drug use; but the habitual user risks developing a more persistent psychosis, and potentially serious consequences (such as action under the Mental Health Acts and complications resulting from the administration of powerful neuroleptic drugs) may follow if an erroneous diagnosis of schizophrenia is made. It is also well established that cannabis can exacerbate the symptoms of those already suffering from schizophrenic illness and may worsen the course of the illness; but there is little evidence that cannabis use can precipitate schizophrenia or other mental illness in those not already predisposed to it." I believe this statement still sums up the consensus on the matter today. Furthermore, the incidence of schizophrenia has continued to drop while at the same time, cannabis use has increased. On the other hand, the Institute of Medicine of the United States National Academies says that cannabis is "moderately well suited for particular conditions, such as chemotherapy-induced nausea and vomiting and AIDS wasting." The bottom line is that we know cannabis helps certain medical conditions, but we do not have a handle on the adverse effects. We know that schizophrenics self-medicate with cannabis, many of whom happen to show the first symptoms (without cannabis) as young adults. The evidence is conflicting. But government agencies keep funding anti-drug studies and are determined to find one that shows a relationship between cannabis and mental illness, and every year someone trots out the old "cannabis causes schizophrenia" claim. But there remains no clear causal link between cannabis and schizophrenia. Viriditas ( talk) 10:14, 3 December 2013 (UTC)

Have you got a source for the view of the Royal College of Psychiatrists? Alexbrn ^{talk| contribs| COI} 10:20, 3 December 2013 (UTC)

Yes, I do, but it hardly matters. Why don't you show me the evidence that cannabis causes schizophrenia? Any causal links? No? And what does this have to do with medical cannabis? Nothing? I see. Viriditas ( talk) 10:25, 3 December 2013 (UTC)

I does matter. Is it a recent view, for example? And in RS? The 2013 article whose abstract we are discussing is specifically concerned with medical cannabis. Alexbrn ^{talk| contribs| COI} 10:28, 3 December 2013 (UTC)

It is the established view on the subject. What matters is WP:MEDRS#Choosing_sources. Why are you discussing an abstract? Did you not read the study or did you get confused by the use of the term "medical cannabis"? It says, "There is minimal information available about drug interactions and contraindications with cannabis-derived pharmaceuticals and medical cannabis." (204) Have you read it? It says nothing about people who use medical cannabis and any association with schizophrenia. This is why you should follow MEDRS and not rely on abstracts. Viriditas ( talk) 10:37, 3 December 2013 (UTC)

Viriditas, I appreciate reading your personal views and opinions on the matter, but for the purposes of this talk page and article content on Wikipedia, we must follow our medical sourcing guidelines over opinion. You have removed text cited to a secondary review and that can be cited to several other reviews. In talk page discussions, we need to stick to what sources say and avoid personal opinions. I hope it won't be necessary to re-tag the article when we have so many high-quality sources from which to work. You've provided no sources; there are scores of secondary reviews that discuss the same things in the text you removed. SandyGeorgia ( Talk) 10:36, 3 December 2013 (UTC)

Sandy, I'm afraid you are mistaken. I've offered no "personal views and opinions", I've simply reviewed the unreliable sources under discussion. The text that was removed has nothing to do with this subject, and per WP:MEDRS#Choosing_sources we don't use or rely on abstracts. Perhaps you would like to review the source yourself and let me know which part is relevant here? Viriditas ( talk) 10:40, 3 December 2013 (UTC)

The article ( PMID  23386598) says:

The purpose of this article is to describe the pharmacology, therapeutic benefits and risks, and various dosage formulations that have been studied with medical cannabis. Specifically, medical cannabis for pain and muscle spasms, the most common uses of medical cannabis, will be evaluated using an in-depth evidence-based approach

. Alexbrn ^{talk| contribs| COI} 11:07, 3 December 2013 (UTC)

Nope. You've been the victim of a bait and switch. It doesn't review medical cannabis and schizophrenia, and I have to say that the study authors were very sneaky because a casual glance at the abstract and study make it seem like they did, so I completely understand your confusion. The relevant material begins on p. 203, in a section called "Safety Concerns", subtitled "Adverse Effects, Drug Interactions, and Contraindications". It correctly starts off examining actual studies of medical cannabis users, which is referenced to Wang et al. 2008. [15] Wang's data listing adverse effects can be found here. [16] However, there's nothing here about schizophrenia. The authors continue until p. 204, where the bait and switch occurs. At the bottom of the page, in a subsection titled "Psychiatric Implications", they begin looking at the "Frequent use of cannabis, especially in adolescence" which they say "is associated with the development of schizophrenia" which they hedge by later following it with "the use of cannabis in adolescence does not cause schizophrenia but increases the risk of its onset, suggesting interplay between marijuana use and genetic predisposition for schizophrenia." Meanwhile, nothing here is based on any study with medical cannabis. But you're right, it sure makes it look like it is to outsiders. Very sneaky. Viriditas ( talk) 04:36, 4 December 2013 (UTC)

Here is what a 2008 Cochrane review (considered by many the gold standard, YMMV, I have a Wikipedia subscription) says (note that the source Viriditas removed is five years newer, 2013 Borgelt):

• Rathbone J, Variend H, Mehta H (2008). Rathbone, John (ed.). "Cannabis and schizophrenia". Cochrane Database Syst Rev (3): CD004837. doi: 10.1002/14651858.CD004837.pub2. PMID  18646115. {{ cite journal}}: Unknown parameter |subscription= ignored (|url-access= suggested) ( help)CS1 maint: multiple names: authors list ( link)

For people with schizophrenia: At present, the data is too limited to support, or refute, the use of cannabis/cannabinoid compounds for people suffering with schizophrenia. For clinicians: There is insufficient trial-based evidence to support or refute the use of cannabis based interventions. Clearly the clinician cannot be sure that treating patients with cannabis/cannabinoid compounds is desirable practice.

Which to me is the same bottom line to our readers-- there are safety concerns which have prevented the use of medical cannabis. You (Viriditas) say there is no risk and have removed all mention of any safety concerns (including the other three in the sentence, impairments in memory and cognition, accidental pediatric ingestions, and lack of safety packaging for medical cannabis formulations); Cochrane 2008 says because the risk of schizophrenia is unknown so it is still unsafe; Borgelt 2013 says it is unsafe because there is a risk. Wherever our text falls on that continuum, we have sources that say that there are safety concerns wrt schizophrenia, yet we've removed all mention, including the rest of the sentence. We've left out something mentioned in secondary reviews, and we've done that so far based only on editor opinion with no sources offered. SandyGeorgia ( Talk) 11:38, 3 December 2013 (UTC)

By the way, now I know how that text came to be added to the lead. See discussion above: Petra added one sentence from that source to the lead [17] (why the lead), which is unbalanced, and the second source added by Petra is directly contradicted by the first, Borgelt 2013, but the text from the first was left out) so I expanded with the direct quote. And questioned why it was added to the lead. Can we not work on the lead last? SandyGeorgia ( Talk) 12:04, 3 December 2013 (UTC)

There is a fair bit of evidence that cannibals use is associated with the risk of psychosis. [18] [19]. There is disagreement if it is causal but there is still a concern [20] [21] Doc James ( talk · contribs · email) (if I write on your page reply on mine) 17:29, 3 December 2013 (UTC)

There is no such causal evidence only associations which have never borne fruit. Correlation does not imply causation. Some cannabis users are schizophrenic. Some schizophrenics are cannabis users. What does that tell us about the risks of cannabis? What about causation? Multiple alternative hypotheses have not been ruled out, and this claim has not been proven in /actual/ studies of people who take medical cannabis, such as Russo et al. 2002. [22] Russo et al. observed "no consistent or attributable neuropsychological or neurological deterioration" in a study of medical cannabis users. In addition to many other tests, they employed "MRI scans, neuropsychological tests, P300 testing, history and neurological clinical examination." The study that is cited in the article does not cite use by medical cannabis, it cites recreational cannabis users who may have been misdiagnosed, who may already have mental illness, or who are suffering from other disorders. The idea that cannabis causes psychosis is not supported by good evidence and the study in question does not concern patients who use it. These sources are being misused to claim that medical cannabis users are at a greater risk of mental illness, when actual studies of medical cannabis users have found no such association. The fact remains, the numbers of schizophrenia cases have gone down while cannabis use has increased. We would expect to see more cases of schizophrenia as cannabis use becomes more prevalent. That has not happened. Where are the rising cases of schizophrenia caused by medical canabis? Surely, we should see it by now. In 2011, depending on how you count the numbers, there were anywhere from 1-2+ million medical cannabis users in the United States. Surely we should be seeing a huge uptick in mental illness if this claim of causation had merit. Are we? No, we are not. At least 70% of kids have used cannabis, but for all this time schizophrenia only affects 1%. The numbers have not increased. If you want to talk about a risk to patients, then cite reviews of medical cannabis studies. Russo et al. 2002 did the research and found no such risk or result. Citing cases that study cannabis use in adolescents who are of the age of onset for mental illness, and who may have not been screened properly or misdiagnosed, and who are not (in the majority of cases) likely candidates for medical cananbis use (i.e. adults) is playing hard and loose with the facts. Let's look at the known risks in relation to the facts: in just the years from 1999-2009, 300,000 Americans died from legal prescription drugs. [23] And, according to the CDC, "more deaths are caused each year by tobacco use than by all deaths from human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined." So, legal prescription drugs, legal tobacco, and legal alcohol are the big killers. Any idea how many people died from using medical cannabis last year? More to the point, how many people who had a prescription for medical cannabis were admitted to hospitals for adverse effects? If you don't know the answers to these questions, then tell me how you can possibly claim that medical cannabis can lead to mental illness? Please don't cite me irrelevant, associative studies of recreational drug use by teenagers or CYA, mandatory disclaimer legalese on the back of pharmaceutical boxes. Show me the evidence. Viriditas ( talk) 03:30, 4 December 2013 (UTC)

It is a concern and reliable sources support this as a concern. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 04:54, 4 December 2013 (UTC)

Er, no they have not. In the two examples up above, both Russo et al. 2002. and Wang et al. 2008, two different studies of medical cannabis users, did not cite any such concern. Quite the opposite actually. Cherry picking off-topic sources about recreational cannabis use, cannabis use by the mentally ill, and cannabis use by adolescents is a misuse of MEDRS and has nothing to do with this topic. Viriditas ( talk) 05:18, 4 December 2013 (UTC)

The difficulty with toxicology studies is many are simply not ethical. One cannot simply randomize young people to cannabis versus no cannabis. There is a strong correlation between cannabis and psychosis and supporting animal data. [24] Thus it is a concern. This is something known as the precautionary principle. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 05:07, 4 December 2013 (UTC)

And another [25] Doc James ( talk · contribs · email) (if I write on your page reply on mine) 05:08, 4 December 2013 (UTC)

Viriditas, you continue to engage in long arguments based on primary sources and non- PubMed indexed journal reports, while Wikipedia's medical sourcing guidelines stress secondary reviews. We cannot use primary and advocacy sources to contradict secondary review-- particularly in a case like this suite of articles, where we have a large number of secondary reviews. Our discussions and text improvement will be more productive and move along faster if you please access secondary reviews. SandyGeorgia ( Talk) 17:52, 4 December 2013 (UTC)

I have done nothing of the kind. What I said about schizophrenia is covered in review sources. I have not cited any advocacy sources of any kind. Your "scholarly review" appears to consist of ignoring the medical cannabis literature. Our discussion and content improvement will be more productive if you use sources about the subject. Anti-drug sponsored studies which have nothing to do with medical cannabis should not be used. Viriditas ( talk) 20:26, 4 December 2013 (UTC)

Second revert

This article states "There is considerable evidence to suggest that the abuse of illicit drugs, particularly cannabis and methamphetamine, has aetiological roles in the pathogenesis of psychosis and schizophrenia" [26] Doc James ( talk · contribs · email) (if I write on your page reply on mine) 05:10, 4 December 2013 (UTC)

You're editing the wrong article. Those studies are about Cannabis (drug) and about people with genetic predispositions for mental illness. I've explained the problem in detail here. Again 1) Borgelt et al. 2013 review adverse events of medical cannabis studies reported by Wang et al. 2008. Wang et al. do not discuss or report schizophrenia as an adverse event. Neither does Russo et al. 2002 reported above. 2) Borgelt et al. then switch gears and talk about the psychiatric implications of non-medical cannabis studies, specifically use by adolescents. They make it clear that while adolescent use of cannabis is associated with schizophrenia "the use of cannabis in adolescence does not cause schizophrenia but increases the risk of its onset, suggesting interplay between marijuana use and genetic predisposition for schizophrenia." In other words, Borgelt et al. 2013 is being cherry picked by editors to cite non-medical cannabis research results while ignoring the medical cannabis research in the article. (Wang et al. 2008) Wang et al. found that "the rate of nonserious adverse events was 1.86 times higher among medical cannabinoid users than among controls. However, we did not find a higher incidence rate of serious adverse events associated with medical cannabinoid use." This is similar to what Russo found when he wrote that there was "no consistent or attributable neuropsychological or neurological deterioration" in a study of medical cannabis users. So this is clearly a misuse of sources and a bait and switch. It was removed from the lead because it was inaccurate (not about medical cannabis use) and undue (does not accurately reflect the studies of medical cannabis use). You reverted back for what reason? Are you not aware that we are discussing cannabis for medical use? How are the citations you've added and referred to even relevant to this discussion? We are not discussing illicit drug use, nor are we discussing the use of cannabis in a recreational manner by adolescents. Those topics are completely irrelevant. It sounds like you are abusing MEDRS. The actual studies of medical cannabis users have not reported any incidents of schizophrenia. Viriditas ( talk) 05:14, 4 December 2013 (UTC)

This article is about "medical cannabis" [27] and it raises the concern of schizophrenia. That is enough for me. A reliable source say it as a concern. We do not need to do original research to explain it away. We can simple report their conclusions. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 05:22, 4 December 2013 (UTC)

No, that part of the article is not about medical cannabis nor sourced to studies about medical cannabis. It's a bait and switch. The actual sources about medical cannabis say nothing about schizophrenia, so this is a misuse of MEDRS. I've also explained this in depth several times above. Further, if you cannot cite an actual source about medical cannabis and schizophrenia based on actual studies, it is entirely undue to include it in the lead, not to mention inaccurate. Since the medical cannabis sources do not discuss schizophrenia, why is it in this article? And since this concern can neither be proven nor supported by actual evidence, why is it in the article? Viriditas ( talk) 05:47, 4 December 2013 (UTC)

Jmh649m you added the following statement:

Concerns about its use include a greater risk of schizophrenia when used by the young, memory and cognition problems, and the risk of children taking it by accident.

This is completely undue and the source does not actually say that about medical cannabis. About recreational cannabis in general it says "the use of cannabis in adolescence does not cause schizophrenia but increases the risk of its onset, suggesting interplay between marijuana use and genetic predisposition for schizophrenia." The sources about medical cannabis in the study you cite say nothing about these risks. This is a classic bait and switch. These "concerns" do not seem to be in the medical cannabis literature, nor have any medical cannabis researchers expressed such concerns. Why is this in the lead section? This is taken completely out of context (it's about the use of recreational cannabis, not medical cannabis) and has no bearing on the safety and efficacy of medical cannabis. The notion that there is a "greater risk of schizophrenia" has been debunked many times in the literature. For only one example, the review study published by Frisher et al., 2009 [28] looked at historical studies going back to the 1970s and nine years of recent data from 1996-2005. The researchers concluded that "the causal models linking cannabis with schizophrenia/psychoses are not supported". [29] That's one of many studies debunking the resurgence of this continuing "reefer madness" propaganda. There isn't a single cannabis researcher who thinks cannabis causes schizophrenia, nor could it as the evidence points to genetic etiology. I can cite review after review debunking this "concern". I find it strange that the leading exponents of MEDRS are deliberately misusing medical sources to push "reefer madness" propaganda that lacks a sound scientific basis in hard data. This reminds me of the history of cannabis prohibition which shows that in the 1930s, the public was told that cannabis caused immigrants to murder and rape. In the 1940s, they blamed it for Jazz music. In the 1950s, they blamed it for sexual perversion. In the 1960s, they blamed it for political activism and anti-authoritarianism. In the 1970s, they said it was a "gateway drug" and caused people to lose their motivation. In the 1980s, they said it had no medicinal value. In the 1990s, they said it caused cancer. Now, in the 2000s, they say it causes mental illness. Some things never change... Viriditas ( talk) 10:35, 4 December 2013 (UTC)

Viriditas, I hope you're aware that PMID  19560900 is not a review, it's a study, a primary source.

Separately, I agree that we need not necessarily mention schizophrenia in the lead, but we do need to mention it, and we do need to mention safety concerns in the lead. (I always advocate writing the lead last as a summary, and this article as of now is almost wholly undeveloped, frequently off-topic, and we have multiple sections that need to make better use of summary style to daughter articles, for example History of cannabis and History of medical cannabis.) Back on topic; we have multiple secondary reviews that mention schizophrenia, and Borgelt 2013 does mention it in the context of medical cannabis. Please do not continue to revert, and we do not use primary sources to rebut secondary reviews. Unless anyone disagrees, for now I believe it would be better to move the schizophrenia information to a section within the article and out of the lead. We need a Safety section.

Separately, as I follow edits I am noticing that Dala11a frequently introduces original research, weasly text, and grammatical errors. There is too much to keep up with there when the basic parts of the article are in need still of so much work. I am thinking of refocusing for now on how to better organize this suite of articles so that text can be worked on in one place for each topic. Borgelt 2013, for example, does a very good job on explaining each pharmaceutical product, some history, etc, and it could be used to improve that information, but before beginning that work, I'm thinking we should discuss how to improve the overlapping structure of the entire suite of articles. SandyGeorgia ( Talk) 14:28, 4 December 2013 (UTC)

PMID  19560900 (Frisher et al, 2009) is a key study, along with Degenhardt et al, 2003 and Cranford et al,. 2009 that dispute the idea that there is a relationship between cannabis and schizophrenia. They are covered in many review sources, such as PMID  19783132 and Richardson 2010. You seem to be focusing on one side of the dispute. You also claim that Borgelt et al., 2013 mentions schizophrenia research in the context of medical cannabis, which I guess is true if you stretch the meaning of words and ignore the fact that she mentions this non-medical cannabis research has implications for medical cannabis use. But the fact is, Borgelt et al., 2013 does not refer to schizophrenia research conducted on medical cannabis patients, which means it is a bait and switch. I'm glad you've decided to remove it from the lead, but I see that it is still there. I'm still very concerned that reviews of actual medical cannabis studies are not being added, in favor of focusing on anti-drug sponsored studies of adolescents who use recreational cannabis. This appears to be a misuse of our sources on the subject. Viriditas ( talk) 20:17, 4 December 2013 (UTC)

It is still there because, a) I've been busy trying to tag reviews, while I b) waited for all of you to weigh in on the proposals I made. I see that in spite of being active on this page, neither you nor Petra have agreed yet to my proposal. I tend towards editing around consensus, and not making unilateral changes until others have had a chance to weigh in. This article is huge, making work on it difficult-- complicated by some of the habits on this talk page which increase the noise. If you and Petra and anyone else active here (Dala?) would kindly weigh in on the various proposals I made, I'll be happy to enact them. SandyGeorgia ( Talk) 20:48, 4 December 2013 (UTC)

Also, re You seem to be focusing on one side of the dispute, I am not focusing anywhere yet, because so far I've spent most of my time in the massive amounts of cleanup needed. Borgelt 2013 became a focus because Petra4chan47 inserted it into the lead. SandyGeorgia ( Talk) 00:17, 5 December 2013 (UTC)

To Sandy: You claim me for "orginal reasarch" you must specify what you are talking abut. I have for ex. today corrected the text unbalanced text about Maltos-Cannabis. The sources from the 19th century state clearly that maltose sugar was the important part of the product, but somebody had deleted that including the source. Dala11a ( talk) 15:38, 4 December 2013 (UTC)

Dala11a - It was I who trimmed this content. I did mention that the drink contained maltose and I retained the source (putting it in a nice template). I removed the discussion of maltose's claimed health benefit, as it is not really relevant here. I also removed mention of the drink's low THC component which, in answer to my request for a source, you had sourced to the 1894 newspaper article, which I can't imagine is correct. Alexbrn ^{talk| contribs| COI} 15:43, 4 December 2013 (UTC)

Dala11a, I saw you add uncited text several times today, and I saw that Alexbrn had to tag one. SandyGeorgia ( Talk) 15:57, 4 December 2013 (UTC)

I can add another source that state that "the European hemp almost completely lack the narcotic effect"[ [30]] Dala11a ( talk) 17:08, 4 December 2013 (UTC)

Dala11a - kindly don't. The most we should say about this obscure old drink can be derived from what reliable sources say; we should not be including our own analysis by commenting on how narcotic it was or wasn't, based on sources that don't mention the drink. Alexbrn ^{talk| contribs| COI} 17:15, 4 December 2013 (UTC)

(after ec with Alexbrn) I'm still catching up on all of the secondary review journal literature, but we have medical sources that can be used for all of that text; there is no reason to be using other sources for the medical content in this information. Getting to all of it is going to take some time. It would be helpful, Dala11a, if you would use medical sources for medical information-- they are plentiful. SandyGeorgia ( Talk) 17:16, 4 December 2013 (UTC)

I hope you are spending your time reviewing sources about medical cannabis, like the kind published by CMCR. Anything else is off-topic. Viriditas ( talk) 20:20, 4 December 2013 (UTC)

Not really; Cannabis (drug) also needs attention, as does the entire suite of articles, so all of my journal reading has been fruitful. Anything of value published by CMCR will also likely be found in scholarly journals. SandyGeorgia ( Talk) 00:14, 5 December 2013 (UTC)

Er, the list of active research and reviews found in scholarly journals appears on that site. It would help if you familiarize yourself with the literature as that will end the continuing misuse of non-medical cannabis sources to push a POV. Viriditas ( talk) 03:28, 5 December 2013 (UTC)

Active research is found in PubMed as well. Viriditas, I do not want to have to put you on notice, as you are a well-enough established editor to know that continuing to allege POV is personalization and creating a battleground, and giving you a talk page warning should not be necessary. We haven't even begun to write this article, and this is not a good start. Please confine your use of the talk page to discussion of reliable sources. SandyGeorgia ( Talk) 05:14, 5 December 2013 (UTC)

Interim proposal for the lead

Viriditas, Petrarchan47, Dala11a Alexbrn? SandyGeorgia ( Talk) 20:53, 4 December 2013 (UTC)

I would move the schizophrenia text from the lead to a "Safety" section, but per WP:MEDMOS#Sections, I'm unsure how we typically organize such pharmaceutical content. MEDMOS calls for "Adverse effects", and we now have some safety information listed under Adverse effects. Does that make sense? Borgelt 2013 (I appreciate Petra for finding this recent soruce, which is quite comprehensive) gives ample information there for expansion of that section, as do several other secondary reviews. SandyGeorgia ( Talk) 15:57, 4 December 2013 (UTC)

Yes the section on adverse effects is where we discuss potential adverse effects and safety issues. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 15:58, 4 December 2013 (UTC)

Thanks, Doc-- I'll work on moving schizophrenia from the lead and upgrading the Adverse effects section later today. Edit wars to put or keep information in the lead in undeveloped articles are always lame; this one resulted when Petra added undeveloped information, not mentioned in the article, to the lead; leads should summarize.

Viriditas, please stop using the talk page to advance your personal views with long essays; focusing on what secondary sources (not primary studies) say will shorten the amount of time it takes to get these articles in shape and remove tags. There is much work to be done, and long-term effects of cannabis is still POV (as is this one for now, in the interest of good faith, I've not tagged it). SandyGeorgia ( Talk) 16:04, 4 December 2013 (UTC)

I have added a summary of the evidence to the lead. Feel free to move. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 16:06, 4 December 2013 (UTC)

Wang PMID  18559804, Borgelt PMID  23386598 and several other recent secondary reviews should be expanded in the article body, and then summarized back to the lead in one or two sentences. (Separately, I'm wondering why we're using a five-year old secondary review, but for now, it will do.) As leads summarize the article, not every statement in it needs a citation (if it is an accurate summary, the text supports). We now have in the lead:

Cannabis has been used to reduce nausea and vomiting in chemotherapy and people with AIDS, and to treat pain and muscle spasticity.[2] Its short term use while increasing minor adverse effects, does not appear to increase major adverse effects.[3] Long term effects are not clear.[3] Other concerns include a greater risk of schizophrenia when used by the young, memory and cognition problems, and the risk of children taking it by accident.[2]

I suggest provisionally (that is, for the purpose of avoiding edit wars while the text is being developed) replacing that with:

Cannabis has been used to reduce nausea and vomiting in chemotherapy and people with AIDS, and to treat pain and muscle spasticity; its use for other medical applications has been studied but there is insufficient data for conclusions about safety and efficacy. Short-term use increases minor adverse effects, but does not appear to increase major adverse effects. Long-term effects are not clear, and there are safety concerns.

That would be an uncited summary, leaving out specifics for now for the avoidance of edit wars; ideally, we would later have a better, cited summary.

Separately, when reading over some of the journal reviews last night, I realized this article does a very poor job of distinguishing the various pharmaceutical products and stating which has been studied in which condition, which is another reason I hope we can settle for now on a compromise lead, as we develop the text. SandyGeorgia ( Talk) 16:17, 4 December 2013 (UTC)

It is very important for controversial topics to leave the refs in the lead IMO. People will come along and either 1) remove it without bothering to read the body or 2) tag it. We could hide it like this <!-- Ref here --> Doc James ( talk · contribs · email) (if I write on your page reply on mine) 16:29, 4 December 2013 (UTC)

Otherwise I am happy with you changing the text to the wording you suggest and moving the more details content to the appropriate section. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 16:30, 4 December 2013 (UTC)

I don't mind leaving the citations in; I'm just after an interim compromise so we can get back to work. SandyGeorgia ( Talk) 16:34, 4 December 2013 (UTC)

I have a strong preference for leaving the lede until we can make it a good summary of a reworked body. If Borgelt is to be cited in the lede, "both sides of the coin" must be used - my preference would be not cite Borgelt at all in the lede. Alexbrn ^{talk| contribs| COI} 21:04, 4 December 2013 (UTC)

I am still waiting to hear from the other parties active on this page. SandyGeorgia ( Talk) 00:04, 5 December 2013 (UTC)

Anything relevant to medical cannabis use is fair game. However, the continuing misuse of non-medical cannabis sources to push a POV is unacceptable. Case in point is the schizophrenia nonsense which is not currently cited to any research on medical cannabis and is completely undue. The adverse effects of medical cannabis have been studied, but those sources are not being given due weight due to this misuse of sources. I should also like to point out that while MEDRS is a helpful guideline for best practice, it does not outweigh or supplant our general policies which take precedence over local WikiProject consensus. This is especially true for sensitive issues where science is tarnished by political influence. In the case of medical cannabis, one of the most highly politicized drug topics in the last century, researchers have been subject to persecution, studies that have shown positive outcomes have been threatened, and cannabis users and patients have been subject to persecution. This is not hyperbole, this is a documented fact supported by hundreds of our best sources on the subject. If editors attempt to misuse a local consensus guideline to thwart our primary policies, then the usability and application of MEDRS will be called into question. In other words, Wikipedia editors can edit this article without adhering to MEDRS as long as they follow our standard policies. If MEDRS is used to undermine these policies given the political nature of the topic, then this will be actively challenged. Viriditas ( talk) 03:43, 5 December 2013 (UTC)

Completely agree, if there are no secondary sources which review cannabis used as medicine opposed to recreational use or something else, then we can only mention the level or correlation found in primary sources. Götz ( talk) 04:09, 5 December 2013 (UTC)

Götz there are numerous secondary sources on the topic of medical cannabis; we've barely scratched the surface here at incorporating them, but the article is now trimmed enough to begin to work. The premature insertion of one source into the lead was unfortunate as it seems to have gotten things off on the wrong foot here; working first on the article body is usually more effective. There is still plenty of content to be built, and plentiful secondary sources that can be used. In many sections, I've so far added only one sentence from one main secondary source; each of those can be expanded and there are still many untapped secondary sources. SandyGeorgia ( Talk) 05:47, 5 December 2013 (UTC)

Viriditas We could use the talk page more productively if people would stick to policy, guideline and sources and remember that talk pages are WP:NOTAFORUM. SandyGeorgia ( Talk) 05:07, 5 December 2013 (UTC)

Yes, we could use the page more productively if people would stop moving threads around and making bad faith assumptions about other editors. Viriditas ( talk) 20:38, 9 December 2013 (UTC)

I've been working overtime to get what is on the page to a state where we can begin the necessary expansion; is there no one here interested in or able to finish sourcing the botanical strains section? There is a multitude of sources listed at User:SandyGeorgia/Cannabis sources; I don't have time to get to everything. SandyGeorgia ( Talk) 22:10, 9 December 2013 (UTC)

I agree that we are jamming too much legal stuff into the lead of this section which is looking at the evidence for use. Tried to remove this really old stuff "The Institute of Medicine, run by the United States National Academy of Sciences, conducted a comprehensive study in 1999 ^{needs update} assessing the potential health benefits of cannabis and its constituent cannabinoids. The study concluded that smoking cannabis is not to be recommended for the treatment of any disease condition, but that nausea, appetite loss, pain and anxiety can all be mitigated by cannabis. While the study expressed reservations about smoked cannabis due to the health risks associated with smoking, the study team concluded that until another mode of ingestion was perfected providing the same relief as smoked cannabis, there was no alternative. In addition, the study pointed out the inherent difficulty in marketing a non-patentable herb. Pharmaceutical companies will probably make smaller investments in product development if the result is not possible to patent. The Institute of Medicine stated that there is little future in smoked cannabis as a medically approved medication, while in the report also concluding that for certain patients, such as the terminally ill or those with debilitating symptoms, the long-term risks are not of great concern. ^{[23] [24]}" But it was returned. We are also concentrating too much on legal positions around smoking which should go latter in the article. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 19:34, 9 December 2013 (UTC)

Additionally this should go lower "The U.S. Food and Drug Administration (FDA) has not approved smoked cannabis for any condition or disease as it deems evidence is lacking concerning safety and efficacy of cannabis for medical use." Doc James ( talk · contribs · email) (if I write on your page reply on mine) 19:49, 9 December 2013 (UTC)

James, one of the recent secondary reviews discusses the 1999 info in a historically significant context. With so many sources, it will take me some time to locate again, but the issue is, yes, it needs to be placed in historical content. It seems that some editors here want to place things higher in the article for reasons that are hard to follow. I will catch up and find the mention in a recent secondary review, but the insertions of numerous errors into the article by Petra is a very time-consuming way to edit. SandyGeorgia ( Talk) 19:55, 9 December 2013 (UTC)

Found, see PMID  22129912. SandyGeorgia ( Talk) 20:09, 9 December 2013 (UTC)

It might be easier if both of you would stop edit warring and assuming bad faith. Viriditas ( talk) 19:58, 9 December 2013 (UTC)

I don't know who "both of you" refers to, but I don't edit war. And if you have a diff of assuming bad faith, by all means bring it to my talk page. I do see, as diffed on this page, that both you and Petra have edit warred, and that there are numerous discussion sections above you have not engaged. SandyGeorgia ( Talk) 20:09, 9 December 2013 (UTC)

Sandy, this is a diff of you edit warring. Do you have consensus to add the tag? Nope. Viriditas ( talk) 20:46, 9 December 2013 (UTC)

Sandy, you are moving threads again. The timestamp clearly shows I was referring to Jmh649, yet you moved your reply at 20:09 above my mine posted at 19:58. You really should not be constantly altering the discussion like this. Also, I just looked at the edit history and I do not see any edit warring by myself. Viriditas ( talk) 20:27, 9 December 2013 (UTC)

I have moved no threads; this notion that I am is becoming increasingly off-topic and impeding discussion here. Please explain on my talk page, with diffs, an example of what you think is me moving replies. I am not aware that you will find much support for removing maintenance tags and referring to their reinstatement as edit warring. On December 3 to 4, you twice removed well-cited text [31] [32] during active discussion occurring here about text inserted by Dala and Petra. SandyGeorgia ( Talk) 21:03, 9 December 2013 (UTC)

You have moved thread responses several times and interjected new comments above older ones. You unilaterally added the maintenance tag to this talk page, and when it was explained to you why it was not appropriate and removed, you were invited to discuss it. Instead, you added it back and said that we had to have consensus to remove it, not add it, which avoids the burden altogether. People are blocked for edit warring over tags every day, although less so on talk pages. Apparently, this page is under an unwritten rule of Sandy's way or the highway. Viriditas ( talk) 21:11, 9 December 2013 (UTC)

I have now reviewed all of the diffs from recent talk discussion, and there is no thread or responses I have moved. Period. (I knew that, but thought I'd check anyway in case there was some weird edit conflict or something that caused the confusion.) Someone is confused, perhaps because editing here was moving fast. My post at 20:09 is right below Viriditas' post of 19:58, right where I put it, correctly threaded. Nor have I interjected new comments above older ones. I realize editing here on talk was moving fast, but please avoid derailing discussion; if you had a diff of me moving a response it could have been placed on my talk (since I didn't, you don't). What would be helpful on talk would be for you (Viriditas) to answer questions directly, with sources, rather than conjecture. For example, you start the next post with "which is actually not true", following quoted text for a reliable source. What is actually not true, and what is the source for that claim? SandyGeorgia ( Talk) 04:10, 10 December 2013 (UTC)

I am sorry to intrude in this beautiful little fantasy world you've created (love the palm trees and tiki decor, nice touch) but the diffs show that you moved my comment into a new section and placed a new comment above my own. Please accept it and move on. Viriditas ( talk) 23:03, 10 December 2013 (UTC)

Which is actually not true considering the outcome of the Compassionate Investigational New Drug program when the FDA was forced to recognize the safety and efficacy of cannabis use. They can pretend it never happened, but anyone who is a student of history can see that it did. And considering the FDA's leading role in cannabis prohibition (documented by various sources) they are hardly an authoritative source on this subject. Viriditas ( talk) 19:58, 9 December 2013 (UTC)

It is not clear to me which part of the discussion above you are saying is untrue; pls clarify. SandyGeorgia ( Talk) 20:09, 9 December 2013 (UTC)

The FDA's statement that it "deems evidence is lacking concerning safety and efficacy of cannabis for medical use" has been a flat out lie since 1976 when this went to court and the government was forced to supply medical cannabis to patients. 37 years of lying is still a lie. Viriditas ( talk) 20:42, 9 December 2013 (UTC)

Removing the IOM stuff was in support of Petra's statement "Please remember this article not the "Medical cannabis in the US" article," Doc James ( talk · contribs · email) (if I write on your page reply on mine) 20:13, 9 December 2013 (UTC)

Smoking cannabis is not the most popular route of administration for medical cannabis patients in 2013, it's vaporizing and eating, so the concerns about smoking are no longer as relevant. As harm has been reduced, the initial concerns about smoking have been addressed. Also, medical cannabis patients don't depend on pharmaceutical companies, they depend on knowledgeable growers who are licensed in their respective states. Viriditas ( talk) 19:58, 9 December 2013 (UTC)

Every secondary review I've read says smoking is the most common, and that is what has been cited in the text to secondary reviews. DO you have a compliant source that says otherwise so we can add it? It's hard to see how we can say the concerns about smoking are irrelevant when multiple recent secondary sources say it is. SandyGeorgia ( Talk) 20:10, 9 December 2013 (UTC)

Sandy, please do not refactor my comments without asking me. I was directly responding to the above comment. Viriditas ( talk) 20:17, 9 December 2013 (UTC)

MY apologies; I have yet to understand what your objection is, and thought that was a new issue. It would be helpful to have an answer, now to both issues, pls. SandyGeorgia ( Talk) 20:20, 9 December 2013 (UTC)

Sandy, you may be confusing secondary reviews of recreational cannabis. If you're not, then you may be reading outdated or misinformed reviews by academics motivated more by the "publish or perish" bureaucracy than by actual evidence. Medical cannabis patients use vaporizers and/or eat cannabis, thereby minimizing the harm caused by smoking. I was directly responding to the content cited by Jmh649 at 19:34, 9 December 2013. Because you moved the discussion, it is no longer threaded. Viriditas ( talk) 20:22, 9 December 2013 (UTC)

I have not moved anything. SandyGeorgia ( Talk) 20:32, 9 December 2013 (UTC)

Actually, you moved several things. First you moved my comments below by removing it from the thread and adding a subheading. Then you moved your new comments above my own, disrupting the flow of the reply. Viriditas ( talk) 20:34, 9 December 2013 (UTC)

I added a sub-heading to what I thought was a new section at the bottom without moving anything; you removed the sub-heading. Moot-- could you please answer the questions? SandyGeorgia ( Talk) 20:43, 9 December 2013 (UTC)

Sandy, when you add a sub-heading above a comment in a threaded discussion, it moved the comment to a new thread, which was exactly your intention. Please stop disrupting the talk page. Viriditas ( talk) 23:08, 10 December 2013 (UTC)

I would like to propose we remove the old IOM stuff mentioned above. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 20:28, 9 December 2013 (UTC)

Are there newer comprehensive studies that have been performed by the IOM since 1999? If not, why would you remove it? Viriditas ( talk) 20:34, 9 December 2013 (UTC)

If I am now understanding correctly, Viriditas is referring above to what she calls an "FDA lie", which is part of the history of the matter of how the IOM report came to be relevant, and how marijuana came to have an interesting status in US law. The recent secondary sources do a very good job of covering this from all aspects. Yes, it needs to be included, but I would add it under History, rather than Society and culture. It will be tricky to write this correctly; what we have now is a total mess relative to the very good info in sources. Might I suggest that we slow down on this matter, and have everyone consult:

• PMID  16540272 (Ben Amar 2006) We have free full text
• PMID  22129912 (Clark PA, Capuzzi K, Fick C 2011) We have free full text
• PMID  22675784 (Svrakic 2012)

and quite a few others? SandyGeorgia ( Talk) 21:11, 9 December 2013 (UTC)

From Viriditas:

Smoking cannabis is not the most popular route of administration for medical cannabis patients in 2013, it's vaporizing and eating, so the concerns about smoking are no longer as relevant. Viriditas 19:58, 9 December 2013

Sandy, you may be confusing secondary reviews of recreational cannabis. Viriditas 20:22, 9 December 2013

From this version of our article:

Smoking is the means of adminstration of medical cannabis for many consumers, ^[25] and the most common method of medical cannabis consumption in the US as of 2013. ^[26]

From the sources:

Although smoking remains the most common mode of ingestion for medical cannabis, vaporization of cannabis is becoming increasingly popular among medical cannabis users due to its perceived reduction of harm given the release of a significantly lower percentage of noxious chemicals. Borgelt 2013 PMID  23386598.

Smoking has been the route of administration for many cannabis users. This is not a viable option when using cannabis therapeutically, owing to the potential for long-term adverse effects from smoke inhalation. Oral preparations such as nabilone, a synthetic cannabinoid, and dronabinol have been used. However, oral administration is also problematic due to the uptake of cannabinoids into fatty tissue, from which they are released slowly, and the significant first-pass liver metabolism, which breaks down 19THC and contributes further to the variability of plasma concentrations. Curtis A, Clarke CE, Rickards HE 2009 PMID  19821373

You are correct that the older source (2009) does not specify medical, although it is a UK source (not US-centric), and the newer source (2013), which is US-specific, does address specifically medical cannabis. Please provide other sources if you have them. SandyGeorgia ( Talk) 20:50, 9 December 2013 (UTC)

Either way, Curtis et al., 2009 looked at 28 patients and Borgelt et al., 2013 cites Abrams 2007 to make the claim that vaporization is in the process of becoming popular. Well, it is now 2013, and vaporization is the physician-recommended method of consumption for medical cannabis patients. It's also the most popular for these types of patients, given that smoke shops can't sell pipes anymore and the vaporizing industry is booming. I honestly don't believe that actual medical cannabis patients still prefer to smoke it. The technological advancements from 2007-2013 in the vaporizer industry have been nothing less than revolutionary. It's amazing how the private sector rushes in to fill a need when the government doesn't interfere. Viriditas ( talk) 21:04, 9 December 2013 (UTC)

What we need to back your assertion is a source showing that vaporization is the most common method of consumption. I've been up to my eyeballs in journal reports for two weeks, and have come across no such thing yet (not saying it's not there, but I don't recall seeing anything of the kind). Also, the part from Curtis et al about smoking was from their general review of medical cannabis, before they launched into the specifics of the 28 TS subjects. Typical to Cochrane, it is a review that covers a lot of territory before getting specific. SandyGeorgia ( Talk) 21:15, 9 December 2013 (UTC)

My point is 1) knowledgeable physicians recommend that medical cannabis patients use vaporizers, and 2) I don't know how many medical cannabis users are following this regimen, but the benefits outweigh the risks, and 3) from 2007-2013, the proliferation of the portable vaporization market has exploded (along with electronic cigarettes, the same/similar technology) making it cheap and easy for any patient to purchase, and 4) this technology did not really exist when Abrams 2007 published. At the time the market was upscale and very expensive, which priced many users out of the market. Portable "vaping" is now priced below $50, making it an easy option for many patients. Viriditas ( talk) 21:21, 9 December 2013 (UTC)

We can't contradict recent high-quality secondary reviews without a source; do you have one? SandyGeorgia ( Talk) 21:32, 9 December 2013 (UTC)

I'm not arguing that we should contradict anything. I'm saying that the data is out of date, and the technological explosion of vaporizer technology and adoption has occurred subsequent to the sources relied upon in this articles. I'm also saying that physicians recommend using vaporizers to mitigate any health dangers. The question at hand is this: is smoking the most common mode of ingestion for medical cannabis in 2013? I really doubt it. A hell of a lot has changed. Viriditas ( talk) 21:44, 9 December 2013 (UTC)

Everything is so US centric. And "Well, it is now 2013, and vaporization is the physician-recommended method of consumption for medical cannabis patients" without a ref? Doc James ( talk · contribs · email) (if I write on your page reply on mine) 21:51, 9 December 2013 (UTC)

Really? Could you point me to the policy that says talk page comments should have refs? And are you actually claiming that physicians don't recommend vaporizers? I mean, that is based on Abrams 2007, is it not? Do you even read the sources you discuss? The notion that physicians should recommend vaporizers comes from this study, which is used by the sources up above. Less knee-jerk reaction posting and more thoughtful responses would be helpful, please. Viriditas ( talk) 21:59, 9 December 2013 (UTC)

This is going in circles. Sources say smoking is still common; what is the text change you propose? If there is none, then what is it that we are discussing? We don't get to ignore recent, high-quality secondary reviews just because we may disagree with them. What is the proposed text issue here, pls? Or am I the only one who has lost the plot here?

Separately, could we have a medical source indicating that vaporization results in lower health risks, because I've been looking for that in reviews, and all I've been able to find is a statement that users perceive it lowers health risks, but with no evidence. If there is evidence, and a source, could we please see that so we can discuss adding it? SandyGeorgia ( Talk) 22:07, 9 December 2013 (UTC)

There's nothing going in circles. Even the strange wording by Borgelt et al., 2013 is disputed: "...vaporization of cannabis is becoming increasingly popular among medical cannabis users due to its perceived reduction of harm given the release of a significantly lower percentage of noxious chemicals." Perceived reduction of harm? Significantly lower percentage of noxious chemicals? This kind of editorializing isn't supported by the sources that are actually referenced. First of all, in the press release, Neal L. Benowitz, the co-author, said "By a significant majority, patients preferred vaporization to smoking, choosing the route of delivery with the fewest side effects and greatest efficiency." This was not a "perceived" reduction of harm. Second of all, the study itself indicated "little or no exposure to gaseous combustion toxins", the same toxins that "reflect a major concern about the use of marijuana cigarettes for medical therapy as expressed by the Institute of Medicine." That's a far cry from a "significantly lower percentage". Far from going in circles, this addresses all three concerns: 1) vaporization studies were conducted as a direct response to the health concerns about smoking voiced by the IOM, notable concerns that have not been superseded by any other study, a study that Jmh649 would like to remove for no reason, and 2) according to sources, medical cannabis patients prefer vaporization, and 3) it has nothing to do with perception at all, and the evidence that it lowers health risks is found in Abrams 2007 that Borgelt et al., 2013 (and many other studies) refer. Viriditas ( talk) 22:22, 9 December 2013 (UTC)

You are referencing above a press release that hasn't been revealed on this page, unless I missed it; discussions could be so much shorter here if you would cite your sources (although a press release, is, well ... a press release). My question remains; do you have a source disputing that smoking is common or most common; and do you have a review that says that vaporization removes these risks? I see a press release that discusses "fewest", not absence of, effects. Again, we can't dispute secondary reviews without sources. Do you have one? SandyGeorgia ( Talk) 22:52, 9 December 2013 (UTC)

User:Viriditas This is so strange. One asks for a reference for a statement made and all they get is personal attacks. Yes if you want to add something to the article it needs to be supported by a high quality source. If you just want to pontificate and not improve the article please go do so elsewhere. The talk page is not a soap box. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 00:08, 10 December 2013 (UTC)

So, I take it the answer is no, you didn't read the source. Exactly what soap box are you accusing me of being on? You accuse me of making personal attacks, but the only one I see here is from you. Funny how that works. The pattern here of you and Sandy refusing to answer questions yet turning it around and making personal attacks is transparent. Viriditas ( talk) 22:43, 10 December 2013 (UTC)

Vaporizers

OK, no sources were provided for the assertions above about vaporizers, so I've gone to PubMed for a search on "cannabis vaporizer". I found only one review, quite dated ( PMID  9141290 from 1997); full text is not available, so I'm unsure if it will be helpful (anyone?)

Looking then at all article types, the first PubMed hit on "cannabis vaporizer" is PMID  21943539, a case report of a 19-yo who died:

Fatal alveolar haemorrhage following a "bang" of cannabis. The probable mechanism is pulmonary damage due to acid anhydrides released by the incomplete combustion of cannabis in contact with plastic. ... We draw attention to the extremely serious potential consequences of new methods of using cannabis, particularly the use of "bang" in homemade plastic materials.

That's only a case report, but so much for the argument that cannabis never killed anyone.

The next hit is PMID  20451365:

These preliminary data reveal meaningful improvements in respiratory function, suggesting that a randomized clinical trial of the cannabis vaporizer is warranted. The vaporizer has potential for the administration of medical cannabis and as a harm reduction technique.

which indicates that no controlled clinical trials have been done. We seem to have no evidence, and no reviews.

And while I was in PubMed, just in case anyone needs any more reason why we don't cite articles to case reports and primary sources, and prefer reviews, we also have PMID  22847056:

A case of self amputation of penis by cannabis induced psychosis. Here we present a case of a 35-year-old male who self mutilated his penis due to dependence on cannabis for the past few years that led to a condition called cannabis induced psychosis.

So, this is why we cite medical text to high-quality, secondary reviews, and we don't add material sourced to advocacy websites or based on primary sources. The secondary reviews are at odds with the claim that was previously in this article that no one had ever died from cannabis use, and now we have a case report rendering that claim demonstrably false, at the same time as it renders dubious the claims made here on talk about vaporizers. Let's stick to what the reviews say, engage MEDRS, and not be responsible for making poorly sourced claims that could end in bad places. SandyGeorgia ( Talk) 03:54, 10 December 2013 (UTC)

You appear to be misreading the sources. The cannabis was not responsible for killing anyone, nor could it. Also, it is highly ironic that you are cherry picking sources while accusing others of your own behavior. You apparently don't understand the difference between a "bong" and a "vaporizer", not have you employed the necessary critical reading skills to tell the difference. But hey, you did a key word search and the word vaporizer brought you to an article about someone who died using a homemade plastic bong, a death which had absolutely nothing whatsoever to do with cannabis or vaporizers. Then, as if this absurdity wasn't enough, you claim that cannabis caused a guy to cut off his penis. Really, Sandy? And what does any of this nonsense have to do with the safety of vaporizers? Sandy, please try to read closer for comprehension in the future, because you seem to be distracting from the topic of the discussion while pushing an anti-cannabis platform. Viriditas ( talk) 22:54, 10 December 2013 (UTC)

I will restate the point you may have missed, or I may have failed to state clearly enough the first time. I posted the primary sources, case reports as examples of why we do not use cherry-picked case reports, clinical studies, and primary sources to build articles (which is the way these articles have been built), rather our medical sourcing guideline prefers secondary reviews. Precisely because a search on anything can turn up anything. At any rate, because you have provided no sources for your assertions about vaporizers, I went looking. It appears there are none which back your statements; if there are, please produce them. Lowering the vitriol would help advance the article. SandyGeorgia ( Talk) 02:21, 11 December 2013 (UTC)

Sandy, you've done it yet again. For whatever reason, you have separated a point made in a completely different discussion, turned it into a different thread, and now changed the topic by bring up totally unrelated items (such as bongs and deaths) that have nothing to do with the original thread. Either you are deliberately changing the subject in every discussion, or you are unintentionally disrupting the talk page. To reiterate my point yet again, Borgelt et al., 2013 is disputed. The notion that "vaporization of cannabis is becoming increasingly popular" is cited to 2007, not to 2013. Patients use vaporizers because it has the "the fewest side effects and greatest efficiency". There is nothing in the original sources about a "perceived reduction of harm". The cited source used by Borgelt et al., 2013 said ""little or no exposure to gaseous combustion toxins" and provided actual data. These studies were conducted in response to the concerns by the IOM in 1999, showing that the vaoporization of medical cannabis meets the requirements for safety. Because of this fact, physicians recommend that patients use vaporizers. Either you do not understand a word of this, or you are intentionally changing the subject to irrelevant discussions about "bongs" (definitely not a vaporizer) and "castration" (not under discussion). I hope that clears up your confusion for the last time, Sandy. Viriditas ( talk) 04:57, 11 December 2013 (UTC)

I will take your views about vaporizers into consideration; sources are always helpful. SandyGeorgia ( Talk) 21:57, 11 December 2013 (UTC)

Death by cannabis

Sharing knowledge for those studying the subject. This is a note from a biochemist who studies cancer and cannabinoids. He has agreed to help us out here, but for now I've copied some understanding from an earlier communication with him: petrarchan47 t c 22:53, 10 December 2013 (UTC)

• There is no LD-50 for cannabis. LD-50 is the drug amount that will cause death in 50% of recipients. The reason no one dies from cannabis is that there are no CB-1 receptors in the brain stem where the centers of breathing and heart function are located. Thus there can be no suppression of breath or heartbeat regardless of the dose of cannabis.

Further understanding from biochemist today:

• Drugs generally kill people by depressing the part of the brain that controls breathing and heart rate, we all know this. There are no cannabinoid receptors in this region of the medulla, so no one has ever died from cannabis. If you need a reference, you will find this line in the second paragraph of:

http://www.drugscience.org/Petition/C4I.html

“… marijuana is a non-toxic substance; overdoses produce sleep, not death, because of a lack of cannabinoid receptors in the medullary region of the brain that controls breathing and heart rate.”

From Sanjay Gupta:

• "Most frightening to me is that someone dies in the United States every 19 minutes from a prescription drug overdose, mostly accidental. Every 19 minutes. It is a horrifying statistic. As much as I searched, I could not find a documented case of death from marijuana overdose." CNN

Petra, you're wasting your time. Don't even bother responding to this nonsense. If the good doctor and Sandy want to engage in reefer madness propaganda, by all means let them, it just makes their arguments look ridiculous. There is an enormous amount of literature on cannabis therapeutics, and we are apparently standing on a soapbox when we point out that the drug is well tolerated by patients, safe, and efficacious. But don't let the facts get in the way. Viriditas ( talk) 22:59, 10 December 2013 (UTC)

At some point, doesn't the act of research and learning become more interesting than pushing a POV? I am banking on that. This is an absolutely fascinating subject, and the fact that a non-toxic herb doesn't kill people should be the easiest argument to make, and add to the article(s). I think once the biochemist elaborates on what I am saying here, people will have no choice but to re-think former fixed positions on the matter, or at least 'act-as-if', given that NPOV is an absolute requirement for participation in the editing process. petrarchan47 t c 23:04, 10 December 2013 (UTC)

You make an excellent point and at the same time, you've made a constructive recommendation for expanding the article. One of the reasons patients choose cannabis is because of its safety. Of course, this choice and its safety should be emphasized. In other words, how safe is cannabis compared to similar drugs? And if medical cannabis is so safe, why do studies keep telling us it is not? Have those studies been debunked? What about the political nature of government-funded studies? NIDA said, off the record, that they would only fund studies that showed cannabis was harmful, not helpful. Do we find this kind of bias in the cannabis literature? And how does the recent criticism of the scientific literature by Randy Schekman play into this? Does MEDRS account for the politically charged negative bias against cannabis? Viriditas ( talk) 23:19, 10 December 2013 (UTC)

NIDA's statement is well known. The bias in research funding has to have an impact on the availability of findings, and therefore, on our coverage, so this aspect should have its own section in the article, if it doesn't already. This is my first edit to the Cannabis article, by the way, when I found it a year ago. I still have a dent in my forehead from the resulting face-palm when I saw the proclamation - not surprising for Wiki - that cannabis was known to kill. petrarchan47 t c 23:22, 10 December 2013 (UTC)

...face palm statement has now been added back to the article. petrarchan47 t c 02:19, 11 December 2013 (UTC)

This is all interesting original research, but we have secondary reviews on the topic, so we don't need to speculate or cobble together primary and laypress sources, or unpublished, unreviewed wisdom from friends. I realize that laypress and primary sources were used in these articles in all good faith and with the best of intentions in the past, probably because editors here were not aware that we had guidelines for sourcing medical content, or didn't understand how to locate or use them. We can make statements about what is known without having to resort to original research, television personalities, or non-compliant sourcing:

• Calabria B, Degenhardt L, Hall W, Lynskey M (2010). "Does cannabis use increase the risk of death? Systematic review of epidemiological evidence on adverse effects of cannabis use". Drug Alcohol Rev (Review). 29 (3): 318–30. doi: 10.1111/j.1465-3362.2009.00149.x. PMID  20565525. {{ cite journal}}: Unknown parameter |month= ignored ( help)CS1 maint: multiple names: authors list ( link)

The notion that "politically charged negative bias" affects the publications is outdated; I've read dozens of reviews in the last two weeks, and have found that most are cannabis-friendly, which makes sense because the legalization in many states of cannabis means doctors need facts from which to prescribe. SandyGeorgia ( Talk) 02:32, 11 December 2013 (UTC)

Sandy, the notion is not outdated, it's part of the historical record and is an ongoing problem. History doesn't go out of date. The fact that NIDA and the DEA have prevented cannabis from being regulated by the FDA is a matter of historical record. If you were in the least bit familiar with the medical cannabis literature, you would find that the catch-22 argument against medical cannabis is repeated on a regular basis in the journals, with the last one being made by John Fletcher in March of this year in the CMAJ. [33] People like Fletcher argue that because cannabis hasn't been approved by the FDA (or other similar organizations), physicians should not prescribe it. We have evidence that the NIDA and the DEA have worked hard to setup roadblocks for regulating cannabis for this reason. In just 2009, Lyle Craker at the University of Massachusetts was prevented by the DEA from researching cannabis in a new facility. Craker has argued that the supply provided by NIDA is of an "inconsistent quality, difficult to obtain, and that efforts to widen that supply are being stalled for political reasons." This is not outdated. In 2011, physicians representing the California Medical Association called for legalization so that it can be studied and regulated. According to their white paper, "Cannabis illegality has perpetuated the effective prohibition of clinical research on the properties of cannabis and has prevented the development of state and national standards governing the cultivation, manufacture, and labeling of cannabis products, similar to those governing food, tobacco and alcohol products, most of which are promulgated by federal agencies...Cannabis is currently not sufficiently regulated. In order to allow for a robust regulatory scheme to be developed, cannabis must be moved out of its current Schedule I status within the DEA's official schedule of substances. Rescheduling cannabis will allow for further clinical research to determine the utility and risks of cannabis, which will then shape the national regulatory structure for this substance." Totally current and relevant. Viriditas ( talk) 04:48, 11 December 2013 (UTC)

Sanjay also covered this, "I mistakenly believed the Drug Enforcement Agency listed marijuana as a schedule 1 substance because of sound scientific proof. Surely, they must have quality reasoning as to why marijuana is in the category of the most dangerous drugs that have "no accepted medicinal use and a high potential for abuse....They didn't have the science to support that claim, and I now know that when it comes to marijuana neither of those things are true. It doesn't have a high potential for abuse, and there are very legitimate medical applications. In fact, sometimes marijuana is the only thing that works...We have been terribly and systematically misled for nearly 70 years in the United States...On August 14, 1970, the Assistant Secretary of Health, Dr. Roger O. Egeberg wrote a letter recommending the plant, marijuana, be classified as a schedule 1 substance, and it has remained that way for nearly 45 years. My research started with a careful reading of that decades old letter. What I found was unsettling. Egeberg had carefully chosen his words:

"Since there is still a considerable void in our knowledge of the plant and effects of the active drug contained in it, our recommendation is that marijuana be retained within schedule 1 at least until the completion of certain studies now underway to resolve the issue."

Not because of sound science, but because of its absence, marijuana was classified as a schedule 1 substance. Again, the year was 1970. Egeberg mentions studies that are underway, but many were never completed. As my investigation continued, however, I realized Egeberg did in fact have important research already available to him, some of it from more than 25 years earlier." CNN. petrarchan47 t c 17:44, 11 December 2013 (UTC)

All of that history is covered in secondary reviews, and there is no need to cite CNN or a television personality. Could you please engage the WP:MEDRS-compliant secondary reviews? Many have free full text (see User:SandyGeorgia/Cannabis sources for some). Doing so will save us all time (and space on talk) and get the job done here more quickly. SandyGeorgia ( Talk) 18:26, 11 December 2013 (UTC)

Why would I need to cite MEDRS to talk about the history of the DEA's decisions on the law? You are completely overstepping your stated purpose for taking over this article, which was to ensure MEDRS was being used properly when it comes to medical claims. You've also stated you have an intense desire to remove dangerous information about herbal medicine from the internet after seeing someone hurt by the use of St John's Wort. This bias is coming across. You have no right to demand that your views take center stage, or to place yourself as the gatekeeper for anything that is said in the article, or how people relate on the talk page. petrarchan47 t c 19:38, 11 December 2013 (UTC)

Your statements about me in relation to St John's Wort are 1) wrong (perhaps a misunderstanding or unclear writing on my part), and 2) belong on user talk not here. My attempts to engage you on usertalk have not been fruitful; please do so, and keep personalization out of article talk space. I actually am quite prone to complementary and alternative medicine myself. Anyway, the point is that journal sources are higher quality than CNN; we have them, we can use them. SandyGeorgia ( Talk) 20:02, 11 December 2013 (UTC)

Can we get back on topic please? The political material is part of the history of medical cannabis, and probably belongs in a history or politics section. We have plenty of books, journal articles, and news sources to draw upon for that information. Viriditas ( talk) 20:53, 11 December 2013 (UTC)

Deaths attributed to cannabinoids

Wang 2008 PMID  18559804 has a chart and text discussing deaths among users of cannabinoids; I have not had time to work this in. Free full-text is available if someone has time to look at that. I believe their conclusion was not a statistically significant difference in the number of deaths vs controls, but someone might have a closer look. SandyGeorgia ( Talk) 18:34, 11 December 2013 (UTC)

Why is this being discussed? "The total number of participants exposed to cannabinoid therapy was 1932, yielding 445 person-years of cannabinoid exposure. Among the 1209 people assigned to control groups (either placebo or standard care), there were 239 person-years of exposure; of these, 1121 people (accounting for 236 person-years) received placebo...Fifteen deaths (3.4 per 100 person-years) were reported among cannabinoid users (3 because of pneumonia, 1 because of cervix carcinoma, 1 because of convulsion, 10 not specified), and 3 deaths (1.3 per 100 person-years) were reported among controls (1 pneumonia, 1 myocardial ischemia, 1 not specified)...We found that the rate of nonserious adverse events was 1.86 times higher among medical cannabinoid users than among controls. However, we did not find a higher incidence rate of serious adverse events associated with medical cannabinoid use. The fact that 99% of the serious adverse events from randomized controlled trials were reported in only 2 trials suggests that more studies with long-term exposure are required to further characterize safety issues." Yes, more studies are needed because after thousands of studies, cannabis is still found to be safe. How terrible. Viriditas ( talk) 20:10, 11 December 2013 (UTC)

The article is about medical cannabis, no? And you don't think we should include adverse effects (or the absence of statistically significant same), eg death, for cannibinoids? OK then, we'll leave that out; there's plenty of work to be done, and we'll let our readers guess at whether cannibinoids are safe. But then when we include the areas of safety concern, and leave out the areas where no stastically significant difference in adverse effects is found, please don't say it's cherry-picking. SandyGeorgia ( Talk) 20:38, 11 December 2013 (UTC)

I did not say that. But the article isn't about the deaths. If you study 2000 people, especially if they are older patients suffering from some kind of disease, some of them are going to die during your study. Is this a surprise of some kind? Viriditas ( talk) 20:50, 11 December 2013 (UTC)

The article should mention the problem of "correlation vs causation", for one thing. There is a need to differentiate between natural cannabis and effects attributed to it, and isolated compounds. The pharmaceutical version of THC, Marinol, has at least 4 deaths attributed to it already - so clearly natural cannabis and the pharmaceutical versions are not interchangeable, and the difference should also be explored in a good-sized section. petrarchan47 t c 22:12, 11 December 2013 (UTC)

We mention "correlation by causation" if sources do; it was throughout these articles before as original research. Ummmm ... precisely the reason I started this section is that the deaths due to pharmaceutical cannabinoids are discussed in Wang 2008 (there are not four only attributed to Marinol, there are more). Wang reports deaths due to cannabinoids, and goes on to discuss the statistical significance and more. Wang is exactly the sort of source we should be using to discuss the kind of text you (petra) suggest. Viriditas says it doesn't belong <shrug>. But then, if we leave it out, that's cherry picking. Strange place, this. SandyGeorgia ( Talk) 22:19, 11 December 2013 (UTC)

Wang 2008 is pretty clear that there was no difference in serious adverse effects between those taking medicinal cannabis and controls, but there was a very significant increase in nonserious adverse events, such as dizziness, among those exposed to cannabinoids. That's probably the extent of what we can take from that source and isn't really surprising. It's probably what we ought to be saying in the second sentence of the "Adverse effects" section. I would question, by the way, why we are attributing the opening line? Is that 2013 review somehow relegated to an opinion? We normally assert simple facts when a good, recent secondary source isn't contradicted per WP:ASSERT. -- RexxS ( talk) 01:15, 12 December 2013 (UTC)

When work started here, the article was chock full of primary sources, so I got into the (typically unnecessary, but here it seemed necessary) bad habit of specifying who was saying what. You are correct; when we are asserting facts from recent reviews, we shouldn't need so much attribution. This article is now at a fairly clean starting point for expansion, so we could probably go back and delete a lot of the attribution; I've now moved far enough along on the work that I've been able to add a type= parameter to each cite template, specifying which are reviews. RexxS, there are multiple sections above where I've raised queries that have gotten narry a response. Would you be interested in wading through them? For example, in the "Tourette syndrome sample" section above, I raise the question of whether we should even include the old reviews when we have a newer Cochrane review. As a sample, on TS, I cited and attributed even the old reviews, and then asked for opinions here on that. Got no response (as in most discussions above). SandyGeorgia ( Talk) 01:49, 12 December 2013 (UTC)

A 2013 literature review said that exposure to marijuana had biologically-based physical, mental, behavioral and social health consequences and was "associated with diseases of the liver (particularly with co-existing hepatitis C), lungs, heart, and vasculature".

We're talking about the adverse effects of medical cannabis. Does that source discuss that topic? Does it show causal associations? No to both questions. This study was funded by the United States Department of Veterans Affairs. The government has expressed their displeasure with cannabis and has refused to allow the FDA to regulate it. Their position is that all illegal drug use is abuse, even medical cannabis use. What does this study have to do with the adverse effects of medical cannabis use? Nothing. It starts out assuming the cannabis is bad, and then sets out to prove cannabis is bad by associating anyone who has used cannabis with a disease that they also might have. Is this even science? Viriditas ( talk) 05:05, 12 December 2013 (UTC)

Title: "Medical consequences of marijuana use: a review of current literature".

Methodology: "We examine the recent literature on the physical harms associated with illicit and legal marijuana administration."

Conclusions: (1) "healthcare providers should be cognizant that the existing literature suggests that marijuana use can cause physical harm"; (2) "evidence is needed, and further research should be considered, to prove causal associations of marijuana with many physical health conditions".

The source discusses legal marijuana administration. It clearly states that further research should be considered to prove causal associations. How did you reach your conclusion that it doesn't discuss the adverse effects of medical cannabis? The source of funding of a review is not our concern unless bias has been demonstrated by other reliable sources. PMID  24234874 is an up-to-date literature review published in Current Psychiatry Reports, a respectable journal in the Springer Verlag stable. The place for expressing your personal dislike of the review is with Springer. This page is for discussion of improvements to the article and we have a perfectly good guideline in WP:MEDRS for identifying the best sources for that purpose. Gordon 2013 fits that guideline and there is no valid reason why it should not used here. -- RexxS ( talk) 07:37, 12 December 2013 (UTC)

Was the review published by a government source that assumes a priori that cannabis is dangerous? Is this a form of bias? And since this is a review, which medical cannabis studies show an association with these diseases? There are many valid reasons why this study might not be a good fit here. Is it relevant? Is it biased? Is it authoritative? Is it accurate? Viriditas ( talk) 08:05, 12 December 2013 (UTC)

(1) Who cares? (2) Who knows? (3) It's neither my job nor yours to do amateur analysis of secondary sources; that's the job of the peer-review and the editorial oversight in the journal that published the source. Take it up with them; when you get a result, feel free to cite it here. -- RexxS ( talk) 08:11, 12 December 2013 (UTC)

You are mistaken. Please read WP:RS, WP:NPOV, and WP:V. If it isn't about harm found in actual medical cannabis studies, then it is irrelevant. If it isn't accurate, then it fails V. If it isn't authoritative and neutral, then it fails an evaluation as an RS. Since you want to include it, perhaps you could point me to the medical cannabis studies it claims to have reviewed. "Amateur" analysis of the appropriate use of sources is called evaluation, and it is required to prevent misuse. If you want to keep this source, then briefly show how it is relevant to this topic. Viriditas ( talk) 08:21, 12 December 2013 (UTC)

It seems you're the one who is mistaken - and please note that you're the first to resort to ad hominem here. Considering your clear POV, you have far more need than I to be reading WP:V and WP:RS - as well as WP:MEDRS.

• Here's what WP:V says in its first paragraph: "Its content is determined by previously published information rather than the beliefs or experiences of its editors." - you don't get to decide what is true or not. At present your argument goes like this: "I disagree with this source; therefore it's not true; therefore it fails WP:V". What utter nonsense.
• Here's what WP:RS says in its Overview: "Articles should be based on reliable, third-party, published sources with a reputation for fact-checking and accuracy. This means that we publish the opinions only of reliable authors, and not the opinions of Wikipedians who have read and interpreted primary source material for themselves." - you don't get to decide what is authoritative and what is not. At present, what I hear from you is "I disagree with this source; therefore it's not authoritative; therefore it fails WP:RS". Your personal unsupported opinion on the source is worth zilch.
• Evaluation of sources is the province of WP:WEIGHT and here's what it says: "Neutrality requires that each article or other page in the mainspace fairly represents all significant viewpoints that have been published by reliable sources, in proportion to the prominence of each viewpoint in the published, reliable sources." and WP:MEDRS tells us how to find those reliable sources. It states "Ideal sources for such content includes literature reviews or systematic reviews published in reputable medical journals, academic and professional books written by experts in the relevant field and from a respected publisher, and medical guidelines or position statements from nationally or internationally recognised expert bodies." Oddly enough, it doesn't say disqualify any source where you don't like the source of funding. and it doesn't say don't use a source if one tendentious editor claims it's "an outlier".

Gordon et al 2013 is (1) recent; (2) a review of current literature; (3) published in a reputable medical journal; (4) published by a respected publisher; and (5) is an examination of "recent literature on the physical harms associated with illicit and legal marijuana administration" (my emphasis). Your objections are noted and refuted; it's time to move on. At some point, continued failure to use this talk page to improve the article will exhaust the patience of your fellow editors and start to border on tendentious editing. -- RexxS ( talk) 16:09, 12 December 2013 (UTC)

You have not addressed the substance of my query in any way. You also seem to misunderstand what an "ad hominem" argument is, as I haven't made one. I asked that the source in question be evaluated for reliability. This has not been done. Instead, you replied by asserting the source is reliable, you have not demonstrated this is true. Perhaps you could start by reviewing the actual source and citing the passages and sources relevant to this topic per V. Viriditas ( talk) 22:03, 14 December 2013 (UTC)

I have requested a copy on research exchange per WP:PAYWALL. Unbeknownst to some editors in this discussion, verifiability does not guarantee inclusion. At least one editor claims that this source meets our reliability standards, but because there are unresolved issues related to WP:UNDUE, and WP:REDFLAG ("cannabis will kill you!"), I have requested editors who wish to use this source to demonstrate how it fits into this article topic per WP:PAGEDECIDE. The source is as follows.

• Gordon AJ, Conley JW, Gordon JM (2013). "Medical consequences of marijuana use: a review of current literature". Current Psychiatry Reports. 15 (12): 419. doi: 10.1007/s11920-013-0419-7. PMID  24234874. {{ cite journal}}: Unknown parameter |month= ignored ( help)CS1 maint: multiple names: authors list ( link)

The content that I have questioned concerns the statment that cannabis is associated with liver disease, lung disease, heart disease, and vascular disease. I am not aware of any supporting statements about such concerns in any literature involving medical cannabis patients so it appears to be taken completely out of context and looks like an association fallacy. Just because sick people use cannabis, or just because people who use cannabis have a disease, doesn't mean that cannabis caused the disease. From where I stand, this source appears to be misused in this article. There are also unanswered questions about the authors (do they publish about medical cannabis?) and their funding (are they funded by anti-drug sources intent on pushing government propaganda?). Viriditas ( talk) 04:00, 15 December 2013 (UTC)

Cannabis appears to be somewhat effective in treatment of chronic pain, including pain caused by neuropathy and possibly also that due to fibromyalgia and rheumatoid arthritis. A 2009 review states it was unclear if the benefits were greater than the risks, while a 2011 review considered it generally safe for this use. In palliative care the use appears safer than that of opioids.

I am unclear why this section says "A 2009 review states it was unclear if the benefits were greater than the risks". You would think the patients using it were very clear on the benefits, and that the physicians prescribing it did so because the benefits outweighed the risks. So what are the "potentially serious harms" Martín-Sánchez et al., 2009 refer to here? Cannabis use is not associated with any serious harm, so perhaps the authors have made a new discovery. Well, try not to laugh, but according to the review authors, the "potentially serious harms" are "euphoria", which normal people define as "a feeling or state of intense excitement and happiness" or as they call it in San Francisco, "stoned", the kind of thing that usually happens when you ingest cannabis; it's just shocking, I know. OTOH, Lynch & Campbell 2011 also reviewed 18 studies noting cannabis was a "modestly effective and safe treatment option". I'm sorry, but are we supposed to take this seriously? "Euphoria", the state of being excited and happy, is defined as a "harm", and this is the justification for saying it was "unclear if the benefits were greater than the risks"? Yes, the patients got stoned. I think it is safe top say that in terms of reliving pain, the risk of having to deal with excitement and happiness...is called pain relief, otherwise known as a benefit. This is approaching a level of absurdity. Euphoria is the opposite of pain. Were the patients complaining to their physicians about how excited and happy they were to not be in pain? In what kind of fantasy world is pain relief "harm"? I believe it is safe to say that this kind of nonsense has no basis in reality. Cannabis is generally considered safe for pain relief in the literature and the benefits are said to outweigh the risks, otherwise physicians wouldn't prescribe it. We shouldn't be highlighting outliers like this and I recommend that Martín-Sánchez et al., 2009 should be removed. It's not a reliable review of the literature, it's an editorial about whether patients should be allowed to feel happy and pain-free. All of the "harms" reported by Martín-Sánchez et al., 2009 are not harms at all. Patients seeking to remove pain by ingesting cannabis do not consider the effects "harmful". While it is true that some might desire more or less effects (and some none at all), it is unrepresentative of the literature to claim that the risk of being "high" outweighs the benefits of pain relief, and it is unproven to claim that being "high" is a potentially serious harm. Viriditas ( talk) 06:02, 12 December 2013 (UTC)

Argue with the sources all you like, but until you either publish a review or present one to back up your claims you won't be getting anywhere. CFCF ( talk) 07:28, 12 December 2013 (UTC)

How is euphoria a potential serious harm that outweighs the benefits of pain relief from cannabis administration? Viriditas ( talk) 07:56, 12 December 2013 (UTC)

See Straw man for the answer. -- RexxS ( talk) 08:05, 12 December 2013 (UTC)

To answer your original question: the potentially serious harms that Martín-Sánchez 2009 refer to include

• events linked to alterations to perception (NNH=7)
• events affecting motor function (NNH=5)
• events that altered cognitive function (NNH=8)

To be clear, "potential harm" is not the same as "harm". To take an extreme example, the consequences of alterations to perception, motor function or cognitive function for someone asleep in bed, or sitting at a desk may be very different from the consequences for someone operating machinery or driving. Martín-Sánchez 2009 is a four-year old systematic review and meta-analysis of cannabis treatment for chronic pain, published in a respectable journal (Pain Medicine) and you don't like it. What's new? -- RexxS ( talk) 08:05, 12 December 2013 (UTC)

PMC3628147 - "Marijuana is classified by the Drug Enforcement Agency (DEA) as an illegal Schedule I drug which has no accepted medical use. However, recent studies have shown that medical marijuana is effective in controlling chronic non-cancer pain, alleviating nausea and vomiting associated with chemotherapy, treating wasting syndrome associated with AIDS, and controlling muscle spasms due to multiple sclerosis. These studies state that the alleviating benefits of marijuana outweigh the negative effects of the drug, and recommend that marijuana be administered to patients who have failed to respond to other therapies." petrarchan47 t c 08:11, 12 December 2013 (UTC)

Agreed. Earlier reviews found the evidence unclear whether the benefits were greater than the risks; later reviews found it generally safe. That's what our article says, so what do you want to change? -- RexxS ( talk) 08:18, 12 December 2013 (UTC)

That review is an outlier and describes the harm as getting high. That is not a harm. Most sources do not now say that the risks are greater than the benefits. We have lots of sources which make wild claims but we don't have to cite them. Is this source a notable or authoritative study? Because if it's not, it shouldn't even be in the article. Viriditas ( talk) 08:25, 12 December 2013 (UTC)

Who says it's an outlier? You? Where does the review describe "the harm" as "getting high"? Give us the quote. In fact, as anyone can read, Systematic review and meta-analysis of cannabis treatment for chronic pain - Martín-Sánchez 2009 describes the potentially serious harms as "events linked to alterations to perception, OR: 4.51 (3.05-6.66), NNH: 7 (6-9); for events affecting motor function, 3.93 (2.83-5.47), NNH: 5 (4-6); for events that altered cognitive function, 4.46 (2.37-8.37), NNH: 8 (6-12)." How many times do you need to see an actual quote before you understand what the review was saying? -- RexxS ( talk) 16:23, 12 December 2013 (UTC)

I know exactly what the review said and I paraphrased it accurately. The "harm" it describes are nothing more than the known side effects of ingesting cannabis—in other words "getting high". These same "potential side effects" are found in many OTC and prescription drugs. Their "potential serious harm" continues to kill tens of thousands of people each year, so we know this is real harm. On the other hand, there is no recorded death attributed to cannabis. The claim that "getting high" is a potential serious harm that outweighs the benefits, is an extreme interpretation that is not supported by the current research nor by the physicians who prescribe it nor from the patients who use it. This is a misuse of a source to push an anti-cannabis POV, and the source does not appear to be well founded in evidence of any kind nor is it reflected in the literature. Viriditas ( talk) 21:55, 14 December 2013 (UTC)

Now you are back to arguing views that weren't present in the article. You still fail to explain how the article is an outlier. An outlier, as in out of two articles it states differently than the other? CFCF ( talk) 22:11, 14 December 2013 (UTC)

According to the more recent review article by Lynch & Campbell, 2010 already in the article, the conclusions of "potentially serious harms" put forward by Martín-Sánchez et al., 2009 are "not consistent with our [Lynch & Campbelll's] clinical experience". In the studies Lynch & Campbell reviewed, there were no serious adverse events. When they did occur, they were "well tolerated, transient or mild to moderate and most commonly consisted of sedation, dizziness, dry mouth, nausea and disturbances in concentration." In other words, the patients felt "high". This is not generally referred to as a "potentially serious harm" in the medical cannabis literature. Martín-Sánchez's conclusions appear to diverge from the consensus of clinical practice. In spite of patients feeling high, the authors concluded that the analgesic effect of cannabinoids was safe and it was "reasonable to consider cannabinoids as a treatment option in the management of chronic neuropathic pain with evidence of efficacy in other types of chronic pain". This is the clinical consensus in the literature, and it's why medical cannabis is recommended by physicians. This absurd notion that the feeling of "getting high" is somehow a "potential serious harm" is unrepresentative of the literature. Martín-Sánchez et al., 2009 are welcome to their opinion, but its use here is of undue weight as it implies that this is a legitimate conclusion reflected by the reviews, when in fact it is an editorial opinion added on top of the review, in spite of it, by Martín-Sánchez et al. without any justification. The notion that the beneficial effects of cannabis may be "offset by potentially serious harms" as the authors suggest is an imaginative fantasy with no basis in reality. Lynch & Campbell's conclusion that "cannabinoids are safe and modestly effective" in dealing with pain is based on actual clinical evidence and experience. Viriditas ( talk) 07:25, 15 December 2013 (UTC)

What were the "views" presented in the article? Why don't you summarize them for me? Are you referring to the view that risks related to euphoria, altered perception, altered motor function, and altered cognitive function (in other words "being high") are greater than the benefits? According to the literature, patients use it precisely because the benefits are greater than the risks, and physicians recommend it for this reason. The "views" appear to be those of authors who don't seem to study cannabis and who aren't cited widely in the literature. Does the medical cannabis literature conclusively say that the risks of being high are greater than the benefits of pain relief? No, it does not. Again, this is the undue use of a source. Viriditas ( talk) 03:28, 15 December 2013 (UTC)

( edit conflict) You think that a piece of text that says "Cannabis appears to be somewhat effective in treatment of chronic pain ... it was unclear if the benefits were greater than the risks" is pushing an anti-cannabis POV? That content is supported by reliable secondary sources, and the only problem with it is that you don't like one of the sources. What do you suggest the text should say then? and what sources would you adduce to support your suggested text? -- RexxS ( talk) 22:16, 14 December 2013 (UTC)

See above. Editors are pushing this view by pushing undue weight. It is very clear in the medical cannabis literature that the benefits of using cannabis to relieve pain outweigh the risks. Otherwise patients wouldn't use it and physicians wouldn't recommend it. And the so-called "risks" here are no different than any OTC or prescription medicine. You could be describing diphenhydramine and it would make no difference. Even though I don't use drugs, I don't drink alcohol, and I don't smoke tobacco, I am susceptible to allergic reactions once or twice a year. I keep diphenhydramine in the medicine cabinet when this occurs, and whenever I need to ingest it (no more than twice a year), it takes me 48 hours to recover mentally and physically because of the side effects. The literature is very clear that the benefits of using diphenhydramine outweigh the risks. But perhaps you think differently. One could describe the feeling of love (euphoria, altered motor function, impaired cognition) as having a potential serious harm. In fact, scientists have found that the feeling of love is located in the same part of the brain as drug addiction. Perhaps you feel that we should ban Valentine's Day and give people lobotomies? Viriditas ( talk) 03:28, 15 December 2013 (UTC)

So, what text do you want and what are your sources? -- RexxS ( talk) 21:38, 15 December 2013 (UTC)

The section on multiple sclerosis used to be sourced to Lakhan & Rowland 2009, a review of six studies (Killestein 2002; Zajicek 2003; Wade 2003; Vaney 2004; Wade 2004; Collin 2007). The authors note that five of these studies "concluded that cannabis extract may decrease spasticity and improve mobility in patients with MS" while "one study reported no reduction in spasticity."

The authors "found evidence that combined extracts of THC and CBD may reduce symptoms of spasticity in patients with MS. Although the subjective experience of symptom reduction was generally found to be significant, objective measures of spasticity failed to provide significant changes. In a previous study of spasticity-related pain, MS patients also reported a subjective perception of symptom reduction with cannabinoids. However, since at least one past animal study has provided objective, physiological evidence for the antispastic properties of cannabinoids, the distinction between perceived symptom relief and objective physiological changes in humans should therefore be primary in future research efforts."

The authors conclude by saying "there is evidence that cannabinoids may provide neuroprotective and anti-inflammatory benefits in MS. Neuroinflammation, found in autoimmune diseases such as MS, has been shown to be reduced by cannabinoids through the regulation of cytokine levels in microglial cells. The therapeutic potential of cannabinoids in MS is therefore comprehensive and should be given considerable attention."

I'm very surprised to find that the section does not currently say this. Instead, Lakhan & Rowland 2009 have been removed from this section and replaced with Thaera et al, 2009. The section now says, "cannabis does not appear to improve measured spasticity but may improve the persons feelings of spasticity." In fact, the most current reviews do not say this and it makes one wonder why this single page review of one study was even added to this article (the other two pages are an abstract and a list of refs).

Lakhan & Rowland 2009 is highly cited and I can barely find Thaera et al, 2009 anywhere. Furthermore, more recent reviews, such as Tikoo et al., 2012:50, and Leussink et al., 2012 reflect more recent research on the endocannabioid system, the objective evidence showing the reduction of spasticity in mice, and more recent evidence showing how "cannabis improved spasticity, pain, tremors, and depresion" in MS patients. Apparently citing the same studies as Lakhan & Rowland 2009 and Thaera et al, 2009, Tikoo et al., 2012 reports "significant improvements in spasticity, pain and sleep quality" with the followup showing "a remarkable decrease in spasticity". On the other hand, all authors report mixed results.

Thaera et al., 2009, which can hardly be called a review (one page with an abstract, one page of discussion, and one page of nine references) looks at one study (Zajicek 2003 which looked at patients from 2000-2002) from more than ten years ago! The authors conclude from looking at one study: "Oral cannabinoids do not improve MS-related spasticity as measured by the Ashworth scale; Oral cannabinoids are associated with subjective improvement in symptoms such as muscle stiffness, spasms, pain, and sleep problems with MS; Further studies are needed to develop valid, reproducible measurement instruments for MS-related spascitity and to evaluate the symptomatic effects of cannabinoids for MS."

Thaera et al., 2009, admit that "there is evidence that Ashworth scores do not correlate well with function or other spasticity measures". Maura RZ Madou attributes the discrepancy of subjective versus objective outcomes to drug delivery: "Patients who smoke marijuana benefit from the higher bioavailability of THC when smoked versus taken orally. They can also dose their THC intake per session by varying inhalation based on symptom severity. Mucosal sprays attempting to get around the issue of bioavailability have shown promise, but have yet to match the symptomatic benefit achieved through inhalation." Thaera et al, 2009 ask the same question as Madou: "Could it be, as some patients suggest, that the oral route is simply not as effective a delivery system as smoked cananbis, leading to a discrepancy between the experimental trial and "real world" experiences"?

The anecdotal reports of the benefits of smoked cannabis have been tested and are supported with clinically significant evidence on the Ashworth scale. With a grant from the University of California Center for Medicinal Cannabis Research, Corey-Bloom J, et al., 2012 found that "smoking cannabis reduced patient scores on the modified Ashworth scale by an average of 2.74 points more than placebo." The authors "saw a beneficial effect of smoked cannabis on treatment-resistent spasticity and pain associated with multiple-sclerosis".

Furhtermore, as Lakhan & Rowland 2009 (and Tikoo et al., 2012 and others) report, animal studies have "provided objective, physiological evidence for the antispastic properties of cannabinoids". Thaera et al., 2009 note in the journal Neurology that "progress in the field has been modest, in part because of these problems, but also because of the political and legal issues that surround cannabis in most countries". Ironically, they did not do their "research". A year before they wrote about the political and legal issues that surround cannabis, German medical authorities acknowledged that in controlled trials, cannabinoids showed benefits for patients suffering from MS symptoms. In 2011, Germany approved a cannabis-based extract to treat spasticity in multiple sclerosis patients. [34]

Years later, and in marked contrast to Thaera et al., 2009, Leussink et al., 2012 writes: "The oromucosal administration of THC and CBD in a 1:1 ratio has proven to be a well tolerated therapeutic option for treating spasticity in patients with MS who respond poorly to conventional antispastic drugs. Assessment of the efficacy is limited by the fact that spasticity as a symptom is very difficult to measure reliably, objectively, and validly. Current study data support the position that the beneficial effects of nabiximols on subjective and objective endpoints in a selected patient sample outweigh the adverse pharmaceutical effects. The effects of long-term nabiximols treatment on neuropsychological processes and the structure of the endocannabinoid system need to be further characterized."

While both Lakhan & Rowland 2009 (a review of six studies) and Thaera et al., 2009 (a review of one) reported subjective improvement and a lack of objective measures, Thaera et al., 2009 appears to have been used to make the extreme claim that cannabis has no real, objective benefit for MS patients. More recent reviews, such as Tikoo et al., 2012 and Leussink et al., 2012, and more recent objective evidence from Corey-Bloom J, et al., 2012 show that Thaera et al., 2009 is not only outdated, but only represents one study from more than a decade ago, and is hardly a review of the literature. Leussink et al., 2012 has since reviewed Notcutt et al., 2012 which shows "long-term symptomatic improvement of spasticity" in patients receiving Sativex. The study shows "further evidence of the maintenance of long-term efficacy of Sativex as an add-on therapy in the treatment of MS spasticity, in patients who have already been identified as responders." [35]

In summary, Lakhan & Rowland 2009 is a true review of the literature, which in combination with more recent reviews, gives a more accurate interpretation of the current research results. Thaera et al., 2009 appear to argue that cannabinoids do not reduce multiple sclerosis-related spasticity, but this conclusion is not widely supported in the literature and appears to represent one side of the literature over the other and introduces editorial imbalance. Viriditas ( talk) 08:38, 11 December 2013 (UTC)

Summarizing a very long discussion:

Sources used in this version:

• Borgelt 2013 PMID  23386598
• Clark Capuzzi Fick 2011 PMID  22129912
• Grotenhermen 2012 PMID  23008748
• Oreja-Guevara 2012 PMID  23011861
• Thaera 2009 PMID  19901724

Sources suggested by Viriditas:

• Lakhan Rowland 2009 PMID  19961570

I believe this section was written by Jmh649 and Alexbrn. I do not have the full text of Thaera, and it doesn't seem to be freely available. Viriditas, could you please summarize what changes you would like to see in the text? SandyGeorgia ( Talk) 15:13, 11 December 2013 (UTC)

I'd favour having Borgelt 2013 ( PMID  23386598) as the centrepiece here. It's most recent and seems thorough, so would seem the natural choice for that. Alexbrn ^{talk| contribs| COI} 18:05, 11 December 2013 (UTC)

It's neither a centerpiece nor relevant to this discussion nor a current review of MS literature. Viriditas ( talk) 18:14, 11 December 2013 (UTC)

My mistake. Alex provides a good interim fix as Borgelt appears to be current up to 2011 which is better than what we have now. I did not notice that before now. But this thread provides more current sources that can also be added. Viriditas ( talk) 18:57, 11 December 2013 (UTC)

If so, then why did they remove the review source that was already in place and replace it with a review of one study that isn't cited anywhere in the literature, and then fail to check the literature for more current sources that show the efficacy of treating spasticity with cannabis? I have the full text of Thaera and you can find copies online. It's barely a few paragraphs and is unrepresentative of the current literature and outdated. Given the concerns above, I would like to know why it was added. And no, I am not recommending using Lakhan Rowland 2009, I've simply said repeatedly that it was in the MS section before it was removed. Obviously, there are much newer review sources listed above. So this is another example of problematic edits being made with no explanation on talk. Petra appears justified in her concerns, and this discussion points out major problems with only one set of edits to one section. Based on this sample, how likely is it that I will find similar problems with other new edits made to other sections? Viriditas ( talk) 18:14, 11 December 2013 (UTC)

Could we please avoid personalization? If you will explain what you want added or changed in the text, I will review all of the sources I have, but I do not have Thaera. If copies of Thaera are available online, would you mind being so kind as to share it with the rest of us? I speak Spanish, and Oreja-Guevara 2012 PMID  23011861 is the most recent review specific to Multiple sclerosis; if you will explain what is needed, I will plow through it again. SandyGeorgia ( Talk) 18:38, 11 December 2013 (UTC)

I have access to the full text of the Thaera article and can email it to you. I don't actually see a conflict here—it looks like Thaera et al. reached essentially the same conclusion as Lakhan & Rowland. To wit, cannabis produces subjective relief of spasticity associated with MS, although there was no statistically significant improvement in objective metrics of spasticity (e.g. the Ashworth scale). Both articles discuss possible reasons for this discrepancy, including concerns about the validity of the Ashworth scale as an objective measure of spasticity. Reading both articles, I'm struck by how similar their conclusions are. MastCell  ^Talk 18:52, 11 December 2013 (UTC)

Thanks, MastCell; so I remain unclear on what changes Viriditas wants to see, and plowing back through a Spanish-language source will take some time. I'd like to know what I'm specifically looking for. SandyGeorgia ( Talk) 18:57, 11 December 2013 (UTC)

Thaera et al., 2009, a review of one study from a decade ago, is being used to claim that "cannabis does not appear to improve measured spasticity but may improve the persons feelings of spasticity" when this claim is both disputed ("The validity of the Ashworth scale as an outcome measure has been previously questioned") and outdated (Tikoo et al., 2012; Leussink et al., 2012; and Corey-Bloom J, et al., 2012). It appears that Thaera et al., 2009 is being misused to highlight the known limitations of the ability of this scale to measure objective spasticity in order to claim that cannabis doesn't work for MS. But, Thaera et al., 2009 is not a current review of the literature. Leussink et al., 2012 notes that "assessment of the efficacy is limited by the fact that spasticity as a symptom is very difficult to measure reliably, objectively, and validly." In their review of the literature, they write:

The potential role of cannabinoids in the treatment of spasticity in MS was highly controversial following publication of the first studies [Smith, 2007]. Their inconsistent results can be attributed to the heterogeneity of the study drugs used as well as to the various, sometimes unsuitable measurement parameters used to quantify the symptoms of spasticity. A meta-analysis of three studies on the therapeutic efficacy of nabiximols in the treatment of MS including a total of 666 participants found overall good efficacy of nabiximols as an antispastic therapeutic [Wade et al. 2010]. However, the phase III study published by Novotna and colleagues was the first to identify a clinically highly significant reduction in spasticity [Novotna et al. 2011]. The design applied in this study, with the exclusion of therapy nonresponders in the placebo-controlled study phase, facilitated demonstration of a therapeutic effect of nabiximols on spasticity. In view of the initial 4-week open-label phase with single-blind therapy of all study participants with nabiximols, a significant unmasking of the therapy responders randomized for the placebo-controlled phase cannot be ruled out as a result of side effects of nabiximols [Rog, 2010]. Reduction of spasticity perceived by the patients and reflected in the subjective analogue scales can likely be attributed, in part, to the known analgesic effect of nabiximols. Nevertheless, in a recently published 5-week placebo-controlled, parallel-group, randomized withdrawal study in patients with ongoing benefit from nabiximols, long-term symptomatic improvement of spasticity mediated by this drug could be confirmed [Notcutt et al. 2012].

As for smoked cannabis, Corey-Bloom J, et al., 2012 found that smoked cannabis "reduced patient scores on the modified Ashworth scale by an average of 2.74 points more than placebo." I do not believe any of the above reviews cover MS studies on smoked cannabis. In any case this undue focus on Thaera et al., 2009 in the face of all the new evidence is very unusual. Viriditas ( talk) 19:54, 11 December 2013 (UTC)

MastCell says both Thaera and Lakhan say the same thing. As far as I can decipher, the wall of text above is about this one sentence in this version of the article:

In multiple sclerosis (MS) cannabis does not appear to improve measured spasticity but may improve the persons feelings of spasticity.

which is cited to Thaera. You appear to have all the sources at hand, and have spent more time typing than it would take you to propose here the correction you want. Would you mind doing so? That would be a faster route for all of us. With so much work to be done in here, collaboration and AGF will help.

Also, is {{ Update}} a correct indication that the entire section is outdated? Do you disagree with the rest of the statements, or is the entire section template because of one sentence? SandyGeorgia ( Talk) 20:17, 11 December 2013 (UTC)

"MastCell says both Thaera and Lakhan say the same thing." What's with all the straw man arguments? That's not what I'm discussing here at all. I have already said many times that Thaera et al., 2009 should not have been added. It's a review of one study from a decade ago being used to claim that "cannabis does not appear to improve measured spasticity but may improve the persons feelings of spasticity" by focusing solely on the Ashworth scale, a questioned measure of spasticity. As I've shown above, newer sources like Leussink et al., 2012 show that a lot has changed since Thaera et al., 2009. Please do not bring up Lakhan & Rowland 2009 in your reply. It was raised in this discussion because it was originally in that section before it was replaced with Thaera et al., 2009. They are similar, but they are not the same. Yes the section is outdated, as I just showed several times by citing Leussink et al., 2012. At this point, I can see that just using the talk page is useless. I should just follow WPMED's example by just editing without using the talk page and then revert anyone who disagrees. Viriditas ( talk) 20:20, 11 December 2013 (UTC)

I'm finding it frequently hard to figure out what you're discussing. You started out discussing Lakhan, and now you don't want it mentioned. OK. For a section I haven't even worked on, this is quite an exhausting way to approach article talk. In the event it will be helpful, here is what the English-language abstract only of Oreja-Guevara 2012 PMID  23011861 says:

Randomized, placebo-controlled trials, as well as longer-term open-label extensions, have shown a clear-cut efficacy to reduce spasticity and their associated symptoms in those patients refractory to other therapies, with a good tolerability/safety profile. No tolerance, abuse or addictive issues have been found.

On a very quick glance through the Spanish-language full text (I read fluently in Spanish, but it's slow going), I don't see anything that seems at odds with the distinction between "spasticity" and "feelings of spasticity" you have made above. I don't know what else in that section is outdated according to you, so can't offer any more help. SandyGeorgia ( Talk) 20:32, 11 December 2013 (UTC)

No problem, I'll remove Thaera et al., 2009 myself, since it is an outdated "review" of one study from more than a decade ago that focuses solely on the disputed Ashworth scale mesaurements which doesn't accurately measure spasticity. And yes, you are finding it hard to figure out what I'm saying. I started out discussing Lakhan & Rowland 2009 because that's what was in the article before it was replaced with Thaera et al., 2009 and I questioned why it was replaced. Other newer reviews, such as Leussink et al., 2012 cite newer studies and drugs such as Novotna et al., 2011 and Notcutt et al., 2012. And current research, such as the kind conducted by the California Center for Medicinal Cannabis Research (Corey-Bloom J, et al., 2012) have shown that smoked cannabis reduced patient scores on the Ashworth scale, which older studies failed to look at. The reviews and studies show that MS-related spasticity is improved by oral and smoked cannabis, objectively and subjectively. Is this in question? Viriditas ( talk) 20:46, 11 December 2013 (UTC)

Viriditas, might I kindly suggest that the next time you want to question a source used for one sentence, that you simply ask Jmh649 or Alexbrn (I'm unaware who added Thaera) why they chose it, rather than assuming it was for some nefarious purpose? You might get a surprising answer, and it would surely save us all time, effort, and bandwidth. And then next, briefly propose the text and the source you would like to switch to? You might have found 25KB ago that no one objected. Since we still don't know what you plan to write, or why you find the rest of the section outdated, this is a very frustrating approach to talk page use. SandyGeorgia ( Talk) 20:54, 11 December 2013 (UTC)

Sandy, might I suggest you read my original comment? Why would I ask Jmh649 or Alexbrn why they chose it? I have no idea who added it, I only know what the previous version said before everything was changed. I've explained why it is outdated multiple times now. Do you think it it represents a current review of the MS literature per WP:MEDRS? It's a review of one large study from more than a decade ago. Do you think other review sources like Leussink et al., 2012 (or as Alex suggested above Borgelt et al., 2013) are more current? If you had read my original comment then you would know that Thaera et al., 2009 looks at Zajicek 2003 which covers a single study from 2000-2002. Is that current? Viriditas ( talk) 21:01, 11 December 2013 (UTC)

I'm not here to argue for the sake or arguing. Proposed text and source, please? SandyGeorgia ( Talk) 21:04, 11 December 2013 (UTC)

Nobody proposed anything for adding Thaera et al., 2009, so I'll just come up with something and add it just like WPMED. Viriditas ( talk) 21:10, 11 December 2013 (UTC)

Writing correctly sourced, neutral, up-to-date, comprehensive text is usually more time-consuming and productive than criticizing the attempts of others to do same. Except in this case, where the criticism seems to have taken about ten times as long as writing new text to begin with might have. YMMV. SandyGeorgia ( Talk) 22:24, 11 December 2013 (UTC)

Go back and read my initial comment. I did not criticize any individual editor, I merely raised the point that this section is unbalanced and out of date. Imagine my surprise after coming home from work, to find that this section is still unbalanced and out of date. I'm adding the maintenance tag back in. I have been very clear about the problem. Viriditas ( talk) 04:48, 12 December 2013 (UTC)

Looking at Care of Patients with Multiple Sclerosis: Guidelines (Feb 2012 - CADTH), the first mention of cannabis as a treatment is the Lakhan & Rowland 2009 systematic review, so that looks like a good candidate to base our content on. The last Cochrane review I can find on the topic is Shakespeare et al (2003), so is really too old to be useful to us. Borgelt et al (2013) is bang up-to-date, but seems to be addressing the general use of medicinal cannabis rather than addressing the specific question of its efficacy in treating MS. I'll update the text to reflect Lakhan & Rowland and see where we go from there. -- RexxS ( talk) 22:45, 11 December 2013 (UTC)

Well, I could have done that easily myself, but ... "Please do not bring up Lakhan & Rowland 2009 in your reply. Viriditas (talk) 20:20, 11 December 2013", so thanks! SandyGeorgia ( Talk) 23:14, 11 December 2013 (UTC)

Thanks and agree RexxS. Changes look good. Just simplified the wording a little. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 23:28, 11 December 2013 (UTC)

Sorry, RexxS, but, Lakhan & Rowland 2009 is out of date, as I've repeatedly said. I do not understand why it was added back. Lakhan & Rowland 2009 review very old studies from Killestein 2002, Zajicek 2003, Wade 2003, Vaney 2004, Wade 2004, and Collin 2007. We have had many new reviews since then that have followed up on newer studies, as I have repeatedly stated many times in this thread, including Leussink et al., 2012, which reviews Rog, 2010, Wade et al. 2010, Novotna et al. 2011, and Notcutt et al. 2012, among others. Viriditas ( talk) 04:48, 12 December 2013 (UTC)

I disagree. Repetition of your opinion does not turn it into fact. Lakhan & Rowland 2009 is not out of date; as I've shown above, it's the most recent review that closely addresses the question of the use of cannabis in treatment of symptoms of MS and it is not contradicted by any later secondary source that I am aware of. I don't accept that one editor's amateur analysis of a four-year old review's choice of sources carries any weight at all. However, your suggestion of using Leussink 2012 seems fine to me - it's a good review specific to the question of spasticity, but says nothing new in its conclusion: "Assessment of the efficacy is limited by the fact that spasticity as a symptom is very difficult to measure reliably, objectively, and validly. Current study data support the position that the beneficial effects of nabiximols on subjective and objective endpoints in a selected patient sample outweigh the adverse pharmaceutical effects." Nevertheless, please feel free to tweak the current wording if you can improve on it, and/or use Leussink 2012 as a reference - I see no contradiction with the current content. -- RexxS ( talk) 07:09, 12 December 2013 (UTC)

What about PMID  20541836 ? I used this in the first pass of clean-up, but it has since been removed. Alexbrn ^{talk| contribs| COI} 07:59, 12 December 2013 (UTC)

Of course it's out of date. It doesn't review any of the most recent studies during the last 6-7 years. And more to the point, does it review studies of smoked cannabis or Sativex? Those have only taken place in the last few years. How could it be current? Viriditas ( talk) 08:11, 12 December 2013 (UTC)

A four-year old review that's not superseded is not out of date. There are no new conclusions in the later review that you suggested. I haven't found a review that specifically discusses comparative efficacy of Sativex, but if you want to examine the cost-effectiveness of Sativex, there's Slof & Gras 2012, a Spanish-German analysis - but you may wish to balance that with Statement of advice from the Scottish Medicines Consortium (2011) which shows that NHS Scotland is not yet sufficiently satisfied to recommend the use of Sativex. The USA isn't the only country to hold opinions on these topics. -- RexxS ( talk) 08:38, 12 December 2013 (UTC)

A four-year old review that covers studies from 2002-2007, which makes it about seven years old now. It has not reviewed any studies from 2009-2013, like the ones listed above. You claim that is not superseded, but it appears that much has changed in newer reviews that do not rely solely on the flawed Ashworth scale. Leussink et al., 2012 as cited above, reviewed newer studies of THC, CBD, and nabiximols. In the case of nabiximols (Sativex) in particular, they found that "current study data support the position that the beneficial effects of nabiximols on subjective and objective endpoints in a selected patient sample outweigh the adverse pharmaceutical effects" while according to the authors, long-term symptomatic improvement of spasticity were recently confirmed in Notcutt et al. 2012. I believe this goes beyond subjective reporting and represents objective improvement. Viriditas ( talk) 03:40, 15 December 2013 (UTC)

Didn't you argue just four days ago "Lakhan & Rowland 2009 is highly cited ..." and "Lakhan & Rowland 2009 is a true review of the literature, which in combination with more recent reviews, gives a more accurate interpretation of the current research results." I know that the literature is changing quite quickly in this field, but surely three days is just too short for a 2009 study to completely go out of date? or do you just come here to argue?

For what it's worth, Leussink et al 2012 reviewed literature from 1980 to April 2012 - they obviously thought it was worth looking at older studies, even if you don't. I'd be quite happy to use Leussink in this section; it's very relevant to the topic and meets MEDRS (in my humble opinion). It also has free full text, which is a bonus for the reader. So what text would you like to use to summarise Leussink? How about something like:

• " Nabiximols is a useful and apparently safe option for treating MS in patients that do not tolerate conventional antispastic drugs. The benefits outweigh adverse pharmaceutical effects, although the long-term effects have not yet been researched."

I'm not convinced that is very different from what we already have, but it's quite a firm set of conclusions and perhaps could replace the second sentence in our text? -- RexxS ( talk) 22:29, 15 December 2013 (UTC)

I recently deleted a paragraph concerning Canasol, a drug that didn't turn up hits on pubmed, NHS or FDAs websites. The only review that seems to be from a main-stream journal is this one I found from 2002, is there any point in mentioning it? http://www.ncbi.nlm.nih.gov/pubmed/12182967 CFCF ( talk) 19:34, 2 December 2013 (UTC)

Google Scholar turns up some stuff; not sure how notable it is overall. I believe it was a standalone article topic once (!) Alexbrn ^{talk| contribs| COI} 19:37, 2 December 2013 (UTC)

I couldn't find anything useful, so removed Canasol from the table (the table format by the way isn't very useful). Alexbrn, if you have any good sources, pls re-add. SandyGeorgia ( Talk) 15:46, 9 December 2013 (UTC)

I'm not seeing anything recent; at the very most this might be worth a historical note. About the best source I can see is Kabat, Alan G.; Sowka, Joseph W (2007). "Just Say No: Ganja for glaucoma? A simple answer still works best for this difficult question". Review of Optometry. 144 (2): 138... The money quote is:

a ganja-based product called Canasol (Cannabis sativa, Ampec Chemicals) is available; we have encountered several patients from the Caribbean who used this medication. A PubMed search shows no evidence of peer-reviewed publications regarding the safety and efficacy of Canasol, but a letter (penned by the drugs primary developer) in the British Journal of Anaesthesia states that Canasol is comparable with timolol maleate, and is compatible with the commonly used anti-glaucoma agent

Alexbrn ^{talk| contribs| COI} 16:05, 9 December 2013 (UTC)

Svrakic 2012 ( PMID  22675784) includes an excerpt written by Charles Lederer (ophthalmologist) that says:

Glaucoma treatment involves lowering the intraocular pressure (IOP). This helps preserve visual function by slowing or halting progressive damage to the optic nerve. Smoking or ingesting marijuana can, indeed, lower the IOP.1 In addition, THC (marinol), the major psychoactive ingredient in marijuana, has been shown to have an IOP-lowering effect when ingested orally. However, due to a variety of factors, it is not possible to transform these observations into a widespread and clinically useful method of glaucoma treatment at the present time. The pressure-lowering effects of inhaled marijuana are variable and of short duration. To achieve continuous IOP lowering, this short duration of action requires smoking marijuana every three to four hours.2 ... Inhaled marijuana compares poorly to the eye drops we have available to lower IOP. Currently available glaucoma eye drops have been extensively studied and are usually well tolerated and effective. They have a much longer duration of action when compared to inhaled marijuana. A variety of laser and incisional surgical techniques, both established and recently developed, are also available. Marijuana has a complex composition, containing 60 known cannabinoid compounds. Study of these compounds is ongoing, and it may well be that one or more of these compounds will become a valuable method of glaucoma treatment. At the present, however, despite public fascination with the concept, smoking marijuana as a way to treat glaucoma is not well established or practical, and may be a dangerous option.3

I'm out of time for now; perhaps someone will write this section. SandyGeorgia ( Talk) 17:03, 9 December 2013 (UTC)

I don't think we've done this yet? SandyGeorgia ( Talk) 16:03, 23 December 2013 (UTC)

Our text says:

and it may be a reasonable option in those who do not improve with other treatments.

cited to PMID  23008748. PubMed indicates two follow-up letters about that source (the authors have a COI). Could someone with journal access please provide detail on the two follow-ups? I'm not sure we need to cite a COI review, because I think we have similar text from other reviews. SandyGeorgia ( Talk) 16:32, 4 December 2013 (UTC)

Have no problem with you switching out the ref for another one. It is not a particularly controversial statement. Doc James ( talk · contribs · email) (if I write on your page reply on mine) 16:35, 4 December 2013 (UTC)

We also have this very old source-- can it be updated?

• Jordan K, Sippel C, Schmoll HJ (September 2007). "Guidelines for antiemetic treatment of chemotherapy-induced nausea and vomiting: past, present, and future recommendations". Oncologist 12 (9): 1143–50. doi:10.1634/theoncologist.12-9-1143. PMID  17914084.

I don't think we've done this yet? SandyGeorgia ( Talk) 16:04, 23 December 2013 (UTC)

I read the article that Petrarchan47 found - Nagarkatti P, Pandey R, Rieder SA, Hegde VL, Nagarkatti M (2009). "Cannabinoids as novel anti-inflammatory drugs". Future Medicinal Chemistry. 1 (7): 1333–49. doi: 10.4155/fmc.09.93. PMC  2828614. PMID  20191092. {{ cite journal}}: Unknown parameter |month= ignored ( help)CS1 maint: multiple names: authors list ( link) with interest.

Although I agree with ‎Alexbrn that I wouldn't use it to support content lifted from just one survey, I was impressed by the overall thrust of argument in the paper, that "... cannabinoids have exhibited significant potential to be used as novel anti-inflammatory agents." This is a 2009 survey of research (it doesn't analyse in the way that I expect a review to) and I don't know if much more research has been done in the meantime, but it does indicate several potential applications and I wondered if we ought to examine them?

I'm always loathe to suggest putting content into the Research section, as it all too often seems to turn into a magnet for every speculative experiment ever made, but in this case we have a solid source suggesting something that we don't already examine. Does anyone else have any thoughts on whether we could say something in Research about the potential of cannabinoids as anti-inflammatory agents? -- RexxS ( talk) 20:47, 23 December 2013 (UTC)

Have you had a chance to look at Pertwee 2012? I haven't yet read Nagarkatti, but Pertwee is newer and deals with anti-inflammatory action. SandyGeorgia ( Talk) 21:55, 23 December 2013 (UTC)

The patent is for cannabinoids, of which cannabidiol is one. An extensive quote, which looks like a hype for an individual company because a grant for study was "contemplated" over two years ago, was added, trimmed by me, and reinstated in its entirety to cannabidiol. Does text about the patent belong at cannabinoid, cannabidiol, or medical marijuana, and are the overquoting and mention of a "contemplated" grant to an individual company two years ago UNDUE? SandyGeorgia ( Talk) 11:05, 10 January 2014 (UTC)

Under the history section it states that Emperor Shen-Nung wrote a book on medicinal cannabis in 2737. We should edit 2737 to 2737 BC to diminish any confusion there might be. Neweditingexpert7422 ( talk) 18:10, 6 March 2014 (UTC)

Good point. Done. Psyden ( talk) 21:26, 6 March 2014 (UTC)

http://www.nybooks.com/articles/archives/2014/mar/20/pot-and-myth-shen-nung/

5.81.26.164 ( talk) 00:40, 10 March 2014 (UTC)