Jewish World Review Jan. 24, 2003 / 21 Shevat, 5763
By Robert A. Wascher, M.D., F.A.C.S.
http://www.NewsAndOpinion.com |
There has been a great deal of debate regarding the impact of marijuana use
on the subsequent use of other illicit drugs. Those who believe that
marijuana serves as a "gateway" to the use of "harder drugs" often cite
limited scientific evidence suggesting that most hard drug users began with
marijuana before graduating to other substances.
On the other side, there
is evidence suggesting, albeit often anecdotally, that the majority of
occasional cannabis users do not go on to use other "hard drugs."
Unfortunately, there has not been a lot of hard scientific evidence to
support either camp's position, although previous studies have appeared to
show, variously, that genetic or environmental factors might play a role in
a predisposition to graduate from marijuana to other substances.
The current issue of the Journal of the American Medical Association
contains an interesting Australian study that attempts to resolve this
controversy. The study enrolled 300 pairs of same-sex twins, both identical
and fraternal, with an average age of 30 years. The twin-pairs were
surveyed between 1996 and 2000, with each pair of twins consisting of one
person who began smoking marijuana prior to age 17, and a second twin who
abstained. The study looked at the use of nonprescribed sedatives,
hallucinogens, cocaine and other stimulants, and opiate narcotics. Alcohol
dependency and cannabis use were also assessed.
The study determined that individuals who began using marijuana before age
17 had 2 to 5 times the risk of subsequent progression to other drugs, as
well as to alcohol dependency, when compared to their twin siblings who did
not use marijuana. When the researchers corrected their results for other
potentially contributing factors (e.g., early-onset alcohol or tobacco
dependency, parental conflict or separation, childhood sexual abuse, and
psychiatric disorders), there was no significant change in their original
findings. There was also no significant difference in the results between
identical and nonidentical twin-pairs. The authors, therefore, concluded
that the early onset of marijuana use (before age 17 in this study) was
associated with a 2 to 5 times risk of progression to the use of other
illicit substances, and to alcohol dependency. The use of same-sex twins in
this study was designed to eliminate potential genetic or environmental
variables that might have had an impact on the results of the study. While
these results do not provide a precise explanation for the observed "gateway
effect" associated with early-onset marijuana use, it may be that peer
pressure and social pressures associated with marijuana use leads to a
reduced threshold for experimentation with other illicit substances and
alcohol (as well as easier access to these non-cannabis drugs from cannabis
dealers). Ironically, the current legal status of marijuana may also be an
important factor, as cannabis use is proscribed by law, making its use a
criminal act. Having breached this legal threshold, there may be fewer
reservations regarding the subsequent use of other illicit substances. It
would, therefore, be interesting to see a similarly designed study of the
impact of early tobacco and alcohol use (both are legal psychoactive drugs)
on subsequent illicit substance abuse. While there may well be certain
genetic and environmental factors that predispose to substance abuse in some
cases, the contribution of marijuana's current legal status to both its
initial use, and to the subsequent progression to use of other drugs, has
not yet been studied. Whether you take a libertarian view or a conservative
view of substance abuse, and the laws that regulate the use of all
psychoactive substances (including tobacco and alcohol), this study raises
as many questions as it appears to answer.
THE SUPER-SIZING OF AMERICA
Our fast food
culture has made it possible to spend less than 10 minutes in a fast food
restaurant's drive-thru lane before driving off with a single meal
containing, literally, an entire day's supply of fat, protein and calories.
We no longer have to stalk, hunt or tediously grow provisions for ourselves
and our families. For that matter, we don't even have to walk to or from
our cars, as many restaurants now deliver prepared food to our front
doorsteps.
I often like to observe people when I am out and about. I never cease to be
amazed at the degree of aversion many people have to even the most modest
expenditure of effort in their daily lives. One especially poignant example
of this phenomenon is the behavior that I like to call the "20 steps (or
less) parking plan." Surely you have seen this same behavior yourself while
trying to find a parking space at a large shopping mall. Many people will
drive round and round the parking lot, endlessly searching for that elusive
parking spot that is within 20 paces of the mall's entrance. They lurch
from lane to lane, scanning the rows of cars for an empty space, or for
signs of another car's incipient departure. They verbally accost you when
you are walking by, asking if you are about to leave. However, once you
have passed beyond the critical 20 pace threshold, the drive-by
interrogations rapidly thin out. Meanwhile, dueling motorists frantically
attempt to simultaneously maneuver their vehicles into a single coveted
empty space within the "20 paces zone," their faces screwed into expressions
of anger and frustration. Occasionally, they will indulge in acts of
"mutually assured exclusion," each preventing the other from gaining access
to the prized parking space as if they were hunger-crazed beetles fighting
for some prized bit of detritus. Overeating and underexercising have become
the American Way of Life for many of us overworking undersleeping
overstressed citizens, and our burgeoning waistlines testify to the
consequences of such a lifestyle.
An intriguing study, also published in the current issue of the Journal of
the American Medical Association takes a look at the patterns and trends in
food portion sizes in the United States between 1977 and 1996. More than
63,000 individuals, aged 2 years and older, were surveyed regarding their
eating habits during the period of study. The surveys inquired about
specific food items consumed, as well as portion size and the locations
where each meal was consumed. The study determined that portions sizes
varied according to the location of each meal. Not surprisingly, the
largest portions of food were consumed at fast food eateries and at home,
while the smallest (though still quite substantial) portions were consumed
at sit-down restaurants. Between 1977 and 1996, food portion sizes
increased for meals eaten both inside and outside of the home. Oddly
enough, the consumption of pizza, among the various specific food items
tracked by this study, did not increase in terms of portion size between
1977 and 1996. However, energy intake from food, based upon portion size,
significantly increased during the period of study for salty snacks, soft
drinks, hamburgers (my own personal weakness), french fries, and Mexican
food (another of my own personal weaknesses).
This study is one of very few studies that have actually quantified the
inexorable upsizing of food portions over the past 20 years in our country,
as well as identifying the locations where most of this super-sizing is
occurring. The overabundance of inexpensive calorie-dense foods in our
culture provides a temptation that caters to our genetic predisposition to
energy hoarding. Unfortunately, we expend almost no calories while circling
endlessly in the parking lot in search of the parking space that puts us as
close to the mall's front door as possible.
Eat less, exercise more.
BO-TOX THAT BO AWAY!
Neither
the patient nor the person administering the injections knew which armpit
got the Bo-tox and which pit got the saline solution. After a period of 7
days, body odor was assessed, and I am not making this up, by a "T-shirt
sniff test." The authors found that the armpit area on side of the T-shirt
that was treated with Bo-tox was significantly less smelly, and that the
quality of the odor on the treated side was less unpleasant, when compared
with the side of the placebo injection. While I cannot say who made the
greater sacrifice for science by participating in this study (i.e., the
people who let someone inject Bo-tox and saline into their armpits, or the
"T-shirt sniff test" sniffers), it is nonetheless reassuring to witness the
march of science towards the eventual eradication of both life-threatening
diseases and offensive body odor. So, don't be surprised if the host of
that next Bo-tox Party that you attend asks you to raise your arms and close
your eyes. (Remember, you read about this first at JWR!)
JWR contributor Dr. Robert A. Wascher is a senior research fellow in molecular & surgical oncology at
the John Wayne Cancer Institute in Santa Monica, CA.
Comment by clicking here.
Marijuana: A Gateway Drug?
Over the past two years, I have reported on a number of epidemiologic
studies that have confirmed a pandemic of obesity among both adults and
children in the United States. Our society's unprecedented girth and heft
have been largely (no pun intended)... attributed to our penchant for fatty
calorie-rich diets, and an aversion to physical activity, which has been
abetted by a bevy of effort-reducing "convenience devices."
Don't ask me who originally came up with the idea for this study, but the
current issue of the Archives of Dermatology has published a study looking
at the effects of Botulinum toxin (Bo-tox, for you Hollywood types) on body
order. However, to be fair, Bo-tox has been used, experimentally, to treat
a condition referred to as hyperhidrosis. People with hyperhidrosis
experience excessive sweating (usually in the armpit and groin areas), which
is, needless to say, often accompanied by an increase in body odor. In this
small study, 16 volunteers had one of their armpits injected with Bo-tox,
and the other armpit injected with plain salt solution (placebo).
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