Evidence prevails: No medical marijuana for autism in Michigan—for now

[Note: In October 2017, when I transferred Respectful Insolence to a new platform hurriedly, somehow this post was lost. Fortunately, I was able to reconstruct it. Unfortunately, that means the comments are gone. Fortunately, the comments still exist after the version of this post archived by the Wayback Machine.]

I must admit that I’m surprised. Pleasantly surprised, but quite surprised. The reason is that yesterday the Department of Licensing and Regulatory Affairs Director Mike Zimmer rejected the recommendation of the Michigan Medical Marijuana Review Panel to add autism to the list of qualifying conditions for which cannabis can be prescribed in the state of Michigan. I didn’t expect this outcome, but I am pleased.

Although I’ve changed my mind over past stands and am now in favor of legalizing marijuana for recreational use, I have been harshly critical of the “medical marijuana” movement. Indeed, I have referred to it as the “new herbalism” because when it comes to evidence for the efficacy of marijuana in the myriad conditions that cannabis is claimed to be able to treat, its proponents’ hype far outweighs the actual medical promise, at least when you look at the evidence objectively. As I’ve pointed out before, for example, cannabis does not cure cancer, passionate testimonials otherwise notwithstanding, and the state of the evidence supporting the use of medical marijuana for almost anything is, at best, weak and contradictory. That’s not to say that cannabinoids, the active compounds in cannabis, don’t have some medical uses, but, again, a dispassionate look at the medical literature suggests that the hype far exceeds any realistic promise.

Three weeks ago, I wrote a post likening the use of “medical marijuana” for autism to a form of quackery that I have written about many times over the years, namely so-called “autism biomed.” As I mentioned, a certain segment of the “autism biomed” movement has enthusiastically embraced medical cannabis, to be added to the other dubious treatments used to “treat” autism, such as chelation therapy, various supplements, hyperbaric oxygen, homeopathy, Miracle Mineral Solution (MMS, a.k.a. a form of bleach), and the like. (I’m talking to you, “Thinking Moms.”) As I detailed in that post, the parallels are unmistakable. In the case of cannabis for autism, there is the same evangelical embrace of cannabis as the next big thing that can help autistic children and the same dismissal of the extreme lack of evidence supporting the use of medical cannabis for autism and the lack of knowledge of the effect of long term cannabis use in very young children on their neurological development. Remember, we’re talking about children as young as three years old here and the use of cannabis over potentially many years.

Three weeks ago, I was concerned that the Michigan Medical Marijuana Review Panel, an advisory panel that makes recommendations to the Michigan Department of Community Health regarding what conditions qualify for medical marijuana use, had voted 4-2 in favor of adding autism to the list of qualifying conditions for medical marijuana, specifically in this case cannabis oil, can be prescribed. The panel was apparently impressed by some very dubious evidence and testimony, specifically a paper by Joe Stone and Dr. Christian Bogner, “The Endocannabinoid System as it Relates to Autism.” Basically, this “paper’ was not peer-reviewed or published anywhere reputable. More importantly (given that blog posts and articles, when referenced and written properly, can be quite compelling from a scientific standpoint), the article cherry picked studies and massively oversold weak preclinical results in cell culture and animal studies. The panel appeared also to be particularly impressed by the testimony of Dr. Harry T. Chugani, the head of pediatric neurology at Children’s Hospital of Michigan, who, despite the lack of evidence, has apparently become convinced on the basis of testimonials and personal observation despite the lack of anything resembling rigorous scientific and clinical evidence that cannabis is an effective treatment against autism.

Kudos to Mike Zimmer for seeing through the flimsiness of the evidence and not being blinded by eminence when evaluating Dr. Chugani’s testimony:

Department of Licensing and Regulatory Affairs Director Mike Zimmer, in a final determination released Thursday, cited a “concerning” lack of scientific evidence regarding medical marijuana use by autistic patients, specifically by children.

“While the record is replete with sincere and well-articulated testimony on the potential benefits of medical marihuana to autism patients and, in particular, parents of autistic children, several troubling concerns remain,” he wrote.

Reading the final determination, I was impressed at how Zimmer saw through the tactics of the medical marijuana movement. First, he noted the overbroadness of the petition to add autism as to the conditions that qualify for medical cannabis:

The petition under consideration lists “autism” without limitation as the medical condition proposed for inclusion as a qualifying condition under the MMMA [Michigan Medical Marijuana Act]. Although “severe autism” is referenced in the petition, the petition does not limit the proposed qualifying medical condition to “severe autism,” nor is the term “severe autism” defined anywhere in the petition. Thus the petition seeks to add autism without limitation as a qualifying condition under the MMMA.

Nice catch there. Advocates of medical marijuana frequently go beyond what the scientific evidence will support and seek the broadest possible indications for the use of their favorite weed (or extracts thereof). Here’s another good catch:

In the justification section of the petition, the petitioner indicates that “medical marijuana has been used successfully in Michigan to treat the syptoms of severe autism in patients who also suffer from epilepsy.” (emphasis added). It is, therefore, important to examine the petition’s illustrative linking in the justification section to epilepsy. In fact, many of the parents who participated in the public hearing indicated that their severely autistic children suffered seizures as a result of that condition. An examination of the language in the MMMA, however, establishes that these may already be eligible.

Of course, as I’ve noted before, the evidence that cannabis is useful for epilepsy is also pretty weak, but it is—shall we say?—considerably less weak than the evidence supporting medical cannabis for autism.

Noting that the MMMA explicitly allows the use of medical marijuana for seizures and citing the appropriate section of the law, Zimmer goes on to state that “our discussion on this petition is focused on autistic patients without associated seizure disorders” and then does just that, citing how the state’s Chief Medical Executive Eden Wells had “bemoaned that there were not more clinical trials to provide checks and balances on the benefits versus its possible ill-effects.” He even cited Dr. Chugani himself, noting that he “would not support a general recommendation for cannabis to treat all children with autism, as little scientific evidence exist to demonstrate gains in skill acquisition and research is still needed to assure children would not suffer short or long term psychotropic effects.

Zimmer also saw through the petition’s claim that requiring two doctors to sign off on prescriptions for medical marijuana for autism would protect children:

At public hearing, several suggested that the lack of scientific supportive research could be offset by strict certification practices by a patient’s physician. Mr. Michael Komorn, an attorney for the petitioner and ardent advocate, stated that under current law, two doctors must sign off on approval for the use of medical marihuana by minors and that “obviously in the case of minors these doctors will likely be their doctors, their autism specialist (5/27/15 Hrg. Tr., p. 17).” Similarly, Dr. Harry Chugani, in his letter to the panel, stated that “I also highly recommend that determinations of which patients may be appropriate should be made strictly by a highly skilled, experienced medical doctor, with significant experience in treating autism.” Unfortunately, there is no such requirement in the MMMA. MCL 333.26426(b)(2) simply requires written certifications from two physicians and does not contain any requirement that those physicians be expert, comply with certification practices, or even be trained in the treatment of autism.”

But, then, many of the advocates who promoted this petition probably already knew that. Basically, any physician who wants to can prescribe medical marijuana, no special training or expertise necessary. That’s the way the law was written, and intentionally so. Ironically, Zimmerman also noted that the way the law has been written and interpreted by Michigan courts almost certainly precludes the use of cannabis oil because it probably does not fall under the definition of “usable marihana” outlined in the MMMA, but cannabis oil is what the petition was for.

Medical marijuana has always been a blatant back door strategy to legalize marijuana for recreational use, so much so that most advocates don’t even bother to deny it. While I support legalization of marijuana, I do not support the corruption of medicine and medical evidence inherent in the claims of the medical marijuana movement. In other words, I do not support the loosening of the standards of medical evidence that is required to justify widespread medical cannabis use for conditions for which there is little or no evidence of efficacy. When it comes to cannabis, preclinical evidence is routinely touted as indicating clinical efficacy, and studies are blatantly cherry picked to justify its use. Worse, poor quality evidence that, if used to support the approval of a pharmaceutical drug, would provoke justified howls of outrage from the very same people advocating medical marijuana for autism, is touted as convincing scientific evidence that autism should be added to the list of qualifying conditions for medical marijuana. As always, I advocate for one standard of medical evidence. Unfortunately, advocates of medical cannabis, like advocates of “complementary and alternative medicine” (who not infrequently include the same people), advocate for a weaker standard of evidence for their favorite herb.

If you don’t believe this is far more about advancing an agenda leading to legalization, witness the reactions to the decision by advocates, for example, of Robin Schneider:

Zimmer’s order also said there was insufficient scientific research to justify using cannabis for autism. That’s a concern about many of the conditions that are clearly aided by the drug, since marijuana research has been largely illegal to conduct under state and federal drug laws, said Robin Schneider, a spokeswoman for the National Patients Rights Association, a medical-marijuana advocacy group based in Grosse Pointe Farms.

“But in this circumstance, the petitioner did an incredible job of putting together a great deal of scientific information,” Schneider said. The petitioner was Lisa Smith of Van Buren Township, mother of Noah, a 6-year-old boy with autism.

Of course, if it is true that cannabis research has been made very difficult by drug laws, the correct order of business would be to work on repealing those drug laws to allow the research to proceed. Advocates instead just assume that medical marijuana “works” and then cherry pick the evidence to try to support that assumption, ignoring its extreme lack of quantity and quality.

Elsewhere:

“I’m disappointed and I’m frustrated. I think that obviously he used a lot of words to explain an inconsistent and subjective decision in opposing the panel’s recommendation,” said Komorn.

The goal of the petition was to extend legal protections of the medical marijuana law to parents who want to treat their autistic children, he said.

“If these parents know or believe that it’s working, they’re going to do it,” he said. “We’re asking them to be removed from the battle field of the losing war on marijuana.”

This is a ridiculous argument, even coming from Komorn, but very telling. For one thing, Zimmer’s decision was far clearer and more consistent than any argument I’ve heard from Komorn in support of medical marijuana for autism. More tellingly, Komorn doesn’t appear to care much whether medical marijuana has any beneficial effect whatsoever in severe autism. The “tell” is how he just can’t help himself and has to justify his argument by referencing the “losing war on marijuana.” To Komorn, fighting for medical marijuana for autism is simply a a tactic in the larger war to legalize marijuana, nothing more. From my perspective, he doesn’t really care that much about autistic children and their parents, per se. Rather, he sees them as weapons to use in his wider war.

Let’s just put it this way. His argument is that parents are going to use marijuana for their autistic children anyway; so he wants to “make it legal,” so to speak. I wonder if he’d accept the same argument for MMS enemas (a.k.a. bleach enemas) for autistic children. Some parents are going to subject their children to this treatment anyway. It’s a ridiculous argument unless, as Komorn does for medical marijuana for autism, you were to see MMS as a battle in a wider war. I’ve seldom seen such a blunt, bald-faced admission that the main reason for medical marijuana is as a means of legalizing recreational use of marijuana. Sure, he didn’t say that, exactly, but taken in context his meaning is clear. Medical marijuana for autism is a battle in a wider war.

Collateral damage in this war includes parents like Dwight Zahringer, whom we met before the last time I discussed this topic. He only wants to do what’s best for his son Brunello and, because of the hype, has come to believe that medical marijuana is what his son needs to help him. Consequently, he joined the movement to add autism to the list of qualifying conditions, and he is very disappointed in this ruling:

“I’m going to have to keep looking at more treatment options and to be part of the movement to educate these people in Lansing,” Dwight Zahringer said.

“I feel like we’ve had a lot of politics involved in decisions like this,” Zahringer said.

Zahringer is correct, but not in the way he thinks. It was a ton of politics to twist the thin evidence for marijuana into a petition that got through the Michigan Medical Marijuana Panel by a 4-2 vote. Now that it’s been rejected, he understandably feels betrayed, as though a major source of hope for his son has been taken from him.

Unfortunately, I doubt that this is the end of the story. I have little doubt that advocates like Komorn will be back. It Zimmer rejected this petition because it is too broad, expect advocates to be back in the near future with a more carefully crafted petition this more narrowly defines “severe autism.”