Documents reveal the politicking that led to changes to marijuana entry in federal cancer treatment database

In March, The American Independent was first to report that the National Cancer Institute (NCI), a component agency of the National Institutes of Health (NIH), had acknowledged the medicinal benefits of marijuana in its online treatment database. Newly obtained documents showing the development of NCI’s summary over months of emails and text revisions now reveal not only how NCI database contributors arrived at their March 17 summary of marijuana’s medical uses, but also the politicking that went into quickly scrubbing that summary of information regarding the drug’s potential tumor-fighting effects.

Phil Mocek, a civil liberties activist affiliated with the Cannabis Defense Coalition, obtained the documents as a result of a Freedom of Information Act (FOIA) request he filed in March after reading The American Independent’s coverage of the NCI action. Mocek has made a portion of the hundreds of pages of at-times heated email exchanges and summary alterations available on MuckRock, a website devoted to FOIA requests and other government documents. The American Independent has obtained the remainder of the documents from Mocek.

As stated on NCI’s website, the treatment database is called the Physician Data Query (PDQ); the PDQ entry on marijuana (“cannabis and cannabinoids” are the terms NCI uses) is maintained by the Complementary and Alternative Medicine (CAM) Editorial Board. The lead reviewer of the marijuana summary statement is CAM board member Donald Abrams, the director of Integrative Oncology at the University of California-San Francisco cancer center.

Abrams is an advocate of the use of marijuana in cancer treatment, and his desire to provide a complete picture of its medical application becomes clear early in the documents. As the CAM board discussed the upcoming PDQ entry back in December, board director Jeffrey White asked for Abrams’ approval in including controversial results of an African study that some have claimed links marijuana use to cancer. Abrams came back with:

Gee, I would rather not. It flies in the face of all that is known. And it seems far-fetched to have to go to northwestern Africa to find a case control study. Could be a number of confounders! What’s wrong with the Tashkin study from LA[?] Or the Kaiser cohort? We could run the article by Tashkin and I will have a look myself, but I would strongly object to adding this and would prefer to delete the whole Cannabis section! I guess I feel pretty strongly about it!

The Tashkin study that Abrams refers to was a program funded by the National Institute on Drug Abuse (NIDA), a separate National Institutes of Health agency that holds a controversial monopoly on government marijuana research. Lead researcher Donald Tashkin, of UCLA, was surprised to find in 2006 that not only does marijuana appear not to cause lung cancer, it actually seems to reduce the risk of developing cancer at all. Similarly, the “Kaiser cohort” — from Kaiser Permanente — found that regular marijuana use doesn’t appear to have any correlation with increased risk of dying of just about anything (the one exception being deaths from AIDS, and even then, only in men — a finding that is likely not causal). Meanwhile, the African study found that men who smoked both tobacco and marijuana massively increased their chances of contracting lung cancer, but that men who smoked only marijuana saw no such increase.

Ultimately, the authors included all three studies in the summary page, but they explain that even the African study appears only to confirm that smoking tobacco can cause lung cancer, but that marijuana use has no meaningful correlation to it.

And that seemed to be the end of it — at least until March 17, when the finished summary went online. A week later, on March 24, The American Independent reported on the summary, and the attention that story received sent agencies within the NIH scrambling.

Later that day, Susan Weiss, chief of the Office of Science Policy and Communications within the NIDA (the drug abuse and addiction agency that sponsored that Tashkin study, whose results shocked its backers) sent NCI officials an email saying that her agency had just caught wind of the summary. She told them that the NIDA wanted the summary changed to acknowledge that the FDA hasn’t approved marijuana; to take away any implication that it was recommending prescribing marijuana; to highlight the addiction potential of marijuana; and to link to the NIDA’s own page on the adverse effects of marijuana.

The NCI balked at the last two (“I am unaware of any convincing evidence indicating that marijuana is addictive,” said communications officer Rick Manrow), but decided the first two were fair requests. Days later, as the CAM board grappled with how to cooperate with the NIDA’s requests without compromising its independence or editorial integrity, more federal agencies chimed in. Brooke Hardison, NCI media relations analyst:

[A press officer with the FDA] contacted me this morning because he has been getting calls from FDA staff, as well as at least one high-profile reporter, asking about NCI’s “endorsement of medical marijuana.” I provided him with the background I had. He needs to provide information for staff at the FDA, and they are trying to figure out how to respond to this issue. I suggested that it might be good for him to have a conversation with those more closely involved in this issue.

Meanwhile, as attention to the story continued to grow, the NIDA continued to fret about how it was being received. On learning that Ethan Nadelmann, founder and executive director of anti-drug-war group the Drug Policy Alliance, had tweeted about the summary, the NIDA’s Weiss wrote to NCI, “We will be contacting our colleagues at ONDCP just to give them a heads up about it.” She also wrote to NIDA colleagues, saying, “We think that ONDCP needs to be informed.”

The ONDCP is the Office of National Drug Control Policy, better known as the office of the drug czar. Current drug czar Gil Kerlikowske has made no secret of his opposition to marijuana, which he has called a “dangerous drug” lacking any evidence of medicinal benefits. It’s unclear whether the drug czar’s involvement in this issue went beyond a “heads up” briefing from the NIDA.

At any event, the NCI did acquiesce to the NIDA’s demands by removing any implied support for prescription of marijuana — noting that the FDA hasn’t approved marijuana as a prescription drug in any form — and removing a reference to marijuana’s anti-tumor properties, much to the consternation of lead reviewer Abrams:

You know, the epidemiological data from Kaiser and Tashkin do possibly support an anti-tumor effect in humans. After reflecting for a few hours, I am not happy that NIDA has been able to impose their agenda on us. The text was vetted by the whole Board. I would ask that we [involve] the whole Editorial Board in the discussion before being bulldogged.

I am considering resigning from the Board if we allow politics to trump science!

In the end, all the relevant CAM board members agreed to the version that ultimately went up on March 29 and 30. That last day was when Mocek submitted his FOIA request and is accordingly the last day that appears in the records made available to him.

Interestingly, however, toward the end of the correspondence record, NCI and NIDA officials were in conversation about the latter agency providing further information on the adverse effects of marijuana so that the CAM board could take it into consideration during its May 6 board meeting. Several NCI and CAM officials said that any convincing evidence could spur larger changes to the entry.

NIDA prepared a list of talking points, including the claim that 9 percent of marijuana users become addicted to the drug and an undocumented claim that marijuana use leads to permanent cognitive impairment, in the hopes of compelling just such changes. Yet, May 6 came and went without any changes being made to the database.