Marijuana and Testicular Cancer

NIDA touts controversial 2009 study.

After 50 years of rumor, study, and argument in the research community, the National Institute on Drug Abuse (NIDA) has come out squarely behind the assertion that marijuana use in men “may increase their risk for developing testicular cancer.”

But a problem exists. The evidence just isn’t that good. Especially if you base the conclusion on a single small study, as NIDA is apparently doing.

Writing in NIDA Notes for December, 2010, Lori Whitten highlights a study of 369 men from the Seattle area with testicular cancer, and a control group of 979 disease-free men. “The researchers found that the odds of having testicular cancer were 70 percent higher among men who reported current marijuana use compared with nonusers…. They also found that the odds for testicular cancer among men who used marijuana at least weekly were twice that of nonusers.”

The hypothesis supporting this statistical correlation is not terribly robust: Testicular cancer has doubled in the past 50 years in the U.S. So has the percentage of the population that smokes pot. And since cannabinoid receptors are found on the cell membranes of the testes, and chronic marijuana use is associated with decreased testosterone plasma levels and reduced spermatogenesis, marijuana smoking must somehow interfere with the growth of germ cells in the testes. The result: cancer.

But wait, there’s more. Whether or not this contention can be considered true and proven remains quite arguable, but the study does appear to show a statistical association between marijuana use and one particular form of the disease. Marijuana smoking was strongly associated with only one form of testicular cancer, called nonseminomas, a fast growing type representing 40% of all testicular germ cell tumors (TGCT). The other type—seminomas—accounts for the other 60%.

Dr. Sudhansu Dey, a NIDA-funded researcher involved in the study, published in Cancer, told NIDA Notes that the association between marijuana smoking and nonseminomas, but not seminomas, is “difficult to explain.”

Here’s one possibility: Testicular cancer is too rare, and the study in question too small, to be anything but suggestive. It does not show a direct linkage between testicular cancer and pot smoking, and the authors do not claim that it does. In fact, they point to several limitations of their own study. The researchers were only able to directly interview a little more than half of the eligible cases and controls. And the study relied on self-report questionnaires, which, in the case of an illegal drug like marijuana, can skew the results. For example, “patients with cancer may be expected to more accurately admit to the use of an illegal substance than individuals in a control group.”

Specifically, the report states that “the incidence of seminoma from 1973 to 1998 in the US was 64% compared with an increase of only 24% for nonseminoma…. If the increase in nonseminomas was caused in part by an increase in the use of marijuana, then some other increasing exposures must account for the higher incidence of seminomas over time.” The point, as the researchers acknowledge, is that “none of these explanations likely would be specific to nonseminomas. Indeed, if the association is true, then new avenues of research will be needed to address the specificity of the association to nonseminomas.”

In other words, the argument that pot smoking might increase cases of one particular kind of testicular cancer is not accompanied by an explanation of the biological mechanism by which marijuana would be capable of exerting such effects.  The primary risk factor for testicular cancer seems to be a family history of the disease, followed by abnormal development of the testicles or undescended testes.

“If these interesting findings are replicated in a large, national representative group of participants,” Dr. Vishnudutt Purohit of NIDA’s Division of Basic Neuroscience and Behavioral Research told NIDA Notes, “then future research should delve into the molecular mechanism underlying the association.”

At present, that is a very big “if.”

Daling, J., Doody, D., Sun, X., Trabert, B., Weiss, N., Chen, C., Biggs, M., Starr, J., Dey, S., & Schwartz, S. (2009). Association of marijuana use and the incidence of testicular germ cell tumors Cancer, 115 (6), 1215-1223 DOI: 10.1002/cncr.24159
Graphics Credit: http://testicularcanceronline.info/

Everybody wants to be Keith Richards

Whereas they might be better off as Patti Smith.

There was a time, not really so long ago, when the growing legion of Rolling Stones fans was divided: Did Keith spell his last name as Richards, with an “s,” or was it just plain Richard?  Many inquiring minds wanted to know, and for some time, the interesting part was that Keith himself seemed unsure of how to end the argument.

As best I can determine, bringing all my powers as an investigative reporter to bear on this weighty matter, Keith lost track of the final “s” at some point during the late sixties, roughly coinciding with his decent into heavy heroin addiction. However, as the eighties began, Keith, newly detoxed, became “Keith Richards” again, the family name to which he has remained faithful ever since.

This incident is not mentioned in Keith Richards’ new autobiography, “Life.” And I relate this story not to suggest that Richards literally forgot how to spell his name during the peak of his several drug addictions—though such things are not outside the bounds of possibility for, say, severely addled speed freaks.  I am, however, suggesting that the Jekyll/Hyde nature of living a life simultaneously in the open and in secret, as an active addict, does exact some form of toll on one’s internal representation of self.

Did the years of the famed guitarist’s most severe addiction coincide with the years of peak quality output from the Rolling Stones? They did. The same can be said of Charlie Parker, Miles Davis, Hendrix, and on through the roster of illustrious addicts. Do these same addictive years also coincide with a period during which an abnormal number of people around Keith Richards suffered and died? They do. And this doesn’t count the number of people who were mistreated, ignored, inconvenienced, and otherwise dealt with abominably in the course of coping with a key band member’s destructive behaviors when addicted. 

I knew a friend of a friend who almost died partying with Keith.  After a night of cocaine—only the best, pharmaceutical stuff, as Keith is at pains to remind us throughout the course of the book—they took my guy to the hospital in an ambulance, after he suffered some sort of coronary meltdown. This incident is not mentioned in “Life.” Too many similar nights with similar friends to recount them all.

In the end, however, we must allow a certain amount of space to exist between the artist and the art. As for Keith, I’m a lifelong fan. His book is by turns funny, thoughtful, barbed, and observant. It is a book about a man with addictions, but it is not a book about addiction.  In Keith’s opinion, the drug problem is a qualitative matter; a result of Thunderbird, Ripple, and bad acid.  Here, in one passage, are all the contradictions writ large:

I did a couple of cleanups with Gram Parsons at this time—both unsuccessful. I’ve been through more cold turkeys than there are freezers. I took the fucking hell week as a matter of course. I took it as being a part of what I was into. But cold turkey, once is enough, and it should be, quite honestly. At the same time I felt totally invincible. And also I was a bit antsy about people telling me what I could put in my body (p. 284).

In the end, this is how we want Keith Richards to be: smart, arrogant, unruly, piratical.  Is he, as so many say, lucky to be alive? I don’t know. I have no idea what that means. Some people get addicted to heavy drugs and die, and some don’t. If you’re convinced you are one of the lucky ones, then I hope you’re right.

****

Meanwhile, in New York City, a tough little unknown artist named Patti Smith was busily scissoring photos of Keith Richards out of magazines, ultimately cutting her hair and wearing clothes that made her look, as much as possible, just like her idol.

Patti’s Smith’s memoir, “Just Kids,” which won a National Book Award last year, doesn’t dwell at length on drugs, either. But we get the drift of Patti’s thinking easily enough. Max’s Kansas City, the famed punk venue, “was as darkly glamorous as one could wish for. But running through the primary artery, the thing that ultimately accelerated their world and then took them down, was speed. Amphetamine magnified their paranoia, robbed some of their innate powers, drained their confidence, and ravaged their beauty.” (p. 117).

Earlier, staying in a hotel for junkies with Robert Mapplethorpe, Patti strikes up a conversation with an old addict in the next room: “He told me the stories of some of his neighbors, room by room, and what they had sacrificed for alcohol and drugs. Never had I seen so much collective misery and lost hopes, forlorn souls who had fouled their lives. He seemed to preside over them all, sweetly mourning his own failed career, dancing through the halls with his length of pale chiffon.”

Alcohol at the Movies

More booze scenes in European flicks.

Films popular in Europe feature more drinking episodes per movie than their equally popular American counterparts, according to a report by the European Centre for Monitoring Alcohol Marketing (EUCAM).

The trend toward incorporating name brand alcohol in movie scenes as a form of product placement took off more than a decade ago. In 1999, the U.S. Federal Trade Commission reported that in the two previous years, “eight reporting alcohol companies placed alcoholic products in 233 motion pictures and in one or more episodes of 181 different television series.”

Given this background, it is scarcely surprising that watchdog groups like EUCAM in Europe and the Marin Institute in the U.S. have hammered at this issue for years. The Marin Institute was particularly peeved that Carlsberg beer was all over the “Spider-Man” film franchise, despite that film’s popularity with children and preteens.

EUCAM looked at the amount of “alcohol portrayal” in about 30 popular movies playing in 27 European countries in 2009. Eight of the movies were accessible to all ages, including “The Twilight Saga: New Moon,” “Angels and Demons,” and “The Hangover.”

Overall, 12% of the movies examined by the group contained alcohol portrayals or promotions. Surprisingly, Hollywood movies came out looking pretty good. Seven of the 17 Hollywood movies examined contained no alcohol references at all. “In contrast,” says the report, “all of the European movies depicted alcohol or referred to it in the dialogue.”

The report notes that the “highest number of alcohol portrayals of the Hollywood movies was found in ‘Inglorious Bastards’ (eighteen scenes), (a movie that takes place almost entirely in Europe).” And what about second place, I can hear you asking. That honor went to “The Final Destination 4,” with eleven drinking scenes.

One striking difference noted by the report was “the prevalence of drinking while working” in European movies, compared to Hollywood films. And while the Hollywood movies portrayed what the EUCAM defined as “binge drinking” eight times, the group found fifteen instances of binge drinking in the popular European films. This finding may be the most interesting of all, given the public problems with binge drinking that have been reported in parts of Europe and the UK.

“While the alcohol flowed freely in much of the most popular films of Europe,” the report states, “product placement of alcohol was not used in many productions.” Very view of the European drinking scenes employed recognizable logos or brand names.

Finally, only 1% of intoxications scenes in Hollywood movies showed characters passing out, while “in the European movies, this percentage is eight times higher.”

 -----

Recently, I watched an old episode of TV's "Gunsmoke," in which Doc Adams tries to help Dan the Drunk, finding him a new job and a new set of clothes.

“He’s an awful nice feller,” says Chester, “until he ain’t.”

And Doc responds, “When he gets a sniff of the stuff, he drinks till he drops.” And then Doc offers the following thoughts:

"He’s only got one weakness. It sure is a whopper, but it’s the only one he’s got.  Wouldn’t it be something if you could cut it out of him, or patch it up, or something? Wouldn’t that be real doctorin’, though? Wouldn’t it?”


Picture credit: http://www.collegeotr.com

Top Ten for 2010

Marijuana leads the list.

Most viewed Addiction Inbox 2010 blog posts, ranked by total pageviews:


1. Marijuana and Memory: Do certain strains make you more forgetful?

“Cannabis snobs have been known to argue endlessly about the quality of the highs produced by their favorite varietals: Northern Lights, Hawaiian Haze, White Widow, etc….”

2.  The Bong Water Case Revisited: Minnesota v. Peck.

“Astute readers will recall the Great Bong Water Decision of 2009, in which the Minnesota Supreme Court determined, 4-3, that water used in a water pipe can be considered a ‘drug mixture’….”

3. Cannabis Receptors and the “Runner’s High”--Maybe it isn't endorphins after all.

“What do long-distance running and marijuana smoking have in common? Quite possibly, more than you’d think. A growing body of research suggests that the runner’s high and the cannabis high are more similar than previously imagined….”

4. More Vanishing Cigarettes: Churchill, Bette Davis, Don Draper, and Pecos Bill.

“In my last post, I highlighted some examples of attacks on cultural history represented by cigarette censorship, to wit: a cigarette taken out of the hand of Paul McCartney, and out of the mouths of Jackson Pollock and Burt Reynolds.…”

5. Cocaine Treatment and the Stroop Test: Treatment dropouts do poorly on color/word match.

“It’s commonly used to demonstrate behavioral inhibition, but it’s also a nifty parlor game. It is called the Stroop Test, and it plays off the fact that people are far better at reading words than they are at intentionally ignoring them….”

6. Liking it Vs. Wanting it: The joylessness of drug addiction.

“Hedonism, the pursuit of pleasure for its own sake, is not really the answer to the riddle of drug addiction. The pursuit of pleasure does not explain why so many addicts insist that they abuse drugs in a never-ending attempt to feel normal….”

7. Mephedrone, the New Drug in Town: Bull market for quasi-legal designer highs.

“Most people in the United States have never heard of it. Very few have ever tried it. But if Europe is any kind of leading indicator for synthetic drugs (and it is), then America will shortly have a chance to get acquainted with mephedrone….”

8. Sex, Drugs, and… Sex: Pharmaceuticals and sexual performance.

“The search for aphrodisiacs is an ancient, if not always venerable, human pursuit. Named for Aphrodite, the Greek goddess of love, aphrodisiacs are compounds that have the reputation, real or imagined, of increasing sexual desire, pleasure, and potency….”

9. Meth Babies—Fact or Fiction? Research team finds brain abnormalities.

“When it came to babies born to crack-addicted mothers, the media went overboard, creating a crisis in the form of an epidemic that never quite was. By contrast, when it came to babies born to alcoholic mothers, Fetal Alcohol Syndrome went unrecognized in the science and medical community until 1968….”

10. Marijuana Use Up, Up, Up: NIDA releases annual survey of teen drug use.

“Research compiled from an annual survey of 8th, 10th and 12th graders by the National Institute on Drug Abuse (NIDA) shows that “marijuana use increased among eighth-graders, and daily marijuana use increased significantly among all three grades….”

Graphics Credit: http://www.thoughttheater.com/

Science Books for Christmas

Women and children first.

It’s not my fault that some of the best science books of 2010 were written by women. In fact, I’m just going to say it: All of the best science books of the year were written by women. Here are a few candidates.

--Rebecca Skloot, The Immortal Life of Henrietta Lacks 

Publishers Weekly: “A tale of medical wonders and medical arrogance, racism, poverty and the bond that grows, sometimes painfully, between two very different women—Skloot and Deborah Lacks—sharing an obsession to learn about Deborah's mother, Henrietta, and her magical, immortal cells.”

--Mary Roach, Packing for Mars: The Curious Science of Life in the Void

Publishers Weekly: “Roach (Stiff) once again proves herself the ideal guide to a parallel universe. Despite all the high-tech science that has resulted in space shuttles and moonwalks, the most crippling hurdles of cosmic travel are our most primordial human qualities: eating, going to the bathroom, having sex and bathing, and not dying in reentry.”

--Mia Szalavitz, Born for Love: Why Empathy is Essential and Endangered 

Product Description: “An inside look at the power of empathy: Born for Love is an unprecedented exploration of how and why the brain learns to bond with others—and a stirring call to protect our children from new threats to their capacity to love.”

--Deborah Blum, The Poisoners Handbook: Murder and the Birth of Forensic Medicine in Jazz Age New York

Publishers Weekly: “Pulitzer Prize–winning science journalist Blum (Ghost Hunters) makes chemistry come alive in her enthralling account of two forensic pioneers in early 20th-century New York. Blum follows the often unglamorous but monumentally important careers of Dr. Charles Norris, Manhattan's first trained chief medical examiner, and Alexander Gettler, its first toxicologist.”

--Jennifer Ouellette, The Calculus Diaries: How math can help you lose weight, win in Vegas, and Survive a Zombie Apocalypse

Nature: "In The Calculus Diaries, science writer Jennifer Ouellette makes maths palatable using a mix of humour, anecdote and enticing facts...Using everyday examples, such as petrol mileage and fairground rides, Ouellette makes even complex ideas such as calculus and probability appealing."

--Susan Casey, The Wave: In Pursuit of the Rogues, Freaks and Giants of the Ocean

Bookmarks Magazine: “Part science lesson and part adrenaline rush, The Wave is an intense thrill ride that manages to take a broad look at oversized, potentially devastating waves. The critics praised Casey's eloquent writing and jaw-droppingly vivid descriptions of chasing--or trying desperately to steer clear of--these aquatic behemoths.”

And:

Smithsonian science books for kids.

Graphics Credit: http://www.zoology.ubc.ca/

Marijuana Use Up, Up, Up

NIDA releases annual survey of teen drug use.

Research compiled from an annual survey of 8th, 10th and 12th graders by the National Institute on Drug Abuse (NIDA) shows that “marijuana use increased among eighth-graders, and daily marijuana use increased significantly among all three grades. The 2010 use rates were 6.1 percent of high school seniors, 3.3 percent of 10th -graders, and 1.2 percent of eighth-graders compared to 2009 rates of 5.2 percent, 2.8 percent, and 1.0 percent, respectively.”

At a news conference held to announce the results of the study, NIDA director Dr. Nora Volkow said that “high rates of marijuana use during the teen and pre-teen years, when the brain continues to develop, place our young people at particular risk. Not only does marijuana affect learning, judgment, and motor skills, but research tells us that about 1 in 6 people who start using it as adolescents become addicted.”

The annual report, called “Monitoring the Future,” takes the temperature of current teen drug use through interviews with more than 50,000 students across the country. The research is conducted at the Survey Research Center in the Institute for Social Research at the University of Michigan.

The survey showed that teen use of Ecstasy is on the increase as well. According to NIDA, “The MTF survey also showed a significant increase in the reported use of MDMA, or Ecstasy, with 2.4 percent of eighth-graders citing past-year use, compared to 1.3 percent in 2009. Similarly, past-year MDMA use among 10th-graders increased from 3.7 percent to 4.7 percent in 2010.”

As for cigarettes, the recent downward trend has “stalled” after several years of steady improvement, said NIDA. “Greater marketing of other forms of tobacco prompted the 2010 survey to add measures for 12th-graders’ use of small cigars (23.1 percent) and of tobacco with a smoking pipe known as a hookah (17.1 percent).”

For the first time, according to the survey, “declines in cigarette use accompanied by recent increases in marijuana use have put marijuana ahead of cigarette smoking by some measures. In 2010, 21.4 percent of high school seniors used marijuana in the past 30 days, while 19.2 percent smoked cigarettes.”

The survey detected a downward trend in binge drinking across the board. Prescription drug abuse remained fairly steady.

The survey also tracks students’ perception of drugs and their risks, and the degree to which drug are viewed as harmful. The report concludes: “Related to its increased use, the perception that regular marijuana smoking is harmful decreased for 10th- graders (down from 59.5 percent in 2009 to 57.2 percent in 2010) and 12th-graders (from 52.4 percent in 2009 to 46.8 percent in 2010). Moreover, disapproval of smoking marijuana decreased significantly among eighth-graders.”

The survey at the University of Michigan is led by Dr. Lloyd Johnston, operating under a NIDA grant. Additional information on the MTF Survey, as well as comments from Dr. Volkow can be found at http://www.drugabuse.gov/drugpages/MTF.html.

Era of the Electronic Cigarette Officially Begins.

Court blocks FDA from prohibiting e-cigarettes.

It’s official: The e-cigarette is here. The right of a distributor of Chinese electronic cigarettes to market the product in the U.S. was solidly affirmed last week by a three-judge ruling in the U.S. Court of Appeals for the District of Columbia. The Food and Drug Administration’s refusal last year to allow importation of e-cigarettes by Sottera Inc. had been the basis for a lower court decision in Sottera’s favor. The earlier court ruled that e-cigarettes did not require FDA approval because they were neither new drugs nor new drug delivery devices. (The FDA is prohibited by an act of Congress from barring the sale of tobacco products outright.)

Last month, under a consent judgement worked out with California state Attorney General Jerry Brown in a related case, Florida-based Smoking Everywhere Co., another distributor of Chinese electronic cigarettes, had agreed not to target minors in its advertising, or to make claims that its products are safe alternatives to tobacco. The move came shortly after the FDA announced plans to regulated battery-powered e-cigarettes as new drug delivery devices, culminating in the Sottera lawsuit.

The legal argument before the appeals court hinged largely on semantics. The court found that electronic cigarettes are “battery-powered products that allow users to inhale nicotine vapor without fire, smoke, ash or carbon monoxide. The liquid nicotine is derived from natural tobacco plants.”

Here is the catch: “The FDA may only approve a product for marketing under the Federal Food, Drug and Cosmetic Act (FDCA) if it is safe and effective for its intended use,” the Appeals Court Justices ruled.  However, the FDA has “exhaustively documented” that tobacco products are unsafe for pharmacological use of any kind. The earlier court had concluded, stealing a page from “Alice in Wonderland”: “If they cannot be used safely for any therapeutic purpose, and yet they cannot be banned, they simply do not fit” within any conceivable regulatory scheme.

Hence the difficulties in the FDA’s attempt to regulate by agency fiat. E-cigarette manufacturers and distributors, having sensed an opening, are now ready to drive a convoy of semis right through it. This wasn’t a completely straightforward march, as the e-cigarette forces, in the appeals presentation, were required to thread the needle on such conundrums as: Does it matter that e-cigarettes do not, strictly speaking, contain “tobacco products?” Nicotine is a component of, not a product of, tobacco.

You see the problem. The relevant statutes have not been written with pure nicotine delivery devices in mind. In fact, having nicotine--but not the evil substance tobacco--in your product turned out to be a definitional advantage for the e-cigarette marketers: The court pointed out that, unlike products containing tobacco, which the FDA has found to be associated with “cancer, respiratory illnesses, and heart disease,” the FDA has manifestly NOT found that nicotine or tobacco-free products that deliver nicotine are inherently unsafe. And second, the “tobacco-specific legislation” invoked in earlier court cases “simply does not address products that deliver nicotine but contain no tobacco.”

Matthew Myers, president of the Campaign for Tobacco-Free Kids, said in a prepared statement: "This decision will allow any manufacturer to put any level of nicotine in any product and sell it to anybody, including children, with no government regulation or oversight at the present time. We urge the government to appeal this ruling."

Among the many  questions the ruling leaves open is the status of e-cigarettes under existing no-smoking regulations. That litigation has not even gotten underway.

See my earlier post on the e-cigarette question HERE.

For the full court decision, click HERE.

Graphics Credit:  http://thestrobel3.blogspot.com/