Spring 2006
O'Shaughnessy's
Journal of the California Cannabis Research Medical
Group
|
Dreher Recounts Jamaican Study
On Cannabis Use in Pregnancy
In the 1980s Melanie Dreher and colleagues at UMass Amherst
began a longitudinal study to assess the well-being of infants and
children whose mothers used cannabis during pregnancy. The researchers
lived in rural Jamaican communities among the women they were studying.
Thirty cannabis-using pregnant women were matched for age and socio-economic
status with 30 non-users. Dreher et al compared the course of their
pregnancies and their neo-natal outcomes, using various standard scales.
No differences were detected three days after birth. At 30 days the
exposed babies did better than the non-exposed on all the scales and
significantly better on two of the scales (having to do with autonomic
stability and reflexes).
Follow-up studies were conducted when the kids were four and five (just
before entering school and after). The moms were defined as light users
(1-10 spliffs per week), moderate (11-20), and heavy (21-70). Consumption
of ganja tea was also taken into account.
The children were measured at age four using three sets of criteria:
the McCarthy scale, which measures verbal ability, perceptivity, quantitative
skills, memory and motor; a “behavioral style” scale measuring
temperament, based on a 72-item questionnaire filled out by the child’s
primary caregiver; and a “quality of housing” index to
indicate socioeconomic status.
“ No differences at all...”
When they controlled for the household ratings, Dreher recounted in
Santa Barbara, her team “found absolutely no differences” between
the children whose mothers were non-users and the children from the
three groups of users. “No differences at all.”
When testing the children at age five, Dreher measured school attendance and
introduced an additional measure, the “home scale,” accounting for
stimulation in the physical and language environment, and other inputs affecting
development. “ Low income Jamaican children do not have a lot of toys,” Dreher
noted, “but It is not unusual for a two-and-a-half year old to be washing
out her father’s handkerchiefs to learn some adult skills.”
As with the age-four studies, no differences were found among the exposed and
non-exposed groups. But analysis of the home scale revealed that “stimulation
with toys, games, reading material” was significantly related to measures
on the McCarthy scale —verbal, perceptual, memory, and general cognition— and
to mood. There was also a relationship between basic school attendance and McCarthy-scale
measurements.
“
We can’t conclude that there is necessarily no impact from prenatal ganja
use but we can conclude that the child who attends basic school regularly, is
provided with a variety of stimulating experiences at home, who is encouraged
to show mature behavior, has a profoundly better chance of performing at a higher
level on the skills measured by the McCarthy scale whether or not his or her
mother used ganja during pregnancy,” said Dreher.
“
Hello, hello! If you go to school you’re going to do better on these criteria.
It doesn’t sound like a very interesting finding but given what everybody
else was finding, we thought it was pretty darned interesting.”
After recounting her methodology and conclusions, Dreher said: “This study
was published in 1991 —15 years ago. What is the impact of this study?
Absolutely none!”
A recent article by Huizink and Mulder reviewing all the literature on cannabis
use in pregnancy reports only two longitudinal cohorts —Peter Fried’s
Ottawa Prenatal Prospective study and Richardson and Day’s Maternal Health
Practices and Child development study. They reported increased tremors and startles
(Fried); altered sleep patterns (R&D); signs of stress (Lester); impulsive
and hyperactive behavior at six years old, more delinquent behavior, more impulsive
behavior... The review article didn’t even mention that Dreher’s
Jamaican findings differed from those cited!
[Peter Fried has been the darling of the National Institute on Drug Abuse, well
funded for decades after discovering that children whose mothers had smoked marijuana
showed impaired “executive function.”]
In 2003 Fried was asked by Ethan Russo, MD, to contribute a review article to
a book on Women and Marijuana. Fried’s reference to the Jamaican study
in the Russo book did not identify it as a longitudinal study, even though he
had been a consultant to the project.
When Dreher sought funding to re-examine her cohort at ages nine and 10, “NIDA
said they were not interested in funding this study anymore, but if I made Peter
Fried a co-principal investigator, they would consider funding it... So, the
research has languished. Which is a shame.” She’s looking for alternative
funding. Last summer Dreher returned to Jamaica and located 40 of her original
subjects. They are now adults and many are parents. “They are doing quite
well,” she generalized.
Dreher criticized the media response to research, which tends to focus on alleged
negative aspects of use. “Peter Fried himself has said ‘very little
impact up to three years old. Beyond that age, no impact on IQ. No relationship
of marijuana use to miscarriage, to Apgar status, to neonatal complications,
physical abnormalities, no impact on cognitive outcomes’ until, he says,
age four. His tremor and startles findings did not hold up,” said Dreher, “neither
did [his findings of differences in] head circumference, motor development and
language expression.
“
None of those data are really in the literature for people to see. This results
in a lot of misunderstanding on the part of the public.”
Dreher asked: Why the reluctance to acknowledge this study in the peer-reviewed
literature? She answered first as an anthropologist: “There is a terrible
arrogance and ethnocentrism in the science that refuses to accept the experience
or the science of other cultures.” She cited Ethan Russo’s “irrefutable” review
of cannabis use by women in other cultures. “Contemporary evidence from
the UK, Denmark, Jamaica, Israel, the Netherlands, even Canada tends to be disregarded
unless it’s funded by NIDA with Peter Fried as the principal investigator.”
Dreher recommended a 1989 Lancet article called “The Bias Against the Null
Hypothesis” in which the authors reviewed all the abstracts about the maternal
use of cocaine submitted to the Society of Pediatric Research in the 1980s. Only
11% of negative abstracts (attributing no harm to cocaine) were accepted for
publication, whereas 57% of the positive abstracts were accepted. The authors
determined that the rejected negative papers were superior methodologically to
the accepted positive papers.
Dreher decried “the politics of trying to get published.” She now
sees it as “a miracle” that Pediatrics published her work on neonatal
outcomes, however belatedly, in 1994. (Her paper on five-year outcomes came out
in the West Indian Medical Journal before Pediatrics ran the neonatal outcomes.)
She suspects that a review of “all the fugitive literature that’s
out there that didn’t get published” would convey “a very different
picture of prenatal cannabis exposure.”
Honest research is also impeded, Dreher said, by “the politics of building
a research career. Most research is done by academics and academia is a very
conservative environment where tenure often is more important than truth.” (Dreher
is the Dean of the College of Nursing at the University of Iowa.)
The end result of biased science, Dreher observed, is a misinformed public. Recently,
she “googled to see what was out there for the general public regarding
pregnancy and marijuana.” Typical of the disinformation was an article
entitled “Exposure to marijuana in womb may harm brain’ that began “Over
the past decade several studies have linked behavior problems and lower IQ scores
in children to prenatal use of marijuana...” A reference to Dreher said
she had “written extensively on the benefits of smoking marijuana while
smoking pregnant!”
Dreher concluded: “Marijuana use by pregnant women is a big red herring
that prevents us from looking at the impoverished conditions in which women throughout
the world have to bear and raise children. These women are looking for the cheapest,
most available substance to alleviate their morning sickness and to give them
a better sleep at night in order to get the energy to do the work they have to
do every day in order to support those children.
“
A red herring is something that distracts us from what’s really important.
Instead of restricting our search for relatively narrow outcomes, such as exectuive
funciton, we need to be looking at school performance, peer relations, leadership
skills in children, prenatal and family relations, healthy lifestyles. Are they
participating in sports? Are they using tobacco and alcohol and other substances?
“
NIDA and the NIH still prefer to fund randomized clinical trials that have to
do with symptom management in specific diseases. We need research on how marijuana
affects the quality of life.
“
It’s not an evolutionary accident that the two activities needed to sustain
life and perpetuate life, eating and sex, are pleasurable as well as functional,
and that marijuana enhances both of these activities.”
B.C. Dispensary Study Shows...
Cannabis Relieves Morning Sickness
Medical researchers wishing to test the safety and
efficacy of drugs need people willing to participate in their clinical
trials. Cannabis dispensaries serve people with a wide range of conditions,
many of whom are ready, willing and able to take part in studies.
In February 2003, a doctoral candidate at the University of Victoria,
Rachel Westfall, and Philippe Lucas, director of the Vancouver Island
Compassion Society (VICS), developed a dispensary-based survey protocol
to determine the effectiveness of cannabis in relieving “Morning
Sickness,” the nausea and vomiting experienced by many pregnant
women. (A very severe form called “hyperemesis gravidarum” is
experienced by 1-2% of pregnant women.) The ensuing study became Westfall’s
doctoral thesis and has been published in a peer-reviewed journal,
Complementary Therapies in Clinical Practice. Lucas (one of three co-authors)
described the study in Santa Barbara.
Staff from VICS and the British Columbia Compassion Club Society distributed
surveys to 142 women and got completed responses from 79 who had been
pregnant. All were current users; all but four used by smoking; 59
reported suffering from nausea and/or vomiting while pregnant; 51 used
cannabis while pregnant and 40 of them used it specifically to treat
nausea and vomiting. 93% described cannabis as effective or very effective
in relieving nauses; 75% reported it relieved vomiting; 95% reported
appetite stimulation. Overall, 92% of those who used it during pregnancy
found cannabis “effective” or “very effective” against
morning sickness.
Lucas concluded, “I believe that medical cannabis dispensaries
are just starting to prove their worth as research centers and that
the move from simple distribution to scientific contribution will significantly
add to the legitimacy of these indispensable organizations in the eyes
of both the public and our respective federal governments.”