Dr. Strange and Strange Trips

Lucas Richert on the relationship between superhero Dr. Strange and his newly released book called Strange Trips: Science, Culture, and the Regulation of Drugs.

**

In 2016, the film Doctor Strange was released to moderate acclaim but much fanfare. It was considered Marvel’s trippiest film to date. Critics praised the hypnotic visuals (for being next level Inception) and its mind-bending, time-twisting ending. They also praised Benedict Cumberbatch’s full-on arrogance, and Tilda Swinton’s performance as the bald Ancient One.

One critic argued that the film provided “a thrilling existential dilemma in which its flawed hero’s personal search for purpose dovetails beautifully with forays into the occult New Age realm of magic and sorcery where Doctor Strange ultimately finds his calling.” Another critic noted that the movie was “basically a reboot of Iron Man, only with a lot more prettier things to look at while you’re stoned.” A third and final reviewer noted how the film was grounded in “the mind-expanding tenets of Eastern mysticism” but was “different enough to establish a solid niche alongside the blockbuster combine’s established money machines.”[1]

In 1963, when comic book readers were first exposed to Dr. Stephen Strange, he wasn’t terribly likable. Serious and with silver-streaked hair, Strange was middle-aged and aloof. He was a different kind of hero. There was no super strength nor a billion-dollar trust fund to draw from; he had no callow jokes and there was certainly no unadulterated patriotism. Alex Pappademas has done a great job in writing about him for  the website Grantland (when it still existed, that is).

Strange wasn’t a puncher. He solved problems and defeated villains by entering dreams, jettisoning his physical body, and studying (yes, studying) his library full of ancient magic books for hours upon hours upon hours.

As he once put it, “I have truly gained the greatest power of all. That which the fountainhead of all other power…I have gained the gift of knowledge.”[2] His rise to become the Sorcerer Supreme, the sole protector of the earthly realm, was predicated on learning and revising – occasionally cramming the night before – magical and mystical techniques.

***

So how does Dr. Strange relate to my new book, Strange Trips?  

Prior to becoming a thoughtful and magical superhero, Stephen Strange was at one time the finest surgeon in the United States, as obnoxiously arrogant and money-driven as he was brilliant. He was a personification of free-enterprise medicine and the biomedical model in action.

When a fellow physician told Strange that a patient wished to thank him for performing an operation successfully, his response was: “I can’t be bothered!” Lighting a cigarette coolly, Strange added, “Just be sure he pays his bill!” And worse still, Strange refused services to anyone without resources to cover the costs. “Sorry,” Strange heartlessly told a potential patient as he examined X-Rays, “if you won’t pay my price, I can’t help you! Find another doctor!” Whoa.

Kwame Opam suggested (rather inelegantly but accurately) that Strange had an “asshole streak.” Joshua Rivera argued that he was pretty unique.

However, Strange’s life was irrevocably altered after a single-vehicle collision and the resulting nerve damage in his all-important hands. Everything went downhill. His career was over; he would never perform surgery again.

Yet, Strange was unwilling to give up. Having heard whispers of a miracle physician, a mystical being who could cure any health problem, Strange travelled abroad. In a state of desperation and anxiety, he ventured to India to seek out the Ancient One, even though it was clear he was doing so for greedy and selfish reasons. Only after a period of introspection and a series of trials (including saving the Ancient One’s life) does Strange realize the error of his ways and begin his spiritual conversion; essentially, his transition from a Western-trained doctor to a different kind entirely.[3]

Dr. Strange’s first appearance in the comic book world was in December 1963 and other real-life doctors were contemplating mysticism and the medical model.

In November of that same year, Harvard divinity-school grad Walter Pahnke published the results of his “Good Friday Experiment,” in which volunteers were dosed with psilocybin in Boston University’s Marsh Chapel. Timothy Leary and Richard Alpert, who both held doctorates in psychology and supervised the experiment, were dismissed from Harvard that same year. Not without some irony, it was Andrew Weil, the future alternative-health celebrity doctor, that told The Harvard Crimson about the nature of Pahnke’s research.

Timothy Leary and Allan Ginsgerg

(I was lucky enough to learn more about Leary and Pahnke at the Psychoactive Substances Collection at Purdue University. You can read about it here.)

By the beginning of the 1960s, LSD and other hallucinogens had become well-known substances within bio-medical research circles, but had yet to influence mainstream society in any significant way. And as the 1960s wore on, the capacity of researchers to establish quantifiable and verifiable results became ever more puzzling.[4]

(Of course, there’s tremendous discussion now about the return of these types of medicines. See below.)

While counterclaims – that LSD produced madness, for example – were perhaps over the top, medical researchers still found themselves caught in a moral panic over the value of LSD.

Sandoz, undoubtedly worried about its reputation, temporarily suspended production of its LSD supplies in 1963. Richard Alpert, for his part, set off for India in 1967, and there he found the conditions for his own spiritual conversion. After training under Hindu holy man Neem Karoli Baba in India, Alpert was renamed Ram Dass. By 1970, he was trying to influence medicine and society more broadly through his promotion of psychedelics and, bizarrely, in 1970 he told an audience of health professionals that they could learn much about caring for the sick from Dr. Strange and the comic book Strange Tales in which he featured!!

***

Dr. Strange embodies several important lessons about medicine and health – many of which play out in the pages of my book.

Most obviously, he blends science and culture.

Beyond that, he captures, firstly, the economics of American medicine. Strange was once all about the money, whereas many physicians were adopting a more activist role in society, intensifying their participation in such social practices as parenthood, early childhood education, poverty, and the wider economy.[5] In 1964, for instance, the Medical Committee for Human Rights (MCHR) was founded after an enhanced “medical presence” was requested by activist organizations in Mississippi following the murder of three civil rights volunteers. MCHR’s national membership had by 1971 grown to 10,000 health workers across the country, and one of the dominant principles of the group was that health activism – and not just mental health activism – was a vital national concern. These interventionist impulses represented the “therapeutic ethos” of the Great Society.[6]

Secondly, Strange also represented the medical tourist in action. When he sought out cures for his damaged hands in India, he was by no means an innovator. The practice harkens back to ancient times when pilgrims and patient-consumers journeyed long distances to visit mineral waters or healing temples.

Yet, in recent years, international medical tourism has blossomed in Asia, India, and elsewhere, raising significant questions about patient choice, global competition, and the various costs involved; some critics maintain that medical tourism widens the gap between social classes and creates even greater health disparities, even as the quality of the health care in destination countries is challenged. By contrast, proponents suggest that such tourism exacts pressure on expensive in-country health care facilities to lower prices and foster social/economic development, while at the same time acting as a revenue stream to fund existing services. This rendering holds medical tourism as a leveler of disparity.[7] Either way, patients have adopted medical tourism to get their hands on drugs or have their hands fixed, as in the case of Dr. Stephen Strange. (Daniel Beland writes about medical tourism here.)

Finally, Dr. Strange epitomizes the rise of alternative medicines and the contested nature of medical knowledge. Sometimes this means quackery. Sometimes not.

Strange’s career trajectory, in short, showcases the move from a biomedical model to a mystic or shamanistic one. Through Strange we may view shifting perceptions of how medical recommendations are established and codified, treatments determined, and medicines agreed upon. No longer a licensed surgeon, Strange still healed the sick, just through different means. Histories of “alternatives” to the medical mainstream, which might include traditional Chinese or Eastern medicine, faith-healing, and toe-twisting, have much in common with LSD, ecstasy, and magic mushrooms.[8]

And the 1960s gave greater momentum to “other” or “outsider” medicines that ultimately conflicted with learned medical traditions, which were inextricably linked to scientific progress.[9] In 1963’s AMA: Voice of American Medicine, the author proclaimed how doctors in the US had heroically fought against nostrums and quackery. Much like superheroes, physicians in the American Medical Association never “hesitated to reveal the most sordid aspects of the business” and expose the “graft and ravages of the nostrum vendors.”[10] Published the same year as Strange Tales hit newsstands, Andrew Weil alerted Harvard authorities to the “Good Friday Experiment,” and Sandoz cut off supplies of LSD to researchers, the book failed to discuss the spectral line that separated different kinds of medicines. It was and remains a fine line demarcating legality and illegality, acceptance and demonization.

***

Dr. Strange did not make it into my book. Some topics make it. Others don’t. Just like Dr. Strange and you and I, books themselves go through strange journeys.

However, the topics of economics, medical tourism, and alternative medicines are all included.  The context in which scientific and medical evidence is produced plays a significant role in how a drug and medicine is assessed. For Dr. Strange, this process provided “the greatest power of all…the gift of knowledge.”

***

Sources and a big ‘did you know?’

[1] Alex Stedman, “Early ‘Doctor Strange’ Reviews: What the Critics Are Saying,” Variety, October, 2, 2016, accessed November 20, 2016, http://variety.com/2016/film/news/doctor-strange-review-roundup-1201898171/.

[2] Alex Pappademas, “Career Arc: Doctor Strange, Marvel’s Uncastable Sorcerer Supreme,” Grantland October 24, 2014, accessed December 1, 2016, http://grantland.com/hollywood-prospectus/career-arc-doctor-strange-marvels-uncastable-sorcerer-supreme/.

[3] Ibid.

[4] Erika Dyck, “‘Just Say Know’:  Criminalizing LSD and the Politics of Psychedelic Expertise, 1961-68,” in Ed Montigny, ed., The Real Dope: Social, Legal, and Historical Perspectives on the Regulation of Drugs in Canada (Toronto: University of Toronto Press, 2011): 169-196.

[5] Gerald Caplan, Principles of Preventive Psychiatry (New York: Basic Books, 1964); John A. Talbott, “Fifty Years of Psychiatric Services: Changes in Treatments of Chronically Ill Patients,” Review of Psychiatry Volume 13, John M. Oldham and Michelle B. Riba, eds. (Washington, D.C.: American Psychiatric Press, 1994), 93-121.; Matthew Smith, Hyperactive: The Controversial History of ADHD (London: Reaktion Books, 2012), 89-91; Sandra Bloom, Creating Sanctuary: Toward the Evolution of Sane Societies (New York: Routledge, 2013), 111-117.

[6] Brian Balogh, “Making Pluralism ‘Great’: Beyond a Recycled History of the Great Society,” in Sidney M. Milkis and Jerome M. Mileur, eds., The Great Society and the High Tide of Liberalism (Amherst and Boston: University of Massachusetts Press, 2005), 163. For recent and authoritative works on the Great Society, see: Julian E. Zelizer, The Fierce Urgency of Now: Lyndon Johnson, Congress, and the Battle for the Great Society (New York: Penguin Press, 2015); Gary May, Bending Toward Justice: The Voting Rights Act and the Transformation of American Democracy (New York: Basic Books, 2013). See also: John Dittmer, The Good Doctors: The Medical Committee for Human Rights and the Struggle for Social Justice in Health Care (New York: Bloomsbury Press, 2009).

[7] Hao Li and Wendy Cui, “Patients without borders: The historical changes of medical tourism,” University of Western Ontario Medical Journal (Fall 2014): 20-21. See: I. Glenn Cohen, Holly Fernandez Lynch, and Christopher T. Robertson, eds., Nudging Health: Health Law and Behavioral Economics (Baltimore: Johns Hopkins University Press, 2016); Jill R. Hodges, Ann Marie Kimball, and Leigh Turner, eds., Risks and Challenges in Medical Tourism: Understanding the Global Market for Health Services (New York: Praeger, 2012).

[8] Janice Dickin, “‘Take Up Thy Bed and Walk’: Aimee Semple McPherson and Faith-Healing,” Canadian Bulletin of Medical History 17, no. 1 (2000): 137-153; Charlotte Furth, “The AMS/Paterson Lecture: Becoming Alternative? Modern Transformations of Chinese Medicine in China and in the United States,” Canadian Bulletin of Medical History 28, no. 1 (2011): 5-41; Barbara Clow, “Mahlon William Locke: ‘Toe-Twister,’” Canadian Bulletin of Medical History 9.1 (1992): 17-39.

[9] Charles Rosenberg, “Pathologies of Progress: The Idea of Civilization at Risk,” Bulletin of the History of Medicine 72 (1998): 714-30.

[10] James G. Burrows, AMA: Voice of American Medicine (Baltimore: Johns Hopkins University Press, 1963).

***

Did you know that Benedict Cumberbatch was not the first actor to play Dr. Strange?

Advertisements

New Editors at Social History of Alcohol and Drugs

The ADHS is pleased to announce that the editorship of its journal, *The Social History of Alcohol and Drugs*, will be taken over by Prof. Nancy D. Campbell (Rensselaer Polytechnic Institute), Prof. David Herzberg (Buffalo) and Dr. Lucas Richert (Strathclyde). The society would also like to express its gratitude for the work that outgoing editor, […]

via New editors for SHAD — Alcohol and Drugs History Society

Big Pharma Round-Up V (#Cannabis edition)

https://twitter.com/DavidLenigas/status/948667879368642562

**

Large Indoor Marijuana Commercial Growing Operation With Fans, Greenhouse, Equipment For Growing High Quality Herb. Cannabis Field Growing For Legal Recreational Use in Washington State

CFP Cannabis: Global Histories

19-20 April 2018
University of Strathclyde, Glasgow

In cooperation with Wellcome Trust

The Centre for the Social History of Health and Healthcare would like to invite papers for Cannabis: Global Histories at the University of Strathclyde (Glasgow) on 19-20 April 2018.

One outcome of the recent Alcohol and Drugs History Society meeting (ADHS) in Utrecht was enthusiasm for a ‘histories of cannabis’ workshop/conference to gather together the increasing number of scholars researching the topic.

Paper proposals should be based on unpublished research and should include a 300-word abstract, including a brief CV (2 page maximum). The deadline is 1 September 2017. Participants would then be asked to submit papers of c.7000-8000 words by 15 January 2018. This will enable pre-circulation of papers and also early work on editing a collection of papers for publication.

The geographical location and timeframe are open, while topics may include but are not limited to:

policy and legislation
health outcomes
trafficking and terrorism
comparative approaches
myths
science and evidence
the rise of big cannabis
art and culture

Large Indoor Marijuana Commercial Growing Operation With Fans, Greenhouse, Equipment For Growing High Quality Herb. Cannabis Field Growing For Legal Recreational Use in Washington State

 

Deadline for Proposals: 1 September 2017
Deadline for Papers: 15 January 2018

Please send your submissions or queries to :
Caroline Marley: cshhhadmin@strath.ac.uk or
Lucas Richert: Lucas.Richert@strath.ac.uk

Dried Buds

Cannabis ‘Policy Brief’ Announcement

It’s my pleasure to promote the publication of an important Policy Brief on Cannabis by Kathleen Thompson. Over the past few years she has helped drive conversations about the consumption and control of marijuana. Her recent Policy Brief ought to be read by anyone and everyone! Here’s an extract.

LEGALIZATION OF CANNABIS: THE POLICY CHALLENGES AND OPPORTUNITIES

By Kathleen Thompson, PhD, MSW, RSW, BA (Hons)

“The commitment by the Government of Canada to legalize cannabis
and cannabis products presents a complex range of socio-economic
challenges and opportunities. Creating the right legal and regulatory
framework to address the implications, both good and bad, will be
key in determining whether legalization is deemed successful public
policy.
The federal government plans to introduce cannabis legislation in the
coming spring session of Parliament. The legislation will be based on
the recommendations contained in a report issued on November 30 by
a Task Force of experts who studied the issue for the past year. The Task
Force received input from more than 30,000 Canadians, organizations
and professionals. Entitled “A Framework for the Legalization and
Regulation of Cannabis in Canada”, the report recommends allowing
more flexibility in the current federally controlled cannabis cultivation
model. Specifically, the federal government would regulate a safe and
responsible supply chain of cannabis.”

The full document, which has been sent to law enforcement and government officials across Canada, can be read on the Johnson-Shoyama website or downloaded here thompson-policy

**

Large Indoor Marijuana Commercial Growing Operation With Fans, Greenhouse, Equipment For Growing High Quality Herb. Cannabis Field Growing For Legal Recreational Use in Washington State
Large Indoor Marijuana Commercial Growing Operation With Fans, Greenhouse, Equipment For Growing High Quality Herb. Cannabis Field Growing For Legal Recreational Use in Washington State

**

ABOUT KATHLEEN THOMPSON

Dr. Thompson has worked in health policy analysis and research as a bureaucrat and as a consultant for the last 25 years, specializing in the mental health, disability and corrections sectors.

In 2015, Dr. Thompson created the Cannabis Regulatory Research Group. The focus of the policy research group is on promoting collaborative public policy processes and evidenced-based research with the cannabis industry, governments, academia, civil society and at the United Nations. Additionally, Dr. Thompson consults with individuals and organizations on how to enter the legal cannabis industry.

 

 

THE FUTURE OF UK MEDICAL MARIJUANA REMAINS BLURRY

BUT THERE ARE LESSONS TO TAKE AWAY FROM CANADA

From 2014–2016, Canadian health authorities were forced to address the issue of medical marijuana, even as activist groups and industry sought to influence the decision-making process and its place in the medical marketplace. First, the system was privatized, then issues of use and access, not to mention the full-on legalization of recreational marijuana, dominated headlines.

In light of last week’s shocking medical marijuana report, the policy debate will certainly grow more heated here in the UK. The All Party Parliamentary Group on Drug Policy Reform stated there is “good evidence” cannabis can help alleviate the symptoms of several health conditions, including chronic pain and anxiety. According to Prof Mike Barnes, a leading consultant neurologist who contributed to the report, “We must legalise access to medical cannabis as a matter of urgency.”

In a recently co-edited series on Canadian cannabis called Waiting to Inhale, it became clear that medical marijuana was a supremely complex policy issue. Some of the questions included, but were not limited to, the tenuous balance between consumers and regulators, Canadian physicians as unwanted gatekeepers, marijuana as a measure (and potential leveller) of inequities, and the major struggles between Big Cannabis and craft cannabis.

Looking ahead, the UK can learn lessons from other countries, including Canada.

Background: Canadian medical cannabis

Medical marijuana has been available in Canada since 2001, after the Canadian Court of Appeal declared that sufferers from epilepsy, AIDS, cancer and other ailments had a constitutional right to light up. Prohibition of this “medicine” was, in short, unconstitutional.

The original regulation that allowed patients to access medical marijuana in Canada was enacted in 2001 and called the Marihuana Medical Access Regulations (MMAR). It allowed patients to possess dried marijuana flower/bud with a license issued by the government, provided that the application was signed off by a physician.

One strain of medicine was available for purchase from one single government supplier, Prairie Plant Systems, but optional licenses were available for patients to grow their own plants or to designate a grower to supply medicine to them.

The MMAR was repealed and replaced by the Marihuana for Medical Purposes Regulations (MMPR), enacted on Apr. 1, 2014. With this, medical marijuana was officially opened for business. And the new rules generated a craze as dozens of new entrants jumped into the marketplace.

As of Aug. 24, 2016 the MMPR was replaced with the Access to Cannabis for Medical Purposes Regulation (ACMPR). These new regulations included legislation that satisfied the latest Supreme Court decision to allow patients who possess a prescription from a doctor to grow their own medicine.

During this period, certain problems have hindered the medical marijuana industry’s growth in Canada, and Britain could learn from these.

Dispensaries vs. Big Cannabis

These stores and clubs are illegal because they procure and sell their products outside the federal medical marijuana system, which was overhauled and expanded last year to allow industrial-scale production of pot products that are mailed directly to licensed patients.

The pushback against dispensaries has come from national and local law enforcement as well as the Canadian Medical Cannabis Industry Association. Yet, the Cannabis Growers of Canada, a trade association representing “unlicensed” growers and dispensaries, have fought to be included at the table. Along with several other organizations, the CGC has lobbied the government to be included in the new legal regime.

As the New York Times put it, “a lobbying battle is raging between the new entrepreneurs and the licensed medical marijuana producers, who were the only ones allowed to grow and provide the plant under the old regulations. One side complains about being shut out by a politically connected cartel, while the other complains about unfair and damaging competition from those who are breaking the law.”

Physicians

Medical marijuana has not approved as a medicine by Health Canada, although there is a growing body of clinical evidence regarding its pain-alleviating effects.

As such, physicians in Canada have struggled with the science and ethics of medical marijuana. At the 147th annual meeting of the Canadian Medical Association in Ottawa last August, many doctors expressed serious reservations about prescribing marijuana.

Some doctors said they felt threatened or intimidated into signing prescriptions, whereas others felt as though patients were shopping for doctors. Worst of all, there were reported cases of malfeasance, where doctors charged their patients for a prescription.

The result is that the CMA remains divided on, if not outright opposed to, being the gatekeepers of medical marijuana.

Workplace Safety and Performance

With more relaxed rules around medical marijuana (along with federal legislation looking to legalize cannabis),employers are wondering whether this will grow as an issue when it comes to pre-employment or on-the-job testing.

Aside from certain industries, such as transportation, most provinces don’t have clear policies or precedents for dealing with medical marijuana.

Besides that, workplace screening of marijuana is a mediocre indicator of performance in the workplace as it doesn’t actually test for impairment. Rather, it tests for by-products excreted from the body after the drug’s been ingested.

Looking ahead, human resource departments will be forced to develop a raft of new policies.

Veterans

The core problem rests with the amount of cannabis veterans are authorized to take. In 2014, Veterans Affairs doubled the amount to 10 grams per day for eligible veterans. Yet, this is twice the amount Health Canada considers safe.

An internal Health Canada document showed that more than five grams has the potential to increase risks to the cardiovascular, pulmonary and immune systems, as well as psychomotor performance and has a chance of increasing the risk of drug dependence.

Ferguson’s office could not find any evidence to support this decision to increase the threshold. Veterans Affairs Minister Kent Hehr expressed shock in March that his department lacked an “informed policy” on the use of medical cannabis, even as the number of claims by veterans for medical marijuana grew more than tenfold over the past two years.

Vaping

The intersection of vaping and medical marijuana has also caused tension. As vaping has moved from a niche presence to mainstream practice, its unregulated nature – at the federal level – poses problems to policy-makers.

For example, the Ontario government exempted medical marijuana users in mid-November from a law that bans the use of e-cigarettes anywhere regular cigarettes are prohibited. These regulations were set to come into effect Jan. 1. This exemption meant medical marijuana users could vape in restaurants, at work or on playgrounds. However, Ontario’s associate health minister Dipika Damerla stated that the government would remove the exemption.

Local governments in various cities recently voted to implement a vaping bans in public spaces, with only a vape shop exemption predicated on “safety” concerns, specifically for the uninitiated e-cigarette user who doesn’t know how to install batteries in the device. But it was also predicated on the notion that buyers should be able to see what they’re getting, which is the same argument made by authorized medical cannabis users about the value of a local pot dispensary.

The Future

Marijuana remains a highly contested medicine for various scientific, political and social reasons. That is obvious.

Policy makers from government, industry leaders, and physicians will face considerable question marks. Cutting through all the haze won’t be an easy task, yet all participants, including the public, would be wise to use recent examples from Canada to light the way.