Monday, February 23, 2015

What might be the modern public health story if marijuana had been kept legal and tobacco cigarettes widely banned?

Students in my marijuana seminar know that I think there is much to think about and learn from the history of (alcohol) Prohibition in the United States and the history of marijuana prohibition.   But I have now learned from this fascinating new Jacob Sullum piece that there was an interesting US history surrounding cigarette prohibition that also should be a lesson for modern marijuana advocates.   The lengthy Sullum piece, which is headlined "Today's Pothead Is Yesterday's Cigarette Fiend," should be read in full, but these passages are what engendered the question in the title of this post:

At first the anti-cigarette campaign, which had close ties to the temperance movement, focused on restricting children's access.  By 1890, 26 states had passed laws forbidding cigarette sales to minors, but many children continued to smoke.  Led by Lucy Page Gaston, a former teacher from Illinois whose career as a social reformer began in the Woman's Christian Temperance Union, the anti-cigarette crusaders next insisted that complete prohibition was necessary to protect the youth of America.  Between 1893 and 1921, 14 states and one territory (Oklahoma) enacted laws banning the sale of cigarettes, and in some cases possession as well.

Upholding Tennessee's ban in 1898, the state Supreme Court declared that cigarettes "are wholly noxious and deleterious to health. Their use is always harmful; never beneficial. They possess no virtue, but are inherently bad, bad only. They find no true commendation for merit or usefulness in any sphere. On the contrary, they are widely condemned as pernicious altogether. Beyond any question, their every tendency is toward the impairment of physical health and mental vigor."

In contrast to contemporary anti-smoking activists, who talk almost exclusively about the habit's effect on the body, early critics of the cigarette were just as concerned about its impact on the mind.  In the 1904 edition of Our Bodies and How We Live, an elementary school textbook, Albert F. Blaisdell warned: "The cells of the brain may become poisoned from tobacco.  The ideas may lack clearness of outline.  The will power may be weakened, and it may be an effort to do the routine duties of life…. The memory may also be impaired."

Blaisdell reported that "the honors of the great schools, academies, and colleges are very largely taken by the abstainers from tobacco," adding, "The reason for this is plain.  The mind of the habitual user of tobacco is apt to lose its capacity for study or successful effort.  This is especially true of boys and young men.  The growth and development of the brain having been once retarded, the youthful user of tobacco has established a permanent drawback which may hamper him all his life.  The keenness of his mental perception may be dulled and his ability to seize and hold an abstract thought may be impaired."

In the 1908 textbook The Human Body and Health, biologist Alvin Davison agreed that tobacco "prevents the brain cells from developing to their full extent and results in a slow and dull mind." He added, "At Harvard University during fifty years no habitual user of tobacco ever graduated at the head of his class."

These themes were taken up by prominent, widely admired Americans who were troubled by a cluster of traits that would later be associated with marijuana.  "No boy or man can expect to succeed in this world to a high position and continue the use of cigarettes," Philadelphia Athletics Manager Connie Mack wrote in 1913.  Biologist David Starr Jordan, the first president of Stanford University, concurred. "The boy who smokes cigarettes need not be anxious about his future," he said. "He has none."...

In the decades that followed, the cigarette's reputation underwent a complete reversal. Far from sabotaging intellectual achievement and economic productivity, it was seen as facilitating them through the stimulating action of nicotine.  But the dull, listless underachievers described by Ford and Edison reappeared in the 1960s, smoking something else.

Testifying before Congress in 1970, Harvard psychiatrist Dana Farnsworth noted that scientists had come up with a name for the condition that prevented marijuana users from reaching their potential. "I am very much concerned about what has come to be called the 'amotivational syndrome,'" Farnsworth said. ...

A decade and a half later, Robert DuPont declared that "millions of young people are living as shadows of themselves, empty shells of what they could have been and would have been without pot."  In 1989, his first year as the nation's first official "drug czar," Bill Bennett explained how smoking pot affects young people: "It means they don't study.  It causes what is called 'amotivational syndrome,' where they are just not motivated to get up and go to work."

It is plausible, of course, that smoking a lot of pot in high school might interfere with academic performance, just as heavy drinking might. But Farnsworth, DuPont, and Bennett are describing something more than that: a long-lasting impairment of the will that prevents cannabis consumers from being all that they can be....

Despite its continuing appeal as a propaganda theme, the idea that smoking pot makes people unproductive has never been substantiated.  In their 1997 book Marijuana Myths, Marijuana Facts, the sociologist Lynn Zimmer and the pharmacologist John P. Morgan examined the evidence and concluded: "There is nothing in these data to suggest that marijuana reduces people's motivation to work, their employability, or their capacity to earn wages.  Studies have consistently found that marijuana users earn wages similar to or higher than nonusers."

A 1999 report from the National Academy of Sciences noted that amotivational syndrome "is not a medical diagnosis, but it has been used to describe young people who drop out of social activities and show little interest in school, work, or other goal‑directed activity.  When heavy marijuana use accompanies these symptoms, the drug is often cited as the cause, but there are no convincing data to demonstrate a causal relationship between marijuana smoking and these behavioral characteristics."...

Like the symptoms of cigarette use that worried Ford and Edison, the symptoms of marijuana use are often hard to distinguish from the symptoms of adolescence. Peggy Mann's 1985 book Marijuana Alert, which Nancy "Just Say No" Reagan described in the foreword as "a true story about a drug that is taking America captive," is full of anecdotes about sweet, obedient, courteous, hard-working kids transformed by marijuana into rebellious, lazy, moody, insolent, bored, apathetic, sexually promiscuous monsters. "It was very easy for parents to blame marijuana for all the problems that their children were having, rather than to accept any responsibility," observes Harvard psychiatrist Lester Grinspoon, a leading authority on marijuana. "It became a very convenient way of dealing with and understanding various kinds of problems."...

Current fears about marijuana and other illegal drugs, like fears about cigarettes at the beginning of the last century, reflect the sort of worries that reappear in every generation. Parents want their children to be smart, to do well in school, to respect authority, and to become productive, responsible adults.  The dull, lazy, rebellious, and possibly criminal teenager―the cigarette fiend or pothead — is every parent's nightmare. Adults who have no children of their own worry that other people's kids will become tomorrow's parasites or predators, bringing decline and disorder.

Despite all the alarm that drug scares seem to generate, projecting these fears onto physical objects can be reassuring: Just keep the kids away from tobacco or marijuana (or alcohol or MDMA), we are implicitly told, and they will turn out OK. As symbols of all the things that might go wrong on the path from birth to maturity, drugs offer what every adult confronted by a troublesome teenager longs for: the illusion of control.

A few prior related posts:

https://lawprofessors.typepad.com/marijuana_law/2015/02/what-might-be-the-modern-public-health-story-if-marijuana-was-kept-legal-and-tobacco-outlawed-after-.html

History of Alcohol Prohibition and Temperance Movements, History of Marijuana Laws in the United States, Medical community perspectives, Who decides | Permalink

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