(Author’s note: The state of Florida has an amendment to the constitution on the ballot this Election Day that tries to legalize recreational marijuana. This amendment is being pushed by the marijuana commercial industry for obvious reasons, but is promoted by claiming it will reduce crime, increase school education funding, and make use of marijuana safer. To educate voters about the truth concerning marijuana usage, I am re-publishing a two-part blog from earlier this year.)

The Biden Administration wants to reclassify marijuana as a less dangerous Schedule III drug – on par with anabolic steroids and Tylenol with Codeine. The reason they want to do this is quite transparent – they want to buy the votes of young people in the next election. But is this good for these young people and the country?

When I went to college in the 1970s, marijuana was part of the counterculture. “Hippies” and other radicals of that day smoked “weed” in order to get high and generally to resist conformation to the norms of society. It was the era of the Vietnam War and young people were generally opposed to anything the government was doing. Little was known about the side effects of smoking marijuana but it was generally thought to be no worse than drinking alcohol; maybe even better.

Fifty years later the cannabis culture has gone from counterculture to mainstream. Allysia Finley, writing for The Wall Street Journal, tells us a 2022 survey sponsored by the National Institutes of Health found that 28.8% of Americans age 19 to 30 had used marijuana in the preceding 30 days – more than three times as many as smoked cigarettes. Among those 35 to 50, 17.3% had used weed in the previous month, versus 12.2% for cigarettes. That’s a radical change in the culture and in the perceived health threat of marijuana versus cigarettes.

While marijuana use remains a federal crime, 24 states have legalized it and another 14 permit it for medical purposes. Last month media outlets reported the Biden administration move to reclassify marijuana as a less dangerous Schedule III drug, but experts on marijuana and its health hazards are alarmed.

Bertha Madras thinks this would be a colossal mistake. Ms. Madras, 81, is a psychobiology professor at Harvard Medical School and one of the foremost experts on marijuana. “It’s a political decision, not a scientific one,” she says. “And it’s a tragic one.” In 2024, that is a countercultural view.

Ms. Madras has spent 60 years studying drugs, starting with LSD when she was a graduate student at Allan Memorial Institute of Psychiatry, an affiliate of Montreal’s McGill University, in the 1960s. “I was interested in psychoactive drugs because I thought they could not only give us some insight into how the brain works, but also on how the brain undergoes dysfunction and disease states,” she says.

In 2015 the World Health Organization asked her to do a detailed review of cannabis and its medical uses. The 41-page report documented scant evidence of marijuana’s medicinal benefits and reams of research on its harms, from cognitive impairment and psychosis to car accidents. She continued to study marijuana, including at the addiction neurobiology lab she directs at Mass General Brigham McLean Hospital. In a phone interview this week, she walked me through the scientific literature on marijuana, which runs counter to much of what Americans hear in the media

For starters, she says, the “addiction potential of marijuana is as high or higher than some other drug,” especially for young people. About 30% of those who use cannabis have some degree of a use disorder. By comparison, only 13.5% of drinkers are estimated to be dependent on alcohol. Sure, alcohol can also cause harm if consumed in excess. But Ms. Madras sees several other distinctions.

One or two drinks will cause only mild inebriation, while “most people who use marijuana are using it to become intoxicated and to get high.” Academic outcomes and college completion rates for young people are much worse for those who use marijuana than for those who drink, though there’s a caveat: “It’s still a chicken and egg whether or not these kids are more susceptible to the effects of marijuana or they’re using marijuana for self-medication or what have you.”

Marijuana and alcohol both interfere with driving, but with the former there are no medical “cutoff points” to determine whether it’s safe to get behind the wheel. As a result, prohibitions against driving under the influence are less likely to be enforced for people who are high. States where marijuana is legal have seen increases in car accidents.

One of the biggest differences between the two substances is how the body metabolizes them. A drink will clear your system within a couple of hours. “You may wake up after binge drinking in the morning with a headache, but the alcohol is gone.” By contrast, “marijuana just sits there and sits there and promotes brain adaptation.”

That’s worse than it sounds. “We always think of the brain as gray matter,” Ms. Madras says. “But the brain uses fat to insulate its electrical activity, so it has a massive amount of fat called white matter, which is fatty. And that’s where marijuana gets soaked up. . . . My lab showed unequivocally that blood levels and brain levels don’t correspond at all—that brain levels are much higher than blood levels. They’re two to three times higher, and they persist once blood levels go way down.” Even if people quit using pot, “it can persist in their brain for a while.”

Thus marijuana does more lasting damage to the brain than alcohol, especially at the high potencies being consumed today. Levels of THC—the main psychoactive ingredient in pot—are four or more times as high as they were 30 years ago. That heightens the risks, which range from anxiety and depression to impaired memory and cannabis hyperemesis syndrome—cycles of severe vomiting caused by long-term use.

There’s mounting evidence that cannabis can cause schizophrenia. A large-scale study last year that examined health histories of some 6.9 million Danes between 1972 and 2021 estimated that up to 30% of young men’s schizophrenia diagnoses could have been prevented had they not become dependent on pot. Marijuana is worse in this regard than many drugs usually perceived as more dangerous. “Users of other potent recreational drugs develop chronic psychosis at much lower rates,” Ms. Madras says. When healthy volunteers in research experiments are given THC—as has been done in 15 studies—they develop transient symptoms of psychosis. “And if you treat them with an antipsychotic drug such as haloperidol, those symptoms will go away.”

(Note: More on this subject in Part II)

As we get older, memory declines. It happens to all of us, but in some it is worse depending on heredity and other factors. There’s lots of research being done on this subject because we’re all interested!

Television is filled with advertisements for dietary supplements to boost your brainpower and improve your memory. I’ve discussed these with experts in neurology and none of them believes these products live up to their hype. So, what else can we do to improve our memory?

Jingduan Yang, M.D., writing in The Epoch Times, tells us of four essential nutrients that can help protect our brains from deterioration in cognitive function. The hippocampus, which plays a central role in learning and memory, naturally deteriorates with age. But these essential nutrients can help prevent this deterioration and effectively improve cognitive function.

Before we discuss these nutrients, it is helpful to understand the functions of the hippocampus. We have two of them, left and right, and they have several key functions:

• Processing and storing new information: The hippocampus helps the brain encode and store new information as memories, making it essential for learning.
• Consolidating and forming memories: The hippocampus consolidates fragmented memories into the brain’s memory system. It is crucial in converting short-term memories into long-term ones, thereby solidifying memory content.
• Processing spatial memory: The hippocampus is essential for remembering our surroundings and creating cognitive maps.
• Processing episodic memory: The hippocampus processes and stores episodic memories, which include our daily personal experiences with specific details about time, place, and events.

Damage to the hippocampus leads to short-term memory impairment, affecting the brain’s ability to learn and retain new information. Many people first notice a decline in memory when they begin experiencing difficulties with recent memories. Additionally, hippocampal damage can result in memory loss, either partial or complete, such as forgetting personal experiences from the past. It can also weaken spatial navigation skills and the ability to remember familiar environments.

These are the helpful nutrients:

• Omega-3 fatty acids – Studies have shown that consuming omega-3 fatty acids through diet and supplements can help maintain cognitive function and prevent Alzheimer’s disease.
• Antioxidants – Antioxidants, found in various food and certain supplements, can help protect the hippocampus from oxidative damage.
• Vitamin B12 – Research has established a link between vitamin B12 deficiency and cognitive impairment, as well as hippocampal atrophy. Clinical tests have suggested that supplementing with vitamin B12 can improve cognitive function in patients with B12 deficiency, at least in the short term.
• Curcumin – Curcumin has anti-inflammatory and neuroprotective properties that benefit the hippocampus. A comparative study found that curcumin supplementation can significantly delay the progression of Alzheimer’s disease and improve both locomotion (like walking and running) and cognitive functions associated with dementia.

These nutrients are not intended to reverse changes in the hippocampus in those who have already shown deterioration, but they may protect against damage before it happens. For those who have more advanced cases of memory loss, there are new drugs that offer hope in this devastating disease. For more on these drugs, see my earlier post Alzheimer’s Drug Progress.

Unintended consequences. That’s what often happens when politicians try to fix one problem but create another.

The Wall Street Journal editorial board says that’s exactly what will happen from the Federal Trade Commission (FTC) lawsuit targeting pharmacy benefit managers (PBMs). They say, “Lina Khan claims she’s trying to lower prices, but the Federal Trade commission Chair’s attacks on business often do the opposite. Consider her new charge against pharmacy benefit managers (PBMs), which could result in higher healthcare premiums for all Americans.”

Democratic commissioners on Friday voted 3-0 to bring a complaint against PBMs for extracting rebates from drug makers in return for preferential placement on insurer formularies. The agency filed the charges in its administrative tribunal where it nearly always wins. (The two Republican commissioners were recused.) Congress has been debating how to regulate PBMs, but Ms. Khan isn’t waiting. She’s seeking to effectively ban PBM rebates by deeming them an “unfair method of competition” under the Federal Trade Commission Act.

The FTC’s essential charge is that PBMs play insulin manufacturers Novo Nordisk, Eli Lilly and Sanofi against each other to obtain higher rebates, which their clients use to reduce premiums for all patients. The complaint says PBMs’ “insatiable demand for larger rebates” has led to “artificially inflated list prices that are disconnected from the actual cost of the drugs to insurers,” and “many patients’ out-of-pocket expenses are directly or indirectly tied to these inflated prices.”

Yet even the FTC admits that net insulin prices after rebates have declined over time. This suggests competition fueled by the PBMs is working. But patients who pay co-insurance on medicines—which is set as a percentage of a drug’s list price—or who have high deductibles can get slammed by high list prices.

WSJ editors say, “As the FTC complaint notes, health plans can mitigate high list prices “by applying drug rebates directly at the pharmacy counter when the patient purchases the drug”—known as a point-of-sale rebate. It says employers aren’t doing this, but why is that the PBMs’ fault?”

The FTC says PBMs use rebates to inflate their profits, but this is contradicted by the complaint’s admission that they pass on 90% to 98% of rebate dollars to their clients—i.e., employer, union and Medicare Part D plans. A recent study by the healthcare research firm Nephron Research found that rebates accounted for only 13% of PBM profits in 2022.

In any case, plans have increasingly moved to point-of-sale rebates. This is one reason average insulin out-of-pocket costs fell to $21.19 from $31.52 between 2018 and 2022. Nearly 80% of insulin prescriptions cost less than $35 a month out of pocket in 2022.

The FTC complaint also points out that the three insulin makers last year slashed list prices on their most popular products by 65% to 78%. They also capped out-of-pocket costs at $25 to $35 a month for patients regardless of insurance. Yet the complaint says that even though insulin has become more affordable, PBMs still extract large rebates for other drugs that result in higher list prices. True, but those drugs aren’t the focus of the complaint. Generic competition has resulted in prescription drug prices rising at a third of the rate of overall consumer prices over the last five years.

The WSJ editors then raise an important question: “If rebates are a problem, why does Congress require them for government plans? Drug makers must pay Medicaid rebates that start at 23.1% of a medicine’s average price and can exceed 100%. The Trump Administration tried to ban rebates in Medicare, but the Congressional Budget Office estimated it would substantially raise senior premiums and increase government spending by $170 billion over 10 years. Congress blocked the rule. Yet now Ms. Khan wants to ban rebates in private insurance.”

This is typical federal dual standards – “One standard for thee, but not for me.” Just as the federal employees have a far better healthcare insurance system than the rest of us, they also want a different standard for rebates in government insurance plans than for the private sector.

WSJ editors summarize the situation: “The political irony is that PBMs have grown in size and power owing to government policies. Their vertical integration is a byproduct of ObamaCare’s insurance regulation, including its cap on profits. No less than ObamaCare architect Peter Orszag recently lamented that “the stance of the antitrust authorities is directly and problematically opposed to the thrust of other policies. Government has made a mess of healthcare financing, and Ms. Khan would make it worse.”