Prior to my decision to attend medical school, I was planning to become a basic science researcher. I studied biochemistry in college at a time when it was a relatively young field. My bachelor of science curriculum included 7 semesters of chemistry; 5 semesters of biochemistry, physics, microbiology, and zoology; and a senior honors thesis that entailed designing, completing, and defending a novel research project. I successfully defended my thesis, "An Analysis of the Fate of the Escherichia coli 4.5S RNA Gene in Yeast Using a Recombinant Plasmid," (1) and was planning to attend graduate school in genetics at the University of Washington in Seattle.
Between completing my senior thesis and my planned move to Seattle, I suddenly panicked and wondered: Is this truly the career path for me? Ultimately, I realized I did not have what it took to be a basic science researcher, so I worked for a year as a biochemical technician and applied to medical school--a decision I have never regretted.
Yet, I do not regret my background in biochemistry either. It is the foundation upon which all I have learned of medicine and psychiatry is built. The field of neuropsychopharmacology has evolved over the past 30 years, and I am filled with pride, awe, and excitement to have witnessed the clinical advancements that basic science researchers have made possible. However, in my opinion, there is 1 significant exception to all my accolades for how good science has advanced medicine: the research on cannabis.
The scientific method is used in medicine and has been the established paradigm for scientific inquiry since the 1600s. Thus, all clinical trials submitted to the US Food and Drug Administration (FDA) are meticulously designed to answer a primary outcome question about the drug under investigation. A necessary requirement of the study design is to ensure that the variables in the various arms of the study are identical except for one: drug A at dose X compared with placebo. If multiple doses of drug A or multiple drugs are being compared, each arm is precisely characterized so the conclusions drawn from the primary outcome will be highly accurate and reliable.
Components of Cannabis
Over the past 10 years, I have read numerous articles in the psychiatric literature that draw conflicting conclusions about the effect of cannabis on cognition, its attendant risk of psychosis, its addictive potential, and its effect on suicidality, and about its impacts on depression, anxiety, pain relief, and apathy. (There appears to be only 1 consistent finding: Heavy cannabis use during brain development increases the risk of psychosis and cognitive impairment, especially when other risk factors are present.) A likely explanation for the wide-ranging discrepancies is that cannabis is the product of a plant that is not a single molecule or pure substance. Many articles with the word cannabis in the title can be discarded as meaningless unless the authors took the additional step of testing all of the cannabis used by their study subjects for the quantitative and...