I take issue with trials like these. They barely do any reasonable trial research and try to spin:
"The persons who habitually smoke marijuana have been shown to have higher blood pressure levels when compared to the general population"
"Smoking marijuana in itself causes higher blood pressure"
No doubt pharmaceutical companies have their hands in this, if I may say, bullshit. They stand to lose money if people have a drug that helps their symptoms that they can simply grow in the back yard. Replace "Internet of Things" with "Internet of Non-Critical Thinkers" and you get a recipe in which todays society may be influenced due to their lack of understanding of scientific principles in a world ever increasing in scientific constructs.
EDIT: jetlagged english
It's not even this, it reads as if it was a simple "Have you ever smoked marijuana?" and that's what the conclusion was drawn from.
"Yankey said were limitations in the way marijuana use was assessed -- including that researchers could not be sure whether people had used the drug continuously since they first tried it."
That would be like asking "Have you ever intentionally hurt someone's feelings?" and concluding that people were three times likely to be anti-social.
Im for legalization of marijuana so my thoughts may be biased but I an concerned that this study is bad science. Marijuana isnt legal in most places, perhaps these causes of hypertension are environmental.
"For Yankey's study, information on marijuana use was merged with mortality data in 2011 from the U.S. National Center for Health Statistics, and adjusted for confounding factors such as tobacco smoking and variables including sex, age and ethnicity."
These studies need to be done in a place such as Portugal where marijuana has been legal for a long amount of time to allow for a large arching study to be performed properly.
Link to original study: https://www.researchgate.net/profile/Barbara_Yankey/publicat...
1. There is no establishment of causality, but the article pretends there is. People who use marijuana may use it because they have high-stress lives.
2. It only applies to smokers. About 70% of the marijuana products at the dispensaries I've been to are not meant to be smoked. To quote the original article ['Recreational marijuana is primarily smoked; we hypothesize that like cigarette smoking, marijuana use will be associated
with increased cardiovascular mortalities']
3. No link to original study. [I think it's this: http://journals.sagepub.com/doi/pdf/10.1177/2047487317723212]
4. This could be a million different things. This could be related to the stress of being afraid of being fired, or arrested. This could be tainted drugs from bad suppliers. This could be because marijuana smokers are more likely to take drugs that do change blood pressure.
Take, for example, a report from this week about pesticides in illegal growing spots in California. I can't find the Reuters link that talked about banned pesticides but I found: http://www.newsweek.com/illegal-marijuana-farms-dump-shockin...)
So the question is, do studies on cannabis harmfulness account for this variable, the unknowns and frequently illegal pesticides and other chemicals used to grow it?
I suspect I know the answer...
Example: Is there a difference between someone who smokes a joint every day for 10 years and someone who eats an edible once every two months for 10 years?
I imagine the answer to this is yes, but it's one of those things you need data to back up. The 'findings' have been so oversimplified in this news article that the portrayed results are likely only unreliable. This makes for great politicized sound-bytes but doesn't really help anyone make a real conclusion or decision.
This seems to be the source for the article, I doubt they even interviewed:
Looking at methodology:
We linked participants aged 20 years and above, who responded to questions on marijuana use during the 2005 US National Health and Nutrition Examination Survey to data from the 2011 public-use linked mortality file of the National Center for Health Statistics, Centers for Disease Control and Prevention. Only participants eligible for mortality follow-up were included. We conducted Cox proportional hazards regression analyses to estimate hazard ratios for hypertension, heart disease, and cerebrovascular mortality due to marijuana use. We controlled for cigarette smoking and other relevant variables.
Of the 1213 eligible participants 72.5% were presumed to be alive. The total follow-up time was 19,569 person-years. Adjusted hazard ratios for death from hypertension among marijuana users compared to non-marijuana users was 3.42 (95% confidence interval: 1.20–9.79) and for each year of marijuana use was 1.04 (95% confidence interval: 1.00–1.07).
My own naive interpretation here is that they drew their conclusions from a sample of ~334 deaths (1213 - 72.5%) by people who filled out a survey in 2005, using only the original survey at the beginning of the 6 year period and their public-use mortality file..
The US health system is set up under this model that assumes you're incompetent and should be prevented from making any decisions on your own, and only allowed to use something if it's deemed inconsequential enough.
That is, it is assumed a person has no decision-making competency, and then the burden of proof is on someone to show that you do, or that a decision is within the realm of what someone's limited competency is.
This seems completely backward: you should be assumed to be competent, and then only have that legally determined otherwise through extraordinary means.
All drug regulation should be eliminated, and be replaced by a competency-based evaluation, much like if someone is dementing or cognitively incapable.
That is, if someone is shown to be addicted, they should be ruled incompetent about making drug-related decisions through evaluations by psychologists and the courts, etc. Then that person would be treated as a vulnerable individual, like a child or cognitively impaired adult, and anyone taking advantage of that person would be treated similarly.
The scheduling system and healthcare system is so screwed up and I don't see why this isn't discussed more. There would be so much more competition, and it is completely different from the issue of who pays: you could have the government decide what it wants to pay for, and leave people who want something different to pay for it through different means.
That being said,
>Support for liberal marijuana use is partly due to claims that it is beneficial and possibly not harmful to health
This is extremely disingenuous. No, support for liberal marijuana use is mostly due to claims that it is less harmful than current legal drugs like alcohol, cigarettes, caffeine, sugar (not that it is not harmful at all), that it has measurable and powerful medicinal uses, and that criminalization of it is the biggest US domestic-policy-based moral catastrophe in decades and has done horrific damage to entire cornerstones of American society (minority groups, the police, civil liberties, the legal system, public health) with the explicitly stated and accomplished goal of targeting political and racial groups.
>If marijuana use is implicated in cardiovascular diseases and deaths, then it rests on the health community and policy makers to protect the public.
No, this is disingenuous and extremely dangerous. If use is implicated in these diseases it rests on the health community and policy makers to educate the public about these risks so they may make informed choices, exactly as they do with alcohol and tobacco and caffeine and sugar and trans fats, and to insulate the public from dangers associated with others making these choices by preventing e.g. driving under the influence or secondary exposure.
It seems kind of a no-brainer that inhaling combustion products is going to stress your cardiovascular system, so I'd be interested to see if there's also something about the physiological effects of THC/CBD/whatever-else-is-soluble-in-butter that leads to hypertension as well.
The study controlled for those who had previously been diagnosed with high blood pressure. But it did not take other cardiovascular risk factors into account, including diet and exercise.
It also assumed that those who said they had used marijuana in 2005 continued to do so, and it assumed that users largely smoked their pot and didn't consume it in other ways, such as by eating marijuana-laced brownies.
Those caveats limit the study's validity, said Dr. Vinay Prasad, associate professor of medicine at Oregon Health & Science University and an expert on the design and results of medical studies.
"It does not prove that if you choose to use marijuana you are more likely to die of cardiovascular disease," Prasad said in an email. "I think the major limit of the study is that there may be unobserved differences between the people who used and admitted to using marijuana during the years of this study, and cardiovascular outcomes that the researchers did not adjust for. In fact, that is likely."
Oh. Nevermind. http://www.oregonlive.com/health/index.ssf/2017/08/study_lin...
> We selected participants eligible for mortality follow-up, aged 20 years and above, who answered “yes” or “no” to the question, “Have you ever used marijuana or hashish?” Participants who answered yes were classified marijuana users and those who answered no, as non-marijuana users. Duration of marijuana use was estimated by subtracting participant’s age at marijuana use initiation from the age at the 2005 screen.
from the study
it is open access
I must be misreading that.
Saying that cannabis use makes people unable to eat is funny, since one of the uses it's been known for and approved for for a long time, with heavy use, is helping cancer and AIDS patients eat due to appetite stimulating properties.
I think you may mean a condition called hyperemesis that people think is related to heavy cannabis use, but apparently is that it's related to ingestion of a pesticide. The groups who spread anti-cannabis propaganda for decades are still quite active and are glad to seize on things Like that, and say hey, this nontoxic products that is far safer than almost any prescription drug turns out to actually be really bad for you! Right.
Making concentrates can concentrate not only active ingredients but also harmful contaminants. So, that's a good reason for better regulation - especially testing of finished products for contaminants. In most areas, one still can't easily take a product to a lab or store and get it tested for contaminants due to legalities.
A double blind study between tire, sock and dope smokers would be more interesting than this study.
With the 60 or so cannabinoids (http://medicalmarijuana.procon.org/view.answers.php?question...) and 50 or so hydrocarbons there seems like a lot of scope for causing health issues. Especially given cannabis smoke is more carcinogenic than tobacco smoke.
None of that necessarily provides a reason to ban marijuana but it may give people reason to switch to safer modes of consumption, or taking of only specific active compounds.
Like how the policy makers protect the public from Alcohol, tobacco, and over-the-counter meds?
Also a 1200 person study isn't really enough to draw any major conclusions from.
Of course ingesting anything substance of any kind frequently over a period of time is bound to be harmful to some degree. What we need is context and not one-off sensationalist studies that are used as propaganda fodder on either side of the debate.
I'm not sure why you have been so offended by this research. It looks quite convincing to me, and fairly worrying.
When you say it "looks quite convincing", are you qualified to judge it on its merits?
I'm sure there will be more research in this area, now that there is not the threat of jail if people report on their usage.
First of all, what period did they look at, how many they expected to die, and how many of those did die. 1200 people sounds like a lot, but if their model said that 2.5 people should have died but 9 actually did, your results are extreme but the p-value isn't very high.
Further, do we trust the model that they had for how many should have died? They say what they did. But there are a lot of ways to tweak such a model, and p-hacking is naturally going to lead them to tweak it in ways that make the results look more significant.
Next, even if all of this is true, what is cause versus effect. Are people using marijuana to deal with life stress? If so, is the stress the real risk factor here?
There are a lot of things that can go wrong in a study, and most published studies are wrong. Until I see the methodology checked and the result replicated with a high reported p-value, I'm not trusting this study. Not because I don't like the outcome, but because that's simply how unreliable this type of science is.
In all seriousness, I'd love a breakdown, and references for further study (on how to read medical papers, or scientific papers in general)
I haven't read it, but you'll probably want a book like https://www.amazon.com/Design-Studies-Medical-Research/dp/04... or https://www.amazon.com/Study-Design-Statistical-Analysis-Cli...
realistically you need at least a master's degree in a quantitative field to get the time and knowledge required to evaluate studies like this. I see a lot of armchair "scientists" trying to evaluate studies, it's very common to see basic mistakes in evaluating papers.
To be clear, I think this is good research to be done. Better to know about this than not, obviously, and I hope it leads people to make some better life decisions. But I'm also anticipating that this is going to get held up as, "You see? It's the devil's grass!" in a very illogical and inconsistent way.
Guess how easily you can get any drug.....even in prisons. If we can't keep drugs out of prison then what chance is there to keep it out of the general public?
The war on drugs is over. Drugs won. Legalize them all, provide accurate labeling, and tax it. There is nothing left to "debate".
I'd say they're winning, and will almost certainly continue to. I really wish, for many reasons, we could move that to past tense like you did.
There are plenty of questions to be asked of this study, but blithely dismissing the sample size while attacking the government (and the recommendation that they do more to protect the populace) are not the first two holes to poke at this study.
1200 people is a huge, convincing study for a well-executed prospective, interventional study, like a clinical trial. This is a cross-sectional retrospective study, using merged data from several different sources. Retrospective, epidemiological studies are notoriously subject to bias, particularly ones like this one.
Such retrospective studies are good for forming hypotheses about diseases in study populations (and often, intervention studies are not feasible), but they are often inadequate for testing these hypotheses. As the study authors say themselves, longitudinal studies are required to really draw strong inferences.
I'd have to read the study to be sure, and it's been a long time since I formally studied or worked in epidemiology/biostatistics, but some of the numbers mentioned in this article look fairly unconvincing. For example, this study found very little association between tobacco use and metabolic syndome, which goes against most available evidence. Also, things like having insurance and being married are associated with a significant increase in metabolic syndrome (not sure if this is in line with existing research, but it sounds kind of counterintuitive).
For example, is there a skew in demographics between users and non users? Socio-economic status? Other health indicators? Diet? Pre-existing hypertension? (Were people self-medicating?) Lifestyle? What about delivery? Is this a smoking-in-general related effect or would other forms of consumption also have the same effect?
1200 people is a pretty large study, but from this writeup, it isn't clear that they would be able to completely single out cannabis as the sole factor. I'd have to read the fully paper to know more.
That said -- it is a worrying concern and certainly a good enough reason to continue studying this potential effect. Hopefully they will be able to continue with lab based studies to try and find an underlying mechanism.
That's how propaganda works.
I know it's anecdotal, but I've been a 3 or more times a day (everyday) smoker for over 11.5 years and I'm an no where near the risk of my overweight family members. Blood pressure has been fine and I'm an no risk of hypertension. Demand more proof if you're convinced by this. Something smells fishy. I would like to know how Snoop, Willie, and Morgan are holding up. They must be ready to keel over with how they smoke.
Cannabis is a hard topic for Americans to talk about, because it's been so often unfairly demonized in the past, there's a pro-cannabis camp that sometimes won't admit any downside to it, fearing "Reefer Madness" style FUD which has been very common for decades.
But is it really all that surprising that smoking could be bad for your health, irrespective of what it is? My take would be that people shouldn't be persecuted for this, but that it's straightforwardly obvious that any smoking (and doubly so an unregulated plant that would reasonably be expected to vary tremendously in quality depending on supplier) -- would be harmful.
That's true my comment was partly serious and a bit facetious. And I don't think it's surprising that these are the results. We've known for decades smoking cigarettes of any kind are bad and caused hypertension. It's a major reason I quit smoking combustibles like cigarettes. It definitely has the potential to be harmful.
Yep. The "three-fold" thing sounds awful but I didn't see the actual risk factor in the article. If it's 0.000001% and rises to 0.000003% that's a three-fold increase. If you're getting lots of other positive effects and quality of life effects from use then it may well be worth the risk.
First, alcohol is not as highly regulated as you might think. The contents of the bottle are not strongly regulated, and producers are actually forbidden under the law from listing the ingredients on the bottle. How do you know you're drinking true vodka, and not a mixture of grain alcohol or something worse? Without testing there is no way to find out, and the government doesn't do that unless there is a strong reason to do so. The Alcohol and Tobacco Tax and Trade Bureau regulates the label, they regulate those labels a LOT, but along with advertising that's about it. The rest of alcohol regulation is devoted to keeping it away from those under 21, with some PSA's on pregnancy, alcoholism, etc.
Tobacco is almost as highly regulated. Science has proven, more than we can count, and completely indisputable, that tobacco use leads to serious, life threatening health concerns. The best policy position to take on tobacco is to ban it, but they don't. The next best thing would be to set standards that limit the chemicals in tobacco. They don't. (Incidentally tobacco products weren’t even regulated by the FDA until 2009) This leaves regulation on packaging, advertising , where you can smoke, but has become largely focused on keeping it away from children, and reducing smoking. So in a way the government might seem to be protecting us from tobacco, but in reality, they don't.
Marijuana on the other hand is so highly regulated that it's been extremely difficult to even study it to determine what health affects it might have. I'm not saying one is better than the other, but morality has driven policy on marijuana for so long that the policy research on marijuana legalization, is only now beginning to gain substance. Until marijuana is studied as much as tobacco and alcohol, all policy decisions will be unfairly biased by morality and personal opinion.
What I'm railing against is "news" articles that don't contextualize or think critically about the studies that are being performed, and try to generate clicks through buzz-word filled headlines.
Ratio of sample to population size is mostly irrelevant for statistics. The strength of conclusions from a sample is calculated based on an infinite population size.
Bias: I am a non-drinking, unmarried, low-blood pressure, no cholesterol, extremely underweight stoner
> Marriage greater risk to heart than cannabis: report
But that wouldn't sell as well.
Well... yeah. Exactly like that. State and local laws cover when and where you can drink and smoke. The federal FDA extensively regulates OTC medications. HHS and ATF have extensive jurisdiction here too. And of course there is a very large private sector component made up of groups like AA, AlAnon and MADD that seek to address some of the social problems substance abuse causes.
I mean, you seem to be invoking sarcasm here, but in fact these substances are very heavily regulated right now. You need to expect weed to fall into the same category as it becomes legal and better-studied.
Yes those other things have regulations and restrictions, but how many alcohol related deaths have there been this year? How many heroin over doses that stemmed from prescription abuse?
My point is that context is necessary for these types of studies.
You can draw strong conclusions off of a smaller sample size.
This study is not conclusive, and the sensationalized headlines aren't helping.
First, I'm a little confused about how to interpret the finding that hypertension related deaths increased, but not stroke or heart attack; I have not been aware of hypertension as a common direct cause of death. For example the textbook "Cardiology Explained" states that: "If untreated, hypertension has serious consequences, including renal disease, myocardial infarction (MI), and cerebrovascular accident." Most general literature that I can recall reading seemed to similarly characterize high blood pressure as a risk factor for other causes of death.
Second, the author of study states "Support for liberal marijuana use is partly due to claims that it is beneficial and possibly not harmful to health." Who is supporting "liberal marijuana use"? Support for "liberal use" is not implied by support for decriminalization.
I hope that press release has left out some sort of context or attribution for this, because it is making it hard for me to take the study seriously.
Here is the meat of the abstract, and a link to the full text of the study:
We linked participants aged 20 years and above, who responded to questions on marijuana use during the 2005 US National Health and Nutrition Examination Survey to data from the 2011 public-use linked mortality file of the National Center for Health Statistics, Centers for Disease Control and Prevention. Only participants eligible for mor- tality follow-up were included. We conducted Cox proportional hazards regression analyses to estimate hazard ratios for hypertension, heart disease, and cerebrovascular mortality due to marijuana use. We controlled for cigarette smoking and other relevant variables.
Of the 1213 eligible participants 72.5% were presumed to be alive. The total follow-up time was 19,569 person-years. Adjusted hazard ratios for death from hypertension among marijuana users compared to non-marijuana users was 3.42 (95% confidence interval: 1.20–9.79) and for each year of marijuana use was 1.04 (95% confidence interval:1.00–1.07).
From our results, marijuana use may increase the risk for hypertension mortality. Increased duration of
marijuana use is associated with increased risk of death from hypertension. Recreational marijuana use potentially has cardiovascular adverse effects which needs further investigation."
... Yes? Those are all heavily regulated and/or massively taxed.
Sometime freedom means the freedom to make what others think are bad decisions.
You probably should have made that clear though.
I don't know what you're going by.
My guess is the HN title should probably be:
"Unmoderated ingestion of unhealthy food after smoking marijuana holds three-fold blood pressure death risk"
Second, even if this is true, I'm a fucking adult and can make my own decisions. It changes nothing about my support for legalization especially when shit like tobacco and alcohol are legal which we know for sure cause hundreds of thousands of deaths each year.
Third, from the Oregonian link below because the actual link provides little detail: "But it did not take other cardiovascular risk factors into account, including diet and exercise." Oh yes, let's ignore the most obvious causes of heart problems completely. Surely they couldn't possibly be responsible.
That said, there are so many third variables that are associated with adult chronic usage (no pun intended) of marijuana that covariates may have a hard time removing their influence. What is needed is a mechanism, shown in animal and cellular models with random assignment. I haven't had the chance to read; was one proposed?
"Correlation is not causation."