 Today's podcast is brought to you by FreshBooks.com. Get a 30-day free trial at gofreshbooks.com forward slash David Feldman show. The David Feldman radio program is made possible by listeners like you. You sad pathetic humps. On election day 10 states will be voting on some form of marijuana reform despite the Obama administration's decision earlier this year to keep marijuana as a schedule one drug listed in the same category as LSD and heroin. Chuck Rosenberg, the head of the DEA, said over the summer that marijuana has no currently accepted medical use in treatment in the United States. Despite that, California voters will decide on Proposition 64, the Adult Use of Marijuana Act legalizing possession of one ounce of marijuana for adults over the age of 21. Californians will be allowed to grow up to six plants a year and the sale of marijuana for recreational use would be taxed and regulated. For more on this, we are joined by Dr. Stanton Glantz. He's in San Francisco today. Dr. Glantz is often called the Ralph Nader of the anti-tobacco movement. He's written four books including the cigarette papers and he's also a professor at the School of Medicine at the University of California, San Francisco. Thank you for joining us, Dr. Glantz. Well, thank you for having me. You believe tobacco and marijuana have similar chemical profiles and that as we move towards legalization of marijuana, we need to regulate it more like we do tobacco and less like we do alcohol. Before we talk about the public health framework to deal with marijuana use, I'd like to start looking at the fields of hemp before drilling down into the weeds which marijuana is a weed. In the abstract, Dr., without specifics, are you for the legalization of marijuana? If it's done properly, yes. I think the war on drugs has been a disaster and we need to accept that and move beyond it. In the abstract, do you believe that marijuana is as dangerous as alcohol? In the abstract, just generally speaking, for parents who are listening, do you think tobacco and marijuana? I think that it's probably more dangerous than alcohol. You believe? It's probably in the end going to be as dangerous as tobacco, maybe even a little more dangerous. But you've been writing that we compare marijuana too much to alcohol and not enough to tobacco. So let me just talk about the psychological dangers in the abstract and the addictive nature of marijuana. Do you believe, generally speaking, that we have to watch marijuana the same way we watch alcohol in terms of its addictive nature? Well, it's actually probably worse than alcohol on that dimension too. But the problem is the way people have been thinking about marijuana's health effects have almost been really focused on the questions of psychiatric and psychological effects. But because marijuana smoke is not all that different from tobacco smoke or, for that matter, diesel exhaust, I think we really need to worry about cancer. The state of California has already put it on the list of known human carcinogens and also heart disease and the other kinds of diseases that tobacco causes. So I think the discussion of the health effects of marijuana has been too focused on what's above the neck. The other problem is that marijuana, as it's used now, is probably going to have absolutely no resemblance to what we're going to see five or ten years from now when the market becomes corporatized and we have the kind of modern product engineering that goes into things like cigarettes and junk food. I think the big multinational corporations will be able to make marijuana cigarettes which are much more habit-forming, much more addictive, and other marijuana products that are much more addictive and used at much higher levels. Okay, let's drill down into the weeds here. You write that marijuana has been in the crosshairs of big tobacco since 1969. Why 1969? What did big tobacco realize in 1969? Well back in the 60s and 70s when the tobacco companies were really actively looking at getting into the marijuana business, they thought marijuana was going to be legalized for many of the same reasons that we have today. And so they started doing studies of the product. They started thinking about how they would go about marketing it and how they would engineer the product. Now in the end they abandoned it because the discussion of legalization faded and it's not clear quite what they would have done had history developed differently. But the important point is that we have giant corporations who know about branding, who know about national marketing, and who know about how to engineer sophisticated products to maximize consumption. So you've been fighting tobacco for a good chunk of your career. Are you suggesting that big tobacco would manipulate THC levels the way they manipulated nicotine levels in order to make marijuana more addictive? As I understand marijuana, there's a limit to how much you can smoke. You become sated and you can only get so high. I can't imagine somebody having a three pack a day marijuana habit. Is that what big tobacco is trying to, is hoping to create? Well, whether it's big tobacco or some other big corporations that get into the business, the capitalist market drives companies to profit maximization which means maximizing consumption. And it's not just the level of nicotine or THC in the case of marijuana that you're talking about. There's a million other ways that tobacco products are manipulated to maximize use. And for example, if you look at cigarette consumption in the United States when it peaked, it was hundreds of times higher than it was when the whole market started. Can you say that again? Can you say that again? I'm sorry. Well, let me say it. I didn't say it that well. Okay. Believe me. Compared to me. Okay. Before that, people used tobacco before the advent of the modern cigarette industry around the beginning of the 20th century. But they didn't use very much of it. And with the advent of modern cigarette design and modern cigarette technology which became increasingly sophisticated over the years and mass marketing, the level of consumption of cigarettes exploded. And people look at old movies, which by the way, they were paid to put smoking in and think, oh, everybody was smoking back in the 20s and the 30s. In fact, the amount of smoking going on back then, the per capita cigarette consumption back then was a little bit lower than it is today. Let me back. Let me ask, let me follow up on that. First of all, MGM was taking money from big tobacco. So Betty Davis would appear to be sexy, smoking a cigarette is product plus. Well, I don't know if it was Betty Davis particularly, but yes, like Claudette Colbert was one, another big star that I know for a fact was. There was about a hundred or so that we've been able to document. And the reason we know all this stuff, both about smoking in the movies and all the history of payoffs between big tobacco and Hollywood, as well as the fact that the tobacco companies were looking at getting into the marijuana businesses. We have about 90 million pages of internal industry documents here at UCSF on the internet. And we found all that stuff in there. And when people think of a cigarette, you think it's a bunch of tobacco ground up and wrapped up in a piece of paper. That's not true. It's a heavily engineered product where they control everything from the density of the packet, packing the tobacco to the nicotine levels to lots of additives to control burn rates, particle size, how it anesthetizes your throat so that you can inhale more deeply, change the acidity of the smoke, which affects how fast the nicotine is absorbed and the list goes on and on and on. And so the way marijuana is being used today, because the marijuana that's being grown today has higher THC than it used to, but none of these modern product engineering techniques have yet been applied. And when those come in, I think they're going to see use explode. And that's the big concern I have about Prop 64 is that we'll get to that by a little bit. Let's get to that. Let's get this is your before the big tobacco people dreamed up these new nicotine delivery devices. Was there such thing as tobacco addiction in the 19th century where people addicted to tobacco before big tobacco? Oh, yeah. Yeah, sure. The nicotine, the nicotine and the effects that nicotine has are what they are, but we didn't see the heavy widespread use of the product. So in the 19th century, when I see my cowboys and wider when they're just rolling their own, they're smoking pure tobacco. Correct? Well, I don't I mean, I don't know. I mean, I don't know what they put in it, but it was certainly what they were smoking was wildly different from what people are smoking today. Okay. If I grew my own tobacco plants and cured them and then just when they were ready, crumbled them up and rolled them in rolling paper and smoke them. Would I be sated? Would I be smoking as much? Would I be as at much risk of lung cancer and emphysema as I would buying a pack of cigarettes? Is it safer to roll, to grow your own tobacco, roll it and smoke it then it is to buy a carton of Winston's. If you're smoking the same amount, it's probably a little bit less dangerous because probably the particle sizes are would be larger because probably because you don't have all the additives that affect how deep, you know, how deeply you inhale. It's still going to be pretty dangerous, but it's probably not. But the thing is the thing that the thing that you didn't have that you wouldn't have if everybody smoke grew their own to smoke is you wouldn't have mass marketing and you wouldn't have the kind of sophisticated product engineering that increases consumption. For example, in 2014, the Surgeon General put a big report out and said cigarettes in 2014 were more dangerous than cigarettes in 1964 because as the product, the engineering of the product had evolved, the tobacco company said, figured out how to make the particle sizes smaller, which gets the smoke deeper into your lungs and increases the nicotine absorption, but it also increased. It changed the kind of one cancer people got and it made it made it worse. So you would be more sated. The 19th century cowboys were sated. They didn't need to smoke as much tobacco. No, I don't know that. I don't know if that's true or not. I can tell you they didn't smoke as much tobacco. So whether that was because they were more sated or because it just was harder, it was just harder to in order to consume at the levels that people were consuming by the mid 20th century, you couldn't just make cigarettes fast enough to do it. I mean, it used to be and when you were doing roll your own cigarettes, you know, a really good cigarette maker because people had jobs making cigarettes back then. I think could could could roll like a hundred cigarettes an hour or something. Well, the modern cigarette manufacturing machine would would generate a thousand or ten thousand cigarettes an hour. So back before the advent of the modern tobacco industry, you just couldn't, you know, you just couldn't get the product fast enough to smoke at the levels which are happening today. It was just the two things that led to the modern tobacco industry were the invention of the cigarette manufacturing machine and the advent of mass marketing. And the thing the thing that that then followed that as these corporations grew and became richer and more powerful was modern product engineering to design the product in a way to maximize consumption. OK, so none of that none of that has yet happened with marijuana. But the corporatization of the market, which is what Proposition 64 is going to bring, will make all of that possible. That to me is the scary thing about Proposition 64. And the reason that even though I think marijuana should be legal, because I think the war on drugs has been a catastrophe, I'm going to vote no on 64 because I think we're going to trade a criminal justice and equity problem for a bunch of heart disease, cancer, and other diseases. And we're going to be basically create the new tobacco industry. Now, whether it's the tobacco industry that decides to get in the business, or whether it's somebody else doesn't really matter. It's the capabilities that modern corporate America has. I mean, it's the same the same kind of thinking, the same kind of product manipulation that goes into tobacco goes into junk food, for example, in order in order to try to design the foods so that you'll eat, you'll eat as much as possible. And I have no doubt that with the profit mode of driving and the kind of pro industry regulation, which is written into 64, that these these companies are going to end up in the business and the same exact kind of problems that we have with the tobacco crisis with the junk food crisis are going to we're going to see them admit with marijuana. And I think that there's a right way in a wrong way to legalize and this is the wrong way. Unless you're a venture capitalist, of course, if you're a venture capitalist, it's a great deal. That's why they're backing the initiative. And do we know if big tobacco is backing it? Are they not that I know of? I think they've, they've been very, very careful. They have enough legal problems right now. And they've been very careful to not be visible in the discussion. But you know, if they wanted to get into this business, they could do it in a flash. But if it's not them, it'll be somebody like them. Mm hmm. Before you go, this is fascinating. You're against 64 being passed. I want to get back to the dangers of marijuana, and then we'll wrap it up. I used to smoke a lot of marijuana, but I didn't smoke the marijuana that I'm not gonna say my kids, but my kids smoke. I don't approve of marijuana. I'm progressive liberal. I don't think people should be arrested for marijuana use. I agree with you. I agree with everything you're saying. And that's why I called you because we have a culture now that's pushing marijuana, where people are saying marijuana is perfectly safe. And we haven't even begun to explore what hemp can do for us. And that it's in the interest of big industry to keep marijuana illegal. I don't buy that. I think that marijuana is dangerous. And I, Jerry Brown, who I admire, said on Meet the Press, do we want to live in a country where everybody's stoned? Yeah, I think no, I don't think I don't like marijuana any more than I like tobacco. I don't think people should use marijuana. But the question is, should we be people throwing people in jail if they use marijuana? And should we try to use the criminal justice system in order to reduce use? And it, you know, it hasn't, I mean, regardless of whether you like marijuana or not, or think people should be smoking marijuana or not, the fact is the war on drugs has caused gigantic social inequities in this problem, waste and waste that is huge amount of money, and it hasn't really worked. And so, you know, if the irony in all of this is if you look at tobacco, it's perfectly legal uses declining and it's becoming more and more socially unacceptable. In marijuana, it's illegal uses increasing and it's socially accepted. And so what I think we should do is get rid of the war on drugs, not throw people in jail for using marijuana, but concurrently with legalization, put in place a large demand reduction program modeled on the California tobacco control program. I think we should apply best practices for tobacco control to marijuana, which would include plain packaging, large warning labels, prohibitions on public use and protect to protect bystanders, and ideally sell it in state stores so that there would be no corporate involvement, no mass marketing, no product engineering. And so that if those people who really want it can get it, but where there's not any steps being taken to actively promoted and where the revenues generated from the sale and taxation of the product go into funding aggressive counter marketing to get people to not use it. And instead, what we're doing is we're creating a for profit market, where we're instantly going to have giant corporations coming in making campaign contributions, hiring lobbyists, and we're basically going to be creating the tobacco mess. So it's more than just not wanting people walking around stone. I agree with the governor, we don't want people walking around stone. But the thing that nobody's talking about is for example, marijuana secondhand smoke is even worse for your cardiovascular system than tobacco secondhand smoke is. There's this research we've done here at UCSF. We thought it wouldn't be as bad because THC is a vasodilator. It turned out to be worse. What do you know? Nobody's thinking about that part of it. I love the smell of marijuana. I do. So if people if people want to smell it, good for them. You know, I went to we have a big outdoor music festival here in San Francisco called Hardly Strictly Bluegrass. It's outdoors. It's in Golden Gate Park. I went there to listen to it and walked out wheezing. You know, I don't think people should be I think all the same rules that apply to tobacco should be applied to marijuana. Because if people if somebody's dumb enough to want to use it, just like if somebody's dumb enough to smoke or seduced by the marketing, you know, I shouldn't have to be have that inflicted on me as part of going about my daily life. And the the you're exactly right. The ideology that sort of social framing we have around marijuana today is that it's not only not bad for you, that it's good for you. And and you know, while it's true, there are some legitimate medical uses of cannabis. The claims that are being made for medical marijuana are just ridiculous. But because the Obama administration keeps it unless schedule one, it makes it very, very hard to do research, not impossible, but very, very hard. And going through the FDA and applying the our normal rules for making claims, medicinal claims about drugs have been completely pushed to the side. So if you're sitting there as a business looking for a way to make a lot of money, a legalized marijuana market under the terms that Prop 64 has is like your dream come true. That's why property values are exploding up in Humboldt County. I have a friend who publicly claims that marijuana helps deal with his chronic pain. And then he confessed to me, it's not really true. I just like smoking dope. Is is marijuana are there certain strains of marijuana that help deal with pain? Well, you know, that's not an area that I'm expert on, but I went to a two day meeting back at the National Institutes of Health a few months ago, and there was a whole session on are there therapeutic uses of cannabinoids, which is the scientific way of asking are the smoking marijuana or you or marijuana extracts have any clinical value. And the answer to that is yes, there are some clinically demonstrated values of marijuana. But there also a lot of harms and it would be the current environment around medical marijuana. It's like saying, well, if you have cancer, chemotherapy is a good thing. Therefore, everybody should be using chemotherapy because it's good for everything. Wow. And you know, when we look at the medical marijuana market, it looks to me it's like the nutritional supplements market on steroids. We need I would get rid entirely of the medical marijuana market. And that's another problem was 64 by maintaining a medical marijuana market and a retail recreational market side by side with different rules. It's creates a huge level of complexity, which is going to make any kind of meaningful enforcement very, very difficult. So you're you, I think, excuse me for a second, Dr, you're saying the marijuana dispensaries, medical marijuana doctors writing prescriptions for marijuana. Bad idea. I think it's a terrible idea. I think if we're going to have a legalized market, there should be one unified market. This is actually what Washington State is doing. I think that people should be prohibited from making any medicinal claims about marijuana until they've actually been the same kind of studies that are done for other drugs. And if there is a legitimate medicinal use for marijuana that's been demonstrated to the same kind of standards we use for other drugs, then fine, use it. Well, let me ask you that it shouldn't be it shouldn't what we have now is that you know, it that medicinal marijuana, if you listen to people is good for everything at all doses. And that that's just not true. Some of the some of the claims, I mean, I don't remember the details, but at this meeting I was at an NIH, you know, people doctors are up from Colorado pediatricians were getting up there talking about parents who had sick kids who were bringing them in who were giving them medicinal marijuana in areas where the scientific evidence was showing that it actually was dangerous. And when these these doctors would tell the parents, you know, that's not a good idea. They would get mad at them. I'm going to ask you a rude, can I ask you a rude question? Sure. Okay. Are you a medical doctor? No, you're a PhD in I'm a PhD, but I'm a professor of medicine. And I hang out with them. And you know, I'm not, I'm not talking about practicing medicine, which is the reason I didn't bother going to medical school. But you can know about medicine. And you can know about medical science. So even though you're not taking care of patients, I haven't asked my rude question yet. Okay. We have two big enemies in this conversation. One is big tobacco. The other enemy is big pharma. Are you in the pocket of big pharma? I've never taken a penny from big pharma. Do you believe big pharma as is as big a problem as big tobacco? I don't think big. I think big pharma is a different kind problem than big tobacco. Because there are lots of drugs that big pharma makes that are really good, you know, people's lives are saved. I mean, I have, because you know, in my personal history, I've had a couple of medical problems that I've been in, you know, 100 years ago, what it killed me an infection that would have killed me 100 years ago. Right. So I think the pharmaceutical industry is an important part of our society today. The problem with big pharma is their unmitigated greed and political power. And the fact that that they are taking advantage of the fact that they're making life saving products to gouge people beyond beyond belief. And they do lie a certain amount, not nearly as much as big tobacco, but they suppress science like the tobacco companies do. They make claims that overstate the value of a lot of their products the way big tobacco does. They engage in predatory marketing and see evidence. We're one of only two countries in the world that allows television advertising for prescription drugs. So I think big pharma, there's a whole lot of things that are wrong with big pharma. But they're they're a bit different from big tobacco. But by the same token, big pharma is is another, you know, it's a big corporate enterprise. Their goal is to maximize use, not necessarily appropriate use. And that's in fact how we have the opiate crisis. You know, let me let me ask you, this is interesting. And you've been very generous with your time. Is it fair to say that big tobacco is salivating over the legalization of marijuana while big pharma is foaming at the mouth over the possibility of the legalization of marijuana. In other words, big pharma does not want marijuana legalized. This is no, I don't you know, if you go back, one of my colleagues here at UCSF at center research team back to Colorado to interview people it in it who are selling marijuana commercial marijuana in Colorado. And they came back and said, you know, the primary model they're thinking about is the startup model. I'm going to get a variant going, I'm going to get a business going and then I'm going to sell it out. And whether I sell it out to big tobacco or big pharma or big food, I don't care. I'm going to get this going sell it out and make a gazillion dollars. And you know, I I think the big pharma, if they wanted to get into this business, they could make a ton of money too. I think whether it's big tobacco or big pharma or big food or big something else, it doesn't matter. The thing that matters is the corporatization of a of a for profit market, where you comment where you have matter, modern product engineering, modern mass marketing to maximize consumption, and an industry with a political power to make it very, very difficult to fix the mess that Prop 64 is going to create. You know, another problem with 64 is it's like 60 or 65 pages long. It's very proscriptive. And in order to change it, once people realize that, oh, this might have been a problem, they're going to have to go back to the ballot. And then what you're going to run into is just what we're seeing in the tobacco tax prop 56 here in California. We have a perfectly sensible idea for a tobacco tax to get money to reinforce the state's tobacco control program and fund health care for poor people. There's a gigantic $70 million so far campaign being run against it. 99.96% of the money is coming from three cigarette companies. The rest is coming from some smaller tobacco interests. So there's a huge fight going on to do something that makes a huge amount of sense for both a health and economic point of view in California. And it's been fought back by a few big corporations that are going to lose money if it passes. Right. And I think that's what the situation 64 is setting us up for. We have to wrap it up. This has been fast. One of the things that I find shocking from this interview is you say with marijuana use we have to focus more on the head down what marijuana does to our throats and our lungs. That's and heart and heart and blood and blood vessels. Yeah, that's fascinating. And second hand marijuana smoke you say is more dangerous than second hand tobacco smoke. So that's pretty interesting. From the head from the neck up. Is it fair to say that when a doctor prescribes marijuana for anxiety or depression that that it does have legitimate use for treatment of anxiety. I always assume that's just that's just not an issue that I know enough detail about to comment on it. This is an expert as opposed to I do know I do know that heavy use of marijuana in leads to increases in anxiety. But I don't know whether you know a little bit of it might be good. I don't know. But the problem is that it's very, very difficult to do the kind of studies and to have a regulatory process with the FDA for all of its warts and we could do a whole show on everything that's wrong with the FDA. But you know, at least the FDA is there to try to provide a neutral arbiter of whether these claims are valid or not. And I don't know the answer to that. The problem is we don't have a good system in place for getting an answer to that question that the public and medical practitioners can trust. Yeah, the DEA made the decision this year to keep marijuana as a schedule one drug based on the Food and Drug Administration's recommendation. The problem with the FDA is the drug companies pay for the tests that the FDA makes its decisions on, correct? Of some of them, sure. But you know that I think, I know a lot of people with the FDA because they now regulate tobacco. And the FDA corporate culture is very, very, very, very cautious. And I my guess I think it's less than money. I think it's that they're afraid of it. They don't want to get they know that it'll be difficult and they'd be easier to just not get involved. It would be I think it's I didn't get the you know, that's the problem. I don't think it's that they're getting paid off by the drug company. I don't think it's a matter of being paid off. It's just it's who's the FDA charges the industry for the tests. Right. But if they were to start, if let's say we had my view of a good world where marijuana was off schedule one and people were doing proper medical research on it, and then putting products into the FDA for the normal kind of approvals, then they would pay for it too. I mean that I think that the basics you mean you can argue about whether the drug companies ought to be paying for that because that does create a bit of a conflict of interest at the FDA. So the reason there's no reason we don't have enough studies on marijuana is we live in a country that is controlled by big money. And there isn't enough big money behind the marijuana industry to coerce the FDA into conducting more and more studies on marijuana. So it remains a schedule one drug because the FDA doesn't know enough about marijuana. Well, I don't think that the bad guy here is that they based on our experience because I was been involved in the study we did on second and marijuana smoke and heart disease. I can it's not the FDA. They were never an issue. It's the DEA. They made it. It took my colleague Matt Springer who led this research two years to get all the approvals that he needed. And I mean UCSF is like four blocks from Haydashbury and for them he couldn't just walk down there and buy the marijuana cigarettes on the street. We had to get them from the National Institutes of Health and he had to put a special safe in his office to keep the marijuana cigarettes and the the amount of paperwork and regulatory grief that he had to go through to just do this study was gigantic. So I think the big problem is the DEA. You know, I don't think he didn't get to have any problems with the FDA. The NIH thought it was a great idea. But the the when he tells the story when he lectures, I mean, you know, you could put them on your show. It's it would be funny if it wasn't so pathetic. Some of the things that he had to go through in order to expose rats to marijuana secondhand smoke. It was ridiculous. Dr. Stanton Glantz is the author of cigarette papers, among other books. And he's also professor at the School of Medicine at the University of California, San Francisco. And he's voting no on Proposition 64 in California, which would legalize recreational marijuana use. He's against it because he doesn't believe it has a framework for proper public health. So I thank you for joining us. And I hope you come back real soon. Thank you, Doctor. We'll tell you about a podcast that I listen to to my friends host it. And I think you should listen to it. Andrew Goldstein, maybe you remember him as my Jew on some of our more popular episodes of the David Feldman show. Andrew Goldstein is a brilliant comedy writer from MTV and Race Wars. And Matt Matt Matt Goldich writes for late night with Seth Meyers, brilliantly funny comedian and comedy writer. They have a new podcast. You can download it on iTunes. It's called Sorry, I've been so busy. You know, everyone always says they're so busy. But what exactly are they so busy with? Well, in their podcast Sorry, Been So Busy writer comedians Matt Goldich and Andrew Goldstein talk to their interesting and funny friends to find out what they've actually been so busy with everything for major life and career events to everyday minutia. Sorry, I've been so busy is the only podcast that will never blow you off unless something comes up.