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July 24, 2012

Host: Ted Simons

Expanding Medical Marijuana

  |   Video
  • The Arizona Department of Health Services has decided not to expand Arizona’s medical marijuana program to include new ailments. Hear what ADHS Director Will Humble and UA assistant professor Dr. Sue Sisley have to say about the decision.
  • Will Humble - Director, Arizona Department of Health Services
  • Dr. Sue Sisley - Assistant Professor, University of Arizona
Category: Medical/Health   |   Keywords: medical, marijuana, UA, ,

View Transcript
Ted Simons: A director of the Arizona department of health services has decided no to the expand the state's medical marijuana program to cover new medical conditions. The department was petitioned to add migraines, depression, anxiety and posttraumatic stress disorder, but citing lack of scientific data about benefits and risks the department denied those requests last week. Here to explain that decision is state health director will humble and in opposition, Dr. Sue Sisley. She's part-time faculty for U.A. College of medicine where she is trying to start a study using marijuana to treat PTSD. It was your decision. Why not include PTSD, stress disorder, anxiety and migraines?

Will Humble: I'm a big believer in using scientific evidence to help drive decisions like this. So that's pretty much what we did. We looked at the scientific literature, the published works of scientists around the world, and we looked at the evidence. We hired UofA to do some work for us as well. They looked at the series of studies out there and I had my medical review team at the department of health services, physicians in the department, look at that evidence. They gave me a recommendation. I reviewed the studies and bottom line, I just didn't see the kind of scientific evidence that I need to add those medical conditions to the list. By the way, it's a permanent add. When a director adds something like PTSD to the list, it's there for good. There's no way of pulling it back if later scientific evidence suggests in fact it's harmful. Or doesn't help at all. So there was just a lack of evidence.

Ted Simons: Lack of evidence, not enough evidence. Why is that not a good enough reason?

Dr. Sue Sisley: I think bottom line is that the federal government stymies all this marijuana research. So by setting up a standard saying that you only will accept randomized controlled trials as the ultimate guideline of whether to add conditions sets an unattainable standard for our community. I take care of these patients every day. I'm sitting with patients and their families who are trying to put their lives back together, dealing with PTSD, and most of my patients are combat vets, first responders. Police and fire who have been injured in the line of duty. These folks are going to be -- they are not going to have legal protection under the medical marijuana program. I think that's very disappointing.

Ted Simons: What about the idea that you're looking for the kind of research that no one does because there are so many restrictions?

Will Humble: Well, so in the world of science there's a gradient of studies. At the top, really the top of the pyramid are these randomized controlled clinical trials which is the gold standard for public health and medicine. If there were data in that category that would be the best. If there was data, randomized trial, controlled for compounders, you could say, I can hang my hat on that. But that's not the only kind of study that’s out there. There are things called observational studies which I know it's inside baseball to most viewers but in the world of science there's observational studies which don't meet the same standard as that sort of gold standard study but still can provide really valuable information. We looked at the evidence like I said, looked at the published works and there's not much in that observational category either. Those are much easier to do. Because there are sixteen or so states that have medical marijuana programs. that's your cohort.

Dr. Sue Sisley: I'm focused on PTSD because I participated in that petition. I can tell you that, because these patients are not afforded legal protection it's impossible to recruit patients in to an observational study where we're asking them to come out of the shadows and declare they are using this drug illegally. They live in fear every day of arrest and prosecution. So to ask them to be recruited into a study even if you say it's confidential, if you can guarantee, maybe you can talk to the governor, ask her to guarantee legal protection for these patients so they can participate in an observational study I would welcome it. We would help you. Maybe you could fund the study. Director Humble has done such a good job managing the program, he's accumulated over a $5 million surplus. That could easily be used to sponsor these legitimate trials that he's requesting from the community.

Ted Simons: What about that?

Dr. Sue Sisley: Well, the fund is limited by law. Voter approved language says to implement the program. So we can use the money to implement the program. That means when we get the dispensaries coming online we're going to hire an accountant to look inside their books to make sure they are truly nonprofit. There's a series of things we can do with it. Research at least the way it's defined right now under the law really crosses that boundary. But it could be changed. Takes three-quarters in the legislature. It could be changed but right now the way the law reads we're kind of restricted.

Ted Simons: Without that research, any kind, whatever the strata of research we're talking about here, without that is there not a concern that there could be a placebo effect? Is there not a concern that in some cases you could be doing more harm than good having some of these folks being prescribed marijuana?

Dr. Sue Sisley: Absolutely. There's no question that we need more research and that's why I think -- we do have things to look at. We have, for instance, two states who have already approved PTSD. In New Mexico, they have had it on the books since 2009. The sky hasn't fallen. All the dire predictions have gone unfulfilled. I think what's interesting is that marijuana has remarkably low toxicity. It's much safer than many of the drugs that we physicians prescribe every day. An example is the fact that our own poison center, the manager of the Arizona poison and drug information center in 2010 reported that of 65,000 calls that they received, only 26 concerned marijuana. You can see that when people have a reaction it's minimal and generally I think that what we are here to advocate for is more research. I would really welcome the opportunity to partner with director humble to go to the DEA, to our elected officials and stand shoulder to shoulder with us so we can urge them to eliminate the barriers to legitimate high level rigorous scientific study.

Ted Simons: Before the decision you heard from a lot of folks, a lot of patients, a lot of doctors, a lot family members. They are convinced placebo or otherwise, convinced that this helps them. Did you not totally believe them?

Dr. Sue Sisley: No, yeah. We had a bunch of folks that came to a public hearing. I believed all of them. They looked really sincere. Their stories were compelling. But with a job like mine, you're in charge of making policy decisions like that, you -- I feel like I really need to look at the full scope of scientific evidence. You know, individual testimony is one kind of evidence, a case report is one kind of evidence. But to me, it doesn't cross that line at least for me professionally to say, okay, I'm going to make that leap, add this to the list for good in the absence of good, solid studies. So your point is well taken that there is this absence of studies. It is true that by virtue of the fact marijuana is on schedule 1, the top category most restrictive category, that the federal government is restricting studies and it’s not a high priority for NIH. So there are barriers in place. They are federal barriers, not really an Arizona thing.

Ted Simons: With those barriers in place, it is what it is, to coin the phrase, you still have things like migraines, chronic pain is covered by medical marijuana. I know anxiety an amorphous, PTSD with be vague, but can you not find ways to deal with those patients with what is already covered?

Dr. Sue Sisley: Well, the struggle is that we have worked so hard to make this an exemplary medical program and we're trying to train physicians who participate in the program to strive for the highest ethical standards. So I don't want to then encourage docs to maybe be vague about the diagnosis or fudge it in a way to fit into a category. We want these people to perform in the most exemplary way.

Dr. Sue Sisley: You brought up migraines. And that’s a good one to bring up. That was the one that was really stood out as different than the others in the sense that migraines by their very definition are severe. In order to qualify as a condition, any condition can qualify if it causes severe and chronic pain. Not “or” but “and”. So if a clinician believes that the migraine is causing severe and chronic pain, that's an appropriate treatment for that patient, migraines are a fine diagnosis. My challenge was to add questions to add migraines per-se in the absence of severe or chronic pain and just the data wasn't there.

Ted Simons: With that in mind, last question for you, why not err on the side of the patients, the side of those in pain?

Dr. Sue Sisley: You know what? By using science you are er ring on the side of patients. That's my opinion. The scientific method has gotten us to where we are today in public health and in medicine. I'm not going to abandon the basic principles of using research to make decisions because of stories you might have heard at a hearing.

Ted Simons: Last question for you. Why not wait until more data comes in, until the state and whoever makes the decision is ready to say, we are willing to make this commitment? They are not saying no forever, just for now.

Dr. Sue Sisley: Well, we have to wait now because the petition has been rejected. In the meantime I hope director Humble will step up as a result of this discussion and go arm and arm with us down to our congressional delegation and help us eliminate those barriers to the very research that you're demanding from this community.

Ted Simons: All right, we have to stop there. Great discussion. Thanks for joining us.

Will Humble: Thank you.

Focus on Sustainability: Sustainable Economic Development Initiative

  |   Video
  • The nonprofit Sustainable Economic Development Initiative (SEDI) was established to create sustainable economies in Northern Arizona. SEDI executive director Carol Bousquet and Board Member Holly Yeager talk about the organization.
  • Carol Bousquet - Executive Director,Sustainable Economic Development Initiative (SEDI)
  • Holly Yeager - Board Member,Sustainable Economic Development Initiative (SEDI)
Category: Sustainability   |   Keywords: economy, sustainability, development, ,

View Transcript
Ted Simons: Today's focus on sustainability looks at a nonprofit organization that's trying to create sustainable economies in northern Arizona. Here to talk about SEDI, the sustainable economic development initiative, is its executive director Carol Bousquet, and the board member Holly Yeager, who works for Coconino director of organizational development. Thanks for being here.

Carol Bousquet: Thanks for inviting us.

Ted Simons: What is SED?

Carol Bousquet: Well, SEDI consists of 45 board members plus alternates, plus 45 committed people who are promoting economic prosperity in northern Arizona, sustainable prosperity in northern Arizona.

Ted Simons: I had a definition here. Sustainable economic prosperity through ecological health, social equity and resilient economy.

Carol Bousquet: That's our mission.

Ted Simons: But what does that mean?

Carol Bousquet: Well, I would say what we're trying to do is promote a sustainable economic environment that can be perpetuated, not one necessarily that would -- well, holly, that would land you in a place that you would have to go back if you brought in a company that was there only because of some certain incentives, for example, and then the economy changes and they have to leave and lay off all the people --

Ted Simons: Not good.

Carol Bousquet: That's not sustainable.

Ted Simons: It sounds like you have a resilient economy as you mentioned in your mission statement. Describe a resilient economy against a good, old fashioned strong economy.

Holly Yeager: One of the things for resilience in northern Arizona is it's a great place to live. So we're always looking at how can we keep the companies that we have and how can we really promote companies that want to do the best for their communities. So resilience for us can look like things like having sustainability in the school system. Promoting a culture of entrepreneurship. Helping with local food and promoting local food and local entrepreneurs.

Ted Simons: It sounds like the focus is local.

Carol Bousquet: You got it.

Ted Simons: That's basically what it is. Get it here, keep it here, promote it here, grow it here.

Holly Yeager: What does that mean for northern Arizona, for our environment as well as our economy?

Carol Bousquet: One of the unique features of the flagstaff region is that we're not very close to other urban areas. We count on transportation systems to bring goods and services and if we can contain that, provide more goods and services closer to home, that's easier to sustain.

Ted Simons: We mentioned keeping things local. Work force training would help keep local workers local. Correct?

Carol Bousquet: Absolutely.

Ted Simons: And you have a work force training program?

Carol Bousquet: We have been working for years on putting together a work force training program in the region which we anticipate being launched in January of 2013. So we're very excited about that. It's a collaboration with a host of local entities including the community college, the university, the county, the city, school district. It's a facility that is utilizing an under-purposed what is now a middle school once was a high school and there are empty shop spaces that are going to be renovated for that purpose.

Ted Simons: Challenges getting this work force training -- sounds like it's been a long time coming. Have there been speed bumps?

Holly Yeager: Well, we did a survey. We identified that manufacturers are going to be need ago work force training force in northern Arizona. We're expecting lots of job growth. We have all kinds of things going on including forest restoration initiative. The need to train lots of people in manufacturing. What a great opportunity that we had a chance to use the existing machine floor of the former high school. Things like this wouldn't happen without study. Because, you have government, nonprofit and business leaders all at the table saying how do we make the best of the resources that we have and really make the connection between the university, the work force that we're training and the needs of business.
Carol Bousquet: I would also add to that that some of the speed bumps along the way have been questions about how would that work? How would we partner? What are the odds? How can we overcome those obstacles. It's been a long and interesting process of trying to think creatively about how to come together in a cohesive fashion and make something happen.

Ted Simons: You mentioned developing entrepreneurs up there. I notice on your mission site developing an entrepreneurial eco-system. What does that mean?
Holly Yeager: Well, we're really excited because we're doing an event on october 9th at the high king conference center where we are going to talk about what does it take to create a culture of entrepreneurship. There's really a role that each of us can play as policy makers, what's the role for a local government? What's the role in terms of existing entrepreneurs and ensuring their success and then for people starting out from the very beginning. So we wanted to offer a range of services to entrepreneurs and future entrepreneurs and that's what we're going to do at the summit.

Ted Simons: Something else that looks very important for you up there, sounds like a wonderful opportunity, is eco-tourism. That's got to be huge already in northern Arizona. How is that fitting into what you're doing?

Carol Bousquet: Well, most specifically, “Study Overseas” a Walton family foundation grant which has provided a wonderful opportunity to partner with some other organizations in the Verde Valley, to promote eco-tourism based around preservation of the Verde river, honoring that as a destination point but also a resource for the area. So that's been very interesting. That group has already been in turn been connected -- there's a website that connects with the Flagstaff area, Green Business Network, and together the synergy has provided a rich eco-tourism resource.

Ted Simons: I have heard collaboration. I've heard synergy. Sounds like a lot of folks -- like folks are getting together. Are they getting together? Is it like herding cats?

Holly Yeager: Not really. We have a lot of leaders in northern Arizona, a lot of people who are really committed to the sustainability of the region. People from every sector really coming together. SEDI is very unique in that it brings groups together and asking what's possible. We take a longer term focus, so sometimes we create almost the fertile ground for economic development efforts and with partner with a very long list of folks working on economic development. Sometimes what we do is very simple. We have had a very successful teacher recognition award. It's phenomenal to be able to recognize four teachers a year for what they do to integrate sustainability into their curriculum.

Carol Bousquet: In fact, I think We're going to build on that, bringing businesses and the students, our future leaders, together to partner on sustainability efforts.
Ted Simons: I saw one thing that was fascinating. The idea of keeping food production and food security local, and a regional beef processing plant is being talked about. What is that all about?

Carol Bousquet: Well, we have sponsored some studies to ascertain whether or not there's really a market for it. One thing we have a lot of in Northern Arizona is cattle. Right? All right, so it doesn't seem like a real sustainable practice to ship it to the Midwest to be processed and ship it back to sell it in the grocery store. So what we're trying to figure out is what are the obstacles to keeping that local? Turns out that USDA inspection is one of them. So we, SEDI, have brought in USDA inspectors and said, here are some processing plants in the area. Small ones albeit, but a start. What is it that they can do to upgrade their facilities so that you would come in and do the inspections necessary to make it possible for them to sell it locally. We have found one gentleman who is right now working to upgrade his facilities for just that purpose. Like I said, small but incremental start.

Ted Simons: And local.

Carol Bousquet: And local.

Ted Simons: I kinda, ask you this in a different way, but I want to ask you this again. Basically the response from civic leaders, response from business leaders, response from residents. What are you hearing?

Holly Yeager: I think that we're very progressive community and there's a lot of excitement about economic development and economic prosperity in Northern Arizona. I think that study is very much part of that. Everybody sees that they have a unique role to play. It's great to be part of an organization where you can hear directly from business about what makes our community so unique and how do we make sure we preserve these things as we go into the future.

Ted Simons: What are you hearing, again from civic, business, and just folks?

Carol Bousquet: I think there's a lot of enthusiasm for the future of the region. I think people are coming together. I hear lots of partnerships taking place. In fact, one of the things that SEDI has been increasing our partnerships with is in Verde Valley, in doing is we're holding board meetings on occasion. We have board members from Clarkdale and Camp Verde and sedona. To bring that perspective and energy into the conversation has just been really invigorating.

Ted Simons: All right. Sounds like things are happening up there. Good luck.

Carol Bousquet: They are.

Ted Simons: Continued success.

Holly Yeager: Come see us.