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Paint CHiPs
Viva Le Me

Registered: Jul 2000
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Abolish the FDA

In case you didn't get the memo. The FDA has seemingly divinely come to the iron-clad conclusion that marijuana has no place in medicine, and that it is the FDA's authority (not voters, or states) that wholly determines such things.

When I'm talking to people about libertarianism, one of the things that most normal people relying on conventional wisdom balk at is abolishing the FDA (abolishing the Dept of Education is up there too). But the truth of the matter is, the FDA does more harm than good, at best by a close margin. And anybody that still believes in them as some kind of ideal vision of a sober objective scientific panel looking out for our best interests is fooling themselves--dangerously so. The medical marijuana issue isn't as much a life-or-death one as, say, decades of delay and red tape and outright political hostility to many other kinds of life-saving drugs and technologies, but it certainly is representative of how the FDA operates, and is a pretty darn good flagrant black-and-white example of what's wrong with it.

Anyway, what drove that mini-rant is an article that Slate put up about an hour ago. There are much better articles out there, if you look for them, giving serious consideration to the question of whether the FDA does more harm or good, but I like this one because it asks the easy question and gets the easy answer.

The question: Can you trust the FDA?

The answer: No.

An awful lot rests on that question, and that answer.




All Smoke
The FDA's statement on medical marijuana isn't about science.
By Sydney Spiesel
Posted Monday, April 24, 2006, at 3:36 PM ET

Last week, the Food and Drug Administration reported that it had definitively established that marijuana has no medical use or value. Definitively? Established? I don't think so.

The FDA's announcement begins by acknowledging the claim that smoked marijuana may be beneficial for some conditions. Then the agency points out that among drugs with a potential for abuse, marijuana is lumped in with the most dangerous drugs, the ones that have no potential medical benefits and the highest likelihood of misuse. The FDA next affirms that a collection of federal agencies have together concluded that marijuana is both dangerous and medically valueless, based on scientific studies in humans and animals. The announcement—actually, it's an "inter-agency advisory"—concludes by asserting, with a boldness that might belie a certain uneasiness, that it is the FDA's job to approve drugs. Take that, state legislatures and voters.

The FDA's statement implies that the agency reached its conclusion about marijuana after conducting a new serious analysis of the existing scientific literature on the drug. But of course no such analysis was reported in the medical literature and, in fact, no identifiable official at the FDA took responsibility for last week's advisory. It was just put out there as a statement of fact.

But it's not. In 1999, the Institute of Medicine, the medical arm of the National Academy of Sciences (an organization chartered by Congress to provide independent, nonpartisan scientific and technological advice) examined this same question in considerable depth and published a 288-page report of its findings. Put together by 11 distinguished scientists and physicians, the IOM report examined the known and potential harms of marijuana use and the known and potential medical benefits. The report is broad in its vision and thoughtful and cautious in its interpretations and recommendations. Its authors acknowledged that the medical uses of marijuana entail some risk of harm—for instance, it's pretty clear that inhaling marijuana smoke can't be good for the lungs, and who knows if there are significant psychological side effects for some users. But the authors concluded that these risks were not terribly high. They also found that other putative risks often attached to this drug—the potential for addiction, for instance, or for marijuana serving as a "gateway" to further drug abuse—were much overstated. The report urged further study to determine the real level of risk.

In examining the potential medical benefits of medical marijuana, the IOM report was equally cautious. It described relief from nausea associated with cancer chemotherapy, appetite stimulation for cancer and HIV patients, and treatment of muscle spasticity for patients with multiple sclerosis or spinal cord injury. Though these benefits seem real, the authors of the IOM report point out that we really don't know yet if they are significant or valuable enough to warrant the use of medical marijuana. Again, the report urged further study to determine the real level of benefit.

However, in the seven years since the IOM report was issued, virtually no research on potential risks and benefits has been done, because the government has blocked such studies. So, we know neither more nor less about medical marijuana than we did seven years ago, whatever the FDA says. Why would the agency inaccurately claim that the science is settled when it isn't? I hardly need to say it: This isn't a medical or scientific conclusion. It's a political one.

This is certainly not the first time that politics has trumped science at the FDA. Another recent example: the agency's decision to block over-the-counter availability for emergency contraceptives in the face of overwhelming evidence that the treatment is safe and effective, and support for over-the-counter availability by the FDA's own advisory committee. From my standpoint as a doctor, the question is this: What do you do when federal agencies become so politicized that their recommendations can't necessarily be trusted? Do you have to treat other things they say as suspect? I depend on good advice and honest information from government agencies in the daily conduct of my work. I need to know what epidemic illnesses are circulating in my neighborhood even if that information might put a government agency in a bad light. I need to be able to trust government-sponsored research (especially because, goodness knows, I have learned not to trust manufacturer-sponsored research). I need to know that the advice I glean from government-sponsored agency Web sites will lead to the best care for my patients.

Marijuana as a medicine—whatever its risk and benefits are eventually determined to be—may turn out to be much less important than the question of whether we can count on agencies like the FDA to be honest in their dealings.

Sydney Spiesel is a pediatrician in Woodbridge, Conn., and associate clinical professor of pediatrics at Yale University's School of Medicine.

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Old Post 04-24-2006 10:04 PM
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Trenchant_Troll
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I fucking hate when I agree with you. It just feels wrong.

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Paint CHiPs
Viva Le Me

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Here's kind of a quickie version of the Libertarian case, to give the extreme position on this (that I share). Certainly there are more moderate variants.




Abolish the FDA!!
by Jim Grichar

The time has long since come for the Congress to abolish the U.S. Food and Drug Administration, also known as the FDA. Contrary to the baloney put out on the various pages of its web site, which would lead the unwary taxpayer into thinking that the FDA is actually protecting him or her from some hazard, the FDA has outlived any usefulness its partisans and bureaucrats have claimed for it. Getting rid of this bureaucratic dinosaur would save taxpayers nearly $1.7 billion (the proposed fiscal year 2004 budget), lead to reductions in the prices of food and drugs paid by consumers, reduce lawsuits over product liability, and reduce the number of lives lost and lives shortened due to a lack of drugs and medical devices.

What the FDA claims to do

With a history that dates back to 1848 when Congress required the U.S. Customs service to prevent adulterated drugs from entering the United States, Congress has expanded the FDA’s regulatory authority over food and drugs over the years, all in the name of protecting consumers from any risks associated with food, drink, or drug use. Major milestones (or millstones, for taxpayers and consumers) include the Food and Drugs Act and Meat Inspection Act, both of 1906, which gave the FDA’s predecessor agency power to enforce prohibitions on the interstate commerce of misbranded or adulterated food, drinks, and drugs.

While many of the food-related functions have been transferred to the Agriculture Department, the FDA retains considerable authority in this area, notably in dictating food-labeling standards and in dictating the types of claims that can be made by manufacturers of vitamins and mineral supplements.

As far as prescription drugs go, the FDA has been given additional authority over the years. Notably, in 1962, after the sleeping pill thalidomide was found to have caused birth defects in children born in Western Europe, the Congress passed and John F. Kennedy signed into law amendments to federal drug laws that required pharmaceutical manufacturers to prove to the FDA the effectiveness of their products before marketing them in the United States. Despite the apparent Congressional intent of reducing the risk of using pharmaceuticals to zero, unsurprisingly, the FDA has failed to do so. Instead, FDA began the process of dictating standards for clinical drug trials and tests and conducting a lengthy approval process that a manufacturer needed to pass before bringing a new or modified drug to market.

Beginning in 1976, the FDA was given authority to apply a similar "drug-style" approval process to all medical instruments and medical test equipment.

The FDA has failed

This attempt by the government to insure consumers against the risk of using drugs and medical devices has flopped on numerous occasions. First of all, FDA regulations have often prevented U.S. consumers from gaining access to new life-saving drugs. Examples of this include major delays in the marketing of drugs used to treat cancer, blood pressure, heart attacks, cholesterol, and strokes and delays in marketing such high-tech items as cardiac pacemakers and in the use of such techniques as balloon angioplasty for blocked coronary arteries. For many years, the FDA would not allow the makers of aspirin to claim on their product labels that aspirins thinned blood and could thus save one from dying if taken during a heart attack. The costs of FDA regulation of these markets has likely run into the billions, possibly hundreds of billions, of dollars and is composed of higher drug prices, fewer drugs, and more and lengthier illnesses and earlier deaths.

In a call to the Bush Administration to merely reform the FDA, Henry I. Miller, a fellow at the Hoover Institution and the Competitive Enterprise Institute and a former FDA official, presented a devastating critique of the FDA’s regulatory process and procedures.

In his early 2001 editorial commentary, Dr. Miller stated that the total time it takes to develop a new drug had doubled since the 1960's. And the costs to a manufacturer of bringing a single new drug to market had risen to over $400 million, the highest cost in the world. He further contended: "Costs are spiraling out of control because the FDA meddles endlessly in clinical trials and keeps raising the bar for approval." Furthermore, he cited statistics that showed the average number of clinical trials per average drug increased from 30 in the early 1980's to 68 during the 1994–95 period while the average number of patients in clinical trials for each drug more than tripled! As expected, the average time required for clinical trials for a new drug rose from 85 months in the first half of the 1990's to 92 months in the last half of the 1990's.

And FDA approval of a drug has not been a guarantee that one was or is using a safe drug. This latter contention was once again confirmed in a Sunday, May 18, 2003 New York Times article about trial lawyers focusing their efforts on launching mammoth lawsuits against pharmaceutical manufacturers.

Life without the FDA

While many in the medical community like Dr. Miller believe that sensible regulatory reform of the FDA should be the goal, instead the FDA should be abolished.

Some – possibly many – are about to ask me: "Grichar, are you nuts? What makes you, an economist and not a medical expert, think that the drug companies and medical equipment manufacturers can be trusted to regulate themselves!" To which I would respond, "They will not be regulating themselves; the free market will regulate them."

And here is how that could be done. In the absence of the FDA and with trial lawyers looking for multi-billion dollar settlements in lawsuits, pharmaceutical manufacturers and medical equipment manufacturers have every incentive to be cautious in bringing out new drugs and new medical devices. To this end, they would avail themselves of independent private reviews of the results of clinical trials and tests.

Medical experts – the same ones who testify on behalf of and against manufacturers in various product liability lawsuits – would also become involved as independent private review consultants. Most likely, such experts would become affiliated with independent private review institutes – similar in operational philosophy and techniques to the famous Underwriters Laboratories – which would levy a charge for a review of a new drug or medical device. Currently, the FDA takes in about $250 million annually in fees (really taxes) it charges manufacturers for seeking approval of a drug or medical device. Manufacturers have thus demonstrated the willingness and ability to pay for product reviews.

Insurers might also help fund such independent review boards or institutes, as this would help lower their pay-outs in lawsuits. And contrary to what some may think, medical experts would have every incentive – mainly significant future earnings from participating in drug and medical device and procedure reviews from the independent review institutes – not to take bribes from manufacturers. (For a great description and analysis of what of Underwriters Laboratories does, see What Keeps Us Safe by Mark Thornton.)

If given a seal(s) of approval by accepted review institutes, the new drug or device would be brought to market with that seal(s) publicly displayed. Physicians, who often have to spend a fortune for malpractice insurance coverage, would have the strongest incentive to prescribe, in most cases, only those drugs or those devices that have some seal(s) of approval. Their malpractice insurer would demand that. However, physicians would be free to seek an exemption from their insurer and the consumer in cases where application of a new, but not-yet mass marketed or reviewed drug or device, might make the difference between life and permanent disability or death.

Manufacturers would also be given an extra incentive to seek such expert seals of approval for their new drug and medical device products by their insurance companies, mainly in the form of lower premiums for liability insurance if they get a seal(s) of approval. Those not getting recognized approval would face higher liability insurance premiums, possibly suspension of coverage for those particular products, and likely lower demand for such products. Getting a number of seals of approval, from these strictly independent private review institutes, would further enhance the marketability of a product and help insulate the manufacturer from lawsuits.

Under the free market, insurers would also have the incentive to offer consumers no-fault liability insurance for medical malpractice, including the use of drugs and devices that have not gotten a major seal or seals of approval by generally accepted review institutes. And consumers would have a strong incentive to purchase such insurance.

With such a private market system of insurance and risk reduction, there would be fewer lawsuits and lower settlements. This would be the case because of the extensive and competitive review of products, seals of approval, and also review by various insurers. It would be difficult for even the best trial lawyers to counter numerous expert opinions rendered in such an unbiased manner prior to the sale of a specific drug or medical device.

Dump the FDA!!!

To sum it up, a private market for the review of drugs and medical devices could save the public billions of dollars. Not only would the public (including drug and medical device manufacturers) save the $1.7 billion it pays in taxes and fees to fund the FDA, but effective drugs and devices would be brought to the market more rapidly and at a lower cost. More lives would be saved, there would be fewer permanently disabled, and illnesses would be shortened. Lower lawsuit awards and settlements would more than likely compensate for any extra costs of reviews.

Abolish the FDA and save lives and money!

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Old Post 04-24-2006 10:10 PM
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SocialParasite
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The problem with marijuana as a medicine is that it has, what, three uses? Nausea relief, pain relief, and an appetite stimulant. There are already effective drugs on the market for all of those uses so there is no pressure on anyone to legalize pot in that instance.

Feeling like you're going to throw up? Take some Benadryl. In serious pain? There's a whole host of over the counter and prescription drugs for that. Morphine being the most extreme of the batch, or just a couple Tylenol if it isn't all that bad. As for an appetite stimulant: Marinol, an FDA approved cannabinoid (hah, eat that hippies).

I won't even touch the nutty Libertarian article because the majority of it is just laughable. The rest of it is the usual, "Arrrrr. Dismantle the government" hooey that I've sadly come to expect out of Libertarians.

I suppose I should mention that I am for the legalization of marijuana (medicinal or otherwise), but I'm not going to call for the abolishment of the FDA just because they made a decision I don't agree with.

And as far as the government stance on mariujana: It's largely just towing the line. Marijuana was outlawed sometime in the mid to late 1800's if memory serves correctly, and you'll be hard pressed to find a (viable) political candidate that would want to change the position. It's ingrained into our society and moral fabric now. You don't win votes by rocking the boat on a "hot button" issue like marijuana (or drug law reform for that matter).

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Old Post 04-24-2006 10:47 PM
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Smug Git
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A lot of MS sufferers in the UK (who get virtually free medication, so aren't making this case based on cost) claim that marijuana is the best medication. It's not a bunch of hippies, these are often respectable people. Some of those that refuse to plead guilty to drugs offences and thus get a jury trial have gotten off in some cases because some juries have refused to convict them.

Marijuana was legal until 1937, in terms of not being federally prohibited (some states had laws against it).

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Old Post 04-24-2006 11:11 PM
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loser
oxymoran

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Location: Beringia
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Nothing beats it for a bad stomach. Really.
but it's best to catograize the people who support it as hippies, or druggies. The label robs pot smokers (sick and well alike) of their humanity, which distracts from the debate, which is good for the anti pot folks, because about the best they can come up with seems to be "harr har silly hippies."

personally, though, I don't care if it has medical properties or not, I just like to get stoned.

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Old Post 04-24-2006 11:52 PM
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Smug Git
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You're a fucking hippy.

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I have shampoo, fuck you.

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Old Post 04-25-2006 12:03 AM
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Paint CHiPs
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quote:
Originally posted by SocialParasite
The problem with marijuana as a medicine is that it has, what, three uses? Nausea relief, pain relief, and an appetite stimulant. There are already effective drugs on the market for all of those uses so there is no pressure on anyone to legalize pot in that instance.



While it's no cure for AIDs, I think you shouldn't really try to push the "What? Your tummy hurts? Take some Benadryl, hippy!" line. I realize you work with retards and not cancer patients, but with the side effects of hardcore cancer treatment, we're not talking about "tummy owie". There are a myriad of reasons why marijuana might be the best option for all three of those problems you mention, in cases of cancer patients specifically, and while saying "best" rather than "only" takes it to a matter of degree (which it is), they're fairly significant degrees, and when those are weighed against the really paltry negative side effects of pot (especially as opposed to, say, Morphine or what have you), it's a pretty substantial ancillary medical benefit we're talking about. The equation often comes down to "take pot, or take a medication with less positive benefits and more negative side effects", and when you're talking about the kind of degrees that even a relatively simple (were it you or I) problem like appetitie loss or nausea entails, it can mean the difference between life or death, or at the very least, by most anyone's concession, between fairly substantial degrees of suffering. There's really no reason to poo-poo that.

What's nutty about the Libertarian article? I think a lot of people knee-jerk against it (like I said), but I chalk that at least as much to just programmed conventional wisdom than to any kind of reflected thinking (at least in most cases, and at least in my experience). Same problem with stuff like Social Security or New Deal legislation--people born into a country where it was the norm and status quo for awhile just view it as natural, like it's the most obvious and self-evident thing in the world, when oftentimes it's anything but. To put it another way, I'd be interested in seeing a study detailing and scientifically trying to outline the postive benefits of the FDA's expanded authority post-1962. My own feeling is that we probably got on alright prior to 1962, and for every case of people dying from imbiding snake oil or whatever prior to that, what you don't hear about are the cases of hundreds of thousands of people dying every year despite the fact that there exist products and medicines that have been tested, have been determined to be safe, and would in all liklihood save their lives--they just can't have them for another 10 years until the completely arbitrary FDA measures have been satisfied (and on that point, there's another knee-jerk tendency to assume that medicine approved by the FDA is "safe", and that not approved is "unsafe"--that's horseshit, "safety" as it concerns medicine exists as a range, and particularly with heavy duty medicines, exists as a tradeoff--right now, the FDA is making that tradeoff for you, beyond your control, for oftentimes spurious, politicized, and probably often corrupt reasons). If you want an interesting case study that really supports the Libertarian claims, do some research about AIDs drugs. You'll be absolutely staggered by how much needless death and delay has (and still) resulted from FDA over-regulation, both in terms of 20 year waits for drugs that have been "on the market" for years, and in the pricing beyond the range of most anybody the most effective medicines, that in other places might cost you a third of what you'd have to pay in America.

I don't think we should abolish the FDA based on some kind of "hemp makes good rope" hippy crap, nor based on this case alone. What makes this case interesting though is how illustrative it is of the basic failing of one of our most revered regulatory agencies, and I'd be hard pressed to find ANY evidence to support the FDA here--it's not really an "agree to disagree" situation where maybe they're right and maybe the hippies are right. Of course the hippies are right, and the FDA doesn't even pretend otherwise--they just flat out don't believe we should be allowed to have the conversation. AT THE VERY LEAST we can't be certain of the pro-marijuana side's scientific evidence on this because the FDA (and political climate generally) has so thoroughly chilled the research atmosphere that you for all intents and purposes can't even STUDY the problem before making an assessment.

Most people support the FDA because they believe we should be able to objectively examine, free from market or political concerns, the scientific evidence about medicines, procedures, and technologies, and make qualified, independent judgements based on that.

If that's what they, or you, think the FDA does--we'll, that's the laughable proposition, if you ask me.

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Old Post 04-25-2006 12:22 AM
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loser
oxymoran

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you're a fucking hippy.

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Old Post 04-25-2006 12:48 AM
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CHiPsJr
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I don't really know how effective marijuana might be as a medication for any of its stated purposes. Neither does anyone else. There were several preliminary studies which seemed to merit follow-up, and then the government clamped the lid on the whole thing. Bush is by no means the first President to use science for political ends.

The real case for radical reform of the FDA lies, as Paint notes, in patent medications. The byzantine machinations required to work a new treatment through the FDA labyrinth are in many cases beyond ridiculous. Drugs which have been saving lives in Europe, with minimal adverse reactions, spend an average of seven years and hundreds of millions of dollars in the approval process, with the US patent clock ticking all the while; many non-American pharmeceutical companies simply opt not to bother.

The problem, as always, is that the deaths in the absence of an FDA would be very apparent and easily tied to the absence of regulation; whereas the thousands who can and do suffer and die under current policy are harder to trace, and the causal connection less easy to establish.

As a Libertarian, I'd love to see the FDA abolished, but as a pragmatist I would settle for enormous reform of its organizational structure. Sadly, the existing system is very well tailored to the desires of those who profit by it, so even incremental change is politically unlikely.

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Smug Git
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Smash the Man, man.

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Old Post 04-25-2006 02:14 AM
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3MTA3
Same Tired Monkey

Registered: Apr 2003
Location: I cant say I buy this completely,
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How many of you smoke pot? often?

I dunno about all this, I think its people crying about an agency they set up that does its job too well. The FDA isnt going to say dope is good medicine until someone passes a law and even then they might not because I think these doctors pretty much understand that all marijuana is good for, if anything, is getting people high so they forget about the pain and shit they were in...I mean, feed em a belly full of benzoes...klonopins out the ass...xanax and alcohol IV...whatever right? Theres just nothing cure-ative about it.

I think the potential for abuse is also high on their list because it is a factor...manly because of how we structure drug laws but if you have smoked pot more than say, 20 times, I bet youve done coke or maybe acid or shrooms and all of that shit is a public health concern too. By this I mean people will sell the government weed for $$$ like they sell pills.

Whatever, FDA aint the guys who greenlight all the filthy pot smokin you 'Libertarians' are lookin for with your 'Stop taxing me so I can buy more weed. ps- leave me alone!' platform. You need to like, get someone in office you lazy commies!

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Old Post 04-25-2006 08:25 AM
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Coincidence
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You need to like, smoke more you boring fascist.

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Old Post 04-25-2006 11:02 AM
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Large Filipino
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I don't get this country. Marijuana has been around before booze. Them injuns smoke 'em in peace pipe. It saved lives. It gave peace.
Marijuana is LOVE.
FDA want LOOT. If you can grow aspirin or Morphine it would get outlawed cause then there would be no loot.

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Old Post 04-26-2006 02:56 AM
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SimpleSimon
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You can grow aspirin. Make tea from willow bark. Morphine is refined from the sap of the opium poppy. Marijuana is not a native plant in north America, or south America for that matter. The europeans brought it with them. The indians smoked tobacco, which is native.

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Old Post 04-26-2006 03:11 AM
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Large Filipino
Fuck me hard in my arse.

Registered: Feb 2004
Location: in colorado somewhere!
Posts: 25658

No way. Them injuns didn't look like that with clear heads.

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EEEEEEEEEEEEE!!!!!

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Old Post 04-26-2006 03:22 AM
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