Replying to the CHS Big Think Article
They provide the following summary at the top of the article:
- “Millions of long-time marijuana users are developing intense stomach pain, nausea and bouts of vomiting.
- The condition is called “cannabinoid hyperemesis syndrome,” or “CHS.”
- What makes it happen is unclear, but the only way to stop it is to cease consumption of cannabis.”
Within this article, they are misstating the findings of the two studies they have cited and are in general misinforming their readers about the actual findings of these studies to get more clicks.
This form of “journalism” is becoming far too common and resulting in difficulty separating “fake news” from legitimate articles.
Giant Squirrel’s Big Opinion:
As a follower of Big Think for several years on social media, I tend to enjoy their articles. Appearing to be fairly fact-based and additionally did not form conclusions too often on many subjects saying things like “This was the reason, this caused it, etc”. More often Big Think would conclude “The possible reason, possible cause, etc” on many matters.
I noticed a few months ago, that this had changed and they were falling into the trap of click bait, which is a supplementary reason I chose to “attack their article” in this rebuttal.
“Marijuana is somehow making millions violently sick”
Obviously, this is a click-bait title because if there were millions of people becoming sick because of cannabis, we wouldn’t be hearing about it for the first time through Big Think. I am equating this poor choice of words to the need for clicks.
However, that millions number is coming from Study #2…..
If you have read some of the other articles regarding medical cannabis on Incognito Glass’ Blog, we definitely want more medical studies done. However, if there are flaws, bias, or non-reproducible results then there are some serious questions that need answers before we can rely on the conclusions.
This study took place in 2001 in Australia and was kind enough to publish in 2004 all aspects of the study and not just the abstract.
The study had 19 participants originally, then cut down to 9 and 7 of the 9 were taking PPI medication. All except one had a compulsion to take hot showers or baths.
Between the two studies, I believe this one to be the more reliable of the two. And simply wish to point out some possible issues with relying on it too much.
No testing of the cannabis from each patient for pesticides. As cannabis is still illegal in Australia, it is a possible cause of the vomiting was due to a pesticide that is cheaper to use, but not legally allowed on food causing the slow poisoning.
They did not address the fact that 7 of the 9 were on PPIs, of which a side effect is vomiting. This would indicate to me that either the underlying cause of the vomiting is in their stomach and is being exacerbated by the cannabis use or another possibility that the cannabis is interacting with their medication poorly and should be addressed. It is also possible that they were put on these medications for the treatment of their chronic vomiting.
The conclusion appears correct. The cause of the vomiting was reasonably proven when the use of cannabis stopped and the symptoms ceased. However, it should be noted that the possibility of a shared underlying condition that is simply being exacerbated by the cannabis use is also possible as indicated by the PPI medication or another variable factor.
This study only gives the abstract, but the main issue in this study is that it is simply a questionnaire. While not “wrong” they concluded that if you smoke 20+ days a month and rate having a hot shower as a way to relieve nausea 5 and above on a 10 scale that you had CHS. This seems pretty weak for determining if they have CHS or not. In study 1, the patients were almost compulsive about their showers, it is likely they would have been rating it at an 8+. I think most people would rate a hot shower as a relief from nausea at least at 5, as I plan to have a hot shower to get rid of mine, once this is completed.
Reading the abstract there were more inclusion criteria for the CHS diagnosis than presented in the abstract. But being a simple questionnaire it is not as reliable as the first study.
This study was detailed and well-documented and due to it being linked poorly in the article not seen until having reread the Big Think’s article a third time, was not read until the final portion of this rebuttal article was being completed. The study concluded that CHS should be considered a plausible diagnosis for these symptoms. But, like the first study did not mention anything about testing of the cannabis itself and no information about additional medications was provided.
None of these studies are fatally flawed in the Giant Squirrel’s non-medical nutty opinion. However, the Giant Squirrel does believe that the Big Think article is fatally flawed.
As quoted above they summarized their article as millions of users are having CHS happen. This is false and based on their flawed interpretation of the data. If millions were getting sick from this, they would first cease using cannabis. Second, the cannabis community would know about it in a lot more detail.
When the cause of something is determined to be unknown, it is usually best to state that more research is needed, or that the likely culprit is cannabis but there could be other causes that are creating the reaction to cannabis in this way. Which the articles do mention this, but is only brought in the BT Article to link it below as “This fits the hypothalamic hypothesis…”, which it only fits an aspect, but neglects the other aspects that do not fit in, such as thirst.
The tag line of “Violent cannabis-related vomiting is becoming serious” is also misleading from the stance that there is no indication in these studies that this vomiting was “violent” and could have been normal in terms of vomiting and this is not affecting many people. Far too much of this article is using buzz words and other garbage journalism to create click bait.
Chronic heavy users, this article does not forget to mention the fact that all these studies are for chronic users until it gets to the “What if symptoms arise” section. Reading these studies the participants are mostly Heavy Habitual Users, as we have defined for blogging purposes in Different Usage for Different People, this would not affect a majority of cannabis users. However, this article does not mention that this would only affect a very small portion of the population, even if it does become fully legalized in the US.
These aspects were the main reason for my opinion that this article is fatally flawed.
Final Thoughts & Opinions
Fake news is becoming a bigger problem, but with all forms of “lying” there is always some element of truth, we explore this in the Furry Cannabis Werewolf Section of our blog with each post.
Is what Big Think or Robby Berman doing wrong? That is purely a matter of opinion. You do what you need to. Journalism is struggling to keep afloat in this day and age and if you need to use buzz words or misleading articles to bring more people onto your website it will work, for a time. Once you lose your credibility as an institution people will stop being fooled as much and your numbers will drop again. The best analogy would be if you see The New Yorker with a posted nonsense cover story about “Penis enlargement pills that work”, I suspect they would sell about 150-200 million copies of that issue in the US, but those numbers could not be sustainable and once the public adjusts the numbers will drop lower than before because you lost your base.
The main reason I wrote this rebuttal is that the article reeked (pun totally intended) of “reefer madness”, which is a werewolf we will explore in a future post.
As for CHS, this is a real issue. If it was not there would not be multiple research studies on it. However, due to the lack of research, the cause is still debatable. While most agree that cannabis can trigger a schizophrenic episode, there is no consensus if cannabis use is the cause of the schizophrenia or simply the breaking of the dam. It is likely that this is the case with CHS, it has not yet been determined if the cause of CHS is cannabis or if cannabis is simply triggering this underlining condition.
The magnitude of CHS is also likely significantly lower than what is being indicated in this article. While the conclusion of the study was not incorrect in their data extrapolation, this was a rough estimate that was likely intentionally high. If it potentially could affect ~100,000 people, it might be a bit harder to find research funding.
– A Giant Squirrel