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WEED

Marijuana, Medicine and Neuroscience

History of the Alfred I. duPont-Columbia University Award

Devinsky, Orrin MD; Cohen, Lisa R.; Selig, Roni

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doi: 10.1227/NEU.0000000000000733
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On Tuesday, January 20, 2015, more than 300 members of the American news media from across the country gathered in Columbia University's historic Low Library Rotunda to honor a select group of 14 pieces of audio-visual journalism—the winners of the 2015 Alfred I. duPont-Columbia University Award.

The duPont-Columbia Awards are the audio-visual counterpart to the print-focused Pulitzer Prizes, also administered by Columbia University. Winning topics and investigations this year delved deep into critical issues of our day—the rise of the Islamic State of Iraq militant group (ISIS), the US government's surveillance of its citizens, the Catholic Church's continued exploitation of children, a history of the African American experience that spanned 500 years, criminal justice inequities, and environmental protection, among others. Excerpts and descriptions of all the 2015 duPont winners can be seen on the Columbia Journalism School Web site.

One of these awards went to the complex 2-hour documentary series “WEED: Dr. Sanjay Gupta Reports,” by CNN's Chief Medical Correspondent and practicing Emory University neurosurgeon. The duPont host, NBC News' Cynthia McFadden, awarded the prestigious silver baton, citing the duPont's appreciation for “the tough challenge of making important science accessible to the public.”

“The debate over the perils and potential benefits of medical marijuana took center stage,” she noted before calling Dr Gupta to the stage, “when CNN aired two groundbreaking documentaries, ‘WEED: Dr. Sanjay Gupta Reports' and ‘WEED 2’.”

For 2 years, Dr Gupta and his team of producers traveled the world, from Colorado and around the United States, to Great Britain, and to Israel to take a critical look at the research chronicling the impact of medical marijuana and the lives of those who use it. To make the material accessible to their audience, they used compelling personal cases to illustrate the uses of medical marijuana and their scientific underpinnings. After the first hour aired, a second hour followed that examined the political fallout and jousting around these medical applications.

In the front row of the audience that night sat members of the duPont jury, a group of highly esteemed veteran digital and broadcast journalists, who had convened at Columbia's Graduate School of Journalism in late October 2014 to select the 14 winners from a record-breaking 610 broadcast, digital and documentary entries. By the time the jurors considered the over 100 finalist entries, several hundred others had already been eliminated by two levels of duPont screeners, also accomplished video journalists, many of them past duPont winners themselves.

Dr Gupta's WEED was praised by screeners and the jury alike: “Gupta has been ahead of the recent reporting focus on the possible health benefits of marijuana,” wrote one. “This was a truly original, well-written, simple to understand documentary with terrific characters to put a face on a story that is very much in the news,” wrote another. “I appreciated the gravitas Dr Gupta brought to the reporting; it is so easy to sensationalize this subject, and this program wisely resisted that temptation.” From a third: “an incredible body of work that combines enterprise reporting, exclusive access and powerful human subjects. By examining the medical marijuana debate from the politicians vs patients perspective, the report offers a fresh new angle into federal laws, scientific evidence and the plights of families.”

Dr Gupta's report joined a long tradition of outstanding past work. As our duPont history states, “For more than 70 years, the Alfred I. duPont-Columbia University Awards have recognized excellence in broadcast journalism. Regarded today as one of the most prestigious prizes in broadcast, documentary and digital news, the duPont-Columbia Awards bring the best of those disciplines to professional and public attention by honoring those who produce it.

Jessie Ball duPont created the awards as a memorial to her husband Alfred I. duPont, who died in 1935. Her goal was to honor his dedication to progressive reform and to freedom of information in the public interest by recognizing the “essential and patriotic service” that radio and its commentators provided during the early years of World War II. The criteria she established then still hold true today:

…to honor distinguished and meritorious performance of public service by aggressive, consistently excellent and accurate gathering and reporting of news; the presentation of expert, informed and reliable interpretation of news and opinion; and encouragement of initiative, integrity and public service.

The programs that have won the Alfred I. duPont-Columbia University Awards have captured everything from battlefront reports and commentary to coverage of social issues, from news of the Civil Rights Movement, Vietnam and Afghanistan to economics, science, and the environment, and from global events to small-town stories of ordinary people.

As technology evolved, the duPont Awards expanded to include television, and later cable programming. As the forms of television and radio journalism have multiplied, the awards have responded by honoring investigative series, magazine programs, documentaries, and independent and digital productions.”

Successful, thoughtful programs on medical and scientific subjects are particularly difficult to bring to the public's attention. This is especially the case with the medium of video, which is fleeting and often a one-time only proposition, rushing past the viewer and then out of sight. Even more than for mainstream print, sophisticated scientific concepts must be synthesized and clarified for video, stripped of the complexities only experts in the field will understand. It's a conundrum most journalists acknowledge and cede defeat to.

But Dr Gupta is uniquely qualified to effectively translate science into television, and has been awarded many other journalism honors for his science coverage besides the duPont-Columbia Award, including multiple Emmys and a Peabody Award. A native of Michigan, he joined CNN in the summer of 2001, and has spent the last 14 years helping viewers understand the complexities of health and medical news for all of CNN's broadcasts, including topics such as brain injury, disaster recovery, health care reform, fitness, HIV/AIDS, and military medicine, among others. In 2003, Dr Gupta embedded with the US Navy's “Devil Docs” medical unit for a month and performed multiple brain surgeries in a desert operating room. He traveled throughout Iraq and Kuwait, reporting on medical issues under wartime conditions. In 2009, he followed up with the Army's 82nd Airborne division in Afghanistan. Other areas of conflict and disaster he has covered on location include the Gulf of Mexico oil spill, Katrina coverage, Sri Lankan tsunami coverage and post-earthquake Haiti coverage. At home, Dr Gupta has also sought to make the American public more aware of the importance of fitness and health, with popular anti-obesity and exercise campaigns.

Over the last 4 seasons, he has also contributed to CBS News, as a special correspondent for both 60 Minutes and The CBS Evening News with Scott Pelley. He has investigated counterfeit prescription drugs, discussed chronic heart disease with former Vice President Dick Cheney, and explored the latest research on the toxicity of sugar. Recently, Dr Gupta profiled Dr Patrick Soon-Shiong, the renowned physician and entrepreneur who has invested nearly a billion dollars of his own money to treat cancer innovatively.

At the same time, Dr Gupta has continued to practice medicine, as a member of the staff and faculty of the Emory University School of Medicine. As associate chief of neurosurgery at Grady Memorial Hospital, he performs surgery there as well as at Emory. One of the reasons he cites for declining a 2008 offer from then President-elect Obama to become Surgeon General was the requirement that he discontinue practicing surgery. Instead, he continues the parallel tracks of active practitioner and informed observer/reporter who can use his expertise to help inform the public.

L. Cohen

A Producer's Perspective

There is no doubt that Dr Gupta has emerged as one of the world's most credible and influential voices. It is his clear voice that lays bare the facts around complicated issues. He is tireless, fearless and undaunted as he pursues the truth, pure and simple. As a physician or a journalist, his goal is the same: to make an impact. “WEED” is an example of that impact. In the months after the documentary aired, dozens of states included medicinal marijuana on the ballot, federal funds were made more widely available to study the medical benefits of cannabis and Chris Christie, governor of New Jersey, loosened his stance on the laws regulating its use. Through it all, Dr Gupta continued to strike the ideal blend of scientist and journalist, providing data and repeatedly calling on the Government to allow scientists to simply research, investigate, and better answer the questions around cannabis and perhaps provide a therapeutic option for suffering patients. In part, because of that clarion call, the scientific inquiry around cannabis is now at a watershed moment. We are already learning not only why cannabis can be a medicine, but how it can be one as well.

R. Selig

Marijuana in Medicine

Progress in scientific medicine results from a mixture of patient needs, intersecting interests of scientists and doctors, as well as technological and conceptual advances. The recent interest and research in the medical use of cannabis-derived medicines is an extraordinary chapter in medical history, one that is just being written.

Cannabis was cultivated in China 10 000 years ago and subsequently used for clothing, bowstrings, paper and medicine for a diverse set of disorders.1 The first documented use in epilepsy may be from Assyrian clay tablets from the 7th century BCE.2 More recently, Sir William Gowers,3 in his classic monograph on epilepsy, provided a detailed description of a man whose epilepsy was not controlled on bromide but who responded well to an extract of Cannabis indica. Subsequent anecdotal surveys and case reports in the medical literature supported the potential role of cannabis as an antiepileptic agent.4,5 However, while the basic science of understanding cannabinoids has advanced considerably, the clinical science has been very slow to advance, hampered by federal restrictions that limit access and clinical investigation.

Among the more than 400 chemical compounds in C. sativa, there are at least 85 terpenophenolic compounds referred to as cannabinoids.6 Isolation and characterization of these lipophilic compounds led to studies that found that psychotropic effects are due to Δ9-tetrahydrocannabinol (THC). By contrast, cannabidiol (CBD) is the most abundant non-psychoactive cannabinoid in cannabis. Both THC and CBD have been demonstrated to have anticonvulsant efficacy in multiple species and animal models.7 However, while THC has been found to be provconvulsant in some models of epilepsy, CBD has not.7 Further, in addition to psychoactive properties that lead to the “high” of cannabis, THC can also have adverse cognitive and psychiatric effects in adolescents.8

The scientific exploration of how cannabinoids affect the brain has most rapidly advanced for the study of THC. By the late 1980s, it was found that THC exerts its effects by binding to two G-protein-coupled cell membrane receptors; the cannabinoid type 1 (CB1) and type 2 (CB2) receptors.9,10 Subsequently, endogenous CB1 and CB2 ligands were discovered that are produced by animals and humans. The main endocannabinoids are anandamide and 2-arachidonoylglycerol.11-13 CB1 receptors are largely found within the brain while CB2 receptors are primarily localized in immune and hematopoietic cells. The mechanism of action of CBD is less clearly defined, but CBD does not activate CB1 and CB2 receptors. The lack of binding to CB1 receptors likely accounts for the lack of psychotropic activity for CBD. A leading candidate for the anticonvulsant effect of CBD is the GPR55 receptor. This receptors in the soma and dendrites of pyramidal neurons and interneurons and is important in calcium homeostasis. CBD also binds to multiple other receptors and may work through multiple mechanisms.14 In addition to GPR55, CBD is a relatively potent antagonist of the equilibrative nucleoside transporter (ENT) and the transient receptor potential of melastatin type 8 (TRPM8) channel. Conversely, CBD is an agonist at the 5-HT1a and the α3 and α1 glycine receptors and the transient receptor potential of ankyrin type 1 (TRPA1) channel.6 At higher micromolar concentrations, CBD activates the nuclear peroxisome proliferator-activated receptor-γ and the transient receptor potential of vanilloid type 1 (TRPV1) and 2 (TRPV2) channels, while also inhibiting cellular uptake and fatty acid amide hydrolase–catalyzed degradation of anandamide.6,15 CBD also has anti-inflammatory and antioxidant properties.

Medical science has made significant advances in the basic understanding of the how cannabinoids work. In addition, animal models have examined the efficacy of THC, CBD, other cannabinoids, and CB1 receptor agonists as anticonvulsants in more than six species and 55 discrete conditions or models.7 THC was anticonvulsant in 61%, exerted no effect in 29%, and was proconvulsant in 10% of models. CBD was anticonvulsant in 81% and exerted no effect in 19% of models. However, there has been relatively little progress in performing randomized double blind placebo controlled trials (RDBPCTs) to assess the efficacy of different cannibinoids. One exception has been the treatment of spasticity in patients with multiple sclerosis, where a nabiximol consisting of equal parts THC and CBD is effective in RDBPCTs and is widely approved for this indication.16

Recently, enormous interest has been generated by social media and TV documentaries on the beneficial effects of artisanal medical marijuana (MMJ) with high ratios of CBD:THC in children with treatment-resistant epilepsies (TRE), especially Dravet syndrome.17,18 Dravet syndrome is a genetic disorder, most often due to a mutation in the SCN1A sodium channel gene. However, many other children with treatment-resistant epilepsies have been reported to benefit from MMJ. Many US states have approved the use of MMJ for children and adults with epilepsy, although scientific data on human safety or efficacy is lacking. We stand at an unusual inflection point in American medicine. Parents are presenting evidence of efficacy to large audiences and have created a strong demand for access. In the case of potentially life-threatening disorders, such as severe medication-resistant epilepsies such as Dravet, it is hard to deny these children a chance. Up to 20% of children with Dravet die before age 20 years due to their epilepsy. Further, many of the medications that are approved by the Food and Drug Administration for these children have serious side effects on the body, mind and quality of life. These side effects are even more problematic in children who receive high doses of these medications in multi-drug combinations.

Dr Gupta's 2-part documentary, “WEED,” has given the parents an important voice in promoting their message of getting access for their children. It has helped leading organizations such as the Epilepsy Foundation to support access to MMJ for children with TRE and additional legislatures to pass laws to grant access. The documentary also explored the challenges of a therapy which has not been adequately scientifically studied, and in which the placebo effect could be an important factor. This is supported by the observation that families that moved to Colorado to obtain access to MMJ for their child were reported by the parents to have a more than three-fold higher responder rates for their children than for parents who were living in Colorado and whose children had similar severe epilepsies.19 We await RDBPCTs of single compound (eg, CBD) or mixed compounds (eg, MMJ) to provide more scientific evidence on the safety and efficacy of these cannabinoids in patients with epilepsy.

O. Devinsky

Recent Developments

More recently, Congress passed the federal spending bill, which provides protection for medical marijuana in states where it is legal. Colorado health officials have now also awarded $8 million in research grants to study the use of medical marijuana to treat symptoms associated with Parkinson disease, childhood epilepsy and post-traumatic stress disorder. Dr Gupta continues to investigate the topic of medical marijuana and the potential of this plant to 1 day provide relief for those suffering needlessly.

R. Selig

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