Position Statement on Concurrent Cannabis and Opiate Use

ACNA Position Statement on Concurrent Cannabis and Opioid Use 2013

American Cannabis Nurses Association

Position Statement on Concurrent Cannabis

and Opiate Use

August 4, 2013; Author: Ed Glick

Introduction The American Cannabis Nurses Association supports the monitored and controlled use of cannabis in conjunction with opiate administration for patients (either human or animal) who are suffering from severe pain, intractable pain, severe neuropathy or pain associated with terminal illness. Additionally, any patient on long-term opiate therapy should be evaluated for cannabis therapy to lessen the risk of adverse events associated with opiates.

This position is justified by the evidence base of use patterns, the in-vitro research demonstrating the interaction of endocannabinoid receptors with opiate receptors, the potential severity of adverse events associated with long-term opiate use and the ethical

responsibility of health care practitioners to advocate on behalf of their patients. Pain and Conventional Treatments Pain is the neurological process that provides internal communication via nerve cells indicating an injury or disease. Pain is a cardinal symptom of

many disease processes especially if it is associated with tissue or organ nerve damage.

Pain impulses are carried through nerve fibers which are present in all tissues and organs, and exist in huge numbers in the central nervous system. The CNS is composed of the spinal chord and the brain. The peripheral nervous system (PNS) contains nerves located in the arms, legs, skin and other parts of the body outside the brain and spinal chord. Neurotransmitters like serotonin, dopamine, adrenalin and glutamate, are released by receptors in the cell, in response to specific nerve impulses which trigger their activity. The anatomy of a nerve cell is arranged in order to carry sensory impulses from one cell to another and into the brain and motor impulses from the brain back to a specific area.

There are many different qualities and types of pain. Pain may also be non-physical in nature, arising from psychological trauma or mental illness. Phantom limb pain, for instance, is the perception of pain in an appendage (arm or leg) which has been amputated. Intractable pain is excruciating pain which is unresponsive to medical or pharmacologic interventions. Analgesics are a class of drugs which (are intended to) block or reduce the movement of pain signals to the brain, reducing the perception of pain. There are many different types of analgesics- including opiates- which treat many different types and intensities of pain.

Prescribers attempt to match the analgesic to the pain in the lowest effective dose. As the severity of the pain increases, so does the potency of the drug prescribed. Severe pain, by definition, is pain which defies easy control. The pain cycle often results in escalating doses of one pharmaceutical, until it fails to adequately control the pain or the side effects become excessive. This is followed by a different and more potent analgesic. The side effects and toxicities increase in proportion.

Patient’s suffering from severe pain- like migraines, neuropathy or cancer, present a huge challenge to prescribers because the pain continues often for the patient’s entire life and involve potentially lethal doses of analgesics over a long time period. Large doses of opiates additionally render many patients unable to effectively function, further reducing quality of life. Morphine is considered the standard for the most severe pain. It comes in many forms and dosages and combinations with other agents which are meant to synergistically work with the morphine at lower doses. 

Morphine activates specific receptors which release endorphins. It has very potent central nervous system activity, blocking pain signals in the brain. It can also depress the vital functions of the CNS, like breathing. High doses of morphine can also impair liver function and sensory function and result in constipation. From 1999 to 2010, the number of U.S. drug poisoning deaths involving any opioid analgesic (e.g., oxycodone, methadone, or hydrocodone) more than quadrupled, from 4,030 to 16,651 per year, accounting for 43% of the 38,329 drug poisoning deaths and 39% of the 42,917 total poisoning deaths in 2010. (1)

Analgesic Properties of Cannabis Cannabis is effective as an analgesic due to its potent CB1 receptor binding activity in both peripheral and central nervous system nerve pathways. When inhaled, it rapidly crosses the blood brain barrier. Researchers have demonstrated that cannabinoids reduce hyperalgesia- or increased sensitivity to pain- through activation of CB1 receptors at the site of injury. (2) Endocannabinoid receptor activity represents a parallel,separate, but interconnected pain modulation system with the opioid receptor system in the CNS. (3,4,5) The foundation of the endocannabinoid system is the activity of CB1 and CB2 receptors which cause the release (or inhibit) a complex cascade of endocrine, hormonal or cellular chemicals from the brain or tissues themselves. 

This is the “homeostatic regulatory function” of the endocannabinoid system which help patients “relax, eat, sleep, forget and

protect” (6). CB1 receptors are mainly located in the brain and CB2 receptors are located throughout the body in enormous numbers, especially immune system tissues. Cannabinoid receptors may be activated either by the internal endocannabinoid signaling process with anandamide or 2-AG (arachidonyl glycerol)- which all mammals synthesize- or activated through the administration of exogenous cannabinoids found in the cannabis plant. In essence, the cannabis plant has co-evolved over millions of years with humans to produce homeostatic regulatory chemicals nearly identical to those humans and animals produce themselves.

The neurochemical receptor binding actions of cannabinoids have been described in detail through animal modeling experiments. Cannabinoids interact with serotonergic, dopaminergic, glutaminergic, opioid neurotransmitters , and inflammatory processes. Δ-9-THC reduces serotonin release from the platelets of humans suffering migraine thus inhibiting the pain signals triggered by serotonin. Clinical considerations with cannabis and opioid co-administration Any patient suffering from serious pain conditions should be evaluated for cannabis use. Many analgesics are combined with synergistic compounds in order to decrease the total dose of the most powerful one- usually morphine or codeine. Cannabis is no exception.

A clinician whose patient is requesting or using cannabis should consider the patient’s total pain management program especially the total dosage of opiates, muscle relaxants (flexeril) or benzodiazepines in longterm pain management and the adverse experiences, if any, resulting from high doses. (Documentation of changes in prescription amounts over time after initiating cannabis treatment is easily accomplished. Examination of previous prescription records presents an opportunity to retrospectively determine the therapeutic value of cannabis if the clinician knows when the patient began using it.) Patient’s commonly report a decrease of opiate use from 1/3 to ½ as well as increased functional ability. Some patients eliminate the use of opiates nearly completely. There is no documented data indicating that concurrent use of opiates and cannabis increases adverse outcomes.

Adverse events and contraindications from cannabis/cannabinoids do occur. Most significantly, worsening or precipitation of psychosis. Anxiety or panic reactions may sometimes occur to naive users or patients ingesting substantial doses by mouth. There is no known lethal overdose recorded. Additionally, cannabis (like opiates) may mask underlying diseases. It may also adversely influence the metabolism of other drugs the patient may be using. Cannabis has a long history of use as a harm-reduction substitute for addiction to other substances. Cooccurring substance abuse may or may not be a contraindication to the use of cannabis. 

A detailed understanding of pharmacological, medical and social circumstances will provide guidance to clinicians. Cannabis Hyperemesis Syndrome has been documented in a small number of long-term cannabis users. Users report colicky abdominal pain, recurring nausea and vomiting, with symptom resolution upon abstinence. The etiology of this disorder is unknown and the occurrence is rare. Clinician guidelines should include evaluating the risks and benefits of all treatments relative to one another (as well as presence and severity of co morbid substance abuse). Clinician guidelines should not include coercive drug tests based solely on a patient’s report of cannabis use. The standardized use of detailed “pain contracts” with mandatory- or unannounced- drug screens should be reserved for only those patients who have significant compliance issues which have been demonstrated over time.

The general use of coercive pain contracts undermines the patient’s trust in the physician and fosters miscommunication and deception. “Agreements” (as opposed to contracts) with patient’s to monitor and document analgesic use over time with the addition of cannabis allows a working relationship with the prescriber which fosters trust. In the event that a patient’s drug screen indicates the presence of cannabinoid metabolites, an enlightened health care provider will engage in a detailed discussion with the patient in order to determine the underlying reason for the use of cannabis and if it is improving the quality of life of the person. A patient’s report that he/she “feels better” after they use cannabis should not be detrimental, since the homeostatic regulatory functions of cannabis generally improve comfort.

The refusal of a clinician to discuss with or seriously evaluate the use of cannabis specifically in relation to that person’s underlying medical diagnoses violates the clinicians’ practice guidelines which include detailed evaluation of the patient’s condition through an educated understanding of the complexity of their circumstances and knowledge of different treatments.

Cannabis has been used as an analgesic for 5000 years. (7) As restrictive laws give way to sensible regulation, its use as a medicine will increase, because patients are unable or unwilling to tolerate potent pharmaceuticals, or cannot afford them. All clinicians should be undertaking an education in endocannabinoid therapeutics in order to gain the understanding of this complex system. Clinicians should also understand route-dependant metabolism, federal and state legal barriers, strain evaluation processes, safe handling considerations, research advancements, novel cannabinoid drug development and dosing options- like vaporizers.

The American Medical Association’s Code of Medical Ethics, Opinion 1.02 - The Relation of Law and Ethics (8) reads, in part: “Ethical values and legal principles are usually closely related, but ethical obligations typically exceed legal duties. In some cases, the law mandates unethical conduct.” “In exceptional circumstances of unjust laws, ethical responsibilities should supersede legal obligations.”

The federal ban of the use of medical cannabis by patients may be interpreted as an ethical dilemma for physicians, compounded by the DEA prescriptive authority which may be revoked, rendering the clinician incapable of practice. Physicians and Nurse Practi tioners must weigh these factors. The unwillingness of federal legislators and regulators on all levels to change the scheduling of cannabis represents an unconscionable and inhumane obstacle to cannabis patients, researchers and clinicians. Ethical principles of medical practice require clinicians to work actively to eliminate these injustices and advocate for an intelligent federal policy which does not victimize suffering people and waste tax revenues in the process. Endocannabinoid therapeutics represents a subspecialty of medicine. The guidelines of clinical practice require “evidence- based” practice resting on the principles of science and ethics. Endocannabinoid therapeutics has evolved to the point where it meets these requirements of practice.

Sources

1. National Vital Statistics System. Mortality data. http://www.cdc.gov/nchs/deaths.htm.

2. Richardson, et al, Cannabinoids Reduce Hyperalgesia and Inflammation via interaction with peripheral CB-1receptors. Pain 75, 1998 111-119.

3. Welch SP: Interaction of the cannabinoid and opioid systems in the modulation of nociception. Int Rev Psychiatry 2009, 21:143-51.

4. Desroches J, Beaulieu P: Opioids and cannabinoids interactions: involvement in pain management. Curr Drug Targets 2010, 11:462-73.

5. Lucas, P., Cannabis as an Adjunct to or Substitute for Opiates in the Treatment of Chronic Pain. Journal of Psychoactive Drugs Volume 44, Issue 2, 2012, DOI:10.1080/02791072.2012.684624.

6. Di Marzo, Endocannabinoids: endogenous cannabinoid receptor ligands with neuromodulatory action, Trends Neurosci . 1998 21, 521–528.

7. Russo E., The Role of Cannabis and Cannabinoids in Pain Management, Weiner’s Pain Management, Seventh Edition, 2006, 823-843.

8. American Medical Association: Code of Medical Ethics. Opinion 1.02-The Relation of Law and Ethics. http://www.ama-assn.org/ama/pub/physicianresources/medical -ethics/code-medicalethics/opinion102.page?

Got Lung Cancer? OSU Has An Inhaler For That.

Image of NLCS with all coatings
image from journal submission

Researchers at OSU are bringing science fiction style nanomedicine into the real world. The research will give manufacturers the information they need to make an anti-lung cancer inhaler.

The work, submitted for publication this month, detailed the use Nanostructured(meaning particles only a few billionths of an inch across) Lipid Carriers (NLC) and their efficacy as a means for delivering cancer drugs via inhalation versus traditional intravenous(IV) delivery.

The cancer fighting nanoparticles were coated with four substances. Two siRNAs(Small interfering RNA), one for inhibiting the process used by cancer cells to “pump” cancer drugs out of the cell and another that prevents the cancer from inhibiting the cells natural ability to die, a peptide that selectively bind to the cancer cells,and the actual cancer drugs themselves. Trillions of the particles were then suspended in an aerosol and pumped into the mouths of anesthetized mice who had lung tumors.  

In the mice treated via traditional IV methods, but still using the nanoparticles and their special coatings, only 23% of the therapeutic compounds actually made it into the tumor cells in the lungs. Much of it ended up in the liver(59%) and kidneys(9%) and some even ended up in the mice’s hearts(1%).  Which may have been why that delivery method merely slowed tumor growth down, relative to the controls.

Black line is the control, the purple line is just the targeted carriers,
 the green line is IV delivered carriers,
 the blue line is targeted NLC without siRNA,
the red line is the targeted NLC with siRNA.
image from journal submission

In the mice treated with the aerosol, an amazing 83% of the medication arrived where it was supposed to, in the tumors in the lungs. The effects were truly astounding tumors were shrunk from 40 cubic millimeters to less than 5. In 50% of the trials with the NLCS the tumors were reduced to such an extent that the researchers could not find them.

While this amazing, more research will need to be done to ensure that there are no long term negative side effects to using this kind of delivery system although given that most of the medication made it to where it was supposed to be side effects should be minimal.

Water conservation more important than ever.

500 researchers assembled last week in Bonn, Germany for the Global Water System Project Conference, "Water in the Anthropocene” where they adopted recommendations focused on the “science, governance, and management of water resources.”

They warned that, in as little as two generations, and without global change, billions of people will face severe challenges accessing fresh water. The researchers called on participant nations to renew commitments to adopting multi-scale and interdisciplinary approaches to water science and to make use of recent cross-disciplinary studies of knowledge about fresh water.

Their declaration calls for institutions and cities to recognize the urgent need to train the next generation of water scientists and practitioners in global resource change research and management.

Beyond just access to technology the report urges researchers and officials to consider ecosystem-based alternatives to costly structural solutions for climate proofing. Design, they argue, should make use of the existing environment and include both traditional and green infrastructural improvements.

In order for any of these recommendations to succeed cities, states, and nations will need to stimulate innovation in their water institutions.

Solving the problem of clean water access will require a balance of technical solutions and political compromises that take heed of differing value systems and equity. They warn that a failure to adopt inclusive approaches will make it impossible to design globally effective green growth strategies or implement sustainable economic policies.

Fortunately Corvallis and city water management policy is already moving to be in line with many of the recommendations made by this report. One such project, done in conjunction with the Corvallis Sustainability Coalition, is the “Three Waters Project” at the South-Town First Alternative Co-Op.

Set to finish next month, the project is an ambitious plan that serves as a demonstration that “ businesses and residences can reduce tap water use, plus wastewater and stormwater discharge into municipal systems by 50% while maintaining current standards of living, health, and convenience.”

Given the exponential rise of cities around the world and the influx of once rural residents to urban areas, projects like this will be vital to ensuring adequate access to clean fresh water resources.  

In addition to projects like the this, the city is challenging residents to take the “shorter shower challenge”  and reduce their showers to just six minutes, down from the average of eight minutes. The average shower head sprays out an amazing 2.1 gallons a minute making an eight minute shower a 17 gallon affair.

By reducing showers to just six minutes and using low flow high pressure faucets Corvallis residents can reduce their personal water usage by thousands of gallons a year, which would result in tens of millions of gallons of water saved by the city collectively.

It is not just Corvallis residents and businesses that are working on water conservation. OSU strives as an institution to do its part to reduce the amount of water that it uses and to improve local water resources through aggressive stormwater management.

The university makes use of stone and vegetated swales to reduce debris in and flow of runoff, participates in rainwater collection & reuse, uses permeable hardscapes to reduce run-off, deploys filter and detention manholes, builds green roofs, and plants numerous rain gardens.

While Corvallis is at the forefront of sustainable water management there is more that can be done. The conference participants concluded that “stewardship requires balancing the needs of humankind and the needs of nature through the protection of ecosystems”. However, without a global design framework, they fear that fragmented decision-making and persistent maladaptive approaches to water management will merely make the situation worse.

More people have cellphones than have access to running water.

Humanity is on the precipice of one of the most significant changes in our evolutionary history. For the first time ever, more than 95% of the worlds population has a cellphone and more than 40% of households have access to the internet. More people have access to a cell-phone than have access to running water, indoor plumbing, or consistent electricity.

While that might seem a simple thing, a cellphone and access to the internet, these two technologies are the most disruptive and empowering technologies since indoor plumbing and refrigerators. Think about just how much the Western world has changed since cellphones and the internet went mainstream. New words, communities, jobs, and services have made their way into mainstream society.
The same is true in the developing world, new jobs are being created in the very communities that need them.The desire for western electronics and access to the internet has already ready spurred market innovation. In rural India charging Kiosks have sprung up in response to the demand for electricity for charging electronic devices, and for 15 Rupees, about 10 cents, an individual can get their device recharged.

image courtesy of Thrive Solar

In fact, according to the OECD 20% of the world’s population still lacks basic access to electricity, and yet many of these people have access to a cell-phone. The local desire and need for mobile technology is creating the demand that will drive development.

So while American’s might complain about multi-hundred dollar phone bills, billions of people are connecting, for the first time, to the global telecommunications network. People who never had running water, never had consistent electricity,don’t know how to read, and have never had a landline, are suddenly plugging into the 21st century.

Whole continents are leapfrogging legacy landlines and bypassing desktop computers in favor of mobile devices that enable them to start small businesses and create cooperative exchanges for trading their goods and services.

Cellphone Kiosk owner from the African city of Anam.

In fact, throughout the developing world, mobile broadband is cheaper than fixed broadband, despite prices dropping 82% over the last decade. So while their per bit prices are still higher than the prices paid by their Western counterparts, their societies are saving billions by not investing in legacy technology.

It is important to remember that for these people cellphones are more than just a way to twiddle away with their thumbs. The adoption of cellphones represents an existential change to the way they live their lives. Farmers, crafters, and artisans, many of whom are women supporting extended families, who have never traveled more than a few kilometers outside of their villages are suddenly networking with other small groups to exchanges goods, services, and information about potential threats from warlords and opportunities in regional and global markets.

Killing snails and slugs never tasted so good....to your dog.

With June fast approaching local gardeners are gearing up for their yearly battle with the common garden pests, slugs and snails. The most common tool for combating these pests are

metaldehyde and iron-phosphate based Molluscicide.

Researchers, from OSU, writing for the National Pesticide Information Center, recently released a meta-analysis looking at the previous 11 years of reporting on iron toxicosis in pets due to exposure to molluscicides and the results are heartening. Their intent was to determine whether or not EPA mandated warning labels had reduced incidents of canine exposure to toxic garden pesticides.

The EPA, in 2006, began requiring pesticide manufacturers to clearly label pesticides with metaldehydes in them because pets, dogs specifically, exposed to metaldehydes can experience severe muscle tremors, hyperthermia, and metabolic acidosis(renal failure).

Metaldehyde baits are attractive and toxic to more than just slugs and snails. Dogs,because of the addition of food byproducts like molasses, are also very attracted to these kinds of baits.  According to the researchers, “Dogs tend to eat all of the bait available, even digging to retrieve buried bait applications.”

 

In the analysis, the researchers found that 1,500 molluscicide animal exposures had been reported between 2001 and 2011, with the majority, 81%, coming from the West coast. Of these 1500 exposures, 1285 stemmed metaldehyde exposure and resulted in 35 canine deaths and 603 symptomatic events. The remaining 215 exposures were from iron phosphate exposure and resulted in no canine deaths and only 86 symptomatic events.

Because there is no antidote for metaldehyde poisoning the EPA and these researchers feel it is important that all gardeners who have dogs, or whose neighbors have dogs, be aware of the dangers of using metaldehydes and instead opt for alternative compounds for dealing with garden pests.  

Thankfully, gardeners appear to be getting the message. The researchers noted that there was an apparent increase in the number of exposures from 2001-2006, pre EPA mandate, and an apparent decrease subsequently. They attribute this to an  increasing usage of Iron-phosphate based alternatives.

So this year when you head to your local garden shop for slug and snail bait, make sure you reach for the Iron-phosphate based molluscicides instead of the metaldehydes. Your dogs and your community’s dogs will thank you.

Media Bias - You keep saying that but I don't think it means what you think

Claims of media bias and protestations about “liberal media bias” are old hat at this point. Politicians from across the political spectrum routinely fall back to the idea that their position would be more broadly accepted but for “media bias.”

Leaving aside semantical debates about what “bias” is or what “liberal” or “conservative” actually mean, whining about media bias is common amongst most politicos and ideologues, regardless of their political leanings.  Generally when claims of biased reporting are made, what the claimants actually mean is that media outlet in question is intentionally distorting the truth, in order to advance some “agenda.”  

In actuality, when claims of bias are made, what is generally occurring is that someone’s personal political bias is being challenged.

There are  dozens of different kinds of biases, from memory bias and anchoring bias to confirmation bias and familiarity bias. Humans are simply not particularly good at acting without some kind bias.  So yes, the media, being made up of fallible humans, is biased.

One of the most common and persistent forms of bias is confirmation bias. Confirmation bias is the tendency to seek out information that confirms one’s existing worldview, while simultaneously ignoring information that challenges it.

All humans perceive the world through these biases, or lenses. Individuals acquire over the years, from their parents, friends, and communities, a system of beliefs, or a collection of biases, that anthropologists call “worldview.”

A worldview consists of all the personal truths, political truths, and beliefs that one has and uses to understand one’s place and function in the the world.

Worldviews, unsurprisingly, differ from person to person, are heritable, and have enough flexibility and overlap to allow for grouping. Hence nationalism and the partisan divide in this country between “liberals” and “conservatives.”

The Commuters resident Tea Party Conservative, Dale Hummel, recently published a piece on media bias in which he lamented the current state of political discourse in this country and made the bold claim that, “The lack of reporting on the Benghazi scandal, Fast and Furious, voter fraud, The Secret Service prostitution scandal, Solyndra, the lack of positive Tea Party and Second Amendment coverage are clear signs that most of the media have a clear bias and far from real journalism.”

Rather than being a series of examples of blatant media bias, this is an excellent example of ideology and confirmation bias, leading one to the spurious conclusion that most media is liberally biased.

The easiest way to illustrate this bias is with one of Dale’s claims: the lack of positive Tea Party and Second Amendment coverage being clear signs of bias and shoddy journalism.

This claim rests on two testable assumptions. First, that the preponderance of news media coverage concerning the Tea Party and the second amendment is “negative,” and second, that the preponderance of news media, in general, espoused said view. This is demonstrably untrue.

According to reports at Mediaite on  Nielsen, a television ratings company, media research, “FNC ranked fifth in all of cable during January, behind only ESPN, USA, History and TBS (CNN and MSNBC ranked 23rd and 27th respectively).” The rest of the news networks don’t even place in the top 100 networks watched.

Simply put, Fox’s News coverage is, by definition, the mainstream coverage, as the most individuals who watch cable news watch it on a Fox network.

Given that Fox aggressively promoted Tea Party events, and even let one of their hosts, Glenn Beck, lead a Tea Party event, it is hard to accept the premise that some kind of “liberal media bias” has been occluding the Tea Parties true virtues.  

Dale’s claim perfectly illustrates confirmation bias; for him, and many other Tea Partiers, that their own media outlets are dominant doesn’t affect their reasoning. To them, “the media” is against them, against their beliefs, and are biased.

Rather than being an oppressed minority, the Tea Party has received a tremendous amount of coverage, in no small part because of the National Tea Party patriots relationship with FNC.

They received so much coverage, that despite being a particularly small minority (50% of the Republican party at it’s height), they were able to derail the national conversation about the economy onto whether or not Barack Obama was a citizen.

If there were some kind of systemic liberal media bias it seems that their claims about his heritage would never have seen the light of day.

Dale’s further claims, about a lack of reporting on Benghazi and Solyndra are also examples of confirmation bias. One can quite easily find several articles on the NYT and WaPo, so called liberal institutions, lambasting the administration for their flat-footed response to the Libyan attacks. This alone undermines his entire argument about systemic liberal bias.

One can also find articles, from several different news sources, detailing how Solyndra was a poor investment choice. In fact, every single example that Dale points to as being an example of shoddy journalism, is merely an example of a news agency not agreeing with Dale’s political positions on specific issues.

Solyndra for example - yes, it was a bad investment, but it was an investment made along with several other investments, of which most have returned profits to the administration. It begs the question of why some insist on focusing on just one of the high risk investments, instead of looking at the total package of investments made.

The point here is that there is more than one way of viewing a story. One view may be that government was engaged in crony capitalism to enrich political allies, another view is that the administration was engaged in something called “venture capitalism,” a notoriously high risk/reward investment strategy.

That the bulk of the investments made by the administration in the green energy have panned out doesn’t seem to matter to the Tea Party. All that seems to matter is that one out of dozens failed.

The Fast and the Furious example is yet another story that has more than one view. Simply not believing in the Tea Party version is not an example of intentional bias, but rather is an example of differing political viewpoints.

It is completely possible, even reasonable, that the attempt by the Justice Department to curtail cartel purchases of firearms through sting operations, as are done in cities across the nation, was merely mishandled instead of being some kind of conspiracy.

All of which isn’t to say that explicit media bias doesn’t exist, but rather that most bias is of the incompetent or implicit kind, rather than the nefarious kind.

In fact, just this week Jon Stewart, a card carrying member of the “liberal elite”, took Obama to task over the IRS scandal and the DOJ appropriating AP phone logs. Stewart could have whitewashed, or even ignored these events, but instead he treated them just as he treats all political shenanigans, with wit and sarcasm. His bias towards using comedy as a means for illustration was in full view, but what wasn’t in view was some kind of political bias or secret agenda to support the president.

When individuals watch ostensibly partisan sources like Fox or MSNBC, according to research by FDU political scientist Dan Cassino, results show “Ideological news sources, like Fox and MSNBC, are really just talking to one audience. This is solid evidence that if you’re not in that audience, you’re not going to get anything out of watching them.”

Basically, if you are mostly watching, listening, or reading from ostensibly partisan outlets, everything else is going to be appear to be biased. This “ideological anchoring” is what causes individuals to believe that there is widespread media bias, when in point of fact what there is, is, widespread differences of political opinion amongst the media.