Monday, March 29, 2010

Let the sick decide if marijuana is medicine

Pain can saturate one's entire being. This hit home recently when my
mother endured bouts of chemotherapy for stomach cancer. Drugs to
relieve her relentless nausea offered little benefit. As with countless
other patients, her medicine made matters worse.

For patients in intractable pain, time is not on their side. Therefore,
for supporters, New York's pending legalization of the medical provision
and use of marijuana is timely. Meanwhile, the debate continues.

Good ethics requires good facts, as in accurate, relevant and
evidence-based. Clearly, cannabis' history of illegal use and
association with lethal drugs has overshadowed its supposed therapeutic
value in alleviating chemotherapy-induced nausea, reducing glaucoma's
intraocular pressure, mitigating AIDS symptoms and relieving chronic
pain. Furthermore, its psychoactive component spawns fears of dependency
and abuse, although authorized stimulants, antidepressants and
analgesics also produce highs and lows.

While critics allege medical marijuana to be addictive, a so-called
gateway to lethal drugs and without medical benefit, they also reject it
as valid medicine. So, is medical marijuana "real medicine" or an

This deep-seated question is unsettling.

Why? Because it unearths an unhealthy tension among politics, power and

In his "Social Transformation of American Medicine," sociologist Paul
Starr chronicles this tension by describing how U.S. mainstream
medicine, through licensing and certification requirements, assumed a
purportedly more "scientific" medical paradigm that marginalized
alternative, including herbal, therapies.

Wedded politics and science then enabled federal agencies' virtual
embargo on serious research into marijuana's therapeutic efficacy. To
illustrate, the National Institute on Drug Abuse plantation at the
University of Mississippi is the only place where researchers can
legally obtain marijuana. Yet, with pressure from the Drug Enforcement
Agency, NIDA's ongoing denial of research on the plant's medical
benefits has blocked important clinical studies.

As Madelon Lubin Finkel, clinical public health professor at Cornell's
Weill Medical College asserts, "reasons for this prohibition are clearly
politically ideological."

Politics' power over science is especially apparent since the biggest
stakeholder in defining "real medicine" is the pharmaceutical industry,
"Big Pharma." Generous government funding for research into a synthetic
substitute for tetrahydrocannabinol, the primary psychoactive chemical
in marijuana, led to the 1985 FDA approval of Marinol(r), a prescription
drug for chemotherapy-related nausea and AIDS patients' weight loss.
Touted as safer and more effective than natural botanical marijuana,
Marinol, as "real medicine," may have diverted research from the
therapeutic potential of the plant itself.

Since good ethics requires good facts, without sufficient comparative
clinical studies, findings become arbitrary. Is a synthetic substitute
better than nature's botanical remedy?

In their book "Dying to Get High," sociologist Wendy Chapkis and
communications expert Richard Webb argue that "pharmaceutical purity" is
a misleading notion given the rubric of side effects for most
prescription drugs, ranging from organ damage to heart failure to nausea
to depression to suicidal tendencies. At $30 a pill, Marinol is a costly
trade-off for the patient, but profitable in one of the most lucrative
industries in the United States, Big Pharma.

The moral center of concern in health care should be the patient. When
that center shifts to political ideology, we abdicate moral
accountability to our patients.

Will legalizing medical marijuana help restore accountability?

Although the jury is still out regarding side effects, the Institute of
Medicine's 1999 report "Medicine and Marijuana" finds "no conclusive
evidence that the drug effects of marijuana are causally linked to the
subsequent abuse of other illicit drugs." Moreover, the Drug Policy
Education Group's 2002 account ( refutes DEA
arguments regarding marijuana's harms.

We can bestow dignity on patients by empowering them to make their own
informed choices among reasonable options. As to these options, good
science and sound moral principles -- not political ideology or industry
profit -- should help determine how we characterize "real medicine."

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