Pot Debate Needs a Dose of Hard Science
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16 July 2010
Are traveling doctors who specialize in the lucrative niche of writing marijuana recommendations -- licenses to smoke coveted both by genuinely afflicted patients and casual users who just want to avoid trouble with the police -- running afoul of the canons of medical ethics? Maybe, but that's between them, their consciences and the Medical Board of California.
And even if the answer's yes, the law's not going to do much about it - -- not as the rules stand in California. As long as physicians follow the most basic guidelines of medical practice, no jury's going to convict them of wrongdoing. And it's not as if the patients are complaining of malpractice.
But it's hard not to see a stretching of the state's groundbreaking 1996 Compassionate Use Act beyond all recognition when patients arrive not thanks to a referral from their family doctor, but after hearing a 30-second ad on the local rock station.
Of course, how are these doctors so different from the hospitals that emblazon their names on highway billboards? The pharmaceutical companies that tout the latest high-priced prescription meds between scenes of "House, M.D."? Medicine is a noble healing profession, but it's also a business.
Deeper down, the heart of the quandary is that marijuana is still, in the minds of most Californians, a recreational drug. Yes, it has some bona fide medicinal uses, but in practice the conditions for which it is recommended have become so vague and diverse as to tax its credibility as "medicine."
Nearly all Californians these days would agree that if a cancer patient suffering from severe pain, treatment-related nausea and weight loss found relief from using marijuana, that poor soul should have all the bud he or she needs to endure the terrible disease.
Nearly all Californians would also agree that marijuana is probably the wrong treatment for a teenager whose braces hurt her mouth -- though Redding Police Chief Peter Hansen says at least one Redding girl has managed to obtain a medical-marijuana recommendation based on just that complaint.
In between those two extremes is a vast gray area where a gray market thrives. Here, common sense and intuition are not reliable guides. What patients, doctors and society at large need is a more rigorous scientific understanding of cannabis, its active ingredients, its effective doses, the ailments for which it is genuinely effective.
Without that knowledge, without more clear definitions of the medical promise and limits of marijuana, arguments over medical cannabis are about ideology, not science.
Unfortunately, federal regulations list marijuana as a Schedule I drug, which means that, officially, it has no accepted medical use -- never mind that more than a dozen states say otherwise. Because of those rules, even conducting research is enormously difficult. The American Medical Association last fall called for easing of those federal strictures -- not as endorsement of marijuana but simply to allow more study. And that is the best prescription for a way out of the current mess.
In some cases, marijuana might well be good medicine. In many others, it's surely not. But it's all guesswork without more hard facts -- and the federal government should at least get out of the way of researchers who'd like to gather them.
