A HAZE OF MISINFORMATION CLOUDS ISSUE OF MEDICAL MARIJUANA

As a physician with more than 20 years of experience dealing with
patients who are addicted to drugs, I am often asked my professional
opinion about a contentious public health question: What is the
medical basis for smoking marijuana? The answer needs some context.

Americans today have the world's safest, most effective system of
medical practice, built on a process of scientific research, testing
and oversight that is unequaled.

Before the passage of the Pure Food and Drug Act in 1907, Americans
were exposed to a host of patent medicine "cure-alls," everything from
vegetable "folk remedies" to dangerous mixtures with morphine. The
major component of most "cures" was alcohol, which probably explained
why people reported that they "felt better."

Needless to say, claimed benefits were erratic and
irreproducible.

Marijuana, whatever its value, is intoxicating, and it's not
surprising that sincere people will report relief of their symptoms
when they smoke it. The important point is that there is a difference
between feeling better and actually getting better. It is the job of
modern medicine to establish this distinction.

The debate over drug use generates a great deal of media attention --
including the focus on the administration's appeal this month to the
U.S. Supreme Court against medical marijuana -- and frequent
misinformation. Some will have read, for instance, that the medicinal
value of smoking marijuana represents "mainstream medical opinion." It
is time to set the record straight.

Simply put, there is no scientific evidence that qualifies smoked
marijuana to be called medicine. Further, there is no support in the
medical literature that marijuana, or indeed any medicine, should be
smoked as the preferred form of administration. The harms to health
are simply too great.

Marijuana advocates often cite the 1999 National Academy of Science's
Institute of Medicine report as justifying the drug's medical use.
But, in fact, the verdict of that report was "marijuana is not a
modern medicine." The institute was particularly troubled by the
notion that crude marijuana might be smoked by patients, which it
termed "a harmful drug-delivery system."

These concerns are echoed by the Food and Drug Administration, the
agency charged with approving all medicines. As the FDA recently
noted: "While there are no proven benefits to [smoked] marijuana use,
there are many short- and long-term risks associated with marijuana
use."

Compounds in the marijuana plant do potentially have a medical value.
For instance, a synthetic version of an ingredient in marijuana has
been approved for treating nausea for chemotherapy patients, as well
as for treatment of anorexia associated with weight loss in patients
with AIDS.

Admittedly, these medications have limitations, including the
relatively slow onset of relief. Researchers are exploring
drug-delivery systems that allow rapid relief -- perhaps an oral
inhalator like those used by asthma patients -- as a response to
patient needs.

But these medications are a far cry from burning the crude weed and
gulping down the smoke. Every American is familiar with aspirin, and
some know that it was first found in willow bark, from which the
therapeutic agent acetylsalicylic acid was eventually synthesized.
Surely no one today would chew willow bark, much less smoke a piece of
tree, to cure a headache.

Medical science does not fear any compound, even those with a
potential for abuse. If a substance has the proven capacity to serve a
medical purpose, then it will be accepted. We have done so with
substances as dangerous as opium, allowing the medical use of many of
its derivatives, including morphine, Demerol and OxyContin. The key
term is "proven capacity." Only if compounds from marijuana pass the
same tests of research scrutiny that any other drug must undergo will
they become part of the modern medical arsenal.

Our investment in medical science is at risk if we do not defend the
proven process by which medicines are brought to the market. All drugs
must undergo rigorous clinical trials before a drug can be released
for public use.

The overarching charge to any physician is: "First, do no harm." That
is the test smoked marijuana cannot pass.