DIFFERENCE BETWEEN QUACKERY, MEDICINE

One should take care to not be swayed too swiftly by arguments that
proponents of marijuana legalization offer. (When I speak of marijuana, I
am referring to the illegal substance that is commonly smoked and not
cannabis preparations such as dronabinol and levonantradol.)

Reasons for legalization, according to Robert Sharpe, Thomas C. Mountain
and Roger Taylor (Letters, Aug. 28) can range from unfair crime and
punishment to medical benefits to one's inherent right of freedom.

First of all, Sharpe's argument that "children have an easier time buying
marijuana than beer" is hardly convincing. Children also have easy access
to crystal methamphetamine and cocaine. Does that mean we should make them
available at a store?

Taylor and the Libertarian Party feel that "responsible" adults should be
able to do as they please, as dictated by our right of freedom. True, but
freedom without limits is equivalent to anarchy, and the last time I
checked, marijuana was still against the law.

But let's not talk about politics and the law. As a medical, student, I'm
more interested in the health benefits offered by Mountain.

Mountain rattled off a laundry list of medical conditions, including spinal
cord injuries (I'm curious as to how marijuana can help a paraplegic regain
the use of his legs) that can benefit from marijuana, but he did not offer
any evidence to back up his claims.

Anyone who has done homework on marijuana would know that it has a narrow
therapeutic index, meaning that there is not much leeway between the amount
that may help and the amount that may harm a given patient.

Demonstrated effects can include decreased blood pressure, increased heart
rate, airway narrowing, as well as chronic bronchitis, which one can get
from smoking tobacco. Everything from feces to Aspergillus has been found
in samples of marijuana, things that probably would not be good for
immune-suppressed patients who are getting che-motherapy or who have AIDS.

Just because something works does not mean that it is better or safer than
treatments already available. The difference between quackery and medicine
is that one is claimed, and the other proven.

Of course, all medications have side effects. But the point is that
medications in use already have passed through the rigorous approval
procedures of the Federal Drug Administration. Marijuana has not.

Evidence in support of marijuana's use is largely anecdotal, and
randomized, control trials (the gold standard of research) are lacking.

Emotional issues of patient care should spur, but not supplant, well-
conducted research. Physicians should be empathetic, but at the same time
should not allow that empathy to overrule evidence-based medicine.

The same should apply to politicians, who have no more business in deciding
on health-care issues than physicians do in rewriting the Constitution.

I am not against marijuana itself. Amphetamines and opioids have found
their use in medicine, and I believe that one day evidence will allow
marijuana to do the same. When that day comes, I will be more than happy to
prescribe it to patients who need it.

Until then, I will not deviate from the standard of care that I swore to
follow from the moment I first put on my white coat.

Frank Yuan John A. Burns School of Medicine