HOW POT BECAME DEMONIZED

The Fine Line Between Good Medicine and 'Dangerous Drugs'

A History of the Battle Between Politics and Science Over the Use of
Marijuana As a Medicine.

The following is an excerpt from "Dying to Get High" by Wendy Chapkis
and Richard J. Webb (NYU Press, 2008). Reproduced by permission of
the publisher.

For many modern critics, the concept of "medical marijuana" is a
contradiction in terms. Medicine is standardized, synthetic, and
pure; marijuana involves the unrefined and promiscuous coupling of
more than four hundred components rooted in the dirt. Medicine -- in
its most powerful and privileged forms -- rests in the hands of men,
while the most potent form of marijuana is found in the female
flowering plant. Medicine engages in heroic battles against death.
Marijuana claims only to enhance the quality of life.

Medicine presents itself as an objective science safeguarded by the
ritual of the double-blind, randomized clinical trial. The
therapeutic value of marijuana relies largely on the "soft science"
of subjective experience and anecdotal evidence. From the perspective
of its critics, then, cannabis is an effeminate interloper in the
masculine world of real medicine, a dangerous drug pushed on a
credulous public by illegitimate quacks.

But this story is too simple. The line separating regular doctors
from snake oil salesmen, good drugs from bad, is as much the product
of politics as it is of science. The dominance of politics in
determining the value of marijuana as a medicine was first
demonstrated in the 1930s when the federal government began to
restrict the medical use of marijuana, against the recommendations of
the American Medical Association (AMA).

The struggle between politics and science over the use of cannabis as
a medicine continues. In the final decade of the twentieth century,
the federal government threatened physicians with the loss of their
license for recommending marijuana to patients, made criminals of
patients who followed their doctor's advice, and actively blocked
scientific research into the therapeutic value of cannabis, while
insisting that it was an established scientific fact that marijuana
is not a medicine.

During the opening of a 2004 congressional hearing on medical
marijuana, this ongoing battle over cannabis was described by
committee chair Rep. Mark Souder (R-IN) as a critical front in the
War on Drugs and consistent with the modernization of medicine:

This hearing will address a controversial topic, the use of marijuana
for so-called medicinal purposes. In recent years, a large and
well-funded pro-drug movement has succeeded in convincing many
Americans that marijuana is a true medicine to be used in treating a
wide variety of illnesses .... Marijuana was once used as a folk
remedy in many primitive cultures, and even in the 19th century was
frequently used by some American doctors, much as alcohol, cocaine,
and heroin were once used by doctors. By the 20th century, however,
its use by legitimate medical practitioners has dwindled, while its
illegitimate use as a recreational drug has risen.

Souder thus sets the stage for a morality tale populated by primitive
practitioners and legitimate doctors, dangerous drug fiends and
decent drug warriors.

Fox News personality Bill O'Reilly invoked a similar cast of
characters in his 2004 discussion of medical marijuana with U.S.
Deputy "Drug Czar" Dr. Andrea Barthwell. That year, voters in Oregon
were to be presented with a ballot measure to amend their state's
already-existing medical marijuana law. The proposed amendment (which
ultimately failed) was intended both to increase the amount of
marijuana a patient could have over the course of a year and to
redefine which health professionals could legally recommend marijuana
for medical use.

O'Reilly scoffed at the idea that licensed health practitioners other
than physicians might be authorized to recommend the use of cannabis
to their patients: "Even a shaman could grant permission for you to
toke in Oregon. I mean, this is, you know, any health practitioner.
So you're a shaman from the Amazon and you set up shop. Come on, I
mean, everybody knows this is a ruse. Am I wrong?" Andrea Barthwell
confirmed for viewers that O'Reilly's concerns were quite legitimate:
"No, you're absolutely right, Bill. This is what we've been trying to
make clear to people when they have these proposals presented to
them. This is not about getting medicine to people who are sick and
dying. This is about making marijuana legal."

While both host and guest shared the belief that the Oregon proposal
was no more than a thinly disguised attempt to legalize marijuana,
O'Reilly asked whether cannabis itself might not be a legitimate
medicine if prescribed by a legitimate physician to a patient with a
legitimate need: "But there is a legitimate issue here, Doctor. We
had Montel Williams [another popular TV talk show host] on a few
weeks back. He has MS [multiple sclerosis]. And I believe Montel
Williams when he says, 'Look, medical marijuana helps me, helps me
cope with this disease, cope with my suffering. There's no reason why
I should be denied it.' And I agree with Montel Williams that if this
is the case, if a doctor -- a doctor -- says that he needs it for his
MS, he should have it. You don't disagree with that, do you?"
Barthwell's response was uncompromising: "Well, I do, actually. There
is nothing that tells us from the science now that smoked, crude
botanical should be a medication. We have a process that has been in
place for 100 years in this country that protects the sick and dying
from snake oil salesmen. And just because something makes you feel
better doesn't make it medicine."

In this short exchange, the terms of the debate for dismissing
cannabis therapeutics are neatly laid out: medical marijuana is a
ruse; cannabis is the modern day equivalent of "snake oil"; "crude
botanicals" are not real medicine; licensed alternative health
practitioners are not legitimate healers; marijuana is reduced to and
synonymous with smoking as a delivery system; and "feeling better"
isn't always therapeutic. Taken together, these claims create a neat
division between marijuana and "real medicine," with medicine
narrowly defined as that which is practiced by physicians prescribing
pharmaceuticals to patients who will not necessarily feel better as a result.

The Rise of "Regular" Medicine and the Battle Against Botanicals

According to Dr. Raphael Mechoulam, an Israeli research chemist who
performed much of the original work in the early 1960s isolating the
active ingredients in marijuana: From ancient times to the early 20th
Century, cannabis was used for a wide variety of medical purposes
including the treatment of pain and swelling, depression, arthritis,
impotence, kidney stones, hemorrhaging in childbirth, irregular bowel
movements, cold sores, distending stomach, dropsy, headaches,
diseases of the respiratory organs, hysteria, neuralgia, sciatica,
tetanus, dysentery, fatigue, disorders of the female reproductive
system, convulsions, cholera, delirium tremens, vomiting, spasmodic
asthma, and a host of other ailments. Most of these therapeutic
claims were either based on folklore or were anecdotal, but the use
of cannabis as a therapeutic agent in the past provides an insight
for future drug development. More recently, some of the historical
therapeutic properties of cannabis have been verified with pure
natural or synthetic cannabinoids; however, in several fields no
modern scientific work exists.

In order to understand why marijuana, a promising medicinal
botanical, should now be excluded not only from the modern
pharmacopeia but also from much formal scientific study, it is
necessary to ask why some drugs, but not all, get labeled "medicine";
why some healers, and not others, are "regular doctors"; why some
effects, but only some, are understood as "therapeutic"; and why some
risks are acceptable while others are prohibited under penalty of
law. The answers cannot be found in a simple appeal to scientific
standards. Instead, in order to understand what counts as
"legitimate" medicine, it is useful to ask who, beyond the patient,
might benefit from such distinctions. In our exploration of the role
of organized medicine, state regulatory agencies, the courts, and the
pharmaceutical industry in the demonization of marijuana, the intent
is not to perform the reverse process, demonizing modern medicine.
Over the past century, during which organized medicine consolidated
its authority and cannabis was first marginalized and then removed
from the pharmacopeia, astonishing medical advances have been made.
Unquestionably, the public would be ill served by a return to a time
of unregulated medicine practiced by poorly trained doctors with
recourse to few effective drugs.

Nonetheless, it is also the case that the healing arts remain an
impure science. The most striking difference between marijuana and
"real medicine" is not the physical but the social effects the plant
has on users and healers alike. Association with marijuana marks
those it touches as illegitimate -- a distinction with deep
historical roots. Prior to the professionalization of medicine, lay
healers -- often women -- made extensive use of medicinal plants. But
as modern medicine moved into the ranks of the professions, and into
hands of men, botanicals were discredited along with the women who
had used them. In their pathbreaking study of the rise of the male
medical expert, For Her Own Good, Barbara Ehrenreich and Deirdre
English note that, in the fifteenth and sixteenth centuries, anxiety
over women's knowledge of medicinal botanicals contributed to the
European witch hunts: charges against the accused often included the
provision of herbs.

In Colonial America and the early republic, health and healing
practices also rested largely in the hands of lay women practicing
herbal medicine. Historian Carol Smith-Rosenberg observes that "women
as midwives and as family nurses, women wise in the ancient herbal
pharmacopoeia, had always cared for their own and neighboring
families. A survey of cookbooks and women's diaries for the
eighteenth and early nineteenth centuries shows that women collected
and exchanged recipes for medicines as routinely as they did for pies
and cookies."

By the nineteenth century, however, as medicine entered the
marketplace, male physicians with little formal training claimed for
themselves the designation "Regular doctor" while moving all others
to the margins of the healing arts. In North America, midwives,
bonesetters, and "root and herb" doctors were thus gradually
displaced by the self-proclaimed "Regulars," not through the violence
of witch burnings, as happened in Europe, but rather through
professionalization. This challenge was, according to Ehrenreich and
English, "at bottom, economic. Medicine in the 19th century ...
[became] a thing to be bought and sold."

Professionalization required that the Regulars distinguish themselves
from midwives and herbalists; they did so through "heroic medicine,"
a practice involving dramatic (though not necessarily beneficial)
techniques such as bloodletting, blistering, purging, and the use of
toxic mercury-based medicines. These interventions were intended to
produce "the strongest possible effect on the patient." Though such
therapies were not only dangerous and often ineffective, Ehrenreich
and English observe that they gave "regular doctors something
activist, masculine, and imminently more salable than the herbal teas
and sympathy served up by rural female healers." In fact, despite the
very serious risks of heroic medicine, Smith-Rosenberg notes that the
Regulars insisted that it was they who were protecting "the lives of
innocent citizens from ill-trained, irresponsible 'irregulars,' and
hysterical midwives."

The Regulars prospered during the first two decades of the nineteenth
century and succeeded in securing licensing laws in many states
restricting the practice of medicine to those in their ranks and
limiting membership to men. But growing dissatisfaction with the
results of "heroic medicine," and populist misgivings about
monopolies and elites, led to the temporary repeal of such laws
during the 1830s. The "Popular Health Movement" of the period
challenged the position of Regulars by emphasizing "self-help"
(through better hygiene and healthy living) and by embracing the
therapeutic approaches of alternative medical sects, including those
advocating botanical treatments.

As sociologist Carol Weisman notes, under the banner of science,
Sectarians or Irregulars "were attacked by mainstream physicians as
'quacks,' although the therapeutics of the regular physicians were
not generally more effective than those of the irregulars." The
Regulars reinforced their claim that they, and they alone, were
legitimate physicians by founding a national professional
organization in 1847 -- the American Medical Association --
explicitly excluding both women and sectarian practitioners.

In the second half of the nineteenth century, economic competition
intensified as both Regulars and their rivals -- now known as the
"Eclectics" -- opened medical schools to train practitioners. The
Eclectics, who advocated the use of botanical therapies, also
represented a more populist and egalitarian politics -- for example,
they admitted women to their medical schools. During this same
period, in 1854, cannabis joined other herbal remedies in the
national pharmacopeias and was freely prescribed for a large number
of medical conditions ranging from insomnia to neuropathic pain. In
the late nineteenth and early twentieth centuries, dozens of research
papers were published on the various medicinal uses of marijuana.

This corresponds to a period in which Regulars began to consolidate
the power of the newly organized medical profession, in part by
absorbing Eclectics into their ranks. As Paul Starr observes in his
landmark study, The Social Transformation of American Medicine,
Eclectics "succumbed to quiet cooptation; they were only too glad to
be welcomed into the fold." By co-opting much of the opposition,
physicians were able to secure new licensing laws restricting the
practice of medicine. But Eclectics paid a significant price; with
the consolidation of control by conventional medicine, botanical
therapies were increasingly marginalized by mainstream medicine.

The allopathic approach of the Regulars was not only dominant but
also institutionalized in the early twentieth century when organized
medicine completed its process of professionalization by gaining
control over medical education, access to hospitals, and the right to
prescribe drugs. The dominance of this paradigm was reflected in the
growing strength of the American Medical Association. In 1900 the AMA
had no more than eight thousand members, but by 1910 membership
reached seventy thousand, and by 1920 the majority of physicians in
the United States had become members. In fact, by 1931 only about 5
percent of all cases of illness were handled by non-MD practitioners.

This exponential increase in the power and professional authority of
regular doctors surprisingly did not rest primarily on the provision
of more effective medicines; these were slow to be developed.
Instead, doctors were forced to find other ways to assert their newly
established social and cultural legitimacy. One strategy was to
position themselves as experts in not only the physical but also the
moral health of the nation. In the nineteenth century, condemnation
of birth control and abortion, for instance, provided physicians with
a clear moral platform that allowed them to denounce practices still
largely in the hands of "irregulars." According to Carol
Smith-Rosenberg, these efforts to limit women's reproductive choices
became a key arena "in the war between the allopaths and the
'irregulars' for patients and for power .... The 'irregular'
physician and the 'irregular' wife, the 'regulars' insisted,
conspired together against public order and national well-being." As
Carol Weisman observes, this claim of medical and moral expertise
"provided regular physicians with an element of social respectability
and moral authority, which was enhanced by publicly criticizing the
abortion practices of other practitioners and the crass commercialism
of purveyors of contraceptives and abortifacients."

At the end of the nineteenth century, flush with its legislative
success against abortion, the AMA turned its attention to another
arena that neatly linked morality and public health: the provision of
drugs. Physicians enhanced their professional authority by speaking
out against the dangers of addictive drugs frequently found in
"patent medicines" and available directly to the public. Because the
formulae of proprietary medicines were secret, it was impossible for
patients to judge the safety of those drugs. The practitioners of
organized medicine thus joined forces with muckraking journalists to
bring to the public's attention the possible risks of patent
medicines. This important public service had a significant payoff for
the profession as well, reinforcing a growing distinction in the
public mind between good drugs (dispensed by doctors) and bad drugs
(available directly to the public by unlicensed practitioners).