MEDICAL MARIJUANA

MR. ATTORNEY GENERAL, LISTEN TO THE DOCTORS AND PATIENTS

JOHN ASHCROFT, MEET A CANCER VICTIM

I want John Ashcroft to leave his desk, come into the chemotherapy suite
and participate in the real consequences of his choices. I want him to meet
the bald, frail woman lying in the hospital bed next to mine in the
chemotherapy suite. I want this 70-year-old woman to ask him the same
medical question she asked me.

Because I was a cancer patient receiving chemotherapy at the same hospital
where I worked, the women with whom I shared the suite quickly surmised
that I was also a doctor. The clues were obvious: the colleagues dropping
by, the "doctor" salutations from co-workers and the odd coincidence that
one of my suite mates was also one of my patients.

I braced myself for this woman's question, both wanting to make myself
available to her but also wishing that the world could forget that I was a
doctor for the moment. After receiving my cancer diagnosis, dealing with
surgery and chemotherapy and grappling with insistent reminders of my
mortality, I had no desire to think about medicine or to experience myself
as a physician in that oncology suite. And besides, the chemotherapy,
anti-nauseants, sleep medications and prednisone were hampering my ability
to think clearly.

So, after a gentle disclaimer about my clinical capabilities, I said I'd do
my best to answer her question. She shoved her IV line out of the way and,
with great effort and discomfort, rolled on her side to face me. Her belly
was a pendulous sack bloated with ovarian cancer cells, and her eyes were
vacant of any light. She became short of breath from the task of turning
toward me.

"Tell me," she managed, "Do you think marijuana could help me? I feel so sick."

I winced. I knew about her wretched pain, her constant nausea and all the
prescription drugs that had failed her - some of which also made her more
constipated, less alert and even more nauseous. I knew about the internal
derangements of chemotherapy, the terrible feeling that a toxic swill is
invading your bones, destroying your gut and softening your brain. I knew
this woman was dying a prolonged and miserable death.

And, from years of clinical experience, I - like many other doctors - also
knew that marijuana could actually help her. From working with AIDS and
cancer patients, I repeatedly saw how marijuana could ameliorate a
patient's debilitating fatigue, restore appetite, diminish pain, remedy
nausea, cure vomiting and curtail down-to-the-bone weight loss. I could
firmly attest to its benefits and wager the likelihood that it would
decrease her suffering.

Still, federal law has forbidden doctors to recommend or prescribe
marijuana to patients. In fact, in 1988 the Drug Enforcement Agency even
rejected one of its own administrative law judge's conclusions supporting
medicinal marijuana, after two full years of hearings on the issue. Judge
Francis Young recommended the change on grounds that "marijuana, in its
natural form, is one of the safest therapeutically active substances known
to man," and that it offered a "currently accepted medical use in treatment."

Doctors see all sorts of social injustices that are written on the human
body, one person at a time. We see poverty manifest as a young father who
suffered a stroke because he could not afford cholesterol-lowering medications.

We see racism and sexism evident in the dearth of research that could
specify whether our hypertensive patient might respond differently to
standard treatments based on white male norms. We see the desperate and
damaged homeless arrive in emergency rooms to receive health care on a
crisis-to-crisis basis that rarely ever offers cure.

These social injustices are gargantuan problems that cannot be fixed in the
clinic, and their remedies can only come from broad public reform. But this
one - the rote denial of a palliative care drug like marijuana to people
with serious illness - smacks of pure cruelty precisely because it is so
easily remediable, precisely because it prioritizes service to a cold
political agenda over the distressed lives and deaths of real human beings.

The federal obsession with a political agenda that keeps marijuana out of
the hands of sick and dying people is appalling and irrational. Washington
bureaucrats - far removed from the troubled bedsides of sick and dying
patients - are ignoring what patients and doctors and health care workers
are telling them about real world suffering. The federal refusal to honor
public referendums like California's voter-approved Medical Marijuana
Initiative is as bewildering as it is ominous. Its refusal to listen to
doctors groups like the California Medical Association that support
compassionate use of medical marijuana is chilling.

In a society that has witnessed extensive positive experiences with
medicinal marijuana, as long as it is safe and not proven to be
ineffective, why -shouldn't seriously ill patients have access to it? Why
should an old woman be made to die a horrible death for a hollow political
symbol?

I want Attorney General Aschroft to wipe the vomit off this woman's chest,
help lift her belly so she -doesn't hurt as much when she rolls onto her
back, and explain straight to her grimacing face why she -can't try
marijuana. I want him to tell me why it does not matter to him that almost
every sick and dying patient I've ever known who's tried medical marijuana
experienced a kinder death. Face to face, I want him to explain all these
things to her and to me and to the heartbroken family who is standing by.

Kate Scannell is a doctor in Oakland who is co-director of the Northern
California Ethics Department of Kaiser-Permanente.