MEDICINE'S MORAL MICROMANAGERS

I was distressed by Joyce Nalepka's March 19 letter in which she asserted
that some unspecified National Institutes of Health publication recommends
avoidance of marijuana by people with HIV.

That is perhaps true, but it is also the case that an extensive workshop on
medical marijuana convened by NIH in 1997 presented a great deal of
positive information on its benefits. The Institute of Medicine has
recommended that cannabis be made available to people with HIV, cancer and
other serious illnesses.

Ms. Nalepka, who said that only the Food and Drug Administration should
dictate approval of medicine, may be interested to know that FDA recently
recognized medical indications for cannabis by virtue of its approval as an
Orphan Drug for treatment of AIDS wasting syndrome. Also, FDA approved my
Investigational New Drug application for cannabis in migraine treatment
last year, only to have progress derailed by the refusal of the National
Institute on Drug Abuse to provide the drug for the trial.

It is false to assert that cannabis is ineffective in treatment of
glaucoma. Many patients who have failed standard treatments have preserved
their vision through such treatment.

Cannabis may worsen balance in some, but not all, multiple sclerosis
patients. In contrast, it has had demonstrable benefit on the disease's
associated tremor and spasticity (muscle tightness). Recent studies also
suggest that with cannabis, deteroriation may be slowed.

The moral micromanagers should step aside and leave this debate where it
belongs: with the FDA, patients and their doctors.

Ethan Russo, Missoula, Mont.