EVIDENCE NECESSARY BEFORE PRESCRIBING MARIJUANA

The medical marijuana debate was rejuvenated last month when Vice President
Al Gore suggested that the government give doctors greater flexibility to
prescribe the drug to relieve pain and suffering. Despite the new attention
to the issue, an old problem remains: good, quality evidence that marijuana
is superior to existing treatments does not exist.

Nobody is more aware of patient suffering than those of us who dedicate our
lives to alleviating it. If marijuana were really the wonder drug that some
groups purport it to be, physicians would be in favor of prescribing it.
But the fact is that the majority of patients respond very well to current,
proven treatments. In my own experience, over the past 16 years of
practicing medicine, I have never been tempted to recommend that a patient
smoke marijuana. This is because established treatments have proven to work
well for them. But do understand, however, that not every patient is so
fortunate.

What would we have to lose by trying marijuana in those difficult to treat
cases?

What we lose, more specifically, what the patient may lose, is the chance
to treat the problem with one of the medications that have survived
rigorous, well-controlled studies. To do otherwise, is to risk making the
problem worse by pursuing an unknown course that may cause severe side
effects and even death.

I can't help but think the interest in medical marijuana is derived partly
from myths about health care in America, that somehow magic cures, potions
and "natural" remedies are available, but being denied to the public.

As successful and sometimes amazing as modern medicine has become,
Physicians can not work miracles. The human body remains in many ways a
mystery.

We are learning more, and need to learn much more, to help those patients
who do not respond fully to traditional medicine. But subjecting patients
to drugs that have not or can not pass scientific muster would be a
violation of the physician's oath to do no harm.

Science ultimately reveals secrets to conquering disease, even though the
process may take longer than we would sometimes like.