I feel impelled to dispute some of Dr. Richard E. Tremblay's assertions in
his July 29 column entitled "More Study Needed on Marijuana."

Dr. Tremblay reports that the British Medical Association, while endorsing
medicinal marijuana for a wide list of disorders (as has the prestigious New
England Journal of Medicine), noted that there were few scientific studies
supporting its effectiveness. The dearth of studies is hardly surprising,
since the Drug Enforcement Agency and the National Institute on Drug Abuse
(NIDA) consistently block such studies. For years, Dr. Donald Abrams of U.C.
San Francisco has been denied access to marijuana from NIDA to carry out his
FDA approved study in AIDS patients comparing weight gain and nausea control
of smoked marijuana vs. synthetic THC (Marinol). NIDA willingly provides
marijuana to studies attempting to demonstrate inconsequential harmful
effects. In short, drug war rhetoric cites the lack of studies while drug war
politics blocks the very studies that could prove marijuana effective.

Dr. Tremblay's suggestion that the euphoric effect of marijuana clouds the
evaluation of its therapeutic effectiveness is specious. If the nausea from
cancer chemotherapy is subjectively reduced and the vomiting is objectively
reduced, the fact that patients feel better is, if anything, a plus. Once the
nausea has started, it can't be controlled by Marinol pills, which would be
vomited up well before they took effect (one hour). Inhaled marijuana,
instead, directly enters the bloodstream from the lungs and produces a very
rapid reduction of the nausea. The correct dose of smoked marijuana is
achieved when the psychoactive effects begin. (I've talked with a number of
folks who imbibe alcohol for its euphoric effects, yet demonize the
marijuana-induced euphoria.)

Dr. Tremblay's claims of the dangers of marijuana also bear close scrutiny.
While calling most arguments for its medicinal use anecdotal, he ignores the
anecdotal nature and the methodological flaws in papers reporting its harms.
For instance, even after 30 years of widespread use (more than enough for
development of lung cancer due to tobacco smoking), there are only rare
sporadic anecdotal reports of cancer in respiratory tissues and these are
questionably due to marijuana since they almost all also involve use of known
carcinogens such as tobacco and alcohol. In my 25 year career as a
pathologist I performed or reviewed many hundreds of autopsies on patients
who died of tobacco induced lung cancers, but never one on a person dying of
marijuana induced lung cancer.

In fact, if 60 million regular tobacco smoking Americans develop 150,000 lung
cancers annually, one would similarly expect the 10-17 million regular
marijuana smokers to develop between 25,000 and 40,000 lung cancers each
year. No such epidemic is documented in the medical literature.

Most reports of harm also fail to relate the incidence or severity of the
purported harm to the number of people at risk. It is one thing for one in
ten patients to develop a serious harmful effect. If only one in 100,000 does
so, or if the harmful effect is mild, it's quite a different story. So it is
with most of the claims of damage from marijuana.

How is it that allowing sick patients to use marijuana medicinally sends a
bad message to kids, while medicinal use of hard addictive drugs like cocaine
and morphine (which doctors can legally prescribe) does not?
Now that I-685 has garnered enough signatures to put it on the November
ballot, it is crucial that the public receives reliable information about
medicinal marijuana, and that misleading or incorrect assertions be
challenged.

Physicians should seek to relieve suffering even if they cannot effect a
cure. I fail to see how compassionate physicians can acquiesce in denying
suffering patients access to a safe, effective and inexpensive medication
such as marijuana.

Dr. David L. Edwards is a retired pathologist. He is a member of the
"Thurston-Mason County Medical Society.