LEGISLATURE ASKED TO PLAY DOCTOR

As a family physician caring for patients for over 20 years, I have
had the unfortunate experience of prescribing medicine that later
turned out to have unintended consequences, to have actually caused
harm to my patient. This can and does happen, even when doctors are
careful to stay up-to-date on the latest scientific developments, and
even when they are fully informed about their patient's symptoms and
conditions.

Good doctors take care to minimize the risks of bad effects. Together
with our patients, we carefully consider the benefits and risks of a
medication based on the individual's needs, history, health condition
and possible interactions with other medications. We learn to
prescribe doses conservatively, and to monitor reactions closely -
increasing or decreasing dosages or discontinuing drugs according to
the effect they are having.

Any doctor who made a habit of prescribing a drug for a patient
without specifying the strength of the drug, or the amount or
frequency of the dosage, could expect to be brought before the Medical
Practice Board on charges of unprofessional conduct.

Yet the Vermont Legislature is being asked to approve a bill that
would require me, as the commissioner of health, to approve the use of
marijuana by severely ill and debilitated patients. There is no legal
source from which to obtain this marijuana, and there could be no
control whatsoever over the quality or potency of the drug or the size
or frequency of the dosage.

In this compassionate attempt to ease the suffering of Vermonters, we
are likely to cause harm. While little is known about the effects of
over 400 chemicals in the leaves, sticks and flowers that are part of
smoked marijuana, severely ill or debilitated patients may be
particularly vulnerable to adverse consequences. Potentially
life-threatening effects known to be caused by the chemicals in
marijuana include elevated heart rate, sudden fall in blood pressure
when standing up, and a diminished ability to fight off lung infections.

How many heart attacks, strokes, falls and pneumonia would I cause my
patients to suffer if I were to advise them to consume marijuana? The
fact is that neither the Legislature nor I know.

Some have argued that our compassion for the suffering of the patient
should outweigh concern over the harmful effects of these poorly
studied chemicals. Such a notion implies that severely ill individuals
are not deserving of both compassionate care and the best possible
treatment that medical science and dedicated clinicians have to offer.
I reject that notion.

The bill is called S.76, "An Act Relating to the Medical Use of
Marijuana." Here's what it would do:

* A patient with a debilitating medical condition who is experiencing
chronic pain could get approval from his or her attending physician
for the medical use of marijuana.

* The paperwork would then come to the Health Department, where we
would be required to verify the accuracy of the medical records and
the appropriateness of the approval.

* The patient and his or her caregivers would then get a piece of
paper authorizing them to grow up to seven plants and possess two
ounces of marijuana, and for the patient to consume it.

As commissioner of health, I find aspects of this proposal
unacceptable - even before we get to important questions of whether
administering marijuana to patients is good medicine or makes sense as
public policy:

* The Health Department is not equipped to offer what would amount to
second opinions on the long list of diseases and conditions enumerated
in the bill. Nor, in good conscience, could we simply rubber stamp the
requests that came in.

* But even more importantly, this bill calls for the state of Vermont
to approve and enable the administering of a drug to a vulnerable
population with no controls over potency, dosage or efficacy
whatsoever. This isn't just a matter of the Legislature playing
doctor; this bill asks the Legislature to play negligent doctor.

* Finally, S.76 would put me and any subsequent health commissioner in
a legal bind. The law requires that the Vermont health commissioner be
a physician, and yet this bill would require me to commit two acts that
could be viewed as unprofessional in the eyes of the Medical Practice
Board: It would require me to routinely approve medication without the
controls mentioned above, and it would require me to participate in the
routine violation of federal law, which prohibits the medical use of
marijuana.

Much as I respect the laws of Vermont and the Legislature that makes
them, I find S.76 both legally and ethically untenable.