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All SmokeThe FDA's statement on medical marijuana isn't about science.

By Sydney Spiesel
Posted Monday, April 24, 2006, at 3:36 PM ET

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Medicinal marijuana. Click image to expand.

Last week, the Food and Drug Administration reported that it had definitively established that marijuana has no medical use or value. Definitively? Established? I don't think so. 

The FDA's announcement begins by acknowledging the claim that smoked marijuana may be beneficial for some conditions. Then the agency points out that among drugs with a potential for abuse, marijuana is lumped in with the most dangerous drugs, the ones that have no potential medical benefits and the highest likelihood of misuse. The FDA next affirms that a collection of federal agencies have together concluded that marijuana is both dangerous and medically valueless, based on scientific studies in humans and animals. The announcement—actually, it's an "inter-agency advisory"—concludes by asserting, with a boldness that might belie a certain uneasiness, that it is the FDA's job to approve drugs. Take that, state legislatures and voters.

The FDA's statement implies that the agency reached its conclusion about marijuana after conducting a new serious analysis of the existing scientific literature on the drug. But of course no such analysis was reported in the medical literature and, in fact, no identifiable official at the FDA took responsibility for last week's advisory. It was just put out there as a statement of fact.

But it's not. In 1999, the Institute of Medicine, the medical arm of the National Academy of Sciences (an organization chartered by Congress to provide independent, nonpartisan scientific and technological advice) examined this same question in considerable depth and published a 288-page report of its findings. Put together by 11 distinguished scientists and physicians, the IOM report examined the known and potential harms of marijuana use and the known and potential medical benefits. The report is broad in its vision and thoughtful and cautious in its interpretations and recommendations. Its authors acknowledged that the medical uses of marijuana entail some risk of harm—for instance, it's pretty clear that inhaling marijuana smoke can't be good for the lungs, and who knows if there are significant psychological side effects for some users. But the authors concluded that these risks were not terribly high. They also found that other putative risks often attached to this drug—the potential for addiction, for instance, or for marijuana serving as a "gateway" to further drug abuse—were much overstated. The report urged further study to determine the real level of risk.

In examining the potential medical benefits of medical marijuana, the IOM report was equally cautious. It described relief from nausea associated with cancer chemotherapy, appetite stimulation for cancer and HIV patients, and treatment of muscle spasticity for patients with multiple sclerosis or spinal cord injury. Though these benefits seem real, the authors of the IOM report point out that we really don't know yet if they are significant or valuable enough to warrant the use of medical marijuana. Again, the report urged further study to determine the real level of benefit.

However, in the seven years since the IOM report was issued, virtually no research on potential risks and benefits has been done, because the government has blocked such studies. So, we know neither more nor less about medical marijuana than we did seven years ago, whatever the FDA says. Why would the agency inaccurately claim that the science is settled when it isn't? I hardly need to say it: This isn't a medical or scientific conclusion. It's a political one.

This is certainly not the first time that politics has trumped science at the FDA. Another recent example: the agency's decision to block over-the-counter availability for emergency contraceptives in the face of overwhelming evidence that the treatment is safe and effective, and support for over-the-counter availability by the FDA's own advisory committee. From my standpoint as a doctor, the question is this: What do you do when federal agencies become so politicized that their recommendations can't necessarily be trusted? Do you have to treat other things they say as suspect? I depend on good advice and honest information from government agencies in the daily conduct of my work. I need to know what epidemic illnesses are circulating in my neighborhood even if that information might put a government agency in a bad light. I need to be able to trust government-sponsored research (especially because, goodness knows, I have learned not to trust manufacturer-sponsored research). I need to know that the advice I glean from government-sponsored agency Web sites will lead to the best care for my patients.

Marijuana as a medicine—whatever its risk and benefits are eventually determined to be—may turn out to be much less important than the question of whether we can count on agencies like the FDA to be honest in their dealings.

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Sydney Spiesel is a pediatrician in Woodbridge, Conn., and associate clinical professor of pediatrics at Yale University's School of Medicine.
Photograph of medicinal marijuana by Justin Sullivan/Getty Images.
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Remarks from the Fray:

Medical marijuana reports will be discounted from either side depending on how people feel about it as it is one of the emotional issues. Whether the report is correct or not more studies should be done on every aspect of it because of the potential positives. It may be that it is only good for appetites or temporarily masking some side effects of illness but that has value as well.

Marijuana as medicine has a history that goes back too far and in too many cultures to separate myth from truth with a report. In the end if critically ill people use it and think it helps, then it helps and maybe that is all that matters.

--marylb

(To reply, click here.)

Every time I read the indignant, self-righteous rants of the stoner crowd, demanding that their fundamental right to get mashed not be infringed, I suffer a momentary – but major – lapse in my zeal for a libertarian world. [Stoners,] you annoy me with your blatant dishonesty – your refusal to acknowledge your real motives, and your transparent attempts to couch your pro-doobage arguments in the clothes of medicinal necessity or the miracle of hemp as panacea for all that ails the world.

Pot's illegal for a simple reason: the vast majority are comfortable with that. It's a mind altering drug that does tend to render its regular users increasingly lazy, slothlike, of decreasing use to society. It also is clearly addictive, and it imposes social costs in the cost of treatment, etc. All of these effects would be magnified if it were legalized. […] As many of you already point out, you already enjoy virtual carte blanche to indulge your brain-deadening habit in this country. Don't insist that the rest of us sanction your choice w/ legalization, though. You wanna smoke legally, move to Amsterdam.

--SittingDuck

(To reply, click here.)

The medical marijuana movement is primarily a ruse, an attempt to sneak in legalization of weed through the back door by first finding some "legitimate" uses and blurring the lines between legal and illegal. […]

It sounds superficially like a decent strategy, but I think it could backfire on them badly. If you find yourself defending legal weed purely on the basis that it's medicinal, you've painted yourself into a corner if it ultimately proves not to be a good treatment. In the mean time, medical marijuana proponents are conceding the drug prohibitionists' most toxic and pernicious point, which is that there is no such thing as legitimate recreational use for drugs (a view blithely and perversely ignoring the existence of alcohol, tobacco, and chocholate truffles).

The main thrust of drug prohibition is, in fact, this very assertion that the only legitimate uses for "drugs" (a vague and poorly defined word) is medicinal. I think people who want to legalize marijuana may have committed a strategic mistake by pursuing medical marijuana because they may find that science won't ultimately back them up and there they are, having just spent years of effort and money propping up the anti-pleasure puritan core of our nations attitudes towards drugs.

I say, if you are going to attack, attack the rotten core.

--kolmogorov

(To reply, click here.)

So many of these statements say that any medical benefits would be overshadowed by the smoke inhalation damage. There are other ways to take it. Herbal tinctures are easy and efficient. I believe herbalists used to perscribe this tincture for glaucoma. THC is also fat soluble. Add the plant while making ghee (clarified butter), and use it for cooking or simply put it on toast, etc.

--quistian

(To reply, click here.)

I survived pancreatic cancer at age 40 and am 59 now. One of the permanent disabilities includes occasional severe intestinal cramping. I was prescribed two anti-spasmodics. […] Both were counter-indicated in glaucoma. My eye exam showed left eye pressure at 19, borderline for glaucoma. I stopped both anti-spasmodics.

One -- I repeat, one -- inhale of marijuana stops the pain before I even exhale, and since marijuana is used in treating glaucoma, I feel better about my eyes. The left eye pressure has returned to normal. I'm surprised the Connecticut doctor didn't include glaucoma in success stories. This is another to add. It stops intestinal cramping.

As a middle-aged grandmother now, the stigma of it being illegal is an insult. So are the people I have to deal with about once a year when I run out.

--tolerford

(To reply, click here.)

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