------------------------------------------------------------------- Marijuana Is The Wrong Medicine (Notorious Anti-Pot Zealot Gabriel Nahas Gets A Forum In 'Wall Street Journal,' Whose Fact-Checker Apparently Is On Vacation) THE WALL STREET JOURNAL - TUESDAY, MARCH 11, 1997 BY GABRIEL G. NAHAS, KENNETH SUTIN, WILLIAM M. MANGER AND GEORGE HYMAN The debate over using marijuana as medicine has been distorted by a basic confusion: the assumption that smoking marijuana is a better therapy than ingesting its active therapeutic agent, THC, in pill form or taking other approved medications. This assumption is wrong. THC (known in pill form as Marinol) is an approved remedy that may be prescribed by physicians for nausea and AIDS wasting syndrome. It is safer than marijuana smoke. The prestigious New England Journal of Medicine added to the confusion with its Jan. 30 editorial, signed by Editor Jerome P. Kassirer, entitled "Federal Foolishness and Marijuana." Among its errors: It underestimates the toxic properties of marijuana smoke. This smoke contains carbon monoxide, acetaldehyde, napthalene and carcinogens. Inhalation of THC decreases lung defense mechanisms that are already compromised in AIDS patients, who are extremely vulnerable to pulmonary infections and tumors like Kaposi's sarcoma. Thus marijuana smoke is a questionable choice to treat the symptoms of AIDS or cancer. Safer and more effective medications are available. It implies that marijuana smoking relieves pain. THC does not interfere directly with the endorphin system; indeed, it increases the perception of pain. Dr. Kassirer declares it "hypocritical" to forbid a physician to prescribe marijuana yet allow him to prescribe morphine for the reliefof pain. If he means to imply that marijuana is analgesic, he is simply wrong. If the implication is that it is hypocritical to prescribe one dependence-producing drug and not another, Dr. Kassirer is relying on a spurious analogy that clouds the relevant pharmacological question: What is the effectiveness of a therapeutic substance prescribed by a physician? It makes implausible claims about the advantages of smoking marijuana over Marinol. "Since smoking marijuana produces a rapid increase in the blood level of active ingredients, it is more likely to be therapeutic," Dr. Kassirer claims. But based on pharmacology, the opposite should be the case: Plasma THC concentration following pill administration reaches a more sustained steady level, lasting three to four hours, twice as long as after smoking marijuana. Such prolonged concentration should be more effective than a rapid rise and fall of THC concentration after smoking. It claims the efficacy of new drugs to treat nausea has not been tested. Dr. Kassirer ignores that experimental and clinical studies have clearly established the superiority of substituted benzamide and ondansetron over Marinol, though acknowledges that these drugs may be more beneficial than marijuana. Marijuana Is the Wrong Medicine (continued) It dismisses as "specious" the argument that approving marijuana for medical use would send the wrong signal to the young. Epidemiological surveys, however, indicate that the greater the perception of harm associated with marijuana, the lower the frequency of its use among children and adolescents. It condemns as "misguided, heavy handed and inhumane" the Drug Enforcement Administration's refusal to reclassify marijuana from Schedule I (addictive and illegal) to Schedule II (addictive but legal for some medical uses). Yet this refusal was based on a thorough analysis of reports from medical specialists in ophthalmology, oncology, and neurology. None reported evidence that smoking marijuana was more effective than approved remedies. The DEA's decision was supported by both the Food and Drug Administration and the Public Health Service. A doctor prescribing marijuana to a patient may be "courageous" in Dr. Kassirer's mind--but he is also scientifically misinformed and in violation of federal law. Dr. Kassirer recommends that the federal government get into the marijuana business by "declaring itself the only agency sanctioned to provide the marijuana." Thus, the government would "ensure its proper distribution and use." In effect, Dr. Kassirer is opening the door to the "controlled" legitimization of marijuana as it exists in the Netherlands--but even the Dutch have not approved marijuana for medical use. Finally, Dr. Kassirer makes the obligatory appeal to "compassion" for the suffering. He considers the prohibition of marijuana smoking to infringe on the rights of patients at "death's door." In this instance, the use of marijuana can no longer be considered a therapeutic intervention but one of several procedures used to ease the ebbing of life of the terminally ill. But for this purpose doctors should prescribe antiemetic and analgesic therapies of proven efficacy, rather than marijuana. This therapeutic course is not based on bureaucratic absolutism, political correctness or reflexive ideology--but on scientific knowledge and the humane practice of medicine Dr. Nahas, Dr. Sutin and Dr. Manger are professors at New York University's Department of Anesthesiology and Medicine. Dr. Hyman is a professor emeritus of medicine at Columbia University's College of Physicians and Surgeons -------------------------------------------------------------------
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