Sunday, September 18, 2016

Why I'm Against Medical Marijuana

I have already opined on my disapproval of a medical marijuana law recently passed in Ohio.  Once of my points in that piece is that I did not want legislators making medical decisions for us.  They can’t even do their own jobs.

I am not against medical marijuana; I am for science.  The currency of determining the safety and efficacy of a medicine should be medical evidence, not faith, hope or belief.

Marijuana is a Drug Enforcement Agency (DEA) Schedule 1 drug, alongside heroin, LSD and Ecstasy.  I realize this seems odd since most of us do not believe that marijuana has the health or addictive risks of the other agents on the list.  It doesn’t.  But, danger is not the only criteria used in determining which category a drug belongs in, a point often misunderstood or ignored by medical marijuana enthusiasts.  An important criterion of Schedule 1 drugs is that they are deemed to have no proven medical use.

The federal government recently affirmed marijuana’s Schedule 1 status, which disappointed those who argue that this agent is the panacea, or at least an effective treatment, for dozens of ailments.  The government disagreed.  It reviewed several hundred medical studies and only identified 11 of them that were of sufficient scientific quality worthy of consideration.  None of them demonstrated a salutary effect of marijuana.

DEA Holds Firm 

An advocate of medical marijuana use was railing against this decision and stated that 80% of Americans believed marijuana had medical value.  His point demonstrates the vacuousness of his argument.  He might support letting polling determine if a drug is safe and effective; but I trust the FDA and hard science to make these determinations.

I am sure that if we polled the public on the medical benefits of probiotics, gluten restriction, GMO foods,  organic foods, radiated foods, colonic detoxification, yoga, veganism and meditation that we might find that the public’s belief in these practices doesn’t have firm scientific support.   I do not argue that these dietary and lifestyle practices do not have health benefits or enhance life in other ways, only that they are either unproven or disproven.  There are still folks out there who believe that the measles vaccine causes autism, even though this theory has been thoroughly debunked. In my view, releasing a medicine to market requires firm scientific support.  Anecdotes and low quality ‘studies’ should be afforded the weight they deserve.

Should we open up the gates to all kinds of potions and elixirs that are unproven for the public?  We do!  They are called dietary supplements.  These agents are considered safe until they are proven to be dangerous.  Is this the standard we want for prescription drugs?

9 comments:

Anonymous said...

Your closing comment that dietary supplements are substances that lack evidence of benefit points to one of the problems here. Some botanicals actually have been the subject of dozens of clinical trials that report benefit. How much evidence is enough is not a scientific decision but a value judgment. Another problem: it is well known that the money available to research treatments that cannot be patented or controlled by the medical industry is limited across the board, and in the case of marijuana, one rationally cannot demand that proof of efficacy should have been generated during decades when the federal government prevented any research other than studies intended to claim harmful effects.

Maybe you think, say, that St. John's wort or polysaccharide K have "no proven efficacy", while I think the opposite. You should not be required to prescribe them, but I should not be required to do without them if I have a condition that could benefit from them. The solution is to make them available without prescription. I think it would be appropriate to treat marijuana in the same fashion; reefer madness and racial paranoia set aside, it is a less harmful substance than alcohol-in-excess. Sell it over the counter, and doctors who dislike it needn't get involved. As long as your patients with cancer need your gracious permission to get, or keep getting, any substance that benefits them, they are going to keep badgering you to provide that permission.

Michael Kirsch, M.D. said...

Appreciate your comment. What role, if any, do you think the FDA should have in approving prescription medications? Your comment suggests that a patient should be able to decide if a remedy is reasonable. I respectfully do not agree that this should be a 'value judgment' by ordinary citizen. As you know, St. John's wort is largely beyond the reach of the FDA. Many similar products would not want to be subjected to FDA approval, not only from the enormous expense involved, but also the possibiltiy that rigorous study would not demonstrate efficacy.

Lindsay Beyerstein said...

The FDA has already approved two drugs that are synthetic versions of substances found in the cannabis plant, and another synthetic drug that works similarly to compounds found in cannabis.

Approximately half the states have medical marijuana provisions and practicing physicians in good standing with their respective state medical boards are already dispensing cannabis for medical purposes.

So, the DEA's assertion that cannabis has no credible medical application is far-fetched to say the least.

Of course, keeping cannabis as a Schedule 1 drug throws bureaucratic and legal roadblocks in the path of the very research that might establish (or refute) botanical cannabis as a treatment for chronic pain, MS, various cancers, and other ailments.

Michael Kirsch, M.D. said...

@Lindsey, comment appreciated. Perhaps, my main point in the post is that I do not support legislators - who respond to public opinion - deciding which diseases should be covered by a specific drug or treatment. This issue falls within the purview of the medical and scientific community. This is absurd and threatens the integrity of our existing system and works against the public interest, in my view.

peacefromken said...

Thank you for your reasons why you don't support medical marijuana. The problem here is that doctors have not caught up with the fact that most "science" that they rely on is bogus and subject to the influence of sponsors money, and big pharma plays a large part in protecting their profits. The respected Cochrane Institution CEO has stated that "nearly half"of all scientific studies and reports cannot be trusted to be truthful and unbiased. My company has investigated the Australian health care system, scientific studies and reports, and the medical system. I was literally shocked to find that scientists, doctors, and those in the medical system continually lie to protect their turf, without, in most cases, and guilt about the damage caused to patients, including children and the aged. We CANNOT trust what we are told. You are probably a good, trustworthy and caring doctor, BUT you are being lied to.

Michael Kirsch, M.D. said...

@peacefromken, I cannot deny that there is corruption within the pharmaceutical universe.

RockChick said...

I am fully supportive of medical AND recreational legalization. No I don't think that people should go to work or drive under the influence but in the privacy of their own home they should have the right to use marijuana without getting hauled into our criminal justice system.

Stephanie Thorpe said...

I just have a hard time believe any medical studies anymore. It all depends on who pays for these studies. Are they the pharmaceutical companies who would rather push a drug that makes them money? Make me question the validity of any study these days

Michael Kirsch, M.D. said...

Stephanie, I share your skepticism and cynicism. The system faces many conflicts of interest. No easy answers in a capitalist society. We need the profit motive to incentive drug companies to pursue treatments that cost tens of millions of dollars to develop and bring to market, knowing that many of their R & D efforts fail. Thanks for the comment.

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