Let The Sick Decide If Marijuana Is Medicine
Pain can saturate one's entire being. This hit home recently when my mother endured bouts of chemotherapy for stomach cancer. Drugs to relieve her relentless nausea offered little benefit. As with countless other patients, her medicine made matters worse.
For patients in intractable pain, time is not on their side. Therefore, for supporters, New York's pending legalization of the medical provision and use of marijuana is timely. Meanwhile, the debate continues.
Good ethics requires good facts, as in accurate, relevant and evidence-based. Clearly, cannabis' history of illegal use and association with lethal drugs has overshadowed its supposed therapeutic value in alleviating chemotherapy-induced nausea, reducing glaucoma's intraocular pressure, mitigating AIDS symptoms and relieving chronic pain. Furthermore, its psychoactive component spawns fears of dependency and abuse, although authorized stimulants, antidepressants and analgesics also produce highs and lows.
While critics allege medical marijuana to be addictive, a so-called gateway to lethal drugs and without medical benefit, they also reject it as valid medicine. So, is medical marijuana "real medicine" or an oxymoron?
This deep-seated question is unsettling.
Why? Because it unearths an unhealthy tension among politics, power and science.
In his "Social Transformation of American Medicine," sociologist Paul Starr chronicles this tension by describing how U.S. mainstream medicine, through licensing and certification requirements, assumed a purportedly more "scientific" medical paradigm that marginalized alternative, including herbal, therapies.
Wedded politics and science then enabled federal agencies' virtual embargo on serious research into marijuana's therapeutic efficacy. To illustrate, the National Institute on Drug Abuse plantation at the University of Mississippi is the only place where researchers can legally obtain marijuana. Yet, with pressure from the Drug Enforcement Agency, NIDA's ongoing denial of research on the plant's medical benefits has blocked important clinical studies.
As Madelon Lubin Finkel, clinical public health professor at Cornell's Weill Medical College asserts, "reasons for this prohibition are clearly politically ideological."
Politics' power over science is especially apparent since the biggest stakeholder in defining "real medicine" is the pharmaceutical industry, "Big Pharma." Generous government funding for research into a synthetic substitute for tetrahydrocannabinol, the primary psychoactive chemical in marijuana, led to the 1985 FDA approval of Marinol(r), a prescription drug for chemotherapy-related nausea and AIDS patients' weight loss. Touted as safer and more effective than natural botanical marijuana, Marinol, as "real medicine," may have diverted research from the therapeutic potential of the plant itself.
Since good ethics requires good facts, without sufficient comparative clinical studies, findings become arbitrary. Is a synthetic substitute better than nature's botanical remedy?
In their book "Dying to Get High," sociologist Wendy Chapkis and communications expert Richard Webb argue that "pharmaceutical purity" is a misleading notion given the rubric of side effects for most prescription drugs, ranging from organ damage to heart failure to nausea to depression to suicidal tendencies. At $30 a pill, Marinol is a costly trade-off for the patient, but profitable in one of the most lucrative industries in the United States, Big Pharma.
The moral center of concern in health care should be the patient. When that center shifts to political ideology, we abdicate moral accountability to our patients.
Will legalizing medical marijuana help restore accountability?
Although the jury is still out regarding side effects, the Institute of Medicine's 1999 report "Medicine and Marijuana" finds "no conclusive evidence that the drug effects of marijuana are causally linked to the subsequent abuse of other illicit drugs." Moreover, the Drug Policy Education Group's 2002 account (http://tinyurl.com/yct223a) refutes DEA arguments regarding marijuana's harms.
We can bestow dignity on patients by empowering them to make their own informed choices among reasonable options. As to these options, good science and sound moral principles -- not political ideology or industry profit -- should help determine how we characterize "real medicine."
Michael Brannigan is the Pfaff Endowed Chair in Ethics and Moral Values at The College of Saint Rose. His email address is email@example.com.
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Author: Michael Brannigan
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