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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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