Subject: Letters to the Editor: Marijuana as Medicine
Date: Published: 2/19/93 (96 lines)
Source: Wall Street Journal. Copyright Dow Jones & Co. Inc.

    Letters to the Editor:
    Marijuana as Medicine

    As authors of the study cited in Doug Bandow's Counterpoint
 column, "Sometimes Marijuana Is the Best Medicine" (op-ed page, Jan. 
 28), we would like to correct an overstatement.  While it is true
 that nearly 70% of those oncologists sampled who had made up their
 minds on the subject would prescribe marijuana, these represented
 only about half of our total sample.  An additional third said that
 they would need more information, which is understandable in light
 of the paucity of clinical studies.  (Since these figures are based
 on a response rate of 44%, these views may not be perfectly
 representative of oncologists at large.)  
    Mr. Bandow calls for reopening the Public Health Service's
 compassionate access program.  We agree.  But compassionate access can
 serve only a few.  Furthermore, the program is slow and unwieldy,
 since patients can be approved only on an individual basis after a
 Food and Drug Administration medical review officer has evaluated a
 detailed application submitted by the patient's physician.
    More important than compassionate use is research.  We need
 controlled clinical trials testing whole smoked marijuana against
 the currently available oral THC pills (Marinol) for their currently
 approved indications, nausea control in cancer chemotherapy and
 appetite stimulation in people with AIDS, and for additional
 indications including pain relief of various kinds and control of
 spasticity.  If whole smoked marijuana turns out be the better
 medicine for some patients, research should be initiated into better
 delivery systems to reduce the health risks of smoking, such as
 water pipes and vaporizers.  At the same time, it would be worth
 comparing whole smoked marijuana with both oral marijuana and
 inhaled THC. Since there are no patent rights to be had on
 marijuana, there are no drug companies interested in this research.
 Funding for studies will, therefore, need to come from the
 government or foundations; the sums involved are not large by
 medical research standards.
    There is no necessary or logical connection between the approval
 of marijuana as a medicine and its legalization for recreational
 use.  Morphine and cocaine, for example, are Schedule 2 prescription
 drugs.  The key to making a good decision is to get the medical
 marijuana question out of the hands of drug war partisans, whether
 prohibitionists or legalizers, and give it to medical scientists for
 consideration on its merits.
    Rick Doblin
    Mark A. R. Kleiman
    Cambridge, Mass.
    (The writers are respectively a Ph.D. candidate and an associate
 professor at Harvard's Kennedy School of Government.)  
    ---
    I agree that marijuana contains a component with great
 therapeutic value.  However, Mr. Bandow's commentary is misleading in
 that it confuses the usefulness of a pharmaceutical (Marinol) with
 its suitability in a natural, unrefined form (marijuana).
    Marinol is delta-9-THC, the major active component of marijuana,
 in a purified, stable form.  In 1985, the FDA allowed use of Marinol
 for treatment of nausea and vomiting due to cancer chemotherapy.  In
 December 1992, a new indication was added, treatment of anorexia
 (appetite loss) associated with weight loss in patients with AIDS.  
 The basis for these uses is extensive clinical research:  3,000
 cancer patients, most of whom had failed to respond to other
 anti-emetics, and more than 200 AIDS patients with significant
 weight loss.
    The claim that Marinol is not as effective and/or more toxic than
 marijuana runs counter to the facts.  In studies in which marijuana
 and Marinol have been compared, Marinol has been shown to be as or
 more effective than marijuana.  With regard to toxicity, most
 patients smoking marijuana develop side effects:  "highs," dizziness
 or drowsiness.  By contrast, not more than one out of six patients
 receiving Marinol in appetite stimulation studies had any of these
 side effects.  Marijuana often contains fungal spores and the smoke
 has four times more particulate matter than tobacco.  These
 contaminants are clearly unhealthy for AIDS and many cancer
 patients, who already have compromised immune and pulmonary systems.
    Few physicians today would consider prescribing digitalis leaf,
 cinchona bark or a variety of plant or fungal materials in place of
 their purified pharmaceutical preparations.  Yet that is exactly what
 Mr. Bandow is suggesting with his recommendations regarding
 marijuana.  Simply put, marijuana does not fit the definition of a
 modern pharmaceutical:  a pure, quality-controlled product of defined
 composition in a stable dosage form.
    Once the smoke clears, the scientific rationale for the Public
 Health Service policy becomes quite clear.  Let's not cloud it with
 an agenda based on emotion rather than fact.
    Terry F. Plasse, M. D. 
    Interferon Sciences Inc. 
    New Brunswick, N. J. 
    (The writer is a consultant to and formerly was director of
 research for Unimed Inc., the manufacturer of Marinol.)  

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