nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
See here for more discussion.

Monday, May 17, 2010

Medical Marijuana: Not Going There

 
There's been a lot of discussion of medical marijuana.  I thought a sensible review of the medical research would be beneficial.

Nope.

I give up.  There's almost nothing that's worth writing about.  Clearly people who have intractable pain, from whatever cause, say they feel better.  So do people without pain.  But...OK...subjective improvement is a good indicator.  But, when you turn to the other side, looking for safety and risk, everything I could find is poorly designed, uncontrolled, and biased...both ways.

I can understand that people believe what they want to believe, we all do that.  But it's particularly useless to argue that marijuana use is immoral.  It's a plant.  Only humans can have moral problems.  Take a marijuana user who's a criminal and take away the marijuana:  they're still likely to be a criminal.

Scientists, in general, won't argue that the research on safety and hazard is a mess.  Marijuana advocates will violently disagree.  Commonly they point to one physician in California who contends it's safe, but other experts have disagreed with him.

But there is good research on one issue according to Dr. Jan Gurley at Kevin MD,
Recent, high-quality, long-term, robust research involving thousands upon thousands of people over generations of time, in several populations and countries, has shown that marijuana, especially in teen boys, leads to a measurable increase in the future development of schizophrenia – even when controlling for family and environment.
See published articles here, here, here and here.

As a former policy maker, I find plans to legislate medical marijuana to be flawed in that they rarely contain any provisions for child safety measures or driving while under the influence.  Marijuana is very safe for adults, but there are serious overdose complications in small children.  And all the studies agree that drivers are impaired while under the influence.  Dr. Gurley makes these points and two others about proposed laws: no provision for restricting sale to underage teens, and no quality control of the product.

California EPA has recently classified marijuana smoke as a "proven carcinogen" (June 09).  Marijuana advocates say that it's not; it only "contains" carcinogens. 

Say what?  I'm not aware of any substance "containing" carcinogens where the combination of carcinogens "reverses" the hazard and protects against cancer.  If carcinogens are present, and enter the body in a way they can exert their influence, the risk of cancer is increased.

On the other hand, as a physician, I'm not concerned about lung cancer and chronic lung disease in a patient with a terminal disease.
For a slide presentation on the research data that led California to its decision, go here.

I said I wouldn't talk about this, darn it.

Closing position:  Firmly agnostic, wait for better data.

Doc D
 

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