Correspondence

Marihuana and Its Reviews

N Engl J Med 1995; 332:274-275January 26, 1995

Article

To the Editor:

Dr. Robert Swift (Sept. 15 issue)1 gives a very supportive account of Grinspoon and Bakalar's book Marihuana: The Forbidden Medicine.2 Swift considers the book to present “cogent and convincing arguments for the legalization of marijuana.”

As I pointed out in my review of the book in the Annals of Internal Medicine, 3 Grinspoon and Bakalar have only assembled anecdotes that they use to justify the rescheduling of marijuana. Like the members of the pro-marijuana lobby during hearings held by the Drug Enforcement Agency to consider rescheduling marijuana, these authors believe that marijuana should be used to treat nausea associated with cancer chemotherapy, glaucoma, wasting in AIDS, depression, menstrual cramps, pain, and virtually limitless ailments.3 In their anecdotes there are no controls, no standardization of the dose, no quality control, and no independent medical evaluation for efficacy or toxicity.

According to Grinspoon and Bakalar, the Chinese used marijuana to “quicken the mind, induce sleep, cure dysentery, stimulate appetite, relieve headaches, and cure venereal disease.” One of the references from 1860 states purported beneficial effects “without interfering with the actions of the internal organs” (a statement known to be inaccurate). Potions and remedies were common in those earlier years. Many were absolutely useless, or conversely were harmful to unsuspecting subjects.

The medical issue surrounding the smoking of marijuana can best be summarized by an opinion from Dr. Philip Lee in a letter to Congress after the “medical marijuana” is-sue was submitted to the National Institutes of Health. He states,

Scientists at the National Institutes of Health indicate that, after carefully examining the existing preclinical and human data, there is no evidence to suggest that smoked marijuana might be superior to currently available therapies for glaucoma, weight loss associated with AIDS, nausea and vomiting associated with cancer chemotherapy, muscle spasticity associated with multiple sclerosis, or intractable pain.4

We do not smoke medicine anywhere in our society. We should turn to truly medical solutions to solve our medical problems.

Eric A. Voth, M.D.
International Drug Strategy Institute, Topeka, KS 66606

4 References

1. 1

   Swift RM. Review of: Marihuana: The forbidden medicine. N Engl J Med 1994;331:749-750
   Full Text

2. 2

   Grinspoon L, Bakalar JB. Marihuana: the forbidden medicine. New Haven, Conn.: Yale University Press, 1993.
   

3. 3

   Voth EA, Brookoff D. Review of: Marihuana, the forbidden medicine. Ann Intern Med 1994;120:348-348
   

4. 4

   Lee PR. Correspondence to Congressman Dan Hamburg, United States Public Health Service, July 13, 1994.
   

Author/Editor Response

Dr. Swift replies:

To the Editor: It is amazing to me how strong the emotions are that always emerge with regard to issues of drug legalization. Dr. Voth certainly conveys his strong negative feelings about the medical use of marijuana and its biologically active components. He takes issue with my review of Marihuana: The Forbidden Medicine, which he sees as giving “a very supportive account” of the book. Obviously, he has not been convinced by the arguments of Dr. Grinspoon and Mr. Bakalar. I respect Dr. Voth's opinions, as I respect those of Grinspoon and Bakalar. However, I am concerned that opinions like Dr. Voth's about drug legalization are clouding rational, scientific thinking on this issue of the therapeutic value of marijuana and its components.

I agree with Dr. Voth that some of the evidence presented in support of the medical use of marijuana and its components is anecdotal, with “no controls, no standardization of dose, no quality control, and no independent medical evaluation for efficacy or toxicity.” Grinspoon and Bakalar point out that this situation has occurred because of the strict controls on marijuana research, which have prevented an objective evaluation of the drug in controlled clinical trials.

The one analogue of tetrahydrocannabinol that is approved and marketed as a pharmaceutical agent, dronabinol, has well-documented antiemetic, analgesic, and appetite-stimulating properties. Yet, despite the availability of this legal agent, a substantial proportion of patients with cancer use illicit marijuana as part of their treatment, and almost half of the oncologists surveyed support this use of marijuana for their patients.1 So it seems that at least some patients do “smoke medicine” in our society. As clinicians and scientists, we should endeavor to find out why this is the case.

Our goal should be to provide the best treatment for our patients. I agree with Dr. Voth that therapeutic decisions should be made on an objective, medical basis. I also agree with Grinspoon and Bakalar that policy decisions, rather than objective medical decisions, have controlled research on the therapeutic use of marijuana and its components.

Robert M. Swift, M.D., Ph.D.
Brown University School of Medicine, Providence, RI 02912

1 References

1. 1

   Doblin RE, Kleiman MA. Marijuana as antiemetic medicine: a survey of oncologists' experiences and attitudes. J Clin Oncol 1991;9:1314-1319
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