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The Nation | MEDICINE

Trying the Drugs They Prescribe

September 27, 1998|Scott Gottlieb | Scott Gottlieb, a fourth-year medical student at the Mount Sinai School of Medicine, has recently returned from Britain, where he completed a fellowship on the editorial staff of the British Medical Journal

NEW YORK — Imagine walking into your doctor's office and finding a lit bong. Would that scare you? As a fourth-year medical student, I have been taught how to prescribe medications. Appreciating a drug's pharmacological benefits, however, is often a tempting inducement for some of my fellow medical students to give it a try. Students cleverly argue that their motives for self-prescribing medications are purely educational. After all, they say, how can they prescribe a drug they have not taken themselves?

As the medical establishment advocates a therapeutic role for marijuana, don't be surprised if more U.S. medical students begin smoking pot. Once a drug makes it onto the list of therapeutic medications it becomes fair game for the surprising number of students willing to self-prescribe medication.

This was seen most recently in Britain, where efforts to legalize marijuana became fashionable decades before Americans seized on the same idea. British citizens were surprised to learn that the number of British medical students who smoke dope regularly has doubled in the last decade.

The findings, first reported in the British Medical Journal, found that 46% of medical students in England have tried marijuana at least once, while 10% claimed to smoke one joint or more per week.

The study found that despite greater knowledge of pharmacology, there was no evidence that medical students were any more selective about the legal or illegal drugs they consumed than students in general.

The study pointed out that students overwhelmingly disapproved of cigarette smoking, indicating that health concerns were on their minds. The implication of this finding was that smoking pot was not seen as similarly dangerous.

These dismal findings stand out against a backdrop of increasing liberalization in Britain when it comes to drug use. The British Medical Assn. recently urged the government to allow marijuana to be prescribed in a range of medical conditions and asked health officials to set up clinical trials to assess marijuana's therapeutic benefits. These efforts have the full support of many doctors, including the president of the Royal Pharmaceutical Society and the previous president of the Royal College of Physicians.

Doctors in the United States are erroneously following the British lead. Last year, the American Medical Assn. recommended a review of its policies on marijuana as a "medicinal remedy." A report issued in December by the association's Council on Scientific Affairs recommended renewed research efforts to see if the "potential benefits of smoking marijuana" outweigh the known risks.

The image of smoking marijuana, even for supposed medicinal purposes, is inextricably linked to images in our culture of illicit drug abuse. Whether intended or not, permitting the "medicinal" use of marijuana sends a powerful message that pot is OK. Those who cannot see a connection between the efforts of British doctors to legalize marijuana and the surge in drug use among their medical students mistakenly believe that the students don't take their cues from doctors. Moreover, once a drug is deemed therapeutic it becomes fashionable in some medical circles to give it a try. Indeed, a 1986 study published in the New England Journal of Medicine found that a quarter of American doctors and medical students surveyed had self-prescribed mood-altering drugs, most often tranquilizers and opiates.

Think for a moment about how many medicines doctors prescribe. None involve smoking leaves or chewing plants. What doctors do instead is look for a specific chemical and prescribe it in a known quantity.

The idea of medicinal marijuana merely substitutes the concept of medicinal use for recreational drug use. That's the reason people don't like Marinol, the widely available but rarely prescribed synthetic analogue to marijuana. In short, people want to smoke dope.

If doctors are worried that HMOs have diminished the quality of medicine in the United States, perhaps they're missing their own role in the decline. With 10% of their medical students regularly abusing marijuana, British doctors are realizing the trouble they are in. In the British press, doctors are openly fretting that students on dope "might not be able to remember the volumes of information being thrown at them," as one doctor recently told a London newspaper.

That's where things are headed. That's what happens when doctors argue for legal pot. In Britain, the results are now in, and doctors find themselves hoisted by their own petards. Stay tuned for the U.S. version. A new age of medicine is dawning--the stoned age.

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