One drug, two takes
As assistant district attorney in San Francisco, Keith Vines prosecuted one of the largest illicit drug busts the city had ever seen. Then he came down with AIDS wasting syndrome and lost 60 pounds over three years.
To stimulate his appetite, he started taking marinol, an FDA-approved drug containing THC, one of the active ingredients in marijuana. He says he couldn't control the dose of the drug, which must be swallowed. "I would be out of it for four or five hours," he says.
And so, instead of continuing with marinol, he started smoking medical marijuana, keeping his head clear by puffing only as much as he needed to get hungry. He gained back all his weight, he says.
Medical marijuana: An article in Monday's Health section about medical marijuana said the drug's active compounds pass through the liver when smoked but not when swallowed. In fact, the reverse is true: When swallowed, the chemicals travel to the liver from the stomach. When inhaled, chemicals do reach the liver, but in smaller amounts. The article also referred to doctors as "prescribing" the drug for medical use. Technically, in states where medical use of marijuana is legal, doctors cannot prescribe it. Instead, in California they write "recommendations" for patients, who can then legally obtain or grow it.
Medical marijuana: An article in last week's Health section on medical marijuana said the drug's active compounds passed through the liver when smoked but not when they are swallowed. In fact, the reverse is true: When swallowed, the chemicals travel straight to the liver from the stomach. When inhaled, chemicals do get to the liver, but in lowered amounts. The article also referred to doctors as "prescribing" marijuana for medical use. Technically, in states where medical use of marijuana is legal, doctors cannot prescribe it. Instead, in California, they write "recommendations" for patients, who can then legally obtain it or grow it.
Like many in his condition, Vines flatly disagrees with an April 20 announcement by the Food and Drug Administration and several other federal agencies that smoking marijuana confers no medical benefits.
So do physicians who write prescriptions for medical marijuana. (Doctors can't prescribe the plant.) They say the government hasn't done its homework -- and cite a 1999 report by the Institute of Medicine, a prestigious organization that advises the government, that found otherwise.
That 1999 report concluded that smoked marijuana could stimulate appetite in some patients with AIDS wasting disease; lessen nausea and vomiting caused by chemotherapy for cancer; and alleviate pain.
"I'm disappointed that they haven't really read the research or spoken with people in the field," says Los Angeles internist Dr. Eve H. Elting, who recommends medical marijuana to treat patients with chronic pain due to cancer and injuries; nausea and vomiting caused by chemotherapy; and migraines.
"The FDA statement directly opposes what the [Institute of Medicine] said," says Dr. Jean Talleyrand of Ukiah, who also recommends medical marijuana. "My first question is, how did they come to that conclusion?"
Some scientists involved in crafting the 1999 report were more circumspect.
"I thought there was pretty good agreement among the panel that THC has good benefit, and it's in marijuana," says Billy R. Martin, a professor of pharmacology and toxicology at Virginia Commonwealth University.
But, he adds, "when you turn to the FDA, they require well-controlled studies showing efficacy."
Martin says in many ways the tussle between federal agencies such as the FDA and medical marijuana proponents boils down to politics -- on both sides.
