Last week a U.S. Supreme Court ruling denied Angel Raich and Diane Monson the right -established by California voters in 1996- to obtain and use marijuana for medical purposes. The majority opinion by Justice John Paul Stevens included a paragraph to which members of the Society of Cannabis Clinicians take issue. According to Stevens:
“The exemption for physicians provides them with an economic incentive to grant their patients permission to use the drug. In contrast to most prescriptions for legal drugs, which limit the dosage and duration of the usage, under California law the doctor’s permission to recommend marijuana use is open-ended. The authority to grant permission whenever the doctor determines that a patient is afflicted with ‘any other illness for which marijuana provides relief,’ is broad enough to allow even the most scrupulous doctor to conclude that some recreational uses would be therapeutic. And our cases have taught us that there are some unscrupulous physicians who overprescribe when it is sufficiently profitable to do so.”
David Bearman, MD, responds:
“That is an insult. No one gets in my front door for an appointment unless they represent themselves on the phone as having a well-documented serious disease. If the Medical Board and the feds had not been so damn busy harrassing and intimidating physicians, 10 to 20 times as many California physicians (e.g. 15,000 to 30,000) would be making recommendations. It would take the patient’s principal doctor (and the vast majority of my patients have one) an extra minute or two, and save the patient the time and trouble of having to seek out a cannabinologist. This is what the voters of the state of California had in mind when they passed 215. It’s the Feds and the MBC who have created this economic barrier, uh oh I mean incentive.”
Frank Lucido, MD, thinks Stevens misunderstands the doctor’s role in approving a patient’s request to self-medicate with cannabis:
“The more appropriate analogy is not to a drug prescription, which would involve an exact amount you are ordering the pharmacist to dispense, but to a medical decision of ‘yes’ or ‘no,’ such as: ‘Yes, you are fit to go to camp.’ ‘No, you cannot fly a plane’ (FAA physicals) ‘No, you can’t have insurance from this company that I work for.’ ‘Yes, you should be off work for the next 3 days due to illness.’ ‘No, your injury is not work-related.’ ‘Yes, I recommend you cut back your work hours for health reasons.'”
Robert E. Sullivan, MD, says Stevens’s reference to an “economic incentive to grant their patients permission to use the drug” would apply as well to “a new cure for herpes, hypertension, or erectile dysfunction (talk about a “marketed diagnosis”). One can only conclude that he believes physicians really make decisions on such base motivation. Does he think they get a kickback? Very cynical.”
Sullivan questions the accuracy of Stevens’s line, “In contrast to most prescriptions for legal drugs, which limit the dosage and duration of the usage, under California law the doctor’s permission to recommend marijuana use is open-ended.” Sullivan says: “Not so. The medical board limited the duration of recommendations to one year, like all conventional Rxs. And we, at least, specify an amount (on a weekly basis) for each patient approved. Most conventional Rxs for pain/spasm leave quite a range of dosage/frequency up to the patient. And does Stevens really believe the patients follow it anyway? And, oh yes, what does this have to do with the question at hand?”
Sullivan adds:
“The suspicions people reveal they have about others often reveal their own true motives and styles… My overall impression of the decision is that the ‘What ifs’ have taken over. ‘The parade is a wonderful idea, but What if someone gets run over by a float? Maybe we just better not have it.’
“What I would love to do is get Justice Stevens to go through a day at work with me. To meet an adult daughter who brought in her elderly mother on chemo, neither of whom had had any prior contact with cannabis before trying it and finding it worked far better than any other medicine she’d been given at this point getting a frail smile from mom nodding her head too – and be able to inform them how they could obtain and use it in a manner suitable to them, and have them leave confident with an informed plan, professional endorsement, and ongoing support as needed. To meet the plumber who walked in and seemed normal until telling and showing you a foot that’d been reconstructed thru several surgeries after being run over at an intersection years ago, and now it hurt all the time but the cannabis was the only thing that helped the pain at night, allowed him to sleep and wake up clear-headed so he could still work and support his family… The gentle 45 y/o black man who dropped out of school in Texas because he just couldn’t get it and was considered stupid, tried drugs and lots of menial jobs before self-diagnosing himself in his 30’s with ADD from what he’d heard about it and then deliberately learned about it, never saw a doctor but discovered that cannabis helped him focus so he could finish things. Then got his G.E.D., worked thru college on the dean’s list, and now was an electrical engineer with an LA firm. On cannabis the whole time.
“I’d love to have Stevens meet some of these folks, listen and look them over, then have the courage to go back and tell his friends about it… Entrenched power can see a threat to itself in its own shadow. The fear of loss or change controls the thinking. The only value is self; others are base, unscrupulous, expendable, totally amoral, and, more than anything, bent on taking your power for themselves. Any little loss or change can quickly get out of hand and must be assiduously avoided. We already know everything that’s important so there is no need for new knowledge, or perspective, or goals; indeed, these are likely to contain unseen threats and should be actively stifled. ‘Remember, we are the leaders and certainly know best.'”
FRED GARDNER can be reached at journal@ccrmg.org