The U.S. Supreme Court heard arguments recently in a case involving the medicinal use of marijuana, a drug which is illegal in the United States. The high court will decide the case as a constitutional matter because it involves a conflict between federal and state laws. But the science behind the case - the medical value of marijuana - continues to be a matter of intense debate.
The trouble with trying to have an honest scientific discussion about marijuana's value as a medicine is that the drug is a flashpoint of controversy. In the 1960s, millions of American youngsters casually smoked marijuana to get high, protest authority, and celebrate their drug of choice. Today, years into the "war on drugs," public service announcements on television demonize marijuana as a prelude to date rape or a destroyer of families.
The case under consideration by the U.S. Supreme Court involves Angel Raich, a California woman with cancer, chronic pain and other conditions, whose doctor recommended marijuana, also known as cannabis, to alleviate some of her symptoms.
"She uses cannabis to relieve severe chronic pain, anorexia and nausea, and its resulting weight loss and malnutrition," said Frank Lucido, Ms. Raich's physician. "She's tried numerous regular pharmaceutical medications, including Marinol, the synthetic THC, and these have all failed. In fact, they've often made her sicker, while medical cannabis has worked amazingly well for her."
Mrs. Raich and many others who have used marijuana for medical purposes say the drug works wonders. But for scientists, such reports are dismissed as anecdotal evidence - individual stories that do not have the validity of a rigorous scientific experiment.
"Anecdotal information is absolutely a terrible way to make policy, but it doesn't mean that the anecdote is not true," said Janet Joy, co-editor and staff director for a landmark study on medical marijuana. "One of the issues that the group who put together this report struggled with was the lack of good, comprehensive data. That is, plenty of anecdotes, but a very few reliable clinical studies."
That medical marijuana report was published in 1999 by the Institute of Medicine, an arm of the U.S. National Academy of Sciences. The study found enough reason to believe that marijuana could help with symptoms including pain relief and appetite stimulation that it recommended further research into the matter. It cautioned that smoking marijuana for long-term medical use was not a good idea, while admitting that the concern was not very relevant for terminally-ill patients. And it downplayed the negatives, for example dismissing the idea that smoking marijuana causes users to move on to other, more dangerous drugs. The report was commissioned by the White House Office of Drug Control Policy. Despite the potential seen by the Institute of Medicine and the many advocates for medical marijuana, there has not been a surge in research in the five years since the report was released. One reason is that marijuana, because it is a chemically complex plant with numerous physiological effects, is difficult to study. Another is that marajuana possession is illegal, and that status has had "an enormous impact," according to Janet Joy.
"The anti-drug baggage." she says, "might discourage people from walking into what they might see as a politically-risky field. I don't think that's the biggest deterrent. I think an even greater deterrent is the simple cost of doing the research. And when I say cost, it's not just dollars, but it takes an enormous amount of time to go through all the regulatory hurdles to get approval for it, which you need, because it is a controlled substance in the States."
A synthetic form of THC, one of marijuana's active ingredients, is already on the market. U.S. doctors can prescribe Marinol, or dronabinol, for nausea from chemotherapy and weight loss in AIDS patients. Its manufacturer, Solvay Pharmaceuticals, stresses that it provides a standardized dose and does not contain as many as 400 other substances that are contained in smoked marijuana. But Angel Raich's doctor says it does not work for her, and Janet Joy says it does not act as quickly as smoked marijuana.