When the IOM report was first issued, I said that "Only in a public discourse as debased as that surrounding marijuana could something as mediocre as the Institute of Medicine Medical Marijuana report have such an impact."

See
Will The Titanic Of Marijuana Prohibition Be Sunk By The Ice Cube Of The IOM Report?
-- Analysis.
and links

What is truly bizarre about this column is that they sometimes seem to be misrepresenting their own work!)

April 13, 1999
From The Standard-Times
Copyright: 1999 The Standard-Times
YourView@S-T.com
http://www.s-t.com/

Because of the extensive comments I have printed all of the original in Red, and all emphasis is added. Quotes from the IOM report itself are in green italics.)

By John A. Benson Jr., Stanley J. Watson Jr.
(John A. Benson Jr. is dean and professor of medicine emeritus at the Oregon Health Sciences University School of Medicine, Portland. Stanley J. Watson Jr. is co-director and research scientist at the Mental Health Research Institute, University of Michigan, Ann Arbor. They were co-principal investigators of the Institute of Medicine’s study on the medical use of marijuana.)

Everyone seemed to declare victory when a study on the medical use of marijuana was issued last month.

(Marijuananews note: In fact, NORML was very critical of the report, as was MarijuanaNews.)
See
NORML Special Bulletin -- IOM Acknowledges:
"There is no clear alternative for people suffering from chronic conditions
that might be relieved by smoking marijuana, such as pain or AIDS wasting."
But Still Opposes Smoked Marijuana --

Advocates for legalizing such use said the report aided their cause by concluding that the compounds in marijuana do have some potential as medicine.

As I said, it made a much better case for legalizing marijuana than for medical marijuana. That was an unexpected dividend.

Second, it also said that there are people for whom nothing else seems to work.
"Until a non-smoked, rapid-onset cannabinoid drug delivery system becomes available, we acknowledge that there is no clear alternative for people suffering from chronic conditions that might be relieved by smoking marijuana, such as pain or AIDS wasting." From page 9 of the Executive Summary.

That is really more than is necessary to validate making anything medically available, and that is all that the advocates of medical marijuana have been saying, while the prohibitionists have been saying that marijuana is totally unnecessary. It is a typical prohibitionist tactic to misrepresent the anti-prohibitionist position.)

Their opponents, on the other hand, cheered the report’s conclusion that the harmful effects of smoking far outweigh potential benefits for most patients. In reality, both sides are right.

(Marijuananews note: In reality, no. The Drug Czar himself said that there was "not shred of evidence" that marijuana has medical value. Are Benson and Watson trying to cover up for the Czar? Maybe they are trying to get a job at The Washington Post. Even granting the anti-smoking argument, the point is still that there are patients for whom nothing else works and for whom using marijuana is worth taking almost any risk – including arrest, which they don’t mention. But more on that later.)

The study—which we led for the Institute of Medicine—firmly concluded that the active compounds in marijuana do have potential as medicine. But that future does not involve smoking.
(Marijuananews note: Perhaps, but what about the present? The prospect of better treatments in the future has never been cited as justifying letting a patient suffer and die in any other circumstance.)

Scientific hair-splitting? Hardly. To date it has been nearly impossible to separate scientific evidence about marijuana’s potential from larger societal concerns about its use.

(Marijuananews note: And whose fault is that? Have the advocates of medical marijuana been blocking research? In any case, why would it be impossible to separate a controversy about social policy from scientific data? In the end, their own report refuted or dismissed as irrelevant the prohibitionists’ non-medical arguments against medical marijuana.)

But doing so may be the key needed to advance the rancorous debate that has engulfed this issue since medical marijuana began to appear on state ballot initiatives in the mid-1990s.
(Marijuananews note: Oh, did the debate not begin until it appeared on the ballot? Or was dissent ignored until the initiatives forced the government to find a new way to stall, using people like Benson and Watson?)

For most symptoms there are more effective drugs already on the market, but physicians encounter patients who do not respond well to standard medications, or who need additional therapies. These patients could benefit from new drugs based on cannabinoids, the active components in marijuana.
(Marijuananews note: Notice that the first sentence is in the present tense, "need additional therapies." Notice then that the second sentence is in the conditional, "could benefit from new drugs" – which could maybe possibly be developed sometime perhaps at an unknown time in the indeterminate future. The report says,
"The critical issue is not whether marijuana or cannabinoid drugs might be superior to the new drugs, but rather whether there is a group of patients who might obtain added or better relief from marijuana or cannabinoid drugs." The IOM report also says "even with the best antiemetic drugs, the control of nausea and vomiting that begins or persists 24 hours after chemotherapy remains imperfect." Section 4 page 16.

In other words, the report makes clear that present medications do not relieve suffering in a wide range of cases, but here we are told only that the patients "could benefit from new drugs." They should live so long, if they can bear the pain. They could benefit from marijuana right now!)

Marijuana’s future as medicine rests in developing new ways of delivering these cannabinoids—including the most common one, THC.

(Marijuananews note: The IOM report completely ignores vaporization, as well as ingestion. I know that Dr. Grinspoon specifically told them about vaporizers, but it is hardly a secret. Why did they not even mention studying vaporizers? Was it because the ready availability of vaporizers would vaporize their only excuse for adhering to the prohibitionist party line?)

Presently there is only one such drug on the market. Marinol, a THC capsule, is approved by the Food and Drug Administration for treatment of nausea and vomiting associated with chemotherapy, as well as poor appetite and weight loss associated with AIDS.
See
Gettman Petition For Hearings On Marinol Rescheduling Uses DEA’s Own Arguments Against It.
Why Marinol Is Not Medical Marijuana. Wonderfully Brilliant!
However, some who have used Marinol complain that it takes effect slowly, and its results are variable. Sufferers of pain, nausea and vomiting obviously need fast-acting medication.

(Marijuananews note: If "Sufferers of pain, nausea and vomiting obviously need fast-acting medication," then don’t they need fast-acting policies? Are present sufferers supposed to wait for years until a politically correct way of delivering cannabinoids is developed in the future? Their callousness is damned by their own statement.)

In deciding whether marijuana should be smoked as medicine, society must weigh the reality of this crude drug-delivery system against the benefits it might bestow.

(Marijuananews note: "Society must weigh the reality of this crude drug-delivery system against the benefits it might bestow." What a curious statement in this context! In reality, that is precisely what has been going on in the medical marijuana initiatives. "Society has weighed the reality" and an overwhelming majority of the people have rejected the advice of the medical establishment, the prohibitionist leadership of DEAland, and often the very biased media, and have decided that it is wrong to arrest sick people for using a plant that helps them. They know these numbers: "Public support for patient access to marijuana for medical use appears substantial; public opinion polls taken during 1997 and 1998 generally report 60-70 percent of respondents in favor of allowing medical uses of marijuana." Section 1 page 6.)
See
Gallup Poll Shows 73% Favor Medical Marijuana;
29% Favor Outright "Legalization"!
So What Are The Politicians Really Afraid Of?

Chronic smoking of marijuana increases a person’s chances of developing cancer, lung damage, and problems with pregnancies, including low birth weight. Therefore, it simply is not an acceptable long-term option.

Third, those who need to smoke more may find the risk worth taking for two reasons. Other drugs may simply not work, or they may have debilitating side-effects, a point that is largely ignored here. And, sadly, while their present condition may not be "terminal", their actual life expectancy may be substantially below the average. The "long-term" risks are not of such great relevance, particularly in the face of present suffering.)

Smoking should be allowed only for short-term use among patients with debilitating symptoms, or who are terminally ill and do not respond well to approved medications.
(Marijuananews note: Now here is where it gets nasty. "Smoking should be allowed only for short-term use." "Allowed"? All right, doctors, then what is to be the punishment for using it when you would not allow it?

But they dig themselves in deeper.)

Even in these cases, marijuana use should be limited to carefully controlled settings. Patients who are prescribed marijuana should be enrolled in short-term clinical trials that are approved by an oversight strategy such as institutional review boards, and involve only those patients most likely to benefit. They should be fully informed that they are experimental subjects and are using a harmful drug-delivery system, and their condition should be closely monitored and documented under medical supervision.

(Marijuananews note: No, they should be fully informed that they are the victims of a bad public policy. Patients should always be informed of risks, but what should they be told in this case. That there is a long-term risk? What is the relevance of this warning in a six-month trial? It has no relevance at all!

Why should they be experimental subjects, unless they are going to be "allowed" to continue to use the substance that is proven to help them? If it does not help them, then they will discontinue its use.)

These clinical trials of smoked marijuana should not be designed to develop it as a licensed drug, but should be a stepping stone to the development of new, safe delivery systems of cannabinoids.
(Marijuananews note: In fact, such limited trials would be of no value in developing such a "delivery system." Would injecting or ingesting a drug for six months help develop a new delivery system? This is a really puzzling statement.)

There is no evidence that using marijuana in controlled settings—or cannabinoids in the form of drugs such as Marinol—will lead to increased illicit drug use throughout society.

(Marijuananews note: Obviously I agree, but this sentence seems oddly placed. The whole subject is really irrelevant. Why did they throw it in here?)

Our review of the science behind marijuana and cannabinoids convinces us that the debate so far has been miscast. Rather than focusing on drug control policy, the medical marijuana debate should really be about the promise of future drug development.

(Marijuananews note: First, I don’t see any evidence that they know what the debate is really all about. They avoid the subject of arresting the sick and dying.

Second, my review of the subject convinces me that we should focus on alleviating the suffering of the sick, dying and disabled. I foolishly thought that this was the purpose of medicine. Now I find out that the patients are merely guinea pigs to be used for "the promise of future drug development." Silly me!)

Mining the pharmaceutical promise of cannabinoids will require the same kind of drug development that brought us any number of pain-killing drugs prescribed by physicians today. With public investments in research, or enough incentives to convince private companies to develop these drugs, the perceived need to smoke marijuana to alleviate symptoms could vanish.

The Compassionate Use program may have been ignroed because several of the legal eight are glaucoma patients. The report relied on prohibitionists Kaufman and Green and for most of their information on glaucoma, and so denied marijuana’s utility for its treatment. Therefore the program did not exist??
See
There Are None So Blind As Ophthalmologists Who Don’t Want to See:
Marijuana, Glaucoma, Science And Journalism -- Analysis -- And 3 News Articles

Finally, the report has the following statement:
"November 1998, the British House of Lords Science and Technology Committee published, Medical Use of Cannabis, in which they reported their conviction that "cannabis almost certainly does have genuine medical applications." The House of Lords report was released too late in the preparation of the IOM report to permit careful analysis, and is not summarized here."
See
Chairman of the House of Lords Science and Technology Committee
Criticizes UK Government’s Rejection Of Report On Medical Marijuana
– 2 Articles With 2 of the Worst Prohibitionist Arguments
The IOM report was issued over four months after the Lords report, but they say that they did not have time for "careful analysis." In fact, the above quote greatly understates the conclusions of the House of Lords report. Its very distinguished committee recommended that marijuana be rescheduled so that doctors could prescribe it now. Would it really have taken four months to accurately report what it said?

In one section the IOM report says "Primum non nocere. This is the physician's first rule: whatever treatment a physician prescribes to a patient - first, that treatment must not harm the patient."