Politics, Science, and Medical Marijuana

An interesting piece this morning on Morning Edition about medical marijuana. Thoughtful, but left a few things that I think need to be said.

The opponent of medical marijuana interviewed argued that (1) medical marijuana is a first step down a slippery slope and (2) that the legislative process is the wrong way to go about determining what medications should be available. We have a rigorous FDA procedure designed for that and it is there that science, not politics makes the proper determination. Both of these points are correct.

First, while part of the push behind the medical marijuana movement is about suffering patients who see this as a helpful part of their treatment, but part is also a camel's nose under the tent approach to full decriminalization of pot including for recreational use. The medicinal use and the recreational use are discrete issues, but one (which is more likely to succeed now) is meant in some quarters to hasten a broader discussion of the other.

On the second point, it is true that we ought to have an apolitical, science-based process to go about determining when a potential treatment is effective, how effective relative to other competing treatments, and whether there are significant concerns about side effects or interactions with other medications. We have that for many drugs with the FDA, but there are three points to be made here.

First, the FDA has repeatedly been denied jurisdiction over supplements and "natural remedies." This is mainly because of the political pull of the supplement makers who like the fact that they can make outlandish claims about their products with no need to back them up. Truth in advertising does not apply to natural or homeopathic products and since this is an herb like St. John's Wort or echinacea, it is not clear that it would receive the sort of FDA scrutiny that other treatments would.

Second, there is a problem with testing medical marijuana that makes all evidence sketchy. If any of the molecules in marijuana are medicinally helpful, ingesting it and examining the effects is bad science because there is no way to determine how much of the chemical is being ingested. Just as people range in height, so too how much of any given substance is in a particular sample of something from nature varies. We have two mulberry trees growing side by side and there is a noticeable difference in the the taste of the mulberries, they differ in the amount of sugar found in their berries. If THC is of medicinal value, then what needs to be done is for marijuana to be processed, the THC isolated and administered in controlled dosages at specific intervals. This is what is not happening with medical marijuana, so we have a lot of anecdotal evidence and some clinical evidence that unknown amounts of THC taken at random intervals helps some people with some conditions. This gives us reason to investigate, but we don't have reason to rule in or out. It means there is science that needs to be done.

And that is what brings us to the third point, which is that while the driving force behind the medical marijuana movement is political, not scientific, the reason the science has not been done is also political, not scientific. Our marijuana laws date from the 1910s-1940s and were fueled not by science but by racism against Mexican immigrants and African Americans who were identified with its usage. The social divide of the 1960s indelibly painted the substance with cultural significance and as a result research into anything positive associated with the plant was declared off-limits.

So, the result is that we have politics stopping research on one side and politics driving medicinal use without science on the other. Real science would give us pills containing the exact amount of processed THC, not brownies or bong hits. The proper approach, the middle path would make neither side happy and unfortunately is being held prisoner by a debate that is steeped in politics of dishonest, unspoken motivation.