This is the first entry since the ‘06 NORML Convention
(San Francisco from 4/20-4/22) ended. From now on, I intend to
post more often and expect to have more time to do so, because I
will be spending less of it trying to persuade 'organized reform’
to see the complex issues involved from my perspective. Since I know
from experience that patients are far more likely to ‘get’ the things
I'll be writing about, it makes a lot more sense to to focus my
educational efforts on them through the blog.
Last week’s NORML meeting provided the last bits of evidence
needed to reach that conclusion. As is often the case, one item came
from an unexpected source; the other came from a plan I’d hit on only
after a last minute invitation to participate in a panel on
'clincal use' of cannabis.
First the unexpected source: it was a brain-dead and ill-considered
press release emanating (no other word suffices) from the FDA on
Thursday, April 20, allegedly in response to a request from Rep. Mark
Souder of Indiana. Whatever the truth of that claim, the timing
coincided with the first day of NORML; that some commentators
apparently missed that obvious connection does not inspire much
confidence in their abilities. As noted, the press release itself
provided some key data; but in a completely negative way: it was simply
florid propaganda echoing a former drug czar’s obvious attempt to spin
the 1999 IOM report he'd requested— but then been disappointed by—
because it (timidly) repudiated 2 key items of drug war dogma:
first, that “marijuana” has unique therapeutic value for at last some
patients;
second there’s no compelling evidence to support that the idea that it
leads people to try/use other drugs (“gateway” effect).
Thus the ballhooed 'report' was merely repetition ot a medically
untrained general's opinion from seven years ago–– entirely without
supporting evidence. What it actually demostrated how just how far the
credibility of the FDA has fallen. That s commentators were oustspoken
enough to recognize that fact and take them to task was encouraging; as
was the simultaneous
and unrelated concession by a hard core Right Wing SF journalist
that pot has medical value.
As for the meeting itself; on Friday evening, I attended a hosted, but
informal, dinner conclave of nominal ‘reform leaders’ where the main
agenda item was to be medical marijuana framed in a context which had
originally been ‘recreational’ versus ‘medical.’ Just before the
dinner, I’d learned that ‘social’ had been substituted for
'recrational.’ No objection. I still don’t see the difference; but no
objection. As for ‘medical’ I have always understood that to mean
prescribed by someone with a medical license— as opposed to used on the
person’s own judgement.
The point I wanted to make was that ‘medical’ has picked up so much
baggage in the context of pot that there is no chance of any consensus
ever emerging. In fact, anyone with much clincical experience in the
practice of medicine will tell you that there is constant bickering and
disagreement among physicians over the best treatment of certain
conditions/problems/diseases. That’s the nature of the beast. Most
clinical encounters begin with SYMPTOMS (patient complaints). The
doctor then comes up with a working diagnosis and has to decide
how far to go in confirming it (ruling it ‘in’ or ‘out’). It’s a
complicated algorythm which can vary with a host of factors; not the
least of which is setting. For example, a GP who has known the patient
for years is going to be a lot less worried when someone who has always
exaggerated their physical symptoms complains of a new one— at least at
first. On the other hand, an ER physician, who has never seen that
patient before and won’t be able to conduct a follow-up, might
feel the need to order hundreds (or even thousands) of dollars worth of
tests— mostly for his own protection against a possible law suit.
That’s one of the key reasons an ER is a bad place to go with minor or
vague new complaints. The hardcore uninsured have no such billIng
worries, and must be dissuaded by other means— such as long waiting
periods in ERs. I’ve wandered off-topic, but I hope I've left you with
a feeling for what the working MD gets paid to do: exercise clinical
judgement. Now, I'm off across the Bay to exercise some clinical
judgement of my own. The next entry will why I think the FDA fiasco may
point toward a key strategy change that 'reform' should adopt; I will
also describe more adventures at NORML '06.
