Medical Marijuana is in the news again, this time with a Mormon Connection. This article tells the story of a Utah mom whose son, Stockton May, has a rare epileptic syndrome called Dravet syndrome. These children have a horrible, heartbreaking epilepsy that medication is usually ineffective in treating. At best they decrease the seizures to a point, but total elimination is very rare. These families are often at the end of their rope. They sign up for every medical trial of every new drug. Jennifer May, the mother in the article, states that she has tried 25 treatments in 10 years, only 2 of which helped and both of those had to be stopped due to toxic side effects. There is report of the latest hope for the patients with Dravet syndrome and their families, Medical Marijuana. The idea of giving this to children is, of course, controversial and as a result it has had a lot of newsplay. It is apparently more controversial because Sister May is a devout Mormon. It certainly adds some heft to the degree of desperation she might feel. We Mormons are a straightlaced, teetotaling bunch. The article is very balanced and Sister May’s case as she lays it out sounds quite reasonable. Basically, there are some compelling case reports and animal data that suggest that a chemical in Marijuana, not actually THC, but one called Cannabidiol (CBD), suppresses seizures. Because Marijuana is a schedule 5 drug, studies are hampered and therefore it needs to be legalized and taken off the list, so that it can be legally obtained by suffering children like her son, Stockton.
Marijuana actually has a long history of study in the case of epilepsy, with mixed results. You see, marijuana doesn’t have just one active ingredient but is a mix of many, many different psychoactive chemicals. THC is the most famous and responsible for the hallucinogenic high. It actually has been reported to be associated with increased seizures in patients with epilepsy, perhaps because of withdrawal. The strain of interest is low in THC and high in CBD and therefore does not give a very good high. Not surprisingly, this makes the strain not very marketable for the grower. However, the developers of this strain are reaching out to the epilepsy community and have a corner on the market as it were.
It turns out there is not just one, but many THC’s. Here is where the argument for medical marijuana breaks down. One of them, Delta 9 THC, also known as Dronabinol, is actually an FDA approved medication. It is approved for patients on chemotherapy for nausea and as an appetite stimulant in patient’s with AIDS. This seems to be the great secret that advocates of medical marijuana either don’t know or don’t want you to know. We already have medical marijuana, or more specifically, marijuana derived medicine. It is fully legal and not controlled any more than Vicodin.
To be fair, it is true that it would be easier to test medicines derived from marijuana if it were not such a strictly controlled substance. Most Americans approve of this kind of use. I approve of this kind of use. We need to make it easier to test marijuana so it can be used safely and effectively for anyone who can benefit. It would be nice if it were easier to create more Dronabinols.
There are many families of my patients now coming to my office having heard the news and wanting marijuana for epilepsy. While I live in a state where medical marijuana is legal, I cannot get it for them. The strain responsible for the amazing reports is not available unless you go directly to the specific farm in Colorado and get in line. As the news article states, I could refer the patient’s families to the one clinical trial ongoing for DHC. The problem is that they could end up in the placebo arm. Then there is the whole problem of how the DEA could theoretically still come after me for prescribing it even though this is legal in my state. More important than all of this, the fact remains that this is an unproven treatment. I do think it sounds promising. Unfortunately, in my brief time in practice I have seen many promising treatment turn out not as good as advertised when put through an actual trial. Unfortunately, these families come to me often wanting to skip all the proven stuff first, convinced by a few stories that they have found the magic marijuana bullet. It is a long and frustratingly slow road, but careful, scientific study of any medication is really the only way we safely make progress in the long run. It is how we take what we think we know and see if it is really true. It is how we carefully measure unforeseen side effects or single out people for whom the drug is dangerous. Sadly, it moves too slow for the Stockton May’s of the world who really just want something, anything that works.
In my estimation, the biggest roadblock for us having medical marijuana has been it’s own lobby. They insist that pills will not work and that is must be smoked, though last I heard brownies seem to work as well. They insist that pharmacies not be involved and have created so called “dispensaries” instead. It seems to me they do not want marijuana to be a medicine at all. At best, they want the freedom to use marijuana as the catch all healing herb of their own legends. At worst, they use medical marijuana as a cynical ploy to use public approval as a stepping stone to recreational use. Medical marijuana would actually be an obstacle for recreational users as we have rules about who can prescribe it or dispense it to keep it out of just anyone’s hands. The laws legalizing Mary Jane that have been passed are carefully crafted to avoid the actual medical part of medical marijuana.
There is a growing movement in this country to keep the FDA out of regulating any medication grown from the ground rather than made in a lab. This seems a movement to which Mormons are especially drawn. Perhaps it is the influence of the Word of Wisdom which specifically states that “all wholesome herbs God hath ordained for the constitution, nature, and use of man—” For Mormons this impulse is so strong that it could even overpower our strong tendency to obey the rules and unquestioningly follow the law. Some might even move past our reflexive abhorrence of illegal drugs to embrace the what is increasingly marketed as the wholesome, healing herb of the earth, magical marijuana. We are drawn to this idea of nature providing and caring for us. If only we could be drawn the same way to caring and providing for nature, but that is a post for another day.
Over the past few decades “chemical” has become a dirty and distrusted word. At the same time words like “natural” and “organic” have gained mystical healing properties. The truth is nature, actually everything, is made of chemicals. Many lab produced chemicals, which I think are supposed to be the bad guys, were labeled “organic” long before the word was in fashion. There is a big movement to look into the wisdom of the ancients, to find alternatives to science based western medicine.
To be fair, I think this approach really does have its place. There are many patients like Stockton above, who have tried and failed everything western medicine has to offer. I find no fault in them trying whatever they can find. There are many who benefit from a multifaceted approach. It makes sense to try as many options as you can. I have no problem with any patient who wants to try western medicine and alternative approaches together. The problem comes when you insist on the latter to the exclusion of the former, especially with a serious but treatable condition like epilepsy.
There are scientists and physicians who claim that alternative medicine works by placebo effect. The bigger point for me is that it does, in fact, work. The mind is a powerful tool for wellness. We ignore that at our own peril. Understanding the mechanism is nice, but I will admit we don’t always understand how even scientifically proven medications actually work.
The problem I see is this– unquestioning faith in the healing of nature is unwise. Natural does not equal good. Snake venom, deadly nightshade, cyanide and arsenic are all substances found in nature. They are decidedly unhealthy. The statistically proven outcome of completely natural childbirth is a much higher infant and maternal mortality rate. A century ago childbirth was the leading cause of death in women of such age. The FDA was created for a reason. The 1800s were rife with shady salesmen peddling snake oil. We put a stop to it. We fixed it. We have come up with many breakthroughs since then by use of rigorous scientific testing. Now I fear the salesmen are returning, this time with their oils deemed “essential.” Our prejudices give natural substances a pass. The FDA has a loophole for nutritional substances and an entire naturopathic industry peddling “nutriceuticals” has grown around it.
Many effective medicines start out as a substance found from nature. Aspirin comes from boiled willow bark Native Americans used to dull pain. However, we learned through careful observation that aspirin also makes you bleed easier, leading to stomach ulcers and other problems. To minimize this problem chemists working in a laboratory altered the structure of the effective ingredient to reduce this tendency to bleed and came up with Ibuprofen. This is not an isolated case of science taking the effective and wonderful chemicals in nature and actually improving on them with careful testing to avoid unforeseen consequences. This is how the system works.
The FDA also requires that doctors and pharmaceutical companies be unrelentingly honest and monitor very closely for side effects. This completely shuts down the charismatic snake oil salesman approach. The truth is marijuana has undeniable side effects. Most obviously it causes hallucination. Less well known, it can cause complete loss of motivation, paranoia or schizophrenia. Alternative approaches rely entirely of finding believers to tell their stories of the miracles the product worked for them. Side effects are completely glossed over. These practitioners rely on our belief in the product. Their is some wisdom in this approach. Placebos are more effective the more you believe in them. Our scrupulous search for side effects often undercuts belief in western medicines. We are countering the placebo effect that can be a powerful ally. We are doing so as scrupulously honest and regulated scientists. I fear honesty often makes for hamstrung salesmen.
This is not to say that any positive effect from alternative therapies are all in the mind. I am sure, that like aspirin, many of them work. I am sure that many of them do so very safely. I am even open to the idea that many of these substances are meant to work in the body. I am just not sure which ones because we have not run double blind placebo controlled trials on them. This is done to protect people, help them know unforeseen consequences. In my mind, this is how you follow the admonition in the Word of Wisdom that these herbs are “to be used with prudence and thanksgiving” and “with judgment and skill.” I am not so naïve as to deny that scientific breakthroughs have often led to such unforeseen consequences. The human body is fantastically complex. There is much that we do not know. Failures in the past such as thalidomide have rightly caused concern. I am just not naïve enough to believe the “natural” approach is any better at avoiding these consequences. Faith need not be so blind.