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10 Controversial Medical Questions Answered by Dr. Dalrymple

Where do you stand on these challenging ethical and scientific debates?

by
Theodore Dalrymple

Bio

March 15, 2014 - 8:00 am
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From May 2013:

6. Is marijuana a medicine?

Or is a new generation of addicts emerging?

No doubt I have forgotten much pharmacology since I was a student, but one diagram in my textbook has stuck in my mind ever since. It illustrated the natural history, as it were, of the way in which new drugs are received by doctors and the general public. First they are regarded as a panacea; then they are regarded as deadly poison; finally they are regarded as useful in some cases.

It is not easy to say which of these stages the medical use of cannabis and cannabis-derivatives has now reached. The uncertainty was illustrated by the on-line response from readers to an article in the latest New England Journal of Medicine about this usage. Some said that cannabis, or any drug derived from it, was a panacea, others (fewer) that it was deadly poison, and yet others that it was of value in some cases.

The author started his article with what doctors call a clinical vignette, a fictionalized but nonetheless realistic case. A 68-year-old woman with secondaries from her cancer of the breast suffers from nausea due to her chemotherapy and bone pain from the secondaries that is unrelieved by any conventional medication. She asks the doctor whether it is worth trying marijuana since she lives in a state that permits consumption for medical purposes and her family could grow it for her. What should the doctor reply?

The scientific evidence about the medical benefits of cannabis is suggestive but not conclusive, in large part because governments have placed legal obstacles in the way of proper research, but also because the smoke of marijuana contains so many compounds that need to be tested individually. But it seems that cannabis can relieve nausea (one of the most unpleasant of all symptoms when it is persistent) and some kinds of pain. Its side effects in this context are unlikely to be serious or severe. To worry about the addictive potential of a drug, for example, when the patient is unlikely to survive very long is clearly absurd, though one doctor did raise the question. I remember all too clearly the days when patients who were dying were denied pain relief by heroin because it was supposedly so addictive.

As soon as the subject of cannabis comes up, passions are aroused that seem to make it impossible for people, even doctors, to stick to the point. One correspondent pointed out that a half of American schoolchildren had tried cannabis, but this was irrelevant even to the irrelevant point he was trying to make. No one, after all, suggests that there should be no speed limits because almost every driver breaks the law within thirty seconds of starting out. There may be arguments for the decriminalization of cannabis but this is not one of them.

The author of the article comes to the conservative conclusion that doctors should prescribe cannabis medicinally only when all other treatment options (including the much more dangerous oxycodone) have failed. This might seem contradictory. If cannabinoids should prove as effective in some situations as opioids they would be drugs of first rather than last resort.

But it is unlikely in any case that all doctors will remain conservative for long or will prescribe cannabinoids only as a last resort. In Britain in the 1950s doctors were permitted to prescribe heroin for heroin addicts. A very small number of them began, either for payment or because they believed that the “recreational” use of heroin was harmless or even a human right, to prescribe very liberally. The number of addicts increased very quickly, but whether it would have done so anyway is now impossible to say.

****

Images courtesy shutterstock / Andre Blais / Andre Blais / 

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All Comments   (9)
All Comments   (9)
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More than half of these questions would simply go away if everyone (or their family or close friends as needed) paid for their own health care. For the remainder - perhaps excerpting parental responsibility for an obese child - it is sufficient for everyone to have their own opinion and act accordingly.
36 weeks ago
36 weeks ago Link To Comment
There's so much PC BS on most topics that it's startling to hear or read TS, "true speak." Thanks, Doc.
36 weeks ago
36 weeks ago Link To Comment
RE: Obesity & RE:Healthy Diet. I know 17 people with Hypo-Throidism, & most continue to gain weight eating healthy low cal diets with lots of aerobic exercise. I doubt most overweight people have this, but some do have a medical reason for obesity, likely a small minority. Those who simply choose a poor diet likely fall into one of these categories...1) I will eat what I want (needs immediate & constant gratification). 2) Too uninformed (or ill informed) to make intelligent choices. 3) Too poor to buy healthy food (the price, per calorie, of junk food has dropped, while the cost of real food has skyrocketed). If most people would eliminate all processed foods made with white flour & white sugar, & replace that with a MUCH SMALLER amount of whole grains than the food pyramid recommends & eat mostly lean sources of protein + lots of organic produce, they would naturally loose weight. For weight loss to be permanent, you have to make permanent changes!! "Let thy food be medicine & let thy medicine be food"...Hippocrates
36 weeks ago
36 weeks ago Link To Comment
Here in NV our absurd Medical Marijuana laws require a patient to break the law BEFORE they can comply with it. First, you have to break the law & illegally obtain the seeds. Then you apply for a Medical Marijuana card ($50.00), then pay another $50.00 for an "Illegal Contraband Tax Stamp", (no I'm NOT making that up). Then you have to "grow your own". Once "your crop comes in"...you FINALLY have your medicine. As a patient who laid in bed CRYING AND SCREAMING IN AGONIZING PAIN FOR MONTHS ON END, because pain pills don't work on me, NOT opiates & NOT NSAIDS, I can tell you that "witch hunt" leveled against Medical Marijuana is merely "cover" to TORTURE cancer patients like me. I choose not to break the law, because there's no telling when/who the Fed. Gov't. will turn on next & my Hubby is a legal immigrant, here on a Green Card from Canada...so I SUFFERED!! The freely available (by RX) dangerous, highly addictive, toxic narcotics & their horrific side-effects they "experimented on me with" are what we should be worried about...NOT a plant that grows out of the ground!!
36 weeks ago
36 weeks ago Link To Comment
With the understanding that people should be free to obtain help for obesity, addiction, and all health issues at any age, but cannot demand that others pay for this treatment (Charity given by others is ok and encouraged), my take is as follows. Let the debate begin.

1. Obesity is neither a disease nor a moral failing
2. Alcoholics should not be denied available medical care
3. Psychiatric illnesses merit treatment as much as physical illnesses
4. Doctors sometimes are guilty of giving pain killers to addicts who con them
5. Elderly should not be denied available medical care
6. Marijuana can be a medicine, with side effects
7. Nutrition is important to health
8. Drug addiction is not like non-addiction illnesses but addicts should be treated
9. Obese children are not victims of child abuse
10. Parents should vaccinate their children
36 weeks ago
36 weeks ago Link To Comment
Interesting that the author chose only one vaccine to discuss pros and cons.
36 weeks ago
36 weeks ago Link To Comment
He must be in on the CONSPIRACY!!!!!!!
36 weeks ago
36 weeks ago Link To Comment
A government funded psychiatrist on an NHS pension in on 'the conspiracy'? No. Not possible.
36 weeks ago
36 weeks ago Link To Comment
Thank you, Doctor, for this thoughtful and objective article. These are two qualities that in tandem are virtuous but rarely encountered today.
36 weeks ago
36 weeks ago Link To Comment
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