Saturday, June 28, 2014

The Medical Marijuana Ruse

America is having something of a libertarian moment. At a time when we are being governed by a statist administration that takes its own word for law, young Americans are finding their way to the libertarian cause.

In one sense, this is a great thing. Someone needs to defend free markets, free expression, free enterprise and even free will. If young people do not do so they will suffer the consequences.

In another sense, they risk, as I wrote in my book, The Last Psychoanalyst, confusing freedom for responsibility with freedom from responsibility. After all, if you want to see what freedom from responsibility looks like you need only look to the White House.

In the proper circumstances, free will, which has lately been under attack by behavioral economists does not lead to a free-for-all.

One understands that young people are flocking to libertarianism because they like the Republican Party but do not like social conservatism. They consider it intrusive and inhibiting.

And yet, true freedom does not lie in the other extreme. True freedom is not a synonym for debauchery.

Riding the wave of libertarianism is the movement to legalize marijuana possession. Without taking sides on the issue, it is worth examining Catherine Saint Louis’s excellent New York Times report about the campaign to legalize week. In it, she explains that those who are arguing that marijuana has distinct medical benefits are, as the saying goes, blowing smoke.

If marijuana contributes to debauchery and if young people want to debauch themselves without fear of punishment, they might say so. To pretend that marijuana should be legalized because it is a medicinal agent appears to be largely a ruse.

Saint Louis explains this well:

New York moved last week to join 22 states in legalizing medical marijuana for patients with a diverse array of debilitating ailments, encompassing epilepsy and cancer, Crohn’s disease and Parkinson’s. Yet there is no rigorous scientific evidence that marijuana effectively treats the symptoms of many of the illnesses for which states have authorized its use.

Instead, experts say, lawmakers and the authors of public referendums have acted largely on the basis of animal studies and heart-wrenching anecdotes. The results have sometimes confounded doctors and researchers.

The lists of conditions qualifying patients for marijuana treatment vary considerably from state to state. Like most others, New York’s includes cancer, H.I.V./AIDS and multiple sclerosis. Studies have shown that marijuana can relieve nausea, improve appetite and ease painful spasms in those patients.

But New York’s list also includes Parkinson’s disease, Lou Gehrig’s disease and epilepsy, conditions for which there are no high-quality trials indicating marijuana is useful. In Illinois, more than three dozen conditions qualify for treatment with marijuana, including Alzheimer’s disease, lupus, Sjogren’s syndrome,Tourette’s syndrome, Arnold-Chiari malformation and nail-patella syndrome.

She is not saying that marijuana is never helpful for any patient at any time. She is saying that we need to rely more on science and less on PR:

Patients with rheumatoid arthritis, for instance, qualify for marijuana treatment in at least three states.

Yet there are no published trials of smoked marijuana in rheumatoid arthritis patients, said Dr. Mary-Ann Fitzcharles, a rheumatologist at McGill University who reviewed the evidence of the drug’s efficacy in treating rheumatic diseases. “When we look at herbal cannabis, we have zero evidence for efficacy,” she said. “Unfortunately this is being driven by regulatory authorities, not by sound clinical judgment.”

New York considered including the chronic inflammatory disease on its list, a development that astonished Dr. Mary K. Crow, an arthritis expert at the Hospital for Special Surgery, in Manhattan. People with rheumatoid arthritis have higher rates of certain respiratory problems, she noted.

That’s right. Our solons want to make it possible for patients with rheumatoid arthritis to smoke weed… even though they notably have respiratory problems.

It does happen, Saint Louis explains, that marijuana sometimes helps:

Amanda Hoffman, 35, an information technology specialist in Basking Ridge, N.J., struggles with ulcerative colitis, an inflammatory bowel disease. She has tried steroids and Remicade, an intravenous infusion, but no drug has given her as much relief from frequent daily diarrhea and abdominal pain as her homemade cannabis caramels.

And then there is glaucoma. One often hears that marijuana is a good treatment for that condition.

Saint Louis puts the argument in proper scientific context:

Since at least 2009, for instance, the American Glaucoma Society has said publicly that marijuana is an impractical way to treat glaucoma. While it does lower intraocular eye pressure, it works only for up to four hours, so patients would need to take it even in the middle of the night to achieve consistent reductions in pressure. Once-a-day eye drops work more predictably.

Yet glaucoma qualifies for treatment with medical marijuana in more than a dozen states, and is included in pending legislation in Ohio and Pennsylvania. At one point, it appeared in New York’s legislation, too.

The moral of the story is that the public debate about marijuana legalization is filled with false scientific claims. In many ways it would be better if we were debating whether or not we want to legalize a party drug.

But then we would have to address the real question: how much harm does it do to growing and developing brains? If a fourteen-year-old does not care about whether he is damaging his brain by smoking weed, ought he to have the freedom to do so?


katzxy said...

As we get increasingly regulated, license, rather than freedom, becomes an escape valve. The thinking may be that it's better to have hookups and weed than questioning of the reigning orthodoxy.

Unknown said...

"She is not saying that marijuana is never helpful for any patient at any time. She is saying that we need to rely more on science and less on PR." Are you denying or ignorant to the research of medical marijuana in Israel and the USA or just in denial? Just a simple Google search brings up 1,020,000 results for Israel and 5,610,000 results for the USA. Guess what they found out?

Ares Olympus said...

America's relationship to marajuana has been crazy, and yes, it would be more honest to skip arguing about special cases like medical use, and just legalize it, and tax it.

I have no personal interest in it, and less in friends who find it appealing, but I accept their case that criminalizing self-harm is a fool's errand, and the war on drugs has been a failure.

Myself, it is incomprehensible for a person to be willing to buy something illegal, from a stranger, of unknown origin, unknown contents, or toxic chemicals sprayed on it, and fill my lungs with this unknown. It seems like people must be stupid, or less cautious than me.

But just like medical marijuana is mostly about pain management, I guess if I experienced chronic pain, I can see the attraction to something that seems to fix it.

On the other hand, the placebo effect is such a mystery, I'd think we should be a bit more empirical about it, and study what people are actually doing, and what works, and what works for a while, and what works for reasons we can't explain, and experiment some more.

But myself, I'll stay out of the way, and let other people do those experiments on themselves. I don't want to play.

Sam L. said...

Paraphrasing the bandit chieftain in
"Treasure of the Sierra Madre", We don' need no steenking research!"

Jocker said...

The problem is, that if you smoke one joint, you see, how peculiar conservatism is. Thats why conservatists will never accept this.