Pubdate: Thu, 04 Sep 2014
Source: Sydney Morning Herald (Australia)
Copyright: 2014 The Sydney Morning Herald
Contact:  http://www.smh.com.au/
Details: http://www.mapinc.org/media/441
Author: Nicholas Talley
Note: Professor Nicholas Talley is president of the Royal Australian 
College of Physicians.
Page: 20

A DOCTOR'S DILEMMA ON MEDICINAL MARIJUANA

In recent weeks we have seen the political landscape shifting rapidly 
as moves to legalise medicinal cannabis in Australia gain momentum.

But do we have enough evidence on both its potential long-term 
adverse effects and the short-term health benefits to fully inform 
our decisions?

I believe the answer to that question is no. That is why I am urging 
Australian governments at all levels to urgently invest in and 
support further research and clinical trials.

The risks and benefits of medicinal cannabis should be weighed 
carefully, and its ingredients must be subjected to the same scrutiny 
as other medicines.

The legalisation of medicinal cannabis is an emotionally charged 
issue with medical, legal, ethical and moral considerations.

I, like every Australian, have been deeply affected by the stories of 
individuals searching for a treatment that will ease their suffering 
or improve their health.

As a parent, I deeply sympathise with every parent's desire to do 
what is best for their child's health. After all, what is more 
important than our own health and that of our families?

As a gastroenterologist, I want to be able to offer my patients 
suffering from severe and chronic pain the best and most effective 
treatment available.

As a humanitarian, I believe we must show compassion to those in our 
community who are suffering from terminal or ill health.

I am committed to " the needs of the patient come first", a principle 
so elegantly articulated by William J. Mayo, of Mayo Clinic fame, 
more than 100 years ago. My prevailing duty as a doctor is to base my 
clinical decisions on the best available evidence when treating my patients.

The doctors' Hippocratic oath, " to first, do no harm" guides my 
conduct. I cannot let my heart rule my head. To do so would 
potentially compromise the health and safety of my patients.

Now to the evidence. In the field of neurology, the most promising 
use of medicinal cannabis is in relation to treating spasticity and 
related pain. We also know that there are some limited benefits from 
marijuana and other cannabinoids to treat and relieve the symptoms 
for a number of clinical conditions.

These include chronic pain, AIDS associated anorexia and wasting 
syndrome, multiple sclerosis, epilepsy and glaucoma.

While some patients may experience relief from their symptoms, there 
is still insufficient data available on the effectiveness and safety 
of marijuana or other cannabinoids to treat these conditions. In 
light of all of this, many in the medical community remain concerned 
about the adverse health impacts of marijuana ( for example, 
dependence, repeated vomiting or psychosis), including when it is 
used for medicinal purposes.

Dan L. Longo, MD and editor of The New England Journal of Medicine, 
summed up the current situation well: " We need to improve our 
understanding of how to harness the potential medical benefits of the 
marijuana plant without exposing people who are sick to its intrinsic risks."

After comprehensively studying the evidence around the medicinal uses 
of cannabis and reviewing the benefits and risks associated with its 
use, a UK Royal College of Physicians' ( RCP) report concluded that 
while the active ingredient of cannabis, tetrahydrocannabinol ( THC), 
appears to provide some benefit in the treatment of certain 
illnesses, the RCP recommended further clinical trials.

The results of some of these trials have not been definitive, which 
is why further research is needed.

Let me be clear: I am a strong supporter of research that leads to 
effective medical treatments.

However, until the processes of therapeutic goods regulation and the 
standards of evidence and clinical research produce clear and 
indisputable conclusions regarding the health impacts of medical 
marijuana, we must proceed with caution.
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MAP posted-by: Jay Bergstrom