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FUZZY SCIENCE GUIDES DOCTORS, VOTERS ON POT

Voters Decide Tuesday If Medical Marijuana Will Be Legal in Florida.

In study after study, scientists have scrutinized medical marijuana and found promising - if inconclusive - results.

Smoking pot helped patients with AIDS and Parkinson's disease, according to studies in California and Israel.  In a separate experiment nearly a decade ago, Scripps Research Institute scientists found THC might halt the progress of Alzheimer's disease.

Those are among the studies by reputable researchers that have played up pot's potential.  But because cannabis is an illegal drug, the research has yet to reach the level of rigor required for many doctors to fully endorse weed as a pharmaceutical-grade therapy.

The fuzzy science has emerged as a central conflict in the debate over Amendment 2, which would legalize medical marijuana in Florida.  Voters will decide the issue Tuesday.

Cannabis is something of a Rorschach test for doctors: Skeptics look at the studies and dismiss them as squishy.

"The science is very thin," Dr.  Bernd Wollschlaeger, a family physician in Aventura, said at an Oct.  10 event sponsored by the Palm Beach County Medical Society.

But proponents point to the research as a clear sign that cannabis merits more inquiry.

"The breadth of research that has been published is very compelling," said Dr.  Suzanne Sisley, a Phoenix physician who visited Palm Beach Gardens on Tuesday to campaign for Amendment 2.

In one widely cited study published this year, doctors at Tel Aviv University in Israel asked 22 people with Parkinson's disease to smoke marijuana.  The patients showed "significant improvement" in tremors, sleep and pain.

"Larger, controlled studies are needed to verify the results," the Israeli researchers wrote.

Another study, published in 2007 by researchers at the University of California San Francisco, looked at 50 HIV patients with neuropathy, a painful nerve disorder.  Smoking cannabis yielded "a measurable medical benefit," said the lead researcher, Dr.  Donald Abrams.

Abrams has completed other studies about marijuana's usefulness as a pain medication.  His latest project is studying cannabis' effects on patients with sickle-cell disease, and he dismisses the concerns of doctors who are skeptical about pot.

"I don't need a randomized, placebo-controlled trial to know cannabis is medicine," Abrams said.  "It's been a medicine for 3,000 years."

That's not enough for skeptics, who note that the FDA approves drugs only after they've been tested in thousands of patients in tightly controlled conditions at dozens of locations.

"There seems to be a therapeutic signal," said Dr.  Abbey Strauss, a psychiatrist in Boca Raton.  "But it's very, very far away from medicine."

That refrain is repeated often by doctors, who say it's just not safe to medicate based on anecdotal evidence or on studies of relatively small numbers of patients.  Dr.  Ralph Nobo, a Bartow physician and president-elect of the Florida Medical Association, said too many of the experiments focus on just a few dozen patients.

"Those numbers are too small," Nobo said.  "I want to see numbers in the hundreds, or thousands."

It's a conundrum acknowledged by Sisley, a plain-spoken doctor with a mane of springy black hair.  She calls the evidence "overwhelming" - but she acknowledges it's not enough to persuade other doctors.

"The problem is they're low-level, observational studies," Sisley said.  "In the medical community, the gold standard for science is randomized, controlled trials."

Sisley said she never has tried pot herself.  But many of her patients are former soldiers with post-traumatic stress disorder, and veterans told her that marijuana worked better than prescription drugs.

Intrigued, Sisley began to learn more about cannabis.  She's trying to organize a study of marijuana's effects on PTSD but said she found the federal funding machine is rigged against pot.  The National Institute on Drug Abuse prefers researchers to study weed's dangers, not its benefits, she said.

'We are not going to get any funding from NIDA, because NIDA won't fund efficacy studies," Sisley said.  "The federal government has already decided marijuana has no medical benefits."

Unable to land federal cash, Sisley is seeking private donations.  Her next obstacle: how to legally get weed to use in her study.

Sisley said she has been unsuccessful in buying pot from the federal government's stash.  The feds grow marijuana at the University of Mississippi, but it's a variety that's low in THC, one of marijuana's active ingredients.  What's more, it's full of sticks, stems and seeds, parts of the cannabis plant that lack potency, Sisley said.

"If they'd sell it to us, we'd use it, but we can't even get this substandard material," she said.

Complicating matters is this: Even individual doctors can hold decidedly contradictory views about pot.  Strauss said marijuana merits more study, but he also frets about the dangers of addiction and psychological side effects.

"Most doctors feel really conflicted," Strauss said.

Wollschlaeger, the Aventura doctor, said the science is sketchy, but he also said he has prescribed Marinol, an FDA-approved drug based on cannabis.

Even the federal government's conclusions seem mixed.  In 2003, the federal patent office granted the U.S.  Department of Health and Human Services a patent on cannabidoil, or CBD, which the government describes as a "nonpsychoactive" part of the pot plant.  CBD is useful for inflammation, stroke, Alzheimer's and Parkinson's, the patent says.

In another unexpected turn, the Scripps Research Institute scientist who found THC showed promise in treating Alzheimer's disease is skeptical of efforts to legalize medical marijuana.

"I do not advocate legalizing marijuana," Kim Janda said.  "I believe it is a gateway drug to others like cocaine, methamphetamine and heroin."

In 2006, Janda and other scientists at The Scripps Research Institute in California published a study in the journal Molecular Therapeutics.  THC blocks the formation of amyloid plaque in the brain, they said, and "may provide an improved therapeutic for Alzheimer's disease."

The experiments were conducted in test tubes, not mice or humans.  Despite the promising results, Janda abandoned his research into THC.

"Maybe it was too radical back then, but I had lots of opposition trying to move it forward, so I gave up," Janda said.

For Abrams, it's just one more example of a promising drug being victimized by a decades-long war on drugs.

"Cannabis has been demonized and stigmatized," he said.

Sisley, meanwhile, said marijuana has reversed the usual patient-doctor relationship.

"Patients know more than physicians," Sisley said.  "We're learning from our patients."