Source: Orange County Register Contact: Pubdate: Sunday, 14 December 1997 Section: Page One, Front Page Author: Teri Sforza HEALTH: SCIENTISTS WILL GATHER IN IRVINE TO INVESTIGATE THE PLANT'S MEDICAL VALUE STIRRING A NATIONAL DEBATE. Marijuana causes brain damage.Or it doesn't. Marijuana is highly addictive.Or it's not addictive at all. Marijuana snaps chromosomes like twigs and weakens the immune system or marijuana is a wonder drug that blocks pain and reduces inflammation. So is it Cheech and Chong medicine? Or a natural healing herb used for more than 2,000 years? Sorting through the vast and contradictory scientific evidence on marijuana can be maddening but that's precisely what investigators from the Institute of Medicine in Washington, D.C., will spend the next year doing, in their quest for the truth. This governmentfunded inquiry ordered by federal drug czar Barry McCaffrey and almost unthinkable two years ago is a direct result of medical marijuana initiatives that succeeded in California and Arizona last year, observers say. It brings investigators from the Institute of Medicine to Irvine today to hear public testimony on the highly controversial issue. Busloads of activitsts from as far as San Francisco are expected to converge on the Beckman Center in Irvine. Public comment will be heard. "We may see some fireworks," said John A. Benson Jr., the study's coprincipal investigator as well as dean and professor emeritus at Oregon Health Sciences University School of Medicine in Portland. The sessions continue Monday and Tuesday, when scientists from America's most distinguished universities delve into marijuana's effects on the body. There will be only two more sessions like it: one in New Orleans, the other in Washington, D.C. "Our job is to assess the risks and benefits of marijuana for human health," said Janet E. Joy, study director. "We're not addressing the political issues at all which is not to say we don't understand they exist. We are staying very focused on the science. It's exciting." Some say it's redundantthat what's needed is not a review of old studies, but new studies. To many others, it's not just exciting it's almost miraculous. "Medical marijuana studies supported by the federal government? Who would have thunk it? I wouldn't have thunk it," said Dave Fratello, spokesman for Americans for Medical Rights, the main force behind California's Proposition 215. Prop.215, which passed in November 1996 with 56 percent of the vote, allows doctors to recommend marijuana to people with cancer, anorexia, AIDS, chronic pain and most other ailments without fear of punishment; it also allows patients and their caregivers to grow their own. A similar initiative passed in Arizona at the same time, giving doctors even more latitude to prescribe drugs the federal government now declares illegal. That put the states on a collision course with the federal government. Drug czar McCaffrey said voters were asleep at the ballot box, and threatened to bust doctors who dared prescribe pot to patients. For doctors, that was the last straw. "Physicians finally became enraged," said Donald Abrams, a noted AIDS researcher at UC San Francisco. "They said, 'You can't tell us what we can tell people and can't tell people.' He really opened a Pandora's box." Politics has kept scientists from doing conclusive studies on the medicinal effectiveness of marijuana for decades, researchers say. But after the election, the California Medical Association was imploring the government to approve controlled studies of marijuana's efficacy. The New England Journal of Medicine endorsed marijuana's use as medicine and branded threats of government sanctions "misguided, heavyhanded and inhumane." And things began to change. For more than four years, Abrams had been banging his head against the wall trying to get federal approval for a study of HIVinfected patients who smoke marijuana. The practice is widespread the folk wisdom being that pot increases appetite and eliminates nausea, thus fighting the "wasting syndrome" that causes severe weight loss but there was no hard science behind it. Abrams wanted to investigate how pot's active ingredients interact with the new drugs that suppress the virus. He wanted to see if there was an impact on the viral load, the immune system, hormone levels. Did appetite, caloric intake and lean body mass really increase? Bad science, the federal government told him again and again. It refused to allow Abrams to import researchgrade marijuana from a Dutch grower. It refused to provide Abrams with researchgrade marijuana from its own crop in Mississippi. In frustration, Abrams redesigned and resubmitted the study only to have it rejected again. But the dike broke this summer. Finally, the federal government approved Abrams' study and gave the goahead to the Institute of Medicine's review as well. Abrams' is a $ 1 million, twoyear project titled "Short Term Effects of Cannabanoids in HIV Patients." It's the only new study of marijuana's effects on human patients currently in progress in the United States. He'll speak in Irvine at 10:30 a.m. Tuesday. The Institute of Medicine's study will cost $896,000, and its report will be delivered in about a year to McCaffrey. "But there needs to be more research," Abrams said. And many think there will be. "Abrams' study is the first of more to come," said Fratello of Americans for Medical Rights. "We rattled the cages of the federal science agencies and are pushing the government on this issue. That's something everyone in California can be proud of." But nothing's perfect. Even though Abrams has agreed to speak at the Institute of Medicine's sessions here, he considers its review "superfluous." "They did this in 1980," he said. "To me, it doesn't appear to be necessary to do it again. There hasn't been much more science done in the intervening years." At first, Fratello shared Abrams' skepticism. But he's softening. "It looks like it's shaping up to be something much better than originally promised," Fratello said. "The original order was just to review the existing studies and that's a book report. That's not the kind of information patients and doctors need. But they're taking it farther they're making much more of an effort to hear people out. And that process alone is going to be valuable." Orange County's own crusader for medical marijuana Senior Legislature member Anna Boyce of Mission Viejo will be speaking to the Institute of Medicine's investigators today. She'll tell them how marijuana helped ease her late husband's nausea when he was undergoing chemotherapy, and how it made his last days on Earth less agonizing. "I trust them to be fair," Boyce said. "This is wonderful step forward." Investigators also promise to visit Cannabis Buyers Clubs, the notsounderground network of pot clearinghouses that have cropped up in California to Dispense marijuana to patients. The Institute of Medicine is a private, nonprofit organization that advises the government on health issues. "Our recommendations might say whether the available evidence indicates marijuana is or is not a good medicine for glaucoma, whether alternative therapies are equal, better or not as good," said study director Joy. "We would enumerate the risks and benefits, and the efficacy of different delivery systems. Most people smoke it, but you can eat it. And what about inhalers? Patches? Suppositories?' COprincipal investigator Benson said the report will probably recommend more studies, and how they might be done. "We go in, I hope, with no particular positions or biases," Benson said. "We aren't there to try to rewrite laws or reschedule marijuana or challenge the Arizona and California laws. Our job is to see what the evidence is. It's an important social and medical issue that ought to be settle."