Initiative 692 will ease pain of many suffering patients
by William O. Robertson, M.D.

October 12, 1998 - Everett Herald - newmedia@heraldnet.com

Last year, I voted against the marijuana Initiative 685. Its target was far too broad -- way beyond the medical use of marijuana. This year, I'm going to vote for Initiative 692. By contrast, it is sharply honed and carefully worded to have Washington follow the lead of Arizona and California in bettering the quality of life of seriously ill patients. And it will do so without "legalizing" marijuana -- without treading on the turf of those militaristic purists seemingly dedicated to banishing any and all drugs of abuse from the face of the earth.

But, you might ask, is there really scientific evidence to substantiate the claims of advocates that marijuana can actually improve impoverished appetites, that it can quell overwhelming sensations of nausea associated with cancer chemotherapy, or that it can lower the intraocular pressure of glaucoma and all its consequences? I don't know for certain. Solid data supports the effectiveness of one of its ingredients -- annibinol -- but I'm far from being convinced that either marijuana or its ingredient work as well as many other modern drugs. But that is not the issue. The issue is giving the patient a choice of what he or she believes in. Certainly I'm pleased that at long last the National Institutes of Health have finally gotten around to trying to find out if marijuana works by funding scientific studies that are long overdue. In the meantime, for the patient who is suffering and believes that he or she will feel better, why does society choose to stand in the way, hold up its hand and shout "No way!" Why has it been so, so rigid in its opposition down through the centuries? In truth I'm even less certain about the answer to that question than I am to the question of marijuana's effectiveness.

I'll admit to being a simple pragmatist on the topic -- and I'm proud of it. As a physician, I have to be reasonably comfortable in making many recommendations to sick patients that I'm not at all sure will really be all that helpful. But, if both the patient and I believe it will, many, many times it works. I always worry that my treatment might instead hurt the patient or somehow be harmful. In the case of marijuana, worrying about harm is really a negligible issue for the terminally ill or chronically debilitated. (As you might suspect, I'm far more wary when it comes to the risks of marijuana for the youthful user but that is an entirely different matter.)

Admittedly, we physicians are under the gun to do a better job in helping the chronically ill. Most certainly we ought to be able to do a better job. Some of us blame our shortcomings on being caught between governmental regulators who thrive on making more and more rules about how we should use pain medicines, and those patients who seem to take advantage of pain medicine for other than relief of pain. Remember too, that 50 years ago, physicians seemed to be fully occupied trying to cope with acute life-threatening infections. Today, these infections -- tetanus, diphtheria, polio, etc. -- are gone. Or they tried to cope with poorly understood dietary deficiencies that today are simply historical oddities. In contrast, coping effectively with chronic disease is a task of recent vintage for both physicians and our patients. For the long haul, we'll want to use all the scientific tools at our disposal to find out what works best and how to get everybody to use it. But, for the short term, I'm convinced that we physicians can and should do more -- and listen to patients' ideas about what they think will work -- and then use it if the risks to the patient are minimal.

To me that is the basic question for you to consider when you vote on Initiative 692. Will it make life more tolerable for patients whose lives are simply miserable? I strongly believe that it will. Will it pose a risk to those patients? Of course, it will. Anything carries some risk. Does its use impose a huge cost akin to open heart surgery? No way! It's cheap. And Initiative 692 protects both the patient and the physicians from the clutches of the thought police. And, as I see it, Initiative 692's passage will also go a long way in bringing the "war on drugs" out of the closet for up-front, on-top-of-the-table reconsideration of how our modern society can best learn to live with all the chemicals that are out there. There simply has to be a better way.

Marijuana's history dates back more than 12,000 years. The plight of the terminally ill is equally as ancient and neither is going to go away. Using one to ameliorate the anguish of the other as outlined so lucidly in Initiative 692 would bring solace to the suffering to the detriment of no one and to the credit of our civilization. Vote "Yes" on Initiative 692.

William O. Robertson, M.D. is past president of the Washington State Medical Association.

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