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Bringing in the Sheaves

Medical marijuana is also known as medical cannabis and is beginning to grow support in the legislative body of the State of Tennessee. Depending on the poll, as many as eighty percent of Tennesseans want access to medical cannabis. I frequently ask Stone patients their opinion about the use of medical marijuana. The overwhelming majority of them are affirmative. Most wonder why Tennessee has not legitimized medical use already. Some would say that the issue is complicated. However, thirty states have already passed legislation for medical cannabis. Canada has legalized it nationally. The blueprint exists. Tennessee was late to help fund higher education through the lottery. I am sure Tennessee will be tardy to medical marijuana for our citizens.
 
There is substantial disagreement among physicians about which patients would benefit from medical marijuana treatment. Some are like Sabi Kumar, MD who believes the FDA needs to define therapeutic efficacy for medical cannabis. According to him, double-blind placebo-controlled trials will be required to show both safe and effective marijuana treatment for any disease. Does that sound like a physician who is concerned about his patients’ well-being or a physician who is concerned about the drug lobby? He is also a State Representative. I choose the later; he’s in the pocket of the drug lobby. Thousands of diseases have no FDA approved treatments. Drug companies assess the return on their investment before they consider developing drugs for rare illnesses. Big Pharma must be kept out of medical cannabis since they will only muddy the waters. They will prevent progress.
 
Dr. Kumar may also be in the pockets of the medical insurance industry since they do not wish to pay for legitimate treatments of any kind, much less off-label uses. If Dr. Kumar limits his prescriptions to just FDA approved medications for illnesses he treats, he probably cares for an extremely narrow group of diseases. Off labeled use of drugs is a physician’s prerogative. One example: the use of Plaquenil for Systemic Lupus Erythematosus (Lupus). The FDA initially indicated Plaquenil for treatment of malaria only. Physicians discovered it had benefit for autoimmune diseases, using the drug for years off-label. The FDA eventually approved it for several autoimmune diseases. Without off-label usage, most illnesses would go untreated.
 
Dr. Kumar believes he should be in total control of any therapy he prescribes for his patient, absolving any patient responsibility. He clearly does not want patients guiding their therapy. He is old-school authoritarian. I wish he would take that position for the foods we eat and the water we drink, two of the most important factors in our health. Dr. Kumar should draft legislation to make sure our foods are grown to specific standards, are uniform in nutrition when cooked and free of impurities. Marijuana is much more like an herbal medicine or foodstuff. He will find it difficult to grow the plant to idealized medicinal specifications. He is aware of his outrageous position but continues to espouse his pseudo-concerns to look like he is out helping our citizens. He is not helping, he is impeding the movement. People self-medicate with marijuana all the time, just like those who self-medicate with alcohol in a variety of ways. Dr. Kumar has never proposed to turn back the clock and create prescriptive ethanol and make recreational drinking a crime. On the other hand, no one advocates the use of medicinal ethanol. Perhaps he should.
 
A University of Georgia study identified nine areas where medical marijuana will most affect Big Pharma: Anxiety, chronic pain, epilepsy, post-traumatic stress disorder, sleep disorders, nerve pain, chemotherapy-induced nausea and vomiting, Tourette syndrome and glaucoma. If doctors only prescribed marijuana in a small percentage of these cases, pharmaceutical companies could lose as much as $4 to 5 billion. Think about the impacts if medical cannabis becomes the prescription of choice for treating illnesses such as Crohn’s, ulcerative colitis or lupus. Biological treatments would plummet causing massive revenue losses. The patients will be better for it; Big Pharma would not.
 
I do not know if Dr. Kumar is in favor of the recent opioid prescription changes in Tennessee. We have the strictest prescription laws in the nation. Many physicians have stopped treating pain because of the fear of being investigated by the State Medical Board. Pharmacists have become empowered to refuse filling prescriptions for patients if the pharmacist is uncomfortable with the order. Most pharmacists have no clinical practice experience whatsoever but have the authority to override a physician based on their narrow understanding of a painful disease. A group of pain specialists, as well as other members of society such as law enforcement, prosecutors, health department officials and legislators, created the Pain Management guideline. I did not see one chronic pain patient on the committee to voice their concerns about what is best for them.
 
If we do not have a full commission working to implement a quality medical cannabis program that takes all aspects of the process into account, we will have a failed operation. Much like the Pain Management guidelines which drove patients to black market heroin for pain control. Dr. Kumar’s position, physicians, are the only people allowed to make decisions when it comes to patient care and possible treatment paradigms, is absurd. Physicians like all other medical entrepreneurs have their agenda: what is best for them financially is best for others in general. Doctors who are in bed with Big Pharma and medical insurance carriers have already hog-tied physicians, making it hard for us to practice medicine with our patients’ interest at the center of our caregiving activities. Patients get the short end of the stick. In this case, it may end up that they get the short end of the stalk.
 
I took the opportunity to investigate Prohibition. It was a significant force in state and local politics from the 1840s through the 1930s. Numerous historical studies demonstrated that the political forces involved were ethnoreligious. Prohibition was supported by the dries, primarily pietistic Protestant denominations that included Methodists, Northern Baptists, Southern Baptists, New School Presbyterians, Disciples of Christ, Congregationalists, Quakers, and Scandinavian Lutherans, but also included the Catholic Total Abstinence Union of America and, to a certain extent, the Latter-day Saints. These religious groups identified saloons as politically corrupt and drinking as a personal sin. Does that sound remotely familiar to medical marijuana? I think so.
 
Let’s try to keep Representative Sabi “Doc” Kumar off the Medical Cannabis Commission. Even though there are over sixty peer-reviewed studies into the medical benefits that qualify for FDA field trials, no trials have been initiated due to the politics of our government and the absurd leadership in Washington, DC. If Dr. Kumar wiggles his way onto the Commission, it will give him a soapbox to prevent any medical cannabis to be made available to my patients and everyone else’s patients too.
 
Bringing in the sheaves, bringing in the sheaves,
We shall come rejoicing, bringing in the sheaves,
Bringing in the sheaves, bringing in the sheaves,
We shall come rejoicing, bringing in the sheaves.
Sowing in the sunshine, sowing in the shadows,
Fearing neither clouds nor winter’s chilling breeze;
By and by the harvest, and the labor ended,
We shall come rejoicing, bringing in the sheaves.
 
Sing it again. Everybody!
 
Doc
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