cannabisnews.com: Doctors Without Orders Doctors Without Orders Posted by CN Staff on February 06, 2003 at 15:10:17 PT By Fred Gardner Source: Anderson Valley Advertiser So many doctors who recommend cannabis have found themselves under investigation by the Medical Board of California --which can revoke or suspend their licenses-- that Frank Lucido, MD, has called a conference to compare notes and discuss a coordinated response. The docs will meet in Berkeley on March 8. One of their chief concerns is that the Medical Board has never issued guidelines according to which they can discuss cannabis with their patients. (Tod Mikuriya, MD, has been requesting and suggesting guidelines since 1996.) Another concern is that almost all the complaints that have triggered Medical Board investigations have come not from patients or their loved ones, but from law enforcement or other third parties. The complaint against Lucido, for example, came from a high school administrator. Meanwhile the Medical Board may be moving on its own to address the doctors' concerns. At its Jan. 31 meeting in Los Angeles, the Board's Division of Medical Quality heard attorney Alice Mead, representing the California Medical Association, suggest criteria according to which doctors can recommend cannabis in accordance with state and federal law. Mead reminded the Board that the recent decision by the US Court of Appeal for the Ninth Circuit in Conant v. Walters 'does not apply only to the federal government. Since it is based on the federal constitution, the ruling applies to any state or local governmental entity, including the Medical Board, that may try to punish or restrict a physician for recommending cannabis. 'A physician's intent shouldn't be the primary focus of the Medical Board,' said Mead. 'Even if a physician actually intendsS to provide a recommendation for procurement purposes, Prop 215 still suggests that a physician gets the protections... Therefore, the medical board shouldn't investigate a physician unless the Board has a good faith belief that it has substantial evidence that the physician's practice has fallen beneath the standard of care. 'It should not initiate an investigation simply because some individual, such as a park ranger or a law enforcement officer or even a judicial officer, simply disapproves of the very idea that a patient has a physician's recommendation to use cannabis.' This comment elicited nods of assent from many of the Board members. Investigator Dave Thornton, the Board's Chief of Enforcement, was present and could not have missed the policy implications. The question now is whether he will revisit some of the investigations in progress that were initiated at the request of law enforcement. 'And how is the Medical Board supposed to determine whether or not a physician might have breached the standard of care?' asked Mead rhetorically. 'Proposition 215 specifically includes a number of serious medical conditions [cancer, anorexia, AIDS, chronic pain, spasticity, glaucoma, arthritis, and migraine.] In addition, it applies to 'any other illness for which marijuana provides relief.' That's very broad, and the Medical Board can ensure that the physician has some support for his or her opinion. But that support need not come from double blind, placebo-controlled clinical trials. Most off-label prescription is not supported by such evidence. There is an extensive ( and very consistent ) body of anecdotal evidence for a variety of medicinal uses of cannabisS There are controlled clinical trials conducted a couple of decades ago that can shed light on a particular case. There is considerable data from pre-clinical work done in recent years that supports the clinical evidence, and more continues to come in. And there's actually data from controlled clinical trials coming in from the Center for Medicinal Cannabis Research at UC San Diego, and GW Pharmaceuticals in England. GW has just publicized the result of its phase-three trials involving 350 patients with multiple sclerosis and neuropathic pain using a standardized oral mucosal cannabis extract and finding statistically significant benefits. The Medical Board needs to secure experts who are familiar with the full spectrum of such information. Mead compared the subset of doctors who have written numerous cannabis recommendations to those who treated AIDS patients in the early days of the epidemic. 'Many physicians are too fearful of, or unfamiliar with, the subject to be willing to discuss medicinal cannabis with their patients. So the physician from whom a patient seeks information and advice may not be the patient's primary care physician and may not be responsible for the ongoing care of the patient's underlying condition. That can be appropriate. When I was first at CMA and the HIV epidemic had just broken out, many physicians were ignorant of HIV and fearful of HIV and they didn't want to take HIV-infected patients. A lot of the legal issues landed on my desk. There were a few brave and informed physicians who did take a lot of those patients --a disproportionate number. We never said they treated too many HIV patients. They did it because no one else would. 'So, the primary-care physician may not be the one who provides the information and advice, but his or her practices still have to meet the standard of care. There has to be a good-faith prior exam. The physician has to take a good history before advising the patient about cannabis. There has to be a determination that the patient has a serious medical condition; it doesn't have to be life-threatening, it just has to be something that substantially interferes with the patient's everyday life activities. The physician has to conduct an informed-consent discussion. Document the results of that exam and history and discussion in the patient's medical record, including the conclusion that cannabis might be therapeutic. Consult with the patient's primary care physician and/or get a copy of the relevant portion of the medical record that shows the patient's diagnosis and previous care and treatment. And provide follow-up assessment to determine what effect the medicinal cannabis is having on the patient's overall health. 'And, of course, these requirements should not be applied more stringently to physicians who recommend cannabis than would be to other physicians. 'In a nutshell, physicians and patients should be able to embark on the difficult path of discovering what treatment may be best, including treatment with cannabis. No governmental entity, including the Medical Board, should inappropriately hinder that process. We urge the Medical Board to try to understand the medical issues, and to avail itself of expert information and be fully equipped with the available scientific evidence, because more and more is coming in every day.' Indictments Challenged A few days before the federal case against Ed Rosenthal went to the jury, his lawyers obtained a partial transcript of the grand jury hearing that led to the original indictment. The grand jurors had asked so many questions, and seemed so supportive of California's medical marijuana law that prosecutor George Bevan had a hard time convincing them to indict. According to the defense motion to dismiss, which U.S. District Judge Charles Breyer has yet to rule on, Bevan tried too hard: 'The prosecutor led the grand jurors to believe that federal law offered a 'shelter' for 99 plants or less to enable patients to get their medicine and that state law defenses and a medical defense was available [to Rosenthal].' In a less publicized federal case of equal significance, U.S. Magistrate Judge Dale Drozd has ordered the U.S. Attorney's office to show defendants Robert and Shawna Whiteaker documents in which the Sacramento County District Attorney's office allegedly asked them to take the case because the Whiteakers had nixed a plea-bargain! Drozd also ordered the prosecutors in both offices to hand over documents describing when and how they decide to press charges. The Whiteakers, who are in their early 40s, were growing 242 indoor plants when they were busted in May, 1999. The search warrant had been obtained by a super-zealous Placer County Sheriff's Deputy named Tracy Grant, who had staked out a hydroponics supply store and was going after their customers systematically. The Whiteakers' lawyer, Bill Panzer, contends that Grant routinely obtained search warrants under false pretenses. At a hearing to suppress the Whiteaker search warrant in February 2001, Grant refused to answer questions about his authority to issue federal grand-jury subpoenas. With the judge threatening to dismiss the case, Deputy Placer County D.A. Joy Smiley told the Whiteakers they had 48 hours to accept the deal --28 months in state prison for Robert, a year in county jail for Shawna-- or face prosecution by the feds. 'The ultimatum was clear,' wrote Judge Drozd in his order; and if the feds were indeed functioning as the hammer for local law enforcers, it would be vindictive prosecution --and grounds for dismissal. Now the burden is on the U.S. Attorney's Office and their Placer County cronies to prove their innocence. Newshawk: Ethan Russo, MDSource: Anderson Valley Advertiser (CA)Author: Fred GardnerPublished: February 5, 2003Copyright: 2003 Anderson Valley AdvertiserContact: ava pacific.netDetails: http://www.mapinc.org/media/2667Related Articles & Web Sites:CMCRhttp://www.cmcr.ucsd.edu/Tod H. Mikuriya, M.D.http://www.mikuriya.com/Conant vs. Walters & Judge Kozinskihttp://freedomtoexhale.com//cw.htmEd Rosenthal's Trial Pictures & Articleshttp://freedomtoexhale.com/trialpics.htmFederal Court Says Yes, You Can Talk About Pothttp://cannabisnews.com/news/thread14713.shtmlMedical Marijuana Victory http://cannabisnews.com/news/thread14703.shtml Home Comment Email Register Recent Comments Help Comment #4 posted by p4me on February 06, 2003 at 18:46:17 PT Paragraph of the day-CSMonitor.com The Christian Science Monitor has had some awful stuff to say about cannabis including blaming a water shortage in Afganistan on cannabis instead of a 5 year drought. It is almost like the misadministration cut off their propaganda money because today they sing a different tune- http://www.csmonitor.com/2003/0206/p09s02-coop.html - in an article titled, "Someone, blow the whistle on Bush's excessive secrecy" by Pat M. Holt. The paragraph of the day reads-WASHINGTON – It is time for Congress or the courts to blow the whistle on the Bush administration's excessive secrecy. The secrecy is especially pernicious when set in the context of the administration's proclivity to spin. "Spin" is the fashionable word. "Twist," "distort," "deceive," or "cover up" would be more forthright. A lawsuit involving Fox News cover-up of an artificial hormone injected into milk cows is a telling indictment of the media's cooperation with big business to the peril of us all. Monsanto's rGHB marketed as Posilac is not allowed in Europe or most of the rational world but it is in this country. The story of the Fox reporters that were fired to prevent their story from breaking tell their story and describe their lawsuit at http://www.foxbghsuit.com/ It is a link presented at buzzflash today.Alternet had the best story on the subject of Monsanto's Posilac - http://www.alternet.org/story.html?StoryID=13557 [ Post Comment ] Comment #3 posted by Truth on February 06, 2003 at 16:49:56 PT I hear you I hear you, p, I wish I could burn hemp oil in my diesel motor, much cleaner. [ Post Comment ] Comment #2 posted by JustGetnBy on February 06, 2003 at 16:44:18 PT: FINALLY Finally someone is questioning the motives and procedures behind local LEO prosecutions of MMJ. Placer County Ca has one of the worst reputations for arresting and forcing plea bargains on them with the threat of federal prosecution. It sounds like the federal prosecutor who presented his case to the grand jury against Ed Rosenthal got caught blatently lying to the grand jury in order to get his indictment. FINALLY somebody is begining to hold these people accountable for their actions. [ Post Comment ] Comment #1 posted by p4me on February 06, 2003 at 15:34:25 PT Good thing Frankenfoods don't need testing It is a good thing genetically modified foods don't have to go through 5000 years of testing by millions of people.California should remember there is an issue of freedom involved and call for legalization. Davis should really be embarrassed by his performance on the issue, but I gather he does not do much introspection or he would not run for re-election as the people had already seen he was a dud.Meanwhile, we are be poisoned with every breath we take and in a lot of the food we eat. [ Post Comment ] Post Comment