The U.S. Food and Drug Administration has a
marijuana problem. On April 20 of this year, the FDA rejected
marijuana for medical uses. The FDA said, "no sound scientific
studies supported medical use of marijuana for treatment in the
United States, and no animal or human data supported the safety or
efficacy of marijuana for general medical use."
This conclusion contradicts a lot of other
scientific research and expert conclusions, including that of the
National Academy of Sciences and the FDA itself. In 1985, the FDA
was so convinced of marijuana's medical benefits that it approved
Marinol and Cesamet, both synthetic versions of
delta-9-tetrahydrocannabinol (THC), the main active ingredient in
marijuana.
Here's what the FDA has to say about Marinol.
"MARINOL® (Dronabinol) Capsules is indicated for the
treatment of: (1) anorexia associated with weight loss in patients
with AIDS; and (2) nausea and vomiting associated with cancer
chemotherapy in patents who have failed to respond adequately to
conventional antiemetic treatments."
The FDA obviously thinks that Marinol and
Cesamet are safe and efficacious drugs or else it wouldn't have
approved them. If the synthetic versions are so good, why hasn't the
FDA embraced the natural version? After all, in the Marinol
statements above, the FDA is basically agreeing with marijuana
advocates.
Two reasons that might come to mind are dosing
and delivery mechanism. Although it may seem that an inability to
pin down the ideal dose is a problem, the FDA is fully aware that
the gold standard of analgesia in hospitals is patient-controlled
analgesia (PCA), in which the patient pushes a button as often as
desired to get I.V. doses of morphine. In other words, there is no
one-size-fits-all dose with PCA. Empirical evidence shows that PCA
produces better pain control with less morphine consumed. Marijuana
can be used in much the same way as PCA.
The delivery mechanism of marijuana is usually
smoke, which can irritate soft tissues and perhaps precipitate
cancer. While certainly a problem, I estimate that marijuana smokers
consume about one-percent as much per day as do tobacco smokers.
Marijuana smokers take a few puffs ("hits") while tobacco smokers
may smoke 20 or 40 entire cigarettes per day. Also, many AIDS and
chemotherapy patients will be on short-term therapy or won't live
long enough to worry about marijuana-induced lung cancer. Many of
them would love to live long enough to have such a
problem.
Look at the FDA's statements critically. The FDA
isn't saying that marijuana doesn't have health benefits; it's
saying that no good studies exist to prove that conclusion. In 2004,
the FDA stated, "FDA will continue to be receptive to sound,
scientifically based research into the medicinal uses of botanical marijuana and other cannabinoids." The key term is "sound research."
The FDA recognizes only medicines that have gone through its long,
expensive, and exhaustive investigational new drug (IND) application
process -- its idea of "sound
research."
The FDA is blind to anything that hasn't been
through its process. What's worse, marijuana is highly unlikely ever
to clear such hurdles. Why? The FDA requires controlled and
consistent production batches and it wants to inspect each
manufacturing facility. This would be very difficult for a dried
weed that is grown in thousands of different places under thousands
of different conditions. The FDA also requires placebo-controlled
clinical trials with thousands or tens of thousands of patients.
What placebo could possibly be used? I doubt that any other safe and
medically inactive plant would smell and taste like smoked
marijuana. Last, these clinical trials, I estimate, would cost tens
if not hundreds of millions of dollars. Who would pay for them? Not
the FDA. Not drug companies. Not self-medicating AIDS and cancer
patients.
Drugs like marijuana almost certainly do have
some health benefits for certain patients. But to put marijuana
through the IND process would involve paying for clinical trials,
manufacturing facilities, data analysis, legal fees, administrative
staff, and FDA face-time, which are all private costs that someone
must bear. Marinol's and Cesamet's manufacturers were willing to
bear these costs due to the prospect of profits that accrue to the
patent holder. For a widespread weed that's been around for
millennia, how would anyone garner and enforce such patent
protection?
Some say this is a weakness of the private
enterprise system. The proponents of government spending on medical
research use cases like this as an argument for the role of
government. They shouldn't be too optimistic about their solution
because that's what we have right now and it has failed miserably.
Why? Certain parts of the federal government haven't allowed this
scientific process to happen. Remember that, above all else, the
government is a political organization and the U.S. government is
fighting a war against the production, sale, and usage of
marijuana.
The federal government maintains marijuana's
status as a Schedule I controlled substance, keeping company with
infamous drugs like heroin and PCP. A Schedule I drug is defined as
having a very high potential for abuse, no accepted medical use in
the United States, and a lack of accepted safety data for use under
medical supervision. Interestingly, Marinol is rated as only
Schedule III (less dangerous), just like, for example, Tylenol with
Codeine.
Just recently, the FDA has landed in
more hot water over its marijuana ruling. In 2000, Congress passed
what is known as the Data Quality Act to help ensure that
regulations are based on solid science. The two-paragraph Data
Quality Act wasn't written by a member of Congress, but by James J.
Tozzi, and included in a longer appropriations bill. Now Tozzi, who
is founder of the Center for Regulatory Effectiveness, is suing the
government because the FDA's marijuana ruling has ignored data
showing that marijuana is helpful to some
patients.
Should we pity the FDA? In some ways, yes, we
should. The FDA behaves as a bureaucratic scientist. The FDA will
always to be too slow and conservative and require too much
data.
I am happy that there are such careful and
plodding people in the world. I am not happy that they have the
power to prohibit drugs like marijuana. In some cases, like this
one, the FDA is the wrong tool for the job. Americans shouldn't rely
on the FDA to control widely used and naturally occurring botanicals
such as marijuana. The FDA is simply unable to effectively assess
the medical value of natural plants like marijuana in any reasonable
timeframe. AIDS and cancer are deadly serious diseases and the FDA's
approach is fatally flawed. AIDS and cancer patients deserve a
better path to useful medicines and than through the FDA's
benediction.
Charles L. Hooper is president of Objective
Insights, a company that consults for pharmaceutical and biotech
companies. He is a visiting fellow with the Hoover Institution and
coauthor of Making Great Decisions in Business and Life (Chicago
Park Press,
2006).