Preventive Medicine Column December 13, 2013 Epidemiology over Ideology

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Preventive Medicine Column

December 13, 2013

Epidemiology over Ideology
When LinkedIN decided to create a blog platform for what they called INfluencers, I was very privileged to be in the rarefied company of the 149 other original invitees, including the likes of Richard Branson, Arianna Huffington, and Barack Obama. I have been writing on-line columns for LinkedIN ever since, and proudly so. Periodically, the editors there ask us to address a theme- and recently, they solicited our ‘big ideas’ for the upcoming year. Mine, in essence, boiled down to this: let’s listen to one another.

Medical marijuana may seem an odd place to start my petition, but in fact, medical marijuana beautifully illustrates the fatuous folly of diatribe where dialogue ought to be. If ever there was a societal controversy that was all heat and smoke, and virtually no light, this one is it.

Make no mistake here, I am not a marijuana fan. I have a strong antipathy to all forms of smoking. I am quite straight-laced, don’t sanction the use of illicit drugs, and have never used any myself. I have long warned my own children that any drug or tobacco use would be especially dangerous for them, because if they went there- I would kill them.

But recreational use of marijuana was never the issue. The issue was medical use, by prescription. And knee-jerk opposition because marijuana is “illicit” has massively delayed the availability of what appears to be a uniquely effective treatment for certain cases of otherwise intractable pain and nausea. A whole lot of overheated rhetoric and ranting have all but obliterated the relevant reflection.

What reflection? Consider that Dilaudid is a heroin-like narcotic, many times more potent than heroin- and is available for medical use right now. I have prescribed it myself for severe pain related to surgery and cancer. It is dramatically more dangerous than cannabis.

If that doesn’t clinch it, how about the 7% cocaine solution available in every Emergency Department? We soak cotton swabs in it, and use it to treat epistaxis, i.e., severe nosebleeds. Working as an ER doc back in the day, I made use of it more than once. It’s effective when little else is, which is why its use makes sense. Again, it is a far more addictive and dangerous drug than marijuana- but used medically when benefits outweigh risks.

And, while we’re at it, the class of sedatives known as benzodiazepines, home to such drugs as Valium and Ativan, is among the very few drug classes with a potentially lethal withdrawal syndrome once dependence develops.

So the seemingly intense debate over medical marijuana was a whole lot of nonsense. We routinely use far more dangerously addictive drugs. We routinely use other “illicit” drugs for medically legitimate purposes. The medical marijuana debate has been an ideological parade of competing opinions, uninformed by any relevant principles.

We never get to the principles because we are too busy gravitating to opposing corners so we are well positioned to throw insults at one another, and too far apart for any constructive debate. The principles would argue that whatever criteria determine when a drug can be used for medicinal purposes should be applied consistently. If that were done, medical marijuana- which can be effective when nothing else is, by mechanisms we understand- would clear the bar easily.

That’s it. My big idea involves laying aside preconceptions to consider basic principles, and listening to one another. Re-leashing the dogma of dysfunctional warfare.

The idea is big, because the ramifications pertain to health care reform and government shutdowns. They apply to gun control, reproductive rights, harm reduction programs from needle exchange to planned parenthood, nutrition guidance, food supply improvements, immunization policies, and climate change. They extend to death and taxes.

Everywhere we look in modern society, we see impasses engendered by the lost art of listening, the inability to agree to disagree, the rush to reject opinions not native to our predispositions. Dogma is a catalyst for nothing but quagmire. We are most likely to learn when listening to opinions we didn’t already own.

So here we are. The bells will soon toll to usher in 2014. They will toll for thee, they will toll for me, and they will toll for everyone else. The bells may find us in our opposing corners. But perhaps they could invite us to shake hands, and come out listening. It would be a big deal. For now, it’s just a big idea.
-fin Dr. David L. Katz;; author, DISEASE PROOF

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