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Medical Marijuana (transcript)
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>>Announcer: "SECOND OPINION" IS BROUGHT TO YOU BY BLUE CROSS/BLUE SHIELD, ACCEPTED IN ALL 50 STATES. BLUE CROSS/BLUE SHIELD -- LIVE FEARLESS.

>>Announcer: "SECOND OPINION" IS PRODUCED IN CONJUNCTION WITH U.R. MEDICINE, PART OF UNIVERSITY OF ROCHESTER MEDICAL CENTER, ROCHESTER, NEW YORK.

>> Dr. Peter Salgo: THIS IS "SECOND OPINION." I'M YOUR HOST, DR. PETER SALGO. THIS WEEK, MYTH OR MEDICINE --"THE HEALTH BENEFITS OF SMOKING MEDICAL MARIJUANA OUTWEIGH THE RISKS TO YOUR LUNGS."  AND SPECIAL GUEST BEVERLY McCLAIN IS HERE. HER STAGE IV BREAST CANCER TREATMENT HAS HER LOOKING FOR ANYTHING TO RELIEVE HER SYMPTOMS. SHE'S HERE FOR A SECOND OPINION.

>> Beverly McClain: A PIECE OF CANCEROUS BONE STARTED GROWING INWARD INTO MY OCCIPITAL LOBE. THE SYMPTOMS STARTED SHOWING UP, AND I LOST MY PERIPHERAL VISION. AND I COULDN'T READ.

>> Dr. Peter Salgo: THANKS SO MUCH FOR JOINING US, BEVERLY. I'M DELIGHTED YOU'RE HERE.

>> Beverly McClain: THANK YOU FOR HAVING ME.

>> Dr. Peter Salgo: I KNOW YOU'VE GOT A VERY INTERESTING STORY TO TELL US, AND WE'RE ANXIOUS TO HEAR IT. SO LET'S GET RIGHT TO WORK. FIRST I'D LIKE TO INTRODUCE YOU TO YOUR "SECOND OPINION" PANEL. AND THEY'RE GOING TO BE HERE TO ANSWER YOUR SECOND-OPINION QUESTIONS AT THE END OF THE BROADCAST. FIRST, PRIMARY CARE DOCTOR LOU PAPA FROM THE UNIVERSITY OF ROCHESTER MEDICAL CENTER. AND DR. IGOR GRANT FROM THE UNIVERSITY OF CALIFORNIA, SAN DIEGO, CENTER FOR MEDICAL CANNABIS RESEARCH.  I WANT TO GO BACK A BIT AND TALK ABOUT YOUR STORY. BACK IN 2007, YOU WERE DIAGNOSED WITH BREAST CANCER. TELL ME ABOUT THAT.

>> Beverly McClain: IT WAS PRETTY STANDARD TREATMENT THAT I GOT. I WAS A IIB OR IIIA, WHICH IS KIND OF LATE, BUT NOT -- I MEAN, I WISH I'D CAUGHT IT EARLIER. BUT, YEAH, DID CHEMO AND RADIATION AND EVERYTHING.

>> Dr. Peter Salgo: WELL, YOU HAD SURGERY. YOU HAD A DOUBLE MASTECTOMY.

>> Beverly McClain: AND I HAD A DOUBLE MASTECTOMY, YEP.

>> Dr. Peter Salgo: AND THEN YOU HAD CHEMOTHERAPY, TAMOXIFEN FOR THREE YEARS.

>> Beverly McClain: MM-HMM, I WAS CLEAR FOR ALMOST THREE YEARS.

>> Dr. Peter Salgo: AND YOU MUST HAVE BEEN FEELING AS IF, YOU KNOW, "WE'RE GOING TO GO OKAY WITH THIS."

>> Beverly McClain: I REALLY THOUGHT I WAS DONE. I REALLY BELIEVED IT WASN'T GOING TO COME BACK. A LOT OF WOMEN WORRY THAT, YOU KNOW, PERPETUALLY, AND IT DOESN'T -- AND I JUST THOUGHT I WAS FINISHED.

>> Dr. Peter Salgo: NOT TO BE.

>> Beverly McClain: NOT TO BE.

>> Dr. Peter Salgo: 2011, SOMETHING HAPPENED. WHAT?

>> Beverly McClain: I WENT IN FOR BLOOD TESTS THAT I GOT WITH MY CHECKUP EVERY THREE MONTHS. AND, AND MY C.E.A., WHICH IS A BLOOD TEST THAT MEASURES TUMOR, MEASURES TUMOR MARKERS, AND IT CAME OUT HIGHER THAN NORMAL, AND THAT WAS THE SIGN THAT SOMETHING WAS GOING ON, AND FURTHER TESTS SHOWED THAT IT WAS IN MY BONES.

>> Dr. Peter Salgo: AND, IN FACT, NOT ONLY YOUR BONES, BUT SPECIFICALLY THE BONES IN YOUR SKULL.

>> Beverly McClain: YES, THAT'S ONE OF THE PLACES THAT IT SHOWED UP.

>> Dr. Peter Salgo: OKAY, AND YOU HAD NEUROLOGIC SYMPTOMS. WHAT WAS THAT LIKE?

>> Beverly McClain: WELL, A PIECE OF MY – A PIECE OF CANCEROUS BONE STARTED GROWING INWARD INTO MY OCCIPITAL LOBE.

>> Dr. Peter Salgo: THAT'S THE BRAIN.

>> Beverly McClain: THAT'S THE BRAIN. AND WHEN I WAS ON VACATION IN MEXICO, AFTER A COUPLE OF PLANE RIDES, THE SYMPTOMS STARTED SHOWING UP, AND I LOST MY PERIPHERAL VISION. AND I COULDN'T READ. I COULDN'T -- JUST EVERYTHING WENT. IT WAS CRAZY.

>> Dr. Peter Salgo: NOW, ALL ALONG, YOU'VE HAD QUITE THE STORY. YOU'VE HAD RADIATION THERAPY, YOU'VE BEEN ON ALL KINDS OF CHEMOTHERAPY, RIGHT? YOU'VE HAD BRAIN SURGERY, EFFECTIVELY.

>> Beverly McClain: I'VE HAD BRAIN SURGERY, YEP.

>> Dr. Peter Salgo: AND ALL OF THESE MEDS, THIS COCKTAIL YOU WERE TAKING, HOW DID THAT MAKE YOU FEEL?

>> Beverly McClain: IT WAS -- THE FIRST TIME OUT, BECAUSE THEY WERE GOING FOR A CURE, THEY WERE MUCH MORE AGGRESSIVE WITH THE CHEMO. SO I WAS A LOT SICKER. NOW, IT'S, YOU KNOW, IT'S A PALLIATIVE THING THAT I'M ON CHEMO.

>> Dr. Peter Salgo: WELL, NOW, AT THIS POINT, THEY'VE TOLD YOU YOU'RE STAGE IV, WHICH IS -- PALLIATIVE IS NOT CURABLE.

>> Beverly McClain: RIGHT.

>> Dr. Peter Salgo: RIGHT. SO NOW IT'S KIND OF DAY TO DAY, AND YOU'RE TRYING TO DO YOUR BEST.

>> Beverly McClain: I AM.

>> Dr. Peter Salgo: BUT IN THE MEANTIME, I KNOW, WE TALKED, THAT ONE OF THE ISSUES YOU HAD WAS YOU WERE LOSING WEIGHT AND YOU COULDN'T KEEP WEIGHT ON, WHICH IS NOT UNCOMMON WITH CANCER PATIENTS.

>> Beverly McClain: RIGHT.

>> Dr. Peter Salgo: AND WHAT DID YOU FIND HELPED YOU WITH THAT?

>> Beverly McClain: MEDICAL MARIJUANA WAS THE THING, ABSOLUTELY, THAT HELPED WITH THAT. I WOULD LOOK AT FOOD, I WOULD FEEL HUNGER PANGS, AND THE MORE I GOT HUNGER PANGS, THE LESS I WANTED TO EAT. IT WAS LIKE THIS WEIRD CYCLE. AND I'D LOOK AT FOOD, IT JUST DID NOT APPEAL TO ME. I JUST, I COULDN'T EAT A FULL PLATE OF ANYTHING. AND MEDICAL MARIJUANA WAS THE ONE THING THAT FIXED THAT.

>> Dr. Peter Salgo: AND I KNOW IF I HAD HEARD THAT I HAD STAGE IV BREAST CANCER, I'D BE PRETTY DEPRESSED. I UNDERSTAND YOU WERE, TOO.

>> Beverly McClain: OH, YEAH. WELL, ESPECIALLY WHEN I CROSSED OVER INTO HAVING TO DO CHEMO.

>> Dr. Peter: Salgo: OKAY.

>> Beverly McClain: YEAH.

>> Dr. Peter Salgo: SO HERE YOU ARE -- I'M ASSUMING THE MEDICAL MARIJUANA, YOU AT LEAST THOUGHT WAS GOING TO HELP YOU WITH THE DEPRESSION AS WELL.

>> Beverly McClain: IT DID, YEAH.

>> Dr. Peter Salgo: OKAY. HERE YOU ARE WITH A DRUG, THE ONLY DRUG, IT SOUNDS AS IF YOU'RE TELLING ME, THAT WAS HELPING YOU MAINTAIN YOUR WEIGHT OR GAIN WEIGHT, AND HELP YOU MANAGE THE DEPRESSION.

>> Beverly McClain: MM-HMM.

>> Dr. Peter Salgo: AND IT'S ILLEGAL WHERE YOU LIVE.

>> Beverly McClain: YEP.

>> Dr. Peter Salgo: ILLEGAL!

>> Beverly McClain: YEAH, I'M WELL AWARE.

>> Dr. Peter Salgo: DID YOU BREAK THE LAW?

>> Beverly McClain: YES, I DID.

>> Dr. Peter Salgo: WILLINGLY? [ LAUGHS ]

>> Beverly McClain: YEAH, YEAH, I'M TOTALLY FINE WITH TELLING THE WORLD THAT, BECAUSE I JUST THINK THAT IT'S, SOMETHING THAT IS CRAZY, FOR IT TO BE ILLEGAL FOR ME TO HAVE SOMETHING THAT WORKS FOR ME.

>> Dr. Peter Salgo: BUT IT'S, WHAT, A SCHEDULE I DRUG. BACK IN 1972, RIGHT, GUYS, THE FEDERAL GOVERNMENT SAID: "SCHEDULE I -- YOU CAN'T TAKE THIS DRUG. IT'S A NARCOTIC." WHICH IT'S NOT, CHEMICALLY. HAVE YOU HEARD THIS STORY BEFORE?

>> Dr. Igor Grant: SURE. YOU KNOW, MEDICINAL CANNABIS PROBABLY HAS A NUMBER OF INDICATIONS. THE PROBLEM, I THINK, WE HAVE IS THAT THERE HASN'T BEEN SUFFICIENT CLINICAL-TRIAL EVIDENCE TO REALLY SUPPORT EVERY ONE OF THE POSSIBLE USES.NOW, IN YOUR CASE, THERE ARE A COUPLE OF AREAS WHERE WE KNOW MEDICINAL CANNABIS WORKS. ONE IS NAUSEA, RIGHT? ANOTHER IS WEIGHT GAIN IN PEOPLE WHO HAVE LOST WEIGHT DUE TO CANCER OR HIV/AIDS OR SOMETHING OF THAT NATURE. AND THE OTHER IS PAIN MANAGEMENT, ALTHOUGH YOU DIDN'T MENTION THAT SPECIFICALLY IN THIS CASE, BUT PARTICULARLY THIS NEUROPATHIC PAIN, CHRONIC PAIN, CAN OFTEN BE BENEFITED.

>> Dr. Peter Salgo: NOW, YOUR PRACTICE AND YOUR RESEARCH IS SPECIFICALLY FOCUSED ON CANNABIS. BUT, LOU, YOU'RE A PRIMARY CARE DOC. IF SOMEBODY CAME TO YOU AND SAID, "LOOK, I'VE BEEN TREATED, I HAVE STAGE IV BREAST CANCER, I CAN'T GAIN WEIGHT, I'M REALLY DEPRESSED," COULD YOU, IF IT WERE LEGAL, WOULD YOU EVER PRESCRIBE MEDICAL MARIJUANA FOR ME?

>> Dr. Lou Papa: JUST AS IGOR SAID, IF I HAD GOOD EVIDENCE THAT THERE WAS INDICATIONS FOR USING IT, YES, I WOULD. AND I THINK PART OF THE PROBLEM HERE IS, THERE'S TWO ASPECTS OF THIS -- THERE'S THE ASPECT OF, IT'S DIFFICULT TO STUDY IT. YOU HAVE TO HAVE A SPECIFIC SITUATION WHERE YOU CAN STUDY IT, WITH IT BEING A SCHEDULE I DRUG, IT SAYS THAT THERE'S NO BENEFIT TO IT, WHICH IS CRAZY. I MEAN, WE'RE ALLOWED TO USE RADIATION AND ARSENIC, BUT WE'RE NOT ALLOWED TO STUDY MARIJUANA. THE OTHER ASPECT, WHICH IS THE BIGGER ISSUE FOR A PRIMARY CARE DOC ESPECIALLY, IS, WHERE DO WE USE IT? WHERE IS THE ARMAMENTARIUM? DO WE JUST KIND OF USE IT, OR DO WE ACTUALLY HAVE GOOD CLINICAL INDICATIONS FOR IT?

>> Dr. Peter Salgo: WELL, THAT'S WHERE I WANT TO GO WITH THIS, BECAUSE BOTH OF YOU ARE -- YOU HAVE ACTUALLY MENTIONED -- I WAS GOING TO SAY, "SKIRTING THE ISSUE" -- THERE'S AN 800-POUND GORILLA RIGHT HERE, WHICH IS EVIDENCE! IS THERE HARD CLINICAL EVIDENCE IN DOUBLE-BLIND CONTROLLED STUDIES, ANYTHING YOU LIKE, THAT MEDICAL MARIJUANA WORKS AGAINST NAUSEA, PAIN, DEPRESSION BETTER THAN STANDARD THERAPIES, IF YOU WILL?

>> Dr. Igor Grant: WELL, FIRST OF ALL, THE EVIDENCE FOR ANTI-NAUSEA EFFECT AND THE EFFECT TO HELP GAIN WEIGHT IN PEOPLE WHO HAVE LOST IT IS VERY GOOD, AND, IN FACT, MARINOL, WHICH IS A BASICALLY SYNTHETIC THC, WHICH IS THE ACTIVE INGREDIENT OF MARIJUANA --

>> Dr. Peter Salgo: WHICH IS TETRAHYDROCANNABINOL.

>> Dr. Igor Grant: CORRECT. THAT'S AVAILABLE, AND IT'S APPROVED.

>> Dr. Peter Salgo: OKAY.

>> Dr. Igor Grant: IT CAN BE TAKEN BY MOUTH FOR THOSE TWO INDICATIONS. I THINK THERE IS REASONABLE EVIDENCE FOR THIS NEUROPATHIC PAIN MANAGEMENT, AND SOME OF THE STUDIES CONDUCTED IN CALIFORNIA SUGGEST THAT, AND EUROPE. ALSO MAYBE MANAGEMENT OF SPASTICITY -- MUSCLE SPASTICITY DUE TO MULTIPLE SCLEROSIS. THAT'S ANOTHER INDICATION. SOME OF THE OTHERS HAVE NOT BEEN STUDIED VERY WELL. FOR EXAMPLE, THERE IS INTEREST IN, COULD CANNABINIDIOL, WHICH IS AN INGREDIENT IN CANNABIS, BE USEFUL IN ANXIETY CONTROL OR PTSD? AGAIN, BUT THE EVIDENCE THERE IS VERY SPOTTY, AND WE NEED TO DO MORE WORK IN THAT AREA.

>> Dr. Peter Salgo: DOES IT MATTER TO YOU THAT THERE'S NO HARD EVIDENCE -- AND BY HARD EVIDENCE, I MEAN, THE NEW ENGLAND JOURNAL, TO MY KNOWLEDGE, HASN'T GOTTEN A DOUBLE-BLIND CONTROLLED STUDY IN 10,000 PEOPLE, A MULTI-CENTER STUDY, THAT -- YOU'RE GIVING ME THE SNEER ALREADY -- THAT SAYS, "MARIJUANA WORKS FOR NAUSEA, VOMITING, WEIGHT LOSS, OR, IF YOU WILL, SPASTICITY IN PEOPLE WITH M.S." DOES THAT BOTHER YOU AT ALL?

>> Beverly McClain: THAT THERE'S NO HARD --

>> Dr. Peter Salgo: YEAH, THAT THERE'S NO HARD DATA.

>> Beverly McClain: NO, I HAVE MY OWN DATA.

>> Dr. Peter Salgo: BUT YOU'RE DATA OF ONE.

>> Beverly McClain: I'M A DATA OF ONE, AND OTHER PEOPLE I KNOW WHO ARE IN MY SITUATION, YEAH.

>> Dr. Lou Papa: BUT THERE'S TWO ISSUES HERE. THERE'S DEFINITELY THE ISSUE WHERE I'LL HAVE PATIENTS THAT WILL IMPROVE WITH ACUPUNCTURE OR THEY MAY IMPROVE WITH MEDITATION. I'M NOT DISCOUNTING IT. YOU DO WHATEVER YOU CAN TO HELP THE PATIENT IMPROVE, AS LONG AS IT'S NOT HARMFUL. THERE'S THE PUBLIC HEALTH ISSUE OF THIS. WE HAVE A COMPOUND, WHICH IS ONE OF THE FIRST TIMES THAT WE ACTUALLY HAVE A COMPOUND THAT WE'RE LOOKING FOR THE INDICATIONS FOR, WE HAVE TO MAKE SURE THAT IT IS -- HAS SOME IMPLICATION AND SOME WAY THAT YOU COULD INTEGRATE IT INTO PATIENTS' CARE AND KNOW THAT THERE'S NOT THE HARM, LONG-TERM.

>> Dr. Peter Salgo: WELL, THAT'S PART OF THE PROBLEM, RIGHT? BECAUSE TELL ME ABOUT YOUR RESEARCH. I MEAN, HOW ARE YOU TRYING TO GET AT THIS ISSUE? EFFICACY VERSUS SIDE EFFECTS VERSUS RISK?

>> Dr. Igor Grant: SURE. WELL, IT'S KIND OF AN INTERESTING STORY. CALIFORNIA WAS THE FIRST STATE THAT PASSED A MEDICAL MARIJUANA LAW, BASICALLY. IT WAS CALLED PROP 215, OR THE COMPASSIONATE USE ACT. AND THAT WAS IN 1996, AND BASICALLY, IT ALLOWED FOR AVAILABILITY OF MARIJUANA ON DOCTOR RECOMMENDATION FOR CONDITIONS THAT WARRANTED IT. INTERESTINGLY, ONE OF THE STATE LEGISLATORS THEN SAID, "WELL, HOW CAN WE MAKE THIS MORE MEDICALLY ACCEPTABLE?" AND SO THIS PERSON CAME AROUND, VISITED WITH US, AND WE SAID, "WELL, WHY DON'T WE DO SOME RESEARCH TO FIGURE OUT IF IT ACTUALLY WORKS AND USING MODERN CLINICAL TRIALS?" THE PERSON SAID, "RIGHT, FINE." THEY GAVE MONEY TO THE UNIVERSITY OF CALIFORNIA TO DO THE RESEARCH. THIS WAS, I THOUGHT, RATHER NOVEL, FOR SOME LEGISLATIVE PROCESSES TO ACTUALLY PURSUE A SCIENTIFIC AGENDA, AS OPPOSED TO DECIDE WHAT'S RIGHT. BUT THAT THEN ALLOWED THE CENTER AT THE UNIVERSITY OF CALIFORNIA TO CONDUCT SEVERAL TRIALS, PARTICULARLY IN NEUROPATHY. ND THAT'S WHY I'M SAYING THESE SMALL-SCALE TRIALS REALLY SHOWED EFFICACY.

>> Dr. Peter Salgo: I WANT TO STOP YOU RIGHT THERE, BECAUSE WE HAVE SO MUCH MORE TO DISCUSS, BUT WHAT WE'RE GOING TO DO RIGHT NOW IS TAKE A LITTLE BREAK. WE'LL BE BACK IN A SECOND, BUT FIRST, HERE'S THIS WEEK'S  "MYTH OR MEDICINE."

>> Narrator: MARIJUANA IS THE MOST COMMONLY USED ILLICIT DRUG WORLDWIDE AND THE SECOND MOST COMMONLY SMOKED SUBSTANCE AFTER TOBACCO. MANY PROPONENTS OF THE DRUG PROMOTE THE PLANT'S ABILITY TO SAFELY TREAT SYMPTOMS OF CANCER, AIDS, EPILEPSY, AND OTHER MEDICAL CONDITIONS. SO "THE THERAPEUTIC BENEFITS OF SMOKING MARIJUANA OUTWEIGH THE HEALTH RISKS TO YOUR LUNGS?" IS THAT MYTH OR MEDICINE?

>> Dr. Michael Nead: "THE THERAPEUTIC BENEFITS OF MARIJUANA OUTWEIGH THE HEALTH RISKS TO YOUR LUNGS." THAT IS BOTH MYTH AND MEDICINE, AND I'M GOING TO TELL YOU WHY. MY NAME IS MICHAEL NEAD, AND I'M AN ASSOCIATE PROFESSOR OF MEDICINE AT THE UNIVERSITY OF ROCHESTER MEDICAL CENTER. MARIJUANA IS THE SECOND MOST COMMONLY SMOKED SUBSTANCE IN THE UNITED STATES, SECOND ONLY TO TOBACCO. STUDIES HAVE LOOKED AT THIS -- HAVE LOOKED AT BOTH SHORT-TERM AND LONG-TERM EFFECTS OF MARIJUANA USE. SHORT-TERM, IN SMALL QUANTITIES, MARIJUANA IS PROBABLY RELATIVELY SAFE. WE KNOW THAT A SINGLE JOINT WILL ACTUALLY DILATE THE LUNGS AND LEAD TO BRONCHODILATION, AND IN AN ASTHMATIC, CAN ACTUALLY HAVE A BENEFICIAL EFFECT IN SMALL DOSES. OVER LONGER PERIODS OF TIME, WHEN YOU LOOK AT THE LUNG FUNCTION IN PATIENTS, HOWEVER, YOU DO START TO SEE SOME SUBTLE CHANGES. YOU SEE INCREASES IN FORCED VITAL CAPACITY. WHEN YOU START LOOKING AT THE IMPACT ON SOMEBODY'S WELL-BEING AND HOW THEY DO ON A DAILY BASIS, YOU START SEEING INCREASED WHEEZING. YOU SEE INCREASED BRONCHOSPASM. AND YOU SEE INCREASED SPUTUM PRODUCTION IN PATIENTS THAT SMOKE MARIJUANA ON A HABITUAL BASIS OR DAILY BASIS THAT'S ON PAR WITH HOW MUCH PEOPLE SMOKE CIGARETTES.

>> Narrator: IS THERE A SAFER  OPTION OTHER THAN SMOKING MARIJUANA?

>> Dr. Michael Nead: ANOTHER WAY TO USE MARIJUANA IS JUST AS THE EXTRACTED PSYCHOACTIVE AGENT, THE THC -- YOU CAN TAKE THAT AS A PILL. THE BENEFIT OF TAKING JUST THE THC IS YOU REMOVE THE ACTIVE INGREDIENT THAT MAY HAVE THE DESIRED HEALTH BENEFITS, AWAY FROM SOME OF THE CARCINOGENIC AGENTS. AND THAT'S MEDICINE.

>> Narrator: NOT SURE IF IT'S MYTH OR MEDICINE? CONNECT WITH US ONLINE. WE'LL GET TO WORK AND GET YOU A SECOND OPINION.

>> Dr. Peter Salgo: WE'RE BACK WITH BEVERLY, WHO'S TOLD US HER STORY. BEVERLY, YOU'VE GOT STAGE IV BREAST CANCER.

>> Beverly McClain: YES, I DO.

>> Dr. Peter Salgo: AND FOR SOME OF THE SYMPTOMS THAT THIS IS CAUSING AND SOME OF THE SYMPTOMS THAT YOUR TREATMENT IS CAUSING AND FOR YOUR DEPRESSION, WHICH IS UNDERSTANDABLE, GIVEN THIS PRETTY ADVANCED DISEASE, YOU'VE BEEN USING MARIJUANA.

>> Beverly McClain: YES, I HAVE.

>> Dr. Peter Salgo: THE PROBLEM IS THAT IN THE  STATE WHERE YOU LIVE, IT'S NOT LEGAL. SO YOU'VE BEEN SMOKING MARIJUANA.

>> Beverly McClain: MM-HMM.

>> Dr. Peter Salgo: NOW, MARIJUANA, SMOKED, IS THAT THE SAME AS MARIJUANA TAKEN IN PILL FORM?

>> Dr. Lou Papa: I THINK ONE OF THE ISSUES WITH THAT -- IGOR, CORRECT ME IF I'M WRONG -- IS THAT THE ORAL  FORM IS MUCH MORE DIFFICULT TO ABSORB, AND IT'S NOT AS RELIABLE. THE INHALED FORM IS PRETTY QUICK.

>> Dr. Peter Salgo: BUT IT'S INHALED PLANT -- IN OTHER WORDS, IT’S LIKE TOBACCO, NOT THAT IT HAS THE SAME RISK PROFILE, BUT THAT THERE'S AN AWFUL LOT OF CHEMICALS IN A MARIJUANA LEAF, WHEREAS THE THERAPEUTIC MEDICAL MARIJUANA PILLS, THAT'S ONE CHEMICAL, TYPICALLY, RIGHT?

>> Dr. Igor Grant: RIGHT.

>> Dr. Peter Salgo: SO IS THERE A DIFFERENCE?

>> Dr. Igor Grant: WELL, WE DON'T KNOW CLINICALLY WHETHER THERE'S A DIFFERENCE. ANECDOTALLY, PEOPLE CLAIM THAT TAKING MARINOL, WHICH I MENTIONED BEFORE, BY MOUTH IS NOT AS EFFECTIVE AS SMOKING OR -- THERE ARE ALSO WAYS, BY THE WAY, OF INHALING THAT DON'T INVOLVE SMOKE, THROUGH VAPORIZATION AND SO FORTH. BUT WE DON'T KNOW THAT. THAT'S ONE OF THE STUDIES THAT SHOULD REALLY BE DONE. ALSO, THE PLANT CONTAINS MANY DIFFERENT CONSTITUENTS, AND IT'S POSSIBLE THAT IT'S SOME COMBINATION OF CONSTITUENTS THAT EXERTS THE MAXIMUM BENEFIT.

>> Dr. Peter Salgo: BUT TO BE DEVIL'S ADVOCATE HERE, IT MAY NOT BE THE CANNABINOIDS AT ALL. THERE MAY BE SOME SECRET CHEMICAL THAT WE HAVEN'T EVEN ANALYZED YET IN MARIJUANA, ALTHOUGH YOU DON'T REALLY BUY THAT, I CAN TELL.

 

>> Dr. Igor Grant: WELL, I'M SURE THERE COULD BE SECRET CHEMICALS ADDING TO IT, BUT -- BUT WE DO KNOW FROM NEUROBIOLOGY THAT WE HAVE AN ENDOCANNABINOID SYSTEM IN OUR BRAINS AND OTHER TISSUES AND THAT DRUGS THAT ACT ON THAT SYSTEM DO HAVE CERTAIN EFFECTS WHICH COULD BE USEFUL IN TREATING DISEASE.

>> Dr. Peter Salgo: BEVERLY, YOU'RE ALMOST -- I DON'T WANT TO USE THE WORD "POSTER GIRL," BUT YOU ARE, LIKE, AN EXTRAORDINARY CASE. I MEAN, IF THERE WAS EVER A REASON, IT SEEMS TO ME, MEDICALLY, FOR SOMEBODY TO BE ABLE TO GET MARIJUANA OR PILLS FOR SIDE EFFECTS, IT WOULD BE YOU. YOU HAVE A MEDICAL INDICATION. YOU HAVE RECOGNIZED PROBLEMS.

>> Beverly McClain: MM-HMM.

>> Dr. Peter Salgo: BUT I KNOW THAT YOU'VE BEEN ACTIVE IN THE LEGALIZING THE MARIJUANA MOVEMENT. CLEARLY THERE ARE PEOPLE OUT THERE WHO WANT THIS LEGALIZED SO THAT THEY CAN USE IT RECREATIONALLY. HOW DO YOU MAKE THAT DISTINCTION?

>> Beverly McClain: WELL, I PERSONALLY DON'T HAVE A PROBLEM WITH PEOPLE USING IT RECREATIONALLY. SO I DON'T –

>> Dr. Peter Salgo: BUT APPARENTLY THE LEGISLATORS DO.

>> Beverly McClain: YEAH, THEY DO.

>> Dr. Igor Grant: I'D LIKE TO JUMP IN TO SAY, WE SHOULD MAKE A DISTINCTION BETWEEN SOMETHING THAT IS A MEDICINE OR THE MEDICAL INDICATIONS FOR A DRUG OR AN AGENT, VERSUS OTHER USES OF THAT. I MEAN, CERTAINLY WE'VE MANAGED TO DO THAT FOR DRUGS LIKE MORPHINE AND THE OPIOIDS.

>> Beverly McClain: YEAH.

>> Dr. Igor Grant: JUST BECAUSE THEY'RE LEGAL AS A MEDICINE UNDER CONTROLLED CONDITIONS DOESN'T MEAN WE SAY EVERYBODY OUGHT TO BE POPPING OPIUM ALL THE TIME. SO I THINK THE FACT THAT WE HAVE CONFLATED -- KIND OF MIXED UP -- THE LEGALIZATION FOR RECREATIONAL USE WITH POSSIBLE INDICATIONS FOR MEDICAL USE IS ACTUALLY A BIG PROBLEM.

>> Dr. Lou Papa: IT'S A HUGE PROBLEM, ESPECIALLY FOR PRIMARY CARE, AND THAT'S ONE OF THE THINGS --

>> Dr. Peter Salgo: THEY'RE GOING TO COME TO YOUR OFFICE, LOOKING FOR A SCRIPT.

>> Dr. Lou Papa: RIGHT NOW IT'S SO VAGUE, AND SO MANY INDICATIONS, AT LEAST IN COLORADO, WERE CRAZY, AND THERE WERE SOME STATISTICS THAT WERE FIVE PHYSICIANS WERE PRESCRIBING 30% OF ALL THE INDICATIONS, WHICH TELLS ME TWO THINGS -- THEY'RE DOING A LOT OF PRESCRIBING, OR THE OTHER DOCTORS ARE NOT DOING ENOUGH, WHICH MEANS THAT THERE'S NOT ENOUGH INFORMATION. AND I DON'T WANT TO BE THE MIDDLEMAN IF THERE'S NOT ANY CLEAR INDICATION. IF PEOPLE WANT TO USE IT RECREATIONALLY, THAT'S FINE. YOU CAN GO TO THE LIQUOR STORE AND BUY YOUR ALCOHOL. I DON'T HAVE TO GET INVOLVED. YOU CAN GO TO THE 7-ELEVEN AND GET YOUR CIGARETTES. I DON'T HAVE TO GET INVOLVED. I DON'T WANT TO GET INVOLVED IF YOU WANT TO SMOKE YOUR MARIJUANA FOR RECREATIONAL REASONS.

>> Dr. Peter Salgo: ALL RIGHT, BUT I'M GOING TO JUST SAY THAT THAT'S DISINGENUOUS.

>> Dr. Lou Papa: HOW?

>> Dr. Peter Salgo: IT IS.

>> Dr. Lou Papa: HOW?

>> Dr. Peter Salgo: BECAUSE IT'S BEING LAID AT THE FEET OF DOCTORS.

>> Dr. Lou Papa: EXACTLY.

>> Dr. Peter Salgo: IN OTHER WORDS, RIGHT NOW, WHATEVER YOU MAY THINK ABOUT LEGALIZATION OF MARIJUANA ACROSS THE BOARD, RIGHT NOW PEOPLE ARE TALKING ABOUT LEGALIZING MEDICAL MARIJUANA -- THEY'RE GOING TO COME IN TO YOUR OFFICE, AND WHAT ARE YOU GOING TO DO --

>> Dr. Lou Papa: RIGHT.

>> Dr. Peter Salgo: IF SOMEBODY SAYS, "DR. PAPA, I WANT YOU TO PRESCRIBE MARIJUANA"?

>> Dr. Lou Papa: RIGHT, AND THAT'S PART OF THE PROBLEM. I DON'T HAVE INDICATIONS FOR THAT, AND RIGHT NOW IT COULD BE ACROSS THE BOARD. AND THE DATA IS NOT THAT GREAT, AND I THINK WASTING OUR TIME AND TRYING TO FIGURE OUT HOW TO USE THIS -- LEGALIZE IT IF YOU WANT TO LEGALIZE IT FOR RECREATIONAL USE. IF YOU WANT TO SEE IT, MEDICAL INDICATIONS, START THROWING SOME MONEY AT IT SO PEOPLE ARE NOT WAITING AROUND AND HAVE TO GO AROUND THE CORNER TO BUY IT.

>> Dr. Peter Salgo: HE'S GETTING AGITATED.

>> Beverly McClain: YEAH.

>> Dr. Peter Salgo: HE'S GETTING AGITATED. WHAT DO YOU SAY TO HIM?

>> Beverly McClain: WELL, I TOTALLY UNDERSTAND WHAT YOU'RE SAYING. IT'S -- THERE'S NO REASON WHY PEOPLE SHOULDN'T BE ABLE TO HAVE ACCESS FOR BOTH THINGS, IN MY PERSONAL OPINION.

>> Dr. Lou Papa: AND I THINK THE THING I WORRY ABOUT -- IF YOU WERE MY PATIENT AND YOU WERE SMOKING MARIJUANA, MY RULE IS, "FIRST DO NO HARM," RIGHT? ANY MORE THAN IF I HAD A PATIENT THAT WAS IN EXTREME PAIN AND THEY SAID, "I FIND THAT HEROIN WORKS REALLY WELL." IT'S AN OPIOID. THEY CAN GO AROUND THE CORNER AND BUY IT --

>> Beverly McClain: RIGHT.

>> Dr. Lou Papa: I DON'T KNOW WHO'S SELLING IT. THE ASSUMPTION IS THAT IT'S OKAY AND THEY'RE NOT LACING IT WITH THINGS. AND WE DON'T EVEN KNOW, WITH ALL THESE COMPOUNDS THAT ARE IN THERE, THERE MAY BE A SPECIFIC COMPOUND THAT WORKS SPECIFICALLY FOR A SPECIFIC PROBLEM IN YOU. AND WE REALLY NEED THAT INFORMATION.

>> Beverly McClain: WELL, THE REASON WE HAVE IT, AND I'M SURE YOU WOULD BACK THIS UP, IS BECAUSE IT'S A SCHEDULE I DRUG.

>> Dr. Lou Papa: RIGHT, EXACTLY.

>> Beverly McClain: AND SO, YOU KNOW, THE PEOPLE WHO HAVE WANTED TO DO THE RESEARCH HAVEN'T BEEN ALLOWED TO DO IT -- IT'S A CATCH-22.

>> Dr. Peter Salgo: SO LET ME GET TO THIS SCHEDULE I THING. THE "SCHEDULE I" THING IS A PHRASE, A CATCHPHRASE PEOPLE HAVE HEARD IF THEY'VE LOOKED AT THIS AT ALL. BACK IN 1972, THE FEDERAL GOVERNMENT MADE MARIJUANA A SCHEDULE I, WHICH PUTS IN THE SAME CATEGORY AS, I BELIEVE, COCAINE AND HEROIN, ALL THESE OTHER DRUGS, WHICH IMPLIES THAT THERE'S REAL HARM IF IT'S ABUSED. SO MY QUESTION TO YOU IS, WHERE'S THE HARM?

>> Dr. Igor Grant: RIGHT. WELL, FIRST OF ALL, IT IS MIS-SCHEDULED, BASED ON ANY EVIDENCE THAT ANYBODY HAS REVIEWED, BECAUSE SCHEDULE I, IF YOU COULD PUT IT A DIFFERENT WAY, IT'S USELESS, HARMFUL THINGS ARE IN SCHEDULE I, RIGHT? KIND OF --

>> Dr. Peter Salgo: I DON'T WANT TO MENTION THE KARDASHIANS HERE, BUT WE'LL JUST KEEP GOING.

>> Dr. Igor Grant: [ LAUGHTER ] SO...MARIJUANA, LIKE ANY DRUG, HAS THE POTENTIAL TO CAUSE HARM. THERE'S NO QUESTION ABOUT IT. IT CAN BE HARMFUL TO VULNERABLE YOUTH WHO GET INTO SMOKING IT EVERY DAY AND STOP PAYING ATTENTION AND DON'T REMEMBER ANYTHING AND CAN'T LEARN THINGS. SO I DON'T THINK ANY SENSIBLE PERSON WOULD ARGUE THAT THERE ARE HARMFUL EFFECTS. BUT THE RELATIVE HARM TO, SAY, ADULTS WHO USE MODERATELY IS MUCH, MUCH SMALLER THAN THE RISKS THAT WE HAVE PUT ON THROUGH THE WAR ON DRUGS AND ALL OF THE EMPHASIS ON POLICING VERSUS --

>> Dr. Peter Salgo: "FOCUS ON WHAT'S IMPORTANT," IS WHAT I HEAR YOU SAYING.

>> Dr. Igor Grant: YEAH.

>> Dr. Peter Salgo: NOW, I DID PROMISE YOU THAT YOU WOULD GET A CHANCE FOR A SECOND OPINION. YOU'VE GOT THESE TWO GREAT DOCS. THE FLOOR IS YOURS. ASK AWAY.

>> Beverly McClain: WELL, THE BIG QUESTION FOR ME, AS SOMEONE -- I MEAN, I’VE USED MARIJUANA FOR PALLIATIVE REASONS, BUT I HEAR ANECDOTAL EVIDENCE, AND AGAIN, NOT PROPER TRIALS DONE, FOR THE REASONS OF IT BEING A SCHEDULE I AND SO HARD TO DO IT IN THE CURRENT ENVIRONMENT -- BUT I'M HEARING ALL KINDS OF ANECDOTAL STORIES ABOUT PEOPLE WHO HAVE REVERSED THEIR CANCER THROUGH TAKING, DOING THE HIGH -- IS IT "CANNABINOID" OILS?

>> Dr. Peter Salgo: SO, IF I CAN UNDERSTAND YOUR QUESTION, IS THIS AN ANTI-CANCER DRUG? IS IT POTENTIALLY?

>> Beverly McClain: CAN IT BE AN ANTI-CANCER DRUG? I MEAN, DOES IT KILL CANCER? I MEAN, THEY'VE PROVEN IN TEST TUBES, I GUESS, THAT IT'S -- THAT IT KILLS CANCER CELLS, AND WHAT DO YOU THINK ABOUT IT AS --

>> Dr. Lou Papa: SO DOES BLEACH. I MEAN, THE QUESTION IS -- NO, BUT THE POINT IS, I THINK YOU NEED -- IF YOU HAVE PRELIMINARY EVIDENCE LIKE THAT, ALL THE MORE REASON -- THE WHOLE IDEA THAT WE CAN'T BE ALLOWED TO STUDY ANYTHING AS LONG AS IT ADHERES TO SOME HUMAN COMPASSION AND EXPERIMENTAL GUIDELINES IS, WHY ARE WE RESTRICTED FROM STUDYING ANYTHING?

>> Beverly McClain: MM-HMM.

>> Dr. Igor Grant: WELL, LET ME COMMENT. I THINK THE FEDERAL GOVERNMENT WOULD SAY, "WELL, WE'RE NOT RESTRICTING YOU OR STOPPING YOU. YOU CAN DO THE RESEARCH.JUST SUBMIT A GOOD PROPOSAL, AND WE'LL EVALUATE IT, AND SO FORTH.” AND IN FACT, OUR EXPERIENCE IN CALIFORNIA WAS, WE HAD FUNDING FROM THE STATE. WE HAD TO GET APPROVAL FROM THE FEDS. AND THEY DID APPROVE THE STUDIES. HOWEVER, WHAT'S LOST IN THIS IS THE AMOUNT OF EFFORT IT TAKES TO GET THE APPROVAL.

>> Dr. Lou Papa: EXACTLY.

>> Dr. Igor Grant: THAT THERE ARE -- YOU KNOW, IT TAKES A YEAR OR MORE TO GO THROUGH ALL OF THE REGULATORY FRAMEWORK. SO IT'S NOT LIKE IT CAN'T BE DONE OR SOMEBODY IS PROHIBITING IT, BUT THE PROCESS IS QUITE CUMBERSOME.

>> Dr. Peter Salgo: IT'S A HASSLE. SO, BEVERLY, HOW ARE YOU DOING NOW WITH YOUR CANCER, WITH WHAT YOU'RE TRYING TO DO TO TREAT IT?

>> Beverly McClain: I'M ON CHEMO THAT IS WORKING VERY WELL FOR ME AT THE MOMENT, AND I'VE BEEN ABLE, THE LAST FEW MONTHS, TO LIVE PRETTY MUCH A NORMAL LIFE IN A WAY THAT I WASN'T ABLE TO BEFORE.

>> Dr. Peter Salgo: BEVERLY, THANK YOU SO MUCH FOR BEING HERE AND SHARING YOUR STORY.

>> Beverly McClain: IT'S MY PLEASURE.

>> Dr. Peter Salgo: I CAN'T TELL YOU HOW PLEASED I AM YOU'RE DOING WELL, AND BEST WISHES FOR A CONTINUED SUCCESSFUL FIGHT THAT'S GOING ON OVER HERE.

>> Beverly McClain: THANK YOU.

>> Dr. Peter Salgo: GENTLEMEN, THANK YOU SO MUCH FOR BEING HERE AS WELL AND SHARING YOUR INSIGHTS. WHAT I'D LIKE YOU TO DO IS TO LET US KNOW WHAT YOU THINK ABOUT TODAY'S DISCUSSION AND BEVERLY'S SECOND OPINION BY TWEETING US OR COMMENTING ON OUR FACEBOOK PAGE. AND NOW, FOR THE LAST WORD ON MEDICAL MARIJUANA, HERE'S THIS WEEK'S "SECOND OPINION 5."

>> Dr. Timothy Quill: HELLO, I'M DR. TIMOTHY QUILL, AND I'M HERE TO TELL YOU FIVE THINGS YOU MAY NOT KNOW ABOUT MEDICAL MARIJUANA. THE FIRST THING YOU MAY NOT KNOW IS THAT SYNTHETIC ORAL MARIJUANA IS CALLED MARINOL. IT IS CURRENTLY AVAILABLE FOR APPETITE ENHANCEMENT FOR PATIENTS WITH ADVANCED CANCER OR HIV. MARINOL DOES NOT MAKE PATIENTS VERY EUPHORIC, AND IT IS NOT WIDELY USED. THE NEXT THING YOU MAY NOT KNOW IS THAT VAPORIZED MARIJUANA, LIKE SMOKELESS CIGARETTES, IS SAFER AND LESS TOXIC TO THE LUNGS THAN SMOKED MARIJUANA, WHICH IS ONE OF THE REASONS IT WAS LEGALIZED, ALONG WITH ORAL FORMULATIONS, IN NEW YORK STATE, WHILE THE PROHIBITION ON SMOKING MARIJUANA WAS SUSTAINED. THE THIRD THING YOU MAY NOT KNOW ABOUT MEDICAL MARIJUANA IS THAT THERE IS NO CLEAR OPTIMAL DOSE OF MARIJUANA FOR ANY OF THE LEGALLY APPROVED CONDITIONS, AND THE CONCENTRATION, CONTENT, AND POTENCY OF MEDICALLY AVAILABLE PRODUCTS VARY CONSIDERABLY. ANOTHER THING TO KNOW IS THAT FEW SCIENTIFIC STUDIES SHOW HOW EFFECTIVE MEDICAL MARIJUANA IS, PARTLY BECAUSE IN THE PAST, THE LAW HAS PROHIBITED ITS STUDY AS WELL AS IT’S DISTRIBUTION. AND THE LAST THING TO KNOW ABOUT MEDICAL MARIJUANA IS INDIVIDUALS WITH MAJOR MENTAL ILLNESS MAY BE AT RISK FOR WORSENING IF THEY USE MEDICAL MARIJUANA. AND THOSE WITH A STRONG PERSONAL OR FAMILY HISTORY OF ALCOHOLISM OR DRUG ABUSE MAY BE AT HIGH RISK OF BECOMING DEPENDENT. AND THAT'S YOUR "SECOND OPINION 5."

>> Dr. Peter Salgo: THANK YOU SO MUCH FOR WATCHING, AND REMEMBER THAT YOU CAN GET MORE SECOND OPINIONS AND PATIENT STORIES ON OUR WEBSITE. THAT'S secondopinion-tv.org. YOU CAN SEND US YOUR SHOW IDEAS AND SHARE YOUR OWN STORY, AND MAYBE WE'LL INVITE YOU TO BE ON THE SHOW WITH US. YOU CAN CONTINUE THE CONVERSATION ON FACEBOOK AND TWITTER, WHERE WE ARE LIVE EVERY DAY WITH BREAKING HEALTH NEWS. I'M DR. PETER SALGO. AND I'LL SEE YOU NEXT TIME FOR ANOTHER "SECOND OPINION."

>> Announcer: "SECOND OPINION" IS BROUGHT TO YOU BY BLUE CROSS/BLUE SHIELD, ACCEPTED IN ALL 50 STATES. BLUE CROSS/BLUE SHIELD -- LIVE FEARLESS.

>> Announcer: "SECOND OPINION" IS PRODUCED IN CONJUNCTION WITH U.R. MEDICINE, PART OF UNIVERSITY OF ROCHESTER MEDICAL CENTER, ROCHESTER, NEW YORK.