Opposing Views of Medical Marijuana
I just read the editorial by Randy D. Danielsen, PhD, PA-C, DFAAPA, regarding “medical” marijuana [Clinician Reviews. 2011;21: cover, 4-7). I find this to be a dangerous “drug.”
I worked in a medical marijuana clinic four or five years ago, believing it actually might help people with devastating illnesses and uncontrolled pain. What I found was very different: Staff—including the physicians and other providers—used marijuana while working, which I found appalling.
Many of the people using “medical” marijuana had already been using it as a recreational drug for years, but wanted the protection of “health care” deeming it safe to use for their pain issues, which included chronic back pain or failed back surgery. The fact that health care/medicine was pulled into making this more “legitimate” for users was a direct move by marijuana users and people who had been in legal trouble for use.
The fact that “medical” marijuana clinics are multimillion-dollar-a-year ventures is even more impressive, with physicians who work for these clinics charging $250 per physical (and maybe more). Many of them see 40 patients per day, six days per week, and have four clinics operating in several states. (Do the math; $240,000 per week is what I get, figuring this out). I believe law enforcement, with the backing of the DEA and the Department of Justice, ought to be going after these clinics, not the people smoking the marijuana.
I could go on … but basically, “medical” marijuana (to me) is an oxymoron and should be able to “stand alone,” passing its own test of legality, without the benefit of medicine legitimizing something that is actually illegal.
Meg Helgert, FNP, Portland, OR
As much as we would like to believe that patient well-being and public safety are at the core of the debate over medical marijuana, the truth is that the private interests of the pharmaceutical industry, in terms of potential financial losses, are being protected. In a business that doesn’t stand to earn a profit from patents (with the notably sly exception of Marinol) and that does wield a great deal of influence in Washington, there is no incentive to fund clinical trials nor advocate the use of marijuana for medical purposes.
For example, ibogaine, a plant derivative shown to cure drug addiction, is a Schedule I drug whose patent has expired. No investigation into the efficacy of this treatment is under way because of the lack of monetary incentives, but it remains in its classification because of its hallucinogenic properties.
The negative side effects of medical marijuana pale in comparison to the laundry list associated with numerous prescription drugs that are FDA approved—not to mention tobacco and alcohol, much more addictive products on the market that possess no medicinal value, only detrimental. Additionally, currently available pain medications have been proven highly addictive, and their use and proliferation have led to an epidemic of chemical dependence and related crime.
If the big players in the industry had significant potential gains from medical marijuana, it would have been legalized at the federal level years ago.
Scott M. Arden, PhD, Providence, RI
Ahh, Fell the Mutual Respect!
This letter is in response to one from Nichole Bateman, PA-C, MPAS, regarding collaboration (Clinician Reviews. 2011;21:3): Nichole, you couldn’t have said it better. I have been a nurse practitioner for 13 years, have taught at two major universities, and have precepted many FNPs. I have heard the same negative remarks about PAs from NPs and nursing school faculty and have never bought into it.
I believe that the “ain’t we great” mentality is detrimental to the cooperative attitude we should all have with each other, and it is self-defeating. My observation is that it is born from a lack of self-esteem and has no basis in fact.
I’ve worked with many PAs and have often found their knowledge and insight to be more grounded and evidence-based than that of my FNP cohorts. Unfortunately, just as there are some doctors that are better than others, there exists the same polarity with both NPs and PAs.
You guys do a great job, so whenever you hear the ridiculous, unsubstantiated remarks, consider the source and please know that the feelings expressed are not universally accepted by NPs. And, accept my apologies for the “mini-minds” you hear it from. Your remarks were “right-on.”
Peter Maese, FNP, Santa Fe, NM
Vitamin D: The Cure for What Ails Us
Just some anecdotal testaments to vitamin D (Clinician Reviews. 2011;21:cover, 23, 35): In the fall of 2009, I participated in a study examining vitamin D levels and immunologic response to the influenza vaccine. That is when I discovered that my vitamin D level was at the bottom of the range—32 ng/mL.
That December, I started keeping track of everything I ate for about three months, with the help of a Web site that listed my daily intake of vitamins and minerals. I was only getting about 50% of the recommended dietary allowance (RDA) of vitamin D in my diet, even with occasional supplementation. I started taking 1,000 units about three times per week; when I had my vitamin D level checked again in April 2010, it was one point lower (31 ng/mL). Finally, in May 2010, I started taking 5,000 units daily under the care of a doctor. By November 2010, my level was at 53 ng/mL.
The most important point, though, is that I used to get sick about five to six times per year and needed antibiotics once or twice per year. With the exception of a single occasion in June 2010 (when my daughter was ill), I have not been sick since I started increasing my vitamin D intake. I tried taking 5,000 units just three times per week, but found that I felt mildly ill, but I never actually got sick or had any discharge. After that, I increased my intake back to 5,000 units daily.
My husband and daughter have both been sick several times since last June, so I finally started them on a vitamin D regimen. Time will tell—they are a bit of an experiment for me. I had a patient remark to me (unprompted) that since he started taking vitamin D about a year ago, he has not been sick. And I think back to a coworker who never got sick in the nine years I worked with her. She used to drink a lot of milk every day, and she ate a lot of fish. I suspect this may explain why she was never more than “a little under the weather.”
I try to advise as many people as I can to have their vitamin D level checked and to try to get it to 50 ng/mL, especially if they are getting ill frequently. Three people that I work with have been sick recently, and I suggested that they have their vitamin D level checked. They have come back to tell me that it was low or extremely low. One even had to be treated with a 50,000-unit bolus to start with after the results came back extremely low.
I am not saying that vitamin D is the answer to all upper respiratory infections, but it is something extremely easy to test for and treat. One theory about the increase in illness in winter was due to dry air and people staying together in close quarters, but perhaps there is another, more treatable factor: low levels of vitamin D. Increasing the RDA to 600 units may not be enough for everyone. If someone is having frequent upper respiratory infections, it seems reasonable to check the vitamin D level. For me, I need the 5,000 units daily. I love not getting sick! I wish I had been more aware of vitamin D’s impact years ago.
Anita T. Blenke, PA-C, MS, CCRC, Miami, FL