Researchers still exploring science behind medical use of marijuana [VIDEO]


Doctors who write recommendations for medical marijuana have developed an unfortunate reputation. Ask any Angeleno how easy it is to get the drug and you’ll likely hear about storefront practitioners who pointedly ask clients about “back pain.” Wink, wink.

It’s a notion, however, that masks the reality that any physician in California — from the highest-paid Beverly Hills doctor on down — could approve the use of the drug for his or her patients under state law.

But the health risks and medicinal properties of marijuana are still being studied, and until the drug makes its way through standard channels of scientific research, writing recommendations for it is a risk many providers don’t want to take.

Marijuana is classified by the U.S. Food and Drug Administration as a Schedule I substance, meaning that it is defined by federal law as having “no currently accepted medical use” and has a “high potential for abuse.” Other Schedule I substances include heroin and LSD.

It’s a classification with which many medical experts disagree.

The National Institutes of Health and the American College of Physicians believe that marijuana should be further studied as a federally approved drug. And some doctors say the classification doesn’t line up with what is already known.

“I think it doesn’t match the scientific evidence at this time,” said Dr. Igor Grant, a professor and the executive vice chair of the department of psychiatry at the University of California, San Diego, School of Medicine. “There certainly are good indications that [marijuana] may be useful in some things.”

Grant is also the director of the Center for Medicinal Cannabis Research (CMCR) at the University of California, San Diego, which was established in 2000 to study the potential medical benefits of marijuana as well as the inherent risks. The center conducted some of the first significant clinical trials of marijuana since the early 1990s.

In a report released this year by the center highlighting the results of 10 years of research, experts found hope in the drug’s potential. 

“One of the most promising is the treatment of what’s called painful peripheral neuropathy,” said Grant. “People suffer burning, tingling, painful sensations in their feet and hands and arms related to diseases like AIDS, diabetes and spinal cord injuries.”

While treatments for these symptoms exist, including anti-depressants and anti-epileptic medication, Grant said, they don’t always work, and some patients report negative side effects.

Larry David tackles medical marijuana on an episode of “Curb.” Story continues after the jump.

Marijuana also holds promise in treating painful muscle spasms associated with diseases like multiple sclerosis, he said.

“[Muscle spasms] can affect people’s ability to walk and write and do activities of daily life,” said Grant. “It’s another area where marijuana may be useful.”

But, like any other drug — legal or not — marijuana isn’t without risks.

“Everything we ingest has some risks,” said Dr. Itai Danovitch, who serves as the director of addiction psychiatry services in the department of psychiatry and behavioral neurosciences at Cedars-Sinai Medical Center. “The question is, how do the risks appear for each person?”

Current research suggests that about 8 to 10 percent of people who use the drug will develop an addiction. Danovitch also points to research reporting that the use of marijuana might be a trigger for mental health disorders.

“For people who have underlying risk of things like schizophrenia,” he said, “it appears to unmask that in 1 to 2 percent of the population.”

The acute side effects of marijuana — those that take place at the time the drug is used — are fairly commonly known. They include feeling decreased tension, feeling sedated and possibly hungry. For some users, they include feeling more anxious and even paranoid.

The longer-term effects are less clear, although experts agree that there’s little evidence of a lasting negative impact on the brain. And while marijuana smoke can be irritating to the lungs, it has never been proven to cause lung cancer.

Until the risks and benefits of marijuana are fully understood, though, it’s unlikely that doctors practicing in large medical or academic institutions will be willing to incur the risk of writing a recommendation for patients.

First of all, Danovitch said, marijuana isn’t stocked in most hospitals formularies, which serve as pharmacies to patients.

“Marijuana is definitely not in Cedars’ formulary,” he said.

There are also currently no state or federally regulated growers, aside from some used for federal research, which means that doctors have no way of knowing for certain what they are prescribing. 

Additionally, Grant said, there is no uniform way to administer marijuana.

“Smoking is not a route of administration that’s going to be acceptable for some patients, and not in a lot of settings,” he said. “In hospitals, for instance, you have oxygen tanks, or [in] homes with young children, where you may be worried about secondhand smoke.”

And of course, there’s always the question of the feds.

“It’s not legal under federal law for doctors to prescribe or recommend marijuana,” said Joel Hay, a professor of pharmaceutical economics and policy at the University of Southern California, “so a lot are very leery about doing that — I would argue, the more reputable ones.”

Hay added that doctors practicing out of academic institutions would put their institution at risk by prescribing a federally illegal drug.

“Any doctor that works at an academic medical center like USC or UCLA wouldn’t do this,” he said, “because they would jeopardize all federal funding that institution receives.”

But medical marijuana advocates — activists and researchers alike — believe in the promise of the drug — that, eventually, it has the potential to reach the mainstream as a legitimate way of treating illness and disease.

“From a medical standpoint,” said Grant, “what I would favor is much more serious research on marijuana itself, with much larger clinical trials, and then looking to how the benefits can be delivered ultimately in a different way.”

Drama in Israel, High Stakes in the U.S.


Israeli politics is always a mix of high drama and low comedy, but the current fight within Prime Minister Ariel Sharon’s divided government is anything but entertaining for Jewish leaders here.

Israeli commentators have noted that it is a struggle for the soul of the Likud party. How that turns out will have consequences for the U.S.-Israel relationship and on Israel’s already-low standing around the world.

It will also have a major impact on an American Jewish community that has come together to support a beleaguered Israel, but which is unlikely to stay together to support settlers who want to remain in their Gaza and West Bank enclaves.

According to sources here, the pro-Israel lobby has sent an unambiguous message to Sharon and his warring government ministers: expect problems in U.S.-Israel relations if you can’t approve a comprehensive Gaza withdrawal plan.

The reasons aren’t hard to grasp.

President George W. Bush, initially cool to the plan, latched on to it last month as an alternative to the stalled Mideast “road map.” To help Sharon win the promised Likud referendum on the pullout, the president offered some dramatic concessions, including rejection of the Palestinian right of return and an acknowledgment that Israel can retain some West Bank land after a settlement with the Palestinians.

Bush paid a big diplomatic price for those concessions; European and Arab allies were incensed at just the moment when the administration was seeking their help in the Iraq tangle. Their anger intensified when Sharon lost the Likud referendum and began talking about a watered-down or phased plan, making President Bush look like the sucker of the decade.

The administration can’t afford a second loss. Now, officials here clearly expect Sharon to find a way to sell the plan to his government and start implementing it — pronto.

Bush’s need for a diplomatic victory will only increase as he holds a series of meetings here and abroad this month trying to enlist international cooperation in the effort to bring a semblance of stability to Iraq.

Officials here expect a full withdrawal, not a piecemeal or partial one, and they expect Israel to coordinate with the hated Palestinian Authority to prevent a Hamas takeover when Israeli troops and settlers evacuate Gaza.

Sharon has gotten that message; this week he is sending his foreign minister to Cairo to discuss the handover with Egyptian President Hosni Mubarak.

With an election only five months away and both parties scrambling for Jewish support, the Bush administration has no intention of publicly squeezing Israel.

But the message is going out through diplomatic channels: after Nov. 2, there could be hell to pay if Sharon does not make good on his deal with Bush.

If Sharon loses the withdrawal fight to the well-organized settler minority, the role of the settlers in setting national policy will dramatically increase, with huge diplomatic consequences.

President Bush’s unusually strong affinity for Sharon has everything to do with the Israeli leader’s tough and uncompromising response to terrorism, nothing to do with his longtime advocacy of settlements, which this administration, like its predecessors, continues to regard as an impediment to any peace process.

Rep. Tom DeLay (R-Texas), the House majority leader, may identify with Israeli settlers, but the core of Israel’s political support on Capitol Hill has little sympathy for Israel’s not-one-inch crowd.

Since Sept. 11, the American public has gained a better understanding of the problems Israel faces. But that new sympathy could evaporate if Sharon is defeated by a small band of settlers regarded here as ideological and religious zealots.

There are also potential communal consequences.

The Jewish community has long been divided over the best route to peace in the region, but it has mostly put those divisions on hold since the resumption of widespread Palestinian terrorism in 2000.

Sharon has been a divisive figure over his long career, but by and large American Jews have stood behind his government as it confronts terrorists and a Yasser Arafat that even avid doves concede is not a fit partner for peace.

But beneath today’s veneer of unity, the Jewish community is more divided than ever. An increasingly vocal minority, backed by powerful friends in the Christian community, reject any new territorial concessions. But a majority still support the concept of land for peace negotiations, although many remain skeptical about the current Palestinian leadership.

A failure by Sharon to put over the plan will bring those divisions back into the open and intensify them as American Jews choose up sides in the fight between settlers and mainstream Israel.

The groups that call the Gaza plan a “surrender” or “retreat” plan may be among the loudest in Jewish life today, but it’s the Jewish mainstream that Israel relies on as the foundation of its political support in this country.

That foundation, as well as relations with a sympathetic administration, is at risk as Sharon fights the most difficult battle in a life of difficult battles.

Israel Worried About U.S. Iraq Withdrawl


As Shiite and Sunni resistance to the American presence in Iraq intensifies, Israel’s defense establishment is worried that a U.S. withdrawal under fire could have devastating consequences for the battles against weapons of mass destruction and global terrorism.

And Israel could be one of the big losers: Israeli officials believe a loss of American deterrence would encourage Iran to continue its nuclear weapons program, and its support for terrorism could lead to a hardening of Syrian and Palestinian attitudes against accommodation with Israel and could spark more Palestinian and other terrorism directed against Israeli targets.

Without American deterrence and a pro-Western Iraq, the officials say, Israel might have to rethink its attitude on key issues like the concessions it can afford to make to the Palestinians, its readiness for a land war on its eastern front and the size of its defense budget.

But there is an opposing, minority view in Israeli academic and intelligence circles: The quicker the Americans leave, this view holds, the quicker the Iraqis will have to get their act together. And once they do, they will not necessarily pose a threat to Israel or the West.

Israeli Defense Minister Shaul Mofaz summoned a meeting in early April of Israeli intelligence services and other branches to discuss the implications for Israel of the unrest in Iraq. Some of the analyses were bleak.

When the United States launched a war on Saddam Hussein’s regime in March 2003, Israeli military planners hoped for several significant gains.

Saddam’s defeat and the destruction of the Iraqi war machine would remove the threat of hundreds of Iraqi and Syrian tanks rumbling across the desert to threaten Israel’s eastern border, officials believed. They also hoped for a domino effect that would lead Syria and the Palestinians to seek accommodation with Israel, countries like Iran and Libya to rethink their nuclear weapons programs and terrorist organizations like Hezbollah, Hamas and Islamic Jihad to exercise restraint.

In the first year after the war, some of that seemed to be happening. Now some Israeli intelligence analysts fear a reversal of these processes, with all the attendant dangers for Israel.

In the meeting with Mofaz, there was a general consensus that if American deterrence in the region is weakened, Iran, Syria, Hezbollah, Hamas and Islamic Jihad all will be encouraged to mount or incite even more terrorism against Israel.

Some officers expressed fear of possible Iranian intervention in southern Iraq on the side of the Shiites, if the situation degenerates into war between the Sunni and Shiite populations after a hasty American withdrawal. That could lead to a radical Shiite regime in Iraq, similar to the one in Iran.

If such a radical Iraq were to emerge, some officers suggested, Israel might have to reconsider the huge cuts in the size of its tank forces that it planned after the destruction of Saddam’s army last year. That could impact the key defense budget, which was slashed last year and again this year as part of a general government austerity program.

A loss of American prestige in the region, some officials said, also could impact countries with pro-American regimes like Egypt and Jordan, and might mean that American guarantees to Israel in the context of the Israeli-Palestinian conflict would carry less weight.

In general, American attempts to stabilize the Middle East would suffer a huge setback, with potentially harsh consequences for Israel and the West. The two main goals of the U.S.-led war — curbing the proliferation of nuclear weapons in rogue countries such as Iran and striking a blow against global terrorists such as Al Qaeda — could be reversed.

In an interview with the Yedioth Ahronoth newspaper, Mofaz echoed these concerns, saying, "America’s success in Iraq is essential for world peace. If the Americans manage to stabilize the situation in Iraq — and we in Israel believe they will — that will have a positive impact on the Middle East as a whole, on the world oil market and on the prestige of the international community."

But, he cautioned, "if the Americans are forced to withdraw in the wake of terrorist pressure, a new and dangerous model of Arab regime will be created. The axis of evil will lift its head, and it could threaten world peace."

Some Middle East experts in Israeli academia and the military take a more sanguine view, however. They argue that if the Americans withdraw soon after the handover of power to the Iraqi Provisional Council, scheduled for June 30, Iraq’s Sunnis and Shiites would reach a modus vivendi on shared rule to keep the country from plunging into chaos.

They ask: Would a new Iraqi regime — even if radical Shiites are a dominant part of it — adopt a provocative, anti-Western stance after what happened to Saddam? If they did, who would rearm them? And without sizable quantities of sophisticated weaponry, how could they threaten Israel or the Western world?

Surely, these experts reason, any new Iraqi regime would prefer to tap America’s willingness to reconstruct Iraq and allow oil revenues to create a basis for new prosperity. They argue that an orderly American withdrawal, announced well in advance, would do more for American prestige in the area than an ill-fated attempt to crush the dissident Iraqi militias.

But this is a minority view in Israel, and similar predictions of rational Arab moderation — such as the thinking that led to the creation of the Palestinian Authority — have proven wrong in the past. Most members of the government, the defense establishment and the intelligence community believe America should maintain its military presence in Iraq in an effort to create a Western-leaning regime there and through it, a new and more stable Middle East.

When President Bush says, "America will stay the course," they take heart.

Blessings Over Curses


This week’s Torah portion presents the blessings and curses that follow from observance or defiance of the law. Some people understand this as a rigid system of reward and punishment. Keep the covenant, and all will be well; violate it, and you will suffer.

The blessings and curses can also be read as a loving explanation of consequences. When a doctor warns a diabetic that eating sugar will make him sick, she is trying to help him, not wishing him ill. Torah laws are instructions for how to live in the world from the One who created the world.

Curiously, in Ki Tavo, as in parallel ancient Near Eastern texts, curses far outnumber blessings. But maybe the weighting of blessings and curses is not as disproportionate as it seems.

The whole premise of the High Holidays is that forgiveness is more powerful than a grudge. Repentance conquers sin. Good is stronger than evil. "The wicked spring up like grass" — quick to grow and easy to trample. "The righteous grow like a cedar" — slow to mature, but substantial and enduring (Psalm 92:8,13).

So, too, blessings carry more weight, and last longer, than curses.

In the holiday liturgy, we recite from Exodus 34:6-7, "Adonai, Adonai, merciful and gracious God, patient and abounding in goodness and truth. Keeping lovingkindness to the thousandth generation, forgiving iniquity…." We emphasize God’s blessings using God’s own self-description.

But verse seven continues: "Yet by no means clearing the guilty; visiting the iniquity of the ancestors upon the children, and upon the children’s children, to the third and fourth generation." The prayer quotes only the blessing, but children inherit iniquity.

No less a figure than Jeremiah objected: "They shall say no more, ‘The fathers have eaten sour grapes, and the sons’ teeth are set on edge.’ But everyone shall die for his own iniquity" (Jeremiah 31:28-29).

In truth, if not in justice, the curses of sin are commonly passed down for three and four generations. A man beats his daughter, and it affects her parenting. Her wounds wound her child. Then that child raises children, reacting to, and perhaps passing on, the consequences of a grandfather’s sin. Certainly, the cycle can be broken, but three and four generations live and make choices in the shadow of the sin. Our verse is not prescriptive: here is your punishment for an ancestor’s sin. Rather, it is descriptive: here is a lesson about how sin works in families.

It is harder to understand the blessing. Can we really fathom that God’s grace lasts 1,000 generations? Is lovingkindness that powerful?

When I study Torah, I feel my zeyde’s zeyde with me. Something ineffable — love, communal memory — is passed down with the text. The principle of zechut avot says that we inherit the merit of our ancestors for an unlimited number of generations. No explanation sounds complete or logical — the merit inspires us, it rubs off on us, it shapes our collective unconscious, it delights God. Yet, I have sensed, as I hope you have, that when a crowd gathers on the High Holidays, it is not just the people in the room who are present. Past generations assist us in the work of repentance and forgiveness. Their loving energy remains long after any sins and torment have dissipated.

Lovingkindness enjoys not just longevity, but immediate power. As a rabbi, I have witnessed devastating passages that most of us, thankfully, will never experience. Parents stand by their child’s hospital bed, praying for healing and, if not, at least for release from pain. An accident wipes out a young father’s memory, so that he cannot hold a job — or a coherent conversation.

In such terrible situations, people become exquisitely sensitive to blessings. Sometimes blessings can even eclipse the suffering. Every kindness by neighbors and nurses, every moment of peace and clarity, is felt keenly and deeply. Through the pain, love touches the heart and revives the soul.

High Holiday liturgy and theology acknowledge two types of blessings and curses. There are blessings we merit by practicing repentance, prayer and charity in the face of our own troubles. And there are blessings gifted to us by God’s grace. There are curses we bring on by our own poor choices. And there are "natural" curses — fallout from prior generations, random suffering we cannot explain or justify, and death itself. Life’s blessings make the curses bearable. Blessings have a unique power, regardless of whether they — or we — can fix everything.

This season, we seek to control what we can. We challenge ourselves: What harm am I committing or perpetuating — to others and to myself? How can I maximize blessings in the world?

The Talmud Megillah teaches: "[We read Ki Tavo] before the New Year … so that the year may end along with its curses."

By our actions and God’s mercy, may the coming year bring blessing, life and peace.


Rabbi Debra Orenstein is spiritual leader of Congregation Makom Ohr Shalom in Tarzana.

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