Dan Shapiro was the first person I knew to use medical marijuana. As a junior at Vassar College in 1987, he was being treated for Hodgkin's lymphoma with potent chemotherapy that caused severe nausea and vomiting. When Dan's mother learned that smoking marijuana could relieve the distressing side effect, to help her son, this otherwise law-abiding woman planted a garden full of the illegal weed in her Connecticut back yard. Decades later, marijuana as medicine has become a national phenomenon, widely accepted by the public. Although the chemical-rich plant botanically known as Cannabis sativa remains a federally controlled substance, its therapeutic use is now legal in 36 states and the District of Columbia. [continues 1006 words]
Do you have the heart to safely smoke pot? Maybe not, a growing body of medical reports suggests. Currently, increased smoking of marijuana in public, even in cities like New York where recreational use remains illegal (though no longer prosecuted), has reinforced a popular belief that this practice is safe, even health-promoting. "Many people think that they have a free pass to smoke marijuana," Dr. Salomeh Keyhani, professor of medicine at the University of California, San Francisco, told me. "I even heard a suggestion on public radio that tobacco companies should switch to marijuana because then they'd be selling life instead of selling death." [continues 1034 words]
U.S. Legal Classification Prevents Exploring Many Promising Elements Marijuana has been used medically, recreationally and spiritually for about 5,000 years. Known botanically as cannabis, it has been called a "crude drug": marijuana contains more than 400 chemicals from 18 chemical families. More than 2,000 compounds are released when it is smoked, and as with tobacco, there are dangers in smoking it. Medical marijuana clinics operate in 20 states and the District of Columbia, and its recreational use is now legal in Colorado and Washington. A Gallup poll conducted last month found that 58 percent of Americans support the legalization of marijuana. [continues 515 words]
The death of Libby Zion, an 18-year-old college student, in a New York hospital on March 5, 1984, led to a highly publicized court battle and created a cause celebre over the lack of supervision of inexperienced and overworked young doctors. But only much later did experts zero in on the preventable disorder that apparently led to Ms. Zion's death: a form of drug poisoning called serotonin syndrome. Skip to next paragraph Stuart Bradford Ms. Zion, who went to the hospital with a fever of 103.5, had been taking a prescribed antidepressant, phenelzine (Nardil). The combination of phenelzine and the narcotic painkiller meperidine (Demerol) given to her at the hospital could raise the level of circulating serotonin to dangerous levels. When she became agitated, a symptom of serotonin toxicity, and tried to pull out her intravenous tubes, she was restrained, and the resulting muscular tension is believed to have sent her fever soaring to lethal heights. [continues 1033 words]
Patients with debilitating pain from chronic illness, accidents, surgery or advanced cancer have long had problems getting adequate medication to control their pain and make life worth living. Now the federal government, and especially the Drug Enforcement Administration, is working overtime to make it even harder for doctors to manage serious pain, including that of dying patients trying to exit this world gracefully. In an article in the current New England Journal of Medicine titled "The Big Chill: Inserting the D.E.A. into End-of-Life Care," two specialists in palliative care, Dr. Timothy E. Quill and Dr. Diane E. Meier, state that despite some physicians' commitment to treat pain and despite the effectiveness of opioid drugs like OxyContin and morphine, "abundant evidence suggests that patients' fears of undertreatment of distressing symptoms are justified." [continues 1050 words]
The dozens of letters, phone calls and e-mail messages I've received since writing my recent columns on total knee replacement and pain management reveal that I struck a chord. Some readers chastised me for scaring potential patients away from this surgery, which, when healing is completed, can greatly enhance quality of life. But many others praised me for "telling it like it is" about an often painful and difficult recovery that surgeons don't warn patients about. Clearly I've not been alone in having prolonged, debilitating postoperative pain that was not adequately treated. [continues 1045 words]
For all that has been written and spoken about addiction as a medical disease, most people, including most physicians, understand little about what draws people to drugs and keeps them hooked, often despite severe consequences and repeated attempts to quit. A better understanding of the pull and tug of addiction can help those who are hooked and those who want the monkey off their backs for good. The savings in life-years, quality of life and lost income can be huge, not to mention the costs of drug-instigated crime and medical care. [continues 1019 words]
Chronic pain suffered by 30 million Americans robs people of their dignity, personality, productivity and ability to enjoy life. It is the single most common reason people go to doctors, contributing to an overall cost to the economy of billions of dollars a year. Yet chronic pain, whether caused by cancer or a host of nonmalignant conditions, is seriously undertreated, largely because doctors are reluctant to prescribe -- and patients are reluctant to take -- the drugs that are best able to relieve persistent, debilitating, disabling pain that fails to respond to the usual treatments. [continues 1110 words]
Chronic pain suffered by 30 million Americans robs people of their dignity, personality, productivity and ability to enjoy life. It is the single most common reason people go to doctors. Yet chronic pain, whether caused by cancer or a host of non-malignant conditions, is seriously undertreated, largely because doctors are reluctant to prescribe -- and patients are reluctant to take -- the drugs that are best able to relieve persistent, debilitating, disabling pain that fails to respond to the usual treatments. These drugs are called opioids -- narcotics -- and many studies have indicated that ignorance and misunderstanding impede their appropriate use. [continues 501 words]
Doctor's Story of Hope, Humor and Deadly Cancer In May 1987, Dan Shapiro, then a 20-year-old junior at Vassar College, discovered he had Hodgkin's disease. After seven months of treatment with four chemotherapy drugs and radiation, he seemed healthy again. In 1988, in his first year of graduate school in clinical psychology, he counseled a young girl named Jodi who was not doing well after a bone marrow transplant for the same cancer and who soon died. Six months later, he learned that his own cancer had returned and that his only hope was a bone marrow transplant. His survival chances were 40 percent. Sixteen months after the transplant, in July 1991, he had a second relapse, and few options remained. [continues 1617 words]
