There are certain issues that originate as medical debates but are hijacked by politicians and the media. There are some issues such as euthanasia that deserve a wider platform than the one offered in the medical world. Other medical issues are turned into a public circus simply due to the prejudices of politicians. One such issue centers around the use of an herbal medicine derived from the cannabis sativa plant, known more popularly as marijuana. The medical uses of marijuana have been known for some time, but the scientific veracity of the claims of its proponents have been compromised by the forces that are suspicious of its use. This suspicion is not based on doubts about the scientific legitimacy of the claims made by researchers and patients. It is based on a fundamental distrust of the plant and a feeling that this is some sort of scam by a bunch of potheads to legitimize a dangerous drug.

The debate in the United States has been particularly noisy, bitter and personal. This should be of no surprise. Loud public debates of controversial issues are a feature of American public life, and this is generally a positive force in their democratic process.

There are several areas where it has been suggested that marijuana may have a place to play in the care of patients. Glaucoma is an eye condition caused by too much internal pressure in the fluid of the eye. Patients can gain relief from this condition with this medication. It has been found to be useful in combating the nausea and vomiting caused by chemotherapy for cancer. It has also been found to increase the appetite and enjoyment of food in these patients and also patients suffering from the wasting effect of AIDS. There are reports that it has been found useful in the treatment of neurological movement disorders and can relieve the spasticity caused by these diseases.

I am not going to analyze the data on these claims for it is not my intention to plead for the use of marijuana in these or other conditions. These claims should be investigated with the same scientific honesty and objectivity that any other proposed form of treatment would receive. This has not been the case. The director of the Office of National Drug Control policy, the drug "Czar" makes it difficult for any research to be carried out as he feels that this is an illegal substance and should not be used in the care of patients. In spite of the fact that seven states have legalized the drug in certain situations, the US Congress has voted not to allow this to happen. It is not only in America that this is happening. Other countries have been equally reluctant to investigate the potential of this medication.

One of the areas that needs to be researched are means of administration. Socially, marijuana is usually smoked. It can be taken in other forms, as a pill or a drink. At the University of Mississippi a marijuana rectal suppository has been developed. All this research has proved to be difficult as the substance is technically illegal, and it is difficult to have trials approved.

The leading prejudice about marijuana is not so much the effects of the drug itself. It is regarded with suspicion as it is thought to be a "gateway" drug. It is said to lead to the use of more harmful street drugs. Statistics show that people who are addicted to hard line narcotics usually smoked marijuana prior to starting the more harmful substances. I would suggest that they probably also ate chocolate ice cream before starting on these substances, but there is no effort to ban ice cream.

Marijuana is not a completely benign substance. It probably is less of a threat to the health and life of a patient than tobacco, but it has some worrying effects. In some users marijuana can trigger mood disturbances such as depression or mania. It can worsen schizophrenia and with long term use is associated with apathy, loss of motivation, impaired intellectual performance and behavioral changes. In any research project the risk of these effects would have to be balanced against any apparent advantages.

I am not urging the decriminalization of marijuana, although there are some arguments for this. I do feel that there may be some positive uses for it as a medical drug and it should be evaluated in exactly the same way as any other pharmaceutical.

This column was contributed by Dr. Moreton, an Obstetrician and Gynecologist at Beijing United Family Hospital. Have a medical question? Email it in to ed@beijingscene.com