Okay, I have this vivid memory of sitting with a bunch of colleagues in a doctors’ lounge in Beauvais, France, trying to figure out why we had inflicted upon ourselves the punishment of studying medicine and then practicing it for a living. There were a couple of guys who wanted to be missionaries; really religious folk. Others discussed the exalted status of the doctor in the community, the money that went with it, etc. When it came to a choice of specialty, there was a lot of discussion, even then and even in France, about the difficulty of the studies, of developing a practice, of making a living. Rarely there was a feeling of passion. This was viewed as naive. I remember a woman who wanted to go into oral surgery because she believed that the human spirit was lodged in the teeth (Really). A woman who wanted to be a cancer doctor because her mother had died of cancer far too young. And there was me, the “brain freak,” granted there was a Jewish idea of public service and healing humanity. But my passion for the brain was (and is) real. How it works and what it does to behavior are things I find passionately consuming as well as sacred. Some of the French doctors laughed; others just smiled. I guess they figured I would grow out of it.
As I write this, I am wearing a heart-shaped wristwatch, with a picture of a sagittal section of the human brain.
The point here is that I have never, once, met anybody who had the missionary zeal for–prescribing marijuana. So I am not terribly excited or surprised to learn that it may attract some suboptimal physicians. What I know about the list of illnesses for which it may be prescribed, well, it kind of looks like a list of all illnesses. Especially common ones and psychiatric ones. Headaches? I would go for the aspirin or Tylenol first. Mood stabilization in bipolar? Years ago I had a minor telephone tussle with a doctor in the San Francisco area who admitted that although he had invented a device to measure aspirated marijuana, patients just used to intoxication. We need to be open about this. Most people I know just use the “medical” moniker as an excuse for intoxication.
I love these guidelines, so governmental and official and all, kind of like insurance reimbursement guidelines. If even a small bit of what my patients tell me is true, nobody has any interest in guidelines.
It is kind of like a TV ad, allegedly the first for a marijuana clinic. My response now is the same as then in that there is,quite simply, no discussion of advantages and risks. This is not a regulated field.
It cannot be a terribly difficult specialty to learn. It does not seem to be governed by a specialty board, either. The more I ask my patients, the less I find. They have never been told about dangers. I remember reading some time ago that this stuff is about four times more carcinogenic than tobacco, that all the abusers from the 60′s are discovering throat cancers and the like about now. More in the psychiatric ballpark, there is the ever popular amotivational syndrome. Every single patient I can think of right now, well, I have told all of them that prescription drugs or supplements or whatever else has not been tested with pot; something that does not seem to impress anyone. Every single one of them is somehow “dead in the water” with their attempts to start a business or go to school or do much of anything. I don’t think any of them does a lot of getting out of the house.
Little training and at least relatively high financial return. Why is anybody surprised a few substandard doctors showed up for this one?