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How Pot Became Demonized: The Battle Between Politics and Science over the use of Marijuana as a Medicine 5-13-08
The following is an excerpt from "Dying to Get High" by Wendy Chapkis and
Richard J. Webb (NYU Press, 2008).
For many modern critics, the concept of "medical marijuana" is a contradiction
in terms. Medicine is standardized, synthetic, and pure; marijuana involves the
unrefined and promiscuous coupling of more than four hundred components rooted
in the dirt. Medicine -- in its most powerful and privileged forms -- rests in
the hands of men, while the most potent form of marijuana is found in the female
flowering plant. Medicine engages in heroic battles against death. Marijuana
claims only to enhance the quality of life.
Medicine presents itself as an objective science safeguarded by the ritual of
the double-blind, randomized clinical trial. The therapeutic value of marijuana
relies largely on the "soft science" of subjective experience and anecdotal
evidence. From the perspective of its critics, then, cannabis is an effeminate
interloper in the masculine world of real medicine, a dangerous drug pushed on a
credulous public by illegitimate quacks.
But this story is too simple. The line separating regular doctors from snake oil
salesmen, good drugs from bad, is as much the product of politics as it is of
science. The dominance of politics in determining the value of marijuana as a
medicine was first demonstrated in the 1930s when the federal government began
to restrict the medical use of marijuana, against the recommendations of the
American Medical Association (AMA).
The struggle between politics and science over the use of cannabis as a medicine
continues. In the final decade of the twentieth century, the federal government
threatened physicians with the loss of their license for recommending marijuana
to patients, made criminals of patients who followed their doctor's advice, and
actively blocked scientific research into the therapeutic value of cannabis,
while insisting that it was an established scientific fact that marijuana is not
a medicine.
During the opening of a 2004 congressional hearing on medical marijuana, this
ongoing battle over cannabis was described by committee chair Rep. Mark Souder
(R-IN) as a critical front in the War on Drugs and consistent with the
modernization of medicine:
This hearing will address a controversial topic, the use of marijuana for
so-called medicinal purposes. In recent years, a large and well-funded pro-drug
movement has succeeded in convincing many Americans that marijuana is a true
medicine to be used in treating a wide variety of illnesses .... Marijuana was
once used as a folk remedy in many primitive cultures, and even in the 19th
century was frequently used by some American doctors, much as alcohol, cocaine,
and heroin were once used by doctors. By the 20th century, however, its use by
legitimate medical practitioners has dwindled, while its illegitimate use as a
recreational drug has risen. Souder thus sets the stage for a morality tale
populated by primitive practitioners and legitimate doctors, dangerous drug
fiends and decent drug warriors.
Fox News personality Bill O'Reilly invoked a similar cast of characters in his
2004 discussion of medical marijuana with U.S. Deputy "Drug Czar" Dr. Andrea
Barthwell. That year, voters in Oregon were to be presented with a ballot
measure to amend their state's already-existing medical marijuana law. The
proposed amendment (which ultimately failed) was intended both to increase the
amount of marijuana a patient could have over the course of a year and to
redefine which health professionals could legally recommend marijuana for
medical use.
O'Reilly scoffed at the idea that licensed health practitioners other than
physicians might be authorized to recommend the use of cannabis to their
patients: "Even a shaman could grant permission for you to toke in Oregon. I
mean, this is, you know, any health practitioner. So you're a shaman from the
Amazon and you set up shop. Come on, I mean, everybody knows this is a ruse. Am
I wrong?" Andrea Barthwell confirmed for viewers that O'Reilly's concerns were
quite legitimate: "No, you're absolutely right, Bill. This is what we've been
trying to make clear to people when they have these proposals presented to them.
This is not about getting medicine to people who are sick and dying. This is
about making marijuana legal."
While both host and guest shared the belief that the Oregon proposal was no more
than a thinly disguised attempt to legalize marijuana, O'Reilly asked whether
cannabis itself might not be a legitimate medicine if prescribed by a legitimate
physician to a patient with a legitimate need: "But there is a legitimate issue
here, Doctor. We had Montel Williams [another popular TV talk show host] on a
few weeks back. He has MS [multiple sclerosis]. And I believe Montel Williams
when he says, 'Look, medical marijuana helps me, helps me cope with this
disease, cope with my suffering. There's no reason why I should be denied it.'
And I agree with Montel Williams that if this is the case, if a doctor -- a
doctor -- says that he needs it for his MS, he should have it. You don't
disagree with that, do you?" Barthwell's response was uncompromising: "Well, I
do, actually. There is nothing that tells us from the science now that smoked,
crude botanical should be a medication. We have a process that has been in place
for 100 years in this country that protects the sick and dying from snake oil
salesmen. And just because something makes you feel better doesn't make it
medicine."
In this short exchange, the terms of the debate for dismissing cannabis
therapeutics are neatly laid out: medical marijuana is a ruse; cannabis is the
modern day equivalent of "snake oil"; "crude botanicals" are not real medicine;
licensed alternative health practitioners are not legitimate healers; marijuana
is reduced to and synonymous with smoking as a delivery system; and "feeling
better" isn't always therapeutic. Taken together, these claims create a neat
division between marijuana and "real medicine," with medicine narrowly defined
as that which is practiced by physicians prescribing pharmaceuticals to patients
who will not necessarily feel better as a result.
The rise of "regular" medicine and the battle against botanicals
According to Dr. Raphael Mechoulam, an Israeli research chemist who performed
much of the original work in the early 1960s isolating the active ingredients in
marijuana: From ancient times to the early 20th Century, cannabis was used for a
wide variety of medical purposes including the treatment of pain and swelling,
depression, arthritis, impotence, kidney stones, hemorrhaging in childbirth,
irregular bowel movements, cold sores, distending stomach, dropsy, headaches,
diseases of the respiratory organs, hysteria, neuralgia, sciatica, tetanus,
dysentery, fatigue, disorders of the female reproductive system, convulsions,
cholera, delirium tremens, vomiting, spasmodic asthma, and a host of other
ailments. Most of these therapeutic claims were either based on folklore or were
anecdotal, but the use of cannabis as a therapeutic agent in the past provides
an insight for future drug development. More recently, some of the historical
therapeutic properties of cannabis have been verified with pure natural or
synthetic cannabinoids; however, in several fields no modern scientific work
exists.
In order to understand why marijuana, a promising medicinal botanical, should
now be excluded not only from the modern pharmacopeia but also from much formal
scientific study, it is necessary to ask why some drugs, but not all, get
labeled "medicine"; why some healers, and not others, are "regular doctors"; why
some effects, but only some, are understood as "therapeutic"; and why some risks
are acceptable while others are prohibited under penalty of law. The answers
cannot be found in a simple appeal to scientific standards. Instead, in order to
understand what counts as "legitimate" medicine, it is useful to ask who, beyond
the patient, might benefit from such distinctions. In our exploration of the
role of organized medicine, state regulatory agencies, the courts, and the
pharmaceutical industry in the demonization of marijuana, the intent is not to
perform the reverse process, demonizing modern medicine. Over the past century,
during which organized medicine consolidated its authority and cannabis was
first marginalized and then removed from the pharmacopeia, astonishing medical
advances have been made. Unquestionably, the public would be ill served by a
return to a time of unregulated medicine practiced by poorly trained doctors
with recourse to few effective drugs.
Nonetheless, it is also the case that the healing arts remain an impure science.
The most striking difference between marijuana and "real medicine" is not the
physical but the social effects the plant has on users and healers alike.
Association with marijuana marks those it touches as illegitimate -- a
distinction with deep historical roots. Prior to the professionalization of
medicine, lay healers -- often women -- made extensive use of medicinal plants.
But as modern medicine moved into the ranks of the professions, and into hands
of men, botanicals were discredited along with the women who had used them. In
their path breaking study of the rise of the male medical expert, For Her Own
Good, Barbara Ehrenreich and Deirdre English note that, in the fifteenth and
sixteenth centuries, anxiety over women's knowledge of medicinal botanicals
contributed to the European witch hunts: charges against the accused often
included the provision of herbs.
In Colonial America and the early republic, health and healing practices also
rested largely in the hands of lay women practicing herbal medicine. Historian
Carol Smith-Rosenberg observes that "women as midwives and as family nurses,
women wise in the ancient herbal pharmacopoeia, had always cared for their own
and neighboring families. A survey of cookbooks and women's diaries for the
eighteenth and early nineteenth centuries shows that women collected and
exchanged recipes for medicines as routinely as they did for pies and cookies."
By the nineteenth century, however, as medicine entered the marketplace, male
physicians with little formal training claimed for themselves the designation
"Regular doctor" while moving all others to the margins of the healing arts. In
North America, midwives, bonesetters, and "root and herb" doctors were thus
gradually displaced by the self-proclaimed "Regulars," not through the violence
of witch burnings, as happened in Europe, but rather through professionalization.
This challenge was, according to Ehrenreich and English, "at bottom, economic.
Medicine in the 19th century ... [became] a thing to be bought and sold."
Professionalization required that the Regulars distinguish themselves from
midwives and herbalists; they did so through "heroic medicine," a practice
involving dramatic (though not necessarily beneficial) techniques such as
bloodletting, blistering, purging, and the use of toxic mercury-based medicines.
These interventions were intended to produce "the strongest possible effect on
the patient." Though such therapies were not only dangerous and often
ineffective, Ehrenreich and English observe that they gave "regular doctors
something activist, masculine, and imminently more salable than the herbal teas
and sympathy served up by rural female healers." In fact, despite the very
serious risks of heroic medicine, Smith-Rosenberg notes that the Regulars
insisted that it was they who were protecting "the lives of innocent citizens
from ill-trained, irresponsible 'irregulars,' and hysterical midwives."
The Regulars prospered during the first two decades of the nineteenth century
and succeeded in securing licensing laws in many states restricting the practice
of medicine to those in their ranks and limiting membership to men. But growing
dissatisfaction with the results of "heroic medicine," and populist misgivings
about monopolies and elites, led to the temporary repeal of such laws during the
1830s. The "Popular Health Movement" of the period challenged the position of
Regulars by emphasizing "self-help" (through better hygiene and healthy living)
and by embracing the therapeutic approaches of alternative medical sects,
including those advocating botanical treatments.
As sociologist Carol Weisman notes, under the banner of science, Sectarians or
Irregulars "were attacked by mainstream physicians as 'quacks,' although the
therapeutics of the regular physicians were not generally more effective than
those of the irregulars." The Regulars reinforced their claim that they, and
they alone, were legitimate physicians by founding a national professional
organization in 1847 -- the American Medical Association -- explicitly excluding
both women and sectarian practitioners.
In the second half of the nineteenth century, economic competition intensified
as both Regulars and their rivals -- now known as the "Eclectics" -- opened
medical schools to train practitioners. The Eclectics, who advocated the use of
botanical therapies, also represented a more populist and egalitarian politics
-- for example, they admitted women to their medical schools. During this same
period, in 1854, cannabis joined other herbal remedies in the national
pharmacopeias and was freely prescribed for a large number of medical conditions
ranging from insomnia to neuropathic pain. In the late nineteenth and early
twentieth centuries, dozens of research papers were published on the various
medicinal uses of marijuana.
This corresponds to a period in which Regulars began to consolidate the power of
the newly organized medical profession, in part by absorbing Eclectics into
their ranks. As Paul Starr observes in his landmark study, The Social
Transformation of American Medicine, Eclectics "succumbed to quiet cooptation;
they were only too glad to be welcomed into the fold." By co-opting much of the
opposition, physicians were able to secure new licensing laws restricting the
practice of medicine. But Eclectics paid a significant price; with the
consolidation of control by conventional medicine, botanical therapies were
increasingly marginalized by mainstream medicine.
The allopathic approach of the Regulars was not only dominant but also
institutionalized in the early twentieth century when organized medicine
completed its process of professionalization by gaining control over medical
education, access to hospitals, and the right to prescribe drugs. The dominance
of this paradigm was reflected in the growing strength of the American Medical
Association. In 1900 the AMA had no more than eight thousand members, but by
1910 membership reached seventy thousand, and by 1920 the majority of physicians
in the United States had become members. In fact, by 1931 only about 5 percent
of all cases of illness were handled by non-MD practitioners.
This exponential increase in the power and professional authority of regular
doctors surprisingly did not rest primarily on the provision of more effective
medicines; these were slow to be developed. Instead, doctors were forced to find
other ways to assert their newly established social and cultural legitimacy. One
strategy was to position themselves as experts in not only the physical but also
the moral health of the nation. In the nineteenth century, condemnation of birth
control and abortion, for instance, provided physicians with a clear moral
platform that allowed them to denounce practices still largely in the hands of
"irregulars." According to Carol Smith-Rosenberg, these efforts to limit women's
reproductive choices became a key arena "in the war between the allopaths and
the 'irregulars' for patients and for power .... The 'irregular' physician and
the 'irregular' wife, the 'regulars' insisted, conspired together against public
order and national well-being." As Carol Weisman observes, this claim of medical
and moral expertise "provided regular physicians with an element of social
respectability and moral authority, which was enhanced by publicly criticizing
the abortion practices of other practitioners and the crass commercialism of
purveyors of contraceptives and abortifacients."
At the end of the nineteenth century, flush with its legislative success against
abortion, the AMA turned its attention to another arena that neatly linked
morality and public health: the provision of drugs. Physicians enhanced their
professional authority by speaking out against the dangers of addictive drugs
frequently found in "patent medicines" and available directly to the public.
Because the formulae of proprietary medicines were secret, it was impossible for
patients to judge the safety of those drugs. The practitioners of organized
medicine thus joined forces with muckraking journalists to bring to the public's
attention the possible risks of patent medicines. This important public service
had a significant payoff for the profession as well, reinforcing a growing
distinction in the public mind between good drugs (dispensed by doctors) and bad
drugs (available directly to the public by unlicensed practitioners).