Philly420: Pennsylvania Medical Society misdiagnosing medical marijuana

Why does the powerful lobbying group oppose its use for medical purposes?

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The lobbying group for Pennsylvania doctors opposes medical marijuana legislation, at least until more federal research is done.

The Pennsylvania Medical Society (PAMED), one of the largest lobbying groups in the state, has issued yet another press release about medical marijuana.

This time, they make a special appeal to the federal Food and Drug Administration (FDA) to reclassify and research cannabis. What they are adamantly against is legislators in Harrisburg passing a compassionate access bill. Their politicking on the issue is a confused strategy.

On Jan. 19, a letter was sent by PAMED President Scott Shapiro to Dr. Stephen Ostroff, the acting Commissioner of the FDA. It came on the heels of the Drug Enforcement Administration announcing that a single compound, CBD — not whole plant cannabis — would be slightly more available for a handful of human trials. The move will have no impact to bring meaningful relief to Pennsylvania patients. From the letter:

"Given your prior service at the Pennsylvania Department of Health we are sure you are aware of the high profile political debate at the state level, particularly in Pennsylvania, on the issue of the medicinal use of cannabis. With legislation to legalize medical cannabis currently pending and likely on the verge of passage in some form in our state legislature, PAMED is hopeful that the DEA announcement may serve to slow down the process of state legislation on marijuana legalization in favor of FDA-approved clinical research on cannabis and rescheduling of the substance."

Legislative advocates and patients alike want to use marijuana for a number of illnesses and conditions despite incomplete and limited FDA research on its safety and efficacy. PAMED members have indicated that they prefer additional research and clinical study on the medical use of cannabis before the Commonwealth moves to permit its medical use.

Ostroff was once the acting physician general for Pennsylvania and most recently served as the chief scientist at the FDA. 

Of course, the process for medical marijuana in Pennsylvania could not be any slower. It is currently deadlocked in the House.

Those with HIV, cancer, epilepsy or other potentially qualifying conditions have watched the General Assembly fail at passing a bill since 2009. Tens of thousands of Pennsylvanians already utilize underground cannabis, and thousands more have simply moved away to states that do not criminalize their choice of therapy.

State Sen. Mike Folmer, R-Lebanon, the sponsor of the bill, expressed his deep concern at the lack of progress this week. In a passionate floor speech on Jan. 26, Folmer also took on the PAMED letter, specifically.

"I was told we were going to get a vote in October [2015]. I was told we were going to get a vote in November. And definitely by the first week of December. Those months have come and gone," said Folmer.

Folmer went on to point out that the United States makes up 5 percent of the world's population, but uses 70 percent of the available prescription opiates. He pointed out that the FDA recently allowed 12-year-old children to receive Oxycontin.

"In every state that uses cannabis for chronic pain management their prescription drug overdose deaths are down 25 percent," said Folmer citing a study performed by the University of Pennsylvania Perelman School of Medicine.

Folmer then described various FDA approved medications that are used to treat pediatric epilepsy that have serious, even fatal, side effects. He wondered aloud why cannabis was being withheld.

Folmer told the story of a child in the Harrisburg area whose parents have been breaking the law and giving her cannabis oil. The girl's seizures have greatly dissipated over the last 16 months and she has started to learn math and reading for the first time.  

Cannabis says Folmer has "has helped the cognitive ability of this child to function to as near normalcy as possible. So where's that harm?"  

He went on to bring up the issue of military veterans committing suicide and abusing painkillers in his appeal to pass the medical marijuana bill. 

"All this talk on we need more studies, we need to wait on the FDA, we need to wait on the FDA is nothing more than delay tactics," said Folmer.

The appeal for limited federal reform is indeed a common approach used around the country by opposition groups. On the surface, the request seems almost reasonable. But dig deeper into the details and the red herring is revealed.

First, the FDA simply does not tend to regulate whole plants for medical uses. While a small handful of drugs are plant-derived, the vast majority of drugs on the market are synthetic chemicals. The FDA states in their Botanical Drug Overview that after 400 submissions a total of just 2 plant mixtures have been approved for prescription use.

Moreover, there are many common over-the-counter medications — like aspirin — that have never actually gone through a modern FDA approval process. 

As Folmer rightly noted, the FDA approved, and physician groups have overseen, the tremendous over-prescription of oxycodone pain drugs. This has led to soaring addiction rates and sharp increases in overdose deaths.

The Reading Eagle reported this week that "adults in their 50s had the highest hospitalization rates for pain medicine overdose" in Pennsylvania.

One realm of research that has been undisputed for decades is that cannabis is not lethal in any amount. Period.

In a country full of deadly drugs, the caution PAMED is showing for cannabis is, at best, misguided.

Second, the concept of moving cannabis to Schedule II in the federal Controlled Substances Act (CSA) is not a real-world solution. It might have made sense in up until the 1990's before any state medical marijuana regulations were put into place. Making the shift now would seriously jeopardize existing state laws.

Also, the FDA does not have authority to re-schedule substances. PAMED is likely aware of that fact. The DEA is the governing agency. Decades of legal petitions to the DEA and the U.S. Department of Health and Human Services (HHS) for rescheduling have been denied. Official processes to that end were undertaken going back to the 1980s.

In 2002, the Coalition to Reschedule Cannabis launched the most comprehensive attempt. The DEA and HHS spent years delaying a decision and ultimately denied the request in 2011. Appeals were launched in federal court, but the denial was upheld by a panel of judges in 2013.

Sen. Bernie Sanders, the Democratic presidential candidate, has introduced a more reasonable approach; remove cannabis from the CSA altogether. This would ensure that state regulations stay intact and would truly allow free scientific research into the plant's medical benefits. 

The Pennsylvania Medical Society claims a membership of 20,000 physicians and medical students. Their most recent available IRS Form 990 available lists more than $150 million in assets. Most of that is in the form of private equity, mutual funds, securities and other investments. They collect about $3.5 million each year in member dues. PAMED spends more than $6 million per year on staff salaries and compensation to their board of directors.

PAMED influences politics by lobbying state and municipal government. They listed five hired lobbyists in 2014. Their representatives have testified in opposition at nearly every hearing on the recent iteration of the state's medical marijuana bill. PAMED have issued more press releases on cannabis in recent years (8) than any other single issue. 

They also make campaign contributions. For example PAMED has given more than $25,000 to House Speaker Mike Turzai, R-Allegheny, who, so far, has successfully blocked medical marijuana from a House floor vote. Turzai has been one of the top recipients of the group's campaign money.

PAMED spent less than $1,000 on federal lobbying last year, according to FEC filings.

I reached out to their communications director to ask if they planned on taking their opinion on medical marijuana directly to Congress. Borrowing a page from Donald Trump, their terse reply was that they would not answer any of my questions because my well-documented conflicts of opinion with their own.  

Polling indicates that between 84 and 90 percent of Pennsylvania voters want a medical marijuana law in place. A grassroots, volunteer effort by advocates, families and patients has been underway for years. But the regular people of Pennsylvania are pitted against the top-dollar lobbying machine of PAMED. It is a clear example of how Big Medicine is working to stop seriously ill residents from utilizing a non-toxic plant.

Hopefully, one day, the medical establishment will recognize that cannabis does not threaten their place or their profits. Instead, it offers a valuable companion therapy that can greatly enhance the health and well being of our most vulnerable citizens. 

On this issue, PAMED has left the realm of being scientists and physicians. Instead, they have become the professional spin doctors for the opposition to state-level medical marijuana. 

Perhaps it is time for them to "do no harm" in the State House as well as the examining room.