The MBC statement of 7/03

"The Medical Board's position with respect to what a physician must do before he or she issues a written recommendation for marijuana was articulated as being "no different than what a physician must do before recommending any other treatment option."

Regarding the MBC statement 5/7/04

This is a good statement of what is called the "medical center workup" and a good standard to strive towards when patients have access to affordable health care, and feel confidence in the system.

In fact these standards compare favorably with my published standards which appeared in the recent issue of O'Shaughnessy's, the Journal of the California Cannabis Research Medical Group.  (Attachment: Implementation….)

The fact is that there is a wide range of acceptable standards in most areas of medicine, and this has to be remembered.

Also, what is missing from this equation is the realization that medical cannabis recommendations are limited medical-legal consultations, and NOT primary care, in most cases, and doctors are wise to be clear about this to patients, to minimize any misunderstandings.

General comments on Statement

Generally there are still a lot of slippery words or phrases. i.e. still no definition of "good faith exam" "in all cases" is mentioned twice.

I hope that law enforcement does not misuse the MBC's statements, in its well-documented institutional bias against cannabis.  (See the position paper on medical marijuana by California Narcotic Officer's Association at:  http://www.cnoa.org/position-papers-1.htm and note their obvious untruth: "There is no justification for using marijuana as a medicine."  This lie is thoroughly contradicted by the federal government's own Institute of Medicine 1999 report.)

• I will be monitoring all cases that come to my attention of doctors being investigated for having recommended cannabis.
• I will be posting all pertinent documents on a new website I will be creating: MedBoardWatch.com.

"The Medical Board of California developed this statement since medical marijuana is an emerging treatment modality."

I commend the Board on recognizing cannabis as "an emerging treatment modality".  I am gratified by this.

This is a safe and effective medicine.

I have more critique available if there is a future forum to discuss this and to discuss the investigations past, present, and future.

Now as good as some of the statement was which was published in the July, 2004 Action Report, I was equally stunned to see in Dr Mitchell S. Karlan's President's Report:

"The recommendation of this drug solely for a physician's financial gain- without a patient's medical need and without a history and physical, good follow-up at reasonable intervals, informed consent, recording a listing of potential complications, and without a discussion of alternative options- is not acceptable."

I am quite saddened to see this myth repeated, and it reminds me of the statements from  Dr Ronald Morton and Mr. David Thornton describing cannabis-evaluating doctors as having a cash register.

This canard that cannabis doctors practice just for the money reflects a bias we would never show to our highly paid specialist brothers and sisters.

NO doctor I have ever spoken to has gone into medicine just for the money.

But almost EVERYONE has chosen a specialty for a combination of factors: love of the specialty, life style, geographic location, benefits, income, etc.

There is no evidence that cannabis-evaluating doctors are any more or less likely to have chosen their specialty for the money than the expert reviewers for the medical board in their respective specialty.

More common traits I can identify in cannabis-evaluating physicians are compassion and courage.

A compassion for suffering patients, and a courage to stand up to law enforcement's bias, and their control of the Medical Board.

Speaking of compassion, now that you have published some standards, although admittedly imperfect and subject to discussion and change, I would recommend a truce on going after doctors as a "gotcha", since probably every good doctor here has had an occasional lapse in documentation.  It would show good faith on the part of the Board to reverse the punitive fines imposed, that charge physicians for the "fishing expeditions" that your attorneys engage in to find evidence of wrong-doing when there was no reason to expect any in the first place.  For my part I will do my best to share my 25 years in primary care with my colleagues, to encourage that doctors live up to higher than average standards, as both your guidelines and mine do.

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