Marijuana as wonder drug

March 3, 2007

From the Boston Globe:

A NEW STUDY in the journal Neurology is being hailed as unassailable proof that marijuana is a valuable medicine. It is a sad commentary on the state of modern medicine — and US drug policy — that we still need “proof” of something that medicine has known for 5,000 years.

The study, from the University of California at San Francisco, found smoked marijuana to be effective at relieving the extreme pain of a debilitating condition known as peripheral neuropathy. It was a study of HIV patients, but a similar type of pain caused by damage to nerves afflicts people with many other illnesses including diabetes and multiple sclerosis. Neuropathic pain is notoriously resistant to treatment with conventional pain drugs. Even powerful and addictive narcotics like morphine and OxyContin often provide little relief. This study leaves no doubt that marijuana can safely ease this type of pain.

As all marijuana research in the United States must be, the new study was conducted with government-supplied marijuana of notoriously poor quality. So it probably underestimated the potential benefit.

I have always found the ban on using marijuana for medical purposes ridiculous. I’m studying for a doctorate degree in medicine, and when I get there no so-called “moralist” or conservative politician is going to tell me that I can’t give a patient something I my training and the scientific evidence tell me that is the way to go.

With marijuana it is especially a problem, because anyone can grow it. You don’t have to buy it (well, at least initially from somebody!) and growing the plant is like growing any other plant. I have always believed that there is something else to it:

The pharmaceutical industry is scrambling to isolate cannabinoids and synthesize analogs, and to package them in non-smokable forms. In time, companies will almost certainly come up with products and delivery systems that are more useful and less expensive than herbal marijuana. However, the analogs they have produced so far are more expensive than herbal marijuana, and none has shown any improvement over the plant nature gave us to take orally or to smoke.

We live in an antismoking environment. But as a method of delivering certain medicinal compounds, smoking marijuana has some real advantages: The effect is almost instantaneous, allowing the patient, who after all is the best judge, to fine-tune his or her dose to get the needed relief without intoxication. Smoked marijuana has never been demonstrated to have serious pulmonary consequences, but in any case the technology to inhale these cannabinoids without smoking marijuana already exists as vaporizers that allow for smoke-free inhalation.

Be sure to read the rest of the article here. By the way, the piece was written by Lester Grinspoon, an emeritus professor of psychiatry at Harvard Medical School, certainly not some ignorant hippie:

Hopefully the UCSF study will add to the pressure on the US government to rethink its irrational ban on the medicinal use of marijuana — and its destructive attacks on patients and caregivers in states that have chosen to allow such use. Rather than admit they have been mistaken all these years, federal officials can cite “important new data” and start revamping outdated and destructive policies. The new Congress could go far in establishing its bona fides as both reasonable and compassionate by immediately moving on this issue.

Such legislation would bring much-needed relief to millions of Americans suffering from cancer, AIDS, multiple sclerosis, arthritis, and other debilitating illnesses.

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Hell Just Froze Over – Mandatory HPV Vaccination in Texas?

February 3, 2007

Did hell just froze over because of Texas?

Yes my friends, apparently hell just froze over:

HOUSTON, Feb. 2 — Texas on Friday became the first state to require all 11- and 12-year-old girls entering the sixth grade to be vaccinated against a sexually transmitted virus that causes cervical cancer.

Averting a potentially divisive debate in the Legislature, Gov. Rick Perry, a Republican, signed an executive order mandating shots of the Merck vaccine Gardasil as protection against the human papillomavirus, or HPV, starting in September 2008.

Mr. Perry’s action, praised by health advocates, caught many by surprise in a largely conservative state where sexual politics is often a battleground.

“I had no idea; I was absolutely caught off guard,” said Representative Jessica Farrar, Democrat of Houston, who sponsored a bill to require the vaccinations starting this September. “Normally, the governor does not take things like this upon himself, although I’m glad he did.”

If you live in Texas and see some snow falling, it is not due to global warming, it is because Gov. Rick Perry – a stalwart conservative republican who is against abortion and stem-cell research – finally recognized that doing the right thing is not such a hard thing to do:

“Requiring young girls to get vaccinated before they come into contact with HPV is responsible health and fiscal policy that has the potential to significantly reduce cases of cervical cancer and mitigate future medical costs,” said Mr. Perry, who was re-elected to his second full term last November.

And it is official as well:

It is Republican Gov. Rick Perry who issued an executive order directing the state’s Health Human Services Commission (HHSC) to get ready to administer the HPV vaccine in girls at noted ages before they enter sixth grade.

The order, effective September 2008, also directs HHSC and the Department of State Health Services (DSHS) to “make the vaccine immediately available to eligible young females through the Texas Vaccines for Children program for young women ages 9 to 18, and through Medicaid for women ages 19 to 21,” says the statement of the governor’s office on its website.

See? It wasn’t that hard. Good for you, Gov. Perry. So every parent must vaccinate their school-aged girls with Gardasil, right? Wrong:

Under the order, girls and women from 9 to 21 eligible for public assistance could get free shots immediately. The governor’s office said parents could opt out of the school program “for reasons of conscience, including religious beliefs.”

Ahh, I see. So at least he didn’t completely screw over his conservative friends. I wonder what is the point of having a mandatory vaccination program if parents can opt out because of religious beliefs, but I digress. Time and education will eventually replace misinformation and stereotypes.

But I wonder, did Gov. Perry did this out of the goodness of his conservative heart, or because the scientific evidence finally convinced the guy? If by “scientific evidence” you mean “my former Chief-of-Staff, who is now a lobbyist for Merck, told me this would mean truckloads of money for them and for me”, then yes, he was convinced:

Is Perry’s order politically motivated? No one knows. But, USA Today has reported today that Perry has several ties to Merck, the maker of the HPV vaccine, and Women in Government, a not-for-profit organization comprised of state woman regulators, which some watchdog has claimed is too cozy with Merck.

Media has reported that Women in Government is quite active in promoting the Merck’s vaccine, which analysts say is positioned to make Merck more than billion dollars a year. According to USA Today, Mike Toomey, Perry’s former chief of staff, serves as one of the drug company’s three lobbyists in Texas. Perry’s current chief of staff’s mother-in-law, Texas Republican state Rep. Dianne White Delisi, is a head of Women in Government.

“Perry also received $6,000 from Merck’s political action committee during his re-election campaign,” USA Today says.

Ah, now everything seems to make sense. A conservative politician from Texas is opposed to everything this vaccine stands for, and knows he can lose his conservative base over this, but he can make up those votes from the other side, and make a ton of money for his friends at Merck in the process.

Now let me play Devil’s Advocate for a moment. Is there a conflict of interest here? Very likely. But are Gov. Perry’s actions regarding mandatory HPV vaccination wrong? Well, no. Merck does make the damn vaccine, and a generic will not become available in a long time. This vaccine represents a huge leap forward for women’s health. At around $400 for 3 shots over an 8-month period, it is expensive, and most health plans will NOT cover it. But while preventing cervical cancer is morally and medically correct, it is not exactly sound fiscal policy:

Mr. Perry says it makes sense to use the vaccine to prevent cervical cancer which would otherwise cause a large burden on medical expenditure. But does this mandatory inoculation of the HPV vaccine really save medical costs?

On average, a 5-year treatment for a case of cervical caner would cost $11,000, early studies show. For a 5-year span, about 5800 new cases of the disease are expected to be diagnosed in Texas, which means the medical cost for five years is 63.8 millions or 12.8 million a year.

In Texas, there are about 6.31 millions people now under age 18, meaning the number of girls who are required to receive the HPV vaccine each year is about 0.35 million. The total number of girls to receive the vaccine is 1.76 million, meaning that Merck can rake in 630 million dollars in five years or 126 million dollars in the vaccine sales in Texas alone with Mr. Perry’s order.

The cost for the first year would be double the price tag as girls both at age 11 and 12 will receive the vaccine. The calculation is based on the price of the vaccine at $360 per girl.

It seems that this state mandatory vaccination can save about 700 women’s lives a year in Texas at a cost of 126 million dollars a year spent on the preventive vaccine. These 700 women would otherwise need 7.7 million dollars for treatment of their cervical cancer.

Perry’s order can save some women’s lives, but it does not save money.

I am not saying that vaccinating women with Gardasil is not worth it – it is. It does make sense from a public health point of view, because cervical cancer it is the second most common cancer in women after breast cancer. Gardasil, the HPV vaccine, will definitely be most valuable in the developing world, where most women don’t have access to a yearly PAP smear. But the big fight, the one that will set the precedents for other countries to follow, is taking place in the United States and Texas, of all places, just landed a knockout blow.


Big Pharma not making enough money…

December 30, 2006

Of our suffering that is:

Whenever critics complain about the high cost of prescription drugs, the pharmaceutical industry’s standard defense is that companies have to plow so much money into researching innovative new medicines. But a recently released report from the Government Accountability Office casts doubt on that rationale. Yes the industry is spending heavily on R&D, the GAO found, but it turns out big pharma isn’t actually generating such a good return on their investments.

The congressional watchdog agency’s 48-page study came up with disturbing numbers. From 1993-2004, spending by U.S. drug companies on research and development jumped 147%, from $16 billion to nearly $40 billion annually. But the number of applications the pharmaceutical firms submitted to the Food and Drug Administration for potentially groundbreaking new drugs during that 10-year period increased only a meager 7%. And since 1995, the applications for these innovative drugs have been dropping each year. “The productivity of research and development investments has declined,” the GAO concluded.

This is essentially what the American Medical Student Association has been saying all along.