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mend these n-of-1 clinical trials using the same oversight mechanism as that proposed in the above recommendations.

Other Reports On Marijuana As Medicine

Since 1996, five important reports pertaining to the medical uses of marijuana have been published, each prepared by deliberative groups of medical and scientific experts (Appendix E). They were written to address different facets of the medical marijuana debate, and each offers a somewhat different perspective. With the exception of the report by the Health Council of the Netherlands, each concluded that marijuana can be moderately effective in treating a variety of symptoms. They also agree that current scientific understanding is rudimentary; indeed, the sentiment most often stated is that more research is needed. And these reports record the same problem with herbal medications as noted here: the uncertain composition of plant material makes for an uncertain, and hence often undesirable, medicine.

The 1996 report by the Health Council of the Netherlands concluded that there is insufficient evidence to justify the medical use of marijuana or THC, despite the fact that the latter is an approved medication in the United States and Britain. However, that committee addressed only whether there was sufficient evidence to warrant the prescription of marijuana or cannabinoids, not whether the data are sufficient to justify clinical trials. Conclusions of the Health Council of the Netherlands contrast with that country's tolerance of marijuana use. The health council's report noted that marijuana use by patients in the terminal stages of illness is tolerated in hospitals. It also said that the council did ''not wish to judge patients who consume marihuana (in whatever form) because it makes them feel better....''

In contrast, the American Medical Association House of Delegates, National Institutes of Health (NIH), and the British Medical Association recommend clinical trials of smoked marijuana for a variety of symptoms. The NIH report, however, was alone in recommending clinical studies of marijuana for the treatment of glaucoma—and even then there was disagreement among the panel members (William T. Beaver, chair, NIH Ad Hoc Expert Panel on the Medical Use of Marijuana, personal communication, 1998).

Recent reviews that have received extensive attention from those who follow the medical marijuana debate have been written by strong advocate for (Grinspoon and Bakalar, 199362; Zimmer and Morgan, 1997198) or against (Voth and Schwartz, 1997191) the medical use of marijuana. Those reports represent the individual views of their authors, and they are not reviewed here but have been reviewed in major scientific jourals.7,69,178,180



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