A doctor's case for medical marijuana
-
0:02 - 0:05I would like to tell you
about the most embarrassing thing -
0:05 - 0:10that has ever happened to me in my years
of working as a palliative care physician. -
0:11 - 0:13This happened a couple of years ago.
-
0:13 - 0:17I was asked as a consultant
to see a woman in her 70s -- -
0:17 - 0:20retired English professor
who had pancreatic cancer. -
0:20 - 0:25I was asked to see her because
she had pain, nausea, vomiting ... -
0:26 - 0:29When I went to see her,
we talked about those symptoms -
0:29 - 0:30and in the course of that consultation,
-
0:31 - 0:35she asked me whether I thought
that medical marijuana might help her. -
0:37 - 0:39I thought back to everything
-
0:39 - 0:42that I had learned in medical school
about medical marijuana, -
0:42 - 0:46which didn't take very long
because I had learned absolutely nothing. -
0:47 - 0:50And so I told her that as far as I knew,
-
0:50 - 0:53medical marijuana
had no benefits whatsoever. -
0:53 - 0:58And she smiled and nodded and reached
into the handbag next to the bed, -
0:58 - 1:02and pulled out a stack of about a dozen
randomized controlled trials -
1:02 - 1:04showing that medical
marijuana has benefits -
1:05 - 1:09for symptoms like nausea
and pain and anxiety. -
1:09 - 1:12She handed me those articles and said,
-
1:12 - 1:16"Maybe you should read these
before offering an opinion ... -
1:17 - 1:18doctor."
-
1:18 - 1:19(Laughter)
-
1:19 - 1:21So I did.
-
1:21 - 1:25That night I read all of those articles
and found a bunch more. -
1:25 - 1:27When I came to see her the next morning,
-
1:27 - 1:31I had to admit that it looks like
there is some evidence -
1:31 - 1:34that marijuana can offer medical benefits
-
1:34 - 1:38and I suggested that if she
really was interested, -
1:38 - 1:39she should try it.
-
1:40 - 1:41You know what she said?
-
1:42 - 1:46This 73-year-old,
retired English professor? -
1:46 - 1:49She said, "I did try it
about six months ago. -
1:49 - 1:50It was amazing.
-
1:50 - 1:53I've been using it every day since.
-
1:53 - 1:55It's the best drug I've discovered.
-
1:55 - 1:59I don't know why it took me 73 years
to discover this stuff. It's amazing." -
1:59 - 2:00(Laughter)
-
2:00 - 2:03That was the moment at which I realized
-
2:03 - 2:06I needed to learn something
about medical marijuana -
2:06 - 2:09because what I was prepared for
in medical school -
2:09 - 2:11bore no relationship to reality.
-
2:12 - 2:15So I started reading more articles,
I started talking to researchers, -
2:15 - 2:17I started talking to doctors,
-
2:17 - 2:20and most importantly,
I started listening to patients. -
2:20 - 2:23I ended up writing a book
based on those conversations, -
2:23 - 2:26and that book really revolved
around three surprises -- -
2:26 - 2:28surprises to me, anyway.
-
2:28 - 2:30One I already alluded to --
-
2:30 - 2:33that there really are some benefits
to medical marijuana. -
2:33 - 2:37Those benefits may not be
as huge or as stunning -
2:37 - 2:40as some of the most avid proponents
of medical marijuana -
2:40 - 2:41would have us believe,
-
2:41 - 2:42but they are real.
-
2:43 - 2:44Surprise number two:
-
2:44 - 2:47medical marijuana does have some risks.
-
2:47 - 2:50Those risks may not be
as huge and as scary -
2:50 - 2:53as some of the opponents of medical
marijuana would have us believe, -
2:53 - 2:56but they are real risks, nonetheless.
-
2:56 - 2:59But it was the third surprise
that was most ... -
2:59 - 3:00surprising.
-
3:00 - 3:03And that is that a lot
of the patients I talked with -
3:03 - 3:06who've turned to medical
marijuana for help, -
3:06 - 3:09weren't turning to medical marijuana
because of its benefits -
3:09 - 3:11or the balance of risks and benefits,
-
3:11 - 3:14or because they thought
it was a wonder drug, -
3:14 - 3:17but because it gave them
control over their illness. -
3:17 - 3:19It let them manage their health
-
3:20 - 3:23in a way that was productive and efficient
-
3:23 - 3:25and effective and comfortable for them.
-
3:26 - 3:29To show you what I mean,
let me tell you about another patient. -
3:29 - 3:31Robin was in her early 40s when I met her.
-
3:31 - 3:35She looked though
like she was in her late 60s. -
3:35 - 3:38She had suffered from rheumatoid arthritis
for the last 20 years, -
3:38 - 3:40her hands were gnarled by arthritis,
-
3:41 - 3:42her spine was crooked,
-
3:42 - 3:45she had to rely
on a wheelchair to get around. -
3:45 - 3:47She looked weak and frail,
-
3:47 - 3:49and I guess physically she probably was,
-
3:49 - 3:52but emotionally,
cognitively, psychologically, -
3:52 - 3:56she was among the toughest
people I've ever met. -
3:56 - 3:58And when I sat down next to her
-
3:58 - 4:00in a medical marijuana dispensary
in Northern California -
4:00 - 4:04to ask her about why she turned
to medical marijuana, -
4:04 - 4:07what it did for her and how it helped her,
-
4:07 - 4:09she started out by telling me things
-
4:09 - 4:11that I had heard
from many patients before. -
4:11 - 4:13It helped with her anxiety;
-
4:13 - 4:14it helped with her pain;
-
4:14 - 4:16when her pain was better,
she slept better. -
4:16 - 4:18And I'd heard all that before.
-
4:18 - 4:20But then she said something
that I'd never heard before, -
4:20 - 4:24and that is that it gave her
control over her life -
4:24 - 4:26and over her health.
-
4:26 - 4:28She could use it when she wanted,
-
4:28 - 4:29in the way that she wanted,
-
4:29 - 4:32at the dose and frequency
that worked for her. -
4:32 - 4:35And if it didn't work for her,
then she could make changes. -
4:35 - 4:37Everything was up to her.
-
4:37 - 4:38The most important thing she said
-
4:38 - 4:41was she didn't need
anybody else's permission -- -
4:41 - 4:44not a clinic appointment,
not a doctor's prescription, -
4:44 - 4:45not a pharmacist's order.
-
4:45 - 4:47It was all up to her.
-
4:47 - 4:49She was in control.
-
4:50 - 4:53And if that seems like a little thing
for somebody with chronic illness, -
4:53 - 4:54it's not -- not at all.
-
4:55 - 4:57When we face a chronic serious illness,
-
4:57 - 5:03whether it's rheumatoid arthritis
or lupus or cancer or diabetes, -
5:03 - 5:04or cirrhosis,
-
5:04 - 5:06we lose control.
-
5:06 - 5:09And note what I said: "when," not "if."
-
5:09 - 5:13All of us at some point in our lives
will face a chronic serious illness -
5:13 - 5:15that causes us to lose control.
-
5:16 - 5:19We'll see our function decline,
some of us will see our cognition decline, -
5:19 - 5:22we'll be no longer able
to care for ourselves, -
5:22 - 5:24to do the things that we want to do.
-
5:24 - 5:26Our bodies will betray us,
-
5:26 - 5:29and in that process, we'll lose control.
-
5:29 - 5:31And that's scary.
-
5:31 - 5:33Not just scary -- that's frightening,
-
5:33 - 5:35it's terrifying.
-
5:35 - 5:37When I talk to my patients,
my palliative care patients, -
5:37 - 5:41many of whom are facing illnesses
that will end their lives, -
5:41 - 5:43they have a lot of be frightened of --
-
5:43 - 5:47pain, nausea, vomiting,
constipation, fatigue, -
5:47 - 5:48their impending mortality.
-
5:48 - 5:51But what scares them
more than anything else -
5:51 - 5:53is this possibility that at some point,
-
5:53 - 5:55tomorrow or a month from now,
-
5:55 - 5:59they're going to lose
control of their health, -
5:59 - 6:00of their lives,
-
6:00 - 6:02of their healthcare,
-
6:02 - 6:04and they're going to become
dependent on others, -
6:04 - 6:06and that's terrifying.
-
6:07 - 6:10So it's no wonder really
that patients like Robin, -
6:10 - 6:12who I just told you about,
-
6:12 - 6:14who I met in that clinic,
-
6:14 - 6:15turn to medical marijuana
-
6:15 - 6:19to try to claw back
some semblance of control. -
6:19 - 6:20How do they do it though?
-
6:20 - 6:23How do these medical
marijuana dispensaries -- -
6:23 - 6:25like the one where I met Robin --
-
6:25 - 6:31how do they give patients like Robin
back the sort of control that they need? -
6:31 - 6:33And how do they do it
-
6:33 - 6:37in a way that mainstream
medical hospitals and clinics, -
6:37 - 6:39at least for Robin, weren't able to?
-
6:39 - 6:41What's their secret?
-
6:41 - 6:44So I decided to find out.
-
6:44 - 6:48I went to a seedy clinic
in Venice Beach in California -
6:48 - 6:49and got a recommendation
-
6:49 - 6:53that would allow me
to be a medical marijuana patient. -
6:53 - 6:57I got a letter of recommendation
that would let me buy medical marijuana. -
6:57 - 6:59I got that recommendation illegally,
-
6:59 - 7:01because I'm not
a resident of California -- -
7:01 - 7:02I should note that.
-
7:02 - 7:04I should also note, for the record,
-
7:04 - 7:07that I never used that letter
of recommendation to make a purchase, -
7:07 - 7:10and to all of you DEA agents out there --
-
7:10 - 7:11(Laughter)
-
7:11 - 7:13love the work that you're doing,
-
7:13 - 7:14keep it up.
-
7:14 - 7:15(Laughter)
-
7:15 - 7:18Even though it didn't let me
make a purchase though, -
7:18 - 7:22that letter was priceless
because it let me be a patient. -
7:22 - 7:27It let me experience
what patients like Robin experience -
7:27 - 7:30when they go to a medical
marijuana dispensary. -
7:30 - 7:31And what I experienced --
-
7:31 - 7:33what they experience every day,
-
7:33 - 7:37hundreds of thousands
of people like Robin -- -
7:37 - 7:39was really amazing.
-
7:39 - 7:40I walked into the clinic,
-
7:40 - 7:44and from the moment that I entered
many of these clinics and dispensaries, -
7:44 - 7:47I felt like that dispensary, that clinic,
-
7:47 - 7:48was there for me.
-
7:49 - 7:52There were questions
at the outset about who I am, -
7:52 - 7:54what kind of work I do,
-
7:54 - 7:58what my goals are in looking
for a medical marijuana prescription, -
7:58 - 8:01or product,
-
8:01 - 8:03what my goals are,
what my preferences are, -
8:03 - 8:04what my hopes are,
-
8:04 - 8:07how do I think, how do I hope
this might help me, -
8:07 - 8:09what am I afraid of.
-
8:09 - 8:10These are the sorts of questions
-
8:10 - 8:13that patients like Robin
get asked all the time. -
8:13 - 8:16These are the sorts of questions
that make me confident -
8:16 - 8:19that the person I'm talking with
really has my best interests at heart -
8:19 - 8:21and wants to get to know me.
-
8:22 - 8:25The second thing I learned
in those clinics -
8:25 - 8:27is the availability of education.
-
8:27 - 8:30Education from the folks
behind the counter, -
8:30 - 8:33but also education
from folks in the waiting room. -
8:33 - 8:37People I met were more than happy,
as I was sitting next to them -- -
8:37 - 8:38people like Robin --
-
8:38 - 8:42to tell me about who they are,
why they use medical marijuana, -
8:42 - 8:44what helps them, how it helps them,
-
8:44 - 8:46and to give me advice and suggestions.
-
8:46 - 8:52Those waiting rooms really are
a hive of interaction, advice and support. -
8:53 - 8:55And third, the folks behind the counter.
-
8:55 - 8:58I was amazed at how willing
those people were -
8:58 - 9:03to spend sometimes an hour or more
talking me through the nuances -
9:03 - 9:05of this strain versus that strain,
-
9:05 - 9:07smoking versus vaporizing,
-
9:07 - 9:08edibles versus tinctures --
-
9:08 - 9:12all, remember, without me
making any purchase whatsoever. -
9:13 - 9:17Think about the last time
you went to any hospital or clinic -
9:17 - 9:22and the last time anybody spent an hour
explaining those sorts of things to you. -
9:23 - 9:26The fact that patients like Robin
are going to these clinics, -
9:26 - 9:28are going to these dispensaries
-
9:28 - 9:31and getting that sort
of personalized attention -
9:31 - 9:33and education and service,
-
9:33 - 9:36really should be a wake-up call
to the healthcare system. -
9:36 - 9:39People like Robin are turning away
from mainstream medicine, -
9:39 - 9:42turning to medical marijuana dispensaries
-
9:42 - 9:45because those dispensaries
are giving them what they need. -
9:46 - 9:49If that's a wake-up call
to the medical establishment, -
9:49 - 9:53it's a wake-up call that many
of my colleagues are either not hearing -
9:53 - 9:55or not wanting to hear.
-
9:55 - 9:58When I talk to my colleagues,
physicians in particular, -
9:58 - 9:59about medical marijuana,
-
9:59 - 10:02they say, "Oh, we need more evidence.
-
10:02 - 10:06We need more research into benefits,
we need more evidence about risks." -
10:07 - 10:08And you know what? They're right.
-
10:08 - 10:10They're absolutely right.
-
10:10 - 10:14We do need much more evidence
about the benefits of medical marijuana. -
10:14 - 10:19We also need to ask the federal government
to reschedule marijuana to Schedule II, -
10:19 - 10:23or to deschedule it entirely
to make that research possible. -
10:24 - 10:27We also need more research
into medical marijuana's risks. -
10:27 - 10:29Medical marijuana's risks --
-
10:29 - 10:31we know a lot about
the risks of recreational use, -
10:31 - 10:34we know next to nothing
about the risks of medical marijuana. -
10:34 - 10:37So we absolutely do need research,
-
10:37 - 10:39but to say that we need research
-
10:39 - 10:42and not that we need
to make any changes now -
10:42 - 10:44is to miss the point entirely.
-
10:44 - 10:47People like Robin
aren't seeking out medical marijuana -
10:47 - 10:49because they think it's a wonder drug,
-
10:49 - 10:51or because they think
it's entirely risk-free. -
10:51 - 10:56They seek it out because the context
in which it's delivered and administered -
10:56 - 10:57and used,
-
10:57 - 11:01gives them the sort of control
they need over their lives. -
11:01 - 11:04And that's a wake-up call
we really need to pay attention to. -
11:05 - 11:09The good news though is that
there are lessons we can learn today -
11:09 - 11:12from those medical marijuana dispensaries.
-
11:12 - 11:14And those are lessons
we really should learn. -
11:14 - 11:17These are often small,
mom-and-pop operations -
11:17 - 11:19run by people with no medical training.
-
11:19 - 11:22And while it's embarrassing to think
-
11:22 - 11:26that many of these clinics
and dispensaries are providing services -
11:26 - 11:28and support and meeting patients' needs
-
11:28 - 11:32in ways that billion-dollar
healthcare systems aren't -- -
11:32 - 11:34we should be embarrassed by that --
-
11:34 - 11:36but we can also learn from that.
-
11:36 - 11:38And there are probably
three lessons at least -
11:38 - 11:40that we can learn
from those small dispensaries. -
11:41 - 11:44One: we need to find ways
to give patients more control -
11:45 - 11:47in small but important ways.
-
11:47 - 11:49How to interact with healthcare providers,
-
11:49 - 11:51when to interact
with healthcare providers, -
11:51 - 11:54how to use medications
in ways that work for them. -
11:54 - 11:56In my own practice,
-
11:56 - 11:58I've gotten much more
creative and flexible -
11:58 - 12:02in supporting my patients
in using drugs safely -
12:02 - 12:03to manage their symptoms --
-
12:03 - 12:05with the emphasis on safely.
-
12:05 - 12:09Many of the drugs I prescribe
are drugs like opioids or benzodiazepines -
12:09 - 12:12which can be dangerous if overused.
-
12:12 - 12:13But here's the point.
-
12:13 - 12:15They can be dangerous if they're overused,
-
12:15 - 12:18but they can also be ineffective
if they're not used in a way -
12:18 - 12:21that's consistent with
what patients want and need. -
12:21 - 12:24So that flexibility,
if it's delivered safely, -
12:24 - 12:27can be extraordinarily valuable
for patients and their families. -
12:27 - 12:28That's number one.
-
12:28 - 12:30Number two: education.
-
12:30 - 12:32Huge opportunities
-
12:32 - 12:35to learn from some of the tricks
of those medical marijuana dispensaries -
12:35 - 12:36to provide more education
-
12:37 - 12:39that doesn't require
a lot of physician time necessarily, -
12:39 - 12:41or any physician time,
-
12:41 - 12:45but opportunities to learn
about what medications we're using -
12:45 - 12:47and why,
-
12:47 - 12:49prognoses, trajectories of illness,
-
12:49 - 12:50and most importantly,
-
12:50 - 12:53opportunities for patients
to learn from each other. -
12:53 - 12:55How can we replicate what goes on
-
12:55 - 12:58in those clinic and medical
dispensary waiting rooms? -
12:58 - 13:02How patients learn from each other,
how people share with each other. -
13:02 - 13:04And last but not least,
-
13:04 - 13:08putting patients first the way
those medical marijuana dispensaries do, -
13:08 - 13:13making patients feel
legitimately like what they want, -
13:13 - 13:14what they need,
-
13:14 - 13:16is why, as healthcare providers,
-
13:16 - 13:17we're here.
-
13:18 - 13:22Asking patients about their hopes,
their fears, their goals and preferences. -
13:22 - 13:23As a palliative care provider,
-
13:23 - 13:27I ask all my patients what they're
hoping for and what they're afraid of. -
13:28 - 13:29But here's the thing.
-
13:29 - 13:32Patients shouldn't have to wait
until they're chronically seriously ill, -
13:32 - 13:34often near the end of life,
-
13:34 - 13:38they shouldn't have to wait
until they're seeing a physician like me -
13:39 - 13:40before somebody asks them,
-
13:40 - 13:42"What are you hoping for?"
-
13:42 - 13:43"What are you afraid of?"
-
13:43 - 13:46That should be baked into the way
that healthcare is delivered. -
13:48 - 13:49We can do this --
-
13:49 - 13:50we really can.
-
13:50 - 13:54Medical marijuana dispensaries
and clinics all across the country -
13:54 - 13:56are figuring this out.
-
13:56 - 13:57They're figuring this out
-
13:57 - 14:02in ways that larger, more mainstream
health systems are years behind. -
14:02 - 14:04But we can learn from them,
-
14:04 - 14:05and we have to learn from them.
-
14:05 - 14:08All we have to do is swallow our pride --
-
14:08 - 14:09put aside the thought for a minute
-
14:09 - 14:12that because we have
lots of letters after our name, -
14:12 - 14:13because we're experts,
-
14:13 - 14:16because we're chief medical officers
of a large healthcare system, -
14:16 - 14:21we know all there is to know
about how to meet patients' needs. -
14:21 - 14:22We need to swallow our pride.
-
14:22 - 14:25We need to go visit
a few medical marijuana dispensaries. -
14:25 - 14:27We need to figure out what they're doing.
-
14:27 - 14:30We need to figure out
why so many patients like Robin -
14:30 - 14:32are leaving our mainstream medical clinics
-
14:32 - 14:35and going to these medical
marijuana dispensaries instead. -
14:35 - 14:37We need to figure out
what their tricks are, -
14:37 - 14:39what their tools are,
-
14:39 - 14:41and we need to learn from them.
-
14:41 - 14:42If we do,
-
14:42 - 14:45and I think we can,
and I absolutely think we have to, -
14:45 - 14:49we can guarantee all of our patients
will have a much better experience. -
14:49 - 14:50Thank you.
-
14:50 - 14:54(Applause)
- Title:
- A doctor's case for medical marijuana
- Speaker:
- David Casarett
- Description:
-
Physician David Casarett was tired of hearing hype and half-truths around medical marijuana, so he put on his skeptic's hat and investigated on his own. He comes back with a fascinating report on what we know and what we don't -- and what mainstream medicine could learn from the modern medical marijuana dispensary.
- Video Language:
- English
- Team:
- closed TED
- Project:
- TEDTalks
- Duration:
- 15:07
Brian Greene edited English subtitles for A doctor's case for medical marijuana | ||
Brian Greene approved English subtitles for A doctor's case for medical marijuana | ||
Brian Greene edited English subtitles for A doctor's case for medical marijuana | ||
Joanna Pietrulewicz accepted English subtitles for A doctor's case for medical marijuana | ||
Joanna Pietrulewicz edited English subtitles for A doctor's case for medical marijuana | ||
Joanna Pietrulewicz edited English subtitles for A doctor's case for medical marijuana | ||
Leslie Gauthier edited English subtitles for A doctor's case for medical marijuana | ||
Leslie Gauthier edited English subtitles for A doctor's case for medical marijuana |