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STONED: A Doctor’s Case For Medical Marijuana by David Casarett M.D. (Current, 289 pages, 2015)

“I wrote this book for Judith,” Dr. David Casarett told me. “Judith is a retired professor who came to my practice as a hospice and palliative care physician at the University of Pennsylvania Health System. Her lung cancer had been causing numerous distressing symptoms and she asked me whether marijuana might help her.”

Dr. Casarett had to admit to Judith — after he’d begun to give her “the lecture” that medical school professors had given him, years before, that marijuana is illegal and risky — that he really wasn’t sure whether it could help her, or whether it had any benefits at all.

Then he promised to find out. This book is the result of the doctor’s promise. Writing it, according to Dr. Casarett, was “a series of surprises.”

David Casarett in his Bala Cynwyd office. He sampled the wares before he made his mind up about marijuana. [Tom Gralish/]
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David Casarett in his Bala Cynwyd, Pennsylvania office. Dr. Casarett did the smart thing: He sampled the wares before he made his mind up about marijuana.
[Tom Gralish/]

“People like Judith deserve the best evidence, and the most helpful advice, uncluttered by myths and misconceptions,” Dr. Casarett said. “The patients, doctors, and researchers who have taken the time to talk with me have taught me enough to give my patients the advice about medical marijuana that they deserve.”

The debate over medical marijuana’s efficacy may be raging in mass media and society at large, but those who’ve bothered to arm themselves with knowledge already know it works. Among that number are many medical doctors who – imagine this! – actually fulfill their Hippocratic oaths by doing what’s best for their patients.

Dr. Casarett, a Philadelphia physician, researcher, and tenured associate professor at the University of Pennsylvania’s Perelman School of Medicine, has published more than 100 articles and book chapters, including in leading medical journals such as JAMA and the New England Journal of Medicine.

Casarett sets out to find some firsthand answers about medicinal cannabis, visiting dispensaries in California and Colorado; smearing marijuana paste on his legs while hiking through Nepal; sampling pot wine; learning how vaporizers work; and trying the purest types of hash oil (hey, somebody’s gotta do it).

With the past decade seeing a tremendous increase in both the number of states allowing medical marijuana and the number of patients using it, a new industry has emerged, including farmers, distributors, manufacturers, and clinics.

Chapter 7, “Bodily Harm,” is perhaps the most controversial chapter in the book, because it’s the one where Dr. Casarett examines the reupted dangers of marijuana. He quickly dispatches such myths as impaired pulmonary function and lung damage, talking with Dr. Donald Tashkin, lead researcher of the biggest study ever on marijuana and the lungs which – to Dr. Tashkin’s surprise – didn’t find any evidence of damage.

That’s isn’t all. “The bottom line,” Dr. Tashkin tells Dr. Casarett, “is that there really isn’t any good evidence of an increased risk of cancer.”

But even so, Dr. Casarett is a tad over-cautious when discussing the possible risks of cannabis. For example, as pointed out by my friend and writing colleague Judith Stamps, he says that there are plenty of things in cannabis that can cause allergic reactions. “I believe that such reactions are almost non-existent,” Stamps told me. “But it will go down well with his medical colleagues. And we need more doctors to wade into this territory.”

When it comes to a reputed increased risk of heart problems or strokes with marijuana use, Casarett’s answer is “maybe.” But cannabinoids have also been found to limit brain damage which occurs after strokes.

Then there’s the penis study. One study that recruited 77 pot-using California college students about possible side-effects of weed, and three bozos reported shrinking penises. (Dr. Casarett reasonably concludes, “I’ll go out on a limb and say that marijuana probably doesn’t cause pathological perceptions of penis shrinkage.”)

As the doctor himself candidly admits, almost all reports of risks from marijuana are “little more than isolated reports and theoretical risks.”

“It might even occur to you, as it does to me, that if these risks were real, my entire college class would be dead by now,” Dr. Casarett writes, demonstrating the easy-reading style which makes this book a pleasure to absorb.


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