-3 votes

Dr. Rand Paul, ophthalmologist, politican - I have a few questions for you.

I emailed this to him, but want you people to understand why I am furious about his recent comments. Now he is jacking around with people's ability to make informed medical decisions, and that is the last straw for me.

Dear Dr. Paul-

I am writing in regard to your recent comment in an ABC interview that you would not advise anyone to use marijuana. As a retired COMT, I have a few questions for you.

Are you familiar with the very common eye condition called "glaucoma?" I know you are an ophthalmologist so it seems like you would know about it, but your comment suggests perhaps you are not familiar with the risks, benefits and alternatives for treatment of this potentially blinding condition. Let me recap just a few side effects for you - I know you have been in politics lately, not at the eye clinic so maybe your memory got a little fuzzy.

The first line of defense is usually eye drops. All of them may cause redness, stinging, and blurred vision. They are marketed using a range of drugs to induce various actions. The prostaglandin analogs are the newest class, and they include a risk of change of eye color and excessive lash growth. I know that may appeal to young ladies, but I have seen people with terrible trichiasis as a result. Have you never seen that? Furthermore, these drugs are new enough that long term side effects cannot yet be determined. There are also beta blockers which can affect heart rhythm including cardiac arrest. There are miotics, which can cause heart problems, breathing problems, gastrointestinal problems and urinary tract problems. There are alpha-agonists, which can cause fatigue, headaches and dry mouth and nose. Last, there are the carbonic anhydrase inhibitors, which can cause mental fuzziness, depression and GI problems. While these problems are much more likely in when taken in pill form, the eye drops carry the same risks.

When eye drops fail to produce an adequate decrease in intraocular pressure, pills may be tried. Those pills will fall into the same classes, and the same risks will be increased. When drops and pills fail, it is time to consider laser trabeculoplasty. Of course, the patient will have to be given iopidine or a similar agent as vision threatening pressure spikes following ALT are fairly common. Even with prophylactic treatment, the truth is there is a risk of blindness. For recalcitrant glaucoma, a patient may be advised to have trabeculoplasty. With it comes the risk of blindness and as with any eye surgery, there is a risk of endophthalmitis and sympathetic endophthalmitis which would result in blindness in both eyes. Rare, but a risk. I've seen it happen, have you? It is a life altering experience, to try to help save someone's vision and have them go blind in both eyes.

References for the above:
http://www.glaucoma.org/treatment/medication-guide.php
http://medical-dictionary.thefreedictionary.com/Cholinergic+...
http://www.djo.harvard.edu/site.php?url=/patients/pi/417
http://www.webmd.com/eye-health/trabeculectomy-filtration-su...

Now, what does the literature say about treating glaucoma with marijuana?

"Currently, there are no National Eye Institute studies in the United States concerning the use of marijuana to treat glaucoma."
Why would they not even do research?
"The number of significant side effects generated by long-term oral use of marijuana or long-term inhalation of marijuana smoke make marijuana a poor choice in the treatment of glaucoma, a chronic disease requiring proven and effective treatment."
http://www.glaucoma.org/treatment/medical-marijuana.php

That is some impressive doubletalk - we won't study it because we know other drugs are better, even though every other drug has side effects, some of them life threatening. No one has ever died of marijuana use. Did you know that?
.
If and when legitimate research is done to determine the risks and benefits of marijuana, I would love to debate those with you. Currently, all marijuana research seems to support whatever bias the researcher has. If NORML supports the research, you will be told it is neuroprotective - very important in glaucoma as it is the optic nerve that is under attack.
http://www.medscape.org/viewarticle/715888

If the government does the research, they find it has terrible side effects:

http://norml.org/news/2001/09/06/marijuana-is-neuroprotectiv...
http://www.drugabuse.gov/publications/drugfacts/marijuana

Well, the truth is that NORML research actually came from the Journal of Neuroscience, but who can trust a rag like that? Right?
http://www.jneurosci.org/content/21/17/6475.abstract

So, if you had a patient with glaucoma and they did not feel the risks outweighed the benefits of drops, drugs or surgery, would you tell them about marijuana? If not, I am very glad you are no longer practicing ophthalmology. If the Hippocratic Oath meant anything to you, marijuana would be offered as a first line of treatment, its side effects are among the least problematic. It is a meaningless, isolated case, but I worked with "that patient." The man had tried everything and he had every side effect possible. On his own, he started smoking pot. His pressures stabilized, his Cup to Disc ratio stabilized, and the only side effect he had was feeling relaxed. You would withhold vision saving medicine from that man?

I am very curious, Dr. Paul - is your refusal to advocate for marijuana users based on medicine or politics?

In conclusion, I wish to ask you a question about your faith. I understand you are a Christian. Let me direct your attention to a verse from Genesis (1:29)
"And God said, Behold, I have given you every herb bearing seed, which is upon the face of all the earth, and every tree, in the which is the fruit of a tree yielding seed; to you it shall be for meat."

Did the FDA become a higher authority than God to you?

If you truly do not understand the reason marijuana is illegal, I urge you to do some research. This is an excellent place to start:
http://www.drugwarrant.com/articles/why-is-marijuana-illegal/

If you are playing politics with people's health and liberty, I will spend the next four years on the internet exposing your hypocrisy. You think living in the White House might be nice? You will never get there straddling the fence between fact and fiction. The current faux duopoly is repugnant, but a sheep in liberty lover's clothing is no improvement.

Sincerely-

(fishyculture)
Retired COMT
Truth and Liberty Champion (one cannot exist without the other.)

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Bump for medical knowlege

That was pretty interesting!

There is nothing strange about having a bar of soap in your right pocket, it's just what's happening.

Rand is not against medical marijuana..pushing industrial hemp

in Kentucky also.

That is fine for a politican.

As a doctor, he owes his patients more. He owes them a full discussion of risks, benefits and alternatives. See my reply below for details.

Love or fear? Chose again with every breath.

Uhh....

You realize Rand is in favor of allowing states to legalize/decriminalize marijuana right? Your complaint is that he's not talking loudly enough about it for your taste?

I hate to say it, but you're acting fairly nuts here. Don't you have better fish to fry?

Eric Hoffer

Perhaps the medical jargon went over your head.

Let me dumb it down for you. Rand said he would never advise anyone using it. As an ophthalmologist, that is reprehensible. Current glaucoma medications concentrate on lowering the pressure inside the eye, even though years of research and treatment have proven that reducing the pressure is not addressing the real problem. The real problem is damage to the optic nerve. Marijuana protects nerves. All the acceptable therapies do not address the nerve at all, they only lower pressure. Some people still go blind on current treatment. Marijuana would be the drug of choice as it addresses the real problem, rather than treat the symptoms. playing politics, his comment is giong to play well in Peoria. If he is talking as a doctor, he is doing harm and that is supposed to be a sacred cow in medicine - "First, do no harm."

I guess I am "fairly nuts" about people being told the risks, benefits and ALTERNATIVES regarding their health issues, as that is the legal standard of care. He flippantly dismisses marijuana as medicine. Saying "state issue" is a cop out.

Love or fear? Chose again with every breath.

Tomorrow's news

In tomorrow's news, Fishyculture begins war against every ophthalmologist who isn't assigning marijuana to cure glaucoma.

Errr... wait, you mean you are going to ask every ophthalmologist in the country if they'd use marijuana to treat glaucoma, assemble a list of bad doctors, and then go to war right? Or were you just using this as a reason to go after Rand because it fits your agenda?

How many doctors on the list so far?

Eric Hoffer

Only the ones who get on national TV and say they would not

advise its use.
You see, most ophthalmologists I worked with DO tell their patients about marijuana, in very hushed tones and only if they feel the patient would be receptive to the information. I worked with several who actually cared more about their patients than their political career. Crazy stuff!

Love or fear? Chose again with every breath.