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