wanted to work, seeing work, taking pride in that work status, eschewing welfare, something that is really unacceptable, right? almost, something that violates their sense of who they are but yet, you know bottomed of the -- bottom of the labor market has become so degraded. >> after words airs on booktv every saturday at 10:00 p.m. and 9:00 p.m. eastern. you can watch all previous "after words" programs on our website, booktv dot-org. now dr. david casarett onndt his visions into the medical marijuana around the world. >> welcome, again, i'm georgef wohlreich, welcome to the college of physicians atghte philadelphia. we're delighted to night to bring one of the hand grenades

of current thought and issues, medical marijuana. not recreational use of not marijuana but should marijuana and its derivatives be used forb health purposes, a veryes, controversial issue and one in which frequently there are far more heat than light and where we see frequently see people who seem to be immune to data. we have experts tonight to talk about this it will be moderated by dr. david casarett, who is chief of palliative care at the university of pennsylvania.re i'm a psychiatrist and i often think most people including many physicians don't really understand what psychiatry is. nobody understands what palliative care is. it is a wonderful branch of medicine and needs to be better understood. dr. casarett launch ad book a year ago that was wonderful. this is his second book is he launching here.. no, we do not have royalties on it but i own two copies of it.

so, dr. david casarett will come up in a minute. we believe all of you are literate. we print biographies in the program. this is not grand rounds. i will not sit up here for ten minutes and read every paper that everybody wrote butome dr. casarett will come up, talk for a while. then he will introduce our three panelists. then he will moderate a discussion amongst them. if you have questions during the evening there are note cards. i believe that you can write on and pass them and they will be collected. we'll also put a microphone up later for questions. please don't interrupt thesp speakers in the middle of the thing. t dr. david casarett, plies. [applause] >> thanks, everyone. it's delightful to be here a again, a year later, different topic as divisive as problematic i think.

i'm rearranging the script a little bit. i was supposed to ask thisnoth question in another half anlike hour. i would like to ask it now.d li i would like to know what people in the audience think aboutijua legalizing medical marijuana in pennsylvania. give you threeee options.you can be for or against, or youag can be undecided. we'll ask that question later. so all of those of you who are for? okay. all of those who you who are against? some. those of you who are undecided. ? which often means you have an opinion, you just don't want to state it for the record. it's okay, i've been there. so my goal in the next half an hour or so is not to change your minds. i'm not going to try to take all of those of you or even one of those of you who are pro-legalization and shift you. i'm certainly not going to take those of you who are negative and shift you the other direction, and i'm certainly not going to take anybody in the middle and try to nudge you one way or the other. and, honestly, i shouldn't be

able to do that. if you can be nudged that easily in the space of a half an hour for an issue that's this important, you probably haven't thought through it carefully enough. so that's not my goal, and that shouldn't be your goal here either. what i'd like to do in the next half an hour and what i've asked our panelists to work on in the sessions that they have follow toking this is not to try to change your minds, but to try to give you enough data, enough evidence so you can have a thoughtful discussion to support whatever your opinion is, and to do that knowing what the other person on the other side of the debate thinks too. so what we're after here is not a consensus that medical marijuana either should or shouldn't be legal, but a thoughtful discussion wherever that discussion ends up for any of you, okay? fair enough? so sponsors, thank you to all of these folks. and a special round of applause, if you could, for jill staal who's standing in the back there in the bright dress -- [applause]

who's responsible for doing all of the last minute things including getting me a glass of wine for free about 15 minutes ago which really, really helped. so thanks for that. [laughter] these are my conflicts of interest. i've asked the panelists, also, to describe their conflicts of interest. is she for or against? [laughter] i'll take that as a undecided. >> [inaudible] >> we'll work on that. i don't have any conflicts of interest. the views i'm about to describe are those of myself, not those of the university of pennsylvania. i couldn't resist putting this picture, this appeared with a book review for "stoned." i showed this to some of our social workers on the palliative care service at the hospital of university of pennsylvania, asked them if this guy looked like me, and they said, no, which was good until they said, no, that guy is much more cute than you are. [laughter] so thanks to all of you. this, ultimately, is the question i think we need to

wrestle with whether you're thinking about whether medical marijuana could help you or a loved one or on a policy level whether medical marijuana should be legal. is it a medication, is it a weed, is it something that could be helpful, is it an illegal drug that should be banned. or maybe is there some middle ground that we could find a consensus about. i wrote the book "stoned" for a patient i took care of about a year and a half ago. this was a hospice patient who came to us. i had a conversation with her about some of her symptoms. she had advanced pancreatic cancer, she described to me symptoms of weight loss, nausea, pain that sounded like it had a neuropatrick component meaning pain due to nerve damage. and in the course of that conversation, she asked me whether i thought medical marijuana might be helpful for her, and i told her what i had learned in medical school which is that medical marijuana doesn't exist, marijuana is an illegal drug, there's no

randomized, controlled, trial-date to support its use. but she is a retired english professor, and she spent the last 50 years of her life giving students a tough time and cross-examining them. so when i said there's no day day to that to support medical marijuana use, she said, really? because i went on the internet, and i found a couple of studies, and here they are, and she pulled them out of her bag. it was at that moment that i had to admit to her that maybe this retired english professor knew more about marijuana than i did. so i promised her that i would look at those papers, i'd look for other studies that had been published, and i would ask some of my colleagues and experts in the field, and i would get back to her with an answer about whether and how medical marijuana might help her. and my advice to her was that, yeah, based on the evidence out there, it could certainly be helpful to her. but that realization that one of

my patients with no medical training, a retired english professor, actually knew more about the evidence for medical marijuana than i did made me realize that there are probably other people out there, policymakers in our legislature, patients, families, other physicians who had the same perception that i did, that there's no evidence to support its use. so that's really what led me not just to research medical marijuana for judith, but to also embark on this process of writing a book. and as i did, i came up with three big surprises, probably more than this, but in the next half hour or so i'd like to walk you through these three big surprises. and just parenthetically, a couple of people in the press interviews i've been doing for "stoned" had asked me which science writers i find most influential for me, who i've looked to to be role models in how to be a medical science writer. and there's certainly some, people like mary roach i'm

compared with a lot, sometimes favorably, al very saks. -- oliver saks. but honestly, the most influential examples for me have been travel narratives. the really, really good travel narratives by people like jonathan raven, jan morris, these are people who write travel narratives really, really well. and what makes a really good travel narrative is mistakes and surprises and misconceptions that get rearranged along the way. good travel narratives aren't really about getting from point a to point b, it's about trying to get from point a to point b and winding up somewhere else entirely, or maybe getting to point b in the end and realizing it's not at all what you thought it was going to be. and so when i think of what a good science nonfiction in the medical vein looks like, it's kind of like travel writing in a way. so that's what i'll try to share with you. it's the ways that researching this book, talking to a lot of patients, researchers, reviewing

a lot of studies, talking to a lot of physicians, visiting clinics, trying medical marijuana for myself, what that's taught me not only in terms of the science, but really in terms of surprises and ways in which i've been surprised and, frankly, the ways in which i've been wrong. so the first that i'll tell you about is that there seems to be a science of the way that medical marijuana works. the second is that, as my english professor told me, medical marijuana does have benefits. and, third, that it has risks. although not necessarily the risks that i expected. and i'll walk you through each of these. so there's a science of medical marijuana. i really thought that medical marijuana or the appeal of it was just about getting stoned. it was the feeling of being high. it was the chance to forget whatever else was going on with you whether that was a terminal diagnosis or pain or nausea. it was something that was disassociative. i mean, it kept us from focusing on whatever else was going on, but it wasn't really

therapeutically valuable. that's what i thought. a little bit of background is useful. two main species of marijuana, some people argue that a third species is a true species, some people would mix it in with that these two, but generally when we're talking about medical marijuana or recreational marijuana, we're talking about two species. when we're talking about the active ingredients of marijuana, which i'll show you in a second, the big ones, the main ones that we know the most about are thc, cbd, those are present in these little tricomb that look sort of like nailheads that appear in the buds and, to a lesser degree, on the leaves and stems. so when you're talking about the cannabinoids in medical marijuana, you're really not talking about the entire plant. you talking about what's -- you're talking about what's highly concentrated. you'll really talking about these two molecules. there are a bunch more.

there are dozens out there. it's really thc and cbd that are present in the largest amounts, they've gotten the most attention in terms of what's been studied, but keep in mind although what i'll talk about in terms of benefits and a lot of what you'll hear from the possiblists will be benefits -- panelists will be benefits for thc and cbd, there are a lot, many of which we have no idea what they do, but there's certainly reason to believe they could be therapeutic as well or pose risks that we don't yet understand. another surprise for me in this overarching category was that marijuana, thc, cbd, other cannabinoids, act through receptors. it's not just a global feeling of being high, but there are very, very specific effects. cbd seems to bind to other receptors mostly in the immune system, potentially elsewhere in the body as well. and also, interestingly, in

cells in the brain which has led several scientists i talked to including donald abrams at ucsf to begin to think the cbd may be very, very useful in treating of pain, pain due to nerve damage and due to muscle spasm and multiple sclerosis. other receptors as well, this is just one angle of one snapshot of what we know. what really convinced me, though, that there was a science to medical marijuana that i really hadn't appreciated is that the man pictured here is, arguably, the grandfather of medical marijuana. i made a trip, a pilgrimage would probably be a better term, to meet the doctor in his laboratory at hebrew university or in jerusalem to hear about -- thank you -- to hear about some of his would work. and he was, in addition to other things that he's done, he was

the one who discovered with til devain so-called the bliss molecule. from the sanskrit. and it's interesting for us because it gives us a sense of how marijuana, thc and cbd in particular, do what they do. we don't have -- and this was a surprise to me -- we don't have or we're not born with receptors that are designed to bind to thc. we're not born with thc receptors. we are, however, born with an demand mid receptors. so when you take thc into your body in the form of marijuana that's inhaled or vaporized or eaten in the form of an edible, you're tricking the body into thinking that it's suddenly experiencing an in-rush. i'm oversimplifying a little bit, but just a little bit. so you're basically hacking into the natural endo ca nab nowed system, and you're convincing

the body that it's seeing it, and the reason it's important is the system is really very complicated. it's present in the immune system, this the brain -- in the brain, certainly, this most organs. it's also, by the way, present in pretty much every species except for insects for reasons which i don't really understand. so when you're using medical marijuana or recreational marijuana, when you're taking thc, for instance, into your system, you're really hacking into a very complicated system that we don't quite understand. so not only is the science of medical marijuana much more complicated than just getting stoned, it's even more complicated than just one molecule binding to one or two receptors this the brain. you're really tapping into a really complex in ways that are kind of hard to understand right now, and i don't think we have a full idea of, but you're tapping into a very complicated system in the body. so that was one surprise, that there was really some science, there's microbiology, there are

receptors, there are also natural variations in receptors, your ca nab nowed receptors are not the same as mine, so how you respond is different potentially from the way i would respond to a gummy bear or brownie. that was one surprise. the other surprise is medical marijuana really does have benefits. i really, as i said before, thought medical marijuana was a joke starting out, but i had to admit based on some of the studies that judith showed me and some of the studies and researchers that i saw and talked with, there really is some good data out there. of increasingly, there's a picture of a vaporizer here because increasingly some of the best data on marijuana for a variety of indications including pain come from these vaporizers. the science behind vaporizers is that you heat a marijuana bud usually to a temperature that's hot enough to make the cannabinoids, thc and cbd for the most part, evaporate, turn into vapor, but not hot enough to get the stuff this marijuana

to burn. .. other people are starting to use it. cleaner, potentially, easier way to figure out whether people are getting the doses of cannabinoids that you think they are, which is useful for research purposes. and, this is what one dispensary owner told me, i said there are benefits to medical marijuana. i wouldn't go this far. but one thing i discovered in looking through the world of medical marijuana, particularly dispensary owners, particularly those people who have vestedjuan interest in pushing medicalrti marijuana is there a lot of overstated claims. i would say there are medical benefits to mayor one. i would not say it is the new besta. thing. i would not say it's a wonder

drug. it doesn't cure all ills. it doesn't cure cancer. we'll say that for the record. we will save that for the record to take a look at state laws including some indications include in some of the legislation that's moving through pennsylvania, you see very long list of things that are listed as qualifying conditions. that's one interesting fact. the other interesting fact is there's a huge amount of agreement from state to state. what is the qualifying condition and one state may not be in another state which is fascinating because they there's enough evidence to support use of medical marijuana for ptsd or chemotherapy induced nausea, or there isn't but it's not like that evidence would be greater in california that would be in colorado. there doesn't seem to be huge out of agreement from state to state. there's ideas out there about how medical marijuana can help. so how much is there really of

medical benefit from medical marijuana? i could spend a couple hours walking through the evidence it would be a very, very efficiently putting you all to sleep, which i will not do. there's an article published in the journal of the american medical association just about a month ago now that was a very carefully done and somewhat stringent review of the evidence of both smoked marijuana and cannabinoids, natural and synthetic. they summarize the evidence more thoroughly than i could reasonably get in a short period of time so i will just say what they found. and is more is less passionate and this is more or less what they found. there is some evidence but are not as much as a lot of people would like. certainly not as much evidence as many patients who are looking to medical marijuana for relief would hope would be unavailable. these are their designations, not mine. modern evidence for neuropathic

spain, weak evidence for some of these other indications i've listed. i'm thinking that's although the odd because that's not entirely diametrically opposed to what i said in "stoned" or the impression i got but it seems like it was tougher, more harsh than what i thought. i decide to unpack this little bit. remember if they said there was only modern evidence for the benefits of medical marijuana for neuropathic pain, so i just picked one study more less a brand, done at uc davis which i mentioned, a really well done study published in a decent journal, and it was a study that i cite as evidence that there does seem to be a decent reasonable amount of fairly impressive evidence that medical marijuana is useful in achieving the neuropathic pain. to unpack the a little bit based on the journal articles

criteria, there's notable strength, randomized controlled trial. you can get placebo marijuana. that's a surprise to me in writing this book or even actually in pretty much the same way they remove caffeine from coffee beans. chemically the same process. both processes seem kind of a stupid waste of time to me. am not sure why you'd want to do either one of those unless of course you're a researcher. many use placebo marijuana. also use low and high dose groups to detect those effects. but in that jama article they pointed out to weaknesses only 30 of subjects and imperfect lining meaning some of the people in the placebo group, some people in active group knew how they were outside, knew what they're getting which makes you think about it. if you can't tell whether you're getting real honest to god marijuana are the equivalent of

oregano, you're probably not paying attention. said yes, some people managed to figure out. those two weaknesses were enough to downgrade the study i just showed you despite the fact it was a placebo-controlled, randomized controlled trial to a poor quality study. i don't mean to argue with those criteria. they could use whatever criteria they feel are important but keep in mind those criteria really are pretty tough. those criteria are also to because right now there is no federal funding for medical marijuana research. those of you who are researchers know it's really hard to do large randomized controlled trials, this grading article that the jama article i mentioned used if there was a small study, less than 250 people. so it's really hard to do studies that would hold up to that level of evidence that that jama article would call strong. looking at the wrong criterion,

but when your discussions of evidence being weak or moderate or strong, it's important to note as educated consumers, policymakers, physicians, patients, it's important to know what that means. rather than summarizing the evidence and talking about nuances, i thought it would be most useful to post this question. this gets to the heart of a lot of the debate about medical marijuana and how we should think about it. and that's how much evidence do we really need? i think the answer depends on who you are. if you're a policymaker, if you're a hard-core researcher, the amount of evidence you would want to make sure that any treatment, whether it's a new implantable cardiac device or a form of medical marijuana, to be sure that it works you would want multiple, large meaning some other people randomized controlled trials. if you're a patient as with many of the patients i spoke with,

one young man in his 20s had a bad but treatable form of lymphoma, without the awful, horrendous after every round of chemotherapy. so bad he couldn't even leave the house for about a week. nokia that was so bad, this is a 24 year-old who's thinking about stopping his chemotherapy for lymphoma and enrolling in hospice because he couldn't stand. he had been through four or five different types of anti-nazi medications when his doctor finally recommended that he tried medical marijuana. he said sure, he would give it a try. i tell you that story because his level, threshold for evidence is probably going to be different and a little lower than that of an administrator at the fda only hard-core researcher. i'm guessing one of those two is right, the administrator at fda, his or her job is to protect the public so the job is going to be

to ask for the highest possible level of evidence. if you're that kid trying to struggle through chemotherapy, or if you're a hairdresser naked cdc oil for your kid with intractable seizures, or a guy who is suffering through ptsd like somebody i met when it's researching "stoned," been through a dozen different medications, a couple suicide attempts, needed some form of relief, your level of evidence, the threshold for what constitutes enough evidence will be different. not trying to privilege one of those positions but when i hear people arguing about whether there's enough evidence, often was going on his people know exactly much evidence there is but they just have a different tug boat for what constitutes enough evidence. made me think about that going forward as we enter the debate phase of this evening and it used to parse out some of your thoughts in some of the discussion.

of the things other just about the potential benefits of medical marijuana, is an op-ed i i wrote for "the new york times" which were brief period of time with printing as one of the most e-mailed articles in "the new york times," ahead of paul krugman, which i thought was pretty cool, behind the unfortunate an article about sending copies to prison to be therapy dogs. i beat paul krugman but i lost to the puppies. the point of the article though has made you think a lot about what medical marijuana means, especially in light of the discussion we just had about -- if it seems, probably through, it seems like the utilization of medical or what is getting ahead of the evidence, many more people using it for more indications that are really supported by randomized control trials, i think that is fair, part of reason for that is health system for the most part doesn't do a great job of taking care of patients who need extra attention, x. is for, asked

education, certainly good symptom management. i feel comfortable saying that. many people from palliative care team who i work with were able to do a pretty good job but i think in general that's their job, but i think in general the health system doesn't. i have begun to see interest in medical marijuana not so much based on a belief in the evidence, partly that but also based on dissatisfaction with having to go to a physician not having time to address concerns been in and out in 10 minutes without really having the support and advice you need. evil are getting it as i discovered from medical marijuana clinics and from dispensaries. it's a chance for many patients to begin to take control over their own. i promised you three surprises. the third one, briefly, medical marijuana does have risks. a few of them were pretty sure about the whole bunch other speculative and others are things that i didn't expect that i'll walk you through this

quickly. this is something else i from dispensaries owners, something else that is just frankly not true. those of you with medical train window there's a logical flaw in this argument. marijuana doesn't have any risk. it's a flower, not like morphine. morphing isn't all prelude to the morphine is an opioid. this was a dispensaries owner convinced that marijuana is natural, it has to be safe which is not true. a few known risks, driving impairment could believe it or not i did not think addiction was a significant risk of marijuana. it's probably not as significant as addiction to cocaine as herr went to be there but is probably on par for something like alcohol, both in terms of risk addiction, risk depended. maybe not in terms of health consequences. there's lots of downstream health consequences including liver damage to a call addiction that don't occur with marijuana.

it to be treated with a hot shower for reasons that i just don't understand. known risks, a lot of unknown risks. these are known risks. i walk you through as i do in stoned i think where the evidence lies for each of these. i think some of these are more likely than others. psychotic episodes, yeah, maybe. my card y'all infarction or stroke, maybe not. . . not cancer, not one disease but i just want to call those out quickly. those are the areas of which there've been a lot of very large, very, very well done studies. i spent time talking with a pulmonary function test

physician, at ucla in los angeles and houston some of the biggest death studies of lung function over time and the sound there really isn't any decrease in lung function can increase risk of emphysema from chronic marijuana smoking which makes no sense, right? dislike the stuff that you inhale when you smoke a joint is exactly more or less the stuff that you inhale when you smoke cigarettes. so why doesn't that cause emphysema was this a couple of explanations. some theoretical, but the simplest one is the most obvious and those logical to me that's a matter of those. i used to work in the va. men at the veterans i took care of wood smoke to our three packs of cigarettes a day for 30 or 40 years. that's often for many people what it takes, but those the people, the dose to cause lung damage. imagine, would you be like if you smoke 40 or 60 joints a day

for 30 or 40 years. your results would be the least of your problems. it may be that if he really managed to smoke that much, which would take real guts, determination, anybody wants to try it, go for it, if you were able to smoke that much, you might wind up with emphysema but in the way most people smoke is not a concern. obviously, edible, vaporizing, it's not a concern at all. another surprise to me. it's worth pointing out there some flaws in the data. lots and lots and lots of case reports. somebody used marijuana were racially often invent something that happened to them. and in that resulted in a case reporting alleged. that doesn't marijuana use caused that, whatever it is. >> it's possible to find case >> it takes a lot to sort through that.

the second point is one of the most important. lots and lots of studies of recreational marijuana use but there's important differences. it's also very hard and probably kind of risky from recreational marijuana use to medical use. it maybe hypothetically that a 24-year-old that uses marijuana recreationally four to five times a week with other drugs like meth, it's at increase risk of psychotic episode. does that mean the that administrative oncology patient is also at risk in the same way. i don't think so, but we don't know because all the studies that have been done have been done on recreational marijuana use with often a whole lot of

other drugs in a different setting. here is a challenge for you. this is something that we think about as we wrap up. i try to describe to you medical marijuana uses common. there are roughly 11 million people registered marijuana user in thear country. that billion figure is underestimate. it would be nice if we had controlled data for use, the woman using it for qemo therapy and the guy for multiple

sclorosis. begin, -- again, no federal funding for research. so when i start to think about is how we can get better at crowd resourcing research. how can we get better from the experience people have. a million registered users around the country. there's really no organized way to collect data about their united experiences, no way to collect data about their side effects and risks. a lot of experience that's going to waste. i don't know what to de o about that. you could probably use it if you want it to. it probably wouldn't take much to crash, but i recommend that many people do it. we did this as a fun experiment to get patients to collect and

report data. we could learn from each other and researches can learn from patients. if you see reports of somebody using for a benign tumor that's interesting, but if you see 50 or 200 or 500, some researches are going to start paying attention, we should really do a control trial. so, i think there are three surprises, briefly. there are medical benefits probably notou as many as some dispensary claim, but probable more than the people that oppose medical marijuana would admit, also has risks, which everybody needs to admits, not necessarily the risk that you think about. so medication, weed, i'll leave

that to you to think about and for panelist to help you think through, real risks. it's hard to say it's the medication because one plant is one plant. but there are certainly molecules in marijuana that do have real effects. hopefully i've given you enough facti's relating to science and benefits and risks to think and emerson did which i don't think he was thinking about medicine marijuana. a thank you to many people i interviewed to people along the way.. sasha the dog, german shepherd in california, outside of san diego.

it's the perfect clinical environment, all the outpatient clinics had pets like sasha. so let me stop there, let me thank you for being intentive as i probably walk through more science than you wanted to here. you've been very patient. thanks for that. next i am going to introduce our panel briefly about looking for jill to advice. jill is nodding. i'm going to introduce our panel and ask them to come up. you have in your handouts, you have the bios, i will not walk through the bios.

to my far right, and we have decided to make executive decision, we will use first names, in the question and answer sessions as you begin to answer questions, to my far right jones who joins us from washington , d.c. joseph joins us also from philadelphia. we will ask them to do ten-minute presentations. as they do, if people have questions, i would ask them to be perhaps forward to me or probably it's okay, save those questions until we actually get through their presentation because i really want them to have a chance to give you a sense of their perspective. i'm also aware that what i told you could certainly perceive as having one directionality or

another. i could only request all us a reminder to me, this is a topic that lots of people feel very strongly about. either because you have political or intellectual leadings or some of you have your own personal health experiences of those of family member and i would encourage you because of that to be extra careful and courteous in your comments and questions. last but not least, it's probably not going to surprise youba to learn after having learned of people bios that there's a spectrum of views of medical marijuana represented before you among the panelists and myself and that will jones, he's probably on the more conservative end in given how many hands went up in favor of marijuana when i did the poll 30

minutes ago. i will ask to be respectful of will jones that he's a guest in philadelphia. i promised here that people in philadelphia are much nicer and more polite than the politicians that he's used to deal with in washington. i alsoit promised him that we he much better restaurants and nicer weather. don't make me a lier on that first one. i'm very well he can take care of himself but he is a guest and i would ask to be respectful. gentlemen do we have an order? i'm glad because i don't have an order. take it away. [applause] >> thank you. >> we will be very tough, tough time keepers so beware.

>> in 1887 and published in the therapeutic, clinical and fees -- notice on the the cannubus has been in the profession as a remedy to be used in combating all forms of pain. yet, variations found to be exist as to its activity, it has not received the confidence, which i think it now deserves. i agree, president. he wrote words in 1887, he was president of this college, 1925-1928 when he wrote this he was a professor where medical

materials were therapeutics at jefferson a few blocks away. lets step forward a little bit to a more recent source of material medica this wonder boom called canni -- cannabus farm disturb >> back with cru annabu with the medicine it was only available, this as an example of cannabus in a texture form prior to it being banned for political and racial reasons.

there were other forms. this comes from australia, a combination of cannabus, which was used for mucus -- excess mucus conditions and hay fever. we have drugs for these conditions with fewer side effects. cannabus wasnn part of american medicine even beyond the presidency, the portrait of the president is in the middle upper row who i began to talk with. the textbook i have is the principles and practices of medicine by sir williams, the 1914 edition. he was also a professor at the

university of prefl. the coauthor thomas was a professor at jefferson medical college a few blocks away. this college sitz in doish -- sits in between them. this is under cannabus, i'm sorry, under migraine, that cannabusra is probably the best remedy, the most sates -- sates cannabus is part of american history. there's more to cannabus the

plant. there are many other cannabinoids which affect other cannabinoid. this is called the hole is greater than parts. as an analogy one would have a diet of totally processed foods and take vitamins and live or one would eat very healthy foods, fresh fuits and veght ls, nutsli oils and life and glow. the difference is the sum or whole isi greater than the individual parts. that's the mystery of the cannabus plant. in addition to several cannabinoids, the plant also

contains turkings. they are found in many other plants. different odors and colors. this is the reason why one strain and another strain of the plant may have identical qualities or quantities of chc and bac. the others are going make a difference in therapeutic effect. sadly considered stimulating and strains considered sedating, with someone with severe pain that can't get out of pain, a

more useful for them for somebody with inflammation, who are arthritis, the strain maybe a better choice for them. i want to talk about little known federal program that's been supplying medical cannabus for a very long time to a very small group of patients. this can represents 300cannabus cigarettes that the federal government has been given to roosevelt for about 33 years. irvin wrote a book about it and help launched international movement. medical marijuana in large part is

due to his efforts. see, irvin has a very rare bone disease and discovered that smoking cannabus worked and he tested on and off and sharing us, it provided more relief for them than any other medication including fda approved. so i want to basically stress that there is a lot of ingredient's in cannabus, but there are effects on the plant that are not present on the isolated ingredients. each strain has slightly different qualities. they maybe referred as a scientific treasure troll. also our bodies in the system is very important from the

implementation, earliest to what stimulates a newborn baby to drink. if you will, the munchies. the system is a system that works through signaling and helps restore and balance and helps means of modulate neurotransmitters. people who use cannabus medically because of the interactions. they are more successful.

i'm sure you're going to have a lot of questions. [applause] >> everyone, i would like to thank david, joseph and bill, and i would also like to thank the college to inviting to speak and particularly one a personal note, my picture next to a big -- [laughs] >> that's all i need. i represent a couple of business people who are interested in opening up dispensers here in pennsylvania and also amish who are interesting in growing so it's an interesting dynamic.

so it's an interesting place. thank you for not having my picture next to the pot. i was asked to give a synopsis of where we are here in pennsylvania. i'm going to talk about somewh f the political movements, what a medical marijuana infrastructure would look like here in the state and as a transition, some of my personal reservations here. sos last year, we had a bills 12 and it passed unanimous subcommittee. itt passed 47-7. it would be medical cannabus act. and this shows priority from

1182, we reserve to stopping this, we are going to help our sick veterans. he can't wait for government to step up to the plait. medicamal cannabus, people thout about medical cannabus and then it was 85%. >> reputable agency. 89% of pennsylvanians people don't just check a box, are you favor or against it, undecided, that figure translates to the

ballot's office. 100% of the people, politicians that put their name in 1182, won reelections by landslide. 100% of the people who put their name on medical cannabus won reelection by a -- that was not just them vowing, it's people that are taking a great interest into medical opinions, 20 minutes today i took and i just cruised the internet that were supportive of this bill and medicaetl marijuana, legalizati, specifically for medical purposes. i'll just spend 20 seconds naming a couple. medical association, nurses association, alaskan

association, california medical association and california association, california pharmacisto association, nurses association, connecticut nurses association. federation of american scientists, florida medical association, guam medication association, mississippi association, new hampshire association, new mexico medical association, new york medical society, new york association, new york nurse's association, rhode island medical association, san francisco association, virginia nurse's association on addictions, washington medical association, wisconsinrg association, wisconn public health association. i tried to do it all on one

breath. the then senate bills 182 was then reintroduced by senators, senate bill 3, and this again unanimous passed the subcommittee,i passed 47 in the full senate and 1182 is a marker but it added to help for more pennsylvanians. it added other functions to help people with diabetes, and was brought to the house and gol -- got to the house and got stalled in the house. been redrafted to another bill and under house bills 432. we are hopeful that we'll be able to have this out of committee by early fall, still having our fingers crossed.

senate bill 3, which frame of limited, people who. >> going to then sell it. growers 65, 130 for dispensers, numbers going to be cut down which is unfortunate because there's 12 million people, how many are there. 601 liquor stores. it's a bit arbitrary and low numbers. one of my fears it's going to be in an area where you can't get access tonn its medicine. someone who wants to open up the dispensaries is not going to be allow-patient area,

understandably. so if we're already limiting the norm of suspense ris -- dispensary is limited to the outside. it's not going to be constitutional amendment. one of the things that we saw in florida and the reason we don't have full medical cannabus in florida is because they put as a constitutional amendment. the reason is we wanted to ensure patient, we couldn't have come in and start by right to patient protection. so we're going straight to the legislative process here. the next is senate bill 3 where the hb142, my impression of california is that the defact of legalization.

they need to have a preexisting relationship with a doctor. so in pennsylvania i've been told that you -- in california been told and david can confirm this, if you have $75 you can walk off to a doctor with good story and you're getting a recommendation. that's not going to be the case in a pennsylvania. you're going to have a doctor with whom you have a preexisting relationship, review chart, go back for exams, this is a medicine quite similar to anything else, this is not going to be cbd only. cbd is a component of cannabus. there are hundred of components of cannabus. cru bd does not get you high. it has been shown to help with kids who suffer syndrome,

epilepsy. in pennsylvania children who suffer from epilepsy could have hundreds of episodes a day. we give these kids up to seven. can you imagine given seven candex? 700 episodes a week go down to one to zero. the problems we are now seeing is these kids who are addicted to xanex from birth, they are now 7-9 year's old. this is thee problem we are having. we are going to be more inclusive and having to help our

veterans, activate some of the reasons. the next thing that we are going to see, i just got the one-minute mark so i'm going to give the transition to will, one of my concerns when i started this cannabus association in pennsylvania, is i have friends who are dispensaries in california and when i visited them quite candidly, one of my fears are seeing gummi bears and things attracting to children. i think it's frightening that if we have medicine that could be attractive and attracting to children. so one of the things in pennsylvania if we're going to make sure that our dispensaries don't have these things.

i don't think they should be attracted to children. that's all my time today. [applause] >> hello, everyone, and as i could see from the raise of hands i'm definitely in the minority here. actually in more ways than one. [laughs] >> but that's not a problem for me and i appreciate the invitation to be here and to share my perspective on this in many ways controversial issue today. i'm here with the organization of s.a.m. three administrations in bush and obama and the only senior adviser to the bush and obama administration. also congressmen patrick

kennedy. i'm going to start here. my thought on marijuana just in general has developed immensely over the past few years. honest, i'm 25 right now, and but, you know a few years ago i did not have a conclusive view of the marijuana issue. i knew that it wasn't something that i wanted to do personally as a personal choice but on the legality of it in medical marijuana, all of these things i had no concrete position. i began to do some research myself on the issue and that's led me to be against legalization general for recreational use, we're not talking about that tonight. but also against medical marijuana. i'm going to explain my reasons for why i think that we shouldn't rush into medical marijuana. it seems like the tie today, the

momentum is welcome medical marijuana. i'm going to bring a few reasons why we might want to put on the brakes and slow down before we welcome this with open arms. i would say that every person in this room wants anyone that can be treated by a component of the marijuana plant to have access to that treatment in a safe form. i don't think there's any person here that would stand up and say, i don't want someone that can be treated by something in marijuana so be treated by that, because, you know, marijuana is bad. i don't have any moral issues with the marijuana plant. i don't think it's like a double's weed or anything like that but i do look at -- i'm looking at it less from a medical perspective and more of a society perspective. what's going to be the impact of medical marijuana on society?

what's going to be the impact of youth on medical marijuana? it's not the fact that people can be treated. i think that we would all say, yes, probably, so and we need to do more research to see what can be treated by this. our organization is saying we definitely support research into this process and i met with kids that are suffering from epilepsy and seeing how they are able to access cannabinoid. that'so one thing we need to accelerate the research for that so that they can have access for that and have a better quality of life. i am very concerned about, thousand e, is -- and i think we all should be concerned about is the influence of corporations and businesses in our society

particulary on the marijuana issue, recreational or medical. i'm going toh bring a reminder for all of us, it was not too long ago that there was another plant that was reputed to have many medical benefits. there were doctors endorsement for a long of a list that you could wish testifying to the medical benefits to this plant and we as a society welcomed it with open arms and how we are reefing the consequences of that. i'mnc refer to go -- referring o tobacco. there's videos of panelses and panels of doctors and congressmen testifying and it's going to be a great thing. we are now paying the cost at 500 thousand lives her year.

my concern is not that there's going to be death from marijuana, i'm not going to go into that there, but the impact an industry, an industry that profits off of addiction and that profits off of young users unfortunately. the founder of normal, one of the organizations that lobbies for marijuana and medical marijuana, he said, we're trying to get marijuana reclassified medically, if we do that, we'll be using -- this is a quote, he says, we're trying to get marijuana reclassified medically f we can do that we will be using the issue to give marijuana a good name. that's what i'm afraid what we are seeing today. i'm not afraid that people will be able to treat by components

of the marijuana plant. as was pointed out in places like california, it's ridiculous, npr wrote an article that in los angeles, for example, the number of marijuana dispensaries outnumber the starbucks a thousand -- this article was done in 209, a thousand marijuana dispensaries in los angeles, 600-700 starbucks. this is a very profitable industry. former executive wants to create starbucks marijuana and we have to be very careful when there are t big financial interests ia medicine or any other thing, but we are talking about medicine this evening, that we are not seeing skewed research results, push of billions of dollars which is estimated that

marijuana can bring. we're not being unduly influenced in thes past. would you grade our -- our -- how we handle medicine and use across the nation? a lot of people are saying, we are not doing that great. there's a lot of people getting addicted to the medicines that we current i will do have and it's becoming in certain states epidemic. and this is what i'm very concerned to see that marijuana, i. mean, we're already seeing epidemics with drugs that have gone through all of the research processes that are out there that are fda approved and the

clinical trials with the many restrictions to become medicine. we are seeing abuse with those that are prescribed by doctors. i'me wondering, what are we gog to see when we welcome an industry that has very little restrictions in terms of a medicine that not fda approved. how do people know they are receiving medical marijuana, for example u fu da recently did a study on thing that is were supposed to have oil in them and only about 50% had what they said on the label that they had in them. a lot of people would argue that brings, is a case for lets legalize it so we can better regulate it. first, look and see how we are doing with what we are regulating and ask are we ready to introduce a new drug that has huge financial incentives into the discussion. now, we should do everything that we canth for people that nd

immediate use, for example, kids with epilepsy. they should have access to experimental research and treatment as we're discovering this, but there's no reason to kind of give marijuana an exception that no other medicine has had, no other medicine can you self-prescribe, can you self-dose, which is often most of the time the case with marijuana and we like to point out as well, you don't have to smoke -- i'll put it this way. the way that medical marijuana is most often used is that it's smoikede -- smoked when we are referring to that. you don't have to smoke marijuana or any other medicines to receive the medicina properties. we don't smoke opium.

we shouldn't have to do with marijuana. in conclusion, we are -- i think everyone in this group would be in agreement that we need to do everything we can to see the marijuana plant like any other plant is responsible researched and available for people that areai treated by it. but we have to be very careful that corporations are not undully influencing our quick acceptance of this drug that has looses restrictions. we're already having problems with use across the nation. are we going to add to that problem. i don't have time to go into the potential downside of this as well, but are we ready to welcome that on a national level or is there more responsible way than saying legislators, what can be treated by something that's not approved by the fda

or anything else and let people decide for themselves. so we're really encouraging. lets put ton brake and take a responsible route forward with this plan. [applause] >> thank you very much. that worked out much better honestly than i thought it might. i'm not sure why i thought that. thank you, gentlemen, for taking the time to prepare those statements. those of youth who have questios on note cards, if you could pass them wherefore you -- wherever you see the beautiful jill, she will create, sort, shuffle and then hand them to me. while we are waiting, a couple of questions we already have

that have been used to stack the deck, which requires me to choose. let me ask the question of everybody and get everybody a chance to weigh in briefly u so if medical marijuana comes legal in pennsylvania or potentially in other states u should physicians who have a moral medical objection be allowed to opt out and not to provide those recommendations, in whatever order you choose to weigh in. >> of course u physicians could opt out. most gynecologists won't perform therapeutic abortions, most

internists wouldn't do qemo therapy. >> medical school don't teach this, if he doesn't feel comfortable and knowledgeable we shouldn't force them to do it. >> and yeah, in agreement. if. a physician does not feel that it's good for the patient there's no reason why to have to prescribe that to the patient. >> thanks. sove another question, this is r will and i'll try to work these around so we don't put anyone person on the hot seat more but one question from the audience that i was curious for, will, for you. there ainre other substances oue there, alcohol, tobacco which you mentioned which are also

addictive and also have health benefits. it sounds like a leading question. i certainly don't meani it that way. are ther me ways that marijuanas different that makes you more concerned about it than about alcohol or tobacco or you -- some of your resistance to legal izing expressing the same concerns about alcohol and tobacco? is marijuana different or part of self-concern? >> i'm i'm alive now and have the opportunity to speak about the issue as in the time of alcohol or tobacco i was not alive and did not have the opportunity to speak up or research and say maybe we shouldn't do this so quickly. in terms of timing, that's one way i like to see, just that it's very different. what happened withke alcohol and tobacco is what happened, we

can't -- they are embed in our culture. weur tried prohibition with alcohol and you cannot -- it didn't work. now in terms of medically speaking, i -- there is a difference with marijuana. many studies, psychiatry journal and other medical journals point out that marijuana can have debate rages back and forth, so i'm not going tost say that the studies that i cite arees the oy studies out there, for every study there are great things. there are studies that show -- it can lead to skits -- there are many personal stories about how marijuana has helped. i can also share story about close relative of mine my age

that started using marijuana and now mental issues. so we have to realize that -- there's a difference. tobacco does not impair your driving, you know. there's no really studying that it's going to impair your driving that causes endanger to other people. there's other dangers with tobacco. there are differences in marijuana versus the others. in not so much that it has to be treated differently, if it was in my book, lets take all the liquor stores off the corners, but my consistency wouldn't be to take it easy available to everyone. >> great, thanks. other question. i'll do my best to sort this on the fly. will not just for clarity sake get to all of these. if you could see the podium in

front of me, it look like my professor judith explained to you a few minutes ago had a really bad grading afternoon. it's just a mess. we won't get through all of these. there is a movement towards legalization of medical marijuana. there's also increasing interest in recreational marijuana. certainly now legal in colorado, oregon, alaska, i believe, and other states are certainly considering ita. is that a potential problem for some of the discussions we have been having for very, very careful use, about marijuana as a drug. is it a problem and how should we -- but i'm asking this, how should we deal with that? i'll leave that up to you.

>> this is a question that i thought about a lot. if a state has specific criteria for medical cru annabus use u and the patient does not have one of those conditions but has a recreational cannabus prohibition, they can purchase crow -- cannabus and have the same product ideally that's quality tested and quantified to be free of pesticides, molds and toxins, recreational can certainly help the medical patients. >> i think the two issues are contemplated, unfortunately.

medical marijuana and recreational adult regulated marijuana have in common is the word marijuana. my interest tonight and hopefully the scope of this debate is getting medical access to those who need it most. there are those who are strongly for and against expanding that to having adult choice, and they would cite a multitude of reasons for that, some which, it cites statistics that are going on in colorado right now. they are seeing dramatic decrease in violent crime in downtown denver. they're seeing increased tax revenues. i want to go back to the fact

that i think we need to avoid inflating the issues. there is something that will had brought up in his concern was the impact, the impact in children. i would encourage everyone to take a look at an article put out in forbes last month june 15 citing a study from colombia university and in the study it was a 24-year study, 48 states, one million kids, 13-18, and they have shown that legalize cannabus for medical purposes does not increase teen usage. it's going up everywhere except for the state that legalized it for medical purposes. perhaps it's a speculation on my part. we are showing kids that this is medicine.

there's a difference between use and abuse, when we show that this is medicine, that this is for sick kids and people with aids, cancer and hiv it's no longer view as a party drug and kids don'ter use it. there are many reasons to legalize it for beyond medical purposes, but tonight my focus and discussion is for medical purposes.is >> yeah, we're talking about recreational use, i could go on all night about why that's a terrible idea. on the impact that that's going to have just on society based on different studies that are out and so forth, but not going to go into that, it's interesting that in a lot of states that have medical, sorry, in the states that have recreational marijuana, the market for

medical marijuana is sharply dropping, and one could say that there's no need to get the medicine, need to go to dispensary, you can get it to the closer shop or what have you. i find it interesting if something is truly a medicine, do we become comfortable, then, just buying it from a nonmedical place? i think thatj points to the fact that we don't really know, this is not as dos is. they try very hard today it that way. it's unregulated. there's no standard on these things and so the reality is that medical marijuana for many people is -- is just like recreational miern, -- marijuana in terms of people that get medical marijuana cards across the country. now, again, there's some people

with very terminal illness or kids with epilepsy. most people that right now have for medical purposes, it's really a guy -- it's been a guy -- studies i'd be happy to share with articles with anyone afterwards. the average use is a white male with reported back pain. i think it's very interesting, our perspective is that medical marijuana is to create a broader social acceptance of marijuana so that we can then get to the real money making scheme, which is recreational legal marijuana.

>> so to steven, a question for you, as we've discussed in all the presentations, stiet laws identify qualifying cunción. those state laws often vary. so what's qualifying conditions in colorado may not be in california or washington or vice versa. this question relates both to that aisnd to whether you think it's a good idea that state legislatures should be determinindg what the qualifying conditions, there's actually a second part to that as to whether the states begin going down the road rather than having state laws to determine qualifying conditions, how you think the benefits or risks potentially to having either state medical board or another organization that can make more real-time decisions about what's a qualifying medical position rather than requiring a change

of law. does that make sense? >> yes. two part-question as i understand it. these first part is you take a look at different medical marijuana across the united states, some specifically conditions, if you have one of the conditions, you can get assuming you have this condition and meeting with a doctor to write recommendation for. it'sme more liberal laws, perha, leave it to a doctor of whether or not you should get access to that. i hope everyone in the room would agree with me that i view this as medical issue, not a political issue. i don't know about how, i want want a politician of what i can put in my body.

[applause] >> i would hope that people are making these decisions are physicians and if -- if we read dr. david's book, i'm sure we are seeing that many physicians are not trained in this yet. physicians, people we trust our lives to make medical decisions don't understand the drug, how can we expect politicians to understand this drug. so one could make an argument that we should leave it up to doctors to make decisions given thata it's a medical issue, nota political issue. that having been said, i'm a realist and i live in the real world as we all do and we unfortunately have to make politicalav concessions at the state ofe pennsylvania. if we were to take a look senator bills 82, there are

three pages, everything under the sun that has been used and on the jurisdiction and i was privy to provisions, and people with red wine and diabetes. hey, you want my vote on 1182, it's not tobacco, it's people with, you know, all sorts to agendas and tied to pharmaceutical companies. mr. matt baker has kepted $22 million plus in finance donations, big farm -- pharmaceutical companies and he's the responsible party and allowing clearly to adopt, so

i'm hesitant to allow or to, you know, agree to allowing a list of qualifying conclusion, but unfortunately that's going to have to happen. but fortunately legislature, they recognize that they are not physicians and despite the evidence it's constantly expanding, so we need to have an oversight that acts with great transparency to review now medical evidence involving medical evidence to expand criteria. .. ria. i am sure joseph can speak it can speak a better link so that would make a good fit to that. >> my very simple answer is having patients with chronic diseases on the medical board would really appeal to me for

the obvious reason. they are suffering. they may have been remission from other other people with similar disorders and that's all i want to say i'm not. thanks. >> i would agree it seems bizarre politicians would be deciding who gets medicine. especially with the white areas across state of what qualifies against medical marijuana. i'm kind of scratching my head wondering why medical marijuana is getting this passed. my solution is its part of recreational. but i don't think it should be left in the hands of politicians to decide who gets access to certain medical treatment. what i do think would be better and there's many other options

for moving forward with marijuana research that we are to be honest not exploring because another unfortunate reality for those that differ with the marijuana agenda as we see a lack of a name for those that disagree with the stance. i will bring up another medicine that received an exception. marinol had 20,000 patients. it had 3000 doctors that participated, used yet she come in schedule one substance. compassionate treatment was for those 20,000 patients able to use it by selling something under schedule one. after the proper medical trial to show that with the fact that i'm removed from the category of people cannot access that. that's how we should be moving forward with medical marijuana i prefer to say medicinal properties of the marijuana

plant should be done in a medical way, not a political way at all. >> we have about 10 minutes left. we have about 18 questions. do the math. i will direct questions for each of you and ask you for brief responses and then we'll try to move on get through three of these if we are lucky. dr. joseph. should medical marijuana be covered by health insurance? you don't have to do yesterday now. you can explain your are a little bit. >> i will lead up between the individual patient health insurance company. >> to think health insurance should be obligated to pay for medical marijuana the same way they pay for beta blockers? >> i think that is more of a political question, and i

think -- the answer is i don't know. it's not really a medical question. >> i think it is. let me weigh in. this is my question but i loved it. i think you could make an argument they should. for a couple reasons. it has medical benefits and number two we know lots of patients out there who are stopping their medication than switching to marijuana instead. people like to use medical marijuana because it gets you up with opioids. they are not paying for the medical marijuana you buy at the corner store, the health insurance make money off of the switch to medical marijuana. i've been a little bit doubles at the kitty here. but i think the argument could be made. [laughter] [applause]

>> mr. jones, we talked around it a little bit, but i'd know something we are operated back to some degree how much diversion we know is going on right now for a medical to people using it recreationally and states in which it's now legal. >> the ones they're very, very blurred because it depends on what the qualifying conditions are in a specifics date and whether it is something someone can pretend they have are verifiable they have a certain illness. places like california you mentioned is pretty much legalization. states with area restricted medical marijuana laws. i would say the use of medical marijuana is a lot harder. the respective states as to how much is being done.

on a pure numbers overall across the nation for the studies that have been done, there are so studies showing that the vast majority of people that say these medical marijuana is used for medical purposes. >> stephen, one question from the audience. we talked about the number of dispensaries recommended in the current though in pennsylvania, maybe not as large as it should be. what is an optimal number? maybe the question underneath is how we begin to figure out what the appropriate number of dispensaries with you to provide access. is there a formula that doesn't involve the state liquor board near you? >> it depends how many dispense

areas there should be. because like a population density, or more specifically patient accounts of where these people are. there's actually -- philadelphia has the fourth-largest concentration of hiv-positive people in the united state. i don't know if that's true. perhaps more dispensaries located in this area. certainly one in every county. people shouldn't have to be expected to drive an hour and a half to get medication. >> one last question for joe seven nonetheless each of you to say 30 seconds to one minute tops of rapid statements. and joe said he couldn't go last i'm not able to give you time to think. the question focused for you if medical marijuana because legal in pennsylvania as other states, but carriers do you see it will

face an encouraging, cajoling, nudging physicians to embrace the medical marijuana therapy. >> at the next-line question. medical education is really important and medical education comes formally through continuing medical education credit. it also comes another waste listening to your patients and reading some of the nonspecific medical literature. i want to address the medical education as part of the board exam for the american academy of cannot avoid medicine is really excellent. as far as listening to your patients, i wrote a recommendation for a medical history out of this day, out of this country and i watched and medicaid for multiple sclerosis. he had two types of pain.

one went away immediately with the first inhalation, the second changed in character. that is learning from your patient. the third is her mother's versus. well pointed out that medical cannabis is really just an excuse to get on the recreational side. i think it is the exact other way around that many of the so-called illegal users because we don't have that are self-medicating. let's go down with the industry of the drug pushers, the drug importers, those who poisoned cannabis with pesticides just to sell it and have claimed cannabis patients can use without fear of arrest that are certified as to cannot invite content, chirping content and being free of pesticides. [applause]

it's been a good, excellent clapping. that will suffice as your closing comment. you're not going to be able to top that. i would just run with it. [applause] closing comments >> again, especially taking care of our guests over here, we have a jail in a court in our state and we are taking care of our guests here. thanks again for having us. just in brief summation, take a look at what's happening in other states and what's being done efficiently and effectively. we are not seeing zombies walk the earth that kids are having a fax as to non-psychotropic can have annoyed and we are seeking

24% reduction in opiate use. we are not seeing big cannabis, what's the alternative. let's take a look honestly at colorado. we see decreased crime both filings in burglaries because the cartels are wholesaling leaving colorado had going elsewhere. everyone in mr. cheney and get mexican ditch weed in colorado if you wanted to. instead, patient are getting safe access to medication that has been tested with mold and chirping and give safe access to alternatives that are here. thank you. [applause] >> surely the last preferred.

>> i think that myself and everyone here wants people that can be triggered by any medicinal component to be able to have access to that. we all wanted to be in a medical way. i think too often the discussion on marijuana by this legalization of medical marijuana goes into dichotomies in museums there is. and the experience and it shows that this is not really medical how were going about it. is ample evidence with other drugs that were restricted with preliminary studies that we can follow with marijuana as well so that those that media can have that. the medical marijuana was as they stand necessary medical marijuana move forward across the country, i don't see very much that's very medical about

it. it is basically allowing people to use medical marijuana. if they feel will help treat something they have. it's either cooperate to legalize marijuana and deal with making a medicine later. both colin and what we have right now medical marijuana is not properly in the category. i think it would be less have legalized marijuana or not versus medical marijuana as we see it across the country right now. >> great, thanks. [applause] thanks to all of you and our panelists. george has a few last words. i want to thank you personally for being a great audience and sticking around to the almost bitter end, for being thoughtful, for being curious, for asking great questions, most of which i regret we did have a

chance to get to but you can ask the panelists later. thank you for taking the time to think about this. it's easy to have an opinion about medical marijuana. it's a lot harder to think thinking process and listened and asked the right question on i applaud you for doing that and i applaud her pale for helping us all do that tonight. [applause] >> i can think of no better place in the college of physicians of philadelphia, the oldest professional society in the united states have had this discussion this evening. i also want to say i hope i never need this professional services, but dr. casarett's manner and style is just wonderful. [applause] i am going to put in a prepublication order for his novel, which i suspect is going

to be just amazing. i want to take the chair's prerogative here, full disclosure amongst other things i'm an addiction psychiatrist. some of the worst things i've seen in emergency rooms have been people who thought they were smoking marijuana and were actually smoking really other bad things. secondly, one of the things i is a physician i'm concerned about is there a many physicians perhaps capable of treating addiction and capable of treating very severe chronic pain but don't want to because they don't want guys with gold badges showing up in their offices. it's a very significant discouragement to people in the medical field. do i think we should be regulated? yes. do i think self-regulation is deficient? i won't give me my opinion. i also think it's important and

will jones referred to it very gracefully and didn't go there, but in a city with such significant health care does parodies on both sides of the examining table, where the patients endure the treating people? the socioeconomic and ethnic differences about drug use and access to medications are very significant. .. them here as head of this place. would i invite you to come back to listen to that and the socioeconomic disparities of access to medicine, the use of

illicit drugs, et cetera, i think is something worth considering. i think our panelists did a wonderful job. i wish more of our fellows had been here tonight. i want to thank jill stall for her tremendous work in organizing this and penn and good shepard penn partners for sponsoring this. look on the back of your programs. we are a medically-based organization. we sometimes have fun. we're having a beer party at the end of august. no medical, if you want to talk alcohol, sure we can do that. there will be three of us. later we're having in honor of the pope's visit a discussion by a faculty member of jefferson medical party about the shroud of turin.ge people i know who heard this talk have come out sort of thinking differently than whenii they walked in.if as we hope you did about medica marijuana tonight.

then we'll talk about louie pasteur. everything we do is at www.college of physicians.org. w i wish you well and godspeed and thanks. [applause] [inaudible conversations]. >> booktv is on facebook. like us to get asked you'lling updates be publishing news, behind the scenes videos and talking with authors during our live programs. facebook.com/booktv.