Friday, June 24, 2011

The somewhat arbitrary condemnation of profit-seeking in healthcare

This morning's California Report covered the illegal exportation of marijuana from CA to other states. I really recommend listening to the story linked above. California is the largest medical marijuana industry in the country, after Prop 215 made medical marijuana legal fifteen years ago. What I found most fascinating was the condemnation of "unscrupulous" physicians who were "misusing" their access and prescribing power of medical marijuana to improperly profit from the bounty of California pot. Multiple commentators in the news piece maligned these doctors for their activities. One physician emphasized that doctors should only prescribe marijuana for the "right reasons," and that doctors need to "police" themselves. One commentator notes that "somebody got rich" from the ability to sell the marijuana at about $3000-$4000/lb.

The story prompted me to think about the health insurance industry, which is explicitly designed to maximize profits. Or the pharmaceutical industry, which also turns sometimes naturally-occurring compounds into profitable pills. These legal practices that seek out profit do not receive the same vilification from mainstream media. I realize that the physicians' participation in the export of the marijuana is illegal, but this is one of those moments in which the illegality seems completely arbitrary. This also reflects a by-product of the medical marijuana movement, that in order to garner support and emphasize the innocuousness of using marijuana medicinally, it also needs to be portrayed as an organic, non-capitalistic product. At some point, when/if marijuana is legalized, it will surely be converted into all sorts of packaged and processed products. THC, one of the main compounds in marijuana that helps stimulate appetite, is already purchasable (and reimbursable by health insurance) under the name Marinol. Reading the National Institute of Health's recommendations on the use and dosage of Marinol is unsettling and a great example of the transformation of health and wellness into a highly medicalized practice.
"Dronabinol comes as a capsule to take by mouth. When dronabinol is used to treat nausea and vomiting caused by chemotherapy, it is usually taken 1 to 3 hours before chemotherapy and then every 2 to 4 hours after chemotherapy, for a total of 4 to 6 doses a day. When dronabinol is used to increase appetite, it is usually taken 2 times a day, before lunch and supper, or once a day in the evening or at bedtime. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take dronabinol exactly as directed."
The transformation from a self-medicating product that the marijuana dispensaries allow to an FDA-regulated and medically managed pill is transparent in the package instructions that the NIH has put on its website.

Not once in the story, which links the physicians to underground drug gangs, is there an exploration of the consequence of making the plant illegal. While they discuss the value of a statewide registry to help crack down on moving marijuana into illegal markets, they fail to really consider the challenges of making health part of the capitalist system. I'm not interested in ranting on and on about capitalism, but I do think we need to inject more of the economics of health into the discussions of issues like this one. The story emphasizes how people take advantage of the medical marijuana system, yet not once is there a consideration of how pharma and health insurance companies are also taking advantage of a very badly structured "system." The medical marijuana conundrum is about more than legal and illegal use of a plant, but rather reflects the slipperiness between medicine and profit.

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