Move those goalposts; you said you hadn't seen "any medical documentation of beneficial effects of any cannabinoid". Now you're backpedalling to not-better-than-other-medicines - and apparently implying that this is true for EVERY patient (because if it's not true for every patient, then the no-better-on-average medicine should be available for the sake of those patients for whom it works better).
The meta-analysis found that, at best, it is equivalent to anti-emetics that are already in use—but those don’t cause highs like marijuana does.
See above on no-better-on-average medicine.
I suspect
Your evidence-free suspicions are worth every penny I paid for them.
Oh, and one effect of chronic marijuana use or a single high dose is to cause hyperemesis—not exactly a quality I’d look for in an anti-emetic.
Marijuana-induced vomiting is rare: "With the large prevalence of marijuana use in the world, why does it appear that so few patients develop CHS?" [emphasis added]
- Galli, J. A., Sawaya, R. A., & Friedenberg, F. K. “Cannabinoid Hyperemesis Syndrome.” Current drug abuse reviews 4.4 (2011): 241–249 (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576702/)
When I am looking for evidence of efficacy or harm caused by a substance, I do not look at book reviews, especially those which base their conclusions on meta-analyses. Meta-analyses are extremely weak as evidence.
You're entitled to your opinion - but that's all it is, and evidently contrary to the opinions of the editors of the many journals in which meta-analyses are published.
That is not a backpedal at all. But I see that you do not consider all of the implications of that statement. It is a statement that the best that could be shown in one or two studies was that patients reported that they experienced pain relief equivalent to other drugs.
For FDA purposes, a drug is unlikely to be approved unless it can be shown to be an improvement over current drugs on the market.
In the case of marijuana, the pain relief *may* have been as good (again, the evidence is extremely poor), but not better, than other drugs on the market (than opioids, IIRC). We're not talking about greatly effective drugs, just drugs that happen to be approved for that purpose. On top of that, marijuana has some pretty strong side effects. Yes, I realize that the major appeal of marijuana by so-called "medical" users is the high. However, from the viewpoint of a medical professional, that is an extremely serious side effect. The goal of pain relievers is to enable people to function normally--not to debilitate them by keeping them on a permanent high.
The meta-analysis found that, at best, it is equivalent to anti-emetics that are already in use—but those don’t cause highs like marijuana does.
See above on no-better-on-average medicine.
Once again, if a drug is not better than drugs that are already on the market, it is unlikely to be approved. And given the severe side-effects of marijuana, there is no evidence-based reason the FDA would approve it when there are superior, non-high inducing anti-emetics on the market.
Once again, I am *completely* aware that the so-called "medical" marijuana users are after the high. But I am speaking from the point of view of a medical professional who is more interested in returning patients to normal function than in facilitating their desire to get high.
Marijuana-induced vomiting is rare: "With the large prevalence of marijuana use in the world, why does it appear that so few patients develop CHS?" [emphasis added] - Galli, J. A., Sawaya, R. A., & Friedenberg, F. K. “Cannabinoid Hyperemesis Syndrome.” Current drug abuse reviews 4.4 (2011): 241–249 (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576702/)
This technique is called cherry-picking: taking a single statement out of context and presenting it as if it makes the pseudoscience aficionado's case. It does not. Let me put that statement into context (and add some emphasis):
There are several shortcomings in our understanding of CHS. There exists no epidemiological data regarding the incidence and prevalence of CHS among chronic marijuana users. The syndrome is likely underreported given its recent recognition [74,75]. With the large prevalence of marijuana use in the world, why does it appear that so few patients develop CHS? Certain individuals may have a genetic polymorphisms in the cytochrome P450 enzymes responsible for the metabolism of the cannabinoids [62,72]. This could result in excessive levels of pro-emetic cannabinoids or emetogenic metabolites. Such genetic variations have yet to be studied in patients diagnosed with CHS and represent an area for future research.
Translated into English, this means that the authors did NOT say it is rare. In fact, it indicates that the authors fully expect that the measured incidence of cannaboid hyperemesis syndrome will increase as more clinicians become familiar with the condition.
In this much more recent review, Cannabinoid hyperemesis and the cyclic vomiting syndrome in adults: recognition, diagnosis, acute and long-term treatment, it states that reliable prevalence data does not exist. The same article also states that it takes about ten years to make a definitive diagnosis. So, the number of marijuana users who have hyperemesis syndrome might be significant--we just don't know yet.
You're entitled to your opinion - but that's all it is, and evidently contrary to the opinions of the editors of the many journals in which meta-analyses are published.
Meta-analyses are one of the weakest forms of medical "research" in existence. I'm not going to go into all of the details, but I will say that one of my most frustrating experiences as a medical research professional has been working in a department that oversees clinical studies. Much of the "research" is pure crap, yet it does get published. That is why I stipulated that the most robust type of research is that which is carefully designed and includes strong, appropriate controls. That pretty much excludes meta-analyses.