The attitudes of Drs. Bayer and O'Connell are precisely why we undertook the project of sorting out emotion and passion from science and fact as they relate to the use of crude marijuana as a medicine. We found no compelling reason to abandon the Food and Drug Administration process of proving safety and efficacy and stepping back to the days of unproven and potentially toxic potions and tonics. That is the net effect of views represented by Drs. Bayer and O'Connell. Unlike the anecdotal diatribes that pervade support for the medicinal use of marijuana, our review was extensive and covered existing science.

O'Connell's comments are consistent with those that he voices on pro-legalization or "drug policy reform" World Wide Web sites. He overlooks the fact that crude marijuana is a toxic, impure herb containing more than 480 substances. Marinol has side effects (as does marijuana) but at least is a single, pure substance.

Bayer mixes fact with fiction in his criticism. In fact, many of the positions to which he refers are based on uncontrolled anecdotes, not controlled studies. Contrary to Bayer's assertions, the National Institutes of Health have previously stated that marijuana adds nothing to the currently available regimens for such conditions as nausea, glaucoma, and spasticity (Lee PR. Personal communication to Congressman Dan Hamburg).

Bayer rises questions about the International Drug Strategy Institute. We are a group of more than 40 physicians, attorneys, and drug policy specialists, including some of the most respected authorities on drug policy in the world. We receive no "pharmaceutical" funding and have no vested interest in anything except the health and well-being of patients. In contrast, the medicinal marijuana movement was fathered by the National Organization for the Reform of Marijuana Laws. The stated goal of this organization is to use the medical marijuana issue to gain public support and the ultimate legalization of marijuana [1]. Bayer even cites the NORML Web site as a resource. That site also outlines the medical marijuana and hemp legislative strategy for the United States.

Dr. Lapey draws attention to the organized and well-funded ballot initiatives in Arizona and California, in which millions of dollars from wealthy supporters of legalization essentially bought drug policy. Dr. Lapey makes a calm and sane plea to base medical decisions on the Food and Drug Administration process of proving safety and efficacy-something that the supporters of medicinal marijuana are quick to abandon.

We continue to maintain that research should continue into alternative delivery systems for pure delta-9-tetrahydrocannabinol and its analogues. Patients should be provided with predictable, safe, and effective medicines, not unproven herbal potions.