Lester Grinspoon and James B. Bakalar. 184 pages. New Haven, Connecticut: Yale University Press; 1993. $22.50.

Danny was 14 years old in 1971 when he began receiving chemotherapy for acute lymphocytic leukemia. The treatments caused severe nausea and vomiting, which were not alleviated by the standard antiemetics. Danny's father was shocked when his wife suggested that they obtain marijuana for Danny. He dismissed it because it was illegal and because it might embarrass the doctors at the hospital, who had been so remarkable in their commitment to Danny's care. Danny's father recalls one treatment that surprised him. Instead of seeing his wife and son in their usual state of anxiety, he found them completely relaxed, as if they were playing a joke on him. Finally, they let Father in on the secret. On the way to the clinic that morning they had stopped near the high school and Mother had asked one of Danny's friends to get her some marijuana.

Danny and his mother smoked the marijuana in the parking lot of the hospital just before entering the clinic. Danny's father's surprise gave way to relief when he saw how comfortable Danny was. Danny's parents were delighted that he had no nausea or vomiting. In fact, on their way home they stopped for submarine sandwiches. Danny's experience prompted his physicians to study the antiemetic effects of the active ingredient in marijuana, delta-9 THC. This led to the publication of the study by Dr. Emil Frei and colleagues in The New England Journal of Medicine in 1975, and the introduction of delta-9 THC into the American pharmaceutical market as an antiemetic medication in 1985, where its usefulness has been limited.

Danny's experience also prompted his father, a member of the psychiatry faculty at Harvard Medical School, to reconsider his views on marijuana. He concluded that he had been "brainwashed" by what he perceived as the "climate of psychopharmacological McCarthyism". In Marihuana, the Forbidden Medicine, Danny's father, Lester Grinspoon, and James Bakalar, associate editor of the Harvard Mental Health Letter, argue that the leaf form of marijuana (or, for politically correct spellers, marihuana) should be legalized for use as a medicine and should be "available for use in much the same way alcohol is now available". The analogy to alcohol is telling. Alcohol is not a medicine—it is an intoxicant—and for many it is an agent of disease. The authors acknowledge that "opponents of medical marihuana say its advocates are insincere and are only using medicine as a wedge to open the door for its recreational use". This book appears to prove those opponents are correct.

The evidence supporting the use of herbal marijuana must be scant because, after "twenty years of research," the authors rely on a few unconvincing anecdotes about people with various medical conditions, ranging from glaucoma to quadriplegia, who, dissatisfied with the ministrations of their doctors, eventually triumph over unfeeling physicians by "throwing away their medications for dope". The one interesting common thread connecting these anecdotes is that many of the protagonists appear to have alcohol-related problems. The authors assert that marijuana is an effective treatment for chronic pain and is better than "addictive and debilitating opioids" (they probably do not care for many patients with cancer) and safer than aspirin (from which "500 to 1000 die each year in the United States").

They also argue that marijuana is a useful agent in the treatment of drug addiction. (History shows that similar mistaken claims have been forcefully made for cocaine and heroin.) Marijuana is also supposed to be "good for migraines, pruritus, menstrual cramps, mood disorders, asthma, insomnia and ... it may have activity against penicillin-resistant staphylococcus". In the midst of a tract worthy of a nineteenth-century herbalist, Dr. Grinspoon also manages to include his theory of why it is safe to drive while intoxicated with marijuana because "marihuana users try to compensate for cognitive impairment by speeding less and generally taking fewer risks".

Despite its flaws, this book brings up the important question of when a drug should be considered a medicine. If the definition of a medicine is a drug that restores function and promotes health and longevity, then herbal marijuana does not appear to fit the bill. Unfortunately, this book will probably soon be used as "medical evidence" to support the legalization of this intoxicant. However unconvincing, this book is important reading for physicians because it is representative of the arguments being made by a growing and well-funded movement to legalize marijuana. Many of the assertions in this book are finding their way into newspapers, legislative hearings, and even into the Letters to the Editor sections of medical journals such as Annals. If asked to rate this book we would have to list it (with apologies to the Drug Enforcement Agency) in Schedule 1: "no medical use and a high potential for abuse".