1. editorials
Last chance
’m not a fan of cancer (or the I met a father who had recently lost survivor to finish. Not only did he
I Canucks either if I think about it).
However, both of these have a way
of affecting my life. The Canucks I
his infant son, a mother who had trav-
eled from Alberta to support her son
suffering from a brain stem tumor, a
accomplish this goal, but he was met
by his mother and sister who had trav-
eled secretly from Australia to cele-
can’t do anything about (can anyone?) man who had lost his leg to childhood brate his ride. More tears.
but I chose the Ride to Conquer Can- cancer bravely riding in memory of On the first day I noticed that a
cer as my fundraiser this year. This is his father, and so many more. young man riding beside me was clear-
a 2-day supported 250 km bicycle ride ly a huge cycling fan. He was decked
from Vancouver to Seattle. out in the complete Garmin Transi-
Vascular disease remains the num- tions team uniform. (Garmin is an
ber one cause of mortality in North American professional cycling team
America, but often its victims are As we were based in Europe.) This young man had
older and have lived a life of inactivi- gathered at the start all the gear—jersey, shorts, helmet,
ty, overeating, and smoking. I don’t in the Guildford Mall shoe covers, even the team bike. Wait
think any other disease leaves the parking lot, four a second, his name is stenciled on his
legacy of sorrow that cancer does. Its bike. You moron—that’s because he is
cancer survivors
victims are often young healthy peo- on the team. Amazed at my stupidity
ple in the prime of their lives. Their accompanied a (I know none of you are) I listened to
suffering and that of their families and riderless bike up the his story. Not chosen for the Tour de
friends is often beyond my compre- middle of the crowd. France squad, he had come back to
hension. It is these stories of suffering BC to compete in some of the local
that were shared during the ride that pro races, but mostly to participate in
will stay with me forever. Despite my the Ride to Conquer Cancer in honor
outwardly sarcastic and often insensi- of his brother, who died last year of a
tive exterior, I am a “feeler,” and I Cancer survivors proudly ride brain tumor. He even got a tattoo after
wasn’t on the ride for very long before with a yellow flag on their bicycles. his brother’s death to remind him that
I began to tear up. As we were gath- On the second day I was riding beside you never know what’s going to hap-
ered at the start in the Guildford Mall a young man with such a flag who pen in life, so enjoy what you are
parking lot, four cancer survivors shared his story with me. He had doing and do it well. He had this tat-
accompanied a riderless bike up the moved from Australia and was train- too placed on his inner left forearm so
middle of the crowd. This bike repre- ing for an Ironman marathon when he that it is ever-present when he races
sented all those who couldn’t take part began to experience overwhelming his bike.
as they were currently fighting or had fatigue. He was found to be danger- These stories and many more have
succumbed to this horrible disease. ously anemic due to advanced colon moved me to do my part to fight this
Good thing I was wearing sunglasses. cancer. He had wanted to do the ride disease, because as the tattoo remind-
This event is most amazing not for the last year but remained too ill from his ed me, you never know when it is
bicycle riding, but for the more than chemo to participate. This year his going to be your LAST CHANCE.
2000 people who bonded together, major sponsors offered to double their —DRR
each affected by cancer in some way. donations if he was the first cancer
328 BC MEDICAL JOURNAL VOL. 52 NO. 7, SEPTEMBER 2010 www.bcmj.org

2. editorials
Medical marijuana
t is often problematic when pa- Most physicians are unaware that • At what point does the function of a
I tients request a particular medica-
tion, particularly when the clinician
has reservations about the request.
the BCCCS Practitioner’s Statement
does not grant patients a federal autho-
rization to possess marijuana and does
substance that is almost always used
recreationally become medical?
• Why would the CMPA recommend
Examples in everyday practice include not protect your patient from prosecu- that I have patients complete the
requests for sleeping pills and anal- tion. Practically, however, police are release form for medical practition-
gesics, or antibiotics for nonbacterial usually reluctant to prosecute a patient ers when endorsing marijuana? Will
illness. However, for most of us, few who has a physician endorsement for this really protect me against any
requests generate more apprehension possession of marijuana. The BCCCS claims?
than a request for so-called medical medical access forms are far less In short, I, like most of you, will
marijuana. Despite this, BC still has prescriptive than the federal access move heaven and earth to ensure the
the highest per capita use of medical forms, hence their use by patients with comfort of my patients in need of pal-
marijuana in Canada. conditions that are far from palliative liative care, even to the point of pre-
In my opinion, medical marijuana and which include chronic headaches, scribing THC and, on occasion, com-
is no more medical than so-called anxiety, and even Axis I disorders. pleting the federal access form for
medicinal alcohol. In 2001, Health Requests from these patients can leave medical marijuana. But to all the other
Canada delegated the responsibility me truly baffled. patients wishing my endorsement to
for prescribing medical marijuana to • Why would I recommend a substance sail the misty, uncharted waters where
physicians to treat serious illnesses that has over 60 different cannabi- I don’t belong and don’t want to be—
unresponsive to conventional treat- noids whose actions and effects I don’t ask me.
ment. The criteria for accessing med- know nothing about? —WRV
ical marijuana are relatively stringent. • How can I recommend a substance
Access to medical marijuana can be that has no quantifiable strength?
obtained by completing Health Cana-
da’s Medical Practitioner’s Form B1
or Form B2. Form B1 asks you to con-
firm that your patient has a malig-
nancy or degenerative neuromuscular
condition, on the premise that most
physicians would consider this use of
medical marijuana a type of palliative
therapy. This form takes 5 minutes to
complete. Form B2 is for those very
unusual situations that do not fit the
criteria for Form B1 and requires en-
dorsement or completion of the form
by a specialist. This form takes 10 to
15 minutes to complete. Far easier,
however, is a form supplied by the BC
Compassion Club Society (BCCCS),
which is a series of check boxes and
takes only a minute to complete. How-
ever, unless you are a pharmacologist
specializing in cannabinoids, about
the only statement that you can rea-
sonably agree with (in accordance
with the recommendations of the Col-
lege of Physicians and Surgeons of
British Columbia) is that “this patient
has reported that his/her symptoms are
helped by cannabis.”
www.bcmj.org VOL. 52 NO. 7, SEPTEMBER 2010 BC MEDICAL JOURNAL 329