SANTA BARBARA, Calif. -- After nearly four decades in medicine, Dr. David Bearman seems the incarnation of a trusted old-school physician. His resume is long, his record unblemished. It's his choice of treatment that makes him conspicuous.For most patients, Bearman recommends the same remedy: marijuana. There is the young lady with epileptic seizures, the middle-age man with multiple sclerosis, the amputee bedeviled by phantom limb pain.

Bearman's practice, based on a controversial curative not found on pharmacy shelves, has proved lonely and professionally perilous.Although the courts have upheld a doctor's right to recommend cannabis for the seriously ill, few dare do so. Among the exceptions is a tight-knit cadre of about 15 California doctors. Dubbed "pot docs," even by friends, they blithely claim credit for nearly half the estimated 100,000 marijuana recommendations issued in the eight years since California approved medical use of the drug.

There is Bearman in Santa Barbara and Dr. Frank Lucido, a family doctor in Berkeley. Dr. Tod Mikuriya, a peripatetic medical marijuana pioneer in the San Francisco Bay Area, has written approvals for 8,000 patients. A presidential drug czar once lambasted his brand of medicine as a "Cheech and Chong show."  The criticism has been accompanied by intense scrutiny. At least 11 of the cannabis doctors have weathered investigations by the Medical Board of California. Half the cases closed without formal accusations. But a few drew blood.

Medical Board officials say the problem is not the marijuana, but the way the doctors practice medicine. Are patients thoroughly examined? Do the doctors discuss other options? Joan Jerzak, the Medical Board's chief investigator, said some doctors eager to legalize recreational use "don't mind flouting the law."

To the pot docs, the attacks are about old grudges that will not die. They say they've been singled out by a law-enforcement establishment displeased by passage of California Proposition 215, the 1996 ballot measure that legalized marijuana for the seriously ill in the state. "Their attitude is, 'This isn't medicine, but rather a way to abet drug abusers,' " said Dr. Philip Denney, who practices as if every patient were a federal narcotics agent. "They have scared the hell out of California doctors, and it's been left to us so-called mavericks."

The cannabis doctors say they practice serious medicine, focusing on the sick and weeding out habitual pot smokers looking for protection from arrest. Marijuana remains a remarkably safe substance, the pot docs say, with tremendous therapeutic potential for AIDS wasting, chemotherapy nausea and other grave conditions. Aside from the pot docs, oncologists and HIV doctors write the bulk of the cannabis recommendations.

Bearman, a 63-year-old family practitioner, figures it may be years before marijuana is accepted by the medical establishment -- and by the criminal-justice system. "There's no doubt," he said, "this is part of a larger cultural war at play."

Jessica Griffith, a 27-year-old divorced mother of one, waddles into Bearman's office, a metal cane in hand. She carries a 3-inch stack of medical records detailing her four-year fight against pain. She ruptured two discs in her back trying to lift a box in, of all places, a health-food store. Griffith tells the doctor she will soon have surgery to fuse her spine. Meeting such a patient, someone bearing up under a painful or debilitating condition that could be helped by marijuana, Bearman has a standard response. "You," he tells them, "are exactly the kind of patient the voters were thinking of when they approved Proposition 215." Like other cannabis doctors, Bearman does not dispense marijuana. How patients obtain pot is up to them, but he sometimes points them to Web sites listing cooperatives that distribute the drug.

Mikuriya churns out medical marijuana recommendations like a factory, more than a dozen on a busy day. And he willingly acknowledges, unlike most of his peers in cannabis consulting, that he does indeed smoke pot, mostly in the morning with his coffee. He looks a good decade younger than his 71 years and dresses nattily. The only giveaway of his specialty: an embroidered logo on his white lab coat showing the snake and staff of Aesculapius, the Greek god of medicine, atop a marijuana leaf. Mikuriya, a psychiatrist, has studied the drug's therapeutic potential since the 1960s, when he directed marijuana research at the National Institute of Mental Health. He has written books on its medical use. Mikuriya's list of more than 100 ills eased by cannabis includes insomnia, premenstrual cramps and stuttering. Marijuana is so effective and benign, Mikuriya said, that the bar for patient approvals should be far lower than for prescription drugs. Likewise, the role of cannabis consultants is not to perform exhaustive diagnostic tests, he said, but to determine whether a patient's condition is chronic and could be helped by pot.

Ultimately, the struggle over the pot docs comes down to one fundamental question: Are they good gatekeepers for an inarguably controversial medication? If they don't dig deep to diagnose a patient's ills, "there isn't good medicine going on," the Medical Board's Jerzak said. "It's just sales of a particular prescription. It's Dr. Feelgood." After wrangling with the CMA, the Medical Board in May spelled out a softened approach. If doctors follow "accepted medical standards, they can avoid being investigated." If the board has an agitator, it is Lucido. The state investigated him a few years ago, but dropped the case. Ever since, Lucido has religiously attended board meetings, urging regulators to lay off pot practitioners. "If patients aren't being harmed," Lucido said, "what is the problem?"                                 

Sources: Medical Board of California, Society of Cannabis Clinicians, U.S. Drug Enforcement Administration, Los Angeles Times staff reports.                                               

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