The A.M.A. concludes that the lack of "high-quality clinical research ... continues to hamper development of rational public policy" on medical marijuana. Which raises the question, Why, after five millenniums, doesn't such research exist? Two possible answers: First, the government may have rejected cannabis studies to avoid any challenge to its view that pot is dangerous and medically useless. Second, pot may just be dangerous and medically useless.

The drug wasn't always so controversial in the scientific establishment. The U.S. Pharmacopeia, a doctors' listing of remedies begun in 1820, first included cannabis in 1870. The Pharmacopeia didn't drop pot until its 1942 edition, the first published after cannabis was outlawed in 1937. Eventually most physicians began to view the drug as little more than a crude intoxicant. They tended to favor new-fashioned drugs that were refined by pharmaceutical firms into pure chemicals. Raw marijuana contains some 400 compounds.

It wasn't until the '70s that modern methods were applied to test the medicinal effects of cannabis. As Earleywine recounts, a UCLA study designed to confirm police reports that pot dilates pupils found instead a slight constriction. That's how doctors discovered the drug could help glaucoma sufferers by reducing intraocular pressure. In the years after that discovery, 26 states opened therapeutic research programs.

But the Federal Government, which by then controlled the only legal supply of marijuana, had just passed the Controlled Substances Act of 1970. That law placed marijuana in Schedule I, the designation for drugs without valid medical use. State health officials found it difficult to persuade their federal counterparts to give them cannabis for research, as doing so would undermine the law, at least in spirit, by suggesting there were medical uses. (Only seven states got pot. One was Tennessee, which is why Al Gore's sister was able to try the drug before losing her battle with lung cancer in 1984.)

Then, in 1985, the Food and Drug Administration (FDA) approved dronabinol, an oral form of synthetic THC, to treat chemotherapy-induced nausea. Many doctors believed dronabinol, marketed as Marinol, could provide the benefits of the plant without the impurities. By the mid-'80s, the availability of Marinol and the escalating drug war had killed the state research programs. But Marinol turned out to have shortcomings. Because it enters the blood through the stomach, it doesn't work as fast as smoked marijuana. Because it is essentially pure THC, its users can get too high. "Marinol does tend to knock people out," says Abrams, the San Francisco doctor who has conducted trials with both Marinol and pot. "Our patients [taking Marinol] spent a lot of time in bed, and that wasn't the case with those smoking marijuana." Such problems appeared in only "a small portion of the patients in our clinical trials," says Dr. Hjalmar Lagast, a vice president for Solvay Pharmaceuticals, which makes Marinol. He notes that the drug comes in three strengths, allowing doctors to pick the right dose. By the early '90s, at the height of the U.S. AIDS epidemic, many patients so preferred marijuana to Marinol that they would use the street drug regardless of legality or safety. Abrams and a few others began pushing the government to permit new studies of marijuana to find out what these patients were doing to themselves.

Officials again resisted, and some researchers became convinced the government would never allow evidence of pot's possible benefits to emerge. In 1999, Paul Consroe, a professor of pharmacology at the University of Arizona, failed to win FDA approval for a clinical trial of marijuana for AIDS and cancer wasting. He believes the FDA turned him down because of political pressure. "If you want to study its harmful effects, you can get all the money you want," says Consroe. "But for this one, I would have spun my wheels forever." (An FDA spokeswoman declined to comment.)

It took Abrams five years, but he finally pushed his study through. A stubborn and irreverent oncologist who had watched hundreds of AIDS patients suffer brutal nausea, he won government approval in 1997 for the first clinical trial of marijuana in more than a decade. Marijuana proposals at the time required the approval of three agencies—the FDA, the Drug Enforcement Administration and the National Institute on Drug Abuse—and the DEA and NIDA had resisted. A DEA official worried in a letter about the political fallout if Abrams found positive results. "The government is saying there are no studies proving the medical benefits," Abrams fumed in 1996. "But they're also not letting studies be conducted."

Not true, says Steven Gust, special assistant to the director of NIDA, who has worked at the agency 15 years. "Ever since I've been here, there's been no prejudice against studying the medical applications of marijuana. Frankly, good proposals weren't coming in. The people you've talked to had a bad experience getting approval, and that's going to color their perception."

Whatever the case, Abrams and Gust agree that the government and medical-marijuana researchers are now working together. Abrams has two approved studies under way, and the State of California has founded a new, grander version of its old therapeutic research program. The Center for Medicinal Cannabis Research, which opened at the University of California two years ago with a yearly budget of $3 million, currently supports 11 studies that have received federal approval.

To be sure, many scientists—especially in the government—still squirm at the very idea of medical-marijuana research. Despite encouraging anecdotal reports, the National Institute of Health hasn't initiated a study of cannabis therapeutics in two decades, leaving California's young center as the only U.S. research institution doing the basic science.

Marijuana remains the only drug that researchers must acquire directly from the feds. If the FDA and DEA approve, scientists can get even ecstasy from outside labs, but NIDA is the sole source for cannabis, requiring a third bureaucratic layer. "In an era of privatization, it's shocking that the government insists on a monopoly so that it can choose not to provide marijuana to projects it doesn't like," says Rick Doblin, founder of the Multidisciplinary Association for Psychedelic Studies, a nonprofit pharmaceutical firm. (For 18 months, Doblin's association and the University of Massachusetts Amherst have unsuccessfully sought a license to grow research-grade cannabis at the university.)

Not every country is as pot-phobic as the U.S. Scientists in Britain, which has effectively decriminalized personal use of small amounts of pot, have moved well beyond the preliminary work being done in the U.S. Britain's GW Pharmaceuticals plans to publish results of a large study of its new marijuana product, a whole-cannabis extract rendered into a mouth spray. That way, patients avoid the lung damage of smoking. The British government is likely to make the spray available for prescription if published results are as good as the company promises.

In this country, new drug products like GW's spray rarely appear without cordial cooperation among pharmaceutical companies, research institutions and government officials. Such partnership could take years to develop. But the politics has leaped well ahead of the science, meaning voters will decide long before physicians whether medical marijuana is an oxymoron.

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