The Obama administration offer came after a two-hour meeting between Gupta and Obama in Chicago in November. At that meeting, Obama told Gupta he would have an expanded role in providing health policy advice and would be the highest-profile surgeon general in history.
Gupta has a history in health policy. He served as a White House fellow in the 1990s, writing speeches and advising Hillary Clinton on health policy issues. He is also an accomplished, telegenic communicator.
While he has received criticism from some quarters for being too friendly with big pharmaceutical companies and from others for wrongly accusing filmmaker Michael Moore of falsehoods in his documentary "Sicko," it is his old-school views on marijuana that are raising hackles in drug reform circles. Most famously, in a November 2006 editorial in Time magazine [17], Gupta, while acknowledging marijuana's medical benefits for some patients, went on to repeat a raft of long-debunked anti-marijuana myths as reasons for opposing marijuana reform initiatives on the ballot in Nevada and Colorado that week. In Gupta's words:
"Maybe it's because I was born a couple of months after Woodstock and wasn't around when marijuana was as common as iPods are today, but I'm constantly amazed that after all these years -- and all the wars on drugs and all the public-service announcements -- nearly 15 million Americans still use marijuana at least once a month. California and 10 other states have already decriminalized marijuana for medical use. Two states -- Colorado and Nevada -- are considering ballot initiatives that would legalize up to an ounce of pot for personal use by people 21 and older, whether or not there is a medical need.
"What do voters need to know before going to the polls?
"The first is that marijuana isn't really very good for you. True, there are health benefits for some patients. Several recent studies, including a new one from the Scripps Research Institute, show that THC, the chemical in marijuana responsible for the high, can help slow the progress of Alzheimer's disease. (In fact, it seems to block the formation of disease-causing plaques better than several mainstream drugs.) Other studies have shown THC to be a very effective antinausea treatment for people -- cancer patients undergoing chemotherapy, for example -- for whom conventional medications aren't working. And medical cannabis has shown promise relieving pain in patients with multiple sclerosis and reducing intraocular pressure in glaucoma patients.
"But I suspect that most of the people eager to vote yes on the new ballot measures aren't suffering from glaucoma, Alzheimer's or chemo-induced nausea. Many of them just want to get stoned legally. That's why I, like many other doctors, am unimpressed with the proposed legislation, which would legalize marijuana irrespective of any medical condition.
"Why do I care? As Dr. Nora Volkow, director of the National Institute on Drug Abuse, puts it, "Numerous deleterious health consequences are associated with [marijuana's] short- and long-term use, including the possibility of becoming addicted."
"What are other health consequences? Frequent marijuana use can seriously affect your short-term memory. It can impair your cognitive ability (why do you think people call it dope?) and lead to long-lasting depression or anxiety. While many people smoke marijuana to relax, it can have the opposite effect on frequent users. And smoking anything, whether it's tobacco or marijuana, can seriously damage your lung tissue.
"The Nevada and Colorado marijuana initiatives have gained support from unlikely places. More than 33 religious leaders in Nevada have endorsed the measure, arguing that permissive legalization, accompanied by stringent regulations and penalties, can cut down on illegal drug trafficking and make communities safer.
"Perhaps. But I'm here to tell you, as a doctor, that despite all the talk about the medical benefits of marijuana, smoking the stuff is not going to do your health any good. And if you get high before climbing behind the wheel of a car, you will be putting yourself and those around you in danger."
Whether Gupta if confirmed will support medical marijuana -- as opposed to mere THC-based pharmaceuticals such as Marinol -- or do good for drug policy reform in other ways, remains to be seen. And he did demonstrate a willingness to acknowledge some of the arguments made by the other side. But his apparent blindness to the harm caused to marijuana users by arrest and incarceration is not a great first sign. Change we can believe in for drug policy? Only time will tell.