I, Howard D. Maccabee, declare as follows:

1. I am a physician licensed to practice in the State of California. I have been Medical Director of the Radiation Oncology Center in Walnut Creek, California, for 17 years. I am also an Assistant Clinical Professor of Medicine at the University of California at San Francisco ("UCSF").
2. I received a Ph.D. from the University of California at Berkeley in 1966.. My dissertation research was on radiation biophysics. After extensive research in the areas of physics and medicine, I attended the University of Miami School of Medicine, where I earned an M.D. in 1975. I then completed my Internship at UCSF in 1976, followed by a three-year Residency in radiation oncology, also at UCSF.
3. I am board certified in therapeutic radiology, and am a member of several professional societies. I have published 25 articles on diverse scientific and medical topics.
4. I have also studied the ethical aspects of the doctor-patient relationship and am on the bioethics committees of John Muir Medical Center and the Alameda-Contra Costa County Medical Association. I have chaired symposia on this issue between 1988 and 1994 in Contra Costa County.
5. In my practice, I commonly use radiation therapy to treat the whole spectrum of solid malignant tumors. Radiation therapy is often used after surgery or chemotherapy, as a second stage in treatment. Sometimes, however, radiation therapy is used concurrently with chemotherapy, or even as the first or only modality of treatment.
6. I treat approximately 20 patients each day and provide follow-up care and/or consultation with another 5 or so patients a day. I currently have approximately 2,000 patients in various stages of follow-up to their initial treatment. Most of these are long-term survivors.
7. Because of the nature of some cancers, I must sometimes irradiate large portions of my patients' abdomens. Such patients often experience nausea, vomiting, and other side effects. Because of the severity of these side effects, some of my patients choose to discontinue treatment altogether, even when they know that ceasing treatment could lead to death.
8. During the 1980s, I participated in a state-sponsored study of the effects of marijuana and THC (an active ingredient in marijuana) on nausea. It was my observation during this time that some patients smoked marijuana while hospitalized, often with the tacit approval of physicians. I also observed that medical marijuana was clinically effective in treating the nausea of some patients.
9. During my career as a physician, I have witnessed cases where patients suffered from nausea or vomiting that could not be controlled by prescription anti-emetics. I frequently hear similar reports from colleagues treating cancer and AIDS patients. As a practical matter, some patients are unable to swallow pills because of the side effects of radiation therapy or chemotherapy, or because of the nature of the cancer (for instance, throat cancer). For these patients, medical marijuana can be an effective form of treatment.
10. I occasionally have patients who inquire about the use of medical marijuana. I have always considered it my ethical duty as a physician to provide every patient with the full truth as I know it. This duty includes informing patients about treatment options that I personally do not provide. For example, although I do not prescribe chemotherapy, it is my ethical obligation to discuss this treatment option with patients who are also considering undergoing radiation treatment. Because of the threats by federal officials against physicians who provide information to patients regarding the potential risks or benefits of the medical use of marijuana, I have had to reexamine this basic ethical principle for the first time in my professional career.
11. Due to fear caused by the threats of public officials, I feel compelled and coerced to withhold information, refuse to make recommendations, and modify for non-clinical reasons my advice to patients regarding use of medical marijuana. Since the threats, I have not had any patients ask about medical marijuana. When I do receive such an inquiry, however, I will temper what I say to avoid the risk of government sanction. Based on my years of practice, I am concerned that my reticence in providing information will adversely affect the doctor-patient relationship, a result which is both regrettable and ethically substandard.
12. I understand that one of the reasons behind the threats is to deter physicians who may inappropriately recommend the use of medical marijuana. The threat of abuse in this context is no greater than the threat posed by doctors who misprescribe or otherwise act irresponsibly with regard to any drug. There will always be a small number of doctors who behave irresponsibly; those individual doctors should certainly be sanctioned, but not at the expense of the ability of responsible doctors to provide important medical information to their patients.

I declare under penalty of perjury under the laws of the United States of America and the State of California that the foregoing is true and correct to the best of my knowledge.

Executed at Walnut Creek, California, this 14th day of February 1997.

Howard D. Maccabee