Ben S. Fine, M.D.

Here is a professional summary and analysis of the Affidavit of Dr. Ben S. Fine, one of the key medical affidavits from Randall v. United States. This affidavit contributed significantly to the court's recognition of medical necessity in cannabis treatment:

Affidavit Summary: Dr. Ben S. Fine, M.D.

District of Columbia | September 6, 1972 – March 1976

Affiant: Dr. Ben S. Fine, Board-certified ophthalmologist, based in Washington, D.C.
Subject: Robert C. Randall, patient diagnosed with chronic open-angle glaucoma

Medical Timeline & Treatment Progression

1. Initial Diagnosis and Evaluation (1972)

   • Randall presented with:

     • 20/400 vision in right eye (irreversible)

     • 20/50 in left, correctable to 20/30

   • Intraocular pressure (IOP): 42 (OD), 35.8 (OS) — both severely elevated

   • Diagnosed with chronic open-angle glaucoma

   • Initiated treatment with Pilocarpine 1%

2. Treatment Adaptation and Decline (1972–1974)

   • Initial response to Pilocarpine lost effectiveness

   • Escalated to 2% Pilocarpine and Epinephrine; later added Phospholine Iodide

   • By 1974, pressure fluctuations persisted: ranging 15.6–28 mmHg

   • Additional drugs introduced: Diamox and Ascorbic Acid

3. Specialist Referrals & National Medical Evaluation (1975–1976)

   • UCLA Jules Stein Eye Institute (Dec 1975):

     • Evaluated by Dr. Robert Hepler

     • Trialed with Glaucon 2% and Ocusert Pilocarpine 40

     • Treatment failed to control IOP

   • Wilmer Eye Institute, Johns Hopkins (Mar 1976):

     • Five-day intensive evaluation

     • Concluded Randall was unresponsive to all available medical therapy

Clinical Conclusion

“Mr. Randall’s condition can no longer be adequately controlled on conventional medications. This failure of medical treatment will result in Mr. Randall’s blindness unless another medication is available or surgery is undertaken.”

• Randall declined surgery due to risks, especially given he had already lost vision in one eye.

• Dr. Fine emphasized surgery as a last-resort, with risks of aggravation or further loss of remaining vision.

On Marijuana as Medication

• While Dr. Fine had no direct experience with cannabis, he reviewed Dr. Hepler’s findings from UCLA.

• He concluded:

  “As a physician I believe it is in the best interest of the patient to pursue avenues of possible pressure control, if they are effective, regardless of their conventionality.”

This statement acknowledges the legitimacy of cannabis as a therapeutic option, despite its non-traditional status and lack of widespread clinical adoption at the time.

Significance

Dr. Fine’s affidavit:

• Confirms the failure of conventional treatment after exhaustive attempts.

• Validates Randall’s decision to explore cannabis as a last-resort therapy.

• Strengthens the legal foundation for medical necessity by emphasizing the principle of physician duty to prioritize effective treatment over bureaucratic orthodoxy.

This affidavit was part of a larger body of medical evidence that helped establish Robert Randall as the first legal federal medical marijuana patient under the Compassionate Investigational New Drug (IND) program.