13th March 2017: A former medic writes.....
My name is ‘Deb’, I am a former Rural GP.
Four years of fighting AHPRA and melanoma (the former of which prevents me from identifying myself further) left me with considerable and unforeseen time on my hands – time I chose to spend researching cannabis after stories of its alleged healing properties began reaching me in my bushland surgery in the Queensland backwaters.
If you’re a health practitioner of any kind I’m encouraged by the fact that you’re reading – my own investigative journey led me to to places I could never have imagined, and I’m keen to share what I learned.
Some of what you’ll encounter may be confronting, and my apologies in advance if it is. But, before what I shall call ‘Cannabis Medicine’ can be understood even superficially, there are some uncomfortable truths to be faced.
Before my enforced ‘retirement’ I had in my surgery waiting room a poster, much to the amusement of those visiting. It only half-jokingly asked ‘What is the difference between God and a doctor?’ The answer – ‘God doesn’t think he’s a doctor’ – is one many of us should remember, both when dealing with patients and in matters of our own prejudices and preconceived notions related to our vocation.
So I ask you to keep it in mind as you consider the following points.
Truth: As an entity, the medical profession is no longer honourable
I am not talking here about the average doctor ‘at the coalface’, but of the policy-makers, curriculum-writers, the trainers, and those claiming to ‘protect the public’.
Many no longer act for the common good, and there is now ample proof we, as a profession, have been lied to for generations. Cannabis is an excellent example.
Question to ponder: Why were we never taught about the Endocannabinoid System?
It was, in fact, back in the 80s, the medical discovery of the decade, and should have been welcomed as such. A brand-new neurotransmitter system, and not only that, arguably the most important, since it is also a regulatory system. Such is its significance it could be compared in paramountcy to the endocrine system itself – yet it is barely touched on in Med School, if indeed it is touched on at all.
Why were we never taught about this?
To begin finding the answer, we must look back more than a hundred years. In 1910, a report was commissioned by business magnate Andrew Carnegie exploring American medical colleges – the Flexner Report. And as Wikipedia so appositely points out ‘many aspects of the present-day American medical profession (and therefore the world’s) stem from it and its aftermath‘.
Without detailing its contents too finely, the outcome was the closure or merging of the majority of medical colleges in the US and to deliver education into the hands of individuals like Carnegie himself and John D Rockefeller both of whom provided funding to the new institutions. Although its purported aim was to raise standards and ensure health practitioners adhered to strict scientific standards, only those colleges that encouraged drug-intensive treatment were encouraged. Carnegie, Rockefeller et al all owned large chemical companies (the ‘Big Pharma‘ of their day) so the benefits to the men should be obvious. Two out of three institutions disappeared including any and all advocating natural therapies – a tendency that became mandated worldwide.
Thus, for five generations medicine itself and medical EDUCATION has been philosophically led and largely funded by the pharmaceutical industry. I repeat, EDUCATION. And if that’s the case how can we believe what we’ve been taught, and how many discoveries have been kept from us because of the negative impact on huge corporations and their vast profits?
Here you might feel uncomfortable or be tempted to throw this aside as the ravings of another ‘alternative therapy’ crackpot. But why are you feeling uncomfortable? Because – perhaps – there’s a little niggle inside you whispering I’m not talking BS. I understand this completely. The more I learned the worse I felt. If you’re a truly caring doctor – and many of us are – it becomes gut-wrenching, heart-breaking and soul-destroying – the realisation we may have caused damage because of the lies we’ve been taught. Our profession is built on the tenet ‘do no harm’ after all….
Truth: We have lost our way with patient care
Simply put, we’re actively discouraged from looking at our patients as individuals. It’s insisted we follow the ‘one size fits all’ approach of the pharmacological model, and we can now be disciplined for not following ‘evidence-based’ guidelines. How many of the studies, which form the basis of those guidelines, are funded by drug companies? It is now common knowledge this funding leads to a bias toward positive outcomes.
How can anyone not realise and acknowledge that every patient reacts to every drug and every treatment differently? By failing to do so we are failing to validate our patient’s concerns. How would you feel if you were told you couldn’t possibly have this symptom, that sign, disease or adverse reaction, because the evidence base says it can’t be so? And how many of you report all such adverse reactions to the TGA anyway? Don’t worry, I was just as guilty – the paperwork can be a nuisance.
But ‘Cannabis Medicine’ cannot be practiced unless some of these truths are accepted since cannabinoid treatment must – and can only – be individualised. Such treatment is only truly effective as a whole plant/extract treatment. Its efficacy therefore cannot be studied using double-blind, randomised, controlled trials because what suits one individual will simply not suit another.
These trials, remember, were introduced because of safety concerns, after disasters like Thalidomide. Which leads me to the next truth:
Cannabis is not a dangerous drug
This substance has the highest LD50 of any medicine known to man. It is liberating to realise, as long as we use only whole plant cannabis, we can never kill or seriously hurt our patient by using it. Its adverse effects profile compares favourably to every other drug we prescribe. And while cannabis toxicity is possible, as recreational smokers will attest (it’s called ‘greening out’) such reactions are completely cured by sleep and a good feed, not necessarily in that order. Attractive, if you’ve watched someone intractably vomit for three days after a single 100mg dose of tramadol.
But you’ll need a lot more convincing than this. After all, the American Government worked tirelessly for decades to convince everyone of its harms – and they did a remarkable job. It is worthwhile then to consider:
A VERY BRIEF HISTORY OF HEMP AND HEMP PROHIBITION
:: Before the invention of the cotton gin, hemp (Cannabis sativa) provided 80% of the world’s textiles, and is still the superior substance for making (among other things) sails;
:: Hempseed and oil was used for food for thousands of years;
:: Cannabis indica too has been used medicinally for thousands of years and even now can stake its claim as being among the most widely used medicines in history;
:: In the early 20th century, an effective method for harvesting hemp was invented (the hemp decorticator), and the hemp industry began to enjoy a revival;
:: In the 1930s, the Du Pont Company patented its nylon-making process as well as registering another patent for making paper out of wood pulp to go with an already massive petroleum and chemical industry. Thus, the story goes, Du Pont, along with newspaperman Randolph Hearst lobbied Government to stamp on the use of hemp for their own financial purposes. Others accounts include the fact Henry Ford had planned to use hemp-made plastics to build vehicles which would be powered by ethanol derived, once more, from hemp – again quashed for commercial reasons.
:: What is certain though – whether or not as a result of lobbying by Hearst and Du Pont (which by this time had acquired General Motors), Harry Anslinger, a Government official and leading light in alcohol prohibition was chosen to head the Federal Bureau of Narcotics (the precursor of today’s DEA). Soon began the ‘Reefer Madness’ campaign, with the intention of destroying the hemp industry while fostering racism – and it was successful on both counts.
:: The term ‘marijuana’ was coined and it took the American people over a decade to realise the valuable and harmless cannabis tincture in their medicine cabinet was, in fact, the same ‘demon drug’ they’d been told about. The American Medical Association was against prohibiting it and no distinction was made between industrial hemp ‘sativa‘ and medicinal hemp ‘indica‘.
:: Hybridisation took off in the late 70s, due to recreational demand, and this has led to blurring of the two species – we now talk about sativa traits, and indica traits – extremely important when tailoring treatment.
:: Nixon, also in the 70s, declared his ‘War on Dugs’ and ordered studies to prove how dangerous it was, then buried the findings when positive results, such as the effect on cancer cells, became apparent. The government later took out a patent on its neuroprotective effects, while keeping it a Schedule 1 drug (dangerous, addictive, no medical use).
:: In 2016 an interview with John Erlichman, Nixon’s top aide where drugs were concerned was published in which the official admitted the Drug War in general and cannabis prohibition in particular were scams – tools to target hippies and black civil rights activists who opposed the President: ‘You understand what I’m saying? We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin and then criminalising both heavily, we could disrupt those communities,’ Ehrlichman said. ‘We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did,’ he told Harpers Magazine.
:: Israel has been the leader is cannabis research, and in quick succession during the 80s, 90s and beyond, identified the structure of the psychoactive cannabinoid THC, found the receptors and the neurotransmitters for the endocannabinoid system, discovered a further cannabinoid, CBD, and its receptor, and so on. You will be told there’s ‘insufficient evidence’ for the use of cannabis as a medicine. NO EVIDENCE? With thousands of references in just PubMed alone? And I can also recommend Granny Storm Crow’s List (motto ‘If the truth won’t do, then something is wrong’) –a vast collection of other such material, mind-boggling in its sheer size.
Fellow doctors, the above is a very brief overview, enough I hope to have at least piqued your interest. The two sources mentioned above are a start, but I’d be happy to assist you in further research via this website.
Since this is an introduction I will not delve too deeply into how to prescribe Cannabis Medicine, or the conditions for which it may be used. I will just add though that, when administered holistically and in conjunction with other non-pharmacological therapies such as diet, it could be enormously useful as a first-line treatment for many, many conditions – and does not always require a psychoactive component.
A bold claim, I’m aware, but to sceptics I recommend watching a selection of presentations from last year’s United in Compassion Symposium at which many world-renowned ‘cannabis clinicians’ spoke. Medics like Dr Jeffery Hergenrather (presentation here) and Dr Bonni Goldstein (presentation here) should provide you with an excellent introduction to the great strides being made in this fascinating and hugely significant field. Better still, you could even attend this year’s event in Melbourne to see for yourself how cannabis is being used.
But there’s the rub, unfortunately. Cannabis can and should most sensibly used as a first, not second or third-line treatment since it is both highly effective while doing the least harm of all medicines. For this reason alone doctors should be given the opportunity to administer. Yet, this is exactly what isn’t allowed.
I’ll conclude by sharing a few current facts around cannabis prescription in Australia. The level of control being attempted by those leading and teaching us is horrific.
:: To prescribe the drug you must either be an Authorised Prescriber or use the TGA’s Special Access Scheme ‘Category B‘ and, where applicable, get additional approval from your State or Territory – a laborious, challenging and time consuming process many have described as ‘too difficult‘. The process entails providing clinical indication for use, an explanation of why you’re prescribing the treatment, including efficacy and potential harms, and scientific evidence supporting such treatment. On top you’ll need to show how the drug will form part of the overall treatment plan including any previous pharmacotherapy and/or non-pharmacotherapy then give a proposed clinical review monitoring efficacy, harms and adherence as well as describing pre-defined, objective outcomes that need to be met to judge whether the treatment should be continued. No wonder doctors are reluctant to do it!
:: As if all that wasn’t enough, you have to take full responsibility for any adverse effects from the treatment: – not the drug company or supplier, not the government, not the patient but YOU;
:: Lastly, you must accept the fact, at this point, no insurer is likely to provide you with indemnity for prescribing such medicine.
In some ways, I’m not overly concerned about the final two – you can never cause a death using cannabis (unless – possibly – it’s in the form of a modified pharma product), and frankly, if every patient sued for every adverse drug reaction, there would be none of us left running practices.
And the nature of Cannabis Medicine too – based on mutual guidance in an equal relationship – means the levels of patient satisfaction with this type of care would mean far less chance of being sued anyway.
In such circumstances each patient needs to be viewed as an n=1 trial, and both doctor and patient gain their data and experience in a caring and safe medical environment.
A lovely dream, isn’t it? One we can make come true – by simply refusing to remain as as completely controlled as we are – AHPRA can’t de-register thousands of us, and if you’ve caused no harm, what can it, in reality, do?
The Government recently announced the formation of an ‘expert’ Advisory Council for Medicinal Cannabis. It contains mainly doctors and academics the majority of them anti the drug and none is a cannabidinologist. Patient advocacy on the thing is all but non-existent.
As I have said, cannabis is forbidden as a first-line treatment. We are expected to force our patients to ingest far more dangerous drugs in its stead, where they might fail or cause severe adverse effects (even death), before we’re allowed to use this herb. And that leads me to a final, irrefutable truth:
Patients, as humans, have the right to choose what medicines they put into their bodies
This is the truth that has been denied for so long. We don’t always know best. They – our patients – often do, and it will always be thus, so we need to listen; after all, it is their body we’re dealing with, their condition and they, not we, know how they feel.
Where cannabis is concerned, if a patient asks you about it – you can bet they already know more than you. So please listen, and learn; you’ll find it a satisfying conversation.
It is hard to ‘do no harm’ absolutely, but we can still ‘cure seldom, relieve often, and comfort always,‘ part of an oath we too often forget.