19th Feb 2018: Establishment medicos spread further garbage about medical cannabis
UPDATE 21st Febrauary 2018: Following publication of the RACP’s ‘Position Statement’ discussed in the story below, Professor Iain McGregor of the Lambert Initiative at Sydney University and this country’s foremost cannabinologist hit back hard. His piece in the Sydney Morning Herald and other Fairfax newspapers explains where the College went wrong and virtually accuses them of lying. Their situation is now an awkward one. Will they respond to McGregor or simply ignore his remarks? Meanwhile, Dr David Caldicott who runs Australia’s most intensive medical cannabis course and who is also referred to below, had much to say about the RACP ‘Statement’ on Twitter, including that ‘the AMJ has chosen to publish an opinion piece that is poorly referenced, misleading and certainly does not reflect current global practice…it demonstrates very little compassion and nothing new.’ He went on to say of Israel, which has around 30,000 medical cannabis users and a regulatory system cited as among the best in the world, that the (Israeli) Regulators were ‘VERY explicit when they came to Australia and presented to an audience which included one of the authors of the MJA paper: ‘Sure, we don’t know everything about this plant – but we know more than anyone else. It is too safe not to use.” David then added: ‘They explained that as far as they were concerned, it would be ‘immoral’ to prevent access for something that seemed to work so well. They also provided a copy of the Green Book to NSW Health / TGA and this has never been acknowledged or used in any Australian guideline.‘ The Green Book is an official, Israeli Health Ministry-produced publication offering guidance to GPs when prescribing the medicine.
With almost boring predictability, the combined forces of those working so hard to keep cannabis out of the reach of thousands of sick Australians are at it again, once more conspiring to launch a further, still more vicious attack in their war of misinformtion.
Today (19th June) the Medical Journal of Australia (MJA) – a supposedly trustworthy bulwark of scientific and intellectual knowledge, enquiry and debate – publishes two items about medical use of the plant – one a ‘Position Statement’ the other a paper on epilepsy.
The former, a ‘Perspectives’ piece representing the views of the Royal Australian College of Physicians (RACP) on the matter does indeed make its (and the Journal’s) ‘position’ quite clear – but let’s deal with the other one first.
This, a turgid, deeply uninspiring Review by multiple authors titled ‘Cannabis for paediatric epilepsy: challenges and conundrums‘ follows the same, well-trodden path of revisiting old papers from PubMed, Cochrane and MEDLINE. And – fancy! – comes up with what you’d expect from an exercise as tedious and lifeless as that: the jury is out when it comes to cannabis and intractable epilepsy. Though useful in one sense – the paper does make it abundantly clear all research into the issue in Australia is tied up with one company, and one company alone, GW Pharmaceuticals, which makes the CBD isolate Epidiolex – in other respects it is hideous. No acknowledgement here of the the pioneering work of, for example, the US-based Dr Bonni Goldstein or the extraordinary research happening right now in Israel. Not a mention of the (albeit informal) survey last year by Epilepsy Action which discovered nine out of ten of their patients who used cannabis found it more efficacious than other drugs. Instead we get dire admonitions about the ‘public misconception of the safety and efficacy‘ , ‘anecdotal reports of remarkable results in the media‘ and political decisions being influenced by ‘community demand and case reports.’ Nor does it comment on something GW itself rarely talks about – that Epidiolex does, in fact, contain some THC, as if in quiet acknowledgment of the ‘entourage effect’.
Same old, same old, all this rubbish. Meanwhile some of the country’s most vulnerable kids – those with intractable seizures – are forced onto chemicals with the most horrendous and deadly side effects possible and which often don’t even work – about which the authors say nothing.
And medics – along with the policymakers – will read and believe every word.
Adding insult to injury – as if things couldn’t get any worse – comes the AMJ’s ‘Perspectives’ paper – the ‘Position’ of the RACP.
This, it transpires, was written by, among others, an individual known but not loved within cannabis circles, our old friend Jennifer Martin (Professor) who runs the so-called Australian Centre for Cannabinoid Clinical and Research Excellence (ACRE). This is at Newcastle University. The Centre in turn operates the new, much-discussed $6 million ‘hotline’ for doctors wishing to explore the prescribing of cannabis and which – far from assisting medicos – has merely added a further layer of bureaucracy, interference and restriction to an already un-navigable system.
Martin moreover is no stranger the AMJ at least where the herb is concerned, having already co-authored an unhelpful, inaccurate and unscientific philippic there called ‘Medicinal cannabis in Australia: the missing links‘. That was back in August 2016 and in it was explored the supposed question of how ‘insufficient evidence’ exists to prescribe the drug safely and how it might be put through its regulatory paces.
Nor should one forget of course that it was also Martin who notoriously railed against making pot widely available in case it would adversely affect her research funding – which she and her team have subsequently enjoyed in abundance from Federal coffers via the NHMRC.
In today’s outing, Martin and her friends get even worse than they were even two years ago, this time saying, among other things, that evidence of the plant’s effectiveness ‘is at present limited‘ and that the ‘RACP reaffirms the need to maintain appropriate quality, safety and efficacy standards in the knowledge that substantial harms may be experienced by many individuals using these products, including non-psychoative cannabinoids.’
Non-psychoactive cannabinoids? Presumably they mean CBD and thus hold an opinion which flies in the face of both the World Health Organisation (it recommended de-scheduling the stuff altogether) and the British Government which cheerfully allows retail chain Holland and Barrett to stock Hemp Oil to its heart’s content.
The RACP on the other hand goes on to state it ‘supports the need for further high quality research to define whether or not cannabinoids have a place in contemporary medical practice‘ and that it ‘recommends caution in clinical prescribing until such time as there is clear evidence (significantly greater than placebo) of benefit outweighing harm for a specific product and a specific condition…‘. The authors, who clearly couldn’t give a hoot about what’s actually happening in the real world, also seem inexplicably preoccupied with fears associated with recreational use than as a medicine in supervised clinical treatment, and insidiously conflate the two.
And needless to say, it was splattered all over the press – from The Australian to SBS News, to the Daily Mail to the ABC to Cosmos Magazine – a deliberate and highly concerted effort to make as much noise as possible.
Normally, we’d just say ‘ignore them’ – such absurd non-science-based ramblings do, where cannabis is concerned, represent the last throes of closed-minded, hopelessly out-of-date, ultra-conservative nay-sayers whose thinking (and evidence) was worn out well before the end of the last century.
After all, try telling the existing 100,000 people (or probably far more) currently estimated to be using the stuff right at this very minute that the evidence for it is limited. Does the RACP take all of them to be bloody idiots? Or just pathological liars?
Unfortunately though, this ‘Statement’ can’t be dismissed so easily and duly consigned to the rubbish bin. Why? Because the College sadly comprises the very specialists who so often have control of supporting – or more usually not supporting – GPs’ prescriptions for cannabis.
The TGA or its State counterparts routinely tell these practitioners they’re not specialists themselves and thus need to obtain such support in order to prescribe. The AMJ ‘Position’ therefore sends out the clearest of clear messages: Don’t Even Bother To Try.
Which is precisely the aim of the Statement.
There’s a fascinating back-story to this though, which anyone who’s been following things might find of interest.
That is that the current Editor of the AMJ – and the person ultimately responsible for this latest drivel – is one Professor Nicholas Talley, former President of….what else but the Royal College of Physicians.
Talley, who by coincidence hails from the same University – Newcastle – as Jennifer Martin and her ACRE familiars has long opposed cannabis for medicinal use, from as far back as 2014. In the September of that year he found himself in a spat with Lucy Haslam in the pages of the Sydney Morning Herald at the height of her crusade to get the herb legalised.
‘Do we have enough evidence on both its potential long-term adverse effects and the short-term health benefits to fully inform our decisions?’, he wrote at the time.
‘I believe the answer to that question is no.’
It’s a position he’s not altered since, using his new-found appointment as Gatekeeper of this country’s most credible and highly esteemed channel of communication within Australian Medicine to pour scorn upon the drug and smother any thought that might differ.
We know this because last year, the very article we’re talking about was supposed to have been one of two. The other, its counterpart, had been a joint effort by Wollongong University’s Professor Simon Eckermann, Justin Sinclair, a Research Fellow at Western Sydney University and Associate Professor Dr David Caldicott of ANU – and it gave an alternative view.
But Talley had other ideas.
After approaching Eckermann et al (an MJA email reads ‘Professor Talley along with the team at the Medical Journal of Australia would like to invite you to submit a Perspective paper discussing the benefits of medicinal cannabis‘) and initially accepting their manuscript, an Editors’ meeting led by the Professor himself later rejected it. The authors were advised their paper had been ‘too political.’
Instead then, and with timing that coincides eerily with news of the recently-formed Australian Medical Cannabis Alliance, Talley, Martin and their ilk seem to be doing their best to cause carnage; to stifle and silence the actual facts about cannabis before they begin to take hold.
David Caldicott – one of the second (unpublished) paper’s co-authors and a chap responsible for an impressive list of publications, papers and citations in the field of drug epidemiology said ‘I have never, in a quarter of a century of writing, been searched out to write something, written it, and then had it knocked back by the Editor in Chief, who to clarify, was the immediate past President of the RACP‘.
There’s a first time for everything, David.
The Alliance itself, as well as its individual participants, is likely to take a dim view.
Which brings us pretty well seamlessly to the next subject that’s grabbed a degree of attention of late (see reports etc. here, here, here and here) – the ‘Alliance’ itself, a gathering of like-minded folk coming together in Sydney a week and half ago to talk through what might be done to revivify the ‘basket case’ medicinal cannabis in Australia has become.
And if establishment figures aren’t nervous, they should be – this might be their biggest threat yet.
There’s a lot to say about this Alliance, a lot. Too much in fact to squeeze into just this one piece which is what you’d expect when upwards of thirty five people sit talking solidly for over eight hours. We know this because we were there – AMCSignpost was Observer / Rapporteur.
We know also that much has been made of the fact that the meeting used Chatham House Rule – meaning it’s ok to report what was said but not on the person that said it – and there were very good reasons for this.
Quite simply, several of the organisations present – and some hold incredible sway – have complex and lengthy internal processes that need to be undertaken before a policy – in this case on medical cannabis – can be adopted as an ‘Official Position’. Organisers knew as much from the start and felt it more productive to have such figures present – even in knowledge they wouldn’t be able to lend their immediate (public) support to any statements the group chose to make. Others, engaged with the illicit market, needed some anonymity.
What we can say is the whole thing seemed as much Rebel Alliance from Star Wars as the inaugural meeting of ‘Australian Medical Cannabis Alliance’, as the group collectively named itself just before close of play.
When the idea was first mooted by UIC’s Lucy Haslam, the original intention was to contact a small band of people she’d already been working with and sit them together in a room – with the thought they could perhaps form a team. What happened next though she hadn’t foreseen; more and more people from more and more organisations asked if they could come along. It meat the meeting had to be moved three times to accommodate the burgeoning crowd.
As it turned out, just under twenty statements were derived from the group and were debated and largely agreed on, using a process known as ‘modified Delphi methodology’. By this means, assertions are scored from 1-10 where ten means ‘agree completely’ and one means ‘completely disagree’. By tallying the scores for each statement then dividing the total by the number of people taking part the figures provide final scores that mean:
10 = unanimous
9 – <10 = near unanimous
7.5 – <9 = strong consensus
6 – <7.5 = consensus
5 – <6 = weak consensus
<5 = no consensus
And these are the statements attendees finished up making:
Considers that the legislation/ regulation concerning medicinal cannabis access should be based on what is best for patients as a medical consideration rather than a political consideration.
Recognises human rights and medical necessity as a valid argument for greater accessibility of medicinal cannabis.
Is deeply concerned regarding the public health risks caused by the shortcomings of the current Australian system, which forces genuine patients to the illicit market by imposing unnecessary restrictions on patient access.
Recognises the urgent need to approach medicinal cannabis access as a health issue, and not a criminal justice issue, and hence to decriminalise the valid use of cannabinoids for medical purposes.
Recognises that medical use of cannabis can be part of a potential solution to the opioid and benzodiazepine crisis in Australia, as is being demonstrated in other parts of the world.
Recognises the position of the WHO regarding the benefits and de scheduling of CBD.
Recognises the established science, and rapidly expanding knowledge involving the Endocannabinoid System (ECS) and the need for educational institutions and medical colleges to expedite the addition of the ECS to appropriate medical curriculum.
Recognises the harm done to the mental health of patients and carers who are forced into criminality to meet their health needs. This includes, but is not limited to, returned military veterans with PTSD, and the parents of children with intractable epilepsy.
Recognises the need for compassion and the building of evidence as both being valid arguments for access to medicinal cannabis, sooner rather than later.
Recognises that the Government needs to acknowledge that ignoring patients using the illicit market for their medical condition is not optimising the health outcomes of patients.
Condemns attempts by Health Departments to interfere in the patient and healthcare practitioner clinical decision-making process.
Calls for a National approach and for Medicinal Cannabis to be allocated to COAG Discussions as a matter of urgency. Australian patients need consensus between the states.
Calls for provisions to allow driving for patients using medically prescribed cannabis when there is no evidence of impairment.
Believes that cannabis should not always be considered as a medicine of ‘last resort’ during the process of risk assessment, and that in some circumstances, it could be higher in the treatment hierarchy. Such treatment should be patient-centric and based on clinical indication.
Calls on the Government to update its ‘Guidances’ on medicinal cannabis, based on all available evidence reflecting best practice globally.
Acknowledges the primacy of the patient and healthcare practitioner in the clinical decision-making process, and believe the role of Health Departments should be to support this.
Recognises the benefits of whole plant cannabis extracts and the entourage effect. The group recommends these, where medically appropriate, and produced to a suitable standard, over the more expensive and less effective isolates and synthetics.
Recognises the utility of personalised and preventative medicine as a compassionate and cost-effective means of meeting the needs of patients which minimises risks associated with the illicit market. Evidence should include that generated by the use of n=1 trials, which is ideally suited to this type of research.
Believes that, in the interests of better patient care, doctors be allowed to inform the general public that their practice supports the use of medicinal cannabis for appropriate patients. (i.e. that a register of prescribers be made available to patients, to expedite care).
Calls for the findings of the Senate’s Legal and Constitutional Affairs Legislation Committee Report on the Regulator of Medicinal Cannabis Bill 2014 to be implemented.
Believes that medicinal cannabis should be prescribed by appropriately qualified healthcare professionals.
Next steps will be to present these, replete with their final signatories, in an appropriately packaged up communiqué addressed to the powers-that-be, and then push on with the job of establishing a more formal body. Updates will, of course, be posted here.
It’s to be warmly welcomed, this new development, which, as it finds it feet, should provide an additional – and with luck highly effective – means of challenging Establishment disinformation about cannabis and upending Australia’s disastrous and reprehensible ‘policies’.
It comes at a time when, on a positive note, NSW Labor again moves to legislate sensibly and with compassion on the issue but also as the ‘Dark Legions’ muster. And one only need look at today’s AMJ and the recent outpourings from Alberta University in Canada to know how much they mean business.
Here, once more, old and largely irrelevant studies have been used to conclude – somehow – that the risks outweigh the benefits in terms of the medicine and thus doctors should not prescribe it. Though even in this deeply unpleasant outing the writers were forced to acknowledge evidence exists for the treatment of pain (i.e the thing it’s most used for) their subtext is abundantly clear: We’ve Got To Stop Medical Cannabis. The question is – what’s behind their interest in saying so?
It’s early days for the new Alliance – and it’s to be hoped it does what it says on the tin. Policymakers already have their ears pricked up; where things go from here remain to be seen.