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Peter Reynolds

The life and times of Peter Reynolds

Posts Tagged ‘NICE

NICE Rejects Professor Mike Barnes’ Expertise in Cannabis as Medicine for a Second Time

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Professor Mike Barnes is without doubt the UK clinician with the most expertise in the use of cannabis as medicine. He should have been first choice as a member of the NICE committee charged with developing cannabis prescribing guidelines and, as reported here, its rejection of his application was greeted with astonishment. However, NICE relented and invited Professor Barnes to an interview. Now they have rejected him again.

Mike was responsible for obtaining the first medicinal cannabis licences for Sophia Gibson and Alfie Dingley and he has been involved in countless behind-the-scenes efforts to assist others. He joined the advisory board of CLEAR in July 2016, is an ambassador for the End Our Pain campaign and has since contributed his expertise to several other organisations including UPA. He is also  founder and director of education at the Academy of Medical Cannabis and founder of the Medical Cannabis Clinicians Society.

What concerned NICE in the first place was that in February 2018, Professor Barnes was appointed Chief Medical Officer of SOL Global Investments (known as Scythian Biosciences until June 2018). NICE was concerned this could be a conflict of interest. In fact, SOL is an international cannabis company with a focus on legal U.S. states. It has no investments or plans for the UK. When Mike told NICE this he was invited for an interview. The second letter of rejection reads:

“It was clear that you have relevant experience and expertise in this area however the interview panel remained concerned about possible conflicts of interest around your links to commercial organisations and your campaign work in the area which means that you have a publicly stated position on the topic.”

Few will regard that as a credible or logical reason for not having Mike on the committee. It’s actually absurd and really makes one wonder who makes these decisions and what planet they are on. If there were even a few alternative candidates to consider then it might make some sense but there don’t appear to be any alternatives to Mike Barnes. If there is anyone else in the UK with his clinical qualifications, knowledge, experience and expertise, no one at CLEAR has heard of them. It’s foolish and irresponsible to reject the only real source of knowledge that will command respect from other clinicians and for such very flimsy and poorly thought through reasons.

How many other clinicians on other NICE committees have commercial relationships with pharmaceutical companies or other medical organisations? How many have also expressed their professional or personal opinions on matters of medical policy and practice? Have they been disqualified for the cardinal sin of holding an opinion? Does NICE want people on this committee who are insufficiently informed or so shy that they do not express opinions?

Could this happen anywhere but in Britain? However patriotic and loyal one is to our country, this sort of crass stupidity and hypocrisy seems to be a special gift of the UK civil service.

NICE has Form for this Sort of Self-Defeating Bureaucracy

Its ‘Do Not Do Recommendation’ on Sativex is directly relevant and is based on on a flawed assessment of cost effectiveness which itself is founded on ignorance of the way cannabis works and a determination not to give proper weight to MS patient reports of the benefit they gain from Sativex. None of this is to overlook the unethical and profiteering price which GW Pharmaceuticals wants to charge for the medicine. Pharmacologically identical products are available from US and Canadian medical cannabis dispensaries for about one-tenth the price of Sativex.

NICE has also failed dismally on the Freestyle Libre glucose monitoring system for diabetics. This revolutionary new system not only makes life much easier for thousands of people, doing away with the need for endless finger pricking, it also dramatically improves blood sugar control promising huge reductions in the long term cost of diabetes to the NHS. It’s been available since 2014 and thankfully will now be prescribed on the NHS from April 2019 but for five years NICE has dithered, waffled and procrastinated on it, exactly as it is now doing with cannabis. Until now, just as with cannabis, it has claimed insufficient evidence but the real problem is NICE has a blinkered view and fails to look widely enough for the evidence it requires.

In a remarkable parallel with the way it is handling cannabis, NICE claimed there was no evidence that the Freestyle Libre led to better blood sugar control in type 1 diabetics, But the reason it claimed this was that there was no study supporting it that met NICE’s criteria and by impeding uptake of the device it was making such a study virtually impossible. NICE totally failed to give any weight to the many case reports of really dramatic benefits – exactly as it is doing with cannabis.

So, while our prime minister and the Home Office drugs minister have a direct financial interest in the UK’s only commercial producer of medicinal cannabis, yet direct and control drugs policy, when it comes to caring for patients, the only British clinician with relevant expertise is disqualified by a connection with an overseas cannabis company and for expressing an opinion than cannabis could help many people.


 

As a footnote, I should declare that I also volunteered to give my time to the NICE committee as a lay member and I too was rejected. It’s not for me to question its judgement unless I have good reason to but given its track record with Mike Barnes, I do have legitmate concerns. I first gave expert evidence to Parliament on the subject in 1983 and again in 2012 and 2016. Since 2011 I have worked intensively with hundreds of people who use cannabis as medicine and I lead the group that represents more such people than all other UK groups combined. I am also the author of the study Medicinal Cannabis: The Evidence, which has been translated into three languages and has been cited many times throughout the world. I know of no one in the UK with more relevant experience than me.

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NICE Rejects UK’s Most Eminent Medicinal Cannabis Clinician From Advisory Committee

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Professor Mike Barnes, the UK’s Pre-Eminent Clinician In Medicinal Cannabis

If the UK was setting up an expert committee on fertility and Professor Robert Winston applied to join, he’d be welcomed with open arms. If we were setting up a committee on the origin of the universe and Professor Brian Cox applied, there’s no question he’d be appointed. But NICE, the National Institute for Healh and Care Excellence, yesterday rejected Professor Mike Barnes’ application to join its committee on cannabis-based products for medicinal use.

This follows the appointment of an expert panel in the summer for which FOI Requests revealed that not one member had any knowledge, experience or expertise in cannabis as medicine. And yesterday, prescribing guidelines were issued by NHS England which are absurd in how restrictive they are.  In effect they say ‘do not prescribe’.

The new regulations introduced by Sajid Javid are a breakthrough in UK drugs policy.  They offer tremendous hope to millions of people for whom conventional medicine has failed but the response of the medical establishment is dreadful.  It’s not doctors’ fault that they have been prevented from learning about cannabis but we now need all teh exprtise that we can possibly get.  Rejecting Professor Mike Barnes’ advice is ridiculous and someone, perhaps Sajid Javid himself, needs to step in and put this right.

Written by Peter Reynolds

November 1, 2018 at 1:21 pm

Posted in Health

Tagged with , ,

The UK Is The World’s Largest Producer And Exporter Of Cannabis But Its Citizens Are Denied Any Access At All

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This is the astonishing fact revealed by the International Narcotics Control Board (INCB) in its 2017 report on narcotic drugs.

In the UK no one has any legal access to any form of cannabis except exempt products derived from industrial hemp, most commonly CBD oil.

Theoretically, the cannabis medicine Sativex is available but in practice, in England it is virtually impossible to obtain it except on a private prescription as the National Institute for Health and Care Excellence (NICE) has recommended that it is not cost effective.  In Wales it is available on prescription but doctors are first required to try highly toxic and dangerous drugs such as baclofen, tizanidine, gabapentin, pregabalin, even botulinum toxin or opioids.

The reality is that UK citizens are denied access even though their country is producing and exporting vastly more cannabis even than countries such as the USA, Canada, Israel, the Netherlands and Italy, all of which have legitimate and well regulated medical cannabis provision.

This revelation will further inflame the sense of righteous injustice in the UK.  Against this background the UK continues to prohibit even medical use and is stubborn and intransigent in even being prepared to consider or discuss the evidence in favour.

How can the country which sanctions the legitimate production of more medical cannabis than any other in the world deny its own citizens legitimate access?

CLEAR Medicinal Users Panel. Fourth Delegation To Parliament.

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Freeman meet 1There is real momentum building in Parliament on the issue of medicinal cannabis. The first thing George Freeman said this week when he welcomed us to the Department of Health was: “There is a lot of discussion going on in government about this subject”.

This is extraordinary progress, unimaginable as recently as 2012. Undoubtedly, developments in the US have raised cannabis up the political agenda. Through 2014, CLEAR has been well received by the Home Affairs Select Committee, the Home Office, the Department of Health, the Health Select Committee and just before Christmas I met with Baroness Meacher and Lord Howarth in the House of Lords.  They are chair and treasurer, respectively, of the All Party Parliamentary Group for Drug Policy Reform. They are determined to push reform through to make medicinal cannabis available and have briefed one of the UK’s leading psychopharmacologists to prepare a review of existing evidence on the subject.  Armed with this they have a plan to meet with key individuals in both Houses of Parliament and I have no doubt that they will succeed in changing minds.

Also this week, I met with advisors to Nick Clegg, the Deputy Prime Minister, in the very heart of government at the Cabinet Office.  The Liberal Democrats are planning towards another coalition after the General Election and determined to see drugs policy form part of a new coalition agreement.  Right at the front of their priorities is medicinal cannabis for which there is strong support from existing ministers, Lynne Featherstone at the Home Office and Norman Lamb at the Department of Health.  Expect announcements in the run up to the election.

George Freeman is the Life Sciences Minister, responsible for medicines, NHS innovation, research, development, the MHRA and NICE.  His role is as important as any other minister in achieving the reform we seek.  He is another ally and has asked me to submit a paper setting out our proposals.  Of particular importance is how medicinal cannabis could be regulated, either with a full Marketing Authorisation from the MHRA or possibly registration as a Tradional Herbal Medicine.  The very fact that we are now discussing such detail is a measure of how far we have come.

So there is great cause for optimism at the start of 2015.  We are closer than we have ever been before and this has been achieved by moving away from the old ‘protests’ and outdated campaigning ideas.  I am confident that early in the new parliament we will see substantial progress.