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Peter Reynolds

The life and times of Peter Reynolds

Posts Tagged ‘Professor Mike Barnes

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

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Professor Mike Barnes On The Urgent Need For Medical Education In Cannabis.

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See ‘Cannabis Advocates Really Need To Stop Accusing Doctors of Being Bribed By Pharmaceutical Companies.’

The urgent need now is physician education. Doctors just don’t know about the endocannabinoid system. They have never been taught it and thus don’t understand it and certainly don’t appreciate the benefit of medicinal cannabis. Only education will slowly change entrenched positions.

The launch of the Academy of Medical Cannabis next week will go some way to help – see the website.  I hope that the Medical Cannabis Clinicians Society, also launched next week, will enable like-minded doctors to ‘spread the word’ and provide patients with a contact to a trained and knowledgeable clinician to prescribe for them.

Professor Mike Barnes is a consultant neurologist and has been a member of the CLEAR Advisory Board since July 2016.

Written by Peter Reynolds

October 28, 2018 at 2:04 pm

Dame Sally’s Caution On “Grown Cannabis” Does Not Bode Well For Access To Herbal Cannabis As Medicine.

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Professor Dame Sally Davies

Great news all round!  Professor Dame Sally Davies has, within a matter of days concluded that cannabis does have medicinal value and needs to be removed from schedule 1. No surprise really as the evidence is, as Dame Sally says, “overwhelming”. The simple fact is that our government has been deliberately ignoring it for years.

However, reading Dame Sally’s report yesterday I was immediately struck by her use of the term “grown cannabis” in a disparaging sense. I’m tempted to ask ‘where else does it come from?’ unless its synthetic and that is my second point of concern. I’m surprised by her apparent enthusiasm for synthetic cannabinoids on which there is precious little clinical research and strong evidence of severe, even life-threatening side effects, totally different from the natural product.

Professor Mike Barnes, CLEAR’s medical advisor, and I discussed the report this morning and while we both welcome it, we’re very concerned that access to raw herbal cannabis, specifically the Bedrocan product range, may continue to be refused.

In everything that I have learned over more than 30 years and great deal of practical experience working with patients, vaporised herbal cannabis is the gold standard for safety and efficacy.  Bedrocan products are available in almost every other country in Europe. They can be prescribed and dispensed in the UK tomorrow and if this route is denied to patients there will be uproar.  This is what patients want and need.

I defer to Mike Barnes in his expertise on the evidence but he agrees with me that vaporised herbal cannabis must be fundamental to the new arrangements.  Oils are obviously more suitable for children and some conditions in adults but children will not be the majority of patients needing access and the pharmacology and titration of cannabis when taken orally is very different and nowhere near as effective.

It would suit the medical establishment and the continuing, moralistic, prohibitionst lobby if cannabis for medicine was all about products which are “derived from” or “based on”, not the dried flowers from the plant which is what we must have if this reform is to succeed. If so, this will mean that many, perhaps most, people will prefer to continue in the illegal market and that, in my view, would be a failure of this process that we are now engaged in.

Written by Peter Reynolds

July 4, 2018 at 11:58 am

Cannabis for Medical Use And How The Royal College Of GPs Is Letting Us All Down.

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The last couple of weeks have brought an enormous breakthrough for those who need cannabis as medicine but with the release of the government’s interim measures for licensing, the difficulties of how this will work in practice are obvious.

Unless doctors are properly informed and educated about cannabis many patients are going to remain without any help and forced to continue in the illegal market.

The Royal College of GPs was supposed to have issued guidelines to all GPs by the end of 2017 but evidently politics have interfered. It seems that either there has been external pressure from government to hold back or there’s been internal wrangling with some senior doctors opposed to any information being released.

What is astonishing is that this directly contradicts a resolution of the RCGP Council last September when it resolved (unanimously according to reports) to publish guidelines on the use of cannabis as medicine.  This raises very serious issues about the governance of the Royal College and also an ethical issue in failing to enable doctors to fulfil their professional duty to patients.

It was at the end of 2016 that CLEAR first wrote to all the Royal Colleges suggesting that guidelines on the use of cannabis as medicine should be considered.  The letters went out from Professor Mike Barnes, CLEAR’s scientific and medical advisor.  We referred to evidence that about a million people were already using cannabis for medical reasons and particularly the explosion in the use of CBD products.  We acknowledged that clearly doctors couldn’t endorse the use of an illegal drug but certainly for CBD and because of the reality of what’s actually happening they needed to be properly informed.

Professor Nigel Mathers of the Royal College of GPs took up our proposal enthusiastically. Through 2017, Mike Barnes and Peter Reynolds of CLEAR attended a number of meetings at the Royal College and detailed plans were made.  A formal proposal was put to the council, the ultimate governing body of the Royal College at its meeting in September and approved.  It was agreed and announced that the guidelines would be on the college’s website by the end of the year. It was even reported in The Times.

Professor Mike Barnes, CLEAR Advisory Board

Mike Barnes produced the first draft which covered the endocannabinoid system and a summary of the clinical evidence including side effects and a risk/benefit analysis.  Peter Reynolds contributed a section on methods of ingestion and harm reduction.

Professor Nigel Mathers finalised the guidelines to make them compliant with the Royal College’s standards. It was his last project before retiring from his position as Honorary Secretary.

Then everything stopped.  Both Mike Barnes and Peter Reynolds followed up regularly but were fobbed off, given a variety of excuses until eventually six months had passed and we came to realise that there was a determination from somewhere to prevent publication despite what the council had agreed.

The extraordinary progress of the past few weeks leaves the Royal College stranded.  It has let down doctors and through them their patients.  It had every opportunity to be in front of these developments and to enable doctors to offer advice that patients are now clamouring for.

Mike Barnes said:

“It is a great pity that there has been this delay. Given the events of the last couple of weeks it is now really important that the RCGP lead the way and publish guidelines for their members, as the public will be asking more and more questions about the medicinal value of cannabis.”

Prejudice against and misinformation about cannabis has been rife for many years. At last that is changing and cannabis for medical use is going to be available legitimately in the UK.  We remain ready to assist the Royal College in ensuring GPs get the information they need.

Written by Peter Reynolds

June 29, 2018 at 9:40 am

Let’s Temper Hope For Paul Flynn’s Medical Cannabis Bill With Some Reality.

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Paul Flynn MP introducing his 10 Minute Rule Bill

No one would like to see Paul Flynn’s ‘Elizabeth Brice’ bill  to re-legalise medical cannabis pass through Parliament more than me.  Yet it concerns me that expectations are being raised way beyond what is realistic. There is widespread misunderstanding about what the bill is and what are its chances of getting any further.

The Legalisation of Cannabis (Medicinal Purposes) Bill 2017–19 is a Private Member’s Bill. It was  introduced to Parliament on Tuesday 10 October 2017 under the Ten Minute Rule. This allows an MP to make his or her case for a new bill in a speech lasting up to ten minutes. An opposing speech may also be made before the House decides whether or not the bill should be introduced. If the MP is successful the bill is taken to have had its first reading.

Private Member’s Bills almost never become law.  Those that have the best of a very slim chance are proposed by one of about 20 MPs who win the right to put a bill forward a bill in the ballot that takes place at the beginning of each session.  This also decides the order of precedence for the 20 bills to be given parliamentary time.

A 10 Minute Rule Bill is even less likely to become law.  It is the only way other than the ballot that an MP can introduce a bill personally and if it passes its first reading, as Paul Flynn’s bill did, it is set down for second reading.  All Private Member’s Bills are debated on Fridays and before any 10 Minute Rule can be debated the bills put forward under the ballot will come first and even for those, mostly there will be no time available.  Remember also that on Fridays most MPs will not even be in Parliament, they will be back in their constituencies seeing people in their surgeries.

Sadly, the truth is that the second reading of Paul Flynn’s bill is unlikely even to take place.  Although it is set down for 23rd February 2018, there is virtually zero chance of any time being found for it.  It will simply wither away with no progress or further mention.

Even Parliament’s own website says of 10 Minute Rule Bills “an opportunity for Members to voice an opinion…rather than a serious attempt to get a Bill passed.”

I asked Paul Flynn himself what he thought were the chances of his bill making any progress and his response is illuminating. His exact words were: “I am expecting major changes to political party attitudes in the next 12 months following the developing trends in the United States.”

I think we can all agree on that.  In fact, I would say that there already have been major changes in the attitudes of most MPs.  The single biggest obstacle to any drug law reform is Theresa May. After all, what other leader anywhere in the world, apart from the murderous thug President Durterte of the Philippines, has recently called for a continuance of the war on drugs?

May and Duterte – two of a kind on drugs policy

I am confident that once Theresa May is gone, then whatever party is in power, we will see some progress. There is similar, hopeless optimism about Jeremy Corbyn.  Speaking at a Labour leadership debate in Glasgow, in  August 2016, he said: “I would decriminalise medicinal uses of cannabis.”  I think it was the same day or the day after that both John McDonnell and Diane Abbott contradicted him.   Nevertheless, there is a delusional strand of opinion that Corbyn would act on this immediately he was elected.  Dream on!  The Labour Party has the worst record of any UK political party on drugs policy.  For instance it was Margaret Thatcher who introduced needle exchange back in the 80s and yes, even Theresa May sanctioned the provision of foil to heroin users for smoking as an alternative to injecting.  The Labour Party has never done anything in support of progressive drugs policies that it hasn’t reversed under pressure from the tabloid press.

Progress on access to medical cannabis is coming irrespective of which party is in power.  In the meantime, the best that any of us can do is keep up pressure on our personal MPs and in our local media and through our doctors.  Probably the biggest breakthrough this year on medical cannabis will be the publication of guidelines by the Royal College of General Practitioners (RCGP).  Organised by CLEAR and authored by our Scientific and Medical Advisor, Professor Mike Barnes, this shows MPs that however irresponsible and pig-headed government ministers may be, doctors have a responsibility to their patients, an ethical duty that transcends the grubby and corrupt politics that ministers subscribe to.

Sadly then, 23rd February and the second reading of Paul Flynn’s bill will be a non-event. For the rest of 2018 look out for the RCGP guidelines and drop your MP a line when they come out asking for his or her view.  Also, in July look out for Canada’s legalisation of cannabis for all adults.  Again, another opportunity to bring the subject up with your MP.  The latest, standard, Home Office approved reply from MPs reads as follows:

“Cannabis in its raw form is not recognised as having any medicinal purposes. The licensing regime for medicines is administered by the Medicines and Healthcare products Regulatory Agency (MHRA), which issues licences for medicines in the UK which have been tested for their safety, quality and efficacy. 
 
A medicine derived from the cannabis plant, Sativex, has already been licenced for use in the treatment of spasticity due to multiple sclerosis (MS). The MHRA is open to considering other licence applications for medicines containing cannabinoids should such products be developed.
 
In 2014, the National Institute for Health and Care Excellence (NICE) published its clinical guideline on the management of MS that does not recommend Sativex as a cost effective use of NHS resources. In the absence of positive guidance from NICE, it is for commissioners to make decisions on whether to fund this treatment based on an assessment of the available evidence.
 
I do appreciate that there are people with chronic pain and debilitating illnesses who seek to alleviate their symptoms by using cannabis.  Although such use is illicit, the Sentencing Council’s guidelines on drug offences identify such circumstances as a potential mitigating factor.
 
The Government has no plans to legalise the recreational use of cannabis. The official advice from the Advisory Council on the Misuse of Drugs cites medical and scientific research showing that cannabis use has a number of adverse acute and chronic health effects, especially for people with mental health problems, and continues to present a significant public health issue.”

If you receive this response, first of all, don’t bother writing back, it will get you nowhere.  If you really want to do your bit then make an appointment to see your MP at his/her surgery.  Then give him/her this simple fact that totally devastates the Home Office and MHRA position:

In every jurisdiction throughout the world where medicinal cannabis has been legally regulated, it is through a special system outside pharmaceutical medicines regulation.

This is the government’s very last excuse for denying access to medicinal cannabis. The MHRA process is incapable of dealing with a medicine that contains hundreds of molecules.  It is designed by the pharmaceutical industry for regulating single molecule medicines, usually synthesised in a lab, which have the potential to be highly toxic. Every other government that has recognised the enormous benefit that medicinal cannabis offers has come to the same conclusion: cannabis is a special case.  It is far more complex but much, much safer than pharmaceutical products.

 

Probably The Biggest Breakthrough Yet For Medicinal Cannabis In The UK.

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Peter Reynolds, President, CLEAR Cannabis Law Reform

Since the beginning of 2017, Peter Reynolds and Professor Mike Barnes of CLEAR Cannabis Law Reform have been working on a project that is about to come to fruition.  The Council of the Royal College of General Practitioners (RCGP) meets tomorrow, 22nd September 2017, to consider our proposal to issue guidelines to doctors on the use of medicinal cannabis.

Professor Mike Barnes, Scientific & Medical Advisor, CLEAR Cannabis Law Reform

As ever, the UK’s stubborn, anti-evidence government remains intransigent on permitting legal access to cannabis, even for medicinal use.  This despite an overwhelming tide of reform across the world and the reality that perhaps one million people in the UK are criminalised and persecuted for using a medicine that has been known to be safe and effective for many centuries, facts which modern science now proves beyond doubt.

However irresponsible and pig-headed government ministers may be, doctors have a responsibility to their patients, an ethical duty that transcends the grubby and corrupt politics that ministers subscribe to. Professor Nigel Mathers, Honorary Secretary of the RCGP with responsibility for its governance, has championed CLEAR’s proposal.  He recognises that while doctors cannot be advising their patients to use an illegal drug, the reality is many people already are.

Professor Nigel Mathers, Honorary Secretary, Royal College of GPs

So this is not just another report or a conference.  This is practical action at the point of delivery of healthcare.  If the proposal is approved by the RCGP Council, the guidelines will be drafted by Professor Mike Barnes, assisted by Peter Reynolds, with additional input from the MS Society and Newcastle University.

In due course, probably by the end of the year, a booklet will be available for download by all GPs from the RCGP website.  It will set out balanced and reasonable advice on the appropriate use of cannabis for specific medical indications. The guidelines will also cover harm reduction advice and provide a basic grounding in the scientific evidence and the endocannabinoid system.

If our government refuses to take such sensible steps to improve healthcare and protect patients, then we, campaigners and medical professionals, must do it for them.