Posts Tagged ‘Royal College Of Physicians’
Doctors Are Frightened Of Cannabis. It Challenges Conventional Medicine And Threatens Their Status.
Professor Andrew Goddard and Professor Finbar O’Callaghan at the Health and Social Care Committee, 26th March 2019
The British medical establishment is behaving like a spoilt child that doesn’t understand the rules of a new game.
The irony is that it’s actually a very old game that went out of fashion just a century ago despite thousands of years of practice. The wisdom accumulated across those many years has been dismissed by simplistic, reductionist, allopathic medicine and its return is being driven by patients – real benefit that real patients experience in real life, surely the most important criterion of all.
The doctors responsible for drafting the medicinal cannabis guidelines from the Royal College of Physicians and the British Paediatric Neurology Association have failed patients. Either through error or design they have overlooked the evidence of safety and efficacy that is widely available. They say there is ‘no evidence’ when what they mean is there is no evidence that suits them. For some reason they regard medical practice in Canada, the USA, the Netherlands, Germany, Spain or Israel as not applicable to the UK. Their guidelines are not based on evidence but on the disregarding of evidence and they are merely the opinion of doctors who have no experience of cannabis at all.
These doctors who expect their ill-informed opinions to be treated as scientific fact are directly opposing the doctrine of ‘do no harm’. They stand by while scores of young children suffer life threatening seizures, while hundreds of thousands in chronic pain are offered only highly toxic, addictive and dangerous opioids.
Their arrogance, stubborness and self-serving preference for lengthy clinical trials from which they earn fat fees is both damaging quality of life and putting health at risk for millions of us.
Since Finbar O’Callaghan and Andrew Goddard gave evidence to the Health and Social Care Committee, over three months ago, neither of them, nor any of their colleagues in their ivory towers, have done anything effective to improve access to cannabis as medicine. They have decided that their opinion counts above everything else. They have no interest in what patients have learned from experience, sometimes over many years. They choose to ignore the expertise of thousands of doctors from other countries. They will consider the benefits of cannabis only on their terms. They continue to wildly exaggerate the possible harms and side effects and their position is fixed, stubborn and intransigent.
It was notable in the two professors’ evidence that they preferred only to talk about cannabidiol, where they could refer to the evidence of clinical trials. They didn’t want to discuss full spectrum cannabis at all. Why is it that physicians are so risk averse when surgeons are lauded and idolised for the most perilous use of the knife? They will slice into flesh only millimetres away from vital organs, remove sections of the brain which could kill or paralyse with the slightest error. Yet unbelievably, O’Callaghan actually does recommend slicing into a child’s brain rather than to administer a tiny dose of a very low potency version of a drug which 250,000,0000 people worldwide consume regularly with very few problems.
It’s all about ignorance and fear. O’Callaghan, Gardner and 99% of British doctors have received no education at all in the endocannabinoid system through which cannabis exerts its therapeutic effects and this challenges their status. In our culture, doctors have been treated as infallible, almost as Gods, never to be questioned, only to be obeyed. So a medicine that works, that is safer than virtually all the pills you can buy over-the-counter and has powerful, benefical effects for very wide range of conditions is a real threat to doctors’ status. It shakes their world and so they are eager to disparage it, exaggerate its risks, diminish its efficacy.
This is the real issue with cannabis. It gives medicine back to the people, literally for those who grow their own, and with it a great deal of the power and prestige that the medical profession has held over us.
Of course more and more doctors are opening their minds and learning. It’s the establishment that’s the problem, as it so often is in British life. It’s those at the top of the Royal Colleges, the professional institutions and the NHS bureaucrats at the intersection between money and medicine. These are the people that stand in the way of the most inexpensive, multi-purpose, safe, effective, easily tolerated medicine that we have.
What Is The Matter With Doctors About The Use Of Cannabis As Medicine?
In the UK, most doctors, and the medical profession as a whole, are ignorant and bigoted about cannabis.
Their ignorance is not entirely their own fault. For 50-odd years, since cannabis tincture was last available from UK pharmacies, they have been subject to the same relentless tide of propaganda from the Home Office, successive governments, the tabloid press and rabble-rousing politicians as the rest of society. Many still regard cannabis as a dangerous drug consumed by degenerates that almost inevitably leads to mental illness. The idea that it could be a safe and effective medicine which offers real benefits in a wide range of conditions is regarded as laughable.
However, there is no excuse for such laziness amongst a profession that regards itself as scientific. And this is the charge – indolence, carelessness and laziness – that needs to be laid at those doctors at NHS England, the Royal College of Physicians and the British Paediatric Neurologists Association, that are responsible for the disgraceful ‘guidelines’ published two weeks ago.
Throughout Europe, Israel, Canada and the USA there are thousands of doctors who have made the effort to learn about cannabinoid medicine. They have had to make extraordinary effort to do because even the most basic science is still rarely taught. The endocannabinoid system is on the syllabus of very few medical schools, anywhere in the world, despite the fact we now know that it is the largest neurotransmitter network in the body and affects almost every aspect of our health and all medical conditions. This is a dreadful indictment of the medical establishment but particularly of doctors in the UK, very few of whom have made any effort at all.
So while, to a degree, the ignorance can be forgiven, the bigotry cannot. It is cowardice. These doctors prefer to cover their own backs, protect themselves and prefer an absurd level of caution to doing what is in their patients’ best interests. The incredibly low risk attached to cannabis in any form, at any age and particularly when under medical supervision, is simply overlooked.
Yes, the medical profession is known to be ‘conservative’ but in the case of cannabis this is an excuse. Yes, we live in an increasingly litigious society but any truly professional doctor would not be cowed by such fear when the evidence is widely available, if they could be bothered to look. And what is this ‘conservatism’ of? Modern medicine is barely a century old. It is new in the history of our species and while the reductionist approach has brought great benefit and made huge advances, it is at the expense of thousands of years of human experience which has been dismissed as valueless.
These doctors may feel that the reforms have been foisted on them with no consultation and little notice but this is not a political game, it affects the lives of millions, from the youngest baby to the oldest, most senior citizens. These doctors are failing in their professional duty. For too long they have enjoyed being regarded with ultimate respect, rarely being questioned or challenged by their patients but those days are gone. Most of the population is now far better informed than ever before, largely because of the internet and although this may cause doctors some problems, they have to learn to live with it. They have to respect their patients, parents and carers and recognise more than ever before that healthcare is about co-operation, about working together. They have to come down from their ivory towers and start delivering truly patient-centred medicine.
The Medical Establishment Shows Its True Colours On Cannabis. A Betrayal of Patients.
NHS England has today published what it describes as prescribing guidance – ‘Cannabis-based products for medicinal use: Guidance to clinicians‘.
The actual guidance is buried within a mountain of bureaucratic doublespeak and requires downloading PDFs from the Royal College of Physicians (download here) and the British Paediatric Neurology Association (download here). In both cases, aside from chemotherapy-induced nausea, the guidance amounts to ‘do not prescribe’. This is a travesty of the intention of these reforms and demonstrates how the medical establishment is more interested in protecting its self-interest than in helping patients gain the benefits of cannabis as medicine. Cowardly and scared are the two words which best sum this up.
It’s no surprise that doctors in the UK are ignorant about the use of cannabis as medicine. They have been subject to the same relentless torrent of reefer madness propaganda from government and media as the rest of society. They have been prevented even from learning about the endocannabinoid system by the authoritarian policy of prohibition and any doctor in the UK who has any experience of cannabis as medicine will have been in breach of professional ethics as well as the law.
But it’s deeply disappointing that the authors of these documents have made no effort to understand the excellent work that is being done by medical professionals in other countries. The Royal College of Physicians and the BPNA will be a laughing stock across the world in the many more enlightened and educated jurisdictions where patients are gaining great benefit. But of course, this isn’t a laughing matter. In fact, these two so-called professional bodies are making it a tragedy.
Clearly, what is in the best interests of patients is that we must bring in expertise from overseas. There are eminent doctors abroad who will be glad to step in, particularly in private practice, and pick up this baton which the NHS has fumbled and dropped in the most clumsy fashion.
This is a huge opportunity for those in private medicine who can set aside these cowardly excuses and make the most of the new regulations for patients who are fortunate enough to be able to afford it.
For the average Briton with chronic pain, Crohn’s Disease or an epilpetic child this is a kick in the teeth from the profession that is supposed to care for them.
Guidelines On Cannabis For Medical Professionals.
In a new initiative, CLEAR’s scientific and medical advisor, Professor Mike Barnes, has written to the presidents of several Royal Colleges proposing the development of guidelines around the use of cannabis as medicine.
Professor Mike Barnes
This is a tricky situation for doctors. Surveys and individual reports from CLEAR members indicate that many doctors tacitly endorse their patients’ use of cannabis but clearly cannot recommend the illegal use of cannabis, however safe and effective it may be.
Professor Barnes’ letter refers to the recent APPG report, his own paper ‘Cannabis: The Evidence for Medical Use’ and says:
“…cannabis now has a reasonable evidence base for the management of chronic pain, including neuropathic pain, and the management of spasticity as well as in the management of anxiety and a use in nausea and vomiting in the context of chemotherapy.”
In conjunction with CLEAR, Professor Barnes has written to:
Royal College of Anaesthetists
Royal College of General Practitioners
Royal College of Paediatrics and Child Health
Royal College of Physicians
Royal College of Psychiatrists
His letter goes on to explain that about one million people are using cannabis as medicine:
“I do feel that doctors need guidelines to assist them when patients request advice on the use of cannabis…doctors should be properly informed about harm reduction advice and should be aware of the clinical evidence that is now guiding medicinal use in several other countries around the world.”
Our proposal is for an initial meeting to discuss the idea. If one or more of the Royal Colleges is prepared to back this initiative, CLEAR will set up and fund a working group of clinicians and medical education specialists to develop a set of guidelines.
A Tale Of Two Conferences
“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair…”
A Tale Of Two Cities, Charles Dickens.
It was at its best as the brave Clark French and Cure Ukay gave their personal testimonies as medicinal cannabis users at the European Student Drug Policy Reform Conference. It was at its worst when Peter Hitchens confronted me and Sir Ian Gilmore at the University of Bedfordshire “A Ceasefire In The War On Drugs?” debate.
The Cannabis Panel
I am so proud to have been associated with both Clark’s and Cure’s contributions at the Manchester conference last weekend. There were tears in the audience as first Clark, who has MS, then Cure, who has Crohn’s, explained the reality of their daily lives and the relief that cannabis provides. The following day, Clark had a relapse and he hobbled to the front to explain, his legs in spasm. He went outside to take his medicine and literally skipped back into the conference hall. It was like watching Christ telling someone to take up his bed and walk. It was intensely moving. It refreshed my enthusiasm. It reignited my rage. They are both warriors for the cause of great courage and dedication. They are my inspiration.
The conference was a worthy and well-organised event. Lembit Opik gave a barnstorming speech which had them whooping and cheering in the aisles. There were fascinating contributions from Sebastian Saville and Niamh Eastwood of Release, Darryl Bickler of the Drug Equality Alliance, Chris Hallam and Tom Lloyd of the International Drug Policy Consortium. There were very practical workshops on campaigning and an engrossing lecture from Chris Rose of Campaign Strategies. I know I’m biased but I think Clark and Cure were the stars of the show!
And so to London on Wednesday evening for the debate at Kings College University, near Waterloo. As I walked into the lecture theatre, there was Peter Hitchens chatting with Sir Ian Gilmore. I marched straight up and introduced myself, explaining to Hitchens that I am responsible for the four Press Complaints Commission complaints that he is currently facing. I enquired after his brother’s health and he gave me a long and detailed explanation about Christopher’s oseophageal cancer. He was extremely courteous to me. I took my seat directly in front of him.
Ceasefire In The War On Drugs?
Hitchens spoke first. He is the arch dissembler, presenting facts in such a way that he draws you towards a false conclusion. To be fair, he is a fine speaker but at the heart of his argument is an intellectual vacuum.
Sir Ian Gilmore, ex-president of the Royal College of Physicians went next. He was quiet and dignified and presented a very scientific approach to harm reduction. Finally, Tim Hollis, Chief Constable of Humberside, stood in for David Blunkett. He was an entertaining speaker. I always rather like intelligent policemen. They have a difficult job to do and I think the good ones are very valuable to society.
So to questions…and I was fidgeting in my seat with impatience! I had my go, talked about the harms of prohibition, about taking the more pragmatic approach with a regulated system and the evil injustice of the denial of medicinal cannabis. Right in front of me Hitchens was visibly seething. When I pointed out that his brother is a passionate advocate of medical marijuana he snapped. He pointed at me, glared and shouted “Leave my brother out of it!”.
Steve Rolles from Transform spoke as did Harry Shapiro from Drugscope. Tom Lloyd, who had also spoken in Manchester contributed and there were many other intelligent observations and comments. Hitchens was clearly unhappy.
We went back to the panel and Hitchens was aggressive in his response, gesturing at me and talking of “idiots” and accusing Sir Ian of talking “drivel”. I heckled him. he promised to “deal with you later” with another Alan Sugar-style stab of the finger. Sir Ian was next and he rather politely suggested that “Peter has his head in the sand” – at which Hitchens exploded!
He grabbed his coat and bag and made as if to leave. It was a very deliberate flounce in high dudgeon. Later it was suggested he did it for dramatic effect but no, it made him look foolish. He was flummoxed by the opposition.
The chairman, ex-BBC presenter John Silverman, skillfully restrained him and persuaded him to stay. In his closing statement Hitchens quoted some statistics from Portugal in an effort to disprove that country’s success with decriminalisation. It would be against the rules for me to accuse him of anything more than dissembling but no one in the room recognised any truth in his figures.
It was an entertaining evening and a good opportunity to raise the profile of CLEAR. I’m back next week for another session entitled “How the World’s View of the Drugs ‘war’ is Changing”.
European Parliament – Public Hearing On Cannabis Regulation
The European Coalition for Just and Effective Drug Policies (ENCOD) has organised a public hearing on cannabis regulation at the European Parliament on 8th December 2010. See here for full details.
In March 2009, the European Commission published the “Report on Global Illicit Drug Markets 1998 – 2007” . This concludes that current policies of prohibition are failing in their main objective to reduce the demand and supply of illicit drugs. Current policies may also be a crucial factor in generating and increasing harm to individual drug users, their direct surroundings and society at large.
According to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) in its 2010 annual report, Europe faces new challenges posed by changes in drug supply and use. The report also highlights the increased usage of cocaine, heroin and of a record number of new synthetic drugs.
ENCOD says that prohibitionist policies have failed to tackle the issues of drugs and drug use effectively and it is time to investigate alternative approaches. European authorities must produce a thorough impact assessment of the costs of the current policy of prohibition and the economic benefits of decriminalisation and, as a start, the regulation of the cannabis market.
Victor Hamilton
It has been calculated that cannabis regulation would save billions in law enforcement costs, foster harm reduction, weaken the illegal cartels, and provide the opportunity to generate considerable income from taxes. The examples of California, Spain, The Netherlands and Portugal lead the way.
Victor Hamilton, the well known cannabis campaigner and former Legalise Cannabis Alliance (LCA) parliamentary candidate, liaises as a UK representative with ENCOD. He has submitted the following letter to ENCOD in advance of the public hearing on the current state of cannabis in Britain.
Dear Joep,
Thank you for the invitation to attend the hearing on 8th December 2010. I am afraid that both my health and the expense involved prevent me from attending.However, as you know, ending the prohibition of cannabis and encouraging more and better use of the plant in all its forms is my main concern. Cannabis offers many benefits medicinally, recreationally, spiritually and, as hemp, in ecologically sound fuel, construction materials, paper and plastics alternatives. Prohibition of cannabis is a far greater crime than any perpetrated by those who use it. It is a scandal and a sad litany of wasted opportunity and resources.
In the UK, based on research I have done and confirmed by the Independent Drug Monitoring Unit (IDMU), a legalise, regulate and tax regime could produce between £4 – 6 billion pa in new tax revenue.
For the benefit of the hearing, please allow me to update you on the present situation in Britain.
Calls For Decriminalisation
There have been calls for a relaxation of cannabis laws from a number of sources: The Bar Council, the British Medical Association, the Royal College of Physicians, The Lancet, Professor Roger Pertwee, Professor David Nutt and the Association of Chief Police Officers. The new coalition government’s “Your Freedom” website was swamped with calls for legalisation.
Reaction To Propositon 19
The cannabis community was eager with anticipation for the Proposition 19 vote in California, despite a dearth of media attention. Even the BBC, obliged under its charter to provide balanced coverage, found very little time for an issue that affects at least six million Britons. Strangely, the best of the lot was The Daily Telegraph, formerly known as the most conservative paper, it told us more about what was happening than any of the others.
The result was a disappointment and reminded us how our own campaigning has suffered from internal divisions and a lack of focus. Nevertheless. legalisation seems inevitable in the US, even if only at state level, within the next few years.
Formation of British Medicinal Cannabis Register
This exciting initiative to create a database of medicinal users in Britain was announced only in November. I was honoured to be invited to sit on the BMCR council as a medicinal user representative. Other members of the council include very eminent individuals such as Baroness Meacher, the MP Paul Flynn, Matthew Atha of IDMU and Dr Malcolm Vandenburg, the pre-eminent expert witness on drugs.
The real coup though was the announcement of Professor Leslie Iversen as a council member. Professor Iversen is the government’s chief scientific advisor on drugs. Yes that’s the British government which continues to state that cannabis has “no medicinal benefits”.
Subversion of Schengen Agreement
Several British medicinal users travelled to Holland for prescriptions from a doctor believing that their medicine was then protected by the Schengen Agreement. At first the Home Office agreed but then changed its position to say that British residents are not covered. The ridiculous situation now is that any non-UK resident can bring prescribed medicinal cannabis into Britain and use it without restriction. A UK resident cannot.
Increasing Evidence Of Medicinal Benefits
There is a never ending flow of information from all around the world on the extraordinary power of cannabis as a medicine. Facebook groups, blogs and organisations such as the LCA and UKCIA keep spreading the news. Particularly strong evidence has been revealed for cannabinoids as a treatment for Alzheimer’s, head, neck, breast and prostate cancer, fibromyalgia, ADHD and migraine. The mainstream media seem only interested in scandal and scare stories. They publish news about vastly expensive new pharmaceutical products but not about cannabis cures.
Confusion At The Home Office
Understandably, the British government’s position looks increasingly absurd. The Home Office veers between describing cannabis as very harmful, harmful, dangerous, extremely dangerous and changes its story every time it is challenged.
Approval of Sativex
Sativex won welcome approval from the medicines regulator as a treatment for spasticity in MS. Despite the fact that Sativex is nothing more than a tincture of herbal cannabis, the government now maintains that “cannabis has no medicinal benefits in herbal form”. Sativex is approximately eight times the cost of herbal medicinal cannabis and many health authorities are refusing to fund it.
New UK Drug Strategy
The government is to announce a new drugs strategy in December. There is expected to be a shift in emphasis towards healthcare interventions rather than criminal sanctions but no move away from prohibition. The more liberal views expressed by both David Cameron and Nick Clegg over the last 10 years seem to have changed now they have come to power.
Joep, I hope this is helpful and informative for the hearing and for you and your colleagues.
Victor Hamilton
Home Office Backtracks On Cannabis
A fortnight ago Sir Ian Gilmore, the outgoing president of the Royal College of Physicians, famously denounced drugs prohibition as a failed policy. He said “”Everyone who has looked at this in a serious and sustained way concludes that the present policy of prohibition is not a success.” He then went on to advocate decriminalisation and regulation.
The Home Office immediately issued a statement saying “‘Drugs such as heroin, cocaine and cannabis are extremely harmful and can cause misery to communities across the country.” This statement was reproduced on the Home Office website and has sat there for the last two weeks in direct contradiction to the governments own scientific advisers. Anyone who has even the smallest knowledge of the subject knows that the idea that cannabis is “extremely harmful” is absurd and a lie.
Within the last day or two the Home Office website has been quietly edited to remove the word cannabis from the statement. See here.
Charades, Fibs And Porkies
This correction is very welcome. However it calls into question the honesty, competence and intelligence of the Home Office and the government’s drugs policy. James Brokenshire, the Minister for Crime Prevention has been looking increasingly ridiculous in the last few weeks, contradicting his advisers, spouting pre-Reagan “war on drugs” propaganda and conflicting terribly with the wise words of both David Cameron and Nick Clegg, both of whom have called for drug policy reform consistently over the last 10 years. Young James has made himself very unpopular with the country’s six million regular cannabis users and embarrassed the government and the Tory party with his antics.
Whoever was responsible for this smart and very discreet editing, let’s hope they get to have a look at James’ Drugs Strategy consultation document too. It needs some intelligent correction and adjustment as well. See here for more information on what’s really a very silly game of charades, fibs and porkies.
