When the law fails patientsBMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l1980 (Published 02 May 2019) Cite this as: BMJ 2019;365:l1980
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Re: When the law fails patients. Scientific rigor and academic honesty. concerning the debates on the therapeutic use of marijuana, abortion and euthanasia
In Richard Hurley's article in this journal , I find a great sensitivity towards specific problems of patients. In his opinion, a large part of these conflictive situations are rooted in a lack of will, or lack of interest, in respecting human rights. Certainly, the three situations to which the author refers (use of marijuana, practice of abortion and euthanasia) refer us to complex realities, which generate conflicts and tensions in healthcare. Therefore, they must be approached with scientific rigor and argument honesty. It is crucial, precisely because of the great difficulty that they have, to avoid ideological positions or distorted treatments, due to the confusion of plans, perspectives and situations. For example, with respect to marijuana, a serious discourse must be based on a rigorous analysis of the scientific evidence on the benefit to patients of the use of certain forms of marijuana.
Consequently, we must not confuse or distort this study with other issues, such as media campaigns on the subject, or the wishes of patients. Certainly, social pressure or the wishes of patients are also important issues, but everything must be placed in its place. If there is scientific evidence of the benefit of a specific use of marijuana, and its safety and efficacy is greater than that provided by the other products of the therapeutic arsenal, there is no doubt that its use should be encouraged. But a different question is the strength and pressure of media campaigns, the criteria of patients on the subject or the different ideological positions.
This is precisely what I miss in Hurley's text. In effect, the author mixes, without the necessary precision and rigor, scientific aspects of the problem, with patient wishes, legal regulations, social feeling ... Therefore, I believe that his work, far from contributing clarity to the debate, generates confusion and distortion, by mixing very different cases and confusing the planes of the discussion. It is not understood what is, in reality, the objective pursued by his work: to serve the patient and seek their safety and benefit ?, to influence polemics of an ideological nature? Meet the economically solvent demands of certain sectors of society?
In short, when we face serious and complex situations, such as those that Hurley shows, we must address them with rigor and honesty. From a scientific perspective, it must show the reality of the effects and consequences for the patient of what is being discussed, always based on scientific evidence. From there, ethical criteria of good professional practice will be derived. The rest of issues, being important, should be placed in their rightful place, with academic rigor and argumentative honesty.
Competing interests: No competing interests
Billionaires v. Babies
The call by Richard Hurley in the name of children with severe disabilities citing confused Government laws relating to cannabis is singularly ironical given the dual factors of the now virtually unanimous declaration by medical experts and the cannabis industry alike that the toxic effects of cannabinoids on children both before and after birth are severe and potentially long lasting with manifold ramifications into adulthood and later life of mental instability, impaired cerebral executive functioning and impulse control including addictions and poor concentration 1, and the ready availability in many jurisdictions of Epidiolex. That is to say that children have the most to gain and to lose from the application and misapplication of cannabis and cannabinoids respectively.
The genotoxicity and mutagenicity of multiple cannabinoids is beyond scientific controversy: note the identical genotoxicity and reproductive health product warnings on Epidiolex, Sativex and the hemp oil on your supermarket shelves!
That is without mentioning that cannabis use rates in Canada have just been reported to have risen 27% following legalization there with 646,000 reported trying cannabis for the first time compared to 327,000 in the same period last year. Interestingly Canada has become one of the best countries in the world to demonstrate the close link between all congenital abnormalities in babies and cannabis use, since both metrics are highest in the northern Territories of Canada which smoke more cannabis than the Provinces in the south 2 3. Indeed the historical east-west gradient in cannabis consumption closely parallels the east-west gradient in neural tube defect incidence including anencephaly (no brain) and spina bifida 2 3.
Across USA publicly available data shows that many defects including Down’s Syndrome, Trisomy 18, Trisomy 13, Atrial Septal Defect, Ventricular Septal Defect, Encephalocoele, Anencephaly, Limb Reduction, no ears (Anotia) and Gastroschisis (guts hanging out) are all more common in some or all of the four highest cannabis using states Alaska, Colorado, Massachusetts and Oregon 4. However the most common damage of all is the congenital brain damage mentioned above with syndromes like ADHD and Autism Spectrum Disorder 1. The rise of autism across USA closely parallels the rise in cannabis use both in the nation as a whole and by state 5.
It is increasingly obvious that the global cannabis push is occurring as a generously funded media-driven phenomenon counterfactually against the evidence rather than because of it. Cannabis was banned by the international community at the repeated entreaty of Egypt amongst others in 1926 because the nation was overrun and its social fabric severely decimated by widespread rampant cannabis use. Those who refuse to learn from history are condemned to repeat its mistakes. In the battle of the Billionaires vs. the Babies we cannot allow our children and tomorrow’s generation to be mortgaged wholesale from beneath us.
1. Velez M.L., Jordan C.J., Jansson L.M. Cannabis Use Disorder During Pregnancy and the Perinatal Period. In: Montoya I., Weiss S.R.B., eds. Cannabis Use Disorders. Switzerland: Springer Nature 2019:177-88.
2. Public Health Agency of Canada, Health Canada. Congenital Anomalies in Canada, 2013. A Perinatal Health Surveillance Report.
. In: Public Health Agency of Canada, Health Canada, eds. Ottawa: Health Canada, 2013:1-119.
3. Statistics Canada. National Cannabis Survey, Second Quarter, 2018 Ottawa Canada: Statistics Canada; 2018 [cited 2019 17th March 2019]. Available from: https://www.facebook.com/StatisticsCanada/posts/1636405843137586:0 accessed 17th March 2019 2019.
4. National Birth Defects Prevention Network. National Birth Defects Prevention Network Houston, Texas, USA: National Birth Defects Prevention Network; 2018 [cited 2018 15th July 2018]. Available from: https://www.nbdpn.org/ar.php accessed 15th July 2018 2018.
5. Reece A. S., Hulse G.K. Effect of Cannabis Legalization on US Autism Incidence and Medium Term Projections. Clinical Pediatrics: Open Access 2019;In Press [published Online First: 2019]
Competing interests: No competing interests