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When the law fails patients

BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l1980 (Published 02 May 2019) Cite this as: BMJ 2019;365:l1980

Rapid Response:

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

28 June 2019
José López-Guzmán
Pharmacy professor
Department of Pharmacology. School of Pharmacy. University of Navarra
Department of Pharmacology.School of Pharmacy. University of Navarra. 31008 Pamplona. Spain