Medical cannabis: patients turn to private clinics because of NHS voidBMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l5290 (Published 02 September 2019) Cite this as: BMJ 2019;366:l5290
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There is a mystifying narrative in this article that states that while NHS doctors follow guidelines (and good prescribing behaviour), those who choose to work privately can simply disregard safety, evidence and the law and give out cannabinoids at will because they know better.
There are plenty of interested groups in the UK pushing for medical cannabis on prescription but in the face of anecdote and commercial pressure the job of doctors and the BMJ is to use scientific evidence as the bedrock of good prescribing practice and balanced journalism respectively. NICE has produced its guidance because it has looked at the evidence, and the NICE guidance ought to be the underpinning message here. Instead your article reads as a puff-piece for interested concerns who stand to make money and reputation from cannabis. You may think you have created balance by detailing the extensive commercial conflicts of interest of your two cannabinoid promoting interviewees, but that simply reads as two pages of free advertising for Drs Sodergren and Barnes. Well done them!
For your information, if cannabinoids were shown to be effective, they would be prescribed as of Nov 2018. But the strongest scientific evidence fails to show any meaningful benefit for cannabinoids across a range of conditions. Until the evidence changes, those of us who understand the guidance and who see biased opinion for what it is, will not be in a position to prescribe cannabinoids.
Finally I won’t be the only NHS doctor reading the article who is more than a little insulted at the implication that I would prescribe cannabis if only I was properly educated. We can all access and evaluate the same knowledge base. Those of us who do no private practice and who have no research, professional or commercial ties to cannabinoid companies or clinics, can evaluate the knowledge base without conflicts of interest. Surely that makes us more educated?
The BMJ positions itself as a promoter of good medical practice, free of bias, but in this instance you have let down your editorial guard.
Competing interests: No competing interests
The UK National Institute for Health and Care Excellence has proposed GPs and other prescribers such as pharmacists and nurses should be able to take on prescribing of cannabis based medicinal products once initiated by specialists in expert centres.1 NICE cautions against the use of medical cannabis because of lack of evidence of safety. It is good that GPs are being cautious about prescribing cannabis.
There may be little evidence of long term benefit but there is a wealth of evidence of serious harmful effects. Reece and Hulse published a review of the impacts of cannabinoid epigenetics on human development which is very alarming.2 Cannabis use increases hyper-and hypo DNA methylation of sperm in rats and in humans which may provide a vector for the transmission of transgenerational instability. Cannabis-related teratology includes effects on the neuraxis, cardiovasculature, immune stimulation, secondary genomic instability and carcinogenesis related to paediatric and adult cancers. Trends in the USA, Hawaii, Colorado, Canada, France and Australia relate to mental retardation, and inheritable carcinogenesis.
The outlook for future generations is bleak when fathers have sperm with epigenetic cannabinoid-induced damage and mothers have also taken cannabis before or even during pregnancy. Cannabinoids may be the new thalidomide. As usual powerful drugs are being given with few, if any, checks on the effects on crucial basic biochemistry such as levels of copper and zinc and blood metallothionein.
1 NICE. Cannabis-based medicinal products: draft guidance for consultation. Aug 2019. https://www.nice.org.uk/guidance/indevelopment/gid-ng10124/consultation/....
2 Reece AS, Hulse GK. Impacts of cannabinoid epigenetics on human development: reflections on Murphy et. al. 'cannabinoid exposure and altered DNA methylation in rat and human sperm' epigenetics 2018; 13: 1208-1221. Epigenetics 2019 Jul 11:1-16. Epub 2019 Jul 11.
Competing interests: No competing interests