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Ezekiel Emanuel warns on medical cannabis

PUFF: Cannabis and vaporiser displayed at Newcastle Mater Hospital when Premier Mike Baird announced ‘s first medical cannabis trial in July 2015. Picture: Max Mason-Hubers.OPINIONTALKING to visiting US medico Ezekiel Emanuel on Monday, I noticed that he was an oncologist –a cancer specialist –making him a good person, I thought, to ask a few questions about medical cannabis.
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Last year, when I was reporting on medical cannabis and the possibility thatsome chemicals in cannabis had“anti-carcinogenic” properties, I sought the advice of Hunter New England Health, which put me on to one of the region’s prominent oncologists, Dr Stephen Ackland.

Ackland was cautious –very cautious –in his statements, but he forwarded me three recent scientific papers on the subject, including one from the highly rated British Medical Journal, titled “Should doctors prescribe cannabinoids?”

There are two main justifications given for medical cannabis. The first and most widely quoted reason is the claim that cannabis reduces nausea and pain and other symptoms both of individual illnesses and their treatments.The second claim –as noted above –is that cannabis has anti-cancer properties, whichare yet to be fully understood or accepted by the mainstream medical community.

Emanuel answered my question about medical cannabis with his own question.

“Where’s the evidence?” he said. “Show me the randomised controlledtrials.”

Randomised controls are the gold standard for medical research, in which a drug or treatment being investigated is tested against either another drug or method, or a placebo, with the various treatments being randomly allocated to the people taking part in the trial, without their knowledge.

There have been very few randomised trials on cannabis and pain or nausea, and even fewer on cannabinoids as anti-cancer agents. Most of the trials –as encouraging as they might have been –have either been on cells in test tubes, or on mice or rats.

Emanuel pounced, explaining how a treatment that cured sepsis (caused by bacterial toxins) in mice did nothing, at best, in humans, and in some cases made things worse because “mice are a terrible animal model for sepsis in people”.

“Mice also turn out not to be fantastic for cancer,” Emanuel said. “It’s easy to cure cancer in mice. It’s a lot harder to cure cancer in people. So, do the trials on people, and then we can talk about it.”

He was just warming up.

“What I will say is that the idea of legalising cannabis so doctors will give you a prescription for health reasons is a total farce, and I’m totally against it,” Emanuel said.

“You want to legalise cannabis? Legalise it. There are downsides to it and let’s get serious about the downsides because we haven’t (yet).

“But this idea of getting a doctor to say you’ve got back pain to allow you to smoke cannabis is making doctors liars. I’m totally against the idea of medical cannabis because we know it’s recreational cannabis and we know people end up inventing all sorts of diagnoses. That’s just hypocrisy, and I’m not into hypocrisy.”

And there is plenty of opportunism, at the very least,in medical cannabis,with failed corporate shells being dusted off and re-branded as medical cannabis companies, ready to raise as many millions as they can from “sophisticated investors” hoping fora “ten bagger” (a sharethat multiplies in value 10 times).

It’s a funny world, whengovernment departmentwants to outlawcigarettesand limit alcohol while opening the door onwhat the lawonce called“reefer madness”.

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