Medical Cannabis (Access) Bill
Debate between Kieran Mullan and Katherine Fletcher
Katherine Fletcher
I thank my hon. Friend for the clarification. I think I might have used slightly clumsy language. What I am trying to get at is that for therapeutic use, there is still a required research standard. While cannabis is ubiquitous and lots of people use it for non-therapeutic and currently not legal uses—to quote Marshall Mathers III:
“Marijuana is everywhere, where was you brought up?”—
that does not translate into something that I feel I am comfortable in asking clinicians to engage with.
I want to develop my argument. If I may, I will mention my hon. Friend the Member for Crewe and Nantwich (Dr Mullan) and the five years of blood, sweat and tears—literally, I imagine—through medical school to achieve his title of doctor and take the Hippocratic oath. For those of us who have not gone through that journey, it is worth listening to the oath. The original version—its language is a bit dated now—is:
“I will use my power to help the sick to the best of my ability and judgement; I will abstain from all intentional wrong doing or harm”.
I think that touches on the point my hon. Friend the Member for Penrith and The Border (Dr Hudson) made about how, to avoid doing harm, there needs to be some certainty either way. In its more up-to-date form—this is the oath that doctors from the University of Exeter take—it states:
“I…pledge”—
I am not pledging myself—
“that I will do my best to serve humanity—caring for the sick, promoting good health and alleviating pain and suffering.”
Doctors are coming in wanting to do that, and I do not think the “blockage” that was referred to is anything to do with intention or fuddy-duddyness. Another of the lines they say is:
“I will care for all patients equally and not allow prejudice to influence my practice.”
Again, any doctor looking at a child as sick as Ben can be when his seizures are bad are not, having taken that oath, going to go, “Oh, well, there’s something I could prescribe.” Forgive me for continuing to emphasise the point, but the oath goes on:
“I will respect the autonomy and dignity of my patients, and will uphold their confidentiality. I…support…teachers, colleagues and all those who sustain the NHS.”
Then it gets to these lines:
“I shall never intentionally cause harm to my patients, and will have the utmost respect for human life.
I will practice medicine with integrity, humility, honesty and compassion.
I recognise that the practice of medicine is a privilege with which comes considerable responsibility and I will not abuse my position.”
This oath is a signifier of the integrity of individual doctors and medical ethics. It is their loadstone at the core of what they do, and I agree with them that it needs to be protected at all costs. Each doctor needs to weigh their own decisions, but for these complex cases—especially for some of the people who, by anecdote and, as I would put it, a good old case of looking at, have hugely benefited from medical cannabis—there is not one doctor in the system, but a series of them. While Ben has secured one NHS professor’s support for prescription and one private doctor’s support for prescription—I draw no distinction between the scale of the personal challenge and the qualifications that somebody has regardless of where they work—other medically qualified professionals within the CCG or funding panel are saying that they need more evidence.
Dr Kieran Mullan (Crewe and Nantwich) (Con)
I think it is very important for Members to remember that, at various stages through medical evidence building, there have been occasions when people have said very strongly that something, anecdotally, was working, yet further down the line we have discovered that that was not the case. There is therefore hesitancy when it comes to that kind of observational medicine as evidence, because I am afraid it is not reliable.
Katherine Fletcher
I thank my hon. Friend for his intervention, and if I do not embarrass him too much, may I also thank him for his service in hospital during the covid pandemic? It is the strength of experience and the variety of experience on these Benches that makes sure, when we do put stuff through, that the laws of this country are scrutinised by people from different perspectives, and he is a great example of that.
Joanne position’s is that she is coming to me with Ben saying, “This doctor says he can have medical cannabis, and then I have another set of doctors saying, ‘Well, we need more evidence before we can prescribe it’.”
Katherine Fletcher
The term “anecdote” means, within a scientific context, not statistically proven. While the emotion that the hon. Lady shows on behalf of Ben’s family and other families is important, it is also important to step back. If nothing else, the pandemic has shown us the power of science to find the right answers to solve problems.
Dr Mullan
It is very important that we do not allow our compassion and our concern about individual cases to cloud our judgment about the fact that the NHS, the Department of Health and Social Care and the MHRA have to put systems in place that apply to every medicine across all the many treatments that are used. Questions like this arise repeatedly about many medicines. We should not use one case or one example to change the whole approach, which overall—as my hon. Friend has explained—aims to keep people safe.
Katherine Fletcher
If the Bill solved a specific problem, it could enjoy my support.
Dr Mullan
No. The point I am making is that nothing in the NIHR’s work says that it will only consider research and applications that are RCTs, and nothing prevents NICE from looking at any number of other methods of research. Opposition Members are saying that the Bill is the only way to get people to look at the evidence more broadly, but that is simply not true.
Katherine Fletcher
Briefly, I think I heard the hon. Member for Tooting (Dr Allin-Khan) talk about an RCT being immoral, implying that there is only one specific type of study design. She is talking about an RCT that would include forcing a placebo on children who are receiving medicine at the moment, but does my hon. Friend agree that RCTs can be designed in other ways and that we should not tar them all with one brush?