Men of Dignity

April 2015 marked the finally stages of Advocate Robin Stransham-Ford’s fight with prostate cancer. Being an officer of the courts, he took his final fight with death to the only place he knew best - the high court. His application seeking to be allowed to die with dignity and for the doctor who would assist him not be punished, made headlines all over. Though his request was granted, he died soon after – his final victorious moment. What may not have been equally publicised was his involvement and contribution to the Medical Innovation Bill.

Those who have not read the Bill would assume that the late IFP MP, Mario Oriani-Ambrosini, while tabling the proposal in parliament in February 2014 was calling for an opportunity to be able to smoke weed freely. Or for street vendors to freely sell it alongside sweets and cigarettes.

Stransham-Ford and Oriani-Ambrosini: They were bound by a simple need to never let those after them experience the pains they respectively went through.

Some people have reportedly denounced Bill claiming it to be a ploy to turn South Africa into a country of addicts. While a few could be excused for their ignorance and inability to peruse the proposed law, others have quickly seen a profitable opportunity and have been actively motivating for increased funding for research and such kitties. This was the scene played before the Parliamentary Portfolio Committee on Health on May 28, 2015.

Laysa lel mayti lisaanon fayanToq (Dead men tell no tales). Well, this could have been if we never encountered Oriani-Ambrosini and Stransham-Ford. These two double-barrelle-named individuals were smart enough to know not to trust everyone to understand their intentions.

The intentions of the two men were clarified in an amended version of the Bill that was presented to the parliamentary portfolio committee for health soon after the filing of the initial one. The amendments, we have learnt, were to keep off some scavengers who have been sharpening their claws, readying to harvest from the wishes of the now dead men.

The objectives of the Bill are to?

• encourage responsible innovation in medical treatment by supporting clinical decisions made by doctors based on the principle of “first, do no harm”
• recognise the fundamental right of the individual’s sovereignty over their own body as exercised by their doctor
• clarify lawfulness and liability where a doctor employs their generally recognised principle of therapeutic freedom by departing from the existing range of accepted or authorised medical treatments for a condition
• codify existing best practices of this generally recognised principle of therapeutic freedom for doctors to innovate responsibly where they depart from the existing range of accepted or authorised medical treatments for a condition
• deter reckless, illogical, or unreasonable departure from accepted or authorised medical treatments
• create an open access Medical Innovation Register for the benefit of society
• legalise and regulate the use of cannabinoids for medical purposes under the Act and
• to optimise biomass use from cannabis plants for beneficial commercial and industrial uses

Unfortunately, without any regard for the text that could not have been any clearer, some entities with engrained interests are keen to push for what they want all to believe. For instance, South African Medical Research Council (MRC) would like all to believe their great intentions, but is clearly keen to use the proposed law to solicit for more funding to undertake ‘research’ on the suitability and efficacy of cannabis.

To drum this point to the Committee, they sent ‘classrooms’ of experts – classrooms in the sense of how many lectures the professor could provide to students in the total hours they spent at Parliament.

The first to make appearance for MRC was Advocate Nkosinathi Wiseman Bhuka, the Council’s national manager for legal services, who was there to remind the MPs that theirs was the one-stop-shop for everything medically new in the country. He stated; “So by virtue of those sections (Sections 3 & 4 of Medical Research Council Act No. 58 of 1991) the MRC is basically a public custodian of health or medical research in the South African context…”

Adv Bhuka then concluded his presentation by reminding the lawmakers; “Our (MRC’s) case is that in law there is certainty and it is set in law that cannabis at this point in time is an illegal substance. We feel that it may not be as certain in the medical health practitioners’ practice, and the certainty needs to be achieved by way of further investigations…” He was closely followed by Prof. Charles Parry, the Council’s director of Alcohol, Tobacco and Other Drugs Research Units.

It takes a lot of reading for one to become a professor, and that could have explained the silence that met his presentation. Prof. Parry started by reminding the attentive MPs of a paper he had recently published in the SA Medical Journal - a publication that is not generally available to the public. If that was set to make him appear as an authority on matters to do with medical cannabis, he may have succeeded.

But to a keen listener, his next confession was curious; “My first exposure to medical cannabis was in fact in 2000 when I met Dr. Raphael Mechoulam…” He was reffering to the professor in the Department of Medicinal Chemistry and Natural Products at Hebrew University Hadassah Medical School and School of Pharmacy (also often referred to as the father of Marijuana Research). But of course the MPs had no means of knowing who that was. In fact his pronunciation of ‘Mechoulam’ would not have made it easier for one to conduct an web search.

The MRC’s top most authority presenting to parliamentarians did not know about medical cannabis until the beginning of the millennium. Cannabis for medical use has been talked of for centuries. In fact the most documented and highly circulated was the May 4, 1937 testimony of a highly regarded medical legislative authority, a Dr. William C Woodward, to US Congressional Committee on Ways and Means.

Dr. Woodward, a medical doctor and a lawyer by profession appeared before the committee representing American Medical Association to object to a legislation that finally created a special taxation on cannabis. The Association was more or less unhappy with the secrecy adopted by the Treasury in the creation of the law.

He was recorded to have lamented; “There is nothing in the medicinal use of Cannabis that has any relation to Cannabis addiction. I use the word ‘Cannabis’ in preference to the word "marihuana", because Cannabis is the correct term for describing the plant and its products. The term ‘marihuana’ is a mongrel word that has crept into this country over the Mexican border and has no general meaning, except as it relates to the use of Cannabis preparations for smoking. It is not recognized in medicine, and I might say that it is hardly recognized even in the Treasury Department.”

So in essence, talking of marihuana (marijuana) in 1937 America would be like talking of dagga in 2015 South Africa, and the Medical Innovation Bill, at least the one we have copy of, does not talk of dagga, (for recreational purposes) but cannabis.

How much credence should the parliamentarians give to the professor’s submission?

Next entered Willie Pienaar, a psychiatrist and associate professor in the Department of Psychiatry at Stellenbosch University. Prof Pienaar claimed not to know why he had been pooled to share his knowledge on cannabis with the parliamentary committee. It was clear that the professor wasn’t well-briefed and that was evident in the confusion he caused among the Committee members with one asking; “You say overall yes to the bill, yet you raise a lot of questions that we should go find answers. How do you then arrive at an overall yes?”

Amid the confusion and doubt, Prof. Glenda Gray, the president of the MRC and a clinical trial specialist stepped in with a begging hand; “MRC supports research into medicinal use of cannabis, support pre-clinical and clinical research looking into the effects. We want to know the mechanism of action. We believe we need to carry out well-designed randomized clinical trials, well analysed. In terms of cancer, the MRC spends around R30m a year, and its clearly not enough and we would welcome a huge injection of money for chemical research. The US spends trillions on cancer research, they investigate everything…”

Is the Bill asking for invention of the wheels that would require the professors to have dedicated funding taps? Maybe some re-invention would be required, South African style.

But before the bucket is filled with gold, the unfortunate thing is that there was nobody in the team to point the politicians to the parts of the wheels that have been moving without any research from the MRC team.

In September 1988 US DEA Administration Law Judge, Francis L. Young, in an administrative ruling to reschedule cannabis had stated; “The evidence in this record clearly shows that marijuana has been accepted as capable of relieving the distress of great numbers of very ill people, and doing so with safety under medical supervision. It would be unreasonable, arbitrary and capricious for DEA to continue to stand between those sufferers and the benefits of this substance in light of the evidence in this record.” Exactly what the Medical Innovation Bill is calling for – under medical supervision. 

In an editorial piece for Providence Journal of March 26, 2004, Dr. Joycelyn Elders, former US Surgeon-General was attributed as stating; “The evidence is overwhelming that marijuana can relieve certain types of pain, nausea, vomiting and other symptoms caused by such illnesses as multiple sclerosis, cancer and AIDS - or by the harsh drugs sometimes used to treat them. And it can do so with remarkable safety. Indeed, marijuana is less toxic than many of the drugs that physicians prescribe every day."

Read closely, despite numerous anecdotal evidence of its efficacy, MRC is technically pegging its support for the Bill to additional funding. Would the rejection of the proposed legislation eradicate cannabis from our streets? There are those who believe so, and would use whatever resources they can amass to ensure that the status quo is maintained.

For various reasons, they would use all means to fend off any space for sombre reasoning. See The Experts - Undisclosed Agenda.