A lot of reports these days are covering "fake news" -- stories without underlying truth, and there are cases where governments are making policies based on stories denying climate change and other similar unsupported ideas. I recently collaborated on a cannabis paper that I feel nicely encapsulates the challenges when voters and legislatures start to get involved in science.
My paper, written together with colleagues at Northwestern in this month's Movement Disorders Clinical Practice, is a timely report on a systematic survey of expert neurologists based on an idea by Danny Bega, an up-and-coming neurologist at Northwestern. When we surveyed expert neurologists about cannabis, everyone thought they knew what the appropriate uses of cannabis were but no two people thought the same thing. We think of the FDA as an approver of drugs, but in reality the FDA assesses the evidence for indications and dosage, and "approval" is really a determination that a drug is safe for humans and, when used in a defined set of individuals, provides a benefit to them that outweighs the risks.
In contrast, with cannabis, legislators are effectively simply "approving" its use, without the indications and dosing that any FDA-approved drug would come with.
Of course, cannabis is impossible to "approve" in an FDA process, because the the source plants are actually a family of plants, with dramatically different compositions including varying concentrations and ratios of cannabinoid receptor agonists (which cause euphoria and executive dysfunction) and antagonists (which cause neither). It would be like if the emergency department stocked generically "opioids," and some people presenting in pain got morphine, others got heroin, and another group got tea made from poppies.
Many people are aware of situations where legislators are attempting to legislate science, with people up in arms about policies denying global warming, evolution, risks of antibiotic resistance, pesticides used to fight zika that are neurotoxic to humans (and cause Parkinson's), etc. However, cannabis legalization represents the same mistake: policy being set using cherry-picked science.
In all these situations, people are attempting to set policy to reflect a perspective that exists in (at most) a subset of the opinions on the topic. There is a historical analog of this: throughout much of the 1990s, healthcare strategists attempted to encapsulate into medical guidelines treatment approaches identified through bringing together groups of experts to arrive at consensus on the best ways to treat a disease. These approaches failed miserably, resulting in another shift, this time to "evidence-based medicine." In the best "evidence-based" guidelines, experts on medical-scientific epistemology review all the papers published on a topic systematically, identifying conclusions that are broadly supported.
We need to ensure that when legislators consider science-based policies, that they take a lesson from medicine and adopt policies that appropriately reflect the best insight from across science, and then include a mechanism to review new developments. The importance of this point is encapsulated in the case-study of policies around the legalization of cannabis.
My paper, written together with colleagues at Northwestern in this month's Movement Disorders Clinical Practice, is a timely report on a systematic survey of expert neurologists based on an idea by Danny Bega, an up-and-coming neurologist at Northwestern. When we surveyed expert neurologists about cannabis, everyone thought they knew what the appropriate uses of cannabis were but no two people thought the same thing. We think of the FDA as an approver of drugs, but in reality the FDA assesses the evidence for indications and dosage, and "approval" is really a determination that a drug is safe for humans and, when used in a defined set of individuals, provides a benefit to them that outweighs the risks.
In contrast, with cannabis, legislators are effectively simply "approving" its use, without the indications and dosing that any FDA-approved drug would come with.
Of course, cannabis is impossible to "approve" in an FDA process, because the the source plants are actually a family of plants, with dramatically different compositions including varying concentrations and ratios of cannabinoid receptor agonists (which cause euphoria and executive dysfunction) and antagonists (which cause neither). It would be like if the emergency department stocked generically "opioids," and some people presenting in pain got morphine, others got heroin, and another group got tea made from poppies.
Many people are aware of situations where legislators are attempting to legislate science, with people up in arms about policies denying global warming, evolution, risks of antibiotic resistance, pesticides used to fight zika that are neurotoxic to humans (and cause Parkinson's), etc. However, cannabis legalization represents the same mistake: policy being set using cherry-picked science.
In all these situations, people are attempting to set policy to reflect a perspective that exists in (at most) a subset of the opinions on the topic. There is a historical analog of this: throughout much of the 1990s, healthcare strategists attempted to encapsulate into medical guidelines treatment approaches identified through bringing together groups of experts to arrive at consensus on the best ways to treat a disease. These approaches failed miserably, resulting in another shift, this time to "evidence-based medicine." In the best "evidence-based" guidelines, experts on medical-scientific epistemology review all the papers published on a topic systematically, identifying conclusions that are broadly supported.
We need to ensure that when legislators consider science-based policies, that they take a lesson from medicine and adopt policies that appropriately reflect the best insight from across science, and then include a mechanism to review new developments. The importance of this point is encapsulated in the case-study of policies around the legalization of cannabis.
