The Rise of the Duopoly and the Fall of the Evidence – Labour’s ‘medicinal’ cannabis policy fudges the facts

‘Medicalisation’ is a compromised policy that has its roots in vague and emotive beliefs amongst the public, which are generated primarily by media bias, and then unfortunately perpetuated by politicians for political gain.

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Watching the ‘Leaders Debate’ last night I couldn’t help but feel that this election, as entertaining and unpredictable as it is, is fundamentally unhealthy. Parties will rise and fall, there will be winners and losers and those in between – but I fear the biggest casualty of the night may be MMP itself.

The latest poll numbers make sorry reading for anyone interested in the plurality of our political system and the benefits of proportional representation under MMP. The latest NewsHub poll has National on 43.3%, Labour 39.4%, NZ First 6.6%, Greens 6.1%, The Opportunities Party 1.9%, Maori 1% and ACT 0.6%.

As we move closer to election day there is a real possibility that no third party will reach the 5% threshold. They will then need to rely on electorate seats to have any presence in Parliament at all. That is a disastrous outcome.

Proportional representation has allowed minor parties to advance some of the more radical and defining legislative proposals in our country’s history. It has allowed for policy programmes and ideas that would not normally be pursued by establishment parties to enter the conversation. It has helped to keep our democracy relatively vibrant.

The second Leaders Debate on Monday night made me realise the limitations that a two-party duopoly can impose. It stifles the breadth of opinion and limits the horizon for discussion. As a medical professional, one moment demonstrated this to me more clearly than others – the response by both leaders to the idea of medicalised cannabis.

Medical Cannabis and the “Smokescreen”

Many medical practitioners, myself included, have real concerns about the vague public understanding around the medicinal qualities of cannabis. Unlike many politicians, we have that irritating tendency to try and base our decisions on the evidence. Unfortunately for those who wish to believe otherwise, the medical evidence to support medicinal cannabis is weak.

The most recent systematic review in the Journal of American Medicine demonstrated moderate-quality of evidence for its use in chronic pain and muscle spasticity, and only low-quality of evidence for nausea and vomiting, weight gain in HIV, sleep disorders and Tourette’s syndrome.

In contrast to this, there is good evidence for the harms related to use. Population-based studies show increased rates of psychosis associated with cannabis consumption, and the carcinogenic effects associated with smoking remain unknown. Chronic smoking is linked to respiratory complications, such as chronic bronchitis, and also other mental health issues, including social anxiety, dependence and possible depression.

An article in 2016 authored by two mental health physicians based in Wellington, Professor Giles Newton-Howes and Dr Sam McBride, and published in the New Zealand Medical Journal addressed the discrepancy between the evidence and the public and political position:

“Bearing in mind the weak evidence of effectiveness of cannabis as a medicine, the lack of regulation compared to other medical products and elsewhere, the uncertainty of active drug dose in botanical cannabis, and the significant risks associated with smoking (the most common mechanism of cannabis use) it is surprising there is the capacity to enable doctors to use botanical cannabis at all as a medicine in New Zealand.”

The authors continue that:

“This is not to say that cannabinoids may not be valuable for some patients for some symptoms, nor that many of these problems cannot be overcome.”

This is a considered opinion based on clinical experience and empirical evidence which should be taken into consideration by those in charge of policy. The medical profession is not ruling out potential benefits that further research could reveal, it is merely pushing back against pressure to ‘medicalise’ cannabis – pressure that is generated primarily through the media’s role in formulating public opinion, and by those who use that opinion for political gain.

The article cites the highly publicised case of Alex Renton in 2015, whose family successfully advocated for access to cannabis-based products. They note that:

“This portrayal [by the media] has led to the acceptance of the notion of “medical cannabis”, although this term is poorly defined and often left to the subjective view of the end user to decide upon.”

The authors then make the case for regulation at the legislative level as being the best and most evidence-based way forward.

“There is also evidence…that legislation has a place in the regulation of cannabinoids and this can lead to a harm reduction approach. Regulation at law has been a common mechanism to manage the population-wide use of psychoactive substances. The success of broad smoking regulation to reduce rates of tobacco smoking is an example of this. The failure to implement the primary recommendations related to alcohol use and the lack of impact in relation to associated harms is the converse.”

In short, many facts suggest that a frank and grown-up discussion about cannabis in this country is overdue. But what is important is that this is done in an evidence-based fashion. If we are genuinely interested in reducing the harm associated with cannabis, and paving the way for the potential for further research and possible medicinal use, then we must discuss legalisation and steer clear of the evidence-free whirlpool of ‘medicalisation.’

‘Medicalisation’ is a compromised policy that has its roots in vague and emotive beliefs amongst the public, which are generated primarily by media bias, and then unfortunately perpetuated by politicians for political gain.

The Leaders Who Don’t Lead

This is what makes the responses of both Bill English and Jacinda Ardern in the Leader’s Debate to this question disappointing. Like any political system or formal ideology, there is usually an acceptable range of debate. The media plays a key role in maintaining this, most obviously by choosing the questions, which frame or bracket the limits of discussion.

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I’ve always believed that the first thing one should do before committing to answering a question is to check what answers are actually allowed by the question. It is then possible to see if one’s opinion is being restricted.

Patrick Gower’s question about medicinal cannabis appears like a progressive and bold one, until you realise that it is restricting the concept of liberalisation of cannabis to ‘medicalisation’ – which we have just discussed is not something broadly supported by doctors (who of course would be expected to prescribe it), mainly due to a lack of evidence for its efficacy, and a lot of evidence for specific harm.

Bill English gave a vague and faltering response that didn’t endorse medicalisation and made mention of the need for further research. In many respects is was a pretty shabby, routine non-response. The sad thing is that it was actually better than Jacinda Ardern’s.

Jacinda response was simply “yes.” This was met with praise in the media for its directedness and will no doubt be well-received by Labour’s base and by those in our society who have unfortunately been misled as to the merits and deficits of cannabis as medicine. In truth, it is an ignorant reply not based in reality.

The fact Jacinda and Labour felt they could answer it so emphatically is not a testament to their boldness in addressing the very real problems with our cannabis laws – although this is inevitably how it will be perceived – it is actually an abdication of leadership on this issue and another example of the pursuit of votes over the pursuit of rational policy.

‘Medicalisation’ is an unnecessary and non-evidence based “stepping-stone” that can allow the Labour party to appear to be more socially liberal in regards to drug policy than it actually is, given it continues to not support legalisation, which is the consensus of many experts in the medical and legal community and the New Zealand Drug Foundation.

What was left out of that entire interchange on Monday night was the evidence-based solution – legalisation. What is even more frustrating, is that the minor parties, apart from NZ First and ACT, are openly supportive of legalisation or very close to being so.

This goes back to the main point – that the merit of MMP is the ability to broaden discussion. Personally I think it’s wrong that we have ‘Leaders Debates’ that exclude minor party leaders. Even at the current polling, they still have the support of around 15% of the electorate.

We can see clearly in this example, as in many others during the debate, that without the presence of minor parties on stage and in the public spotlight, there is often no one to call out the orthodoxy of our establishment party positions – there is no one to state the obvious.

The Protectors of Duopoly

The most egregious thing about all of this is that we have a multitude of political commentators whose job it is to convince us that a vote for minor parties is ‘wasted’ and that the duopoly is here to stay. We must not listen to them. They are ‘manufacturers of consent’, and opinion-creators – they are an arm of the establishment, and the protectors of a broken status quo.

John Armstrong’s opinion piece in The Herald last month entitled “This election is a two-party dogfight now” is the prototypical example.

Don’t dabble with New Zealand First. Don’t smooch with the Greens. Ignore the minor parties if you are serious about wanting to change the government at next month’s general election. To optimise the likelihood of a change you must cast your party vote for Labour. Likewise, if the retention of the status quo is your priority, you must vote National.

My response to that is that for those of us who want real change, a vote for either Labour or National is the retention of the status quo. He goes on:

“The upshot is that a vote for the Greens is now akin to a wasted vote for those who want a change of government. Worse, it would be a completely wasted vote if the Greens fall below the 5 per cent threshold.”

I still find it hard to understand why one can’t see the logical fallacy in proclaiming that a vote for a minor party is ‘wasted’ if that party doesn’t get to 5%. Within that argument is an obvious injunction – don’t vote for minor parties. And what would not voting for minor parties do? Not get them to 5%! By that logic, there would be no minor parties at all. This is just tautological scaremongering.

MMP on the Ropes

We must ask ourselves, who benefits from a regression to duopoly? Obviously our two major parties. And in addition to them is the middle class and that upper section of our society who hold significant wealth, as both Labour and National have no interest in taxing wealth to reduce inequality.

The boldest plans to reduce inequality, tackle climate change, end punitive and ineffective drug laws, reform criminal justice, and enshrine and protect Maori rights are found only in minor party manifestos.

If the truly progressive cannot remain loyal to truly progressive policy – as advocated by the Greens, The Opportunities Party, Mana and the Maori Party – and instead choose to throw their support behind Labour, then our democracy will suffer a terrible blow.

MMP is about plurality of opinion and vibrancy of political discussion. Blind allegiance to Labour with the only goal being to “change the government” may end up decimating minor parties with progressive ideas.

For those who would normally vote for the Greens, or who are considering voting for them or The Opportunities Party, but think that voting for Labour is the better option – please consider the injury this could inflict on the vibrancy of our democracy. This regressive National/Labour duopoly is not in the interest of the average New Zealander.

theredgreenpen

 

Newton-Howes, McBride, ‘Cannabis in New Zealand – Smoking gun or medicalised smokescreen? NZMJ April 2016 

For more recent systematic review http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=24625

 

Author: Todd

Hello, thanks for reading. My name is Todd and I'm a 30 year old NZ Maori trainee doctor in Psychiatry. I have a passion for Mental Health, particularly in low-resource settings, and the existential and humanist schools are what provide me with the organising principles to help understand my patients - their hopes, their fears, their dreams and the inner tyrannies under which they often suffer. I have a background in advocating for evidence-based policy solutions and have always maintained an active interest in NZ and international politics - in particular the dynamics between psychology, politics and dominant power systems. Central to my belief is the sanctity and inherent mana of all people and the need be eternally wary of ideologies that reduce them to simple nodes within enormous and fundamentally dehumanising systems. I feel that the history of modern politics and individual and social psychology is the constant tension of this dialectic. We are "human, all too human" and the affirmation of our essential humanness is the common thread in my work. When I was once overwhelmed by the terrible things people can do to one another, someone important to me said, "don't scream at the darkness, light a candle." I hope these pieces are each a candle - all part of the many I hope to light on this wonderful journey. Many thanks and happy reading Todd

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