Dr. Colin Doherty:

A great many issues have been raised. I do not think I would characterise the debate in clinical circles as one of division. There is not a great deal of knowledge. The average clinician would not be aware of it, because of the way that cannabis treatments have arisen and come through families of carers. That is a little unusual. Let me give an example. A new drug Fycompa has been licensed recently for epilepsy treatment and is being rolled out in various clinics for patients with epilepsy. Fycompa came through the usual scientific circles. It was an investigational product at the level of small scientific laboratories and it was taken up by a drug company which developed it as a product. The drug went through clinical trials.

Patients do not come into the office looking for Fycompa. They ask the doctor about new medicines to treat the condition. It is important to know that while Dravet syndrome, which is the form that Vera's daughter has, is at the top of the pile, we still have 15,000 from the 40,000 people with epilepsy who have not got full control of their epilepsy. About one third of patients do not have full control and a smaller number - several thousand - have very severe epilepsy. We are dealing with patients who ask their doctors if they have anything else to treat their condition. Many have reached the end of the line, just like Vera's daughter has. They have tried everything from ten to 12 different drugs and are not looking for Fycompa. The clinician will go through the data on various drugs and may recommend the patient to try out the drug, having informed the patient of the known side effects, and introduce it slowly.

The cannabinoid drugs have come by a completely different route. Patients are coming into the doctor's surgery, telling him or her that they have researched this drug and they want to know why they cannot have it prescribed for them. It has come to the fore in an unusual way. Patients are walking into doctor's offices and they have more information on the drug than the doctor. That is the simple fact, as Ms Twomey can confirm.

Allowing for the fact there are a small number of highly specialised people in the epilepsy field who know the drug, I would not characterise their feelings about it as one of division. It is simply a question of evidence. It is very important to distinguish between evidence in the generic colloquial term, where there is evidence that something works for this child or that child, and what we call scientific evidence. Scientific evidence should not be open to interpretation. We have established in the western canon of scientific thought that one arrives at scientific evidence by conducting an experiment. Typically in the experiment, one gives the drug to one group of patients and the other group with the same condition get a placebo. We follow the two groups of patients. The groups have to be large enough to be able to draw conclusions. One cannot just give the drug to two people, with two others getting the placebo. In an experiment, there are several hundred people in each wing and at the end of a period, usually 12 to 24 weeks, one establishes whether the drug has worked or not. That is scientific evidence. What we need to have is clear scientific evidence that the drug works.

What we know at this time about cannabis is that there is a purified form of CBD oil made by a small pharmaceutical company called GW Pharmaceuticals. This CBD oil is not a scheduled drug in this country, and although it has passed several layers of evidence, it has not quite reached the level that most doctors would be happy to prescribe it. Once the two placebo controlled trials are published, which will be any time in the next three to four months and if the company then submits the drug for regulatory approval, that is usually the point at which people will say they are happy to prescribe.

There is no division, but caution. The medical profession needs to say that they need to wait until it reaches such a level, a mark on the wall of significance. I would separate this out from personal use. I have no problem with people making a personal decision to use a drug and feel that using a drug with varying levels of THC is a decision they have made for themselves or for a family member. That is a question for society.

There is a solemn duty on a doctor when prescribing a medicine to ensure that drug is safe and effective. It is a very solemn duty and it cannot be gainsaid by anybody suggesting that the medical profession is naturally conservative. It is naturally conservative but for the right reasons. If we end up giving all various forms of this drug to children and find out in a year's time that it has created some very difficult behavioural or other problem in the children, that reflects on the doctor. It is very important we separate out those two phenomena - somebody making a personal decision of how much they want to give themselves or a child versus what we are asking the medical profession to do. It is not a matter of persuading one or two doctors. We have to bring the whole profession with us. As Ms Twomey said, the doctor-patient relationship is extremely important. Nobody wins if anything is pushed through and people are being asked to prescribe something they are not comfortable with. There is much more to the treatment, as Ms Twomey will know, than giving a drug. There are support services, rehabilitation, diet and there is a significant amount going on. If we rupture that relationship by forcing a doctor to prescribe something that he or she is not quite comfortable with, people will leave their doctor to go to other doctors who may not have the same level of expertise.

I am very excited about this form of treatment and I think we can use the evidence that exists and in a reasonably short space of time we will come up with the framework and we can all get behind it. If there is a rupture, it will be around forcing people to prescribe something where the scientific evidence does not exist. I am not saying there is no evidence. I am saying the scientific evidence does not exist.