“Medical Cannabis” as a Contested Medicine: Fighting Over Epistemology and Morality

Abstract

Few empirical studies have explored how different types of knowledge are associated with diverse objectivities and moral economies. Here, we examine these associations through an empirical investigation of the public policy debate in Israel around medical cannabis (MC), which may be termed a contested medicine because its therapeutic effects, while subjectively felt by users, are not generally recognized by the medical profession. Our findings indicate that beneath the MC debate lie deep-seated issues of epistemology, which are entwined with questions of ethics and morality. Whereas some stakeholder groups viewed evidence-based medicine and mechanical objectivity as the only valid knowledge base, others called for recognition of a particular experience-based knowledge, championing regulatory, administrative, or strong objectivity. Stakeholders’ interpretations of what should be considered as ethical courses of (in)action corresponded to their epistemological views, with most criticizing the regulators for relying on regulatory subjectivity instead of objectivity. Our in-depth mapping of this arena allowed us not only to shed light on the emergence of the new entity called “medical cannabis” but also to reexamine the link between epistemology, ethics, and action and to elucidate how heterogeneous groups view the validity and objectivity of knowledge and the interface between medicine, science, and policy.

From community of practice to epistemic community – law, discipline and security in the battle for the legalisation of medical cannabis in Poland

“…The strategy is to be geared towards recognising the subjectivity of individual applications towards more generalised validated experiences supported by universal human rights (the right to a dignified life). Similar to the observation made by other researchers (Knaapen 2013;Zarhin et al 2020) ethical principles help to translate one perspective into another and overcome the imbalance between the different status of the rules of knowledge validation. Activists recruiting from the community of practice take the roles of 'brokers' of alternative knowledge contested by the hegemonic epistemic community in health care.…”

Trends in medical cannabis licensure, Israel, 2013–2018

“…It can also reflect increased evidence that cannabis is an efficacious analgesic [18]. As the IMCA Indication Committee attempts to follow an evidence‐based model [2], and physicians become more aware of the potential therapeutic effects of cannabis, it is reasonable to expect that chronic pain will continue to be a leading indicator for MC.…”

“…It began with less than 100 patients and a single Ministry of Health employee in charge of running the program and policy guidelines were not made available to the public. Since then, the program has developed a publicly available regulatory framework which serves over 30 000 patients [1,2].…”

“…In 2011, the Ministry of Health established the Israeli Medical Cannabis Agency (IMCA) to provide governmental 'supervision and regulation of cannabis treatment for medical purposes and research' [2]. IMCA's stated vision is to create MC policies that treat MC in the same way as other medications containing active substances defined as drugs, such as opioids [1].…”

“…IMCA's stated vision is to create MC policies that treat MC in the same way as other medications containing active substances defined as drugs, such as opioids [1]. To achieve this, IMCA has developed various regulatory requirements and processes of oversight, much of which has been achieved by establishing standard and universal guidelines for MC licensing [2]. For instance, acknowledging gaps in the evidence-base for the efficacy of MC, IMCA established an Indications Committee of specialists who help the Ministry of Health's Director General develop and continuously re-evaluate regulatory guidelines for indications, dosages and methods available for MC use [1,2].…”