Albert Francis E. Domingo, MD

my flight of ideas

From Guilty Pleasure to Medicinal Measure: Evolving Cannabis Policy in the Philippines

Posted on | October 23, 2014 | No Comments

When is a drug “therapeutic” as opposed to “recreational”? The first term connotes an established usage in clinical medicine, while the second implies use for leisure with attendant state intervention in varying degrees across multiple jurisdictions.

Cannabis, which is more commonly known as marijuana, has the primary psychoactive ingredient Δ9-tetrahydrocannabinol (THC); other molecules found in its leafy plant include dronabinol and nabilone, both indicated as anti-emetics in cancer treatment and as anti-anorexics for patients with AIDS (Borgelt L.M. et al. 2013).  However, caution has been aired as regards risks versus benefits of medical cannabis use, most significantly with its primary psychotic action (Pierre J.M. 2010).

Following the framework of Calman K. (2009, p.e8)’s intervention ladder, the Philippine state can be said to have eliminated choice when it comes to cannabis, which is a heavily regulated (in fact, prohibited) substance by law (Anon 2002). That may change to something weaker (such as guide choices through disincentives, or even as weak as enabled choice) depending on how a proposed legislative bill will sail through Congress (Geronimo J.Y. 2014a). It would be worth mentioning in relation to the de jure prohibition of particular drugs in the Philippines as elsewhere that some attempts to rationally assess the harm of drugs of potential misuse have shown that such regulatory systems may have a different ranking, and one that may be based on an unspecified or obscured methodology or process (Nutt D. et al. 2007).

The international debate on risks versus benefits of medical use of the traditionally regulated substance is as complicated in the Philippines as it is elsewhere, with healthcare provider groups such as the Philippine Medical Association (PMA) and its affiliate specialty organisations opposing the legislative measure by saying that it is “contrary to the policy of the state to safeguard the well-being of its citizenry particularly the youth from the harmful effects of dangerous drugs” (Geronimo J.Y. 2014b). It would be interesting to find out how much of this zeal to protect the public against the “ill effects” of illicit drugs is founded on what Parker R.N. and K. Auerhahn (1998, p.293) point out to be an ideological tendency “to lump all illicit drugs together, as if all drugs might be expected to have the same relationship to violent behavior.”

While it is becoming a battle of evidence-based policy making versus eminence-based policy advocacy, at this point it might help advocates both for and against the shift in Philippine policy on medical cannabis to appreciate that state protections to safeguard health are not completely black-or-white prescriptions – with frameworks like Calman’s allowing for gradients.

[Note: This is provided purely as an example of one of the academic requirements (specifically, the online seminar) of the course "Population Health and Health Policy" offered by the Global Public Health Unit, School of Social and Political Science, University of Edinburgh. The views expressed are entirely my own, and are not necessarily offered as expert advice in this forum of the internet.]  

 

Work(s) Cited:

  • Philippines. An Act Instituting the Comprehensive Dangerous Drugs Act of 2002, repealing Republic Act No. 6425, otherwise known as The Dangerous Drugs Act of 1972, as amended, Providing Funds Therefor, and for Other Purposes. Congress.
  • Borgelt, L.M. et al. (2013) The Pharmacologic and Clinical Effects of Medical Cannabis. Pharmacotherapy, 33(2), pp.195-209.
  • Calman, K. (2009) Beyond the ‘nanny state': Stewardship and public health. Public Health, 123, pp.e6-e10.
  • Geronimo, J.Y. (2014a) Bill on medical use of marijuana filed in Congress. Journal, [Online]. Available at: http://www.rappler.com/nation/59118-compassionate-use-medical-cannabis-bill [Accessed: 23 October 2014].
  • Geronimo, J.Y. (2014b) PH doctors say no to medical marijuana bill. Journal, [Online]. Available at: http://www.rappler.com/nation/72172-ph-doctors-medical-marijuana-bill[Accessed: 23 October 2014].
  • Nutt, D. et al. (2007) Development of a rational scale to assess the harm of drugs of potential misuse. The Lancet, 369, pp.1047-1053.
  • Parker, R.N. and K. Auerhahn. (1998) Alcohol, Drugs, and Violence. Annual Review of Sociology, 24, pp.291-311.
  • Pierre, J.M. (2010) Psychosis Associated With Medical Marijuana: Risk vs. Benefits of Medicinal Cannabis Use. American Journal of Psychiatry, 167, pp.598-599.
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Hainanese Chicken and Rice (Slow Cooker Method)

Posted on | October 18, 2014 | 1 Comment

Hainanese chicken is a Singaporean dish that is also popular in the Philippines because of its delicate savoury flavour. The idea of rice steamed in the flavourful cooking broth of the chicken itself also makes your average Asian postgrad student easily hungry. Recipes for Hainanese chicken usually involve multi-step and alternating hot-and-cold “shocking” baths for the chicken to get its silky smooth texture just like the ones sold at the hawker centres.

On a Friday afternoon, with my courses done for the day, I realised that I had a lot of time on my hands. Meanwhile, the Crock Pot™ slow cooker that my sister sent over was waiting to be put through its paces. I tried searching for Hainanese chicken recipes designed specifically for a slow cooker, but couldn’t find any. So I decided to adapt one from the recipe Singaporean Hainanese Chicken Rice by Pat on Allrecipes.com.au. Read more

My Chevening Journey to Edinburgh

Posted on | October 6, 2014 | 1 Comment

IT WAS DURING one light moment at work that a question popped into my head: what should be the next step in my career path? Almost five years after I graduated from medical school, I found myself neither practicing in a hospital nor running my own clinic. My doctor classmates were already finishing their specialisations one by one. I am thankful for my very fulfilling and fruitful engagements with the Philippine Department of Health as a consultant in USAID’s Health Policy Development Project, but I could no longer put the “next step” questions off.

Would it be worth the time and effort to study another degree? I thought, yes – because health policy is not exactly part of the medical curriculum. Where shall I study? I have always been a student of the national university – the University of the Philippines. But maybe it is time to go global. And then the most crucial of all items on the checklist: will I be able to leave family and friends for a prolonged period? It will definitely not be easy, but for any change to occur some unsettling will have to happen.

I was looking for opportunities to study abroad that are both economical and prestigious. I hoped for a scholarship that would cover most (if not all) expenses – tuition, travel, and costs of living. I would not be able to work while in full time study, and I also had my old parents to help support. Many scholarships would often disqualify me because of income status; but I definitely did not belong to a socioeconomic class who could pay for their own international studies. I also wanted to be recognised on the basis of hard-earned merit, a good reputation, and most importantly, my slightly jaded but still standing dreams of fixing the mess that my country is in.

I found a great package offered by the British; I chose to become a Filipino Chevening Scholar. I applied around the fourth quarter of 2013. By June of this year, I got in. Read more

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