Hard News by Russell Brown

4

Helen Kelly's letter

This week, Helen Kelly, who has metastatic lung cancer and is terminally ill, received a letter from the Ministry of Health to tell her that an application by her oncologist Anthony Falkov under Sections 20-22 of the Medicines Act to import and prescribe cannabis oil inhalers to treat nausea, anorexia and pain has been "deferred".

Specifically:

The Ministry assessed Dr Falkov's application and considered it to contain insufficient information to enable a decision to be reached, briefing Associate Minister of Health Hon Peter Dunne accordingly.

Consequently, a ministerial decision was made on January 29 to defer the application.

Mr Dunne directed the ministry to follow up with Dr Falkov to obtain the oustanding information to allow an informed decision to be reached.

The ministry's response was swift: it was made the day after Dr Falkov's application was application was received. Subsequent delays appear to have been a matter of difficulty in contacting Dr Falkov. The response was also disingenuous and somewhat inevitable.

The "outstanding information" supposedly being sought from Dr Falkov is information that would help the application meet all the criteria used to guide the process of ministerial approval to import and use non-pharmaceutical-grade medical cannabis products.

These criteria are not stipulated in the Medicines Act. They were drawn up only relatively recently, in response to the Alex Renton case. I have an outstanding Official Information Act request as to how the criteria were prepared and on what advice. In my non-expert view, the criteria are unreasonable and, in this case, not fit for purpose.

Helen has sent me photographs of the three pages of the ministry's response and I've uploaded those in the first comment for this post. But it's worth going through them:

a. severe or life-threatening condition

Yes. Helen has metastatic lung cancer which has spread to her bones and her brain.

b. evidence that all reasonably applicable conventional treatments have been trialled and the symptoms are still poorly controlled

No. Helen is taking morphine for pain and three different drugs to try and manage nausea. But according to the ministry, "The application does not cite other medications or interventions that have been trialled for this patient." Now, remember that Helen has already taken a cannabis preparation and says that helped her sleep and manage her pain in a way that morphine doesn't. But under the criteria, that is immaterial unless the doctor can literally show that everything else has been tried.

The response also faults Dr Falkov for failing to seek advice from a palliative care specialist. It will be interesting to discover whether and to what extent the ministry has itself done this in devising the criteria, which themselves make no specific reference to palliative care.

The response also cites Sativex as "a preferred alternative if treatment with cannabis containing product is indicated". But Sativex is a pharmacuetical grade product – it's approved for use in New Zealand, but not funded. This is an application to use a non-pharmaceutical-grade product, under the rules for such an application. The ministry's response is disingenuous and irrelevant. Moreover, Helen says Sativex is unlikely to manage her symptoms as well.

c. evidence that the risk/ benefit of the product has been adequately considered by qualified clinical specialists – that is, the risk of treatment with an unproven product is less than the risk of non-treatment and account has been taken of any evidence of potential benefit and weighed against known adverse effects

No. The ministry has declined to offer any comment on this section, so it's hard to know what evidence would be satisfactory. But Helen Kelly is dying. She has already taken a cannabis preparation. It's hard to see what further "risk of treatment" might be added by her taking a commercially prepared substitute. Or, indeed, who the qualified clinical specialists" might be.

d. patient hospitalised when treatment is initiated

No. And this is another example of how these criteria are unreasonable and poorly designed for palliative care.

e. patient or guardian has provided informed consent

Yes.

f. application from a specialist appropriate to the medical condition being treated or the Chief Medical Officer of a District Health Board

Yes.

g. applicant or specialist prescriber has sought adequate peer review eg, Hospital Ethics Committee approval, Drug or Therapeutics Committee review

No. "There is no mention of peer review by the applicant. As noted above there is no mention of review or advice sought from another clinician or specialty or the expert [obscured] a panel or commitee as mentioned in the criteria."

I think Dr Falkov's application would have been well-served by a supporting statement from a medical ethics committee or similar. But by the same token, these are criteria drawn up for the specific purpose of guiding approval for non-pharamceutical cannabis products. It would be nice to see some evidence the ministry itself had sought ethical advice in drawing them up. This is, after all, a kind of application that is likely to be repeated in form. It seems a high bar to require every specialist doctor to seek this kind of peer review to help a terminally ill patient.

h. provision of a Certificate of Analysis, preferably from an accredited laboratory, so that the concentration of the active ingredient(s) is known

Bloom Farms, which makes the products Helen wants to import, supplies "medical cannabis dispensaries" throughout California – but California's medical cannabis laws are very loose and Bloom farms isn't really a pharmaceutical manufacturer. Its website repeatedly cites "our mantra: relaxation, relief, creativity and fun" but I couldn't find any formal statement of assay on its website beyond an assurance that its "pure, all-natural cannabis oil contains consistent 45-50% THC content."

It's not unreasonable to seek evidence that a medical product is what it says on the label. It might be unreasonable to demand that every doctor or patient pays for an individual lab analysis.

But another California company, Phytologie, does provide a medical cannabis quality asurance programme that it provides "to our members to share with their physicians, so that their doctors can assist with designing more precise strategies for using cannabis medicinally." Here's one assay of a Bloom Farms product conducted with Phytologie as the client. And another of a high-CBD product. So this kind of testing is done and presumably Bloom Farms would be able to provide this information on request.

In this last respect, I think it can fairly be said that Dr Falkov has failed to provide sufficient evidence for his application. An assurance of the purity and potency of a medicine is an entirely reasonable requirement. But he's an individual oncologist and presumably a busy one. Does the ministry have a plan to build a product register? Or set up a structure to help ensure the robustness applications under this part of the law? Wouldn't that save wasted time and unnecessary suffering?

This issue isn't going to go away and I think the ministry needs to do a much better job than is suggested by these swiftly-drafted criteria, which look in some respects as if they're designed to make the problem go away.

In particular, there should be some better thinking around palliative care. It doesn't make sense to treat every application to improve the quality of life of a dying person the same as a bid to give a sick child an experimental treatment. The criteria are ostensibly specifically dedicated to cannabis products, but they're actually entirely general. We need this to be done better and more transparently.

As I've noted before, the use of cannabis in palliative care represents a particular ethical case. If a patient testifies that the treatment does in fact improve their quality of life and ease suffering in a way that approved pharmaceutical products have not, that should count for a great deal. The case for preventing access becomes much, much harder to make.

Peter Dunne has previously to me that the criteria are only guidelines and don't determine his ministerial decision. But he's a minister who likes to emphasise that he acts on expert advice. And perhaps he has no choice, given his limited stock of political capital in this area.

This is, after all, a government that has chosen to brand itself on never changing the law – either the Misuse of Drugs Act or the Medicines Act – no matter what the evidence. That was, remember Justice Minister Simon Power's response to the Law Commission's view that there was "no reason why cannabis should not be able to be used for medicinal purposes in limited circumstances" by declaring "There is not a single solitary chance that as long as I'm the Minister of Justice that we'll be relaxing drug laws in New Zealand."

Power is no longer Ministry of Justice, but every single initiative to improve the way we deal with drugs in New Zealand still has to climb around this entirely political edict. It's the key reason we have little prospect of dealing sensibly with a fast-changing environment.

During the last election campaign, Prime Minister John Key paid visits to several Kapiti Coast and Porirua schools. When he wasn't insisting that his favourite music was One Direction, Key fielded this question from a student at Kapiti College:

Asked whether he would legalise medical marijuana, he told the school assembly: "This is the fundamental message. Drugs are bad for you."

Yes, the Prime Minister really did say "Drugs are bad, m'kay?"

I sometimes find myself in the position of defending minister Dunne. And it's not that I don't believe he should be doing better – I think he should be – but because what's happening here is not so satisfyingly simple as a prohibitionist minister crushing all bids.

The good part is that the criteria for applications like Helen's can be improved without changing the law. They're not part of the Medicines Act. I think Peter Dunne needs to ensure,  as minister, that the process is fundamentally improved. Because a process so designed as to frustrate all medical cannabis applications will not prevent the use of cannabis in this way.

In the end, we do need to revisit the law – as the Law Commisison and two Parliamentary select committee inquries have already said. Palliative care is not the only element of medical cannabis policy. But it's certainly the place we should start, given the growing use of cannabis this way in defiance of the law. When we fail to do this, we impose risk and stress on desperately ill people and their doctors – and we're saying we don't care enough to properly regulate for their safety.

No one is going to prosecute Helen Kelly for treating her symptoms with cannabis. But what the system currently says is that it can't and won't make that safer for her. We need to do better than this. A lot better.

9

Friday Music: Dark Sounds of Africa

African musicians have been adopting and adapting Western popular music for decades and there's endless pleasure to be had exploring the back pages of Nigerian funk-rock and Ghanaian disco. If you're going to WOMAD this year, you'll be hearing the fruits of the work that St.Germain, aka French producer Ludovic Navarre, did with Malian musicians on his current self-titled album, his first in, incredibly, 15 years.

St. Germain is is a lovely album for the summer, but it does fit almost too comfortably into a loungey, cafe-ethnic space that we can consume without having to think about it too much:

So it's worth being reminded that there are African producers, DJs and musicians making new and disruptive music. And that's what you'll hear on the new compilation Gqom! The Sound of Durban Vol.1, which lifts the lid on a scene that's a million miles from camping at WOMAD. It's not easy listening, but it's street tough.

The notes from a Soundcloud playlist for the album explain:

Derived from an onomatopoeic Zulu word signifying a drum, “gqom” - in the local slang - “iz da sound u get wen u drop a rock on tiles”. This extraordinary, apocalyptic bass music encompasses many influences. Each polyrhythmic track draws on the darker side of electronic music, hip hop, soundsystem culture, kwaito, UK funky and deep tribal African vibrations. As Kolè puts it: “You can feel the troubled history of South Africa. It’s riot music." Tied to a specific dance called bhenga, gqom happens in a DIY-oriented universe, grafting organic and homemade samples on sourced software to create this wholly unique sound. The label’s greater aim is to invest in much needed technology to help build a local creative infrastructure.

And Fact has a deeper primer of what it's all about.

I like this track a lot:

The album is available in various formats on Bleep.com.

–––

I'm delighted by Auckland City Limits' announcement that the festival has handed over the lakeside stage on its Western Springs site to the good people of Golden Dawn, who will curate an eclectic lineup ranging from Delaney Davidson to Carnivorous Plant Society and regular PA commenter and 7" single fiend Alan Perrott.

There's been a bit of commentary to the effect that Auckland City Limits needs an extra international act or two to justify the ticket price, but it's becoming clear that promoter CRS isn't trying to make another Big Day Out and that ACL's selling point is the chance to take in a variety of musical and cultural experiences in a pleasant, family-friendly (kids under 10 are free and there's a dedicated kid zone with its own lineup) setting.

Meanwhile, I was this week able to announce my Listening Lounge talk lineup for next weekend's Splore: the first part is about drugs and the second is about dance music. Fingers crossed that Cyclone Winston gets through quickly – or gives us a miss altogether.

It's a bit of a bugger that the collapse of an Australian festival on their itinerary means it's no longer possible for the Brand New Heavies,  Luke Vibert and Rone to come to Splore. On the upside, there'll now be a Leftfield DJ set on the Saturday night to go with the full show on on the Friday. The full schedule is here.

–––

Paquin, the personal band project of producer-to-everyone Tom Healey, have released Paquin III, which, as the title suggests, is the third EP in a set of three. It's another artful blend of shoegaze and electronic pop, available on Spotify or to buy via Bandcamp. This is the single:

And staying with local indietronica, Doprah have popped out their first track for 2016. It's a taster for their album Wasting, which is out next week, and was premiered this week on the Cool Runnings blog.

–––

Some rockin' business. Both new, in the form of this heavy, heav thing from the cheerily-titled new Beastwars album, The Death of All Things:

Note that Beastwars play Galatos on February 27. Tickets here at Under the Radar.

And some old vibes, in more than one way: my amigo Glenn "The Professor" Prosser last week reminded the world of the album he made with The Defendants, who describe themselves as "unashamedly proud of their links to the golden era of 70s Rock, where British bands like Black Sabbath, Budgie & Deep Purple mutated American blues into heavier, grittier, Rock n' Roll with a HEAVY GROOVE." It's got some swing – and Glenn's a hell of a sinner, er, singer:

That's available on Bandcamp at a price of your choosing. And if you see these men, do not hesitate to alert the authorities:

–––

Tunes!

We're down at the disco this week – well, even more than usual, we are. A Label Called Success has popped out another tune from its house "band", and it's another free download. Smooth groove ...

Furthermore, John Morales has posted several of his unreleased M+M remixes for your downloading pleasure. There's Harold Melvin's 'Bad Luck' as a 12-minute monster:

And a disco dub version on Sandy Barber's 'Steppin'':

And another unreleased mix, originally put down as the guide mix for the mix that was released:

And an entirely different kind of remix from Hober Mallow – hypnotic afro styles. Still all good for the download.

Cup & String have made their brilliant 'Say My Name' remix available as a download again. It's the linked DL from this instrumental dub of same. I'd quite like the dub to keep too!

I was researching Auckland>London>Bali beats queen Lady Flic for our Listening Lounge chat at Splore when I came across this track she recorded as her vocalist alter-ego City hayes. It's cool! Very British-sounding indie electronica:

And also this track Flic produced in 2005. Can you call it nu disco if it's 10 years old?

And some serious old-school Loft groove, crafted by combining two different Larry Levan mixes of the same tune. That's a follow-to-download job on HearThis ...

JEFFREY OSBOURNE - PLANE LOVE [Larry Levan Mix - J*ski Extended] by Jay Negron on hearthis.at

And finally, a new one of an old one from the DJ known as Gigamesh. He manages to embiggen and modernise familiar tunes without falling into the EDM hole or losing touch with the spirit of the original. I do like this. Click through for the download link to three different edits of the tune:

–––

The Hard News Friday Music Post is kindly sponsored by:

The Audio Consultant

16

Listening Lounge 2016: Drugs and the dancehall

When the promoters of the Splore festival asked me to put together another Listening Lounge talk programme for this year's festival, they asked whether I had a dream guest I'd like to bring in. I did. And I'm pleased to say that the plan came together and, with the assistance of the New Zealand Drug Foundation, Dr Sanho Tree will be delivering the keynote speech.

Sanho is the director of the Drug Policy Project at the Institute for Policy Studies in Washington and if you've read any of the work I've done for Matters of Substance in the past three years, you'll probably have seen him quoted. Indeed, at one point my editor felt moved to politely suggest that I should write a story without quoting Sanho.

He's a former military and diplomatic historian and investigative journalist and a one-time personal assistant to entertainer and social activist Harry Belafonte. And he draws on all that to place the war on drugs "at the intersection of race and poverty". He's also witty, quotable and very smart.

Sanho will talk about the foundations of the global drug war in US foreign policy imperatives, the reasons it has failed and the prospects and means for reform. He'll also look forward to UNGASS 2016 – the United Nations General Assembly Special Session on the World Drug Problem, which takes place in New York in April.

I've written an extensive backgrounder on UNGASS for Matters of Substance, which traces an arc from the bold promise of "a drug-free world by 2008" on which UNGASS 1998 was branded, through to 2016, where the slogan might as well be "maybe we're doing this wrong ..."

Sanho's talk will be the concluding part of the first section of The Listening Lounge, at the Living Lounge stage from 10.30am on Saturday the 20th. I'll kick off with a brief summary of the history of psychoactive drugs and the laws that regulate them in New Zealand and an outline of where we're at now.

Then, at 11am, it's time for our panel:

Richie Hardcore is a broadcaster, steward, personal trainer and former kickboxer who spends his days working in the community with people with drug and alcohol problems. The twist? He does not use alcohol or drugs and has not done so far many years. But he's not judging.

Wendy Allison is one of the founders of the Kiwiburn festival, the New Zealand counterpart to Burning Man. She's done fascinating work on what people are really getting when they buy recreational drugs on the black market – and why that's a big problem.

The Rev Dr Hirini Kaa is a historian, social campaigner and Anglican minister. He has characterised the war on drugs as part of a "war on the poor", but, like many Maori leaders, is deeply wary of any move to relax drug prohibition.

Dr Jamie Whyte is, of course, the former leader of the Act Party. In line with his libertarian philosophy, he endorses the legalisation of drugs. But even for a libertarian, does the state have a role to play? And why can't even the party of personal choice get behind drug law reform?

–––

Sanho will speak from 11.30 till noon, when the theme changes to The State of the Dancehall Nation, which takes up the theme of the state of dance music that proved so profitable and interesting with Mr Scruff at last year's Listening Lounge.

 First up is the panel I'm calling The Parliament:

Eddie Johnston (aka Lontalius aka Race Banyon) is a young producer and performer who moves across musical boundaries with disarming ease. He's steeped in dance music history but worries about appropriating cultures he didn't create.

Aroha Harawira gave a fascinating (and sometimes alarming) account of working as a woman in the DJ trade at one of our Orcon IRL events last year and so I've asked her back. She's smart and strong and she know her tunes.

Lady Flic began her DJ career in New Zealand, got her break via the Red Bull Music Academy and moved to London and thence to Bali, where she is music director at the Potato Head Beach Club. She's shared a stage with Snoop Dogg, Fatboy Slim and Derrick May, to name a few.

Nick Dwyer is a DJ and soooo much more than a DJ. After years helming the breakfast show for George FM, he's now creative director at a radio station in Tokyo. He produced and directed the Making Tracks TV series and Digging the Carts, a documentary about video game music. With Dick Johnson he also helms the afro-everything group Weird Together.

Which brings us to the final part of the programme: the House of Lords.

In the late 1980s Hackney brothers the Ragga Twins helped create the original gritty jungle sound that became drum 'n' bass. They're still working, still recording, still a massive bundle of fun – and reggae probably still owes them money.

They're joined by Barry Ashworth of the Dub Pistols, who was in the room (and in Ibiza) when the late 80s house revolution changed the face of global dance music and has worked since as a DJ, musician, TV broadcaster and occasional football pundit. He also helped get The Specials back together, and who can say that?

After all that, I have to leg it over to Splore DJ Stage to play my own 90-minute set of vintage house vinyl from 1.30. I'll probably be due a beer and swim when all that's done.

You can see the full Splore programme and purchase your tickets here.

–––

PS: Note that Sanho Tree speaks at public seminars in Auckland and Wellington in the week following Splore, under the banner A New Deal? Changing approaches to drugs in 2016. If I haven't already made this obvious, he's worth catching.

Moderation

On Friday night, I closed a long, occasionally difficult but undoubtedly valuable discussion thread spawned by my post about incidents of sexual harassment at the Laneway festival. There were two main reasons for doing so.

The first was that the thread had become quite nasty and personalised. I asked everyone, including some people who are not regular contributors here, to pull back and was ignored. People screenshotting each other is not a discussion; or at least, not the kind of discussion I want to host. Some past threads may have run on in a similar state, but literally only because for years I didn't have the ability to close threads.

Moreover, some of what was happening seemed to be the exercising of old and not-so-old enmities from Twitter, which is unfair to people commenting here, especially those who aren't on Twitter themselves. (I've felt the need to talk directly to a couple of people in the past few months when they've discovered themselves being talked about elsewhere and were understandably upset.) The sometimes-difficult relationship between this place and Twitter was well and truly surfaced.

The other reason was me. Moderation, at least the way I've chosen to do it over the years, can be emotionally exhausting. I'd put a lot of time and thought into the thread – even deliberately removing myself for a while on the hunch that I'd had enough to say, especially to other dudes. Fretting about it literally had me lying awake on Thursday night. I'd tried not to look at any comments elsewhere, but it's hard to avoid seeing sneering comments about yourself on Twitter sometimes, and I did find that upsetting. The death of a friend and some emotionally challenging stuff with my sons were also part of the picture. It was a pretty hard week.

I thought the discussion had got to a decent place on Friday afternoon, but when it turned to shit in the evening, I just had nothing. I needed to be able to just spend some time with my family and not worry. I needed to sleep. I was worried about my blood pressure, but a bit too scared to take it. So my mental and physical health and my family life took priority. I'm not public property.

But part of the thread had gradually evolved into a discussion of why some women were no longer comfortable, or at least less comfortable, commenting here. I do care about that and I understand why some people were unhappy at the loss of that discussion. I suggested to Emma Hart that she could reboot things and moderate a new thread on the topic, but she responded: "Jesus no. Fuck no. The last two pages of that thread were insane." Which is pretty much the reason I won't be reopening the thread either.

But there's more than one way to do this, and perhaps a way that doesn't hang people out to dry is better anyway. I've already had a number of sympathetic messages about the thread, all but one from women,  and some of those have also contained some useful tips. I'd like to hear from more members of our reader community – and women in particular – about how they feel about discussions here and what they think could be improved. I don't think the answer is as simple as a formal code of conduct – anyone explicitly abusive or threatening is generally swiftly removed anyway and regular readers know how to use the "report post" button. It's a bit more nuanced than that.

But I would like to hear about it. You can email me by clicking the little icon below this post.

Anyway, I hope you all have a happy and fulfilling week. I felt a lot better after I took some action and went to find some people in real life on Sunday. You might enjoy the blog post I made of it.

53

Mt Eden: Not a closing but an opening

Although I'm fond of the place, I hadn't paid a great deal of attention to the wrangle over the closing to motor traffic of the access road to the summit of Mt Eden.

The car ban has been discussed for years, as part of an imperative to protect the physical cone – buses were mercifully banned in 2011 – but the idea gained momentum in 2014, when the Tāmaki Collective Settlement became law, and care of 14 Auckland volcanoes thus passed to local iwi, via the Tūpuna Maunga o Tāmaki Makaurau Authority.

The maunga authority's strong view was that the tihi, or summit, should be clear of traffic as a matter of respect for its spiritual and cultural significance to mana whenua and, in the words of authority chair Paul Majurey, as "a key measure to protect this taonga, and to reflect the mana whenua and community aspirations of their living connections with this taonga."

The Eden-Albert local board agreed, as did Friends of Maungawhau. A Digipoll survey commissioned by the Herald found strong support.

The most organised opposition came from Act's MP David Seymour, who set up a website soliciting submissions to Auckland Council and the authority. Affordable Auckland's Stephen Berry also took some time away from the important job of hating Len Brown to issue a release declaring that "such a move verges on lunacy".

Neither of them was successful and at the end of last month, bollards were put in place to block the road. Access arrangements for motorists are now what they have been for buses since 2011: there is parking and a roundabout for turning part way up the mountain and visitors can either walk up the short way – a little over 200 metres – or take the longer path that winds around the mountain.

Visitors with limited mobility can call the Auckland Council customer service centre ahead of time to obtain a temporary code to lower the bollards so they can drive up – although they will need to be able to quote a mobility card number. Frequent visitors can apply by email for a permanent code.

Well, that's the detail. But the detail doesn't really capture what's happened here. Yesterday – which was, fittingly, the first Mondayised Waitangi Day – I rode my bike over to Mt Eden and came up the summit road. And it was ... beautiful.

What had been a narrow one-way road was now flocked with Aucklanders walking, cycling and running their ways up and down.

Groups of people from buses parked below trailed over the paths around the cone. And it seemed more possible now to pause on the access road rather than get out of the way lest a car come. One the way down, I stopped to take in a view I'd never really considered before.

And at the summit? It was wide and clear. There were, as ever, plenty of tourists, but there was space for everyone.

One Twitter correspondent told me that the first time he'd been up, there were "people literally singing up there". Another paid tribute to the "great atmosphere" at the tihi a few evenings back – "I'd love to see a summer festival up there one day," she said. "Stalls in the middle of the old car park."

My only reservation is that already having a mobility card is a fairly high bar for people who might be mobile on the flat but can't manage the climb and perhaps a way could be found to accommodate them without letting that concession be abused. But otherwise, what I saw yesterday was a near-miraculous illustration of what happens when you give a space back to people, and not cars. It's not a closing, it's an opening.

So kia ora and thank you to the Tāmaki iwi. Your manaakitanga does not go unnoticed.

–––

Here's one more good thing. Work has begun on the Waterview shared path, which covers the same stretch as the Waterview Connection tunnel and effectively makes it possible to walk or ride across the motu, from harbour to harbour – if by a somewhat less direct route than the tunnel.

NZTA had to be pretty much boxed around the ears by the Waterview Board of Inquiry to take on the job, but it's begun now and it's good thing.  As a bonus, it connects a string of reserves and public spaces that are currently isolated from one another. In doing so, it enhances each of those spaces.

Jessica Rose has a lovely piece over at Bike Auckland on what the project means to her.