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ScienceJuly 26, 2019

Family First rebuked for ‘non-fact based activity’ over cannabis psychosis claims

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Otago scientists say the lobby group has misrepresented the research.

Academics from the University of Otago have torn apart claims made by Family First about the links between cannabis, psychosis and violence in a paper published this morning. Prompted by a Family First petition calling for a government inquiry, the paper critiques a “tendentious” argument drawing on cherry-picked science which perpetuates the stigmatisation of people with serious mental illness.

Joseph Boden, co-author of the paper and an associate professor of psychological medicine at the University of Otago, said he believed Family First were deliberately misrepresenting the science on cannabis and contributing to a climate of misinformation ahead of next year’s referendum.

“It’s the old fake news problem. If someone doesn’t take the time to actually vet things, which most people don’t, then what you’re doing is you are creating a citizenry who are going to exercise their vote without all the facts, or with false facts, or with an alternative narrative that doesn’t do justice to the subject at hand,” he said.

A press release accompanying the petition claimed international studies have found THC is strongly linked to schizophrenia, psychosis and violence, but Boden said there were a number of issues with Family First’s conclusions.

“They want to draw a straight line between cannabis and violence, and there’s really no credible evidence of a straight link between the two. They want to say it’s going to cause psychosis and psychotic people are violent. Well, the first part is it’s not probably not a strong cause of a psychotic illness. There’s very little evidence for that. 

“The other thing is that they’re trying to link psychosis to violence. There are psychotic people who are violent, but they’re drawing from studies of hospitalised psychosis patients who have been sectioned against their will.”

Family First were also misrepresenting the findings of the studies they reference, Boden said. 

“It’s very sloppy but I think intentionally so because they already have an anti position and they’re looking for stuff that they think can support it.

“As scientists, one of the things that we actually have to do apart from maintaining our objectivity about these things is to actually call out when people are misusing research.”

Boden, a substance abuse specialist, is a member of the Christchurch Health and Development Study, which has followed a cohort of more than 1,200 subjects for 40 years, tracking their health, education and life. He said the study has provided researchers with world class data on the effects of cannabis use, and provides a strong platform to have an informed discussion in New Zealand.

“Our research on the psychosocial harms related to cannabis has been some of the best in the world, particularly the contributions of the Dunedin Study and the CHDS. I think we have a terrific basis to start this discussion in New Zealand.

“But I think that people who are engaging in a lot of non-fact based activity – and I’m also thinking of people like Mike Hosking – the spotlight that they take up is far too great.” 

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Ahead of the referendum, the prime minister’s chief science advisor will release a short, unbiased summary of the evidence for the harms and benefits of legalised cannabis, her office announced last month. 

Professor Juliet Gerrard, with assistance from a panel of New Zealand researchers and academics, will draw from longitudinal studies like the CHDS and a wealth of international data from areas where cannabis has been legalised and decriminalised. The report will be audited by international researchers and released to the public in January next year. Boden said it was an important resource to provide ahead of a vote.  

“I think it’s a great step and a necessary step to have all that expertise and building a fact-based document that will serve as a resource for citizens and for the government itself. It’s not going to take a position for or against, but rather provide the best current evidence that we have around this.”

“What’s really important to note in that is that there hasn’t been huge increases in use. Places like Portugal that decriminalised all drugs, use of drugs went down.” 

Last year, Family First accused an American academic of cherry picking data when he pushed back on their claim that legalisation had led to a huge increase in cannabis use in Colorado.

“Since legalisation in our state, cannabis isn’t used at higher rates than it was already before,” he wrote. “But now, it’s non-criminalised, regulated, and brings in tax revenue to our school districts, while not attracting drug cartels. You’re welcome.”

Family First called it fake news, but the state of Colorado said in a report there had been no increase in youth usage, and rates were the lowest in a decade. But the accusation could be a sign of something more sinister than a few local advocates getting trigger-happy, Boden said. 

“What worries me is that it looks to me like opposition is very well funded and coordinated, and why I say it that way is because I think most of us in the field probably agree that a legalised and highly regulated scheme is better than prohibition. It’s a bad law and it’s failed and it’s generally applied in a racist manner.” 

“But if you look at the anti-cannabis lobby groups in the United States, as I have, it’s a matter of public record who their funders are, and their funders are pharmaceutical companies. I think if the New Zealand public were to find out for example that major overseas international corporations were trying to influence their vote by infecting us with fake news, I think Kiwis would be pretty unhappy. 

“Do I think it’s likely that is happening? I don’t doubt it for a second.” 

Update: In a statement to The Spinoff, Family First maintain there is a link between cannabis, psychosis and violence. “In the same way that there is some real evidence that components of marijuana can be made into medicine, there is building scientific evidence suggesting that components of the plant can lead to mental illness, at times severe, that can lead to violence,” they said. “We are simply asking for research and scientific consensus before moving forward as a country with a change this massive.”

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Students come for lectures and learning, but they also come for the possibility of staying in Aotearoa (Photo: Getty Images)
Students come for lectures and learning, but they also come for the possibility of staying in Aotearoa (Photo: Getty Images)

ScienceJuly 25, 2019

Health Sci dropout: What happens when would-be doctors change their minds

Students come for lectures and learning, but they also come for the possibility of staying in Aotearoa (Photo: Getty Images)
Students come for lectures and learning, but they also come for the possibility of staying in Aotearoa (Photo: Getty Images)

Each year, thousands of students embark on a Bachelor of Health Sciences degree, the first step in any number of challenging healthcare careers including dentistry, pharmacy and medicine. But what happens when you realise Health Sci isn’t for you?

This story was first published in the Otago University student magazine Critic Te Arohi.

It was August 2017 and Nick was getting med-worthy grades in Health Sciences First Year (HSFY) at Otago University. But he was not loving life. “I got quite anxious and didn’t feel confident in myself and my abilities. I started thinking I wouldn’t be a good doctor.” Stress turned to sickness and he developed heart problems. He decided he “wasn’t capable” of entering medicine and cancelled his application.

It was a low point. Nick is now in the middle of a busy but rewarding semester – he’s nearly finished a Bachelor of Arts in Politics, Philosophy and Economics (PPE). Although he plans to apply for post-graduate entry into Medicine, he “fell out of love with science” after HSFY. “I was so drained after that year.”

Nick is just one of many students every year who change into a completely different course after studying HSFY.

Holly took HSFY back in 2016. “I wanted to be a doctor just like everyone else, but realised I probably wasn’t going to get A’s and A+’s so I aimed for physiotherapy.” After deciding she couldn’t see herself as a physio, she switched to zoology after first semester, and later to environmental management and politics. She has no regrets. “Swapping from Health Sci was the best decision I’ve made at uni.”

Sophie excelled in science at school and thought that a career in medicine was the “ultimate way” to help people. But fairly early into HSFY in 2017 she realised she “didn’t have the same passion for memorising anatomy and physiology and biological processes as my peers. I really missed doing creative work […] I also struggled with mental health issues and think that studying something that wasn’t right for me was part of that.”

After completing HSFY, Sophie moved to Wellington to study design. “The thought of throwing away everything I had planned for and potentially disappointing some people was scary at first, but not as scary as the thought of staying.” She loves her new course, she’s way happier, and says changing “was the best decision I have ever made”.

There are many stories like Nick, Holly, and Sophie’s, because every year around 1500 students enrol in HSFY at Otago University. Around two thirds are hoping to be accepted into professional programmes: dentistry, medicine, physiotherapy, pharmacy and medical laboratory science. But there are only 490 places.

Otago University. Photo: Getty Images.

In the second semester, only 1150 students continue as HSFY students. Like Holly, around 330 transfer to study other degrees, while around 20 leave university altogether. At the end of the year another 230 students leave uni, which is probably around 1 to 2% more than the background attrition rate, according to Otago’s HSFY director, John Reynolds. Around 33% go into professional programmes, while 30% head into other Otago degrees.

“People will always be angry when there’s a filtering effect,” says Reynolds. “If you’ve come in hell-bent on dentistry or medicine or pharmacy and don’t get where you want to go, that’s obviously going to leave a poor taste in your mouth. We’re aware of that.”

In 2016, Otago University made changes to HSFY. “We cut contact time and extraneous information”, says Reynolds. It’s a “jam-packed year” and students need “time to think”. The main goal for rebuilding the course was to make HSFY “more achievable for students and give plenty of pathways of support. So far, touch wood, anecdotal feedback from colleges suggests it is a better experience.”

Even with an improved course, HSFY is still not right for everyone. But realising that can be hard, especially when students feel pressure to succeed. “Because I was doing three sciences [I felt that] I had to do a professional degree,” says Holly. Sophie felt the same. “I always chose to follow what I thought other people would view as successful and admirable. But you need to be honest with yourself.”

Changing degrees was scary for both of them, but they’re much happier now they’re in courses they love. “It’s nerdy,” says Holly, “but I actually want to go to lectures and want to learn and read literature.”

Stephen Scott, Otago University’s head of student experience, applauds students like Holly, Sophie and Nick. He encourages students to “be brave” when deciding whether to stay on their chosen educational path.

“Really good results happen when students change.”

Students shouldn’t feel like they’ve failed if they switch courses, he says. “Thirty percent of first years fail one or more papers.” The challenges they face are not just about study; many students are away from home for the first time. It can be a good lesson for students to realise that “sometimes [things don’t] work as you thought it would,” Scott says. “It’s not a reflection on you as a person.” Instead, students need to adopt an attitude of “well that didn’t go as I thought, what can I do now?”

It can be tricky reaching out for help. Holly felt anonymous while she studied HSFY. “None of the lecturers know you.” Stephen Scott agrees that it can be a big adjustment. “Uni is not like school [where] your teachers knew your name and could tell if you were struggling.”

“It’s not that we don’t care, just that we don’t know,’ he adds. “[At Otago] there’s a really good suite of support services. [But asking for help] takes being a bit brave and vulnerable, and it’s not easy.” The support on offer at Otago includes the Locals programme for non-residential students, OUSA Student Support, academic help desks, AskOtago, and Student Health.

According to Scott, Heads of Colleges now proactively contact students who are struggling and refer them to course advisors. “We know no one comes down to fail [so] don’t feel hoha. Do something about it.”

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HSFY director John Reynolds says HSFY help desks tend to be under-utilised. Jo Oranje from Otago’s Health Sciences Academic Administration would like to see that change. “Some students think ‘I’m a burden’ [to ask for help], but you’ve paid for this. You never do worse because you’ve gone and asked.”

However, in the competitive atmosphere of HSFY, asking for help feels hard. When Nick struggled with his mental and physical health in first year, he “didn’t want to tell someone or ask for help” because of what people would think.

Nick was comfortable with the HSFY content but found the environment difficult. The culture at his hall of residence was “that medicine is the be all and end all, there is no future outside of it”. This made it hard for him to connect with how he was feeling. “I maybe had depression, but I don’t know.” He felt isolated in the large programme, living in a competitive hall of residence, struggling with financial pressure and being away from home. “I had never even been to the South Island before moving to Otago”, he says.

Nick felt like the competition ramped up from day one. “Lecturers said ‘2000 people do this paper and only 50 people get into dentistry'”. He was constantly comparing himself to others and worried that every year in Medical School would be as intense as HSFY. Pressure built up until he cancelled his Medicine application.

While Stephen Scott believes “competition in study isn’t a good thing” he points out that there are limited places in professional programmes, and competition only gets worse when people buy into the mindset. He says a better attitude for students to adopt is one of competition with yourself.

Scott, whose PhD is in stress in fish, says that while university stress is to be expected, “if it’s too intense it becomes abnormal”. At that point, students need to talk to someone – a friend, RA or even a lecturer – and work on managing their stress in healthy ways.

There are other pressures on HSFY students. Nick was eligible for Pacific Island entry to medicine, but he felt like he didn’t deserve it because he grew up with privilege on Auckland’s North Shore. “I felt like I was taking someone else’s spot.”

His doubts were intensified by comments from other students – things like “Māori and Pacific Islanders don’t have to try” and “Why do they get special treatment?” While doing HSFY, Nick also realised he’d “never had a brown doctor in my life or a professor in HSFY who was not white”, other than guest lecturers on Māori or Pacific health. This “internalised racism” made him doubt whether he was cut out for medicine. Nick eventually realised he wouldn’t be taking someone else’s Pacific Island entry spot, as Med School accepts all Pacific and Māori students who reach the grade threshold.

Holly’s advice for HSFY students is to “try to maintain an open mind”. Rather than focusing on a particular professional programme, “your goal should be to do the best you can do and when you’ve done that, look at what options you have. Only compete against yourself.”

Admittedly, “I wouldn’t have listened to that advice at the start of first year”. But she stands by it.