Good Medicine Research Articles

Advances in Quality Control Methods for Colla Corii Asini Preparations

There are numerous records of Colla Corii Asini from ancient times, which is a good medicine for nourishing yin and moistening dryness, tonifying blood and stopping bleeding. Colla Corii Asini and its preparations are composed of proteins and peptides produced by hydrolysis, amino acids and nucleic acids, polysaccharides, trace elements and other components. The market demand for Colla Corii Asini products has been increasing year by year. This, coupled with natural constraints and the downturn in the donkey farming industry, has led to a shortage in the supply of donkey hides, the raw material for Colla Corii Asini. In order to improve the overall quality and evaluation standards of Colla Corii Asini on the market, it becomes particularly important to study the progress of quality control methods for Colla Corii Asini preparations.

Irregular Warfare Must Combine Good Medicine, with Both Good Tactics and Good Strategies: Position Paper by the French Special Operations Forces Medical Command.

Military operations are no longer limited to the application of counterterrorism and counterinsurgency strategies; they are now characterized by hybrid, irregular, and unconventional features. While some authors have indicated the need for medical support to adapt to these new modes of military operations, they have focused mainly on the tactical level of care on the battlefield. As Sun Tzu states, "Strategy without tactics is the slowest route to victory. Tactics without strategy is the noise before defeat," further proposals are still needed on the application of both medical tactics and medical strategies in irregular warfare. Medical experts from the French Special Operations Forces (SOF) Medical Command have identified specific medical challenges that special operations face in the context of the current transformation of armed confrontations into irregular warfare. This position paper presents original tactical medical proposals for improving medical support in irregular warfare, ranging from the definition of a Primary-Alternate-Contingency-Emergency medical plan to the promotion of telemedical support. Original strategic medical proposals have highlighted the importance of recognizing medical issues in irregular warfare, including the medical actions carried out through and with local partners and the multiple approaches to countering medical threats. The SOF medical community must be closely involved with and facilitate the responses to the shift to irregular warfare. International collaboration and interoperability are more necessary than ever, as they will enable a more effective combination of good medicine with both good tactics and good strategies. These perspectives can also be extended to improve medical care in the conventional armed forces and austere civilian settings. N/A. Original research.

Randomised Controlled Trial on the efficacy of Mamajjaka (Enicostemma littorale Linn.) in the Management of Madhumeha (Diabetes Mellitus)

Diabetes Mellitus is in top ten list of diseases causing mortality. In the year 2011, estimated 366 million people were found to be suffering from diabetes mellitus. By year 2030 this morbidity data will rise to approximately 552 million people worldwide. India is having the largest number of diabetics in the world and gets the name ‘Diabetic capital’. This study was carried out with an aim:-‘To Conduct a Randomised Controlled (Upashayatmaka) Trial on the role of Mamajjaka capsule in the management of Madhumeha (DM type-2)’. In this study total 110 patients of Diabetes were selected from NIA hospital and randomly divided into two groups. Group A (Control group) comprise 54 patients were administered with Tab. Metformin and dose was 500mg tablet 1 BD before meals as advised according to allopathic consultant. Group B (Trial group) comprise 56 patients were administered with Cap. Mamajjaka, dose: 500 mg Capsule 2 BD, before 30 min. of meal with lukewarm water. Total duration trial was 100 days. Results obtained in subjective and objective parameters were analysed for the statistical significance by adapting paired T test and unpaired T test. The study revealed that Group-B was found to be more effective in bringing symptomatic relief and Group-A was found to be more effective in improving biochemical markers in the patients of Madhumeha. Cap. Mamajjaka (Enicostemma littorale Linn.) provided better results, suggests that this can be a good complimentary medicine for the patients who are not getting good relief from modern medicine alone.

Physicochemical and heavy metal analysis of Yavani-Sadav Churan – An Ayurvedic formulation

Ayurveda is the most ancient documented healing heritage of the world that describes health management through natural products. Bhaishjya Kalpana, a branch of Ayurveda, describes details of pharmaceutical preparations of different dosage forms. Chooran kalpana is one of the solid dosage forms considered the secondary Kalpana of Kalka kalpana. In a common language, it is known as powder medicine and is used extensively in Ayurvedic treatment. For promoting Ayurveda, traditional health management introduced the term Drug standardization in the manufacturing of Ayurvedic medicine to ensure good quality medicines for the satisfaction of customers in the international market. Drug standardization is the core issue not only for Bhaishjya Kalpana but also for the entire Ayurveda health care. In the present study, Yavani–Sadav Churan was prepared and the physicochemical and Heavy metal analysis of churan is the main aim of the study. In this study, different parameters for assessment of purity, quality, and safety of Yavanisadava chooran will be carried out like organoleptic characteristics, loss on drying, total ash, acid insoluble ash, water-soluble extractives, and Alcohol soluble extractives. pH, Bulk density, Tap density, Particle size, TLC and Heavy metal analysis by AAS method etc., which contribute to a great extent for standardization.

A good medicine tastes bitter: Environmental regulation that shapes China's green productivity

This study scrutinizes the effect of the Sewage Charges System (SCS) reform on the green total factor productivity (GTFP) across China's provinces. Employing the global Luenberger productivity indicator based on a non-radial directional distance function, we observe an upward trend in China's GTFP during the study period. However, the SCS reform precipitates a contraction in the GTFP, particularly pronounced in low-income and resource-based provinces of China. Empirical findings withstand a battery of robustness checks of self-selection and placebo tests. Further mechanistic tests suggest that the SCS reform influences the GTFP by escalating pollution treatment costs, curtailing R&D investment, and undermining the quality of green innovation via crowding-out effects. Overall, the SCS reform is effective in curbing SO2 emissions, but it reduces economic efficiency. Therefore, how to synergize emission reduction and economic growth is an important issue to be addressed in the area of environmental policy design in China.

The ADEM project: implementation of ‘Good medicines use conversation’ for COPD-patients, embedded in multidisciplinary context.

COPD is a chronic, progressive disease, for which a multidisciplinary approach is crucial. Appropriate follow-up is crucial to improve the quality of life of COPD-patients and reduce associated healthcare costs. 
 A ‘Good medicines use conversation’ COPD is a pharmaceutical care intervention, conducted by the community pharmacist, consisting of a tailored-made education of the COPD-patient on the disease and its treatment. Scientific research (PHARMACOP-trial) has shown that this intervention significantly improves therapy adherence and inhalation technique and reduces exacerbation rates and associated hospitalizations. 
 The aim of the ADEM implementation project was to investigate the needs for a sustainable implementation of this intervention.
 The ADEM project was conducted in Flemish-Brabant (Belgium), with the integrated care region ‘Leuven Cares’ as a separate entity. 
 All participating pharmacies (9 in region Flemish-Brabant and 8 in region ‘Leuven Cares’) received a support package consisting of: 1) a three-part online training about COPD and a visual COPD-atlas; 2) a population management-tool (a query to identify COPD-patients in the pharmacy, resulting in a list of COPD-patients with a ‘score’ per patient as an initial proxy for patient prioritization); and 3) local interdisciplinary meetings (LIM) to discuss and promote the intervention. Pharmacist of the region Caring Leuven additionally received individual care plans, providing an overview of the healthcare status of each COPD-patient, and an individual coaching session.
 Semi-structured interviews were conducted with 8 participating pharmacists (4 region Flemish-Brabant, 4 region ‘Leuven Cares’). Thematic analysis was performed.
  
 All elements of the support package were positively evaluated by the participating pharmacists. The population management tool seemed to support pharmacists in planning, interpreting and prioritizing care for COPD-patients. A follow-up study is needed to further investigate the tool and to what extent population management contributes to a more qualitative and effective pharmaceutical care. 
 COVID-19, lack of personnel, lack of reimbursement and lack of time were identified as limiting factors for the implementation of the protocol-based COPD-intervention. Cooperation with the GP was indicated by the majority as minimal and insufficient. Therefore, LIM’s were evaluated as very important to inform GP’s about the pharmaceutical intervention and make local agreements about the multidisciplinary approach of COPD.
 The findings of this study are in line with the available evidence on the implementation of new services in pharmacies. Many pharmacists have the intrinsic motivation to offer extended pharmaceutical care, but current practices often do not allow this. Population management appeared to be a major factor that can be used to facilitate the implementation. By considering the needs of the local population, pharmacists can work in a more targeted way and prioritize the pharmaceutical services they offer. Given the group of chronically ill people in Belgium is expected to grow in the coming years due to the increasing ageing of the population, there will be an increasing demand for specialized interventions and advice from the pharmacist. It is therefore necessary to provide a sufficient framework for these services, bearing in mind the needs of the local population and the requirement for a pragmatic approach in the pharmacy. 
  

Good Medicine Does Not Compensate for Bad Surgery.

Good Medicine Does Not Compensate for Bad Surgery.

Analisis Pengelolaan Obat dan Strategi Perbaikan dengan Metode Hanlon di Instalasi Farmasi

This research aims to analyze drug management at the Purwokerto Dadi Keluarga Pharmacy Installation using efficiency indicators and implementing improvement strategies using the Hanlon method. The method used is a descriptive design for 2018 data which is retrospective and concurrent. Data was collected in the form of quantitative and qualitative data from document observations and interviews with relevant IFRS officers. The research results show that the drug management system at RSDK Purwokerto does not meet standards. From the results of this research, it is necessary to carry out a priority analysis of strategic plans for improving drug management using the Hanlon method, the results are in accordance with the priority scale order as follows; Minimize dead stock of medicines by carrying out good medicine planning so that medicines experience transactions. By re-evaluating the selection of drugs with prescriptions outside the National Forum by considering drugs that rarely have cases of disease/rarely used, re-evaluating at the selection stage, for the quantity needed and type of drug procurement, carrying out drug planning ( RKO) in the management information system, coordinating to avoid polypharmacy, proposing an increase in the drug procurement budget to the drug procurement section, proposing an increase in drug budget costs to the hospital. In conclusion, the current drug management system does not meet standards, the implementation of improvement strategies using the Hanlon method aims to improve and improve drug management efficiency at the Purwokerto Dadi Keluarga Pharmacy Installation.
  
 Keywords: Efficiency Indicators, Pharmaceutical Installation, Drug Management, Hanlon Method.

Unlocking the anti-diabetic potential of Gymnema sylvestre, Trigonella foenum-graecum, and their combination thereof: Anin-vivo evaluation.

The current study aimed to explore the anti-diabetic effect of aqueous extracts of Gymnema sylvestre, Trigonella foenum-graecum and mixture of both the plants in alloxan-induced diabetic rabbits. A total of 30 rabbits were grouped into six equal groups as: normal control, diabetic control, diabetic treated with 300 mg/kg body weight (bw) G. sylvestre, diabetic treated with 300 mg/kg bw T. foenum-graecum, diabetic treated with 300 mg/kg bw mixture of both the plants and diabetic treated with 500 mg/kg bw metformin for 4 weeks. Diabetes was induced to all the study group animals except normal control by intravenous administration of alloxan monohydrate (80 mg/kg bw). Blood glucose was measured by glucometer and other biochemical parameters were determined through various kit methods. Serum insulin was measured through ELISA kit method. Results showed that both the plants and metformin significantly (p < .05) decreased the fasting blood glucose. Hypoglycemic activity of aqueous extract of G. sylvestre and metformin was found slightly higher than aqueous extract of T. foenum-graecum and the mixture of both the plants. However, a significant (p < .05) rise in insulin secretion was observed in studied plants extract treated rabbits. Serum urea, creatinine, and liver enzymes were found reduced significantly (p < .05) in treated rabbits whereas packed cell volume was also returned to normal in treated animals as compared to control group. The study concluded that G. sylvestre and T. foenum-graecum extracts have comparable effects with metformin in normalizing the blood glucose level and have more pronounced effect than metformin in restoring the serum biochemical parameters to normal levels. Hence, these plants may be the good alternative medicine in managing the diabetes mellitus.

Training on Procedures for Using Good and Correct Medicine for Health Cadres at the Surobayan Sedayu Mosque

During the pandemic and post-pandemic times, public awareness of health has increased. This condition, of course, must be accompanied by increased health knowledge, including knowledge about medicine. The Al-Hikmah Surobayan Mosque Foundation and LAZISMU Sedayu are starting a health center for residents, so this community service is aimed at training health cadres regarding drug problems. The community service, which took place at the Al-Hikmah Mosque Health Center on March 5, 2023, was attended by 22 health cadres aged 50.78 years. In this activity, the speakers were pharmacists from the pharmacist profession study program FKIK UMY and pharmacists from the UAD pharmacy faculty, assisted by students who were members of PIO activities.The training was carried out in stages, starting with a brief introduction to the types of drugs, then how to use drugs, store drugs, and recognize signs of drug side effects. This service collaborated with the Faculty of Pharmacy Ahmad Dahlan University collaborators. The results of the community service that has been carried out show increased knowledge of cadres and the community regarding drugs, as indicated by an increase in the average post-test score (from 69.1 to 81). This activity was continued by sending students who are members of the Drug Information Center (PIO) during the opening hours of the health center on Saturday and Sunday. The pharmacist must assist cadres on an ongoing basis to escort the health center to the Pratama clinic

Perception of Consumers, Stakeholders, and Policy Makers on NAFDAC Anti-counterfeit Technologies and Interventions Regarding Counterfeit Drugs in Nigeria

Counterfeiting medicines is a global phenomenon affecting developed and less developed countries. The World Health Organization, in its report, describes counterfeit medicines as becoming “a global public health crisis. This study examines consumers, stakeholders, and policymakers' perceptions of NAFDAC anti-counterfeit technologies and interventions regarding counterfeit drugs in Nigeria. This study uses a qualitative research method to examine consumers, stakeholders, and policymakers' perceptions of NAFDAC anti-counterfeit technologies and interventions regarding counterfeit drugs in Nigeria. Participants were selected using convenience sampling, and data was collected through an online interview. Data were analysed using thematic analysis. Stakeholders emphasised the importance of NAFDAC having a comprehensive anti-counterfeiting strategy and implementing measures such as checking for NAFDAC registration numbers, inspecting packaging, and requesting seller receipts to identify genuine medicines. Policymakers at NAFDAC acknowledge the seriousness of the problem and recognise the roles of stakeholders in implementing anti-counterfeiting interventions. They emphasise the need for effective communication, engagement, and collaboration with healthcare professionals. Consumers express concerns about the accessibility to good quality medicines and the prevalence of substandard and counterfeit drugs. However, consumers also demonstrate a willingness to support NAFDAC's efforts and show a preference for quality medicines, which is a positive indicator for the Nigerian pharmaceutical industry. The findings underscore the importance of continuous efforts to raise awareness and implement effective anti-counterfeiting strategies to safeguard public health and combat the growing threat of fake drugs. Keywords: Falsified, Substandard, Counterfeit, Knowledge.

Chapter 4 Good Medicine: Prescriptions for Indigenous Archaeological Practice

ABSTRACTWhile the history of North American archaeology points to a long engagement with tribal elders and scholars, these encounters largely consist of unequal, extractive relationships wherein Indigenous collaborators and Indigenous archaeologists have been treated more as objects of study and pity—what Bea Medicine refers to as “creatures”—rather than as equal research partners. As an Indigenous woman and a settler Chicanx woman, we reflect on the life journey and scholarship of Bea Medicine, a Lakota scholar‐activist and mentor to Indigenous anthropologists. Dr. Medicine's work has provided generations of Indigenous anthropologists with the means to participate in the discipline with their whole selves and, importantly, on their own terms. We argue that Medicine's contributions provide good medicine for the field in the form of concrete strategies for continuing to decolonize the discipline and for doing work that centers the direct needs and perspectives of Indigenous peoples. When read alongside Indigenous archaeologies’ often overlooked grandmothers, mothers, and aunties, Medicine's work also highlights continuing disparities in archaeological practice, from our relationships with and to Indigenous nations to the relations we cultivate in the Academy as Black, Indigenous, and People of Color.

Menstrual Hygiene Management (MHM): A Scheme for Improving Women Welfare

The Ministry of Health and Family Welfare implements the Scheme for Promotion of Menstrual Hygiene among adolescent girls in the age group of 10-19 years since 2011. The scheme is supported by the National Health Mission through State Programme Implementation Plan (PIP) route based on the proposals received from the States / UTs. The major objectives of the scheme are to increase awareness among adolescent girls on menstrual hygiene; to increase access to and use of high-quality sanitary napkins by adolescent girls and to ensure safe disposal of sanitary napkins in an environment friendly manner. Under the scheme, a pack of sanitary napkins are provided to adolescent girls by the Accredited Social Health Activist (ASHA) at subsidized rate of Rs. 6 per pack. In addition, Ministry of Drinking Water and Sanitation under Swachh Bharat Abhiyan has developed National Guidelines on Menstrual Hygiene Management (MHM) for creating awareness on Menstrual Hygiene Management (MHM) in rural areas as part of its overall interventions related to behaviour change on sanitation hygiene aspect. Further, to ensure access to sanitary napkins and good quality medicines at affordable price, Department of Pharmaceuticals under Ministry of Chemicals and Fertilizers implements the Pradhan Mantri BharatiyaJanausadhiPariyojna (PMBJP), an important step in ensuring the health security for women. Under the project, over 8700 JanaushidhiKendras have been set up across the country that provides Oxo-biodegradable sanitary napkins named Suvidha at Rs. 1/- per pad only.

Roots and Relations: Celebrating Good Medicine in Indigenous Evaluation

Roots and Relations: Celebrating Good Medicine in Indigenous Evaluation

ROOT CAUSE ANALYSIS (RCA) OF E-CATALOGUE PROCUREMENT OF MEDICINE USING E-PURCHASING IN PUBLIC HEALTH CENTER IN KLATEN REGENCY OF CENTRAL JAVA

E-catalogue procurement of medicine is a method of electronic procurement using a particular website developed by the Government to increase the effectiveness, efficiency, and transparency of medicine procurement. In Klaten Regency, e-catalogue procurement of medicine in the Public Health Center (PHC) experiences obstacles. The study aimed to evaluate performance of e-catalogue procurement of medicine, analyze the root problem and formulate strategies to improve the performance based on the root problems. This descriptive study involved seven PHCs with data on medicine procurement in 2021. Quantitative data analysis was conducted by evaluating six performance indicators of medicine procurement. Qualitative data analysis was conducted by interviewing 17 respondents, analyzing root problems, and formulating improvement strategies The study showed that all PHCs had good medicine availability at 87.71% average, but low realization of e-catalogue procurement occurred in two PHCs. Lead time beyond the contract period occurred in two PHCs. All PHCs experienced low suitability of procurement funds and percentage of procurement through e-catalogue. Percentage of budget allocation for medicine procurement varied between 1.59% to 7.29%. Analysis of the root problem showed obstacles in human resources, mechanism of procurement, policies, system, budget, and environment aspect. It was concluded that the obstacles rooted on the lack of team role and synergy of PHC, District Pharmacy Unit, and District Health Office according to their authority, the lack of pharmaceutical industry and distributor commitments in the provision of e-catalogue medicine for PHC, and also the urgent needs of system and regulatory improvement by the Government.

Laughter as medicine: A systematic review and meta-analysis of interventional studies evaluating the impact of spontaneous laughter on cortisol levels.

Laughter as an expression of humor has been recognized as good medicine for centuries. The health benefits of humor-induced well-being remain unclear and thus we conducted a systematic review and meta-analysis of interventional studies to evaluate the impact of spontaneous laughter on stress response as measured by cortisol levels. Systematic review and meta-analysis. MEDLINE/PubMed, EMBASE, PsycINFO, Scopus, and Clinicaltrials.gov. Interventional studies, which could be either randomized placebo-controlled trials (RCTs) or quasi-experimental studies, conducted in adults that compared any spontaneous laughter intervention to a controlled setting and reported changes in cortisol levels were selected. We examined the impact of laughter on percentage change in cortisol levels by calculating pooled estimates of the absolute differences between arithmetic means before and after interventions as compared to control using random-effects model. Eight studies (315 participants; mean age 38.6) met our inclusion criteria; four were RCTs and four were quasi-experiment studies. Five studies evaluated the impact of watching a humor/comedy video, two studies evaluating laughter sessions administered by a trained laughter therapist, and one study evaluating a self-administered laughter program. Pooling these data showed a significant reduction in cortisol levels by 31.9% (95%CI -47.7% to -16.3%) induced by laughter intervention compared to control group with no evidence of publication bias (P = 0.66). Sensitivity analyses demonstrated that even a single laughter session induced a significant reduction of 36.7% in cortisol (95%CI -52.5% to -20.8%). In addition, analyses including the four RCTs reinforced these results by demonstrating a significant reduction in cortisol levels promoted by laughter as compared to the placebo arm [-37.2% (95%CI -56.3% to -18.1%)]. Current evidence demonstrates that spontaneous laughter is associated with greater reduction in cortisol levels as compared with usual activities, suggesting laughter as a potential adjunctive medical therapy to improve well-being. Registration number: CRD42021267972.

Poster Edukasi Obat Paten Dan Generik

The goals of treatment are to protect and restore health and maintain and improve quality of life. Therefore, the community needs access to affordable and good quality medicines so that the cost of treatment is more affordable economically, without reducing the quality or quality of the drugs. The problem is that currently there are not many people who are interested in generic drugs because they think that low drug prices are synonymous with low drug quality. This community service activity aims to provide education to the public about the differences between generic drugs and patented drugs which in turn encourages people to use generic drugs to reduce medical costs. The educational method used is through the distribution of brochures at 25 K24 pharmacy outlets in the Yogyakarta area. The results of this activity received a very good response from the pharmacy because they felt it helped in providing this information. The community's acceptance of this activity is also very good so that the education process can also be carried out directly to patients while at the pharmacy

The ethics of precision health.

In this paper, I defend an account of the ethics of precision medicine that can explain both its possibilities and limits. Creating a new conceptual and normative model of the ethics of precision health can ensure that good medicine is also excellent and that excellent medicine is also good by providing a resource to scientists and clinicians. First, I propose a new conceptual analysis of precision health. I argue that precision health is defined primarily by targeted medical interventions and not by stratification, as others have asserted. Next, I argue that failure to be adequately responsive to this conceptual analysis explains common ethical abuses in the field. Third, I argue that this conceptual analysis can also pave the way for future research heretofore overlooked. Thus, we can limit abuses in precision health research and care while at the same time openingnew avenues to help historically oppressed communities.

Reflections on internal medicine in Poland on the occasion of the 100th anniversary of &lt;i&gt;Polish Archives of Internal Medicine&lt;/i&gt;

Dynamic development of medicine in the 20th and 21st centuries has only been possible due to its split into narrow specialties. The increasingly complicated and costly technologies used in clinical practice can only be mastered by small groups of highly‑ qualified specialists; however, diagnosis and treatment are not about matching a patient with the latest and most sophisticated technologies but about finding an optimal patient‑ oriented solution, as it is the human being as a whole that needs help. To achieve this goal, a close collaboration of different specialists is required, but the key role rests with a physician with good general internal medicine skills and the right motivation to act. Management of patients presenting to internal medicine departments requires not only the skill of appropriate pathophysiological reasoning based on extensive knowledge and acquired experience, but many times also the civil courage of the physician. The task is further complicated by chronic underfunding of these wards. The aim of the present review is to reflect on the current state and prospects of Polish internal medicine as well as to attempt a definition of an internist and their role in the integration of different medical specialties. It also stresses the importance of a master in the teaching and practice of medicine and presents profiles of 4 eminent Polish internists.

Cannabis, endometriosis, and a high time?

The article proposing cannabis for the treatment of endometriosis is superficially argued and shows disdain for concerned patient care.1 For the medical profession, the addition of another dangerous drug into the mainstream medication market is a serious consideration. Maybe the authors proposing it is ‘high time’ for wider cannabis use have a warped sense of humour? Maybe they have not read about the psychotic-inducing and detrimental mental health issues associated with cannabis consumption. Or its intoxication with consequent poor short-term decision-making, hindered social coordination and mounting driving errors. Or its demotivation and links to educational drop-out rates, or its habituation, addiction, and cannabis disorder potential. In calling for debate on the pros and cons of medicinal cannabis in gynaecology, even the most myopic protagonists would concede there are dangers in cannabis use as an analgesic. In choosing to focus on the narrow use of cannabis as an analgesic for endometriosis, the authors avoid any perspective. Their ‘considerable’ mention of the demerits of medications to treat endometriosis is fair, but their failure to mention any immediate or long-term side-effects of cannabis is hardly even-handed. As researchers ‘undertaking randomised controlled trials’ they will surely present the drawbacks for readers' consideration? There is not a single word to suggest there may be side-effects of cannabis for treating the pain of endometriosis – let alone any dangers in general gynaecology and obstetrics. Solid pharmaceutical evidence for the use of cannabis in the treatment of endometriosis (or any other gynaecological condition) is lacking and the authors agree it is ‘urgently’ needed. However, they argue that such trials ‘are by no means an essential prerequisite prior to prescription’ - the rationale of this disregard being their replacement ‘by a diversity of approaches that involve analysing the totality of the evidence base.’ Say what? But the evidence base is clear – cannabis is a dangerous drug, so failing to accept the facts when they go against your premise is illogical and unprofessional. Prescribing one analgesic agent rather than another that has no effect on the underlying cause of the pain can only hope to persuade the patient to think she is ‘better’. Homeopathy claims that ‘if you think you are better, then you are better.’ Analgesic roulette is homeopathy and not what endometriosis suffers should be offered.2 Evidence-based medicine rests on three pillars, the best available evidence, clinical expertise, and patient preferences. The evidence produced in favour of cannabis thus far is equivocal and anecdotal. The clinical experience in Australia and New Zealand is minimal and unpublished, with patient preferences only, in the protagonists' words, ‘worthy of continued investigation’. The latest systematic review concludes that interpreting existing studies precludes ‘a definitive statement about cannabis for gynaecologic pain relief’.3 Asking doctors not to ‘wait for higher level evidence’ before prescribing cannabis in gynaecology or obstetrics is speculative at best, but against the principles of good medicine, especially in view of the evidence which is available which demands caution.4 Let us weigh the benefits and harms of any progress in our discipline and then – and then only – act in our patients' best interests.