Epistemonikos Foundation has produced the largest and most reliable synthesis of research evidence on the therapeutic effects of cannabis or derived products that has been carried out to date.
It is the result of our independent, transparent and rigorous work, which was not commissioned by any organisation and did not receive external funding.
The motivation to make this information available is none other than to contribute to a decision-making informed by the best scientific evidence.
In 2016 Epistemonikos Foundation started an ambitious research project. Our goal was to synthesise the totality of the scientific evidence relevant to decision-making on the therapeutic uses of cannabis and cannabis-derived products.
Instead of a single study, we are generating a set of studies, which we estimate will total 170 by September 2018. Using different perspectives and methods of analysis, these studies synthesise and update – in the most rigorous, transparent and independent way, and according to all international standards – the whole body of scientific knowledge on this subject.
Our motivations to start this project were strictly academic. Firstly, we were interested in clarifying the uncertainty experienced by the medical professionals in our research team in their clinical practice. They were not sure about the extent to which cannabis and its derived products could be used for therapeutic purposes. Secondly, we wished to demonstrate that it was possible to analyse the totality of the available scientific evidence relevant to this topic. Because of the enormous volume of information available – new scientific articles appear practically every day – such task had not been achieved satisfactorily by any organisation in the world. The technologies and methods developed by Epistemonikos Foundation, together with its extensive network of experts and collaborators, not only allowed us to tackle this task, but also to keep the information continuously updated.
The international launch of the project will take place this September in Edinburgh, at the 25th Cochrane Colloquium, the world’s most important event devoted to the synthesis of scientific information. Like all Cochrane activities, the Colloquium is free from influences of the pharmaceutical industry. We sent our presentation proposal in February this year and in April it was accepted to the most important section of the Colloquium.
On Friday, May 3rd, 2018, at 17:33, we sent a statement to the Health Commission of Chile’s National Congress, presenting an executive summary of our conclusions, which are based on the published and to-be-published data of the project. They are written in a simple language, as free of technicalities as possible. We sent the letter because of an ethical obligation to both contribute to the national debates and allow our legislators to make decisions aligned with the health of the Chilean people. This is a motivation we share with all the scientific associations that adhered to the statement at the moment of sending it to the Health Commission, and also with those organisations and individuals who joined us later, once they learnt about our statement through the media.
Broadly, the project has 4 stages
Stage 1: Search and Selection of the Scientific Evidence, plus its Continuous Updating
Out method responds to a comprehensive approach, which uses multiple approaches, many of them made possible by the Epistemonikos Database, a free-access resource maintained by Epistemonikos Foundation since 2012. It is currently the largest database of scientific evidence relevant for decision-making in healthcare, an achievement recognised by the most important international organisations.
Our specialised algorithms have identified more than 21,061 publications so far. They have been screened at least in duplicate by our research team, who have finally selected 777 publications relevant to our research — 777 publications evaluating dozens of conditions or diseases for which claims have been made about the benefits of cannabis or its derivatives. The PRISMA diagram below describes our selection process.
This is the largest existing collection, far exceeding previous international reports. It includes both published as unpublished studies (such as some of the pharmaceutical industry studies that have produced less favorable results).
- This information has been available, at all times and free of charge, on our platform Living Overview of the Evidence or L·OVE. The platform, purposely built to organise scientific evidence, allows user to browse the information by condition, symptom or illness. https://love.epistemonikos.org/#/diseases/medical_cannabinoids/about
- In order to facilitate the evaluation of our search process by independent entities, we provide the public with the full list of the articles included.
Stage 2: Summary of Previous Evaluations (Systematic Reviews)
Epistemonikos Foundation researchers have developed a method for synthesising and re-analysing all the evidence that is available through systematic reviews related to a specific question. The method is called Living FRISBEE (Living Friendly Summary of the Body of Evidence using Epistemonikos). Technically, the Living FRISBEE is a new type of overview of systematic reviews. It focuses on analysing the differences and overlap between previous reviews, and then adds the reanalysis of all the trials identified by the included systematic reviews, using meta-analysis techniques and GRADE methodology. Like all the publications of this project, these summaries are updated whenever new relevant scientific evidence appears.
These summaries are published in the journal Medwave, an indexed journal of regional scope. We signed an agreement with Medwave after an exhaustive assessment. They were the only journal to meet all our requirements: open access from the moment of publication; bilingual publication; peer review; indexing in major international databases; large readership and impact on the national and international health debates; editorial agility; capacity to produce “living” updates and to republish when new relevant evidence becomes available.
Articles on Epistemonikos’s Living FRISBEES and Epistemonikos’s agreement with Medwave:
Epistemonikos’s and Medwave’s joint presentation (forthcoming) of the Living FRISBEE project at the Evidence Live 2018 conference in Oxford, UK.
Stage 3: Continuous Updating of the New Systematic Reviews (Living Systematic Reviews) Related to the Conditions or Diseases Evaluated
In this stage a new systematic review is produced for each of the diseases in which the therapeutic use of cannabis or its derived products has been considered. The reviews are conducted with the highest rigurosity (Cochrane methodology) and within the “living” model, i.e., they are updated whenever there is new evidence.
Stage 4: Methodological Articles
This stage involves the description of the technologies and methods used to synthesise such a large collection of evidence, keep it up to date, and present it in a coherent whole. This stage also includes a description of the methods of knowledge transfer used with the scientific community, other health professionals, and policy-makers. Finally, this stage explains why previous reports and reviews have reached conclusions different from ours.
Extract from our comparative analysis of Epistemonikos’s report vs previous international efforts (mainly that of the [US] National Academies of Sciences, Engineering, and Medicine.) to synthesise the scientific evidence about the possible therapeutic effects of cannabis or its derived products
Epistemonikos has conducted what is, to our knowledge, the most comprehensive and reliable compilation and synthesis of evidence regarding the possible therapeutic effects of cannabis or its derived products. We decided to circulate the main conclusions of this project and thus contribute to the public and legislative debates, while aiding the authorities in making better-informed decisions. Epistemonikos’s project started out as an academic endeavour, and it used advanced tools and methods to reach its conclusions in an independent, transparent and rigorous manner. We are confident that decision makers now have the best scientific evidence available.