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Pot. Marijuana. Cannabis. Misunderstood Motives.

by Eric Hall

March 30, 2013

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Donate I have had a regular argument over the years with a family member about both the recreational use of pot and the use of pot and derived materials from pot. Many of the claims promoted by this family member surround its use in cancer. In fact, this person follows a group on Facebook called "Cannabis Cures Cancer." Being a regular listener to scientifically-based podcasts, I was skeptical of the dramatic claims being made, as they seemed to be mostly anecdotal in origin. However, I thought I'd take a fresh look at the information to see where the science stands on cannabis.

In comparison to other treatments, the amount of information available discussing the science on this topic took a bit more digging. There are some preliminary studies for a wide variety of conditions, but no large scale studies or anything that would be close to market. To start, I looked over the information presented to me by this family member, which was a link to the National Cancer Institute at the NIH. I use the NIH website to find basic health information about medications I am taking, or to find out about treatments for minor injuries or illnesses, and find it to be a fairly trustworthy source.

However, this link makes me reevaluate that stance. Without any differentiation other than the web address, the entire topic falls under the umbrella of the NIH's CAM (complimentary and alternative medicine) research. The only way to tell it falls here is in the web address itself; there is no disclosure on the page as such. The Science-Based Medicine blog does a great job covering why the NIH should not be promoting CAM. The problem I have lies with the lack of disclosure. The information in the article itself isn't inaccurate, although the way it is written can be misleading.

One of the articles I did have in my stash of information is a recent blog from the Skeptical Raptor blog. This post does a great job summarizing the information being claimed about actually curing cancer. It actually uses published medical information, even linking to the abstracts in the NIH database. The article also addresses the above NIH National Cancer Institute page. Although some of the research into cannabis is interesting, it hasn't progressed much beyond cell cultures and a couple of rat studies. The push-back I received using this article is because the "Skeptical Raptor" worked for the pharmaceutical industry, this is another attempt for "big pharma" to suppress the truth. The raptor does a great job addressing this:
...if cannabis or any of its components actually could show efficacy against any of the 200 or so cancers, Big Pharma would be all over it. Because, they would not be selling joints, they would be distilling the active ingredient, determining the exact dose, determining how to deliver it to the exact cancer site, funding clinical trials, filing documentation with the FDA, then getting it into physician's hands. This is not an easy process, but it would be a profitable one if it worked. Big Pharma and the National Cancer Institute is looking at everything, and they ignore nothing for potential. If cannabis works (and it might), they are all over it. Big Pharma is providing a lot of the funding for it.
And he is right. A cure for cancer would be highly profitable. If it is one thing the conspiracy theorists and skeptics can agree on, it is that corporations are driven by profits. Making money in and of itself is not a sign of bad motives.

Expanding on the thought of "big pharma" doing nothing to hurt their profits by coming up with new drugs is absolutely ludicrous. Compounds by the thousands are in various stages of testing. It would be impractical to test them all with equal vigor. The ones with more promise of efficacy must be tested first. One could argue that perhaps this is the suppression of "big pharma," trying to put more profitable drugs in front of the line. This is true. But guess which drugs are the most profitable...the ones that offer the best treatment.

The charity organization Cancer Research UK has a fantastic explanation of the status of cannabis as a medicine, as well as some great basic education on how science works to improve nature in the field of medicine. They give excellent examples of the naturalistic fallacy, and yet show how nature can serve as inspiration for better medicines. They explain the classic example of aspirin:
Aspirin is another old drug, first discovered in the form of salicylic acid in white willow bark. But this naturally-occurring chemical causes severe stomach irritation, which led to the German company Bayer developing an alternative version — acetylsalicylic acid — which was kinder to the tummy. Aspirin is now arguably one of the most successful drugs of all time, and is still being investigated for its potential in preventing or even treating cancer.
Something from nature used in medicine, improved by science, and is a perfect example of how that process works.

Cancer Research UK starts the section on nature with a nice concise statement on why it is dangerous or not good medicine to treat serious diseases with homemade treatments from natural sources:
There's no doubt that the natural world is a treasure trove of biologically useful compounds. But whole plants or other organisms are a complex mix of hundreds of chemicals (not all of which may be beneficial) and contains low or variable levels of active ingredients. This makes it difficult to give accurate doses and runs the risk of toxic side effects.
This is not to say that natural sources of medicines do not exist. David Kroll, a Institute for Science in Medicine Fellow, actually works for the National Institute of Cancer. He is researching a natural compound (milk thistle) as a possible cancer cure. He serves on the NCI's Office of Cancer Complementary and Alternative Medicine Physician's Data Query Editorial Board -- the very place the cannabis article I mentioned earlier resides. Dr. Kroll explains why it is important to do proper research on natural compounds before they are used as treatments:
When plant medicines were all we had, underdosing and overdosing were common because we had not yet achieved the scientific skills or knowledge to effectively isolate known quantities of physiologically-active constituents.

Today's herbalists and purveyors of alternative medicines will frequently argue that 1) whole herbs possess a synergy that is missing when one isolates and uses pure constituents, or that 2) the mixture is safer than pure compounds because one compound can reduce the side effects of another without compromising its therapeutic efficacy. In the former case, synergy has actually be described in the scientific literature but the cases are extremely rare.
This is my biggest concern when anyone is convinced by claims that a person can purify a plant extract at home, and then be used to treat a large list of illnesses - that the dosing is not controlled and the efficacy is not well-tested.

In regards to the science of cannabis as a treatment, the studies on the cancer fighting properties are mixed. In some types of cancers, application of THC (the cannabinoid in marijuana that gives the high) seemed to suppress the growth of cancer cells. In some cases, it even increased the immune system response to the cancer. However, in other types of cancer, the THC actually accelerated tumor growth and suppressed the immune system response. This is the reason I react when I see people making the blanket statement that "[this substance] cures cancer." In this case, preliminary evidence shows cannabinoids may hold some promise in the treatment of certain types of cancer. However, it could actually be harmful in the treatment of certain other cancers. The research is far from complete.

A very common way to defend these type of treatments among those who don't trust "big pharma" is the use of anecdotes. One story that was passed along was one of Kristina Marie. All of the information on her condition and treatment comes from her video blog she keeps, where she talks about treating her cancer with cannabis oil. She says her cancer is a Cancer Astrocytoma grade 2 - also known as a grade II glioma. However, gliomas are still not well understood. In fact, there are known cases of spontaneous regression of these types of cancer. Harriet Hall writes more about this at SBM, including covering the scenario of what to do when conventional treatments fail. This is a difficult question. I don't blame Kristina for trying something... anything to extend her life. But without knowing the details of other treatments she is getting concurrently or if this is a case where the tumor is regressing on its own, her single anecdote is not proof that homemade cannabis oil is a cancer cure.

Cannabis has other possible uses. Studies show possible uses in treating spasticity in MS and as an analgesic in the use of arthritis. Other studies have not been able to repeat the results, but that can happen at times during early study of new pharmaceuticals. The other key component is these studies use derived forms of cannabinoids, and not homemade oil, and therefore the compound it both pure and precise in its dose. Cannabinoid based drugs have been sold since the 1980s. One was the premier drug for battling nausea, but has since been surpassed by drugs that work better with less side effects. Because cannabinoid chemicals and receptors are so prolific in our bodies, it seems continuing research to find new cannabinoid compounds and uses is justified. If the results can be repeated on a larger scale, perhaps new cannabinoid drugs will make their way to market.

As in the case of aspirin, the real research can often be found to be inspired by natural ingredients. Compounds, inspired by the naturally occurring one, are made to better target the receptors the natural ingredient reaches, thus increasing the effectiveness, and possibly reducing the cost and side-effects. Some of these synthetic cannabinoids also show promise, but the studies are very preliminary and small-scale.

On cannabis, the information leads me to conclude there are some interesting scientific possibilities in using cannabinoids as a treatment for a variety of diseases and the symptoms. The number of receptors in our body would indicate they play some role in our every day biology. However, the attempts so far to find a blockbuster breakthrough on any particular disease using cannabinoids has failed. The human trials are either small and uncontrolled or have results that are not repeated in other studies. In vitro and and mouse studies also show promise, but the positive results are highly dependent on the target, mode of delivery, and dose. I can say with a fair amount of certainty that hemp oil itself is not a cure for cancer, nor a "safe" alternative to traditional medicine. Let's use science to find the best medicines possible, not just the ones we all hope will work.

In the title I placed the phrase "misunderstood motives." I think perhaps people, including my family, can sometimes misunderstand my motivation for posting articles that temper the grand claims being made by their posts. I do so because I have a drive to help people better understand the scientific process. It was one of my motivations to return to school for my graduate degree. I also have a concern that those who read the grand claims of a miracle cure may turn to these treatments and cause themselves harm. The problem with miracle cures is they do not control for dose, they do not have any safety check for possible interactions with other medications, and the cures could turn out to be a huge waste of time and money that could be used for proven treatments. My motive in understanding the science and sharing it comes from something Dr. Steven Novella has said on more than one occasion: "Science is a process in which we make closer and closer estimations of the truth." Science is not perfect, and it cannot claim to be the absolute truth. However, science is the closest we can get to the truth -- and that is what motivates me.

by Eric Hall

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