CBD for Everything
It is not hyperbolic to state that there is practically no consumer commodity on the market that is not offered with a CBD additive, the main non-psychoactive component of cannabis. Especially in an era when more and more jurisdictions are legalizing or decriminalizing the use of marijuana and its various byproducts, everything from food and drink to clothing to supplements to beauty products to pet care to hand sanitizer can be found in a store with CBD added. And when one turns to the alternative wellness websites selling all manner of snake oil for all types of conditions, both real and imaginary, the full scope of the CBD fashion trend comes into focus. It is claimed by someone somewhere to be the miracle cure to every disease, which Big Pharma doesn't want you to know. Today we're going to see if these products do indeed warrant your attention and money.
The irony of the Big Pharma conspiracy theory claim, of course, is that Big Pharma has been selling various cannabinoids for a long time. The only difference is that they're limited to selling prescription medications proven to successfully treat a specific condition; while the free market goes right ahead and sells them any reason or no reason, with or without any accompanying claims or explanations.
CBD, or cannabidiol, is one of the two most familiar compounds found in cannabis, commonly called marijuana or hemp. The other is THC, which is the psychoactive drug that gets you high. CBD is not psychoactive — meaning mind altering — thus it will not get you high. CBD is typically derived from the hemp plant, which has low THC. But although CBD is not psychoactive, it is still pharmacologically active. It is very much a drug, and it has real physical effects in your body.
Unfortunately, that little fact is horribly abused in the market, and pitchmen make every claim you can imagine. I went to just one web page, on a marijuana advocacy website called "Ministry of Hemp", and found these claims for CBD on just the one page:
That's not all that long of a list. You have to go to the flagrantly fraudulent anti-science websites like Mercola.com to get the real dirty laundry list. According to them, CBD treats:
And these benefits are delivered via the following products:
But the fascinating thing — to me, anyway — is that the vast majority of these products make no claims whatsoever for what the CBD will do for you or why you should take it. Evidently it's just "assumed" that it's a good thing. And a lot of consumers do appear to be assuming that: CBD sales in the United States are projected to hit $1.6 billion in 2021.
This claim of treating just about any type of condition is one of the biggest red flags in the alternative health market. What we typically find is that products that claim to treat everything actually don't treat anything — and usually do nothing at all.
Not so with CBD. In 2018, the FDA approved the first CBD prescription drug, called Epidiolex, for two rare types of serious epilepsy, Dravet syndrome and Lennox-Gastaut syndrome, which usually don't respond to other antiseizure treatments. This made it a Schedule V drug, and that made it illegal for anyone else to sell CBD as a treatment for anything. Obviously this is a law which is ignored wholesale, though the FDA burns the midnight oil sending warning letters to offenders.
Update: Epidiolex was subsequently descheduled two years later. —BD
Driven in part by the enormous public interest in CBD, scientists all around the world are constantly testing it to see if it can do more than just treat epilepsy. And so far, not a single case has found sufficient evidence — any claims you see on pro-CBD websites that it has been found to be effective for anxiety, pain, whatever, are (so far) in contradiction with the evidence. Don't believe them.
Unfortunately, the results of legitimate scientific testing have no impact on the general population. Makers of any product can put a term that's legally meaningless — something vague like "clinically tested" or even "clinically proven" — on their package and in their advertising, and to the average person, that means the product works. And what's even more persuasive are anecdotal claims like "it worked for me," especially when they come from someone they know. Compound that with a reasonable sounding challenge like "just try it, you've got nothing to lose," and you'll have throngs of consumers heading to the store shelves to buy — and once they do, that's when all of our human cognitive shortcomings come into play, and we get a generation of people absolutely persuaded that something works, when in fact it does nothing at all.
What are these cognitive shortcomings? We covered this in detail in episode #533, "Don't Try It Before You Knock It". When we approach a personal experiment like trying CBD, we all bring preconceived notions and expectations. We have personal biases. We are subject to all manner of perceptual errors. We make interpretations of our experiences, and we all interpret them differently. We have moods, up days, down days, personalities, tendencies. We have nothing to rely on for the results but our senses, which are prone to error and inconsistency, and everyone's are calibrated differently. All this is why a scientist who wants to test a new treatment never tries it herself; she does not want her objectivity to be tainted. Instead, she designs a clinical trial with thousands of participants who are blinded, meaning they don't know what drug they might be taking, if any; and neither do the people giving them the drugs. The results are measured objectively by blinded technicians who don't know anything about each participant's history. This is how the scientist gets untainted and reliable results.
What's been found in nearly every case where CBD has been tested for some vague wellness benefit or some medical condition other than those few it's been approved for is that CBD doesn't do anything; but in each of those cases, countless people are firmly convinced of the opposite by their own cognitive shortcomings. Overlooking solid scientific results in favor of contaminated personal interpretation should not be seen as a courageous, free-thinking act of patient empowerment and medical freedom, but unfortunately, that's exactly the way the majority of the general public sees it.
Why? It all comes down to our brains' tendency to prefer anecdotal thinking. Notice that when anyone gets a severe compound fracture of the leg, they all go straight to a real medical doctor. Why? A broken leg is visible. It's right there to be seen and verified, and the medical treatment can also be immediately seen and verified. We believe what we see and what we perceive. But when people get cancer — potentially a far deadlier condition — many people reject medical treatment completely and instead head for the herbalist. Why? The cancer is internal and not verifiable by the patient himself, nor can its progression or remission be visually verified. The patient has only his instincts to go by, and if his instincts are to embrace the anecdotes he's heard in favor of CBD or whatever the treatment, then those instincts will persuade him it's working. In a lack of any obvious evidence in plain view, our brains fall back to their database of anecdotes. Thus, the more that diseases lack obvious outward signs, the more we see people treating them with unproven products.
And it's not just that these CBD products are unproven, it's that the dosages and purities available on the market vary wildly and cannot be consistent with any hypothetical treatment plan. A major difference is seen between the CBD products sold in the United States and those in Canada, for example. In Canada, they're legal and required to be independently tested and verified. Their CBD to THC levels are printed on the label and have been verified to be correct; if you want to try a specific formulation, it's easy to go out and get it reliably. But in the United States, access and legality is all over the map, varying by state, and none of the products available in stores are required to be tested. Most have not, and those that are almost always turn out to differ significantly from what's on the label. A number of studies have tested samples bought on the open market; one popular study published in 2018 in the Journal of the American Medical Association found 26% of them contained less CBD than they claimed, and THC was found in 21% that claimed to have none. Concentrations were all over the place, which is to be expected since there are no accepted dosages for any condition. There is insufficient data for there to be any such thing as an informed patient, and if there was, there would be no way to reliably obtain the intended product.
Moreover, since it's a real pharmacologically active drug, CBD has real side effects. It does have potentially dangerous drug interactions, and so anyone taking it should check with their pharmacist. Epidiolex — the active ingredient of which is CBD — has a long list of published side effects, including agitation, chills, irritability, loss of appetite, nausea, throat and stomach pain, and drowsiness. Anyone taking CBD in significant doses should expect these as well.
However, the bottom line is that CBD, when taken in the amounts people generally get in their smoothie or their latte, appears to be generally safe. It is likely among the least risky of pharmacologically active compounds that people use to self-medicate. The question is whether this is something you really want to go out of your way to do: take a prescription epilepsy drug at an unknown dose when you don't have epilepsy. Despite CBD being relatively low risk, I can't think of a single reason to recommend taking it for any condition that the evidence so far has shown us it does not treat. Until that changes, you're probably better off saving your money.
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