"Hello, are you comparing "apples to apples, oranges to oranges?"
In response to an article in Information (Danish newspaper) regarding the effectiveness of Medical Cannabis.
(for the full and edited article)
In an article in Information (13/8/18), Danish professor Nanna Brix Finnerup from the Århus university states that the effect of the Medical Cannabis (MC) on patients with chronic neuropathic pain is no more than the placebo effect.
The Danish professor Nanna Brix Finnerup (pain researcher) concludes from a meta-research that the effect on pain in the group of patients suffering from chronic neuropathic pain is no better than the placebo effect.
Her article and tre research she has conducted is seen in the light of the four-year trial period decided by the Danish parliament that started at the beginning of this year.
The trial period is to be accompanied with a state financed research program aimed at validating the effectiveness of the use of MC in the treatment or ailment of symptoms from four designated patient groups.
If the results are not definite, the future of the program may be unclear.
Evidence from other countries seem to show different results and generally shows a positive response on the same patient group with the use of MC.
The clear difference between the researches that support the use of MC vs. those who reject the effectiveness, is in the products used for as the active components in the research. Whereas the Danish research (and the studies they based their research on) were made on single-molecular extracts, the clinical trials that showed positive responses to the MC treatment were based on smoking, inhaling or full-spectrum extractions of Cannabis flowers.
What is the difference and why is it so important?
Research by Prof. Mechoulam of Hadassah Hospital, Jerusalem and other researchers show the folowing:
In the Cannabis plant there are over 100 active cannabinoids and another 200 Terpenes and Flavonoids. All these work in an "Entourage effect", a symbiosis between the different active ingredients.
The Entourage effect:
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The term entourage effect refers to a concept and proposed mechanism by which compounds present in cannabis which are largely non-psychoactive by themselves modulate the overall psychoactive effects of the plant (these resulting principally from the action of the main psychoactive component of cannabis, tetrahydrocannabinol (THC)).
The dose–response relationship:
The dose–response relationship, or exposure–response relationship, describes the change in effect on an organism caused by differing levels of exposure (or doses) to a stressor (usually a chemical) after a certain exposure time, or to a food.[1] This may apply to individuals (e.g.: a small amount has no significant effect, a large amount is fatal), or to populations (e.g.: how many people or organisms are affected at different levels of exposure).
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The result of this "Entourage effect" is that the effective ingredient is not only the THC, the CBD or anyone of the cannabinoids by itself. The effective ingredient is the whole spectrum of the materials in the plant. Even different plants (genetics) with the same THC:CBD content act differently on the patients, proving that other components have an active and important role.
Moreover, it has been proved in researches that when the effects of single-molecular cannabinoids has been researched, most often the results are a bell-curved response (see "dose response relationship").
In practice, it means that it's extremely difficult to find the optimal dosage and that this dosage is particular to each and every patient.
When performing a clinical trial, the dosage is a controlled variable, thus the amount of medication for a certain group is constant. This may not be, and in most cases can't be the optimal dosage for the majority of the patients.
Adversely, with the whole spectrum as the "active ingredience", the dose-response curve is rising for most of the scale and then leveling out, meaning that there is a better chance of dosing in the "effective area". The issue is easily explained in the following graph.
Its easy to se why negative results may occur from experiments that are carried out on single-molecular products.
In this case, this may be the result of standard medical research and trial methods used where Herbal Whole system research approaches would have been more appropriate.
The discourse surrounding MC in Denmark is at this time concentrated around two main groups: The protagonists, mainly constructed of celebrities and "evangelists" who base their case in anecdotal proof and the antagonists who base their case in lack of scientific evidence.
In my opinion, both groups are misleading the public. The anecdotal proof is important in order to put "markers" for future research. The researchers, on the other hand need to re-calibrate their scientific methods and base them on the methods more suited for multi-molecular substances, in order to validate their findings.
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Peter Israel
CannaBizDev Consultant
+972-52-5516653
Peteri1967@gmail.com
https://peteri1967.wixsite.com/dan-is-cann
Upcoming articles:
"Medical Cannabis for Grandma and Grandpa – what is it good for?"
"Medical Cannabis for tretment of PTSD – They put their lives on the limb for us, we owe them all"
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