In this recent interview, Bruce Kendall and Dr. Hinanit Koltai of the Volcani Institute share the inspiring story of the late Michelle Kendall and how her passion for science and research brought them all together to study medical cannabis as a potential treatment for ovarian cancer.
Michelle Kendall was a scientist. She had a scientific mindset and tackled problems strategically. When she was diagnosed with ovarian cancer, she took those skills and put them to use. She followed the doctor’s treatment plans until they stopped working and then she started her own scientific pursuit into medical cannabis research—going so far as to personally fund research in Israel with Dr. Hinanit Koltai of the Volcani Institute. Michelle also documented her experience in the film Schedule 1, which is available for free on YouTube. Tragically, Michelle passed away from her ovarian cancer before seeing the research efforts fully come to fruition. However, her husband Bruce Kendall and Professor Koltai are continuing the efforts that Michelle started and hoping to one day find improved treatment options for patients with ovarian cancer. Here, Bruce and Professor Koltai share their story and the current state of their research into medical cannabis.
This research is still moving forward today, with the most recent findings published in early November 2022 in the journal Molecules (1). That article was part of a special issue called “Natural Compounds with Activity against Ovarian Cancer: In Memory of Michelle Kendall, an Ovarian Cancer Warrior” (2).
Bruce, can you tell us about your background and how you and your wife, Michelle Kendall, started Canna Onc Research?
Bruce Kendall: I'm a professor of environmental science and ecology at University of California, Santa Barbara. That's completely unrelated to how we got into cannabis medicine. But I do have a background broadly in biology, and Michelle also worked in the environmental field. So, we were both environmental scientists.
Back in the winter of 2016 Michelle was diagnosed with advanced stage ovarian cancer. She responded well to the initial treatment, but had a recurrence after about a year, setting a pattern in motion of repeated treatment, remission, and recurrence.
Toward the end of her second remission, Michelle was introduced to the idea of medical cannabis by a neighbor who was a retired physician. Never having used anything stronger than alcohol, she started taking cannabis with great trepidation, hoping for nothing more than better sleep. At the same time, she was getting bloodwork for a cancer marker every three weeks. At this point, the levels were starting to increase as her next recurrence began. She quickly noticed that the rate at which the marker increased or even whether it increased at all was dramatically affected by whether she was using cannabis during those three weeks and what sort of cannabis she was taking—whether it was high tetrahydrocannabinol (THC), high cannabidiol (CBD), or so forth. She talks about this quite a bit in the movie we produced called “Schedule 1.” She started reading about cannabis and cancer online, discovering “crazy” patient testimonials claiming that cannabis cured their cancer. But with a background in science, she was unfazed by the peer-reviewed literature and dove into PubMed reading the preclinical studies on cannabis and cancer that, at that point, were just starting to accelerate. Michelle also watched lots of videos of talks by the scientists who were working in this field.
So that was exciting because we really saw that cannabis had potential through our personal experiences. And all through this I was cheering her on, but she was really leading the charge to learn about medical cannabis. When she showed me the literature on the endocannabinoid system, I realized that there's real science, there's a real biological mechanism here. I really became convinced. So, there we were. The challenge was, as we know, that cannabis is a complex plant biochemically and cancer is also very complex. And every cancer, it seems like, is different in its underlying mode of action. So, finding a cannabinoid-based treatment for glioblastoma doesn't necessarily say anything about what's going to work for ovarian cancer. And it was clear that there were probably some key cannabinoids that she needed to be focusing on. But at that time, as far as we could find, nobody was doing research on cannabis in ovarian cancer.
So, in the summer of 2020, Michelle started contacting scientists who were working in the cannabis and cancer space, and Professor Hinanit Koltai (PhD) responded enthusiastically. From there, she and Michelle had a series of conversations about what Michelle was looking for in terms of finding which cannabinoids might be most effective in treating ovarian cancer. Professor Koltai’s laboratory at the Volcani Institute in Israel is leading research on cannabis and cannabinoids to identify optimal combinations of cannabis compounds for the treatment of different medical conditions. Professor Koltai came up with a proposed research plan, and we came up with some money from our personal savings. Then we then formed the company Canna Onc Research as a venue to contract with Professor Koltai’s organization to fund research in her lab to identify the key cannabinoids that are most effective in killing ovarian cancer cells in lab culture. So, that was how it all got started—it was Michelle trying to hack her way to finding the set of cannabinoids that might treat her disease.
Professor Koltai, can you share a little bit about your background, how you how you felt about getting involved with the Kendalls, and an update on where things stand with your research?
Professor Hinanit Koltai: Yes, I'm a senior research scientist at Volcani Institute. Volcani Institute is a governmental institute in Israel for agricultural research. I have been a scientist at Volcani for more than 20 years now and I have worked on several different subjects during my career. At some point, when I became a full professor grade scientist, I began to feel that I was not fulfilling my destiny. I worked on the very interesting subject of plant hormones, but I felt that it was not enough. So, my lab and I turned to the research of medicinal plants.
This gave me and my team the clear aim of having products that could benefit people, could benefit patients. We bear this aim in mind. The interest in cannabis started to rise worldwide. When I started to read more about it, most of the research papers were quite old at that time. When I started to read and study the subject of medical cannabis use, I realized that there was a gap in knowledge in the medical use of this plant, among other things of course. This gap was based on the lack of knowledge about the active compounds. What I mean is that there were quite a number of scientific papers that were describing the use of the whole flower, of the inflorescence as we call it, or maybe full spectrum extracts. There were quite a number of scientific papers that described the use of a single compound from cannabis such as THC or CBD. But nobody looked at the composition of compounds from cannabis that could be efficient, beneficial, or optimal for the treatment of different medical conditions.
Cannabis produces hundreds of different compounds as a species, and in each strain you can find several dozen compounds that are being produced. And yet, even today, for medical use, people are looking primarily at CBD or THC. You can find high CBD extract or flowers or high THC extract or flowers. This is maybe fine for recreational use, but it's not good enough for medical use. This is because we know and we have found that cannabis compounds can act in synergy and therefore, finding the best combination of compounds for the treatment of specific disease is highly important. We believe that finding that best combination can lead to proper and efficient use of cannabis. So here I laid out in a few words our basic thinking and hypothesis as well as the aims that drive our research.
About two years ago or so, I got an email. At that time, I used to get quite a number of emails from different entities or commercial companies that asked me about our activity. One of the emails asked me very shortly if we're working on ovarian cancer. And of course, this email was from Michelle. I answered her as I answered everybody and said, no, unfortunately, we have not yet started working on ovarian cancer. Although even at that time, I have to say that we had up until today, two main questions: One, what is the best composition of compounds from cannabis for the treatment of inflammation? And two, what is the best composition of compounds from cannabis that may act as an anti-cancer agent? But at that time, indeed, we were not working on ovarian cancer.
So, Michelle asked me if maybe I would be interested in working on cannabis and this disease. And I said, let's talk. Then we had a Zoom meeting and from the first moment, I was completely captivated by Michelle’s personality, by her hope, and interest in cannabis. I was completely convinced after talking with her that this should be one of the avenues that we should take on with our research. So, since then, we have been collaborating. In the last year of Michelle's life, we were able to move forward together and to uncover initial findings.
Can you please share some of the most interesting findings from the study so far? And how do those relate back to Michelle's journey?
Professor Koltai: During our collaboration, what we were able to find is the actual combination of compounds, of vital cannabinoids, and cannabinoids from cannabis that act efficiently and specifically against ovarian cancer cells. We started with cell lines, with cells of ovarian cancer, and looked for different composition of compounds from cannabis.
We found two compositions that were highly cytotoxic to these cells. It means that these two compositions—both of them, by the way, contain THC and additional compounds as well—acted efficiently and killed the ovarian cancer cells. And yet they were much less potent against normal cells. This was very encouraging. Following this finding, we looked at the effect of these combinations against cells that were extracted from a lymph node of Michelle. These cells were grown in the US after they were extracted and then were sent to us. We found that we could effectively kill these cancer cells.
We also found out more about the ability of cannabis compounds in these certain compositions that were effective: The ability to work synergistically with monotherapy and chemotherapy agents. This was so exciting to show first that the compounds from cannabis were working and killing Michelle’s cancer cells. That's one. And two is the ability of these compounds to work synergistically against the cancer cells with chemotherapy, and the chemotherapy (monotherapy) that we examined, mostly at that time was niraparib. This is one of the treatments that Michelle indeed was receiving at some point, at least for her disease.
Another set of findings that we had and are still working on is the mode of action. We were very much intrigued, all of us, about the synergy between cannabis and chemotherapy. And what we have done up until now is that we are looking at the gene expression that is induced in these cells, in the cell lines in response to the synergistic treatment.
That's just incredible groundbreaking work that you've been doing. So, where does the study stand currently? What are you working on now and what are the next steps?
Professor Koltai: What we emphasize is to examine the combination of cannabis compounds and sets with various chemotherapies. This is so important because it is quite clear that ovarian cancer patients will not use cannabis only or stop receiving chemotherapy or radiotherapy and use cannabis only. Rather, we see cannabis as a complementary and supportive treatment for these patients. And what we found is that cannabis is able to sensitize the cells to chemotherapy. So, they make the ovarian cancer cells more sensitive to niraparib. And we also have some findings as to the ability of cannabis to make these cells more sensitive to other chemotherapies.
In one approach, we think that cannabis should be part of the treatment, though not the only treatment, and be combined with chemotherapy. This view of a treatment is leading the questions that we ask now as well as what we’ll askin the next few months. One question would be about the mode of action. What is the base of this increased sensitivity of cells by cannabis in terms of gene expression, of protein expression, involvement of other genetic elements in this cannabis activity?
Another subject is targeting the stem cells that are developed in between the cancer cell population. I will explain. The recurrence of the disease that was described by Bruce is usually a result of stem cells that are resistant to chemotherapy and are able to invade tissues and to form new tumors. And of course, this is the basis for metastasis. We set forth to target these stem cells of ovarian cancer. And what we ask now is whether cannabis can target these cells specifically, that are part of the cancer cell population and are the most dangerous ones, you may say. And targeting them is so important. So, that's also very exciting. And we're looking into this ability of cannabis to directly target stem cells.
Another avenue of activity is in vivo studies. In these studies, we look for the ability of cannabis compounds in combination with chemotherapy to target tumors that are formed in mice. This is so important to look at because only looking at cells is not good enough. In so many cases, different compounds are working very nicely or wonderfully in stem cells, but not in vivo.
What we can say already about this ongoing work is that we have completed one experiment on mice, and we definitely see that cannabis is able to support and even promote—to some extent—niraparib activity, the monotherapy activity in mice, and lead to a significant reduction in tumor size or volume. But this is only one.
The last avenue that I would like to raise and talk about is clinical trials. We will never be able to say that we have succeeded or that cannabis has anticancer activity unless we have successful clinical trials. Clinical trials are urgently needed because women are diagnosed with this disease and there is not much to offer them today.
As we see, once we find these compounds that might be helpful, we need to go into clinical trials as soon as possible. And here I will leave science for a minute and tell you that clinical trials are usually highly expensive, and we are desperately looking for somebody or entity that could help and finance clinical trials. We feel the urgency in doing so.
Can you discuss the difference in doing research where you're based in Israel compared to the US? I know the funding is a huge issue, but is it relatively easy in Israel to do a clinical trial and conduct this type of research compared to the US?
Professor Koltai: Yes, here in Israel we are in a very productive atmosphere regarding cannabis research at both the preclinical and clinical levels. Thanks to our Ministry of Health we are able to promote the medical use of cannabis in a few ways, although cannabis is illegal in Israel for recreational use.
One of the ways we can promote the medical use of cannabis is the qualification of physicians to register cannabis to patients for medical care. The second is the ability to conduct research. Everything we do, we do under authorization of the Ministry of Health. For example, we can conduct research in the lab and also as clinical trials in hospitals.
This ability to be authorized to conduct research, both preclinical and clinical, has paved the way for making real progress in cannabis medicalization. Yet, the fuel we need to keep moving is funding.
I would like to say that without Michelle and Bruce, we would not be able to move. They were very supportive, and Bruce is still supporting this research. Through this kind of support, they're the ones that have allowed the progress of this research.
Why is this research into cannabis and cancer treatment is so necessary?
Professor Koltai: Maybe I can start, and Bruce can add his thoughts as well. I would reiterate that there are currently no good solutions, unfortunately, and no good treatments. Bruce can say more for ovarian cancer. Ovarian cancer occurs in about one out of every 60 women. So, it's not rare. And still, modern medicine has nothing to offer yet.
Patients, in some cases, are reporting that the use of cannabis led to some halt in the progress of cancer (for this cancer and others). Even if we are not talking about the miraculous recovery or healing, if we are able to get the disease into remission and allow the patients to live longer and better, then I think it's worth any effort.
Bruce Kendall: I think all cancers are horrible diseases, but ovarian cancer is particularly challenging because it doesn't present obvious symptoms and so most women are diagnosed at a very advanced stage when the cancer has already spread through the body. So, the prognosis at that point is always challenging.
From what I understand, the primary treatment for ovarian cancer is usually surgery to remove the gross tumors and then chemotherapy. And for patients, as far as I can tell, it's a binary outcome at that point. Either the disease never recurs and so the patient can be considered cured or there is a recurrence.
If there is a recurrence, then subsequent treatments are never curative. There can be multiple remissions, but it just keeps coming back. And the challenge is that the chemotherapy agents themselves are so toxic that, first of all, patients develop allergic reactions to them after a certain amount of time. And the cancer can develop resistance to them. So, each recurrence becomes harder to treat and eventually becomes untreatable.
That's what happened with Michelle. Her final recurrence came back raging much faster than previous ones. They had to take her off the platinum-based therapy, which had worked so well before. So, that's the context of where we are. If that first line treatment is not successful at eradicating the disease, then there is no long-term cure or even long-term living with the disease.
I think there's still not much known even in terms of patient stories about ovarian cancer, in particular with cannabis. But the fact that Michelle had this initial response that was so encouraging should be discussed. I think this is a disease where we need as many tools as we can get. Cannabis looks like it has the potential to be another powerful tool in the fight against this disease, so we need to learn as much about it as we can and bring it into therapeutic use as quickly as possible.
But I also want to come back to what Professor Koltai was talking about with stem cells. From talking with the cannabis physicians that Michelle worked with and the stories that she had heard when she reached out to other patients, it appears that in many cases, when patients are able to control their disease using cannabis, as soon as they stop taking cannabis, the cancer comes back. So, it seems as though it's not that cannabis is eradicating the cancer altogether, but it may be preventing the cancer cells from proliferating. There are still cancer cells lurking in the body, but the cannabis is preventing them from turning into stem cells and launching a new recurrence, building new tumors, and metastasizing.
There are certainly conventional medicines that are trying to do this same thing, but they're not very effective, at least the ones that we have on the market now. Michelle was on one, and the clinical studies for that drug show the average increase in time to recurrence was just two months. So, it is a very expensive drug that adds just a couple of months to a remission and cannabis seems like it might have the potential to be more effective in that role. If we can make that happen, that would be wonderful.
What role do you think cannabis can play in cancer research and treatment? Bruce, can you share a little bit more about Michelle's experience?
Bruce Kendall: Yes, I sort of touched on that in the previous answer. But I think Michelle's experience was one with a lot of frustration at how little was known about the mode of action and which compounds to take. She was working with a cannabis physician in Southern California who had worked with lots of cancer patients, although not ovarian cancer patients.
In the absence of research, the physician was just basing the treatment on her own clinical experience. Her recommendation was simply to take high doses of all the major and “major minor” cannabinoids, so that was what Michelle was taking in 2020 and 2021. It was unclear whether it provided any benefit—I mean, it was high in THC, but it didn't have some of the compounds that Professor Koltai’s research identified as being part of the mix for ovarian cancer.
So, it was very frustrating. As Michelle used to describe it, it's as if the oncologist was just picking chemotherapy drugs at random to apply to her disease. And that's, of course, not how medicine works. The other challenge that Michelle faced—and everybody who tries to use cannabis to cure cancer faces—is just basically taking a very broad spectrum approach and hoping that there's something in there that works. It's very high amounts of THC, far more than anybody uses recreationally, so it interfered with her ability to focus and get things done. That was very frustrating. Her hope was that a more targeted formulation would be as effective at a much lower dose, so that she could live a normal life at the same time that she was taking this medication.
I think the main thing is that we know from the preclinical research that different compounds—the various cannabinoids, terpenes, and flavonoids—each have different effects on different cancers. The more targeted we can be, the more effective and efficient it can be as a medicine. I think that's really the goal here.
Professor Koltai: I think Bruce summarized it very nicely. I would just add one element of the endocannabinoids. We know today that cannabis compounds bind to receptors that belong to the endocannabinoid system. We also know that the endocannabinoid system is deeply involved with different states of health and disease. And we know that many diseases are associated with the changes and malfunction of the endocannabinoid system. Thus, because of that, we think that the cannabis by binding to the same receptors that are part of the endocannabinoid system, just by doing that, is able to affect many, many processes in the body and then perhaps improve the different medical conditions, the symptoms, and to contribute to the homeostasis of the body, which is of course, desired.
In the cannabis industry, one of the most amazing things is seeing how patients become activists themselves, and they take on this role of wanting to help others where they needed help and pave their own way. Bruce, can you tell us a little bit about how the idea for the documentary, Schedule 1, came about and what were Michelle's goals with creating that?
Bruce Kendall: It was a bit of a serendipitous moment that led to the film. The back story, as we discussed, was that Michelle was really frustrated by the lack of research happening in the US and the fact that while medical cannabis was legal in many states, it was still completely separate from the medical system and largely discounted by most physicians, including her oncologists. They didn't dissuade her from taking cannabis, but they just expressed no opinion and not really any interest in it. At the same time, Dr. David Bearman is here in Santa Barbara, California and so Michelle got a crash course from him on the history of medical cannabis use and regulation. She knew nothing about cannabis before she started this. She had no interest in recreational drugs or any of that sort of thing.
This was a new territory for her. But then she started trying to be active in in the fight to reschedule cannabis to make it easier to do research in the US and was frustrated by the administrative foot-dragging with the US Drug Enforcement Administration (DEA) and the US Food and Drug Administration (FDA). She was having coffee one day with an old friend, who she'd worked with probably 20 years previously and was telling him the story. He is a documentary filmmaker who mostly does environmental and marine documentaries. It turned out he had just finished a big project and didn't have anything else major lined up. He said, “Well, let's make a film together.” So very quickly, they got excited and sketched out what that might look like.
Then the filming started. The first day of filming was the morning that Michelle went into the hospital for debulking surgery for her third recurrence and that scene is actually in the film. But Michelle's real goal was that she wanted this film to use her story to influence policy makers, influence the discussion around medical cannabis, and really make it clear that it's not a fringe thing and it's not just about treating nausea. There are real potential medical benefits to cannabis and we need to change the system, reschedule cannabis to make it easier to do research and turn loose the massive biomedical research machinery in the US on this problem.
She was really hoping to get wide viewership of the film. Her fantasy was that her story would get picked up and turned into a dramatization like Erin Brockovich and become a feature film. But in the short run, initially, they were hoping to get it shown at the Santa Barbara Film Festival in the winter of 2020, but the post-production ran too long to get it into that film festival.
Then she was lining up film festivals starting in spring of 2020, and it actually played at one festival in Los Angeles in mid-March. But by that point we were too anxious about COVID to even go, and we have no idea if anybody actually was in the theater when it played. Then all the other festivals were cancelled because of the pandemic. So, that was a huge disappointment because she was hoping to use those film festivals as a way to get the word out about the film and maybe get it picked up by one of the streaming services or something—some way to get it launched to a higher level of visibility. But when we got over our initial naive ideas that the pandemic would just be a few weeks and it was clear that we were in for the long haul, that's when she decided to simply put the movie on YouTube so that people could at least see it. Then her website and advocacy on Twitter became the main way that she promoted that film and tried to get the word out.
Michelle approached this as a scientist and said, “This is science, this is not just people telling stories, there's real science here.” So, she also used her website and tried build it into a hub of information for people who were looking for resources and information about what's known. At least the little bit that is known scientifically about cannabis as a potential treatment for cancer. She linked to videos by researchers like Dr. David Meiri and linked to some of the key papers and podcasts. Through her website a lot of other cancer patients who were looking for new solutions and exploring cannabis reached out to her. But she was careful to say that she couldn't tell people what to take. She would explain that we don't know what works, but offered what worked for her and shared what the studies said. This was stuff that she was doing on her time. I know some of the people that she interacted with, but not all of them for sure. But she definitely became a voice not only advocating for improving the rules around research, but helping other patients find the limited information that was there and helping them interpret that. I think she made some strong connections that way with people around the world.
Professor Koltai: I would like to add two things. First, I would like to mention Nurit Shalevand a touching story of hers. She's my employee. She has an MSC, so a master's degree only. And for years, she wanted to have a PhD. She came to me and said that she's working just like as a PhD. Everybody from all sides have PhDs and she only has an MSC, so she was frustrated about it.
When this project began, I suggested to both Nurit and the Kendalls that the support we were giving to this project would also be directed to Nurit’s PhD studies. Bruce and Michelle liked this idea. Indeed, as Bruce said, carrying on this research is Michelle's legacy. Within this, Nurit is conducting her PhD studies and research. I think this is a part of the story and an important aspect of it that Michelle and Bruce were able to benefit—beyond benefits to my lab and benefits to science, they were also able to benefit Nurit personally and allowing her to conduct her PhD research.
So, that's the one side that I wanted to raise. Another personal side that I wanted to raise is about the importance of this project, of this research, to me. As I said earlier, I've been a scientist for 20 years. I've got maybe 10 years to go or so before retiring. So for me, this is a chance—maybe the last chance—to make a difference. This project became so important, both professionally and personally, for me as a scientist. I hope to make a difference in the world. So again, this is the personal aspect that I wanted to raise.
What are some of the barriers to cannabis research and how do you hope to see those barriers be overcome in the future?
Professor Koltai: As I said before, thanks to the Ministry of Health, we do not have many barriers in terms of pre-clinical or clinical research and authorization in Israel, which is a huge advantage.
However, one major barrier for going into clinical trials is money. We need support to conduct clinical trials. That's the number one barrier as I see it. Then there are additional barriers that I believe that can be overcome with time. One is overcoming the complicated regulation of developing a new medical product, especially one that contains several compounds. This is something that while conducting clinical trials with the support of a company that could produce these cannabis-based products, we would need to overcome.
The last barrier that I can think of is the stigma regarding the use of cannabis. We know that for years and years cannabis users have suffered from the stigma of it being harmful and the negative association with it. I think that the way that we see cannabis and the compounds that are being produced in this plant as ones that provide a unique and substantial opportunity for treatment of different diseases is not fully accepted yet by many of the stakeholders and many of the MDs. So, this is another barrier to overcome, the stigma of the medical use of cannabis.
Bruce, do you have anything to add?
Bruce Kendall: Well, I would just add that seeing how medical cannabis research can work by watching it in Israel just makes it more frustrating to witness the regulatory barriers here in the US. For example, look at how difficult it is for scientists first to get a Schedule I license to do the research and also to obtain high quality product.
I'm excited that Congress has just passed a medical cannabis research bill that could make this easier. My reading of it is that cannabis research is still going to be highly regulated, and it'll still be one of the more challenging things to work on from a research perspective, just because of the regulatory hoops that have to be jumped through. But I'm pleased to see—and Michelle would be thrilled to see—this moving forward. She was frustrated by the fact that there was so much attention on legalizing cannabis for recreational use and not much thought going into research for medical use. I think this is exciting that maybe the one big reform bill that we do get this Congress is one that will make research in the US easier to do.
The other challenge is, even as Professor Koltai mentioned, is the patchwork of regulations and the patchwork of attitudes in many countries and states in the US that make cannabis absolutely illegal. One of Michelle's other passions was she loved to travel and of course, international travel, while you're taking cannabis, is a very risky thing to do. So, if she was looking at a long-term maintenance treatment of cannabis, we were like, “Well, how are we going to see the world?” And really, until there's acceptance of these compounds as a medicine and that it's treated the same and viewed the same as any other prescription medicine in terms of travel domestically and internationally, you can’t travel. I mean that's what we really need for people to be able to have normal lives while they're using cannabis as medicine. I think that's another area where I think we're making progress, but it's slow and fitful. But countries that have absolute rules about cannabis make large parts of the world “no go” zones for people who need cannabis to treat their disease.
Where can patients go to learn more information or share their experiences?
Bruce Kendall: Well, I think there are a lot of websites that people can go to. I don't know them as well as Michelle did, so I don’t want to recommend any one of them in terms of getting information. While Michelle was maintaining the Schedule1movie.com website, it was a hub of information. However, it's two years out of date at this point.
If someone is actually trying to dive into the science, I think watching videos from conferences such as CannMed is a good way to go. There are also quite a few websites out there that are aimed at patients who don't have that kind of level of scientific desire to get into that level of scientific detail.
In terms of where they can share their experiences, I don't know of any place that they can in a sort of systematic way. That was something that Michelle wished there was. And I think there might be people who are trying to make that happen. But I did a quick search this week and I couldn't find anything that seems like it's a place where patients can go and report their experiences with using cannabis.
What is the most important takeaway from your experience that you would like to share here?
Professor Koltai: For me, the most important take away is first the ability of science, in general, to improve our life. In particular, the potential of cannabis research to lead to the finding of new therapies against cancer.
Many of the compounds that plants are producing are highly beneficial, and many of the medicines that we take today or in the past were originated from plants, starting with aspirin and going into morphine. So, I truly believe in the power of plants in general, cannabis in particular, to improve our lives.
Bruce Kendall: I'd also that the endocannabinoid system is all pervasive in our bodies and our cells all have receptors that cannabinoids can attach to. But every phytocannabinoid, of which there are hundreds, has different effects in the body, on the cells, and in its interaction with the endocannabinoid system. At some level, cannabis provides us with this huge toolbox of tools, of all different shapes and sizes that perform different roles and can work together in synergy. But the effects of any given cannabinoid may be desirable or undesirable, and can affect different diseases in different ways. So, there's a lot to learn here.
It's wonderful that we have this plant and at the very least we can approach it as a whole plant and get some benefit. I think that where the real power lies is in unlocking the effects of each combination of these compounds that make up cannabis in improving the health of our bodies.
I also just want to also say something more about Michelle’s role in all this. She's an extraordinarily inspiring person. And her work in this was amazing. But in a fast-moving disease like cancer, patients don't have time to research their way to a new treatment. Medical research takes too long. But I do think that patients like her can bring a creativity and a kind of fresh look at the problem that physicians mostly don't, or can't, exhibit. Physicians are restricted to thinking about what's already been approved through the whole regulatory process and don't have time to step back and look at the bigger picture. I think that the patients bring an urgency that can sometimes be lost in the day-to-day of scientific research.
Michelle knew that that the odds that this research was going to save her life were slim. But even when it became clear that this wasn't going to be her miracle cure, she was really glad to have funded this research, worked with Professor Koltai and Nurit, and committed us to continuing this research because she believed that she would be making life better for future ovarian cancer patients. This gave her a reason to remain hopeful and future oriented even when she had no future.
Professor Koltai, you touched earlier on the power of plant medicine as well, and so did Bruce about the power to unlock healing for our bodies. Have you seen any differences between studying the plant itself or synthetic cannabinoids? Is there a difference between research there or is it specifically just focused on the plant?
Professor Koltai: We have indeed examined this question. The question is, are there differences between synthetic phytocannabinoids and those that are produced from the plant. There are definitely some chemical differences in terms of stereo isomers. But as much as we would say we did not find any major differences in activity between the synthetic compounds and cannabis compounds. Basically, what we do is we start with the plant and we are looking at the combination of compounds. We find the best combinations of molecules that are most effective. And from this point on, basically a company that produces cannabis-based medicine is able to decide how to go, where it can go, and continue using the plant and its products. But they can also decide to be a fully pharmaceutical company and work and produce products from synthetic compounds (usually) and introducing them into medicine is much harder than using natural compounds, including plant-derived compounds.
But again, it's up to the producing company, the marketing company, and so on to decide how to use the knowledge that we provide. This allows the plasticity in how the producing company is developing. But again, this is up to the company to decide. I would just finalize with saying that several medicines that we are commonly using today went through the same path. That is, they were originally found to be active from ones extracted from the plant and then for the ones where a high potency was proved, they became synthetic or semi-synthetic. So, definitely this kind of development into synthetic phytocannabinoids is something that we would see in the future. But again, even if these compounds are synthetic, we are still using the power of cannabis for the treatment of people.
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