CHAPTER 2
A HERO IN HEALTH CARE
Dr. Michael Masterman-Smith is a biologist and pharmacologist at the forefront of cancer research. Masterman- Smith’s discovery of cancer stem cells in pediatric brain tumors was deemed to be a “high impact discovery” by the National Cancer Institute.1 His research focuses on the development of plant-based drugs, more commonly known in medicine as phytochemicals, to treat diseases. One of those phytochemicals is CBD.
This is groundbreaking work. Masterman-Smith’s findings, as to how to effectively use cannabis medicine, help children dying from usually intractable forms of cancer. What he’s discovered has turned around the lives of families across the country. But, as he tells me, when he talks about his work, he is often dismissed outright, especially by politicians.
“They call me a ‘pot doc.’ And I say, ‘Oh, okay. Alright. You can call me what you want, I’ll be happy to educate you,’” Masterman- Smith says.
CBD and cancer
Most of us have heard about how prescribed cannabis can help alleviate the pain and nausea associated with cancer treatments, but Masterman-Smith’s work is about how CBD can help prevent or get rid of cancer altogether.
In order for a cancerous tumor to grow, it has to start somewhere. The initial stage of cancer, as Masterman-Smith describes it, is when a stem cell changes from having a positive role in the body to a negative one.
As Masterman-Smith explains, “Stem cells . . . normally are in the body to do repair, regeneration and grow parts of our body and build us out. Those types of cells go bad, and they hold all the properties of the stem cells. They can stay alive and do whatever they need to do in our bodies in a health function. This is one of the reasons why people call cancer a heterogeneous disease. But these cells lead to incredibly malignant cancers, and that’s why they’re very difficult to treat.”
Steve DeAngelo is the co-founder and CEO, along with his brother Andrew, of Harborside, the largest nonprofit medical cannabis dispensary in the United States. He is one of the founders of Steep Hill Labs, which is the nation’s first cannabis-testing facility. He doesn’t work with Masterman-Smith, but DeAngelo has been working with cancer patients for more than twenty years, and he explains how these malignant cancers grow faster than we can address them.
“The essence of cancer is that cells that are supposed to die don’t die,” DeAngelo says. “They agglomerate into a mass. That’s the essence of cancer. That happens in two ways. First, there’s a natural process of cell death that usually happens, that’s called apoptosis, and cancer interrupts that process of apoptosis, so the cells don’t die. There’s a second process that cancer uses called angiogenesis, where cancer will appropriate blood vessels that are used normally for other things in the human body, steal those blood vessels and use them to grow the cancer tumor.” All of these cells can divide, either to our benefit or to our detriment. Masterman-Smith calls cancer stem cells the queen bees of cancer: they tell the rest of the cells what to do and when, but the results are always negative. Stem cells tell other cells to divide and conquer through the creation of tumors. Once they found these queen bee cells, Masterman-Smith and his team really got to work. “A lot of really hard lab work is just rigorous drug screening. We looked at drug after drug after drug that might kill these cells. Pharmacology is based on our ability to match a drug to a disease. The drugs already exist, and they’re in what are called libraries. The drug library that we started with included 30,000 compounds: all drugs that were clinically approved for cancer and any other known condition.”
One by one, the team applied drugs to these stem cells and found that the only group of drugs that was toxic to the cancer stem cell were synthetic forms of CBD, which had been known to scientists for about a century already.
“We found a drug class, cannabinoid receptor antagonists, that can potentially treat cancer stem cells,” Masterman-Smith explains. “But then we stopped because we couldn’t progress these drugs into trials.”
Essentially, the form of CBD that Masterman-Smith and his team discovered to be effective wasn’t made in nature but was a chemical version of a cannabinoid created in a lab. This particular early chemical version of CBD made people sick, not well. There’s a pretty simple reason why, says Masterman-Smith. Researchers can recreate what’s found in nature by simply putting together the elements that are in a chemical compound. It’s a lot like following a recipe. The challenge is that, when you try to recreate a meal from scratch, a few key things will always go missing. Scientists are best able to guess at these missing elements, but it’s hard to isolate all of the variables. Synthetic single-molecule drugs can, in some cases, rapidly increase the risk of a range of side effects, depending on the molecules involved, which makes them hard to use over the long term.
Plant-based CBD doesn’t produce side effects, and it works to stop cancer in a really beautiful and elegant way. Inside the tumor itself, CBD restarts apoptosis, which means that the cancer cells begin to die off faster. At the same time, the blood vessels that have been taken over by the tumor (angiogenesis) start to wither and shrink.
“So at the same time the tumor’s being blown up from the inside,” DeAngelo says, “its nutritional lines of supply are being cut from the outside.”
In other words, CBD has the potential to stop cancer in its tracks.
While CBD doesn’t have a positive effect on all cancers, when there are cancer stem cells in play, such as in breast, prostate, pancreatic, ovarian, colorectal and even brain cancers, the chances are that CBD can help shrink those tumors if the cancer is caught at the right time.
“The finding was remarkable,” Masterman-Smith says. “We had shown a potentially useful therapeutic drug class for a particularly lethal cancer. I thought, ‘There’s something here. This is excellent data—we found a drug class to work with.’ I wanted to test plant-based cannabinoids. And I knew this would be a leap from what I had known my entire scientific career, but when you’re looking for a cure, how you get there takes some unusual routes.”
The leap of faith meant that, in 2016, Masterman-Smith chose to leave his job at his UCLA research laboratory and, in essence, become a farmer.
“The goal is to find a cure. I followed my data, I found the drug that could potentially be a cure and I was going to do whatever it took. I said, ‘You know, let’s really dive in and let’s start. Let’s make this transition.’ And I was in the right position as a pharmacologist. It’s my job to develop drugs. Am I going to spend my time on a lab bench? Or am I going to spend my time trying to understand the plant material and understand these strains to go after the cancer? The only difference is that I’m getting it from a plant now.”
The war we should be fighting
Why did Masterman-Smith have to step away from the lab to start looking for a cure for cancer? Why did this highly respected leader in the field of pediatric brain cancer, working to save the lives of America’s most vulnerable children, have to move his research to a farm, rather than continue working under the auspices of a large research group or university?
When it comes to health care, the American way stresses a single standard: rational thought. There’s a structure in place that governs how, when and why we research and evaluate pharmaceuticals and other forms of medicine. Drug research standards are set by the Food and Drug Administration (FDA) so that all Americans can be assured that what they buy is safe to use.
It makes sense. We should be able to look at a problem, research a solution and then apply that solution in every case. We do this everywhere in our society. We create bureaucracies at every level of our economic, legal and scientific institutions because we believe that we can apply rational thought to all aspects of our lives. In these institutions, every person must meet strict and rationalized criteria in their work, usually on a minute- by-minute basis.
For drugs, therefore, the process starts with research aimed at the goal of winning FDA approval. Most of the research in the US must also go through the National Institute on Drug Abuse (NIDA), which looks at the potential for drug abuse in relation to potentially addictive drugs, rather than the therapeutic effects or side effects. In addition, it has to pass the tests of the Drug Enforcement Administration (DEA ), which takes the addiction potential of a drug as sacrosanct in its codification of whether or not a drug classifies as a banned substance. As Masterman-Smith explains, what this means is that, in order to develop a drug and get it through this process and to market, it costs approximately a billion dollars. “Wall Street is basically the only place you go to get that kind of money. Private equity. You’ve got to get massive amounts of money in order to do the basic job of trying to find a cure for cancer,” he says.
The problem for CBD is that it is made from cannabis, a federally illegal substance. Even though it has no psychoactive properties, it becomes the proverbial baby thrown out with the bathwater.
Because psychoactive cannabis has been a strictly controlled substance in the United States since 1940, CBD does not qualify for research status except under very extreme circumstances in which there are a number of checks and balances put into place by the DEA and NIDA; even then, it’s unlikely to happen. And yet other banned street drugs, such as heroin, have their medical equivalents, such as morphine, used on a daily basis in hospitals across the nation.
Thirty years ago, the DEA wanted to address this inconsistency. Judge Francis Young, a DEA administrative law justice, reviewed all evidence from a lawsuit against federal marijuana prohibition in 1988 and found that:
The evidence in this record clearly shows that marijuana has been accepted as capable of relieving the distress of great numbers of very ill people, and doing so with safety under medical supervision. It would be unreasonable, arbitrary and capricious for the Drug Enforcement Administration to continue to stand between those sufferers and the benefits of this substance in light of the evidence. Marijuana, in its natural form, is one of the safest therapeutically active substances known. In strict medical terms, marijuana is safer than many foods we commonly consume.2
The response from a DEA committee was that it refused to reschedule marijuana from its Schedule 1. And yet peer-reviewed studies from one of the most respected medical journals in the world, The Lancet, report that using marijuana as pain relief, even in its psychoactive form, is ten times safer than Tylenol.3 The American Medical Association (AMA) reviewed the randomized, double-blind controlled trials published on the possible adverse effects of medical marijuana over the course of decades and found that it has no substantive side effects.4 No deaths caused by medical marijuana overdose have ever been confirmed in the US.5
Without the DEA and NIDA on side, the FDA won’t even consider easing the way for cannabis-based medicine without a significant backing by a major pharmaceutical firm.
But here’s the challenge: Big Pharma won’t touch it either but not because it’s illegal—because it won’t make them money, at least not on a path they’ve followed in the past.
Let’s take what Masterman-Smith has told me at face value: it takes a billion dollars to create a new drug. The synthetic version of CBD, however, the one that has been created by a pharmaceutical firm sometime in the past, it doesn’t help people. It hurts them. It’s not quite right.
Plant-based CBD, however, can be grown in someone’s backyard.
And it’s safe.
And it works (and we’ll get more into that in the rest of the book).
CBD can be processed simply and easily, and it can be combined with a number of different plant medicines to make it even more effective. But it’s never going to be worth investing a billion dollars in to get FDA approval, because the market for it is simply too diverse. Right now, as we’ll discuss in the following chapters, it’s important to understand that CBD is linked to a spectrum of other cannabinoids that are provided to patients in different, and sometimes very specific, combinations. This means that it can’t be packaged neatly into an easily recognized and marketable drug. As well, it’s a risk for Big Pharma because once people understand how it works, they can access CBD much more inexpensively than a drug company wants to sell it for, simply by growing it and extracting it themselves.
At the time of writing, the company GW Pharmaceuticals is launching, with the approval of the FDA, a CBD-based drug called Epidiolex. It’s targeted at children who have epilepsy, and it consists of a combination of CBD and traditional epilepsy pharmaceuticals. GW Pharma is interested in this work for different reasons than the traditional American firm. First, it’s based in the United Kingdom, not the United States, which means that it has a different set of standards in place for research and development, some of which are funded through the UK university system rather than by the company itself, which offsets the cost of developing the drug. Second, GW Pharma is a relatively small firm in its industry, even though it has more resources than average. It doesn’t quite reach the echelon of what we refer to as Big Pharma, and it’s more flexible in its practices as a result. Third, and perhaps most important, the company can protect its financial rights to CBD only by combining its own pharmaceutical compounds with this plant medicine. Big Pharma does not try to patent entire plants. All a company can patent is the specific genetic design of one generic version of a species. And because countless genetic versions will produce the same and beneficial pharmacological result, there’s no way for a company to make money on the whole plant. What it can do, however, is isolate molecules from a plant and claim the invention of using it for some specific purpose. This is what GW Pharma is doing.
In the United States, in comparison to the UK and other nations, our medical system is affected by a complicated system of laws that allow corporations to do what they’re designed to do— make money in any way that is not illegal, rather than serve the public interest. It’s about money: not only does Big Pharma have the investment dollars to get drug approval via the FDA, they also have the ability to lobby both governments and individual doctors to push their products into the American system.
And that’s why Masterman-Smith, one of the shining lights of cancer research in our nation, has become a farmer.
“We are in a war on cancer,” he says. “There’s no doubt about it, we throw plenty of drugs at cancer, and we do everything we possibly can to treat cancer. It’s a horrible, horrible disease, and we need to go after it with all the guts and gusto we have. But I’d always felt I was an unconventional warrior, so going off to a farm to find a cure was a no-brainer to me.”
Rationality that isn't rational
Masterman-Smith is an unconventional warrior. Most American doctors follow what is known as an allopathic medical code, based on the idea that we can test everything using the scientific method. There is a limit to what we can model in nature, and so there is a limit to what we can prove with pure scientific experiments and the general scientific method. We cannot control for everything. The scientific method requires strict controls on experimental inputs. But any physically realistic system in the universe cannot, even in principle, be disconnected from the influence of the environment or the non-computable complex system’s internal self-evolution of itself. The scientific method, as incredibly important and helpful as it is, has very serious limitations on what can be deduced from its process of controls and experiments. If we can’t test a medicine, then it probably won’t pass muster either legally or socially.
At the same time, the allopathic medical code is also based on the idea that, rationally, we should be able to create a solution, such as a pill or a surgery, and make our health problems go away.
Don’t get me wrong. Doctors are allowed, by law, to look at plant medicines as an option for their patients. In fact, the United States has a pathway to this kind of care unlike anywhere else in the world through the Dietary Supplement Health and Education Act of 1994 (DSHEA). But doctors don’t prescribe these plant medicines, because plant medicines aren’t a part of the conversation in the first place. The system, with respect to the way that it affects physicians, is actually more restrictive than anywhere else in the world, simply because doctors get punished through lawsuits and the refusal of the insurance system or Medicare to pay for plant-based medicines.
The actual conversation, the one that doctors rely on, is the foundation of the Flexner Report. This document transformed the nature and process of medical education in America and established the allopathic biomedical model as the gold standard of medical training.6 This report, written by Abraham Flexner and published in 1910 under the aegis of the Carnegie Foundation, created a world of hyper-rationalized medicine in the United States, in which standards were created that pushed out a range of medical techniques and placed a focus on patented drugs alone, rather than plant medicines. Our common understanding of the Hippocratic Oath, the foremost standard for Western medicine, is “first, do no harm,” but we all know people who experience negative effects from allopathic medicine, and these are ignored. We know that more and more people are taking opioids, and not just for what they were prescribed to heal. In 2014, 20.5 percent of the US population age twelve or older, or roughly 56 million people, reported using prescription pain relievers, tranquilizers, stimulants or sedatives for a nonmedical purpose at some point in their lives. And doctors made that possible, along with the rest of our money-centered medical system that has led to the over-prescription of these fatally dangerous classes of drugs.7
The Flexner Report decreased the number of doctors, as well as what they practiced, and placed an emphasis on pills as solutions. Women, trained and practicing physicians prior to the report, were no longer accepted into American medical schools under this system. Basically, the Flexner Report created a new way of thinking about medical care. This way of thinking tells us that there is only one way to practice medicine, and that is to follow a tradition that privileges drugs over wellness.
CBD does not fit into this system.
Even though it has no side effects, and no associated deaths.
Even though it works to solve some of the most complex illnesses.
Even though there have been more than 10,000 research studies conducted on CBD in the last thirty years using the same evidence-based standards required by the American medical establishment.
What it comes down to is the social space in which we fight diseases in this country. Overall, the United States stands behind most other developed nations in terms of its health care efficacy and efficiency, and it has to do with a belief that we know what we are doing.
Except that we don’t.
There’s a grave misunderstanding in how truly excellent American health care is, or is not. Let’s look at what we’re telling ourselves versus the reality as measured by external less-biased sources.
The American College of Physicians (ACP) prepares metrics each year on our health care system, and these indicators help to shape our policy efforts at least to some degree, depending on the administration in power. In terms of the costs of our health care, the ACP argues that we are on par with the rest of the world, except that’s really not true.
The challenge in much of the ACP’s analysis in comparing the US health care system to that of other countries is that they use percentages of costs paid by patients for comparison, rather than per capita or hard costs, which is different from the approach of the OE CD and other international bodies. This means that the ACP’s comparative statistics make it seem as if Americans are paying less for health care than Canadians or the British, when this is not the case since the cost per service in the US is, on average, more than ten times higher than that in the other countries in the OE CD.8 What this means is that Americans are actually paying a much higher cost per health care service, and our overall cost of care is significantly higher than that of other countries’ citizens. Similarly, while the ACP makes the argument that Americans have a higher GDP per capita than other countries, which they suggest means that more Americans can afford the higher costs of care, they fail to recognize the higher differential between rich and poor in the United States compared to other OE CD countries. A much greater percentage of the population lives below the poverty line in the United States compared to Canada, the United Kingdom and Australia, for example.9
This is why our life expectancy in the US, despite our relative wealth, is lower than much poorer nations such as Greece and South Korea, let alone our nearest counterparts such as Canada, which is close to the top of the list. In the developed world Canada ranks eleventh, which is in the top 5 percent of nations. The US ranks forty-third, which is in the bottom half of countries in this category. This is a remarkable statistic, considering the fact that most foreign visitors driving between cities in the US and Canada would view the two societies as being nearly identical. Something is broken with the system. We spend the most and we probably have the best technology in the world compared to other nations. And yet, at the same time, we are the sickest both mentally and physically in all of the important ways.
Accordingly, we must always use some degree of intuition and common sense along with our experimental evidence. The often remarkable results of traditional plant-based medicine have been discovered over thousands of years of trial and error and intuition by Indigenous people. All pharmaceuticals do not work for all people, and there are countless examples of, for example, antidepressants that have been FDA-approved and scientifically backed and then later found to not work at all, where the results that were perceived were either due to the placebo effect or to an unknown control that was not experimentally managed.10 Because almost all pharmaceutical drugs have at least one troublesome and oftentimes many more horrific side effects, this is a challenging place to begin to treat a patient in pain.11
At the heart of this issue is social equity, as well as a core mentality that we’re better than everyone else and therefore we must know what we are doing, even when this is not the case. Even so, the ACP and the US Department of Commerce have both admitted that there are underlying social discrepancies in access to care in the US that simply don’t factor into policy decisions.12 There is a need to recognize that the health care system’s efficacy and efficiency is not contingent on a large amount of money but rather on social determinants of health. Social factors that limit access to health care may be self-administered or provided by a health care system. These factors are deeply connected to a country’s cultural and social norms. If, as in the United States, the cultural norm is to seek care from a professional with knowledge that is approved by our broken health care system, then the average American will simply not receive effective or efficient care over the long term.
The underlying philosophy of the US health care system is likely to provide exemplary care under extreme circumstances, such as in the case of cancer, but there is an argument to be made that these extremes could be avoided with proper preventative care. For example, the CDC reports that even traditional interventions necessary for treating cancer in the US are accessed, at present, by only 77 percent of men and women over the age of forty,13 and the American College of Physicians notes that people in the United States only receive proper preventative care about 55 percent of the time.14 The outcome that would be preferable to the CDC and other health agencies, of course, is 100 percent compliance with physician or nurse recommendations for disease testing and follow-up examinations, but this does not take place. That’s why Masterman-Smith, DeAngelo and others have chosen to operate in their own world of health care, separate from this shattered system.
The United States ranks at the highest level of opportunistic behavior of health care organizations and pharmaceutical companies; as a result, patients in the health care system have the lowest level of agency, or ability to participate in both personal and community decisions, among all countries in the OE CD.15 People not only have financial barriers to care but barriers to understanding how to manage their own health, participate in healthier behaviors or know when to seek professional assistance.16 As a result, many individuals in the United States are not able to prevent emergent care issues, which is likely to cost more than preventative medicine or health advice from a primary care practitioner.17
The wrong way round
I’ve spent a lifetime exploring how we can use plant medicines to make our lives better, and I know that Americans deserve better health than what we’ve been offered, but the reality is that, perhaps, we’re looking at the question of health the wrong way round.
Scientists like challenging the status quo.
There’s an old story about the English scientist Sir Isaac Newton (1642–1727). You are likely to know his work on gravity and motion, but when he was just starting out as a researcher, Newton bought his first prism in 1666, only one year after Francesco Grimaldi’s work on the diffraction of light was published. A couple of years later, Newton presented the theory that light is made of particles and not waves, based on his experiments that showed that white light could be produced by a mixture of distinct colored rays. This was at a time when the Royal Society contended that color was created by mixing light and darkness. Newton showed them a different way of thinking about the same problem: by passing a beam of light through two prisms that shifted the angle back upon itself, he was able to illuminate how a beam of colored light remained the same no matter how many times it was reflected or refracted. Color was, indeed, a property of reflected light and therefore consisted of particles.
For thirty-two years, however, Newton’s ideas were rejected. English natural philosopher Robert Hooke had stronger social capital than Newton, and Hooke’s popularity gave him the kind of legitimacy that was required to convince others at the time. On Hooke’s death, Newton was finally able to demonstrate his theories on light again, this time to a more receptive audience, and the nature of light as particles was finally accepted. While his theory was eventually shown to reveal only a small aspect of what constitutes light (Einstein believed light was a particle, which he called a photon, and he argued that photons can flow in a wave), Newton was able to shift the way that we think about what we see and how we perceive our universe. In 1704, he was actually elected president of the Royal Society and he published Opticks, a monograph on his theory of light, the same year.
We can challenge the status quo in the same way; we just have to be patient.
CBD and the intervention of health practitioners who look at care in a completely different way than imagined by the Flexner Report may be able to provide us with what we’ve been searching for all along: a healthy and simple way to prevent and treat disease and to make us well.
1. [Hemmati, H.D., Nakano, I., Lazareff, J.A., Masterman-Smith, M., Geschwind, D.H., Bronner-Fraser, M., & Kornblum, H.I. (2003). Cancerous stem cells can arise from pediatric brain tumors. Proceedings of the National Academy of Sciences, 100(25), 15178–15183.]↩
2. [Langner, J. & Zajicek, A. (2017). Social construction of drug policies and target populations: US policy and media discourse. Acta Universitatis Lodziensis. Folia Sociologica.]↩
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12. [DeNavas-Walt, C., Pecoraro, L. & Reese, L. (2008). Income, Poverty, and Health Insurance Coverage in the United States: 2008. Washington, DC: US Department of Commerce.]↩
13. [Centers for Disease Control. (2018). Organizational website, https://www.cdc.gov/]↩
14. [American College of Physicians. (2018). Achieving a high-performance health care system with universal access: what the United States can learn from other countries. Annals of Internal Medicine, 148, 1–21.]↩
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