Interview with Cristina Sanchez - ExpoGrow2016 Irún

Transcript of the interview with Cristina Sanchez:

Are public health in general - and doctors in particular conscious of the therapeutic properties of cannabinoids and terpenes?

Broadly speaking: no. And it is a problem of lack of education. Most times it is because nobody has given them the chance. I'm a professor at the Universidad Complutense and nobody tells our students about the endocannabinoid system although it is a very important system of our body.

We are facing a huge problem here, the lack of information for the medical community, because nobody has taught them what is the endocannabinoid system, where it acts, why the therapeutic potential of this plant is so vast, and the problem is that doctors don't know about it...

And that is a great handicap to apply therapies with cannabinoids...

Yes, that's one of the problems. There are many more, but yes the fact that the medical community can't access all the data that it should have is a true problem.

And one of the main goals of the Spanish Observatory of Medicinal Cannabis is precisely to make this data available, we have not invented this information, it is solid scientific data and we want to transmit it to the medical community so they understand that cannabis is just another therapeutic option.

What is your opinion about the Entourage effect, the sinergy between cannabinoids and terpenes and its greater effectivity in relation to isolated forms?

Well, that is an effect broadly described and well documented. When using isolated compounds – cannabinoids or terpenes a certain therapeutic effect is produced, but it has been observed that effects are quite better if a combination of several cannabinoids and terpenes is used simultaneoulsy, which makes sense because you have several compounds acting on several objectives and this means that the therapeutic effect will be much higher than if you were aiming only at individual objectives.

It's like hearing someone playing the violin, you have a nice feeling, but when you hear a whole orchestra the feeling is even better. That would be an example so people can understand what the entourage effect is.

Right. You found that cells of certain types of cancer “commit suicide” when THC is used... How is this research going and where is it pointed at? Is it being used to develop some type of therapy?

Well, not only us, but there are a number of research groups around the world which are working on this subject, we have observed that cannabinoids have anti-tumour effects, both in cell cultures and animals.

Now we must take the leap towards cinical trials, there are a couple of trials being conducted in the UK and Israel, and in Madrid, part of our team leaded by Guillermo Velasco, they're trying to conduct another one on Glioblastoma patients by combining cannabinoid therapy with Temozolomide, which is the usual medicine prescribed to these patients.

We are trying to conduct and promote as much clinical trials as possible. It's hard because we find plenty of obstacles, especially related to funding and the legal status of these compounds, but we move forward and we hope we'll have much more clinical trials in the future.

Cannabis is being used in several ways but, do you think that the plant itself can be used as therapy, or is it better to isolate the active compounds and then make medicines to treat diseases and conditions?

In that sense, both pre-clinic research and the information that we have from patients suggest that extracts from the plant work much better than isolated compounds.

We have the experience of several legal compounds in the USA – Marinol and Cesamet – which have achieved good results, but not as good as those obtained by plant extracts being used in other countries where medicinal marijuana is legal, and pre-clinic trials show similar results. When using isolated compounds, we notice a “1” effect, while when using plant extracts this “1” becomes “2”.

Is the plant itself potent enough to...?

The plant contains more than 100 cannabinoids, hundreds of terpenes, flavonoids and all of them – or at least the vast majority – have therapeutic potential and create sinergies when acting together.

We could choose to create plant profiles, like types of plants, but I'd choose to use plant extracts which already contain all these compounds and require much less manipulation, I think that this would be a lot easier for patients.

This question was actually aimed at the pharma industry, which hasn't shown much interest on cannabinoid therapies...

Well, we have GW for example with their Sativex, which is an extract from the plant with 1:1 THC:CBD ratio, but that also contains other compounds from the plant, but with exception of this case the truth is that big pharma companies prefer isolated compounds or derivatives from the plant's compounds – rather than plant extracts.

I think there are economical interests behind this position, we can all grow plants at home, we can all make our own extracts at home...

I'm not claiming this situation to be ideal, but from a big company point of view it is difficult to compete with small-scale production, perhaps that is one of the problems or handicaps for which big pharma companies are not that interested on this field.

One of the fields of study that you have been researching lately is breast cancer, right?

Clinical trials with Metformin in cases of HER2 are being successful... Is there any chance that you, or your team, conduct a clinical trial for cancer with cannabinoids, specifically for these patients?

We would love to...we would really love to. Actually, it is the main goal of our laboratory. We continue with pre-clinical research because we want to know more about cannabinoids and how they produce this anti-tumour effect, but what we really need are clinical trials and we'd love if someone would help us to conduct these studies.

A lot of money is needed for that...a lot of money is needed and that is basically what is stopping us, not enough funds and, on the other hand, the lack of interest from medical professionals.

Not everybody...there are few people interested on advancing in this field because there is no clinical data, but we won't never have this data if we don't generate it. It's a vicious circle, but the main problem here is money.

Isn't it curious that during the presentation of the Forum or the Observatory it was said that there are more than 20.000 patients in California using cannabinoids, while there is not a single study showing, explaining or monitoring all these treatments?

Yes, unfortunately, all this information is being lost, we're wasting it... as you say, there are thousands of patients, not only in California, but also around the world, who have been using cannabis with medicinal purposes for a long time.

Nobody is monitoring or conducting a clinical trial on these patients, except very few cases, so all this data is being wasted. So, we must do anything possible to try to recover this data. It is available in some cases but nobody has taken the trouble to analyze it, and that is really a shame because it would be a vein of gold.

All this information is out there, and we should collect it. And above all, people who start treating patients now or people at dispensaries - as I mentioned in my speech - who have medical patients, should do anything possible to gather the information from their patients so it can become scientific data that we can show to the medical community so they can finally realize that this is a serious alternative.

Perhaps we don't have sufficient data to answer this question but, on your experience, do you think that there is any type of conflict between cannabinoid treatments and classic chemotherapy or radiotherapy used today?

We don't have an answer for humans, but once again we do have pre-clinical evidence which points to the opposite direction.

Studies on animals show that the combination of cannabinoids and chemotherapy works better than either alone, and the same happens with radiotherapy.

We have trials that show a much slower development of tumours on animals when treated with both radiotherapy and cannabinoids. Then, as usual, this may or may not happen on humans, but pre-clinical data seems to confirm it, not only the absence of negative interactions but actually the presence of sinergies...

Cristina, we hope that we'll soon have more data, more trials and more funds to conduct more and more studies.

Thanks a lot for your answers, see you soon.

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It is estimated that, approximately, 1 out of 8 woman will have breast cancer throughout life...

Only in Spain, 26.000 new cases are diagnosed every year, which represents 30% of all tumours on women in this country.

Most cases are diagnosed at ages between 35 and 80, especially between 45 and 65.

Still, we don't have a national registration system to obtain accurate figures.