Two Docs Talk: Natural Products

Speaker 1: 0:01

Welcome to MedEvidence, where we help you navigate the truth behind medical research with unbiased evidence, proven facts powered by Encore Research Group and hosted by cardiologist and top medical researcher, Dr Michael Coran.

Speaker 2: 0:17

Hello again. My name is Dr Michael Coran and I'm your host today for this episode of MedEvidence in our two docs talk series. I have an incredibly special guest today, and not only is she incredible just as a person, but she's also incredible in my life, because this is Dr Lisa Curvindaz, who is actually my medical school partner at Beth Israel for third year clerkship in Neutral Medicine. Do you remember those glorious days.

Speaker 3: 0:44

Lisa, yes, I do, the night calls yes.

Speaker 2: 0:47

Yeah, so we were both Harvard medical students together back in the day and Lisa and I became lifelong friends and also resources for each other, because Lisa is a world of knowledge. She trained in internal medicine, then she trained in public health. She worked in New York for a while while I was there, moved to Maryland to do some work and then moved down to Jamaica, which is part of her roots, and has been practicing medicine in Jamaica and is a leader in medicine in Jamaica as we speak.

Speaker 3: 1:18

Thank you very much for having me, yeah thanks for joining us today.

Speaker 2: 1:21

So we thought a neat thing to do would be to talk about how medicines develop from interesting natural means. So we have a pharmaceutical industry right now and the pharmaceutical industry has its ways of discovering new compounds and new ideas for therapies, and nowadays there's more and more biological therapies that are based on genetics, but a lot of really cool stuff developed just by observing nature and observing natural things and then coming up with therapies based on those observations. So we're going to talk about that today. Because of the fact that we met at Harvard and Harvard has one of the interesting traditions, which is the place where ether anesthesia was developed. I thought maybe we'll start with that. Lisa and I obviously are friends and we've been to parties together and they serve alcoholic parties and that's part of our culture and ether actually came from that idea, that cultural idea of having a party together and getting a little intoxicated.

Speaker 3: 2:26

Getting a little high.

Speaker 2: 2:27

There you go. And so back in the late 1700s and the early 1800s, particularly in the UK, the chemist that were working there was this guy named I think his name was Humphrey Davy who discovered a lot of the elements of the periodic table, including sodium, and him and his buddies would figure out how to mix things together and create all different substances. So they figured out pretty early on that if you combine alcohol with sulfuric acid it gives off a gas and this gas turns out to be ether. And then if you sniff this gas you get a little buzz and they would have ether parties. That were the rage amongst college students back then, starting in the UK, but they started doing this in the US as well. And then obviously physicians who are often college educated not all, by the way, back then a lot of them were they kind of took this college tradition and they started thinking, well, how can we use this? And back in 1842, crawford along was a surgeon practicing in the South in Georgia, and probably based on his college experience of sniffing ether at parties, he kind of figured out that you can use it to give people pain relief during surgeries. So he started doing surgeries where we got his patients to sniff the ether and they fall asleep or get intoxicated and know what's going on and cut off their toes or whatever he had to do for surgery. So this was going on for a little while. In simultaneous with that, there was a guy named Thomas Morton. Actually it was William Thomas Morton.

Speaker 3: 4:02

The dentist.

Speaker 2: 4:03

Yeah, he was a dentist, Very good, and he married somebody who was a very, very fancy family in Boston Boston was very snobby back then and he married the daughter of a congressman, if I remember correctly, and they said well, you can get married, we're not crazy about our daughter marrying a dentist, but if you take courses at Harvard Medical School then we'll let that happen so you can bring yourself up to a higher station. And so Dr Morton did that and back in those days you didn't. You basically paid for lectures at Harvard and every other medical school, so it wasn't such a formal program, but you would go there, you would have the famous professors of the time or the prominent people of the time giving lectures and the students would pay a fee for the lecture and then you took enough for those lectures and you could say well, I was educated at Harvard. So that was kind of the way things work. So he started taking lectures at Harvard and got to know some of the people there, and he was also a little bit of a entrepreneur. He was trying to figure out how to make money doing things and he eventually showed that in his dental practice he was able to put people to sleep and extract teeth and do things of that nature. And then he approached Dr Warren, who was a very prominent surgeon at Mass Journal Hospital, and said I'd like to show that you can actually do a surgery while somebody's asleep from ether anesthesia. And they set up this big event back in I think it was October of 1848 in a place called the ether dome. Then you've had some experience there. It's this amphitheater that has these very tall, narrow chairs that are incredibly uncomfortable and that's, they still have those yeah. Well, when I was there, they did.

Speaker 3: 5:48

We graduated at the same time, so that was I was hoping no, but I was hoping they would have changed that, Because I don't think they would change about that because it's a national monument, I think, to preserve it the way it used to be.

Speaker 2: 6:00

But they were incredibly uncomfortable, hard wooden seats that we took lectures in their medical school and you can never get comfortable in them. But it was an operating theater and they actually started showing operations back way before ether anesthesia. If I remember correctly, it was like in the 1820s where they were doing that and then in 1848, there was the first public demonstration of using ether as an anesthetic for surgery and John Warren was a very prominent surgeon. He agreed to work with Morton, who was the anesthesiologist, and they did a painless surgery. But the interesting part of the controversy is that this was being done by other physicians, most prominently Crawford Long and the Mass Journal. People got all the credit because they published it.

Speaker 3: 6:53

So that that means that if you don't publish, you don't get any credit.

Speaker 2: 6:56

Exactly right. It's a really important part of the story is it doesn't matter who comes up with the idea. It matters who publishes the idea, but by publishing it, they also were much more structured than what Crawford Long did, which is a theme that we talk a lot about here at MedEvidence, and that is that you can have a great idea, the great idea may even work beautifully, but unless it's part of some sort of structured experiment, you're not going to get full credit for it, nor do you know how good it is. So back then this was set up with the New England Journal of Medicine or whatever the precursor was, and they had the press there and they had a protocol that they followed in terms of using anesthesia and then, ultimately, during the surgery, they picked a patient ahead of time. They got the patient's agreement to be part of it and, lo and behold, they show this publicly and it was published by the New England Journal. It got picked up all around the world and it was actually the first time that the Europeans who are very snobby about their advances in medicine at that time they were first is the first time the Europeans actually gave the Americans a little bit of respect for coming up with an innovation and it kind of launched certainly the preeminence of American medicine in surgery and ultimately it was the first major breakthrough where American medicine introduced an idea to the rest of the world. So that's an example of going from a party drug to something that really revolutionized how we do things in medicine and based largely on having a simple structured experiment and publishing it. So there's been a debate about I know this still goes back and forth about should Crawford Long get credit for developing anesthesia, or Thomas Morton, william Thomas Morton, but that debate will go on, but I'm sure Mass General will take credit for it. So, anyhow, that's just one example. So give us another example of something that may be more akin to what you do day to day, where there's a discovery that leads to some sort of innovation.

Speaker 3: 8:58

Well, I mean the basic ones that we talk about, you know, opium we have the opium. You know the opioid epidemic but opium we actually use morphine. Morphine we use daily.

Speaker 2: 9:11

There is good example, something that comes from a plant that you kind of figured over the years how to use it.

Speaker 3: 9:16

So it also gets you high. Also good for pain, but we have no involved to a drug. But no, we still have the opioid epidemic that we have to deal with. We also have taxal, which is from a tree and that is actually used for breast cancer. And, interestingly enough, it was being used in South America to treat breast cancer as a as a herb, Really yeah. And there was a doctor working there who got breast cancer and in doing her research she actually used it as well as her own chemotherapy.

Speaker 2: 9:57

Is that right?

Speaker 3: 9:58

That's crazy Interesting, but that's actually and we use that today as one of the basic drugs for breast cancer. I think I've talked to Dr Coran before about a drug. Well, it's not. It's an herb that we use in the islands for wound therapy and, working in Jamaica, we unfortunately run out of drugs a lot in our public hospitals and what we found, that Papine, which is from Papaya we prepared a certain way and we put it on diabetic wounds and, while I didn't do a protocol or publish, by actually treating a lot of wounds and controlling their sugar better, we decreased amputations by more than 75%.

Speaker 2: 10:50

That's crazy. So that would be called an observational experiment, which is, you know, the first level of coming up with an idea and developing the idea, and then you need to go from that observational experiment to a randomized experiment. We talk a lot about that in MedEvidence is that many observations will turn out to be valid but some won't, and the only way you figure out what's valid and what may be less effective is by doing a randomized study. I'm going to talk more about that process, but that's a tremendous example of it. Another example of it, I guess, would be development of aspirin.

Speaker 3: 11:32

Willow bark tree.

Speaker 2: 11:33

Yeah you got a willow bark tree, and so that was actually known in antiquity to be a cure for headaches by just sleeping under a willow tree. And of course it was synthesized, I guess, by the Bayer company in Germany. At some point they actually figured out what the active ingredient is in that willow bark that took away your headache. And of course, here you have aspirin, and you know to this day we do randomized clinical trials to see how well aspirin works. And what's crazy about it is that we know a lot about aspirin but there's a lot that we still don't know, like what the best dose is for different reasons. What's the best dose to prevent a stroke? What's the best dose to use with other agents prevent your heart arteries from getting clogged up again after a stents placed? So interestingly, even something from antiquity that was first discovered based on observation that now is established as a good medical intervention, still has lots of questions around exactly how to use it.

Speaker 3: 12:33

True.

Speaker 2: 12:35

So in our next episode we're going to talk how we go from that observational stage to truly understanding how to dose products and in what patients use them in the real world.

Speaker 1: 12:47

Thanks for joining the MedEvidence podcast. To learn more, head over to medevidencecom or subscribe to our podcast on your favorite podcast platform.

Narrator: 0:01

Welcome to MedEvidence, where we help you navigate the truth behind medical research with unbiased, evidence-proven facts, powered by ENCORE Research Group and hosted by cardiologist and top medical researcher, Dr. Michael Koren.

Dr. Koren: 0:17

Hello again. My name is Dr. Michael Koren. This is part of our Two Doc Talk series and I'm very privileged to have my dear friends and colleague, Dr. Lisa Kirvin Dawes, with me. As I mentioned during our last segment, we were medical students together at Harvard and we've been lifelong friends and do a lot of work, including medical education work, together. And here we are.

Dr. Kirvin: 0:39

Yes, you do.

Dr. Koren: 0:40

Here we are talking about something that Lisa is very passionate about and very accomplished in, which is the concept of using natural remedies and ultimately figuring out best ways of applying this knowledge to her patient population. She practices internal medicine and runs internal medicine in a big hospital in Jamaica as we speak. So thanks for joining us, Lisa, and we left our last segment talking about aether anesthesia the fact that it started out basically as a recreational drug amongst a bunch of nerdy chemists that were discovering new elements back in the 1700s and early 1800s. It kind of came over through the college ranks here in the US, ultimately developed by Dr. Crawford Long and Dr. William Thomas Morton and became really a revolutionary way of doing surgery. And then we talked about a bunch of other examples. So talk to me a little bit more about an example of what you've done in Jamaica with regard to these natural remedies, but particularly how you start to pick doses like how do you get more scientific about your approach, just putting a bunch of sav on versus really being studied and thoughtful about it?

Dr. Kirvin: 1:57

Well, I think in Jamaica, as in a lot of the Caribbean islands and third world countries, we have all grown up using herbs and they will tell you a pinch of this. You mix this amount and you put this amount and they're very specific, like one of the herbs we use or one of the food herbs we use for ulcers. We know that it only works. You have to keep it in the fridge for 48 hours. After that you have to make a new batch. It won't work as well, but this has been actually traditionally handed down and I think if you look back in the day with Digitalis, which is now the Jackson, they used to pinch off a piece of the herb and say take this much every day or you will be in trouble. So they have worked it out, but usually it's passed on.

Dr. Koren: 2:46

Right, and that gets into what we're talking about is how you develop things. So Digitalis is a good example of that. It comes from the Fox Club plant. It was used by Sir Weathering back in the 1700s and it was used initially for edema, which was, of course, a sign of congestive heart failure, and so that was the original discovery. And, if I remember the story correctly and somebody will fact check me on this, but Sir Weathering was a physician who actually learned it from a woman who was practicing herbal medicine back in those. Well, she was even practicing herbal medicine. She was, I think she was like a housewife who was just the, you know, the local.

Dr. Kirvin: 3:27

you know there's usually a woman that's the local healer that people come to for stuff for headaches, mensural cramps.

Dr. Koren: 3:35

It was just like a local woman who turned Sir Weathering onto this idea, and then, of course, he brought it to the next level in terms of development, studying it, and then he realized that it wasn't just the Fox Club, but it was the particular chemical of Digitalis, which is eventually become Digoxin. But we pharmaceuticalized it by starting to understand that when you use a plant there may be different concentrations of the active ingredient, which is maybe hard to standardize. And then ultimately, you needed to be able to test the levels of Digoxin in blood to know how to dose these things. And so this empirical concept of just looking at observational data gets you to a certain point. But then you got to transition to more scientific methods by which you are giving people a set amount of the product and then seeing what their levels are. Is that a very simple example? So that would be part of the standardization, of the basic observation. And so I may you know that's sometimes hard to do with some herbal remedies because the cost involved in developing those concepts is prohibitive, but you maybe you can comment a little bit on that.

Dr. Kirvin: 4:47

The problem with herbal remedies that people have been using is sometimes when you take out one chemical, it may be you may need about two or three chemicals working together to get the effect that you want. Classic exam turmeric is an anti-inflammatory, but you need the circumvent or the black pepper to work with it in order to get some of the effects. There's also other chemicals in it that we think actually boost it as well. So if you're making a drug, then you have to make sure you take all of those into account in order to in order to get the effect that you want.

Dr. Koren: 5:29

Right, so so again, that is one of the discussion points and maybe even attention between just herbal medicine and more traditional medicine, meaning what we do, let's call it organized medicine, and we have advanced organized medicine through structured observation, whereas it's sometimes more difficult to do. An example of that would be statin drugs. So red yeast rice has the basic ingredients of Lovastatin and it's actually interesting. I think, if I remember correctly, Merck, who developed Lovastatin, wanted to get red yeast rice off the market, but they were not successful because that was just a naturally occurring chemical that people had been using. And red yeast rice will definitely lower your cholesterol level. It won't do it quite as well as as Lovastatin, because Lovastatin is a pure product, and certainly not as well as the newer stentons like like a torvastatin or a resuvastatin, but it didn't actually work. And Lovastatin is an effective therapy and it's been evidence based, proven. But your point would be well, the red yeast rice has other components and maybe those other components are less likely to cause statin side effects. For example this has come up before I've actually had situations where I've had a patient that says I can't take any statins. But I ask them can you take red yeast rice? And they say, yeah, I think I can do that. So I give it to them. It lowers their LDL by 20%. It's not as good as I want, but I'll live with it and they feel like it's a natural product that doesn't cause the muscle aches. Now, whether or not that psychosomatic or actual, real, it doesn't really matter, because when we're treating patients we just wanna help them get to their goals and in this case we wanna reduce their LDL cholesterol, which is everybody agrees is a positive thing. But, to your point, we don't know if that patient is truly just projecting the side effects, depending on whether or not it's a pill versus a powder, whatever the preparation is, or there's something in fact different in taking a pure chemical versus a combination of natural factors. And again, the only way you figure these things out is by testing, and that testing probably has not been done as much as it should be done, in my opinion, and how you feel about that.

Dr. Kirvin: 7:56

Yes, I agree.

Dr. Koren: 7:57

Yeah, so talk to me a little bit more about taking your organized medicine training and melding that with some of the traditional therapies that you're exposed to in Jamaica.

Dr. Kirvin: 8:09

Well, I think, when I first moved to Jamaica, a lot of medicines that we have great access to here we don't have there, and so you're gonna decide what you're gonna use to treat the patients. So, you're gonna use what's available there or what and what isn't. I mean, we have done stuff like with patients kind of handle aspirin, we'll do fever grass tea, which also helps them in the same way. So you learn, you have to learn to combine. What we do try to teach is herbal medicine can cause side effects to it. Just because it's an herb doesn't mean it's totally safe and you have to take that into account with their other medical problems. But you know, I used to do that here while I was in the US as well.

Dr. Koren: 9:00

Oh, has that.

Dr. Kirvin: 9:02

Well, when I was in practice, I always had an interest, because of how I grew up, with using a lot of herbs. I grew up in Jamaica, in the country, so we've always used a lot of herbs, and what happened was, in my practice I realized a lot of patients were using herbs along with their regular medicine. This is like 30 years ago. That's a long time and what I would say is bring them all in and I would look them up and then I would say you can take this one, this one, this one, tell them you can't buy this one, and you can't take this anymore and so I did that for several years. And there was one of the people who worked for me who wanted to lose weight and got this new Chinese medicine and I was supposed to look it up and it was a very busy week. I didn't get to look it up and they called me on the weekend to say she's in ICU and she had chest pain and I went up to see her and I said you took it. I guess that means you can't take this one.

Dr. Koren: 10:03

All right. Well, that's one way to learn. That's one way to learn.

Dr. Kirvin: 10:06

But so just because it's an herb doesn't mean that it will help you. It may, and I've used a series of herbs with helping pregnancy, so it's always been something that I have been interested in. I just tend to read more about them and what are the medicines they're taking and what the other medical problems are.

Dr. Koren: 10:26

Yeah, so there are a couple of elements to that. One, of course, is patient acceptance. Some patients rather have an herbal or natural remedy versus a pharmaceutical, some people the opposite. But if they're only willing to take a natural remedy, that's what you go with. Honestly, I deal with this also. I have plenty of people that come to me as a traditionally trained cardiologist but they don't want to take any drugs. So I have to suppress my first instinct and say well, why'd you come to me I am a doctor that prescribes drugs? So I would think that that may be one of the main reasons you come to me, but of course, there's other reasons. And then, of course, you just get pragmatic. So I also am not discouraging at all about people that want to use herbal remedies, but I do. The same thing is you need to look them up, and a lot of them have stuff in them that you wouldn't want your patients to have or that patients don't even know about. So you know, for example, I get a real kick out of this. You've probably seen this. But memory we do a lot of memory research here at our institution and I have patients that come in oh, I saw this product on the internet. That is supposedly great at memory. It helps your memory. There's all these testimonials saying that my memory improved when I got this and this 14,000 testimonies, whatever it is and I said, okay, well, bring it in. So bring it in. And what's the main ingredient? Caffeine, caffeine.

Dr. Kirvin: 11:56

Right, I was gonna think it was ginkubaloba which is the problem.

Dr. Koren: 11:59

Well, they put that in as well, but the main ingredient is caffeine. So, yeah, you know, after a cup of coffee I think I can remember things better than before it, and so that gets into some of the marketing, but also the fact that we don't know that much about these certain things. Like you know, very simply, we all use caffeine to help us with our concentration. You know, at least most people in medicine.

Dr. Kirvin: 12:23

They just keep us awake.

Dr. Koren: 12:23

Yes, yeah, it helps your concentration, we know that. But there's a lot and we kind of figure out individually, like does one cup of coffee do it for you? Do you need two, do you need five, do you need 10? Remember I had one fellow intern in New York who had diet cokes. That was his caffeine source and he knew exactly how to dose it during the course of the day in order for him to keep his concentration going, and he kind of figured that for himself. But we don't know that much about it. More globally, like, for example, when does the trade-off occur when you're taking in too much? And these are interesting elements of research that tend not to get funded because there's no obvious funding source. But get back to this whole concept of quote things that we just discover in nature for our day-to-day lives that have medical implications. So I don't know if you have any other thoughts about that. With regards to your practice in Jamaica, are there things that fall into that category that come to mind?

Dr. Kirvin: 13:30

I mean we use a lot of herbs, just naturallyp eople go into the backyard and actually pick these.

Dr. Koren: 13:36

What kind of problem? Give me a problem that you would go for

Dr. Kirvin: 13:42

Menstrual cramps. There are certain plants that you take as a tea and it helps. Menstrual plant it supposedly helps menstrual. There's stuff for headaches, stuff for fevers, there's a plant that you bathe in for when you have chicken pox or any sort of itching, and stuff that does work.

Dr. Koren: 14:06

What's that called Guaca Guaca Guaca plant? Is it like Guacamole?

Dr. Kirvin: 14:11

Guaca You go to there and you pick some guaca bush.

Dr. Koren: 14:14

And do you know what the active ingredient is?

Dr. Kirvin: 14:16

I don't think it's ever been looked at.

Dr. Koren: 14:18

Really interesting.

Dr. Kirvin: 14:19

I don't think it's ever been looked at.

Dr. Koren: 14:21

And for the antipyretics that you were talking about for fever. It has a salicylic acid undergrowth. Yes, salicylates Interesting.

Dr. Kirvin: 14:29

Which is very interesting because my gardener they called me that he was dying and I'm like I rushed outside and said what happened. He said, oh, I had a belly ache and so I had to mix me some fever grass tea and know it's worse than ever and I'm going that's like having aspirin, like yes, it's worse. Because, he sort of knew it as pain, not differentiating pain.

Dr. Koren: 14:53

Right, right, yes, and also, of course, the bleeding elements that could have been, he could have actually had a bleeding ulcer and making it worse with that. That's actually a great anecdote of how you combine traditional medical knowledge, or organized medical knowledge, with naturopathic knowledge.

Dr. Kirvin: 15:10

But there's a bush practically for almost for every problem in Jamaica.

Dr. Koren: 15:15

All right. Well, hey, we're going to leave this session on that note. There's a bush for every problem in Jamaica. Because, while I'll be down, there next week Podcast.

Narrator: 15:24

Thanks for joining the MedEvidence podcast. To learn more, head over to medevidence. com or subscribe to our podcast on your favorite podcast platform.

Narrator: 0:01

Welcome to MedEvidence, where we help you navigate the truth behind medical research with unbiased, evidence-proven facts, powered by ENCORE Research Group and hosted by cardiologist and top medical researcher, Dr. Michael Koren.

Dr. Koren: 0:17

Hello again. I'm Dr. Michael Koren hosting another episode of MedEvidence, and I have the great pleasure and privilege to be with my dear friend and colleague, Dr. Lisa Kirvin-Dawes, who is a friend of mine from medical school and somebody that now practices internal medicine in Jamaica. She did her training with me in Boston and in New York and eventually practiced a bit in Maryland and then moved down to Jamaica where she is both a country physician, helping people with natural remedies and also running internal medicine at a hospital. So those are two very, very different things. Lisa and I can do that, but anyhow, we're going to talk a little bit more about things that went from sort of natural discoveries or even recreational drugs to therapies that are either being studied or that we use day to day, and Lisa has had actually an interest in cannabis and psilocybin. You actually have a really nice lecture about cannabis at the Academy of Physicians and Clinical Research a couple of years ago. I learned a lot from that lecture, so tell me a little bit about how your interest developed in those areas and what you're doing with it these days. Other than using it in college. Excuse me, please edit that out, okay?

Dr. Kirvin-Dawes: 1:38

So in terms of cannabis, marijuana, we use it in Jamaica a lot for medical reasons. It's one of the things we actually use for pain. As I said, Jamaica uses a lot of natural remedies, so people have always used it for pain and cancer. When I moved back, I realized we had to use a lot of herbs because the country couldn't afford to buy big medicines sometimes. So for certain cancers pancreatic cancers, the nausea and the pain we always use marijuana, and they allowed you to use it prior to becoming marijuana becoming very popular and then, because of politics, really try to be controlled. As long as the consultant or the attending in the hospital was taking responsibility, you could use it with patients.

Dr. Koren: 2:29

So as long as the attending was using it, then the patient can use it as well. By the way, I came up with that because it was actually an ethical principle in research years ago. They used to say that to protect the patients against the use of products that were not proven, that were investigational, that the PI the principal investigator can only prescribe to the patients if he or she was willing to use it himself?

Dr. Kirvin-Dawes: 2:58

Or if they were willing, okay, but granted, that was actually a concept, but granted, though, what we used it for and now I mean in terms of cancers was really, really helpful. Even now, when we use chemotherapy, we realize, for certain chemotherapy- if you give marijuana they actually have less nerve damage. So they don't have the nerve problems that a lot of people get that have known with certain sort of chemotherapy. So that's how we became interested. We were using it mostly for cancer and pain in the early days.

Dr. Koren: 3:38

Explain to people. A lot of people know this, but some people don't. THC versus CBD Okay so.

Dr. Kirvin-Dawes: 3:44

THC is what people know it as it's part that gets you high, but CBD is the part that and that's tetrahyba-hydro-cannabinoid.

Dr. Koren: 3:53

Cannabinoid, right, Cannabinoid. Okay, thank you.

Dr. Kirvin-Dawes: 3:57

And the CBDs are usually what people think is the one that actually is helping to treat the problem. However, you need both in order for it to work. People say you need strictly CBDs. It doesn't tend to work that. You always need a little THC to activate it, and marijuana probably has over 200 active components in it. So that is what becomes very tricky and we don't know which ones are doing what. We know some of the main ones, but we don't know all of them. But you need both what the US has done in many places to call it CBD. You have a lesser percentage of THC, but it's usually not just none Interesting.

Dr. Koren: 4:44

Yeah, so that chemistry is fascinating. So we obviously have receptors in our body that respond to both THC and CBD and there's been research in the area. I was very involved as an investigator in our organization. I was very involved in the studies that looked at a drug called Rimonabant, if you remember that from about 10, 15 years ago, Rimonabant.

Dr. Kirvin-Dawes: 5:09

That's about it.

Dr. Koren: 5:10

Yeah, and so that was basically something that was being used for weight loss. So we know that marijuana causes the munchies and Rimonabant blocked those receptors and was considered an anti-munchies drug and it actually worked. It worked really really well to help people lose weight. But, it didn't come to the market because it was increased suicidality for people that were taking the drug. So obviously, as it helped people lose weight, it also made them feel more depressed. And we actually had quite a few patients in those studies and a lot of them did not want to stop the drug because they were losing weight. But they also said you know, I feel kind of blue and I'm not feeling great, but I am at least intellectually excited about the fact that I'm not that hungry and I can control my appetite. So it was really interesting to see that observation within a randomized clinical trial that ultimately produced really neat data about how these receptors are activated and how we can manipulate these receptors to try to create some medical benefits. But at the same time there's a trade off. So I think that was fascinating. But getting back sorry to interrupt you, but getting back to marijuana so you use that a lot for pain Is that your number one go to, or do you give opioids at all?

Dr. Kirvin-Dawes: 6:30

We give opioids. Now Jamaica is interesting. We do not have a big opioid problem.

Dr. Koren: 6:38

W hat's the theory for that?

Dr. Kirvin-Dawes: 6:42

We've been trying to figure it out. I think our culture looks at pain differently, so that's part of the problem. It's sort of a culture where you just handle the pain, be a man and just deal with it and move on. So, I think that's part of it is cultural as well, and we do use a lot of marijuana for pain, but we use it to increase appetite also with cancer patients. But I mean a lot of people in terms of cancer use marijuana and have been using it for many years. People are allowed to, or used to, grow their own marijuana without regulation. Now they have some regulation that you're allowed to grow a limited about per household.

Dr. Koren: 7:24

The government can get it on the deal right.

Dr. Kirvin-Dawes: 7:25

Yeah, it's become mostly over-regulated, which is why Jamaican marijuana, which everybody used to know about Jamaican Ganges, it's hard to get any more.

Narrator: 7:37

Is that right?

Dr. Kirvin-Dawes: 7:38

Yeah, because it's become very expensive to grow, unless you're doing it illegally.

Dr. Koren: 7:43

Really.

Dr. Kirvin-Dawes: 7:44

The licensing are five to 15,000.

Dr. Koren: 7:47

Wow Interesting.

Dr. Kirvin-Dawes: 7:49

For a small plot.

Dr. Koren: 7:52

How many joints to get of a small plot. It's bad.

Dr. Kirvin-Dawes: 7:58

It's really is over-regulated and they come in and check. You have to have electric fences, the security and the average person that was growing marijuana and the poor Gange farm. I can't do that. It's out of business.

Dr. Koren: 8:12

Interesting. Yes, the downside of regulation is you can sometimes take away the means of survival for people in prosperity. So let's move to psilocybin. So tell me how you use that.

Dr. Kirvin-Dawes: 8:26

Magic mushrooms. Yeah, there we go. Well, it is not illegal in Jamaica, while I hear in the US it is.

Dr. Koren: 8:34

Yeah, I think it is pretty illegal here.

Dr. Kirvin-Dawes: 8:36

Right. So in Jamaica it's not. It's just not regulated. So people are trying to do it quietly so it doesn't get regulated. But people have used magic mushrooms to. They go on a retreat and they take the mushrooms and then they have certain insights into what's really been bothering them. So people say, like a week of going on a retreat of mushrooms somebody has said is equal to 20 years of therapy.

Dr. Koren: 9:09

So interesting, okay.

Dr. Kirvin-Dawes: 9:12

It does put you I have tried it in another state of mind and things that you haven't thought about in years it does bring up. It is a psychedelic, so people can't see things. I don't think people should do it on their own unless they know and have done it before, because it can make people see things and be very afraid. You need proper support of what's going on with you? But in fact there are a number of American retreats in Jamaica doing psychedelic mushrooms. I have friends who run programs.

Dr. Koren: 9:48

So how would you guide somebody in terms of this? Is it, do you know how much psilocybin people are getting per mushroom or has? That depends on the mushroom.

Dr. Kirvin-Dawes: 9:57

Okay, so it depends on the mushroom. There are certain grams and it. Well, okay, this is a thing that's not regulated well. So you find most of the people that run their own sites favor certain types of mushrooms. They all don't use the same ones, and so the amount of grams you get and usually now they're a little better and measuring it in terms of grams, but it will differ per each person and your tolerance. So they'll start lower, see how you react, and then go up.

Dr. Koren: 10:29

I see. So how long do you have to assess somebody's response, l ike give me, get a little bit more explicit.

Dr. Kirvin-Dawes: 10:36

You know the okay, so when you take it most people you'll start to see a response in about three hours to three hours, so you start with like a half mushroom or no, they come in pills about five grams.

Dr. Koren: 10:48

Okay, five gram pill Okay.

Dr. Kirvin-Dawes: 10:50

But it really depends on you. Can anyway from 0.5,. Some people start with one milligram some people start with two. It really depends on the person.

Dr. Koren: 11:02

So when you prescribe that for somebody who's say, has PTSD post-traumatic stress disorder. And they said Dr. Dawes, I heard that you're the expert on helping people with this. I'm talking to a therapist and not getting anywhere. I see these flashbacks of the government taking over my marijuana farm and I need your help, so tell me how you would address that patient.

Dr. Kirvin-Dawes: 11:29

Usually if they're interested in psilocyberin therapy for PTSD. I wouldn't recommend you just start that on their own. They actually need to go into a treatment program and actually be there with a number of people, in case there are people that can have psychotic episodes.

Dr. Koren: 11:45

Okay, so it's not something you wouldn't give them a prescription for two milligrams of magic mushrooms.

Dr. Kirvin-Dawes: 11:53

No.

Dr. Koren: 11:53

Okay, but you have a dispensary that you would trust to.

Dr. Kirvin-Dawes: 11:57

Yes, we have. There are a few dispensaries in Jamaica.

Dr. Koren: 12:00

yes, and so how about a friend of yours that is gonna be a little bit off the grid and say I'm really having a hard time? I was wondering if maybe a mushroom weekend can.

Dr. Kirvin-Dawes: 12:12

Yeah, we have people there. We have people we can refer to. Okay, because you want to have people that if something happens they know how to deal with it.

Dr. Koren: 12:20

Okay, so you would advise them to be with other people.

Dr. Kirvin-Dawes: 12:25

Usually, most of the retreats are with anywhere from 10 people altogether.

Dr. Koren: 12:34

So you wouldn't advise it, staying home on the weekend with your partner and taking two milligrams of mushrooms.

Dr. Kirvin-Dawes: 12:38

No, it shouldn't be done with somebody who doesn't know anything about mushroom therapy.

Dr. Koren: 12:42

So the consequences are severe enough where it should be done in some sort of group setting where there's people around.

Dr. Kirvin-Dawes: 12:51

You need support. Yes. But the thing is, because you don't know who is going to, you have some people that go through it, and they're quite mild, and there are other people that just go off and when you're taking it.

Dr. Koren: 13:01

It's unpredictable.

Dr. Kirvin-Dawes: 13:02

Yeah, so you can predict.

Dr. Koren: 13:04

Yeah, yeah so.

Dr. Kirvin-Dawes: 13:06

You want somebody there when you're seeing certain things, can help you to interpret it, because people do see things.

Dr. Koren: 13:13

Yeah.

Dr. Kirvin-Dawes: 13:13

And to sort of help with the interpretation and be supportive. So it has to be someone that they trust as well. So, no, not recommended to do it on your own, even if you have access, unless you're very experienced.

Dr. Koren: 13:26

It's interesting. Yeah, it's definitely unpredictable. Now I know there are clinical trials that are looking at it. I know I brought up PTSD because I know specifically there have been some trials talking about that as a potential, potential problem that would particularly respond well to psilocybin, and I know that it's been also looked at for a severe depression. And you know, having gone to college in the United States, I also have some experience with some college kids that took it. In fact, my college roommate took mushrooms when we were senior. He remained nameless one of my college roommates and he I don't know what was going on, but he became obsessed with the idea of burying a chair from our apartment. So he literally started like trying to figure out how to get shovels and build a hole or construct a hole that he can put the chair in, to bury the chair. And so where this came from I have no idea, but that was a famous college story amongst my peer group.

Dr. Kirvin-Dawes: 14:36

But it's interesting the whole concept of him burying a chair if he had someone there who knows what's going on they actually sit and talk to him a little bit about it and sometimes you can get what they're really thinking about. But if the person has no, because it may not have been about the chair, it may have been about burying a secret that happened and it's really bringing that out of the person.

Dr. Koren: 14:53

That's genius, oh my God. I'm a little reluctant to say this but the insight just hit me on this particular person, but you're exactly right. It's funny how, like, you think about things that happened years ago and you have more experiences, and then your whole insight changes and what you just said just triggered something that is spot on. I can't say it on camera because it would identify the person. But now I just understand something in a very different way than I just did so. Thank you for that. And so that gets to our you know sort of. The final concept is how you get trained medical people to interface with non-traditional therapies so that they tend to have more good than harm and, either from a counseling standpoint or a side effect management standpoint or a dose choosing standpoint or a patient selection standpoint, come up with the best solutions, and we desperately need more research in those areas.

Dr. Kirvin-Dawes: 15:58

Well, what the herbal guys have told me is that they feel disrespected and some of them say I'm one of the few doctors that will sit there, talk to them and actually work with them. I think because we go to medical school and because we have done different training, some of these guys have had things passed down for years, have a lot of experience, have seen what it does and we can learn from each other. It's just a about respect and they need to feel our respect. They don't feel respected.

Dr. Koren: 16:33

Well, respect is important, but structured observation is also important.

Dr. Kirvin-Dawes: 16:38

You can work with them on that. That's what they are thinking. Well, you can.

Dr. Koren: 16:42

Yeah, and again I've been in a situation where people have come to me I want to do a study that shows this and the other thing, and we always have to tell people. Well, how about if the study shows your idea doesn't work? So you have to be prepared for that, and that's the humbling part of doing clinical research is that, as much as we believe in something, once you put it through an objective test, it may work and may not. And, of course, if it doesn't work doesn't mean that your idea is completely nonsense. It means that you need to redevelop your idea and come up with a solution in which that situation will actually work to accomplish what you're trying to accomplish. Hey, Lisa, this was a fabulous conversation. I really appreciate it. I always learned something from you. It's a pleasure and keep the good work and thank you for being part of Two Docs. Talk Natural Medicine.

Dr. Kirvin-Dawes: 17:33

Thanks for having me.

Narrator: 17:35

Thanks for joining the MedEvidence podcast. To learn more, head over to MedEvidence. com or subscribe to our podcast on your favorite podcast platform.