PLACEBO EFFECT, THE ENDOCANNABINOID SYSTEM AND HOPE

When we think of the “Placebo Effect” we think of an effect that is “imagined”. For example, when a patient feels better after an IV is started but before any medication is given. Or in the 1950’s when a child had an acute asthma attack, ambulances would often be sent to transport the child to the hospital. It was very commonly noted that the child’s breathing improved before any care was administered. Reassurance and a hug seemed to help the child breathe.

So, in these two instances, “nothing” was given but the patient improved. Of course, in fact, so much was given. (1)

There have been reports of sham surgeries of the knee showing the same results as opening the knee and closing it without any repair. (2)

In all these situations, no direct care is given, but there are significant changes in how the patient feels. Is this a placebo? I suppose it is, but I have learned to count and rely on this effect in medicine and life.

It is sensible that we would have a mechanism to make us feel better, a mechanism to give us hope and a mechanism to allow self-healing. For certain, it would have evolutionary benefit making us more adaptable to a wide range of stressors. (3)

The Endocannabinoid System is an immense physiologic system found in all vertebrates. Endogenous cannabinoids interact and activate cannabinoid receptors. The CB1 receptor is largely found in the brain and peripheral nervous system and the CB2 receptor is found in the immune system, the Gastrointestinal tract and more. These endocannabinoids are responsible for the wellbeing of countless interactions in the human body.

Just as THC and CBD are the two major plant or phytocannabinoids, Anandamide and 2-AG are our primary two “Endo” or internal cannabinoids. The plant cannabinoids as well as our endocannabinoids bind to the major Cannabinoid receptors as well as many other receptors outside and inside our cells. Lowered “tone” or levels of our endocannabinoids is associated with many diseases including, but not limited to, Fibromyalgia, migraines and irritable bowel.

The Endocannabinoid system is involved directly or indirectly in most of our bodily functions, which helps explain why cannabinoids have such far-reaching effects. One of these effects, particularly related to Anandamide, is the function of the Placebo Effect. When we are feeling better with clearer breathing, slower heart rate, etc., it is largely from increased tone of our endocannabinoid system and specifically elevation of our Anandamide level. Anandamide plays a large role in cancer surveillance and is a part of the anti-cancer effects of cannabis. (4)

Studies have been done measuring Anandamide and 2-AG levels in cerebrospinal fluid. Patients with Endocannabinoid deficiency have low Anandamide and 2-AG levels, which can be elevated with treatment with CBD. An “Endocannabinoid Deficiency Syndrome” is now well established as described by Dr. Ethan Russo as a cause of many diseases. (5)

Am I suggesting that making someone feel better; hence increasing their Anandamide level, might further protect us from disease? Yes, I believe there is a very good chance that anything that makes us increase our endocannabinoid tone will make us feel better and further protect us from many diseases including cancer. (6)

When we are told, “everything will be ok” we feel better. Our endocannabinoid levels are most likely elevated, and this very likely promotes healing and wellbeing. Our breathing is better, our pulse is more regular, we are less anxious.

I often speak with physicians about how critical “infusions” of “hope” are for the wellbeing of the patient. The more I study this area of medicine the more critical it becomes. The physician cannot mislead the patient or family, but he/she can and I believe is obligated to, help the patient and family maintain hope. After nearly 40 years of private practice in Internal Medicine, I have no doubt that this is a major responsibility of the physician. Every physician has seen patients do way better and sometimes way worse than they expected. We should not be in the business of giving out life sentences of one month or two months to live. Patients surprise me all the time and with any given patient there are just way too many variables and unknowns to be able to give out “life sentences” to our patients.

The “hope” infusion needs to be an integral part of the patient-physician relationship. I sometimes struggle with what I am going to tell a patient as the end of the visit approaches. The patient will do better with some encouragement. However, when a physician is delivering a message of hope, the physician must not be glib or insincere. He/she must also be honest.

The physician can make statements such as “I have seen a number of patients more ill than you who are doing well”, IF this is actually a true statement. I often find myself stating, “I really believe you will do very well”. Patients hug me for just making this very simple comment. They tell me that they were desperate for some “hope” and this simple positive statement, with a smile, goes a long way. Patients often hang on every word a physician says – particularly when very ill.

Again, we cannot mislead patients or present unrealistic outcome possibilities, but we can do a lot better. We must do better. One area that deserves attention is the care and maintenance of our Endocannabinoid System. (7) With the combination of a little bit of cannabis oil and a lot of hope, I offer my patients a new approach to their health and wellbeing.

 

1. https://www.ncbi.nlm.nih.gov/pubmed/21963514

2. http://www.nejm.org/doi/pdf/10.1056/NEJMoa1305189

3. https://www.ncbi.nlm.nih.gov/pubmed/25510510

4.https://www.ncbi.nlm.nih.gov/pubmed/26272535

5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5576607/

6. https://www.ncbi.nlm.nih.gov/pubmed/21410463

7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3951193/

Author
Allan Frankel, MD

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