During this is the interview, Dr. Aggarwal talked at length about how he feels Cannabis is not only going to change how palliative care is administered, but how the healthcare industry is going to be turned upside down when the medicinal benefits of marijuana will be discovered by scientists and researchers alike.
Dr. Sunil Aggarwal thinks cannabis legalization will help lower healthcare costs.
As a home grow blogger, I ask Dr. Aggarwal if he supported people growing their own, and fortunately he does. He believes there should be public libraries dedicated to people learning how to grow their own cannabis. We at cheaphomegrow were happy to hear that.
Below the YouTube and SoundCloud Video/Audio files is a transcription of the interview.
Shane: Hello, everybody this is Shane from Cheaphomegrow interviewing Dr. Sunil Aggarwal. Doctor, if you would, could you please tell my audience about yourself?
Dr. Sunil Aggarwal: Hi, my name is Dr. Sunil Aggarwal. I am a medical doctor MD and a Ph.D. doctor in medical geography. My specialties in medicine are all traditional or certifications and hospice in palliative medicine and physical medicine and rehabilitation.
My research specialties are in the medical geography and distribution of cannabinoid botanicals, IE cannabis, the ways that they interact with our endogenous cannabinoid signaling system and the different ways they have implications for health and society, and how cannabis and similar such plants that are prohibited, generate social, structural violence, and general health. I work in the Seattle, Washington. I’d done a bunch of research, and I’ve trained on the East Coast and the West Coast.
I’m originally from Oklahoma. My parents are from India, and I’m also an overseas citizen of India and involved in the medical cannabis movement over there.
Shane: What is the name of your practice?
Dr. Sunil Aggarwal: I’m a contractor with a clinic called Sage Med integrative medicine. SageMed.co is our website in Bellevue, Washington. I see patients with all kinds of insurance backgrounds including Medicare and Medicaid and private insurance and of course people just want to pay privately.
I also see patients through telemedicine in other parts of the state that can’t travel to me, and I also do international or domestic across the state line, Tele-education.
Shane: What is palliative care?
Dr. Sunil Aggarwal: Palliative care [of palliative comes from a Latin word (Palliat)] which means to cover or to cloak. It came from the tradition where people had severe wounds in the Middle Ages. They would stay in respites, which is where the word hospice comes from, to ease the pain of the wound that they couldn’t cure because they didn’t have antibiotics. They would just cover it and make sure it wasn’t as painful.
It has to do with medical practices geared toward improving pain and symptom management and quality of life, that focuses on all these physical, emotional, psychosocial, spiritual suffering. Often it can be used in the context of illnesses that are not curable or progressive, more chronic and even terminal.
It’s kind of a parallel medical system or medical specialty that helps to support patients no matter what kind of care they’re receiving for their illnesses, to promote quality of life. We used just to do it in hospice, Patients who had six months or less to live, and that’s kind of what hospice care is, trying to maximize the quality of life.
If you’re facing a terminal illness and no longer trying to cure it, you can use that same skill set much earlier in a disease course, and not necessarily for terminally ill people that have conditions that are chronic and limit their life.
Shane: What does that have to do with cannabis? How do they intersect one another?
Dr. Sunil Aggarwal: Cannabis is a traditional, botanical medicinal plant that’s been used for millennia in medical systems, religious system, and social, ceremonial practices, and many traditional medical systems around the world have utilized cannabis for its properties.
In some old texts they say, relieve distress, relief from anxiety, pain. It is any form of distress. That’s a beneficial thing to have when you’re dealing with conditions that cause stress, pain, nausea, and vomiting, depressed mood, low appetite, muscle spasms, spasticity and gut overactivity.
Cannabis is a kind of a ‘jack of all trades’ useful botanical plant medicine that can be widely utilized for palliative purposes.
It works so well because it taps into our natural endocannabinoid signaling system which does a lot of important functions for our body and quality of life.
Shane: You wrote an article on current-oncology.com, and you talked about various researchers that were studying cannabis. Can you give a brief overview of what you wrote? And can you define what do you mean by a cannabinoid integrative medicine?
Dr. Sunil Aggarwal: I wrote this article in one of the large Canadian journals of oncology called Current Oncology in their special issue on cannabis.
They invited me to write a perspective for the use of cannabinoids in palliative care and oncology. In that article, I tried to describe the way in which you can think about Cannabis in medical practice in oncologic palliative care, but really in medical practice in general. It’s helpful to think about it in the frame of integrative medical practice.
We’ve been using this term integrative medicine for some years now. It was popularized by Dr. Andrew Weil at the University of Arizona, who’s pioneered a lot of work in what they used to call alternative medicine.
It’s kind of like complementary medicine which borrows from the best of different traditional systems; it’s grounded in evidence and practice, and can it be integrated with what we call conventional medicine.
Integrative medicine is kind of bringing the best of all different medicines systems together, looking at patients holistically. A lot of times that involves the use of medicinal plants and herbs and supplements and acupuncture and different practices, mind, body medicine, etc.
We already have a medical system that recognizes multiple types of healing systems. To add into that the cannabinoid piece is to recognize that there is a natural system in our bodies and in life that is called the endocannabinoid signaling system, that has important roles.
As I mentioned earlier, mood, appetite, memory, inflammation, pain perception, bone growth, extinction of reversive memories or management of trauma, an internal reward for exercise, things like that. It’s quite a vast system.
Then recognizing that there are botanicals that can tap into that system, such as cannabis, being one of the master ones, but other ones as well.
So that’s how I come up with this term cannabinoid integrative medicine as a way to think about the cannabis in medical practice, to frame it in a way. There’s no such thing as a medical system that’s just dependent on one treatment.
Medicine is bringing multiple treatments together to help patients, and while cannabis is an excellent treatment, it’s not a panacea, and it works best when it’s combined with other forms of treatment. So, that’s my cannabinoid integrative medicine term.
In that paper I described how cannabinoid integrative medicine could be used in the palliative care of cancer patients, and I talked about three different sorts of ways to think about that.
1. Number one was palliation of symptoms in cancer patients suffering from numerous symptoms that impact their quality of life and caused suffering such as pain, pain from cancer, tumor invasions, pain from procedures and tests and surgeries and overall inflammation and things like that.
Nausea and vomiting related to the condition or the treatments, depressed mood due to getting a serious diagnosis, anxiety as well as trauma, low energy and low appetite, and all of these symptoms can be palliated with cannabinoid integrative medicine and other things as well, but cannabinoids tend to have a nice effect can be dosed.
I covered a lot of research studies that had been done in cancer patients that showed many such improvements and reduction of use of other pharmaceuticals.
2. The second domain that cannabis integrative medicine is useful for in these patients is palliation of spiritual and existential suffering.
I separated this out. It’s a unique formulation to think about how the way the psychoactive properties of cannabis that can be harnessed to help people improve, enhance their senses, to increase their pleasure and enjoyment in life, which is very important when you’re dealing with life-threatening or even potentially terminal illness and that phase.
Also, helping to forget the severity of the illness and the treatments that they may have gone through, which can be very dramatic. Many people have trauma secondary to major medical practices and procedures and ICU stays, and all the range of things that happen.
The idea of cannabis as it’s traditionally been used, as the catalyst for spiritual growth, helping people put themselves in a larger perspective, helping them to refine their search for meaning and purpose and values, those are very important when you’re with the spirit of suffering, which as I said earlier, in palliative care also attends to just as much. That’s another very important domain. I think we have a lot more cases of that based on folk knowledge and traditional medical practices with cannabis.
The final domain was the use of cannabinoids in Canada as an experimental treatment to help to slow or modify actual cancer itself, as opposed to just the palliative, but because it’s still classified as palliative because it comes from the internal desire of people to continue to have hope in the faith of terminal illness.
I think that hope should be supported and if traditional plants can potentially provide something, even if it’s not well researched, as long as it’s safely done I think people have a right to try that.
There is lots of helpful evidence in the preclinical animal studies, petri dishes that have shown cannabinoids affecting cancer cells.
With that being said, we’ve had some very early human studies in certain brain tumors that cannabinoid sprays, extracts can prolong life when combined with traditional high-dose chemotherapies in very aggressive brain tumors.
Shane: Does Cannabis show promise in fighting specific types of cancer?
Dr. Sunil Aggarwal: Your question hits the nail on the head.
There are so many different types of cancer, hundreds and hundreds and hundreds, each from a different tissue type and different settings, genetics, toxins, viruses, other kinds of exposures, we don’t know, etc.
So, it is a mixed cluster. You can say something generally like our immune system is very important in helping to surveil our bodies for cancer. That’s one of its jobs, not just fighting bacteria and viruses.
It also helps to find cells, our own body’s cells that have gone haywire, and that’s an essential function or we would all get many more cancers if that weren’t working well.
It seems like with rates rising, maybe something is going on there, but the cannabinoid system in the body, the endocannabinoid system, is very much involved in modulation of the immune system and some of the mechanisms that have been proposed as to how can cannabinoids might be helping when we take them externally. We’re helping to boost that internal system of cancer surveillance regulation for that to be said, quite generally across multiple cancers.
It’s dependent on research, and ultimately the rubber meets the road when you’re dealing with a life-threatening illness like that, and you don’t want to have conjecture. You want to have hard evidence to help guide you.
In human studies but there’s nothing compared to it. Were not wrapped in petri dishes or even tissues, we don’t live in these perfect conditions where you couldn’t get higher doses in a local area that you couldn’t get as well in human beings. You’ve got to compare it and look at that.
Right now, the best human clinical studies on helping to retard the growth of cancer were in the condition called Glioblastoma multiforme, GBM, which is what Senator Ted Kennedy died of, and I believe Senator John Mccain also has been diagnosed with at the moment.
So it’s a pretty well-known condition in high-profile folks. Which typically has a five-year mortality survival is around five percent. Ninety-five percent of people are dead within five years of diagnosis. It’s very aggressive and very deadly, and we do have chemotherapies.
One is oral chemotherapy, called Temodar. In specific cases where the tumor has come back, and they’re using high doses of that chemotherapy, they were able to show in a randomized study where patients who are getting something like 12 sprays have a 2.7 and 2.5 milligram one to one CBD to THC cannabis spray. They were able to live longer. They showed higher rates of survival in year one and year two. That’s statistically significant. I can’t remember the numbers offhand. This was just presented last December at a brain oncology meeting in San Francisco. It was done at UCSF and generally in a controlled fashion.
So we are now getting hard data that’s showing because people use a cannabis product with specific doses, we know that they beat the survival curve more than people who didn’t over the course of several years, and that didn’t mean the cancer went away. That doesn’t mean that they all survived. There’s some evidence in this study that without it, it was correlated. It helped cause the prolong survival.
Other studies have shown in epidemiological ways that, if you study populations of people, and were not controlling the doses, but they’d been using cannabis. It seems that they tend to have lower rates of specific forms of head and neck cancers as compared to the control who weren’t using cannabis. It seems like in tobacco smokers and some epidemiological studies that are in the Los Angeles area, La County, that people who smoke tobacco and smoke cannabis joints, had lower rates of lung cancer, causing what we think is as a protective effect.
So there are other indications from human beings regarding an epidemiological population level, but we may be seeing the anticancer effect that’s consistent with what we know from the underlying science. There are lots of reasons to be hopeful. But again, our human data is still very restricted, and so you can’t say it for all conditions. You can undoubtedly extrapolate from the data that we do know in the animal studies and pre-clinical, but that’s all very still experimental.
Shane: How come we don’t know more about the endocannabinoid system?
Dr. Sunil Aggarwal: How come we don’t know more about Mexico, or we don’t know more about our nearest neighbor? We are a very programmed and insulated society.
Our government has done us quite a bit of disservice in restricting knowledge about “sins” that they deemed harmful.
Like children, not allowed to watch certain channels by our parents because they’re above our age, in some ways cannabis became a target of political suppression, all knowledge associated with it, including banks.
Just imagine, you ban something so harshly and arrest millions and millions of people were being associated with it. Then when scientists got a hold of it, in studying how it worked in the body, they found out this whole new system that regulates all these things and that it has significant ramifications for medicine and biology and physiology and evolution, and all these things.
It’s something that people should understand as much as they understand how insulin works in the body, or what type of diet is necessary for good health, or how necessary your thyroid hormone is, or any basic understanding that we have of how things work to help us care for ourselves and for doctors to care for ourselves.
This is on par with that because it is a master regulatory system helping to achieve homeostasis in multiple domains, and help us to also connect mental and bodily mind related illness and issues and gut and brain and all these things. So why not? Why don’t we know more? Well because we put a lid on all that cannabis stuff.
Politically by banning it and making it hard to study, only promoting negative sides of it. All of that came out of a sorted history of corruption and ignorance and racism. All the stuff that we haven’t gotten over or move past.
We haven’t had a liberalization of cannabis laws on a fundamental level, ever, and it’s only gotten more controlled. Regarding the ultimate law and certain states have moved forward but the federal government does the most funding for research, that’s basic medical research.
Not just here, internationally. The funny thing is, it’s because of the federal research that we know so much about the endocannabinoid system, even researchers at the NIH. , due to them alone, that we’ve understood so much and we’ve also funded research internationally from the US, such as Dr. Raphael Mechoulam in Israel.
With that research, those countries are moving forward, but we’re still not even using our own research to move our country forward. It’s a terrible injustice.
Shane: There was a recent Bloomberg article that came out, I believe either yesterday or the day before, that talks about how Israel and Canada are flying by us in how they approach the studying of cannabis.
Dr. Sunil Aggarwal: I read that article this morning. They’re also putting it into practice. Letting people do business with cannabis and production, trade and international exportation.
I am concerned about over monopolization of Cannabis by big business, just like it’s been happening in pharmaceuticals; it is a traditional plant medicine, so accessibility isn’t an issue, especially on the grow side. That’s why I like your blog website name, on home grow.
Shane: You said something interesting; you said a traditional plant medicine. What exactly do you mean by that?
Dr. Sunil Aggarwal: We have the official classification of international law, the World Trade Organization.
The World Trade Organization is an international organization that regulates corporations and corporations who are international sit on that tribunal. There’s a special class category in international law that recognizes traditional medical practices.
These are practices that have been around for a very long time, tied to indigenous people and have a well-documented history of use. Even the WTO says it’s intellectual property. It’s a document that says explicitly that you can’t patent those things, [referring to corporations]. Corporations that are sitting on our tribunal or our boards, if you’re going to use that in your in your corporation, you have to figure out a way to equitably share profits with the people that came up with this stuff.
Countries can’t restrict these too harshly to prevent the traditional practices from taking place with the traditional medicines. There’s kind of a whole body of international doctrine of law and human rights that give traditional medicine systems and practices an understanding.
It’s kind of like the way that we respect certain traditional cultural practices of native Americans in the United States. Even though we’ve done so much to make over the decades to restrict their ability to speak their languages and dress in their appropriate fashion, but because of all those things the US wasn’t the only country to do that. Many countries and have helped to set up this international framework.
There’s even a protocol called the Nagoya Protocol, it was signed in Japan, that regards how companies if they use traditional germplasm or plant resources from other countries or traditionally traditional systems, they have to have some form of not, just lip-service but fair sharing.
So that’s what I’m talking about it, we can’t treat cannabis like it just showed up out of some of somebody’s lab and now it’s patented, and now nobody can access it for fifty years. Before you know, it’s monopolized. Five people can grow it, and ten people can dispense it, or just individual companies are going to sell it to us.
All of those things are severe violations of people’s rights to have to access to their heritage, and that’s traditional knowledge that you can read in a library, that was known in medical practice.” They use an eleventh-century textbook just to show people that it was already in medical practice in India in the tenth or eleventh century. So don’t pretend like you just came up with it, that’s what I mean.
Shane: As a doctor, do you believe cannabis can lower healthcare costs?
Dr. Sunil Aggarwal: No doubt about it. We’ve got a couple of studies published in the Journal of Health Economics by a father, daughter, professor team in Georgia.
That have shown cost savings to Medicare and the Center for Medicare and Medicaid Services (CMS).
Which is a federal organization that pays healthcare costs for many people who are qualified to receive that type of insurance, but significant cost savings, significant reduction in prescription drug prices as prescription drug costs in states where cannabis has been allowed for medical practice, for traditional things that we know cannabis can help alleviate or treat pain and spasms.
So they were able to do some modeling and figuring out just how much is being saved. Also lower deaths from toxic adverse events from medicines that cannabis can be used instead of, as another cost saving.
There’s no doubt about it when you have good medicine, and you utilize it, you’ll save money because you won’t have to spend on other things that are not as effective or more dangerous.
Shane: You believe it will lower healthcare costs if the broader population starts to use it for medicinal purposes?
Dr. Sunil Aggarwal: Oh yeah. We have to educate left and right, and we also have to make sure the system that we generate and build to make cannabis available for people because not everybody’s going to be able to grow it easily.
We have to have systems of dispensing and production and processing, but those systems can’t be too onerous cost-wise, and with time, the market will be allowed to grow and serve the needs of people.
It should work itself out regarding economies of scale, but with the pharmaceuticalized model, where cannabis is being made by one international company “selling soil” and then extracted and brought to the US, and with intellectual property protections on the way it’s being produced. With a company’s shares being traded on Nasdaq, you can expect that kind of thing when it gets FDA approval.
There have been some estimates published in the Wall Street Journal of something like 80 to 100,000 dollars per-year, per-patient to pay for that, but they’ll want their insurance companies to pay the company to supply, a CBD rich extract of cannabis, for example.
That’s the kind of thing that, I don’t think will lead to cost savings. It’ll lead to more gouging of the system, and would make the rich richer, with more yachts and more helicopters or private jets and that kind of thing.
That’s the opposite of what I’m talking about. I’m not saying that we shouldn’t have a system where the FDA approves it, but if they want to get their prices that high, they’re going to want to restrict the prices in the traditional market. You can imagine the difference we’ve been talking about. There are tens of thousands of dollars difference in cost.
Shane: So basically you would support people growing their own?
Dr. Sunil Aggarwal: Yes, of course. We need to have libraries and traditional genetic seed banks available so people can have access to different germplasms and genetics, which again, I think is our commonwealth right, for everybody.
There are issues with cultivation, pesticides, cleanliness and things like that. I think people can be educated about that, just like they grow their own spices for their kitchen cooking and fruits and vegetables.
It could be taught, especially for less fancy cannabis products, for example tinctures, THC rich, THC with some CBD or CBD rich. Those things can be done, and that certainly would help to lower costs.
I’m not talking about big commercialization, but just homecare or care for a small community. These things should be allowed, and there should be some reasonable testing and reasonable regulations. That would be great.
Shane: Would you recommend any particular method of ingesting cannabis? Is one way better than the other?
Dr. Sunil Aggarwal: No, I feel the methods that are best vary from patient to patient.
I do discourage smoking cannabis herbs, when it can be vaporized or if they’re smoking it to trying to minimize damage from that, but people can have injuries from the soot and heat. Some of that is just not necessary to get the cannabis in a form that can be utilized.
I’m also interested in combining cannabis with other plant medicines to help to improve its tolerability and improve its efficacy. That’s how it has been traditionally used; it was never just a solo thing. It has been used as a solo thing, but it also can be used in combination.
For example, we have pain relieving products in the cannabis dispensaries, and shops regulated system where they combine things like willow bark, or they’ll combine turmeric which has inflammatory properties.
There’ll be cannabis products to help people sleep where they combined Valerian root and Chamomile extract and sometimes melatonin, I believe, different scenarios, and then topicals where they’ll use cannabis and Arnica, a well-known topical pain reliever. It’s nice to see it at home with other plant extracts and to see if that can help to lower the dose and prove the efficacy of what you’re trying to treat.
By and large, in patients, it’s nice to use things orally or mucosally to help to prolong the effect. So tinctures, concentrates, edibles, capsules, and vaporization for immediate relief.
With vapor, you can even lower the dose because it goes straight to the nervous system.
It varies from patient to patient, but there are many different routes that you can utilize.
Shane: Do you believe cannabis is a gateway drug?
Dr. Sunil Aggarwal: No, that’s all horse BS. There’s no evidence to support that. That’s all based on the politics of reefer madness and the drug war which tried to create an association of criminality and social deviant with cannabis use — marijuana — as it has been called, it’s part of that scare campaign, and there’s no logic to that.
Addiction is a complex psychosocial, emotional, spiritual problem which is related to childhood trauma, emotional bonding disorders, some genetic propensity and lack of social-emotional support.
Cannabis actually can be therapeutic for helping people deal with some of the traumas that bring people into addiction and help people to mitigate addiction. I’ve seen that as well.
So it’s not about gateways. There’s research that came out recently showing injection drug users in Canada or people or who were in a marginalized population that were at high risk of injection drug use, when they had cannabis onboard or used it; they were less likely to start shooting heroin.
The truth is quite opposite, and that propaganda was a lie. Which is very common, often propaganda stats are just the absolute opposite of the actual truth.
Shane: Earlier in the conversation you talked about Canada and Israel and going back to that part of the discussion, from a regulatory or legislative perspective what do you think America can learn from Canada and Israel concerning how they look at cannabis?
Dr. Sunil Aggarwal: They can recognize it at the federal level as a medicinal useful product plant. We’re not even there. We don’t even have that definition.
In Canada, they’re federally “allowed” though it’s very restrictive in some provinces. The monopoly and pharmaceuticalization issues are prominent in both countries by the way. It’s not like their systems are like the peoples’ accessible market, that we want to see. There’s lots of money in high tech and private capital investors in stocks that are going into both of those countries.
Sometimes it’s the way to build businesses, and that generates excitement, but it can also be a way to restrict access to the market to only people who have enough capital laying around for traditional plant medicine, but that’s not right.
At the same time, they are creating systems; they’re studying it, they’re recognizing it’s medical utility. They’re allowing doctors across the country to prescribe it.
In Canada, they’re rolling out a system for non-medical use by adults for all the other conditions for reasons that people might use cannabis, but don’t require you to see a doctor. Those are things that we can learn from those countries.
Shane: What do you think is the future of Cannabis, coming from a medical perspective? What do you think we’re going to discover 5, 10, 15, 20 years down the road?
Dr. Sunil Aggarwal: I think the endocannabinoid system will start to become more prevalent and relevant in terms of how we think about patient conditions and what they’re presenting with, and we’ll have better tests to figure out exactly what they’re cannabinoid levels are. Rather than just clinical parameters and we’ll be able to utilize cannabis in integrative forms, ratios of CBD to THC, and other cannabinoids, and CBG.
The many cannabinoids that seem to have very promising properties and we’ll be able to have whole plant extracts of various “forms” of those and be able to administer those to patients and see improvements in their cannabinoid disorders; From pain disorders, GI disorders, viral issues, oncologic issues and rheumatologic issues.
I think every field of medicine can be touched by this knowledge and system. You’ll probably see cannabis products, as I said, both in an integrative system, whole herbal plant extracts with other plants — mixed inform.
You’ll probably see pharmaceuticalized cannabis products. I think the two can live side by side as long as we have different systems of medicine around cannabis can be in all those different systems.
I think we’ll see more wellness systems around cannabis, helping people tolerate physical therapy or yoga or exercise.
Maybe they’ll be more rediscovery of cannabis in spiritual practices like it has been around traditionally.
I think cannabis also has lots of other values in terms of food and nutrition, environmental health and sustainable textile and other product production.
Food side is very interestingly, the hemp seed omega six omega three fatty acids in the seed, plus complete protein content we still have a very small amount of knowledge due to prohibition, and a lot of conditions can be improved with improved nutrition. So those are different areas that I can see happening.
Shane: With the right food mixed with cannabis, one can live a healthier life?
Dr. Sunil Aggarwal: Yeah. I was talking about cannabis seeds, but there’s also cannabis juicing.
Teaching the flowers and leaves with the acid forms, the raw cannabinoids that are not being decarboxylated by heat. I think we need to do more research, but there’s some interesting anti-inflammatory, anti autoimmune properties that need to be looked at more.
Shane: Is there any questions that I’m missing, that I should be asking or do you want to make any a final statements?
Dr. Sunil Aggarwal: Well, I’m just want to say thank you, Shane, for helping educate your viewers and listeners about cannabis.
And putting it in the context of something that they can actually produce themselves and helping to educate people about the real medicinal, scientific facts about it, including its history and it’s current and future uses.
Final thoughts, there’s a lot of potential, and there’s already known reasons to be utilizing cannabis in medical practices, and be more mindful of what our governments are doing to either restrict us from this or coordinate it off to just a few select private interests. Neither of those systems is good for us in the long run.
I have a Patreon account as patreon.com/humansunil, which I’m hoping to get some more support to educate people more about what I’m doing and what I think should be the way to go.
Shane: OK, fantastic. Thanks for coming on the show and I do appreciate it.
Dr. Sunil Aggar: Thanks for the great questions. I really enjoyed it.