Group 5 Last year, Deryn Blackwell and his mother, Callie, was all over the news. Why? Because, after battling off leukemia, Deryn was diagnosed with the extremely rare and very hard to treat Langerhans cell sarcoma in 2012. Deryn would undergo three failed bone marrow transplants, and doctors told him that his fourth would be his last chance. Soon after his operation, Deryn trapped his finger, which got infected. Deryn had no immune system to fight it off, and was given three days to live. Deryn Blackwell in hospital undergoing a bone marrow transplant. By this point, Deryn was ready to face the music. On the UK TV show, This Morning, he told the presenters “Once you accept it [death], it becomes very calming, it’s nice in a sense.” At this point in time, Deryn was in severe pain, taking very harsh antibiotics and had undergone 4 years of chemo- and radiation therapy. Such a treatment program would defeat anyone. Callie started to look for other forms of treatment for her son. The one thing that kept popping up over-and-over again? Cannabis. There are a huge number of studies on cannabinoids being used to treat cancers and tumors, with generally positive results. However, most of these studies are in vitro (in glass – studies on cells outside of their normal biological context) or in vivo (animals). The use of cannabinoids to beat cancer in humans has not been tested yet, and clinical trials are few and far between. This means that using cannabinoids to treat cancer is still in a highly experimental stage. Quite simply, we do not know which cancers cannabinoids can treat, at what dosage and what sort of cannabinoid-terpenoid profiles are best for specific types of cancer. Cancers are also notoriously “fickle”. They can spontaneously regress, meaning that, on occasion, people try an “alternative”. They then go to the doctors, who go on to report a clean bill of health. The person using the alternative then jumps to conclusions, and states that the alternative treatment worked. Other people can take such advice, and follow it to their own detriment. We should always be careful of anyone who claims to have a miraculous cure, and a healthy dose of scepticism is always helpful. Of course, when you’re at your wit’s end and have a dying son on your hands, you’re probably going to try whatever you can to save him. Callie did her research and decided to try cannabis for her son. First, she would ask the doctor for Bedrocan, which is a cannabis plant bred in the Czech Republic that has a standardized cannabinoid-terpenoid profile (22% THC and less than 1% CBD, according to their website). Of course, this being the UK, cannabis is illegal and cannot be prescribed as medicine unless the primary care organization agrees to funding. The doctor refused Callie’s request. Rather than stop there, Callie decided to administer Deryn cannabis anyway. This is illegal in the UK, but once again: you have a dying child on your hands, and no effective treatment for what’s killing them. The only treatment that may work is illegal. Do you decide to stay on the side of the law and let your child die, or do you become a lawbreaker and give your child the chance to live? For Callie, as with so many other parents, the answer was a no-brainer. She wanted to give Deryn a shot at living, and cannabis was possibly one of the better options available other than the current, proven treatments. Thirty minutes to one hour after taking the cannabis, Deryn was already starting to feel better and in much less pain. “The effect of it blew my mind, we noticed after thirty minutes to an hour he was chilled out.” This is perhaps not surprising. Cannabis does look to be an excellent form of palliative care for cancer patients, and is especially useful for beating chemotherapy-induced nausea and maintaining appetite, as well as being a painkiller. Whether or not cannabinoids work when it comes to beating cancer is not yet proven. We have Dr. Michael Masterman-Smith’s excellent work with the National Cancer Institute (NCI), where several cannabinoids were shown to have anti-cancer properties. Cannabinoids may work by modulating signalling pathways involved in the growth and spread of cancer cells, telling the cancer to kill itself. We also have hundreds if not thousands of papers on cannabis for cancer. What we don’t have is the real-life, hard, clinical data, although there is some. In Deryn’s case, we do have a clinical trial of sorts – just not a very controlled one. Deryn Blackwell at hospital, 2 days before application of cannabis tincture. After 5 days of being given cannabis and no medical help, Deryn’s white blood count started to rise. His finger began to heal and his immune system started to function again. Wondering if this was just chance or a matter of his other treatments starting to work, Callie would withdraw the cannabis. As soon as she did, Deryn’s blood count started to drop again. Callie insists that cannabis did not “cure” Deryn’s condition, but rather helped him live – as Deryn did not suffer from cancer at the time, it did not “cure” his cancer, but rather the cannabis helped treat his bone marrow. In the absence of evidence, and add in the fact that correlation does not mean causation, then Callie is entirely correct in her assessment. The cannabis was most likely not the cure, but it may well have been an excellent form of palliative treatment. Although LCS is different from cancers like leukemia, leukemia has been associated with an over-expression of CB2 receptors. LCS may also disrupt the body’s endocannabinoid system (ECS) in some way. Again, though, we must tread carefully – until the studies that we are basing our knowledge off of improve in quality and actual clinical trials are allowed, meta-analyses are likely to show no conclusive, unbiased evidence that cannabinoids work as a treatment for cancer, palliative or otherwise. Until we do, there will be desperate people throwing their money away at charlatans, abandoning proven medicine in favor of something that may not work, or indeed possibly even make their condition worse. Deryn Blackwell with mother, Callie Blackwell, and a friend. So, is cannabis a “miracle cure” for a condition that affects one in seven billion people? We do not know and, although Deryn’s case is certainly of great interest, there are many variables at play here. The stem cell infusion Deryn received may have taken longer to work than it usually does, and perhaps the last bone marrow transplant really was successful. There are also a whole host of other treatments that Deryn may have received that may have worked – we do not know the precise ins-and-outs of all aspects of his treatment program. Taking the balance of probabilities into account, it is more likely that the traditional treatment methods of surgery and chemotherapy saved Deryn than the cannabis itself. What is certain, though, is that stories like Deryn’s are certainly of great interest, and certainly merit more scientific study into the use of cannabinoids as both a palliative treatment and its potential to inhibit cancerous cell growth. There is certainly enough evidence anecdotally, in glasses, in animals, and even a small number of high-quality trials, to suggest that cannabinoids can play a part in treating cancer. This is why Leafwell will be meeting with MPs in the UK this coming Wednesday – a rational, evidence-led policy needs to be instituted regarding medical cannabis, in the UK and elsewhere.