Dear Doctor The Drug “anti-pot”
As a health professional I work to communicate with my peers. One interesting topic I try to share involves the failed weight loss drug,”Anti-pot”. Okay the true drug was called, Rimonobant. I drafted the letter below two days ago, I post it here as an example or professional interaction and it also highlights how in the practice of evidence based medicine we have to both discourage unproven therapies (like turmeric) and encourage those with supporting data (cannabis).
4/7/2020
Dr. J. B., Rheumatologist, Grand Rapids, MI
Dr. L. R. S., Endocronologist, Farmington Hills, MI
Dr. P. S., DO, Novi, MI
Dear Doctors:
I hope this communication finds you well, personally and professionally.
Subject: Three Spades (patient name/DOB replaced by random playing card, selected during patient encounter. Original information used for direct communication but not this post, also the doctor’s names above shortened to initials)
Medical summary: XX y.o female with rheumatory arthritis using medical cannabis for symptomatic relief. The interaction was done via video-chat with is a new medical tool useful in these changing times. Approving medical cards seems to be outside the scope of practice for many medical professionals, and I’m happy to pick up the slack.
A topic discussed was turmeric and its constituent curcumin. The patient takes an OTC supplement containing this compound. It appears this drug is notorious for giving false positive on high-throughput screens. The chemical society even has an acronym for this class of highly cross reactive chemicals, PAINS (pan-assay interference compounds). All subsequent clinical trials show no benefit. Unlike cannabis, use of turmeric is not evidence based.
I’m a board certified cardiologist (Internist, interventional cardiology and stents). Practice the same medicine as we all should, evidence based. Sure I got on the bandwagon a few years ago recommending folic acid supplements to reduce heart disease, but when the data showed it didn’t work, I stopped. I believe medical cannabis works for our patients. I will work together with these patients as we chart a new course. Collecting data about symptom relief, strain variety, side effects, and patient safety concerns about delivery methods, are some of the clinical areas in which I plan to focus.
I am not sure if you are aware of the “reverse” clinical trial that supports medical cannabis.
The story involves the weight loss drug, Rimonabant (trade names Acomplia, Zimulti). I knew about the drug back in 2006 when it promised to be the next block-buster drug for the pharmaceutical industry. The drug bullet points were: 1) An effective drug (sustained 12 pound weight loss over 2 years) with 2) no cardiac side effects. As a cardiologist I was well aware of the cardiac side effect limitations of almost all the available weight loss drugs. Rimonabant interestingly blocked the newly discovered cannabinoid receptor (Anti-Pot).
So what side effects did this Anti-pot cause: Depression, suicidal ideation, nausea, anxiety, seizures, sleep disorders, diarrhea, vomiting, and muscle spasms? In post marketing surveillance data, the risk of psychiatric disorders in people taking rimonabant was doubled.
I agree that turning off a receptor causing one response does not guarantee turning on a receptor with have the opposite response but it makes sense. Side-effects for one are the treatment target for the other, is the medical proposal we are planning to pursue with your clinical support.
Dr. Scott Jay, M.D., Ph.D., FACC
Cardiologist, Williamsburg MI
Addendum: I hope the above promotes professionalism. Also depression and anxiety are two of the medical conditions for which medical cannabis are not approved. The reverse trial above is suggestive for benefit, but not yet proven. Only by working with patients, collecting accurate unbiased data, can we make progress in helping patients in need.
