How I Got Here
May is Osteoporosis Month and it is a great time to talk about that here and then now for bone health and the role of the Endocannabinoid System (ECS). Increasing fractures in the older population are increasing at an exponential rate. This is in direct relationship to the advancing age of the U.S. population and the amount of bone loss secondary to age.
My dance with osteoporosis started back in 1975 as a research postdoctoral fellow waiting to start my orthopedic journey. I was not crazy about the idea of research because it did not appear to be action-driven enough. Well, I can tell you that I was wrong. That year was probably one of the most exciting years in my young orthopedic life.
I did have a decisive advantage going into that postdoc year and principally because I knew at least one of the projects that were latent for the research fellows, one that I had requested or talked about doing my course at the Penn Medical School.
During my medical school foray, I had an opportunity to do orthopedic research and it got me familiar with the Department of Orthopedics. There were projects for medical students and there were projects for postdocs. I was put into the medical student swim lane, and I had to look over the wall at this groundbreaking research that was out of reach for me at that time. I was made aware that this particular project was for postdocs.
I was accepted to the University of Pennsylvania orthopedic program three years later. In this research year, there were seven Orthopaedic Residents selected from around the country who were admitted to the Penn program. We were to do research at the University of Pennsylvania Hospital and Medical School for one year before transitioning into the surgical arena.
I was the only postdoc selected from Penn that year into the Penn Orthopaedic program. I had not seen the principal investigator I worked with during my medical school doing that orthopedic research course in my second year in medical school.
When I left the classroom after my second year, I was spending time away from the University in completing my clinical rotations and time at different hospitals under different tutelage in this study of medicine throughout the Philadelphia area. However, I do believe that the research orthopaedic professor recognized me on my return to the laboratory.
That major research project was still ongoing that I had asked about during my medical school days. This time, I got the OK for that research project and it was like a heart-filled promise come true. I now met the criteria to get that particular project. That project was around bone stimulation, electrically induced osteogenesis.
Bone stimulation has been a phenomenon that has garnered a great deal of study over time without necessarily all the answers being achieved. Bone stimulation notoriety was being looked at in about three or four major universities throughout the United States at that time.
This research needed quantitation and qualification of the amount of electrical current and the quality of the bone that could be formed. This research was carried out and the results that we were able to obtain convinced the University Institutional Research Board (IRB) that we had a clinical study.
This groundbreaking study would affirm the amount of bone production possible with a small amount of electrical current to the fracture site. After 12 weeks, the fracture could be declared as a healed fracture, addressing a major problem in the healing of fracture known as non-unions. At the end of that research year, I was selected to present our results and paper at the American Academy of Orthopedic Surgeons annual convention, what an honor!
Four decades later, I find myself in another situation or circumstance regarding osteoporosis and bone stimulation. In those 40 years, the problem of bone stimulation continued to be a moving target. Mega analysis studies on Vitamin D played down Vitamin D’s ability to prevent fractures. For decades, a number of medications still did not solve the problem of the bone loss.
Life expectancy in the United States is predicted to hit 90.3 years by 2030, and 1-3 children born today will live to be 100. What will this do for a more bone-brittle population? If we do not understand or find equilibrium trying to balance the amount of bone formation and bone loss, we will not have a leg to stand on. A full pun is intended.
I started studying the Cannabis sativa L plant when we found that it had very good and a number of different endpoints. Drug overdoses were escalating and there were companies that were stating that there were no addictive qualities to these medicines which was not true. Opioids became highly overprescribed and helped to change the culture of the medical community.
I got involved because I knew the addictive qualities in my practice as an operative orthopedic surgeon with a great degree of respect, fear, and trepidation of getting my patients in a predicament of drug addiction with prescription writing. It was like well my kids would say they lived in a “NO fun zone” when they grew up. I guess I carried it over to my professional aspirations where there was a “NO fun zone” because orthopaedics is serious business. Medicines are not to be played with. They should be considered therapeutic.
After my introduction to the Cannabis sativa L world, I had to study hard because there was very little information to be shared because of the Federal criminalization of the plant, Cannabis sativa L in 1970 with the Controlled Substances Act.
Looking back to my first year in medical school that year, what was being discussed was not necessarily true about cannabis. Maybe they formulated our own culture of skepticism of medications that they say worked and did not work, a topic for another time.
Fast forward 2018, I made this decision to cultivate this hemp plant in a special state administered program that came to be with the signing of the 2014 Farm Bill. Experimental development and experimental growing of this hemp was now possible. I took my research attitude and applied it and grew hemp from the seed to the harvest.
Let me tie this back into osteoporosis. Learning all that I have learned about the ECS, we know that we have CB1 and CB2 receptor sites and these receptor sites are affected by different endocannabinoids and phytocannabinoids. What has been discovered more recently is the fact that CB2 receptor sites are bone stimulating. Of course, this excited me and was a continuum of my sojourn that started many years ago.
My work is not done yet and I have some great people that I am trying to connect with and work with and try to attack this problem of osteoporosis which will be a major public health problem in the 21st century. So, this is the start of my story and I have learned that everything is a story, and I shall continue to tell you mine as we go to the next blog and talk maybe more about osteoporosis because May is Osteoporosis Month, and this is how I got here.
Please and thank you and please go to http://www.dailyvitamincbd.com and read my other blogs. I shall try to explain why this cannabinoid medicine is not fool’s gold or some type of tonic that cures ALL!
Eric I. Mitchell, MD FACPE