Medical Cannabis: First-Hand Insights from Dr. Benjamin Caplan on Cancer, Dementia, and Skincare

Surprising Medical Uses of Cannabis: First-Hand Insights from Dr. Benjamin Caplan on Cancer, Dementia, and Skincare

Dr. Benjamin Caplan: Compared to the medicines we have now, which all have side effects, which are all appropriate for certain populations, cannabis is a slam dunk. The evidence to support it in many applications — even if it's just for feeling better, even if it's just for sleeping better. But I'm saying more than that — even for specific illnesses, the disease process of certain illnesses like diabetes — cannabis can be amazing. Bryan Fields: What's up guys, welcome back to another episode of The Dime. I'm Bryan Fields, and with me as always is Kellan Finney. This week we've got a very special guest, Dr. Benjamin Caplan, author and founder of Seed Clinic. Dr. Caplan, thanks for taking the time — how are you doing today? Dr. Benjamin Caplan: Thanks Bryan, good to be here. Things are good, I'm really excited for what'll be a great conversation. Bryan Fields: Excited to dive in. Kellan, how are you doing? Kellan Finney: I'm doing really well, really excited to talk to Dr. Caplan, really excited to dive into all of his work in the medical field and all the good things he's doing out there. It's nice to connect with someone who's got his heart on the West Coast — I know his wife's on the West Coast, and his early academic career was spent on the West Coast. Bryan Fields: Yeah, I think that's fair — I think we can all say our hearts are on the West Coast. Dr. Caplan, we just need to put you on the record — physically, are you located on the East Coast or the West Coast? Dr. Benjamin Caplan: I am physically on the East Coast, but my heart is on the West Coast, so I'm bicoastal. Bryan Fields: I got love to go around. Awesome, awesome. Yeah, that's a very fair record. So, looking forward to diving in — let's get right into it. Can you give a little background about yourself and how you found your way into cannabis? Dr. Benjamin Caplan: Sure. So I'm a traditional doctor — a primary care doctor, board-certified, licensed, trained. I'm not the quacky sort that gives you kind of funky hanging things off the ceiling. I care about evidence, I care about academia, and I care most about my patients. My career started off in some of the academic centers of Boston that we all know about from the news, and some elite universities. But I heard my patients calling out for guidance with cannabis, and they didn't have any — it's mostly card flippers out there and bud tenders at the stores who don't know much beyond what they're selling. So I decided to do what felt right, which was fill that need for academic understanding of the literature and translate that to my patients so they can make healthy decisions for themselves. Kellan Finney: I'm fascinated — early on in your career, had you always been a proponent of cannabis, or did you read something or did someone say something to you that got you started? Are you asking if I smoked a lot of weed — is that really what we're boiling down to? Not necessarily — more, were you more pro-utilization of these types of tools, or did you read the scientific literature and think, hey, maybe this could help my patients? Dr. Benjamin Caplan: Right, so I am a nerd through and through, and I actually never consumed cannabis — I was afraid of it, the same stuff I hear my patients telling me all the time now, that they're worried about becoming dumb or lazy, or they don't know what THC is going to do. I was subject to the same idiotic misinformation everybody else was, even through medical school — I literally knew nothing. Of course, I had friends who had a good time with it and seemed happy, and it seemed to be saving them from drinking alcohol, so that seemed like a positive in my youth. But I didn't know anything personally, apart from people having a good time and Bob Marley seeming pretty creative — and that was it. All of my learning happened because I opened books and read what's publicly available from legitimate published literature, and the story is overwhelming — it's actually really positive, but nobody's learning about it. Doctors aren't changing their views based on what they're reading, or maybe they're not reading. And there's no real leadership on the medical side for cannabis. There are a couple of "hot docs" out there who smoke a lot and say some good things, use fancy language, but nobody's really reaching the public and trying to get everybody on the same page — which is my mission. Bryan Fields: Was there a critical point, though — prior you were just dabbling in the research, and then finally you thought, all right, this is it, I'm going to get involved, I'm going to get to the front lines. What was that critical point? Dr. Benjamin Caplan: My dad is an icon of neurology — when you think about strokes and stroke neurology, that's my dad. He's published upwards of 50 books, 300 manuscripts — he's the guru. This year, Time magazine called him the GOAT of medicine, not even just neurology. He's a badass when it comes to neurology, so I grew up in a long shadow. I knew I wanted to be like him and lead something, but I thought, what am I going to do? So there was part of that business drive — like, what can I find my niche in? But really, it was patients in my office. Doctors sometimes face a week where, for whatever reason, the stars are aligned and everybody has the same thing — a sore throat, a broken elbow. There was one week in my office in the suburbs of Boston where everybody was saying, "Doc, I don't need your stuff, I have cannabis." I'm sitting across the table, supposed to be the one who knows it all, and I'm thinking, boy, I don't know anything — these patients don't need me for back pain, menstrual cramping, headaches, muscle pains. I have one professional athlete who uses it after practice — I was clueless. That felt awful, but it also motivated me to learn more. Bryan Fields: So was there a piece of literature you went to — because this is where the nerdy aspect is really fascinating — where you saw a journal, a published article, that led you to this discovery, where you started understanding, hey, cannabis can be this tool? Was there a specific piece, and do you remember exactly what that was? Dr. Benjamin Caplan: Right, so I teach people not to look at just one piece — if you're ever reading, you have to read at least four or five articles about the same topic, because you're not going to see the same story. That's the way good medical research happens — you have something on A, then something counter to A; something on B, and counter to B. For me, it was PubMed, which is publicly available, anybody can search there, and I looked for the free articles, because at the time I couldn't afford to pay for articles. I started downloading as much as I could and built what has now become the world's largest library of cannabis publications — the Seed Library. I give that away for free — it's literally my two-terabyte Google Drive that I share with anybody who wants to search and read about this stuff without cost. It's there to be read. Bryan Fields: Have you seen a drastic change in sentiment publicly since that first moment where you got started, to kind of where we are today? Dr. Benjamin Caplan: Oh my God, yeah — I've watched it change incrementally. Twelve years ago, nobody talked about it — it was just something you didn't do, like, "I'm not going to become a prostitute, I'm not going to consume cannabis." It was this crazy thing, like, why would I do that, it was an automatic idiot move. That evolved to something like "don't ask, don't tell" — you didn't tell your doctor, your doctor didn't ask, everybody was hush-hush about it, but it wasn't so negative. That evolved to, "well, if you're going to do it, I don't really know what to tell you" — that was the doctor's line, clueless but go have fun and be safe. That eventually changed to what we have now, which is I actually get referrals from some of the pain doctors out there, from doctors who have complicated patients they can't help — they send them to me first because people are finding such relief with cannabis across the spectrum, and these doctors don't understand why, because none of us were taught about it in medical school, and they don't get the physiology of what's happening at a cellular level with cannabis. We still hear the stigma for some reason — maybe grandmothers out there have a loud voice saying, "don't you do that" — but cannabis is really helping people, and when someone gets out of their comfort zone and gives it a try, maybe because they heard their neighbor or someone they know had cancer and tried it, people are all bowled over with the benefit. It's shocking because we don't have much information about it culturally. Bryan Fields: One interesting thing a couple of guests have mentioned is that the endocannabinoid system isn't taught in medical school. At what point do you think that's going to change? Dr. Benjamin Caplan: I don't know — this gets into the intersection of payment, how medical schools are businesses funded by rich people with very particular opinions, so it's hard to get the curriculum to change. I've literally knocked on the door of my alma maters and they're not so interested. I give talks once in a while and share as much as I can through free channels, but it's hard to open the door to new thought. And actually, this is a good thing — we don't want doctors who influence health swinging from one extreme to another, and that happens sometimes. We all hear "salt is good, salt is not so good, salt is terrible," and then "vitamin D, you need a lot of it, but wait, you can get it from the sun." We go through these swings in medicine that are confusing, but that's because science is what it is — we learn one thing, and other scientists with the same outlook find a different result, and that's normal science. So I think it'll take time, but we also live in a different age where medicine isn't necessarily taught in one certain way — the internet has made everybody search, and depending on your perspective, you'll find different search results. It's interesting to see how modern life is changing medicine. Kellan Finney: But on one side of the coin, you see patients on a regular basis, so some of the access and visibility you get is real change, whereas other doctors might not experience that same aspect — they might be a little more sheltered from what cannabis can do. Can you take our listeners through some of the patients you see, and how it works with cannabis, and how you work with them? Dr. Benjamin Caplan: Yeah, it's a really cool phenomenon I actually knew nothing about. As a naive medical student, and even a provider, I would read literature and apply what I'd learned to my patients — I wasn't as much a blank slate learning from my patients. But now with my clinic, Seed Clinic, which I started on my own because I felt the clinics I'd tried out in cannabis were just a joke, I'm actually learning from patients. I spend more than fifteen minutes getting to know people, learning about their routines, and I've developed this living laboratory of real people with real concerns and real situations. I've followed them now over ten years, and I'm learning what's really happening in the world with real products — that's kind of cutting-edge for medical learning. I'm finding trends about things like dementia and cancer that aren't even surfacing yet from the medical literature, which is bonkers, but I get to be on that front line. I'm learning from people who are exploring, going out of their comfort zone to try, say, high-dose cannabis because they've tried everything else and nothing's working — and some of them are doing incredibly well with X, Y, or Z. That's exactly what I put together in the Doctor-Approved Cannabis Handbook — pages and pages of what I've learned from the literature, bolstered by what I've learned in the clinic. Bryan Fields: I'd imagine there are conversations, though, when other doctors read some of the work in your book and see some of the findings — are they blown away? Do they still have the stigma, or are they more open to it? Take us through the thought process — do they say, "Hey, Dr. Caplan, did that really happen?" Are there continued conversations, or are they more open to the nuanced aspects of trying cannabis? Dr. Benjamin Caplan: I definitely didn't cure the skepticism of doctors, nor would I want to. Actually, I like that people are skeptical — I like that people have their scruples and say, "wait a minute, this goes in the face of what I've learned," and that's part of why I focus not just on medicine. I'm not here to spew science at people — I point to the history and the politics of the 1930s, and to the fact that our country was a racist country that looked down on people who looked or acted differently, and cannabis laws evolved around that picture, which doesn't make sense for us today. We know much more now, and the full picture — probably what's kept me interested — is not just the science. The science is a slam dunk; if enough doctors read it, even just what I've translated, but better, go to the raw literature and read from both sides of the aisle, they will see a knock-you-out kind of picture. Cannabis is amazing — it's not good for everything, nothing is, it's not a panacea. But compared to the medicines we have now, which all have side effects and are only appropriate for certain populations, cannabis is a slam dunk. The evidence supports it in many applications, even if it's just for feeling better or sleeping better — but I'm saying more than that, even for specific illnesses, the disease process of certain illnesses like diabetes, cannabis can be amazing. So I haven't cured the skepticism, but I don't want to — I want doctors to be doubtful, to question what they've learned, because we've all kind of eaten this BS sandwich. We live in a house of cards when it comes to medicine — we go into a doctor's office thinking this is going to cure me, and everybody's ticked off when it doesn't work out that way. I think we all have to be a little more skeptical, a little more patient, and a little more open-minded that the solutions in front of us may not be the best ones. Kellan Finney: That's so well said. Do you think cannabis is able to treat this wide array of diseases and illnesses because the endocannabinoid system is so involved in homeostasis, which is intricate and intersects with all these other systems in the body — or do you think cannabis just inherently has a diverse chemical profile, and these different compounds are interacting with different systems? Is there a current leading theory on why it's so great? Dr. Benjamin Caplan: I'll give you two possible answers, because I don't have the answer. People need to understand we're all born with cannabis on board — we call it the endocannabinoid system. It's the most widespread communication system in the body. If you haven't heard of the endocannabinoid system, that's as if you haven't heard of serotonin, dopamine, or adrenaline — it's flowing through all of our bodies, touching almost every cell. It's a big deal, and it's a whole-system actor. When we think of medicines, we think of a pill for an ill — if something's wrong with your eye, you need an eye doctor and eye medicine. Cannabis is more like exercise, nutrition, or sleep — it touches all the different systems, and some of the benefit crosses boundaries of your organs, so you get a kind of natural leveling, like on a boat — an equilibrium, or stability, or a kind of cross-adaptation of the whole system that levels out some problems. Just like sleep seems to make everything get better, cannabis, touching all these different systems, is going to make everything feel a little better. Another way of thinking about it, totally separately, is that cannabis as a plant is a freak factory of natural pharmaceuticals. If we could jump behind the counter at Rite Aid, CVS, or Walgreens and put all those pills and creams into a blender, that's very much what cannabis is — this plant producing tons of different pharmaceuticals. If your body is missing something, it makes a lot of sense that this mush of stuff is going to fit into what's missing. Bryan Fields: No, I think that was very clear and perfectly said — it actually made me want to use more cannabis on a regular basis. I want to talk about some of the areas you treat, some of your patients' experiences. I think a lot of people listening are going to say, "Hey doc, that's great, but I don't know where it can help me." Can you list off some of the experiences you've seen cannabis help, just to open people's perspective to what's currently possible? Dr. Benjamin Caplan: Sure. The three most common domains where cannabis is used are pain, anxiety/depression/mental health, and sleeplessness, because those are the conditions most of us alive in modern culture deal with — we're all stressed out, we're all having trouble sleeping to make ends meet, and from time to time you're going to have pain — none of us gets out of life unscathed from the ravages of time. But there are other things people don't know about cannabis that are still important — cannabis and sex is a big thing, and sex is a hot topic in the media, but it's sometimes a shy topic between a patient and a doctor. Cannabis can be remarkable for bad sex, whether one partner feels anxious or another doesn't feel satisfied — there's a lot of opportunity in the bedroom where cannabis can be really helpful, and there aren't many great options. We know about the blue pill, which is very male-centric, but cannabis, thankfully, is very female-centric — it helps women feel more physically comfortable as they reach menopause, helping with body physiology and comfort levels. It makes everybody feel more comfortable. There's stuff about cannabis that's unique to certain domains, but also stuff that touches all of us. Bryan Fields: How does someone looking for a specific product know if it will help them for pain, sex, or sleeping, given the plethora of different products and forms? How do you go about recommending a product to someone new, who's interested but walks into a dispensary and sees a hundred products? Dr. Benjamin Caplan: Bryan, your question reveals your bias, and the way we've all been taught about medicine — "wait, where's the eye medicine for my eye problem?" I think the solution is actually focusing on the person first — what is this person like, what are they looking for out of a medicine? In my book, I broke the decision down into three major choices. The first is about timing — some products work very quickly, with an effect now; other products work for a whole long day, giving you a foundation through the day. You probably want control over your life and to know what's happening to you in the moment, whether it's a cushion through the day or something instant — that starts with you, not the product. The second decision is about alteration — some people just can't deal with being high, they're worried about it or afraid of it, and there are plenty of choices from totally not altered to totally altered, and everything in between. The third decision is about energy — some products are stimulating and activating, like a cup of coffee, and others are the opposite, helping you unwind, calm down, relax, and sleep better. Those are total extremes you don't want to mix up. All three decisions are about you and what you're looking for. Dealing with depression, you might want something that works right away, but also something that's a cushion through the day. You might also want something that won't mess with your workday, but will help you unwind at night — that's personal. And third, you may be sick of feeling depressed all the time, and a little artificial levity might be okay, a nice balance to what you're used to. So I'm talking all about the product, but I haven't even mentioned the specific product yet — this is all focused on what someone needs. I walk my patients through their choices and preferences and then match them to certain products. Kellan Finney: Is there a dose threshold for certain illnesses — say someone's coming in for treatment of cancer or something similar, where there's a known metabolic pathway that requires a certain amount of the cannabinoid in the blood to facilitate that action? Is there a minimum threshold you follow, and is that the approach you typically take? Dr. Benjamin Caplan: Yeah, totally. In medicine we think about that as "trigger" versus "tone." A certain dose of a medicine will trigger a downstream effect — like tickling some cells in your brain, which then produce a compound that cascades to other systems that produce more of a compound your body needs. That's different from having a "tone" in your body, where, say, you have ten thousand pieces of cancer — you want ten thousand pieces of cannabis to attack them, because they only work one-on-one. With conditions like cancer, at the front lines, I'm seeing patients who take small doses and feel much better — for symptom management, that's great, because chemotherapy is vile, and the structural changes to someone's life as they lose their hair and feel like they're going to die are awful. Smaller doses help them feel like life is manageable and worth living, but that's very different from wanting to kill the cancer with poison, like chemotherapy, without dying from the effects of too much of it — that has to be fine-tuned. What we see about cannabis killing cancer is that because it's affecting the communication system of normal cells and cancer cells, it cues our natural immune system to fight the cancer cells and leaves normal cells untouched. Study after study of mice or petri dishes shows normal cells untouched, while cancer cells either apoptose — self-destruct — or stop growing, possibly because cannabis stops blood vessels from feeding new cancers. Other studies show cannabis stops cancer from breaking through its own tissue and becoming metastatic. These are separate studies, all showing positive benefits, but people are still worried about cannabis as this evil thing, and there's so much stigma that doctors won't take it seriously, and patients are afraid to look it up. So here I am trying to scream it from mountaintops. Bryan Fields: Did that surprise you, and what do you think is necessary to get other doctors to open their eyes to what could be a very good offer for cancer treatment? Dr. Benjamin Caplan: Oh my God, I'm continually flabbergasted every day. People tell me, "Dr. Caplan, this has saved my life, why isn't this out there?" and I think, what can I do to get this message out — I'll try a podcast, newsletters, writing a book, whatever I can think of. I'm a crazy doctor in that I can think outside the box — a lot of doctors are trained to do well on tests, study literature, read guidelines, and abide by them. I'm almost the opposite — I don't belong in the box, I constantly question what's around me, what I've been taught, what I hear. It comes from curiosity more than anything else, but that's a weird combination. I think doctors just have to be pushed by their patients — people they know and trust. So everyone listening, if you're experiencing something positive, challenge your doctor. That's the relationship as it should be — patients teaching their doctor what's working for them, and hopefully the doctor's open-minded enough to listen. Doctors who don't listen to their patients — their patients probably want to know that anyway, and can vote with their feet. Bryan Fields: You mentioned earlier things not yet in the literature — can you share some early findings you think are really promising? Dr. Benjamin Caplan: Sure. Dementia is a big black box — my dad, the famous neurologist I mentioned, doesn't even believe in the term "dementia," since it's a broad, non-specific term for things falling apart and breaking down, not very useful diagnostically. But I see categories of patients we'd call having dementia — Alzheimer's, Parkinson's, Lewy body dementia, and other forms — and I see remarkable results when they use cannabis. I have one Parkinson's patient, actually in the book — he used to be a ballet dancer and was nervous because he wasn't going to be able to dance at his daughter's wedding. He came to me, we designed a routine for him that made him feel so fluid — one of the issues with Parkinson's is rigidity — and he was able to dance at his daughter's wedding. It was a huge success, and this was a treatment I'd never conceived of in medical school, certainly never saw in training. That's an example of, my God, this has to get out there — I don't quite understand what's happening, though there's literature that points to it and supports what I'm saying on paper, but it's not enough for most doctors to feel comfortable with. It's this weird infancy of medicine where cannabis is concerned, and it has to go through its growing pains and reach the right audience. Bryan Fields: When you have this conversation with your dad about it, what's his perspective — have you seen him shift through your experience as well? Dr. Benjamin Caplan: Totally — great question. My dad, thankfully like me, is very evidence-driven — he reads the papers, he doesn't care what society thinks, he wants to see the literature and try it out with his patients, and he trusts my perspective. He's read what I've written quite critically and helped me translate things, but he's been remarkably in favor of cannabis, even before I was, because he'd read the literature and knew about it before I did. He never once dissuaded me — he's always supported me, and people look up to him to translate complicated science the way I've learned to do too. In many ways I'm blessed to have his model and to follow in his footsteps in a different domain. Kellan Finney: It's super cool, right — from a neurological perspective, it's obvious that ingesting cannabis causes a direct effect neurologically, since it interacts with the nervous system, and Parkinson's and Alzheimer's are diseases of the nervous system, so there's got to be some interaction. Can you walk us through some current studies trying to tease out what's going on there, and why there's success from treatment like you just described? Dr. Benjamin Caplan: I think we'd put the audience to sleep with the full mechanism, but let me give you two neurological phenomena I think are more interesting. The short answer is the research points to new cellular-level changes that are over the heads of most people — is it more like an equilibrium, or a lock-and-key situation? At a nerve level, what cannabis does is slow signal transmission. If you have hand pain, cells in your hand are transmitting a signal saying "this hurts," which travels down your arm into your spinal cord and back into your brain — there are multiple places to interact and slow the signal, like turning the volume down on a stereo. That happens with a topical cannabis cream at the site of transmission — if you had a cut, you could theoretically put cannabis around it to slow the local pain signal. Separately, you could have systemic cannabis that slows all of those nerve signals up the chain, and cannabis reaching the brain has a totally different effect. All of these tend to slow signal transfer, but here's an opposite effect that's also very cool and confusing: in a functional imaging machine, without cannabis, we see a certain area of the brain light up — say, watching TV or listening to a podcast. With cannabis on board, we see whole other areas of the brain also light up — it's almost like the whole brain is spiced, with much more cross-communication between areas, or in sixties language, it's mind-expanding. There's knowledge and wisdom in that culture we've kind of ignored. With the nerve-signaling effect and this broad brain activation, the body almost resets or restarts in ways that relate to pain — over time, someone consuming cannabis for hand pain develops less acute pain, becoming habituated and starting to ignore it. Conversely, in the brain, that universal activation can form new pathways, which is why people feel cannabis is so helpful for creativity, and why so many famous artists and scientists throughout history have consumed it — it activates new areas, it's mind-expanding. Bryan Fields: That has to be an aha moment for people — if you can see it lighting up on a screen, there's no longer a question of does this help or not. Have you taken people in to show them that, and was that the moment they were like, wow? Dr. Benjamin Caplan: I can show publicly available images about cancer reduction — glioblastoma, a brain cancer, and other brain cancers, where we see a tumor the size of a tennis ball turn into almost nothing, just because of cannabis. This person wasn't on anything else — they consumed cannabis at the right dosage and frequency for them, a routine over time, not magic dust. There have been so many moments where I think, my God, this has changed everything I understand about medicine. But if you step back, we all grew up with a medical understanding missing a gigantic piece right in the middle — we didn't understand there was an endocannabinoid system touching every single system in the body. Without that, of course there are going to be holes, and I get to see them firsthand — it's amazing. Bryan Fields: Is it all forms of cancer, or only certain forms? Dr. Benjamin Caplan: Not all forms have been studied, but most of the forms we've seen — pancreatic cancer, brain cancer, certain organ cancers. I have patients in my office who had nerve sheath tumors — nerves around areas running to your fingers — that just shrank with topicals. It's a wide spectrum. It seems to be a phenomenon about cancer itself. We all develop close to five thousand cancers a day — that's why we have T cells; when you hear about AIDS patients and HIV, their T-cell counts are low because we worry about their T cells being able to fight their own battles. When you have cells that are messed up, your T cells tag those cells for destruction, so your immune system is essentially fighting cancer on a daily basis. When cannabis is on board, it creates another avenue of support for your immune system. When cancers are small enough, your immune system can find, tag, and kill them. When cancers start producing compounds that attract blood vessels, that's when they become really dangerous, growing big and traveling to new areas of the body. What helps stop or prevent that is called anti-angiogenesis — the stopping of blood vessel growth — and guess what, all vegetation and fruit on Earth is anti-angiogenic. Cannabis, as a microcosm for vegetation, is very anti-angiogenic, so as people consume more of it, it's preventing blood vessels from connecting with the micro-cancers we all produce, helping people prevent and stop cancers from growing. Bryan Fields: Seems like what we've got is "an apple a day keeps the doctor away" and "smoke weed every day" have now merged into one — or maybe laughter is a better medicine. Dr. Benjamin Caplan: We didn't understand why laughter is good medicine, but now we're starting to understand — wait a minute, this is part of our body's mechanism for healing itself. Pretty wild how much we don't know about the human body. Bryan Fields: All right, I've got to dive into a quote I read on your blog — cannabis is the "Swiss army knife" of skincare treatments, while other skin medicines are individual knives. Is it true that CBD cream is an alternative to sunscreen? Dr. Benjamin Caplan: It is, and that's one of the hidden gems in the book that I didn't announce very heavily. I actually wrote a regular sunscreen blog recently and didn't even include cannabis in it. The shape of the cannabis molecule is a lot like a shield, physically. When you're consuming something, people don't really get the physics of medicine floating through your blood vessels and veins — we think about the destination, but not the traveling. As someone consuming systemic cannabis routinely — not just topical — the UV light that hits us constantly from sunlight will interact with the cannabis and literally be shielded, so that bolt of UV energy won't damage your cells the same way. And if you use a cream, that shield sits around your hand, giving extra protection, preventing sun and UV light from damaging that area. Bryan Fields: With any type of CBD cream — how do I know if I'm selecting the right kind of product to combat that? Dr. Benjamin Caplan: I'm still figuring that out myself — I'm swapping out my sunscreen now, maybe my moisturizer too. That's one of the cool things about cannabis — it seems to have this Swiss army knife effect: good for inflammation, maybe good for protecting against the sun, doing all these nice things, smelling nice, other components too. We don't know exactly which ones, or what to look for, but from my perspective, the shape of the molecule for both CBD and THC is almost identical — not a lot of people know that. In our culture, CBD is totally legal and THC is totally illegal, but it's only one tiny part of the molecule that's different, which shows how little politicians and governors know compared to science. Kellan Finney: That little difference does have a substantial impact from a pharmacokinetic standpoint, though, right? Dr. Benjamin Caplan: Fair enough — but if someone is consuming CBD in an acid form, say in the stomach, those are interchangeable, and we have evidence that CBD actually does turn into THC. In real life, truckers and people on Department of Transportation testing say, "wait, I've been taking CBD, why did I test positive for THC?" This happens all the time. It doesn't make sense to have a system where only one is legal and the other isn't — it's ridiculous. Bryan Fields: What has impressed you most about cannabis so far? Dr. Benjamin Caplan: How much it's laid bare what we don't know. Even through medical school, I had so much confidence in the medical establishment, that what we knew was complete. I'd heard about doctors needing to be humble and reverent to skepticism, but I never really saw the holes as clearly as I do with my patients on cannabis — patients with fibromyalgia, uncontrolled diabetes, dementia, cancer, who feel the system doesn't work for them, and plenty of non-extreme cases too, like depression, anxiety, and sleeplessness. I see all these holes through my patients and realize, wait a minute, all of these holes are exactly part of the endocannabinoid system — the system medicine doesn't quite tap into. It feels like I see the hole and I see the thing which can fill it. But then I also see a culture that throws spaghetti at the wall, thinking cannabis is just whatever makes you high, or smells good, or looks good in packaging — imagine going into CVS and picking medicine based on what smells good or looks good on the box; we don't treat medicine that way at all. There's something about guided cannabis, getting to know someone's illnesses, where I can help them as a physician with a new tool I didn't have before — that's just special and remarkable. Bryan Fields: For those still hesitant listening, what would you like them to know? Dr. Benjamin Caplan: Educate yourself — knowledge really is the best power. That's where I spend most of my effort. I'm not a doctor who's a dictator or commander — I don't tell my patients what to do, I give them knowledge, share suggestions and recommendations, and then I learn from them. Depending on where someone's coming from, they'll find choices that work for them, and only they know that path. It's up to me to tease that out and help them feel more comfortable, either with knowledge and the scoreboard of literature, or my own experience of what's worked for others — I kind of humanize the process. For people who want knowledge, I put out as many resources as I can find; for people who want personal guidance, I have a clinic where I see patients from all walks of the earth. This stuff crosses borders — it's not about the state medical system — knowledge crosses everywhere, and I can teach people as far as Israel and Sudan, down to the United States and all the states in between. Bryan Fields: What's your opinion on recreational use? Dr. Benjamin Caplan: I think all cannabis is therapeutic. We look through a lens of judgment passed down by our predecessors, that we should judge people who are consuming cannabis and feeling good — but point to history, we live in a puritanical culture; cannabis was used by priests and the religious community for ages, kept special because it gave people certain experiences that felt godly. Archaeochemistry shows people were consuming cannabis and psychedelics for tens of thousands of years — this isn't new. Recreational use is great — everybody should have levity and feel good and enjoy their lives if they feel like it. If they feel like it's cheating somehow to use an external substance, I'd disabuse them of that silliness — we don't feel bad enjoying a piece of art or a delicious piece of food, we shouldn't feel bad enjoying medicine either. I also think all cannabis is medicinal — no matter who you are, life is a struggle, and nobody has a get-out-of-jail card from the struggles of life. It's a matter of picking and choosing which things you want to address in the time we have left, and cannabis is a great solution for a lot of people, if you have guidance from someone who knows what they're doing. Bryan Fields: What is the number one surprise or shocking statistic in the Doctor-Approved Cannabis Handbook — something you showed someone and they said, wow, Dr. Caplan, I can't believe that? Dr. Benjamin Caplan: I think people are often surprised by how complex things are. We have a medical system that tries to keep things simple — you have a headache, here's a headache medicine — but in my sleep chapter, I put in a questionnaire, sort of like a Cosmo quiz, that goes through sleep and the numerous things that affect it, crossing borders — your environment, your pillows, blankets, mattress, but also whether you exercised that day, the foods you ate, the person next to you, your cell phone possibly ringing at any moment. What cannabis has helped me realize is that we don't know everything, and the full puzzle is really complex. I've given patients the same cannabis recommendation, and it worked for one but not the other, and as a scientist I ask, what about their history made this one work but not that one? I've learned it was because they had their cell phone in the room, or a TV on to help them sleep. I craft a holistic view of sleep — it's not just "this one had cannabis and this one didn't," it's the full picture of what's going on at home. Sometimes doctors have forgotten to do that — we all have this idea that doctors can cure everything with a pill, and sometimes we want that, but it takes a doctor to say, wait a minute, it's not just a chemical problem, it's also an environmental one. Bryan Fields: If I gave you a magic wand, or money and ethics were no issue, what would you study? Dr. Benjamin Caplan: I would study what I am doing actually, which is older adults. As we get older, our endocannabinoid system wanes — it gets weaker over time, partly due to the immune system, as our bodies break down. We see that people are less happy as time goes on, partly because those around them are dying and becoming sick. Studying older adults and learning how the endocannabinoid system can be boosted is a source of really universal benefit — all of us are going to get older, and the older population is the fastest-growing one. I want to pull them out as a separate entity and help them individually, because I think some of the solutions are unique. Bryan Fields: What question do you wish more people asked you? Dr. Benjamin Caplan: How can I help my doctor learn about cannabis? I'm not afraid to teach doctors, I'm not shy about it — it's not about me, I'm pointing to my work and the work that's published. I wish more people felt comfortable challenging the system, because it's meant to work for us, and if we don't benefit, we're the only ones to blame. We like to blame a shortage of doctors, or pharmaceutical companies making all the money — but I think we all have a responsibility to take power and control in our own hands and do what we can to improve things, and in this case, that's teaching doctors what can be done better. Bryan Fields: Is that a conversation where someone like myself asks my doctor, "hey, have you looked into cannabis as a therapy, can cannabis help me here" — is that what you're referring to? Dr. Benjamin Caplan: Yeah. The in-office experience should be, "hey doctor, I have questions about cannabis, are you comfortable helping me with my health when it comes to cannabis?" — because the doctor's, nurse practitioner's, or PA's job is to help you on your terms, not to make decisions for you; it should be joint decision-making. Ask if they're comfortable with cannabis, and if not, why not — it's okay to question the knowledge of someone who has your health in their hands. If they are comfortable, ask about your experience and what they can guide you with, or who they can refer you to if they don't know. It's pretty basic, but still very hard for a lot of people — we feel shy that we're going to get in trouble talking about it. Bryan Fields: Last question for you — who do you think is the perfect reader for the Doctor-Approved Cannabis Handbook, and where can people pick it up? Dr. Benjamin Caplan: I wrote it for everybody. I see a pediatric population that isn't addressed in this book, and I really wish I had — that'll wait till volume two. This is for people who are curious about cannabis, want to understand it in simple terms, and want to keep their skepticism — they want it to be evidence-based, because every single claim in this book is backed with a reference in the back. This isn't "trust the doctor," this is, here's the evidence, here's the work that went into it, and here's a translation of it. In terms of where to get it, it's everywhere books are sold — libraries across the country have it in stock, Amazon has it, and I have signed copies I personalize for people on my website, caplancannabis.com. Anytime you can learn more and help yourself, you'll thank yourself later. Bryan Fields: I appreciate you taking the time — this was a lot of fun.