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Ep.361: Prof. Zvi Bentwich, Ben Gurion University/Tikun Olam

Cannabis Economy Podcast
Ep.361: Prof. Zvi Bentwich, Ben Gurion University/Tikun Olam

Ep.361: Prof. Zvi Bentwich, Ben Gurion University/Tikun Olam

On his awakening to the scientific value of cannabis, Ben Gurion University’s Zvi Bentwich, now also the Chief Scientist for Tikun Olam- “I know enough to say, or at least think, that there was a common denominator. The common denominator was the central nervous system. So, if this plant, or whatever it contains, has an effect on appetite, which is via the central nervous system, then it’s not that surprising that it would have beneficial effect on spasticity.”

Transcript:

Dr. Bentwich: Zvi Bentwich.

Seth: Okay. So, Professor Bentwich, that will be okay?

Dr. Bentwich: Perfect.

Seth: Alright. So, you do so much more than cannabis, but we in the cannabis industry, know you for all that you've done in cannabis, which is quite substantial in our little community.

Dr. Bentwich: Okay.

Seth: When did cannabis come to you? Let's start there and make sure we understand as much as we possibly can.

Dr. Bentwich: So, as you well know, I have been mainly involved in HIV/AIDS. I was the first physician to deal with HIV/AIDS in Israel, starting from 1982, when I saw the first patient. As a result, I became exposed to the remarkable effect marijuana/cannabis had on patients with advanced HIV/AIDS, suffering from loss of weight, nausea and loss of appetite. These patients using marijuana, mainly in the west coast of the United States, were very much helped. I was actually brought to see that by Don Abrams, whom I knew from before. As a result, I started advising. I wouldn't say prescribing, because it wasn't legal, so I advised my patients in Israel to start using marijuana/cannabis for that purpose.

Dr. Bentwich: This goes back to the beginning, actually beginning of the 90s, I would say. So, this was the first, I would say, the first chapter, and then-

Seth: When you say that purpose, I want to make sure that we get that. So that, was for appetite. That was also for pain, am I correct?

Dr. Bentwich: No, no. It was first and foremost for loss of appetite. You know, changing, of course, these patients were very often in an extremely depressive, or certainly not optimistic outlook on life. So that, helped them as well, but sort of the medical reason was the loss of appetite and loss of weight. So that, was the first chapter.

Dr. Bentwich: As a result, I became, I would say, convinced that, that indeed was very helpful. So, due to another political constellation, I was able to have discussions with then Minister of Health, called Dahan. This is in the end of the 90s. Actually, I think it was 2000. To start legalization of medical cannabis. As a result, he indeed formed, I would call it a consulting committee, scientific consulting committee. So, he formed, as a result of these discussions, he agreed to form a scientific advisory committee that would approve medical cases that justify prescribing or proving the use of cannabis. Literally, the first patient that got such a permit, was my patient.

Dr. Bentwich: Zvi Bentwich.

Seth: Okay. So, Professor Bentwich, that will be okay?

Dr. Bentwich: Perfect.

Seth: Alright. So, you do so much more than cannabis, but we in the cannabis industry, know you for all that you've done in cannabis, which is quite substantial in our little community.

Dr. Bentwich: Okay.

Seth: When did cannabis come to you? Let's start there and make sure we understand as much as we possibly can.

Dr. Bentwich: So, as you well know, I have been mainly involved in HIV/AIDS. I was the first physician to deal with HIV/AIDS in Israel, starting from 1982, when I saw the first patient. As a result, I became exposed to the remarkable effect marijuana/cannabis had on patients with advanced HIV/AIDS, suffering from loss of weight, nausea and loss of appetite. These patients using marijuana, mainly in the west coast of the United States, were very much helped. I was actually brought to see that by Don Abrams, whom I knew from before. As a result, I started advising. I wouldn't say prescribing, because it wasn't legal, so I advised my patients in Israel to start using marijuana/cannabis for that purpose.

Dr. Bentwich: This goes back to the beginning, actually beginning of the 90s, I would say. So, this was the first, I would say, the first chapter, and then-

Seth: When you say that purpose, I want to make sure that we get that. So that, was for appetite. That was also for pain, am I correct?

Dr. Bentwich: No, no. It was first and foremost for loss of appetite. You know, changing, of course, these patients were very often in an extremely depressive, or certainly not optimistic outlook on life. So that, helped them as well, but sort of the medical reason was the loss of appetite and loss of weight. So that, was the first chapter.

Dr. Bentwich: As a result, I became, I would say, convinced that, that indeed was very helpful. So, due to another political constellation, I was able to have discussions with then Minister of Health, called Dahan. This is in the end of the 90s. Actually, I think it was 2000. To start legalization of medical cannabis. As a result, he indeed formed, I would call it a consulting committee, scientific consulting committee. So, he formed, as a result of these discussions, he agreed to form a scientific advisory committee that would approve medical cases that justify prescribing or proving the use of cannabis. Literally, the first patient that got such a permit, was my patient.

Seth: There we go.

Dr. Bentwich: So, he was an AIDS patient. He had several problems, but loss of appetite and loss of weight was the primary reason for doing so.

Seth: Okay. At that time, in the year 2000, as far as what you were bringing to the table ... You've been prolific as far as peer reviewed papers, what had you already known? What had the science proved in the year 2000, if anything?

Dr. Bentwich: Nothing.

Seth: Nothing? Okay. So, we needed to do this?

Dr. Bentwich: It was just the ... I would even say, most strongly, I was ignorant of the finding, say, of Mechoulam.

Seth: Of course.

Dr. Bentwich: I knew of Mechoulam, but I was not aware at all of his studies, and neither of any other studies that ... I knew Ruth Galilly, was actually my teacher. So, she's an immunologist, and at that time, she already started doing some basic research, and I was not aware. I was totally unaware of that.

Seth: Okay. So, let's just ... We'll go slow on this part, because this is really where it all happens. So 2000, your patient is, what? Prescribed cannabis, actually?

Dr. Bentwich: Yeah. He ... It's kind of intriguing that there's no way he can get cannabis, but through the police. So, he goes to the police and he gets-

Seth: Just like Mechoulam. It's back in the day. It's a drink, and the coffee, and the whole thing.

Dr. Bentwich: Right.

Seth: What did you learn from that case? What did you prove out, scientifically?

Dr. Bentwich: I wouldn't say very much. I was just impressed with ... I would say the primary observation, that here was a plant that was considered not only illegal, but dangerous, a narcotic actually, and that it's shown, and I attest to that, that it has very impressive therapeutic effects.

Seth: So, let's talk about those. The papers that you've written, the things that you know about the actual therapeutic effects, please speak to those.

Dr. Bentwich: So, one has to jump ahead.

Seth: Sure.

Dr. Bentwich: Because, I was involved in other things, and cannabis was certainly not a major interest of mine, at that time. So, I would always say that I sort of supported what began then, or a few years later, as a ... I became aware of Tikun Olam, because it was the first company, and two other patients of mine, AIDS patients that I treated, that were under my supervision or monitoring, through them, I became aware of additional effects, but mostly mental, and I would even say, neurological effects.

Dr. Bentwich: For instance, one of those patients that later became very active in not only in Tikun Olam, which I don't know, somehow he was associated, but also for Ale Yarok. There was a movement, Green Leaf, that tried to promote ... This was several years later, so I'm not sure exactly, but around 2000 ... Between 2008 and 2011. This guy had, for other reason, had a very severe neurological problems. As a result of having sever trauma to his spinal cord, and as a result, he became very spastic. I was also impressed, at that time, from the anti spasticity effects of marijuana, of cannabis.

Dr. Bentwich: So, this was another layer, let's put it this way, of effects that I was not aware of before.

Seth: And, you're a physician, yes?

Dr. Bentwich: Right.

Seth: Okay. So now, you see the plant effect someone's appetite-

Dr. Bentwich: Right.

Seth: And then, on the other side of the spectrum here, someone's spasticity.

Dr. Bentwich: Right.

Seth: You, as a physician, did this make sense to you? That it could possibly be one plant that did both of those things, let alone others?

Dr. Bentwich: Yeah. Look, as I emphasized before, I think, basically, I was really ignorant of the story.

Seth: Of course.

Dr. Bentwich: In other words, I was not in there, but I know enough to say, or at least think, that there was a common denominator. The common denominator was the central nervous system. So, if this plant, or whatever it contains, has an effect on appetite, which is via the central nervous system, then it's not that surprising that it would have beneficial effect on spasticity.

Seth: Now, I'm not a scientist.

Dr. Bentwich: Right.

Seth: Of course. But, as far as the endocannabinoid system, how does that work with the central nervous system? How easy is this to explain?

Dr. Bentwich: Now it is, first of all, it's much easier, let's put it this way. But, even then, it was already known that there are endocannabinoids, in other words, there are natural products of our body, not of the plant, that are similar, let's say, in structure and function to the plant derived materials. Secondly, which is not less important, is that there are natural receptors for these substances in the nervous system. So that, was already ... This is my, of course, hindsight, because I was not aware of that, but these were the main findings, I would say, or main contributions of Mechoulam.

Seth: Of course.

Dr. Bentwich: So, it does make sense. In other words, that's not that far away to misunderstand.

Seth: Understood. And, you say, you were ignorant of it. We are living on Earth where, what, 99.999% of people are still ignorant of it. You're one of the few people that does understand this.

Dr. Bentwich: No, no doubt. No doubt. This is, I would say, a fair assessment of the situation. Right.

Seth: Okay. So, you take this information forward, how? You've got your patient that was dealing with appetite. You've got your patient, now, that's dealing with spasticity. What is the next step, as far as Professor Bentwich is concerned?

Dr. Bentwich: So, the next step was, actually, I would call it a latent period, in which, from roughly speaking ... I don't know, between, in the 2000, at least, certainly until beyond 2010, I actually don't do almost nothing, aside from two things. Number one, I do prescribe cannabis to HIV/AIDS patients that come to me and ask for, let's say, a recommendation, or medical report type of letters. To that committee, that would sort of-

Dr. Bentwich: That would sort of end in approval.

Seth: Aha.

Dr. Bentwich: Secondly, because I am member of this kind of committee which has to approve the single cases that come to its attention.

Seth: Aha.

Dr. Bentwich: So then I certainly support the mostly neurological conditions that are associated with either some congenital situation, or neurological based diseases, such as paralysis, such as trauma, such as multiple sclerosis already.

Seth: Aha. And when you say trauma, are we saying-

Dr. Bentwich: Trauma is-

Seth: PTSD as well, or?

Dr. Bentwich: PTSD was not-

Seth: Not on the-

Dr. Bentwich: Not in our attention.

Seth: Not on the board-

Dr. Bentwich: No, no.

Seth: ... as of yet.

Seth: So when you say trauma, what do you mean?

Dr. Bentwich: I mean physical trauma to spinal cord, mainly to the nervous system as a result of road accident, war accident, injuries and so on. But these are single cases all together, and not anything like what happened then or next, which again I'm not sure that I'm exact on the dates, but there is a transition in the Ministry of Health, which happens around 2010.

Seth: Roughly.

Dr. Bentwich: Something like that.

Seth: That's fine.

Dr. Bentwich: Again I'm not sure.

Seth: That's okay.

Dr. Bentwich: Roughly so.

Seth: Yep.

Dr. Bentwich: Which then opens the door. First of all, this committee that I'm talking about is replaced by ... I would call it an authority. Sort of a cannabis legalization process, which already [Judah Baruch 00:15:54] by the way is the guy that mostly responsible for that, because he's at the head of the section, I forgot if it's a committee or a section, that is nominated by the Ministry of Health, and then opens the door to much larger, bigger number of indications, that allow people to receive cannabis legally.

Seth: And you call them indications, we call them qualifying conditions, but same thing.

Dr. Bentwich: Okay. Qualifying conditions.

Seth: Same thing, indeed.

Dr. Bentwich: And these goes hand in hand with the what I became aware later, but I was not aware of that time from 2007, this is more or less the time [inaudible 00:16:40] starts, and it gives the extract or the plant, mostly the plant, to cancer patient. And then it is the combination of loss of appetite, and pain, and adverse effect of chemotherapy.

Seth: Aha.

Dr. Bentwich: This is a company, and again, I'm not exactly sure when, but between 2010 and 2012 or '13, there are additional companies coming into the scene. And I was approached by [Tikkun Olam 00:17:27], I think the first time was in 2012. But officially became the chief scientist in 2017.

Seth: Okay. And now you're overseeing clinical trials, so-

Dr. Bentwich: I agree to join them. They asked me what do I want to do, they are sort of very open to allowing me to become their board member, which I don't want to do.

Seth: Okay. "I'll just be the scientist," right?

Dr. Bentwich: So I said that I will be chief scientist and I will overlook clinical trials.

Seth: Now, let's take them one by one for as much time as we have. As far as the learnings from these clinical trials, this is the research that you are doing. This is the research Israel is doing, that really no one else is doing on this.

Dr. Bentwich: Right.

Seth: So please take us through it.

Dr. Bentwich: So, I think what impressed me actually from Tikkum Olam and it was through [inaudible 00:18:36] that I have to mention that was at that time, trial Monetal that I will call her, that she was already in... That I will say, the following thing is what really impressed me. Number 1, they did collect data, record data on patients receiving their product. Secondly, that there was already a beginning of one I would say mostly, most important trial on inflammatory bowel disease which was initiated by Dr. [inaudible 00:19:23]. And thirdly, that they were having already, I would call it, impressive results in pediatric [inaudible 00:19:33].

Seth: Okay.

Dr. Bentwich: These were, I will call them the three main things that impressed- and so as a result, and that didn't happen immediately, Analysis of the recorded data that accumulated roughly speaking, from 2009/'10, enabled Tikkum Olam through Lehhee, then I was instrumental in helping him become a graduate student and then moving on. And so she, with the help of Professor Novak and [inaudible 00:20:24] sort of agreed to be on that-

Seth: Right.

Dr. Bentwich: Were able to sort of bring forth the clinical observation, cumulative observation on what cannabis was doing to patients. And I would say the majority were cancer patients, but there were from other diseases as well. And as you know, pain, loss of appetite, mood, use of other medications, sleep were the most dominate... beneficial effects.

Seth: Meaning the reduction of use of other medications. Just to clarify.

Dr. Bentwich: Correct. This was quite dramatic even-

Seth: Sure.

Dr. Bentwich: People that really were very much helped. Then following that, I was also very impressed with, I don't know if you met her in Bal, she's now out of Tikkum Olam but she was there at the nulse at Tikkum Olam but mostly treating old patients and geriatric patients. People with agitation with various degrees of Dementia. Again, what I would consider a dramatic effect, this is still non-documented, it's now been approved and there is a start of a clinical trial of agitation in old age or in Dementia, which has started in hospital, but it is based on those observations I alluded to.

Dr. Bentwich: Thirdly, as I mentioned before, the studies off [inaudible 00:22:09] which started, she's a Gastroenterologist and suddenly due to her initiative, observing patients that came under her treatment that told her that they were using cannabis, and cannabis helped them. And so she started by doing off her retrospective, in other words asking these patients what the effects were and going into perspective trials of both and Ulcerative Colitis and Crohn's Colitis and the next result is again, very impressive.

Dr. Bentwich: Though in this case the mechanism is not clear, so in other words, there was clear clinical effect, but there are questions regarding the mechanism, how it does.

Seth: One level deeper, just so we understand that.

Dr. Bentwich: So when you talk about effecting the nervous system so you can see the results, or basic studies in animals and in laboratory systems that can show that by the binding of the cannabinoids through their receptor, they transmit, or they have some mediating effect on the effect of other neurotransmitters and so they can let's say, either improve function, or block other functions and as a result you get those things that you see. Loss of appetite, gain of appetite, spasticity, sleep, all these are related to binding of the cannabinoid to its receptor. In the case of inflammatory bowel disease, this is a totally different situation.

Seth: Totally different. Understood.

Dr. Bentwich: And it is, as far as we understand today, it is an immune based disease. What do I mean by that? Immune mechanisms cause the inflammation. It is not a micro or virus, or chemical that causes the disease, but it is an ongoing inflammation effecting the mucosa, the upper layer of the intestine. Causing ulceration, causing even sometime perforation. So it is a very serious disease, resulting in many symptoms but most important of which, bloody stools, diarrhea, loss of weight, accompanied by what that entails.

Seth: And a tremendous amount of pain. My friend has a very case of Crohn's.

Dr. Bentwich: Okay. Alright, so the mechanism, why cannabis would be helping... as a first guess I would say was maybe it effects the nervous system like it does, and as a result of effecting the mood of the patient, psycho semantic mechanism that through mental disturbances you will cause some problems in your intestine. Which is not impossible, but kind of less likely.

Seth: Got it.

Dr. Bentwich: So this is one route that was tried to explain. But more than likely, and very much more possible, was the idea that cannabis has antiinflammatory, if you can call it immunosuppressive effect. So in other words, it has its effect not through the nervous system, but through effecting the immune cells. The cells that consist or that form the immune system.

Seth: Okay.

Dr. Bentwich: And when you have, for various reason, the immune system tells against you what we call "autoimmune disease". The inflammatory bowel disease are probably such a situation. In which the immune cells attack the gastro intestine tissue, also diverticulitis is the colon, Crohn's colitis is more the small intestine. And so cannabis maybe suppressing inflammation through its direct effect on the immune system. I can only say that there are several lines of study that support this idea, but in the case of Crohn's and in the case of diverticulitis so far from what we have seen and what we have studied, the question of the mechanism is still not sufficiently clear.

Seth: We still don't know.

Dr. Bentwich: We know that it has a positive effect. [inaudible 00:27:34] these diseases most probably through the immune system, but exactly how? That is still the question.

Seth: Understood. So we can prove out that there is a positive effect.

Dr. Bentwich: Right.

Seth: We're still finding out kinda how.

Dr. Bentwich: Correct.

Seth: Does that include the prostate by the way? Or is that a completely different thing?

Dr. Bentwich: No, that is a completely different thing.

Seth: And have you any information on that? And I'm asking for a friend.

Dr. Bentwich: No, for prostate, we don't have any indication.

Dr. Bentwich: For prostate, we don't have any indication aside from it may be affecting frequency. In other words, patients with large prostate have a urge to go to the bathroom and sometimes it's very bothersome and so on. So in theory, cannabis may be affecting the nervous system like it effects the spasticity. So it may affect the nervous system of the bladder and therefore it may have beneficial effect. I'm not aware of them.

Seth: So we still don't know. Do you go as far down into the cannabinoids themselves? So, obviously CBD, but CBG, CBC, do you?

Dr. Bentwich: No. So I would just complement what I said in saying that I think the most dramatic observations that I consider extremely telling at this point, aside from what I said, sleep, loss of appetite, and so on, and spasticity, and if you like, PTSD as well as one of those situations which clearly are helped. I think the story of autism and of epilepsy stand out at as the most dramatic effect so far. Doesn't mean to say that there are no additional situations, but autism is something unbelievably difficult and bothersome and ruins the life of parents and families and so on, and it is not such a real situation.

Seth: And there's no information to help, right?

Dr. Bentwich: And there's no information. And there's instances in which, first of all, that I've been exposed to that, I have heard from doctors, are so impressive that you cannot remain neutral when you see them. So here is again a situation that we are completely ignorant as to why does it do so.

Seth: But it does. [crosstalk 00:30:30] And what does it do, I guess? What have you seen?

Dr. Bentwich: So, I really recommend that you see the film that [inaudible 00:30:38]. If you go to the conference I'm sure there will be a booth, and go to the [inaudible 00:30:46]. There is, by the way, a trial that is carried by ... What's his name? From Charlotte ... He does a serious, good trial. But if you went [inaudible 00:31:02] she has a clip, a video clip, actually there's a whole movie, which demonstrates ... You can see the dramatic results of children, aggressive, intolerable almost, which this just transforms them. [crosstalk 00:31:31] I think that is ... This is probably the most dramatic thing I have seen. And the epilepsy is also something unbelievable, because children that are resistant to therapy or have lost response to therapy, you can see, I don't know 16 fits per day going to zero, going to one, and that's almost unheard of.

Seth: So now we've got the nervous system, we've got the immune system, we've got, specifically, autism, and when you take all of these together, does this surprise you?

Dr. Bentwich: No, I usually, when I give talks nowadays, I say very clearly that cannabis and its components present probably the largest, or the next major impact, on the biomedical sciences, on clinical medicine. So we can expect to see, because of its heterogeneous effects, which are probably related to the various components, on anything from nervous system to metabolic effects to immune system. And so the list, or the scope, of its effect is going to make a really ... Probably one of the largest impacts in the history of medical sciences.

Seth: On the scale of what? To make sure that we understand what you're saying.

Dr. Bentwich: I have been part and parcel of the, let's say, the growing impact of immunology on medicine. So I saw the exponential growth in studies, in findings, and in results, which started many, many years ago. But I would say the dramatic period has been from 70's to the beginning of this century, certainly. So it's still a major impact. So I think that ... Alright, that's one example. The second example: neurotransmitters. The discovery of neurotransmitters has made a tremendous impact on psychiatry, on neurology, on the neuro-pharmacology. So by the same token [crosstalk 00:34:22] cannabis is going to be the, I would say, the additional value of cannabis is because it's not just neurological effects, it has a wide spectrum of effects far beyond just the nervous system.

Seth: And if I'm hearing you right, the discovery of neurotransmitters, which were in our body, and only affect certain parts, this is a solution whereas that was finding how the system works. This is a solution, and so finding a solution of this scope and scale is beyond anything that you've seen in your career. How far back does it go?

Dr. Bentwich: I don't know. I can only say that it's going ... There's no doubt. If you look at the history of biomedical sciences in general, usually expectations are much bigger than what happens later.

Seth: Of course.

Dr. Bentwich: So I believe that that probably will apply in this case as well, but you don't want to say that it is something that has not been precedented, but I think it's a major, major impact.

Seth: We will leave it there. I've got three final questions for you. I'll tell you what they are, and then I'll ask you them in order. The first is going to be difficult, becaause it's what's most surprised you in cannabis? Although you might have already answered that. The second is what's most surprised you in life? And then on the soundtrack of your track [inaudible 00:35:48] one track, one song that's got to be on there. But first things first, let's get down to cannabis. What has most surprised you?

Dr. Bentwich: The scope of its effects. I was totally ignorant and unaware of its wide spectrum of effects on several systems. In a way that was, at least, not within my understanding, because I thought it was wholly a totally focus on the nervous, which is in itself is a lot, but that here as something that was way beyond that. And to complement that I would say that because it has such widespread receptors through the body, that probably accounts for that. So in other words, it's certainly doing things biologically that we have not appreciated. So that's number one.

Seth: And we will continue that conversation. What's most surprised you in life?

Dr. Bentwich: In my life?

Seth: Sure.

Dr. Bentwich: That there is always that biology, human being, human body, whatever, is a continuing undiscovered challenge that you will ... Endless.

Seth: Yeah. It's very surprising when I speak to people like you and [inaudible 00:37:25] how much you do know and which points out to you folks how much we don't know.

Dr. Bentwich: Yeah, absolutely.

Seth: Alright. So how can we do this? On the soundtrack of your life, one track, one song that's got to be on there. Is there a song that you love?

Dr. Bentwich: That's funny that you ask. There are many, but usually [inaudible 00:37:46]. There is Sachki Sachki, there is ... You know Sachki Sachki?

Seth: Who is artist? Or it doesn't matter. Many people, right?

Dr. Bentwich: Sachki Sachki it's on the dream of if you like Zionism.

Seth: Okay, we will look into that.

Dr. Bentwich: I'm an ardent Zionist.

Seth: With a tip of the cap to Theodor Herzl then, right? I would imagine?

Dr. Bentwich: I belong in, if you like to, Mayflower of Israel because my grandfather is [inaudible 00:38:18] so he's one of the first ... You know there's a hospital after his name.

Seth: That's your grandfather?

Dr. Bentwich: Yeah, so that's one side. And the other side. Bentwich, was the attorney of Herzl. On the agenda of the Zionist organization. So I belong to them.

Seth: Can I ask you a different question here? One more different questions. How are we doing with Israel? Is there anything we can do better? Anything we can change?

Dr. Bentwich: I will answer you very explicitly and without hesitation. Stop the occupation.

Seth: There we go, look at you. Zvi, very much appreciate your time, Professor Bentwich. We will see you down the line.

Dr. Bentwich: Thank you.

Seth: And there you Dr. Zvi Bentwich. Very much appreciate his time. Very much appreciate your time. Stay tuned.

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Cannabis Economy is a real-time history of legal cannabis. We chronicle how personal and industry histories have combined to provide our current reality.