“P4 Medicine” is an obscure term to most people. If you look up the literature online, its proponents appear to be futurists looking beyond the horizon into the divinity of a medical utopia in which renders illness harmless, or at most, a minor inconvenience. Given its infancy, the cannabis industry is still starting to ramp up for personalized medical marijuana.
The lauded Dr. Leroy Hood is the prophet to these preachers of healthcare revolution. He was one of the first people to build gene sequencing machines in the 1980s. Since then, he’s started a host of successful biotech firms and nonprofits in between accepting various scientific honors like the National Medal of Science. How do Hood and his P4 acolytes hope to bring about this new age of wellness?
If you try to find out more about how this new movement plans to implement its revolutionary principles, you’ll find either dense techno jargon or broad generalizations, all of which are only marginally comprehensible to a layperson.
What does come across is that P4 medicine relies on a preventative, personalized approach to healing that depends heavily on DNA, family history and the tools of technology.
But really, what the hell are these people so excited about? And why are you reading about this on a website dedicated to information about the medical benefits of marijuana?
Let’s first consider a couple of hypothetical scenarios to help convey the vision of P4’s advocates.
How does the current medical system work?
Imagine you’re a man in his early 50s who doesn’t have much of an idea about your risk for cardiovascular problems, other than your dad died of a heart attack. You’ve felt fine so far.
You know you should exercise and eat better, but you like how you’ve always done things, and you’ve been none the worse for it. Unfortunately, for the last couple days, you had some pain in your chest and arm.
You dismiss it at first, figuring you tweaked a muscle reaching for the maple syrup in the high cabinet at breakfast or something.
But it doesn’t go away, so you call your doctor, who, to your bewilderment, tells you to go straight to the hospital.
The doctor orders an expensive battery of tests and images to search for abnormal heart rhythms, exposing you to EKGs and needles to hunt blockages and test cholesterol levels. She immediately prescribes a cholesterol-lowering statin drug.
Turns out you have 70-percent blockage in a major artery and need an angioplasty right away. Nurses rush you to emergency surgery, and you’re out of commission for days. You go home from surgery with serious, unexpected changes required for you to survive with any kind of quality of life. This includes a daily regimen of pills — each with its own irritating side effects — to keep your cholesterol in check.
What are the benefits of P4 medicine?
Consider an alternate scenario:
You’re a man in your early 50s, and you exercise two or three times a week — mostly jogging, but some weightlifting too. You do this because your doctor for the last 20 years has had a copy of your gene sequence that shows a predilection to cardiovascular problems that can come with age.
As a result, you’ve been able to stave off some of the worst effects of cholesterol and high blood pressure. A diet you follow fairly closely helps, too.
But even when you break down and have that doughnut, you enter it into your smartphone, which tracks your diet, physical activities, and vital signs. The app helps you eat healthy with reminders about your calorie intake throughout the day.
You developed these habits with the help of a nutritionist/health coach when you first learned the results of your genome 20 years ago. It was hard at first, but now it’s just the way you navigate your day.
Trouble is, you’ve been having chest and shoulder pain over the last week.
You search on WebMD to find these may be symptoms of potentially serious heart issues. Then, you make an urgent appointment with your doctor, who agrees to see you that day.
You describe your symptoms to her as she uploads the contents of your personal fitness device to look at your heart rate and vital signs through the last week or so.
The doctor asks you about a particularly strenuous workout at the gym you had on Tuesday. What kind of exercises did you do?
Pushups, you tell her. More than usual because you were making up for time you had skipped the gym.
So, without donning a stethoscope or drawing a drop of blood, she informs you that you simply have a pulled muscle, and prescribes only rest, maybe a couple ibuprofen if the pain keeps you awake at night.
What exactly is P4 medicine?
This second scenario is healthcare as some of today’s medical evangelists believe it could be — the promise of P4 medicine as described by its visionaries.
The abbreviation “P4” stands for medical care that is “predictive, preventive, personalized and participatory” rather than a reaction to a particular symptom or disease. This is an approach to medicine for which wellness is the focus, and technology — both consumer and commercial — is a matter of reflex.
Hood and his co-authors said in an 2013 article for the journal PerMed that a holistic “systems biology” approach to medicine would revolutionize the field.
“Systems approaches to biology and medicine are now beginning to provide patients, consumers and physicians with personalized information about each individual’s unique health experience of both health and disease at the molecular, cellular and organ levels,” The article states. “This information will make disease care radically more cost effective by personalizing care to each person’s unique biology and by treating the causes rather than the symptoms of disease. It will also provide the basis for concrete action by consumers to improve their health as they observe the impact of lifestyle decisions.”
What do strains have to do with personalized medical marijuana?
Thousands of strains of cannabis on the market all have varying levels of the different active chemicals, including the most-studied Delta-9 tetrahydrocannabinol (THC) and cannabidiol (CBD). These — as well as other cannabinoids, terpenes and a host of different chemical classes in whole pot — affect the body in wildly different and sometimes opposing ways.
Furthermore, all these chemicals interact with each other to induce what scientists call an “entourage effect” within one’s endocannabinoid system, which is still poorly understood and differs with each cultivated strain. To complicate things even more, everyone’s endocannabinoid system can vary drastically– making personalized medical marijuana a necessity for finding the right treatment method.
Add this to the fact that researchers have seen promising results from cannabis and its derivatives to treat conditions as diverse as epilepsy, insomnia, schizophrenia, post-traumatic stress disorder, anxiety, panic attacks, chronic pain, anorexia, chemotherapy-induced anorexia, depression and other conditions. The need for personalized medical marijuana is pressing.
In traditional western medicine, the “trial and error” approach rests on the assumption that if it works for most people, it should work for you. Until recently, that was the only approach available to physicians. If you’re a doctor and your treatment plan has worked for dozens of patients with the same ailments as your current patient, you may say to them:
“Try this. If it doesn’t work, we will try another.”
The problem with this approach is 770,000 people in the U.S. experience injury or death by adverse drug events each year – an alarmingly high figure that could be lowered with an increasing adoption of personalized medicine practices.Of course, no one has ever died from cannabis, but there exist a slew of negative experiences that can result from choosing the wrong strain of medical marijuana.
An individual’s medical information is particularly important in choosing a strain to fill your medical marijuana prescription. The wrong strain could actually exacerbate any one of the conditions mentioned above. For instance, if you have anxiety problems, a high THC strain could throw you into a panic attack even when a high CBD strain might calm your symptoms. Furthermore, if you are feeling tired regularly and the underlying condition is that you have Chronic Fatigue Syndrom, the right cannabis product to help you would be different compared to if you have jet lag. Someone looking to assist a patient with their lack of energy wouldn’t know how to proceed without knowing more about the person that is feeling tired.
The complications and need for personalized medical marijuana explode when you consider that there are hundreds of cannabinoids and terpenes found in cannabis and each strain expresses them in different concentrations. The reason we state that personalized medical marijuana is the future of cannabis is that such practices can actually help cannabis users engage in preventative healthcare. For example, if you have a genetic marker that shows you are predisposed to Alzheimer’s Disease, then it might be prudent to select strains high in alpha-pinene which has been shown to improve memory.
Another example of what can go wrong when not leveraging personalized medical marijuana: cannabis use is proven to potentially cause psychosis among people with a genetic predisposition for schizophrenia and schizotypal disorders, but CBD, when administered in isolation, is as effective as standard anti-psychotic drugs in treating acute schizophrenia.
This is why cannabis vendors are starting to enter the market with apps developed to help cannabis buyers navigate the thousands of strains available.
WoahStork’s own StrainGenie acts as your digital bud tender. To start out, you order a DNA test kit and send it back with a saliva sample. The experts at StrainGenie sequence your DNA and feed the results to the artificial intelligence that runs StrainGenie. Strain Genie also offers a cheaper option where you can upload your 23andMe (or Ancestry / other DNA sequencing companies) raw data and get a personalized cannabis health report.
StrainGenie then generates a personalized report based on your unique genetic profile. You’ll get information on which strain is best for you, whether you’re trying to achieve a particular recreational goal — like relaxing after a hard day or energizing for a fun physical activity — or if you simply need to fill a prescription for a specific ailment.
Strain Genie’s efforts mark the first major step towards personalized medical marijuana– never before have you been able to find the ratios of cannabinoids and terpenes that work best with your brain, body, and endocannabinoid sytem.
After finding the right products, don’t forget to find them at local dispensaries in your area by ordering on WoahStork.
References For Personalized Medical Marijuana
“Predictive, personalized, preventive, participatory (P4) cancer medicine”
Leroy Hood & Stephen H. Friend
Nature Reviews Clinical Oncology
P4 Medicine Institute Web Page
“P4 medicine: how systems medicine will transform the healthcare sector and society”
Mauricio Flores, Gustavo Glusman, Kristin Brogaard, Nathan D Price, Leroy Hood
“The Importance of Personalized Medicine and Its Role in the Cannabis Industry”
“Marijuana stops child’s severe seizures”
“The new holism: P4 systems medicine and the medicalization of health and life itself”
Henrik Vogt, Bjørn Hofmann, and Linn Getz
Medicine, Health Care and Philosophy
“Cannabidiol as a Potential New Type of an Antipsychotic. A Critical Review of the Evidence”
Cathrin Rohleder et al
Frontiers in Pharmacology
“Pot Can Trigger Psychotic Symptoms For Some, But Do The Effects Last?”
National Public Radio