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Jerusalem Netletter Tu B’Shevat 5774

Barbara Sofer

Happy Tu B’Shevat from Jerusalem!

The 15th of the Hebrew month of Shvat is the date for determining the age of trees—an important calculation for taxes and tithes. Tu B’Shevat has gone from being a minor holiday to a very popular one in Israel. Not a kiosk or food store is without its prodigious stock of dried fruits. One stall in the Machaneh Yehudah open air market in Jerusalem had a hundred different kinds! Eating dried fruits is left over from the times--not so long ago-- that you couldn't get fresh fruit in the winter. Yesterday, in the women's locker room at the pool in Jerusalem, two of the women were busy comparing their families' extensive preparation of dried fruit for Tu B’Shevat in Kurdistan. In Eastern Europe, the etrog from Sukkoth was preserved for serving on Tu B’Shevat. Children had the day off, and teachers met them at the synagogue with honey cakes. In Connecticut, where I grew up, we always ate jawbreaking carobs from Israel. Thinking back, I wonder how all those carobs got to Connecticut!

Today, Israel is blessed with an abundance of fruit. Not just oranges. We have so much fruit we're major exporters. That's a great achievement for a country where half the land is desert! We've even become a world leader in loquats and persimmons. Who would have guessed! The popular long-life tomatoes and cucumbers we eat today were all improved by Israeli scientists. Add your daily salad to the list of contributions by Israelis.

Another great achievement is, or course, our greening of the barren land. Tree-by-tree we have also turned the desolate land green. This has been the work of our partner, the JNF. The latest Hadassah project of which is the River Park in Beersheba. Did you know that Israeli school kids have go out to plant trees on Tu B’Shevat?

They've been doing this for more than a hundred years. And you can't do that on a computer!

This has been a stormy winter, but our own relatively cold weather has been warmed by the large numbers of visitors from abroad. Just imagine that in one week we had Bar and Bat Mitzvah youngsters from Mexico, the US and Australia doing mitvah projects and making donations to Hadassah's hospitals! What a joy that this new generation sees entertaining children at Hadassah through magic or building an interactive healing garden to lighten the burden of chronic illness as a worthy goal. Their Hadassah families have made Jerusalem the focus of their coming-of-age, and they're a good example to all.

HADASSAH'S POT PIONEER

Among the new crops in Israel is a controversial one: marijuana. Medicinal, of course. You won't be surprised that Hadassah is involved. Please meet Professor Raphael Mechoulam, 83. A recent Jerusalem Post magazine cover story on Cheryl Shuman, the founder of the Beverly Hill Cannabis Club's visit to Israel reveals that she has made a pilgrimage to the Hadassah campus to visit Prof. Mechoulam. The international boom in medical marijuana she anticipates is based on his research.

"Much of our work was begun half a century ago," says Prof. Mechoulam, whose research career has fluctuated with the lows and highs of interest in this weed.

His addiction, says Prof. Mechoulam, is to the independence of research, not to cannabis. He was born in Sofia, Bulgaria, son of a Viennese-educated physician. The family survived World War II by running from village to village, and moved to Israel in 1949. He studied chemistry and researched insecticides in the IDF.

When he returned from a post-doc at the Rockefeller Institute in New York he became fascinated by the borderline between chemistry and biology. He noticed that cannabis, to use his words, "was ripe for investigation." Fluent in a variety of European languages, he read 19th century papers on the possible potential of the plant. No one had isolated its pure form. The Israel police gave him five kilos of high quality Lebanese hashish they'd apprehended from a smuggler. He coined a new term, "cannabinoids" and isolated first CBD, a non-psychoactive constituent which, according to research at Hadassah, reduced sugar levels in diabetes-prone mice and ameliorated effects of heart ischemia.

Then he isolated THC, the psychoactive constituent, as well as half a dozen other cannabinoids.

Cannabis activist Shuman claims that the drug goes far beyond easing the discomfort of chemotherapy to helping her defeat her own ovarian cancer. But even numerous anecdotal reports are no substitute for proper clinical trials, insists Prof. Meshoulam. Pharmaceutical companies have been reluctant to fund such trials because of marijuana's reputation and the impossibility of patenting it.

CNN health columnist Dr. Sanjay Gupta says that meeting Prof.Meshoulum contributed to his much-publicized turn-around about the importance of using the drug.

Like any drug, cannabis needs to be well-regulated and to be under strict medical control, says Prof. Meshoulum.

"The possibilities are endless. Cannabis remains a medical treasure trove which waits to be discovered."

USING CANNIBIS IN THE PAIN CLINIC

Figuring out what's inside that treasure chest is the research project of Dr. Elyad Davidson, the Scottish-born anesthesiologist , who heads Hadassah's Pain Clinic, and meets patients for whom usual painkillers don't work.

Is cannabis the new aspirin?

"We're still pre-clinical, which means that although cannabis is being used, we're guessing on efficacy and safety," said Dr. Davidson. "This is a drug where research is often agenda-driven, and we have to be particularly careful on what we claim it does. In addition to legitimate medical requests, we have to make sure that we're not providing a subsidized source for recreational use. Pain isn't something you can quantify, so we rely on the reliability of patient reports."

In 2007, the first cannabis fields were approved by the government. Today, ten official cannabis growers/dealers have been given permission to grow fields of the green leafy plant by Israel's Ministry of Health. There is no standardization of the product yet. "That means that one dealer might be using leaves, another blossoms, and a third a different strain of cannabis altogether, "said Dr. Davidson. Certain strains and sub-strains have higher psychedelic qualities. This makes prescribing difficult.

" A patient will come into the clinic with a bag of marijuana and ask me how much and how he should take it. But we are in the learning stages of finding out what and how much works," said Dr. Davidson.

Scientists don't even know if consumption of Alice B. Toklas brownies or smoking joints is the best way to administer a drug that has worrisome side effects like paranoia and addiction. Cannabis is best known for helping patients through the nausea and appetite loss of chemotherapy, but even that doesn't work for everyone, according to Dr. Davidson. It's also thought by some to help with inflammatory bowel disease, Parkinson's disease, AIDS and MS. In Israel, other pain drugs are used first, and only as a late resort is cannabis recommended and approved.

"There are 60 different cannibinoids in the plant.It's not as if we are doing research with the pure THC extracted by Prof. Meshulam when we began experimenting," said Dr. Davidson.

Those experiments showed that some 20 percent with various maladies finding pain relief from cannabis. Another Hadassah study showed that 85 percent of patients found marijuana effective as an adjunct therapy for the pain associated with bone marrow transplantation. Many questions remain. For instance, does smoking pot actually decrease pain or just help a patient deal with ongoing pain?

At Hadassah, Dr. Davidson has launched an on-going survey of how patients have used cannabis and how effective it was for them.

"There are now 14,000 patients in Israel who have received government permission to take cannabis—with that number rising, so we're in a hurry to quantify the results to share with the international community."

KOSHER POT COOKIES FOR MS SUFFERERS, TOO

"Patients are of course looking for an announcement of a single development that will improve or reverse their disease. What we have this year is many small advances which greatly improve the lives and prognosis of MS patients," said Professor Tamir Ben-Hur, Chairperson of the Hadassah's Department of Neurology.

Several hundred patients who have muscular sclerosis and their families attended a recent conference sponsored by the Center for Muscular Sclerosis at Hadassah's hospital in Ein Kerem to hear updates on research and treatment of the disease which affects more than 5000 Israelis and 2.3 million persons worldwide.

Hadassah's MS center is unusual in combining clinical care with immunological research which allow the development and direct implementation of innovative therapies for the disease. Hadassah physicians are testing novel immunomodulatory drugs such as Linomide and Laquinimod, treatment of vaccination with T-cell lymphocytes and transplantation of stem cells to encourage new growth of neurons, myelin forming cells and protective brain tissue.

Therapeutic cell transplants were first developed in Hadassah, are given only in the framework of clinical trials. Such trials have paved the way for experimentation at major centers throughout the world, according to Prof. Ben-Hur.

Professor Dimitri Karussis, who heads Hadassah's MS Center described the most promising areas of research that are likely to lead to a significant breakthrough in the next decade. At Hadassah, these include immunotherapy and stem cell research. Important clinical trials are waiting government approval.

In the meantime, an enhanced arsenal of established and new medications already can slow the progress of the disease and decrease the number of debilitating attacks. All the medications are positively impacted by taking large quantities of Vitamin D, said Dr. Adi Vaknin-Dambinsky a senior physician who outlined the advantages and side-effects of the available medications. Other medications are available to improve the manifestations of MS: difficulty in walking, chronic fatigue, and attacks of laughter and crying.

Medical cannabis—available in drops, inhalation and cookies-- is among the medications found effective for some patients in treating muscle spasticity from MS. A local bakery is involved in producing the cookies, which are certified kosher. Patients need to undergo psychological examination before using cannabis, which may have hallucinatory side-effects.

PSYCHOLOGICAL IMPACT

Hadassah Rehabilitative psychologist Yarden Levi stressed the importance of patients addressing the psychological challenges of living with MS, which are often as difficult as the physical challenges.

"Overcoming anger and the feeling of loss of control to accepting the disease and discovering those areas of life that haven't been touched by disease, are critical," said Levi. He spoke on the importance of community, and the special challenges for couples grappling with the disease. In addition to both partners receiving psychotherapy, he suggested that MS patients undergo neuropsychological testing to determine the extent that MS has affected short-time memory and speed of decision-making. The degree of cognitive damage is not necessarily connected to the stage of physical disabilities.

"Partners often think an MS sufferer is just being obstinate or lazy when there has been a real change in cognitive function," said Levi. "The good news is that there are new programs for cognitive rehabilitation."

Have a fruit-filled day!
Barbara
Barbara Sofer
Israel Director of Public Relations
Hadassah, the Women's Zionist Organization of America Jerusalem
www.barbarasofer.com

Date: 1/16/2014 12:00:00 AM

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