Episode Transcript

Trevor:  Kirk, we're back.

Kirk:  Hey Trevor, how's it going?

Trevor:  Good. So, pediatrics. That's something we haven't done a lot of time with. Tell us who you found.

Kirk:  Yeah, I did a search when I got back from Morocco, which seems like decades ago, and you know, looked at our podcast and we had a lot of international guests and so there's some irony to this because I sent out a request looking for Canadian researchers in cannabinoids and cannabis research and I only got back a few, a few in my search. So. I sent out, you know, sent out letters saying, hey, we're Reefer Medness looking for Canadian content, would you like to talk to us? Well, Dr. Kelly's assistant got back to us and said, yeah, we'll talk about cannabis and here is some of the areas of her expertise. And it took a few weeks, maybe a couple of months to coordinate a schedule. And I was off trucking with Van Hoot off to the coast when you had the first meeting, I believe.

Trevor:  Yeah, and when you hear a little bit about her pedigree, you will hear why she is tough to get to nail down. She's got many, many different hats, but we are super glad she agreed to talk to us about, and spoiler, we managed to get her for two episodes, but today is sort of her main focus. Her day-to-day thing is pharmacology of pediatrics, So, drugs and kids. And how cannabis sort of worked into her research there.

Kirk:  Yeah, do you want to lay out her pedigree, her qualifications, and then we'll go on to the interview?

Trevor:  I'll say that she's a pharmacologist at the U of M, an assistant professor, and I think we'll let her do her intro.

Lauren E Kelly, PhD:  Hi Trevor, thanks for having me. So my name is Lauren Kelly. I'm an associate professor at the University of Manitoba and I am what is called a pharmacologist. So I'm in the Department of Pharmacology and Therapeutics. And what that is, is really someone who studies how drugs work.

Trevor:  Okay, that sounds good, because it always ends up being some interesting questions. Cannabis, was this something that you've been interested in a long time or recently, or how did your interest in cannabis come about?

Lauren E Kelly, PhD:  Yeah, it's really interesting. So I've been a child health researcher for my whole career. So more than, oh gosh, close to two decades now. And when previous to legalization, part of our discussion, so I had never been studying cannabinoids. I think if you asked me when I was going through graduate school, if I would be studying cannabis in kids, I would have thought you were a little bit bonkers, but... I came to this because through our network, so I was studying opioids, so all my graduate training we were looking at opioids for pain, opioids in pregnancy and we started in our community hearing lots of conversations around medical cannabis and this is before legalization and so the Canadian Pediatric Society back in 2017 actually did a survey of pediatricians in Canada and about 50% of them were caring for kids that were using medical cannabis and this is before Legalization was happening. This is not a lot of kids per doctor, and I think that partly why folks are so, have such limited experience, but it became this question of, wait, this is questions that are coming from communities, lots of different places, not just Vancouver anymore, but we're getting questions from all over, and how are we really going to study this? And in the pediatric community, it kind of became this question of well, use is happening, and this legalization is going to change the way that we can to study it and the access to these products. How are we gonna learn what's safe and if these can work to help kids with complex conditions? And so did I think I was always, you know, dreaming of being a cannabinoid scientist? No, but I will say that I stumbled into cannabinoids from the patient communities and the clinical communities we're working in the pain space. And so, you see, I run a national research program now which has more than 140 individuals from all across the country, you now, physicians, nurses, parents, youth, researchers. And we all came together because there wasn't a community to help each other answer some of these questions and design research. And so I'm a researcher, my job and the team is to design the research that's gonna answer all these questions we have about if cannabinoids are safe and if they work for kids.

Trevor:  No, that's fascinating because people want to know what's the name of your group that looks like cannabis and kids.

Lauren E Kelly, PhD:  Yeah, so it's called C4T, or the Canadian Collaborative for Childhood Cannabinoid Therapeutics, lots of Cs, four of them. And our website is medcancids.ca, so M-E-D-C-A-N-N K-I-D-S dot C-A. And this is a group, again, it's an academic research group, so we hold funding from academic funders, so from the government, from hospital foundations, from other provincial funders to run research on cannabinoids.

Trevor:  Cool now way back when I was in pharmacy school some of our profs are beat into us that the kids are not just little adults. They're not just you don't just reduce the dose. They are different and so I'm assuming we have some extra complications with, the kids are different. And Like you said parents were just kind of using cannabis on kids without sort of any Trials ahead of time. So what kind of complications were you getting from that?

Lauren E Kelly, PhD:  Well there's lots of places where we are concerned about giving kids cannabinoids in general and so you know our research focuses on medical cannabis use, meaning kids who are receiving or taking cannabinoids for a therapeutic intention. That doesn't necessarily mean they always have authorization. But in our space, we're not looking to be conflated with like, every kid should have access to cannabis. We're really talking about apples and oranges because in the recreational sort of cannabis space, we know there's lots of different active compounds in the cannabis plants. And what we're talking about from a therapeutic perspective is mostly these high CBD products that have minimal or low amounts of THC. Irregardless, both THC and CBD interact with what's called the endocannabinoid system, which hopefully some of your listeners will know a little bit about. But this is the system in our body that responds to cannabinoids and the cannabinoids our body makes, as well as the cannabinoids from the cannabis plant. And with kids, the endocannabinoid system plays a really critical role in how our neurocircuitry forms and the connections and synapses between neurons. And the ECS or endocannabinoid system actually has a role as early as like implantation and development of a placenta. And so those, those concerns range throughout pregnancy and fetal exposure as well. Because what we don't know right now is what happens if we disturb that endocannabinoids system in kids during critical points of development. And so I think. You know, with kids there's lots of other complexities. I mean cannabis products are illegal if they are under the age of 18. They do require legally an authorization for medical cannabis to be able to possess a CBD oil. So, you know parents who are you know maybe unaware, maybe you know accessing products from from the recreational market and those are the same quality products as a medical stream. So it's not that I think products are any better from medical stream, but that authorization is a really critical piece because from legal perspectives that would that would, that's what authorizes anyone under the legal age to even possess cannabis and so there's legal perspectives but then there's also of course stigma and of course teenagers being teenagers and folks you know using cannabis for different reasons and maybe not disclosing it to their families or their doctors right and so you know if you've ever met a teenager they're not always the most open of books. And conversations around cannabis can be difficult. And a lot of times, what they hear in school is, don't do cannabis, stay away from drugs. But then they may have a conversation and one of our youth partners put this perfectly. She said, she was prescribed Nabilone, which is a synthetic THC for her migraine. And she said, this was the most effective therapy that has ever worked for me. I'm able to go to school, but at school, I'm sitting in a lesson where they're telling me that cannabis is gonna ruin my life and I should go to jail. And she's like, I don't know how to tell my friends. I don t tell my friends anything about my medication. I don't feel like I can talk to anyone about it. And because they have that perception, I think, too, it makes it less likely they're going to talk about these conversations. And so the whole gambit of pediatric exposures is complex from a physiologic perspective, but also from, you know, what's complicated about studying kids, right? They can't take cannabis oil to school the same way that they can take their inhalers. They should be able to, but they don't always have procedures and processes in place that's very school specific. You know, there's not necessarily the same kinds of training on how to administer these products in school. And so even, you know, an oil, a CBD oil product, some of the things we hear from families are absurd around administration during the school days. And even from the clinicians who are authorizing these products, you know saying things like, well, we let the school know. You know once the kid is doing better and then we do school administration. So kind of starting with like two times a day to avoid school until they see how the kid is doing and if they are going to do well then introducing it three times a day meanwhile that's what they wanted to do all along but they you know trying to plan around some of those extra barriers for cannabis is tough.

Trevor:  And not trying to beat up on the teachers too much. It's just funny. Literally one of the people I work with at the pharmacy, her daughter is in school and is on a four times a day antibiotic and the school's decided they won't administer to that. So she had to leave work early so she could get to school to give the kid the antibiotic. So maybe not just cannabis, but yes, I can only imagine some of the hoops that some of parents had to go through. But before Kirk and others accused me of promoting stigma, I did say what were some of the problems with cannabis in kids. Maybe we should go the other way. Are we, because I think by now probably everybody's heard of Charlotte's Web and high CBD products for kids with seizures, especially some dramatic seizure conditions like a Dravet Syndrome. What are some of the things that are working well for cannabis in kids?

Lauren E Kelly, PhD:  Yeah, so, I mean, working well depends on who you ask and how you kind of find well. I'll just say that to start. But what I will say is we do what's called a Living Systematic Review, meaning we actually look at an update every two years. We do a reassessment of all of the studies that have been done. And so our last one, which was published last year, I mean, there's like seven thousand seven hundred kids that have been in, I think there's, like, two hundred and eighty-six studies, eighty-one clinical trials. And yes, many of those trials are an epilepsy because, of course, there is a marketed product for that indication. But the other two areas where there is quite a, I won't say quite a bit, where there's emerging amount of research, it feels like quite a bit because it's from zero to, you know, five studies, which is quite of a bit, is in the space of neurodevelopmental disorders in the face of autism, there's been a lot of work, not a lot. Again, a lot being compared to zero. Some work coming out, smaller studies coming out of Israel and South America. And there's actually a product in Australia that is being marketed, a pharmaceutical grade CBD with small amounts of THC, CBDA product that has passed its Phase Three study in pediatric autism and also in Rett syndrome as well, in terms of things like they're looking at behavior and other standard measures for core autism symptoms. In the space of pediatric oncology, I will say that there was a really big wave of use. So we did a survey, I want to say about 2020 now, and I mean 92% of pediatric oncologists and palliative care docs were caring for kids using medical cannabis, not because there's a bunch of studies that say it's safe and effective, but because those are the families that are reporting that they're using it. And so, I would say that in those spaces, so in the spaces of oncology, mainly for symptom management, but some use for treatment as well. And in the space of autism, there's more evidence evolving. And then of course, you know, in this space of seizures, there is more research too, not only looking at CBD isolates, but we actually have a trial now comparing the isolate to a cannabis herbal extract, so a product that contains other cannabinoids and small amounts of THC. And so even in that space, there are questions as to who will benefit most from a combined product. Do we administer them at the same dose and kind of comparing those more on a head-to-head because, as you said, epilepsy is really the only space where the evidence is strong and high quality, not because everywhere else we've looked at it and they didn't work, but we really just haven't looked at. Clinical trials are very, very expensive and take lots of time. And so in terms of what cannabinoids work for from the standard sense of like evidence-based medicine and those kinds of standards, the answer really right now is just sort of drug-resistant epilepsy and seizures. But that's not to say there's not a lot of other work that is coming up in the next few years in other areas, again, mainly in the neurology space.

Trevor:  Let's stick with neurology for a second and autism because it comes up a lot. Two different questions, but you seem like the right person. Let's start with first seizures. Easy is not quite the right word, but if someone is having less seizures, that's easy to count. What do some of the cannabinoid products do to help with autism? What are we measuring? Pharmacologically, what do we think they're doing in autism?

Lauren E Kelly, PhD:  Yeah, so such a great question. And I will say, we have this discussion quite a bit about what does improvement look like when every single kid looks different, right? So, a seizure is a seizure, is a seizure. Yes, all seizures yes there are different types of seizures, but seizures are seizures. Whereas with autism, I mean, every single child with autism has different presentation. They're less similar than they are, less alike than they're are different, or whatever that term is.

Trevor:  You've met one person with autism. You've meet one person with autism

Lauren E Kelly, PhD:  Exactly. Exactly. You'll never meet another one like that. And so I think with what we talk about with our autism working group is really around looking at what we call Self-directed Goal Attainment Scaling. So one thing we've implemented, we actually did this in our headache trial as well, because yes, you can count headaches, but how do we actually get to like, not just these quality of life scales, but like what matters. And so this is something that, you know, autism, of course, sorry, there are scales, validated scales, violence scales that look at like social communication and behavior, aggression, and the idea being that the CBD... A, some theories are that some cases of autism, they may actually have like a lower level of endocannabinoid signaling. And some theories are more around like the inflammation and the way that CBD affects some of the transporters and how that can reduce some of the inflammation and things that are happening. And so we don't have a clear picture of this connects this, which would affect this. And that's because CBD acts through, you know, five, six, seven different pathways and receptors. It's not just exclusive to the endocannabinoid system. But what I will say in terms of measuring that, so how do we know it works in autism, is a great question. So again, there are, what the clinical trials in Australia are looking at, is what they call like the Clinician Global Impression of Change, and the Family's Global Impression of Change which is basically like... Do you think that they've done better or or not? Are they worse than before? And so what we want to do is a little bit different. And so, what we do is we actually ask the participants like, what are your three goals? Like, what do you want to improve? And, so, for the youth, this is amazing because it's like, I want to ride my horse three times a week. I want get straight A's. I want to play video games without feeling tired. Like, they get to pick what they actually want to see improve. And then we have them rate their progress towards the goals at every study visit and so. For us, that gives us a way to really better understand pain is pain is pain. Pain is also influenced by many different factors. And there's lots of subjective stuff that's happening in their lives. But for us, what's important is A safety. So we have standard assessments of safety. Those are, you know, those are not negotiable. But when we talk about benefit, it's it's individualized more to that person as to like what is the reason like what are you actually trying to improve. And so I think. When we plan out our autism trials that it will be very similar in our approach and that's not really great for a primary outcome for a trial because it's not validated and it's hard to...

Trevor:  That's what I was going to say. That must drive your status. Good for the patient, but that must drive your statisticians crazy because how do you make sure one versus the other?

Lauren E Kelly, PhD:  If my statisticians are listening, you know, well, I won't apologize because you know what you got yourself into. But we, so again, so primary outcomes tend to be things like these clinical global impression of change, where there's lots of data that says like, okay, well, if a patient improves two points, we think that's significant. So whether or not I think that is the right approach of how to power a study or not, I think as long as I, as an investigator, I'm able to get that picture, I think. You know, that's the most important piece there, but hopefully that answers your question.

Trevor:  No, no, that was that was excellent and very thorough. Thank you. Something we cover here a lot, which, you know, probably not a big surprise. Most I think it's getting better. I'll start with not just be negative, but clinicians we talked to both on the podcast and off, be they doctors, nurses, pharmacists, students, pharmacy students, they don't seem to have a whole lot of cannabis training. So, in your your realm and pediatrics, your your GPs, your pediatricians, your your pediatric neurologists, do they know much about cannabis and if not how are we trying to change that?

Lauren E Kelly, PhD:  Yeah, I think they all would probably tell you they'd like to know more, regardless of if they were part of the group that got like one lecture in med school and like maybe a lecture if they're a subspecialist in like palliative care, but I will say the training is not standardized and not well integrated and we actually rewrote the position statement. So, the Canadian Pediatric Society is the society that all, you know, the pediatricians and subspecialists are part of. And we actually wrote the Position Statement and I think it came out in 2024, that summarized all the evidence and basically gave like our recommendations. And our main recommendations are that we need to develop real training about this because it's happening and we need a response plan. I will say we have not had much luck getting funding for developing training. And this is where it becomes, something that we have evidence now to support. Can build training but it costs money to develop all of these things and disseminate them and there has not been investment from the government or from any, like there's not a mechanism for that to be developed and so there are opportunities so as, I don't think i mentioned but I'm currently the president for the CCIC or the Canadian Consortium for Investigation of Cannabinoids and that's like our national non-pediatric, non-clinical. It's all the of its researchers in Canada. And they have a program that was created before I even, I want to say in like 2019, but again, it's not about pediatrics, it's all online. It's not quite like self-paced or interactive. And so, I think they've been having, you know, it needs to be updated. You know, we can't be teaching evidence from 10 years ago because it didn't exist for pediatrists. And so, you now, we've really, as a society, been looking for opportunities for funding to be able to like put together like an accredited training for pediatrics. We're not there yet, but it is certainly something that the community has been asking for. And then, you know, certainly, you know, we have conversations with the Canadian Pediatric Society regularly on like what kinds of research we need. And we just actually finished some work with the developmental pediatricians on what they've been seeing and what their priorities are. And I will say their top barrier to the use of medical cannabis and children with autism is that there is no evidence. And they're uncertain on the efficacy because they don't have you know the traditional things you know there's no product monograph that says in this study this many kids did this well. We don't half that and so it's almost like flying blind in a space where they may see one or two kids a year so they're not developing that confidence and having the discussions. And so most, many developmental pediatricians and other subspecialists will have sort of like a cannabis expert that they'll refer folks to for the authorization. So sometimes that might be a family doc in the community who runs a cannabis clinic. Sometimes it's one particular neurologist who does all the cannabis prescribing in a couple places. It's like the palliative care guys, the cannabis guys. So they do the authorization, so it's a little bit of, you know, looking for help because I think there's a lot of discomfort in a place where there's lot of risk. And not a lot of data to support making that decision. And so some of the things that we do, so for example, as a part of our network, if there's an oncologist who says, hey, I have this really challenging case, I'd like to talk to someone about it, we can try and find another oncologist who may have some more insight and kind of connect them to talk about cases. But other than that, there's not a formal community or mechanism for clinicians to support each other in making those decisions and giving them a bit of comfort. And so I think, again, a big gap really in how we're supporting care. And one I hope that pharmacists will help us to fill because I mean, the reality is that clinicians are never gonna be the experts in drugs. No offense to all the clinicians listening, but really that's a pharmacist's role is right, to understand which drugs interact with which drugs and how much of them should be given for what. And so I think like there's such a huge role here for the pharmacist to play. And we do have a few pharmacists in some of the pediatric hospitals that are a part of our network as well. And I see them as really being the key here to supporting the doctors making the decisions because they can also advise on what to look for and kind of be that second brain to review what the recommendations are.

Trevor:  Think that segues nicely since you're talking about community and support. Let's instead of talking about studies this time let's go down to let's picture someone who's listening right now they have a child or a child in their family who you know they've been talking about amongst themselves. Would my child do better if they were on cannabis? So let's that's before they just go give them that CBD oil that you know their friend and their mommy's Facebook groups said to try. What, how should they approach I think my child should use cannabis because it doesn't matter what where how do you recommend they do it properly?

Lauren E Kelly, PhD:  Yeah, so again, I think it really depends on your health care practitioners and what you have available to you because my first recommendation is going to be whatever reason you want to use it for. Please speak with whatever clinician manages that for your child. So whether it's a GP because you're worried about sleep, whether that's a psychologist because you are worried about depression or anxiety. Whether that is a developmental pediatrician because you were worried about something else, I really do think that they're a critical. Part of a discussion, understanding they may not always be a facilitator, right? There are going to be times where that person is going to maybe say, absolutely not. But I think it's important to come in with a clear picture as to why you want, like what is it that you are trying to change with the cannabinoids. And why is it that you believe that cannabinoids are a good choice? And coming in and saying, Sally's mom said it worked for her is OK. But you can also, like on our website, we have infographics. We have published literature that's summarized. And I think coming in with some evidence behind you saying, look, these five studies have been done in Israel and South America and Australia. Just because they haven't been done in Canada doesn't mean that they're not valid. And so coming prepared with what you really are trying to change. And being open to discussions too, because I mean, you know, lots of times folks, once they are ready to have that discussion, they're almost like they've kind of made the decision. And what I would challenge folks to do is be open to listening to other suggestions for there may be other options for what you are trying to manage that may be safer and may have more evidence. It's not necessarily, you now, for all of the reasons, but I do think that it's important to also keep open mind of like there may be real reasons why this isn't a safe option for my kid. And so the reality is for each kid, that risk picture looks totally different depending on what other medications they're on, what their disease status is. So discussions with our colleagues in palliative care look very different than on the oncology board, where thankfully many of our children with cancer do really well and are gonna live long and productive lives. Those are very different conversations about how we use THC, for example. And so, it's always going to be up to the kind of, you know, individual case. But I really think, you know coming prepared with a really clear idea of what it is that you're trying to change. Why you believe this is a good option, and what other, you know, resources sort of support your decision is really going to help you, you know come into this with hopefully and well received, you know, from the from the clinical encounter. You know, acknowledging that it's very different, right? Than if they were asking for a benzodiazepine or something that you need a prescription for. I would say, you know the approach of coming in being like, I'm gonna do this anyway is probably not the right way to start the conversation even if that's, you now, a bit where your discussion's already going. So maybe try and have the conversation before your mind is made up.

Trevor:  No, I think that's fantastic advice and we will make sure that we have the C4T website linked in the show notes so if you want to have a look at some of those resources that'll be good. And yeah, so not to beat up on any of the parents out there, but yes, please listen to your clinician that, you know, you might not think that it's always a discussion. You know, they might have really good reasons why they think Ritalin is better for your child's ADHD than cannabis and you might be might strongly disagree for whatever reason and that's fine but but if you can listen to what your clinician's reasons were, I think it's always a more helpful helpful conversation. Now I'm going to get the hate mail from the people who say I'm pro-Ritalin but that's just an example. We are getting close to the end of time so just so I don't miss anything was there anything else you think our listeners really need to hear about, you know, we could go on for hours, but we've got to keep this relatively short about pediatrics and cannabis that you wished we had covered.

Lauren E Kelly, PhD:  Yeah, I think just the only thing, like, for the healthcare providers out there, or those folks who may be, you know, used to having lots of literature and long-term studies and all of this data to support their prescribing, the reason we don't have data on kids in medical cannabis is because it's not a prescription. So, I can't look in my provincial health records and type a DIN number in. And pull data and match a cohort and look at these short and long-term effects. So one of the reasons why we don't have a lot of evidence is because our system's just not set up to generate evidence. And so that's kind of one of my hopes for the future is that we can agree on the standard sets of data that get collected during clinical encounters and some kind of tool to better collect them so that we give clinicians the evidence that they want and need to feel comfortable in having these discussions.

Trevor:  Kirk, what stood out for you from Dr. Kelly?

Kirk:  Well, it's another one of those stories where our guest stumbles into cannabis. You know, she was studying opiates and learning about pain management using opiates when cannabis surfaced and I believe she said it came from the floor, it came form a patient who was interested in it. So I thought that was, you know, that she followed the path.

Trevor:  Yeah yeah no and and yeah so and because both of us had talked about this off air we really were kind of floored by pre-legalization. Like 2017 and earlier there was a survey by the Pediatric Society of Canada that already 50 percent of pediatricians were looking after kids with medical cannabis and so that was kind of one of the light bulb moments for her but yeah people are using cannabis in kids a lot and have been for a while. So that honestly that's that number that 50% kind of blew my mind.

Kirk:  Yeah, and the other thing that also stood out for me is, and you mentioned it a little bit when you used the antibiotic story about one of your work colleagues having to go to the school to give antibiotics and that had a little bit of stigma attached to it, but cannabis, the stigma is the kids' stigma.

Trevor:  Yeah, yeah. No, no, talk about this. This really blew my mind when she was talking about what they had to go through.

Kirk:  Well, yeah, but also just how the kids are left in a lurch where they don't want to talk about the medicines they're taking. And we've talked about this, I've talked, about this. I've written about this in our blog, reefermed.ca, The Blog where everything about cannabis is fear based. And especially with children and the whole, and at one point, the whole Kaiser report about youth using cannabis before the age of 25 can alter their brain patterns and cause psychological disorders and schizophrenia. This is the fear that's out there. Meanwhile, cannabis is helping more children than I think any research will say it doesn't. Right? Like the amount of kids that are being helped by cannabis is more than the amount of kids being harmed by cannabis, is my point. And I think the literature stands out that way. But yet, but yet, even though pediatricians have been using it for, you know, almost 10 years, if not longer, still the kids are taught to fear it, you know? I don't know any other medication where kids are thought to fear it.

Trevor:  Yeah no um yeah her her her story about the the the child who had migraines that was treated with nabilone a synthetic cannabinoid worked great but now she's too afraid to talk to even her peers you know about the medications she's on because of what she's learning in school. Like yeah you know we talk you said we talk about stigma all the time but I hadn't really thought about that that too afraid to talk about to my friends about what I’m taking to make my headaches better. So that's a barrier.

Kirk:  Yeah, I also liked the fact that how we need to get into research, you know, subjective evaluations of patients' pain. I thought that was interesting because when I'm working in the clinical environment, you know the pain scale for children is a grumpy face or a smiley face. So you're dealing with concepts and and also you're doing with the maturity level of your patient. I can't think of anything harder to care for maybe a cow because it's got two stomachs, but but you know you're trying to talk to children and trying to get... Four stomachs for a cow?

Trevor:  I think so.

Kirk:  Yeah, okay. See there you go, right? But doing, you know, doing an abdominal assessment on a child can be very difficult because of the subjectivity of the pain. So I found that interesting how they do the research individually. They have to subjectify their objective information.

Trevor:  Yeah yeah and without getting too deep into how studies are run I was honestly feeling a little bit for her her her statistician because you know you it's easy enough to count the number of seizures a child say had in a day and see if that number went down that's pretty easy but you know if you start if one child like she said if one children wants to ride their horse three times a week. Another wants to play video games without getting tired. Another wants get straight A's. No, those are all really good goals for that person. But as the statistics for the research, like for us to say, this improved a person's life in this way. Well, that gets to be really hard to do the stats to show that there was an improvement if everybody's looking at a different outcome.

Kirk:  Yeah, I thought that was interesting. I enjoyed this one and I managed, I guess, spoiler alert, we had two interviews with Dr. Kelly and I got to be a participant in the second one and found her quite compelling. It was quite an interesting conversation. I am sorry I missed this with you.

Trevor:  Well, no, you got in on the next one. And you know what? How about we'll say who we are, wrap this one up, and then we'll go do the wraps for the next ones.

Kirk:  Yeah, yeah.

Trevor:  So I'm Trevor Shewfelt, I'm the pharmacist. You're at Reefer Medness The Podcast.

Kirk:  Yeah,.

Kirk:  The podcast where we never remember to introduce ourselves at the beginning. We were found at reefermed.ca. Kirk, who are you?

Kirk:  It is funny, we sit down and we promise ourselves we're going to interview ourselves at the beginning. We never do it. Yeah, I'm Kirk Nyquist. I'm the registered nurse and you can find us at reefermed.ca. I encourage you to go to our website if you are a new listener. Go to our web site because that's where you'll find the episodes all laid out like a library. You can search it and you find topics of interest. This one, for example, will be linked to pediatrics, which... And if you go to our page and go pediatrics, you'll see all the other related stories that we've had on pediatrists. So if you're curious about cannabis and pediatric, I think we've got three or four episodes. So yeah, reefermed.ca. Check us out and give us an evaluation on that there internets.

Trevor:  And Dr. Kelly, thanks again for giving us your time, two days in a row on two different topics. And we'll leave that as the teaser for if you come back, you get to hear more of Dr. Kelly.