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22 doctor focus cannabis patient care | vol. 3 no. 2 cannapatientcare.com extra question. "I've always looked at things like why a certain treatment or drug works. And why this treatment or drug isn't working. So, I was already asking the extra question," she said. "I knew that, with the conventional medical process as we know it, we're not answering questions. I knew we needed to look elsewhere." Along her pathway to better understanding the benefits of cannabis as medicine, both her husband, Dr. David Knox (an emergency room doctor for more 40 years) and their two daughters, Dr. Jessica Knox and Dr. Rachel Knox (3), became convinced she was on to something important that impact- ed them all. "I told my husband that I'm a trailblazer. I always dance and walk to a different tune. And when he saw what I was doing, and the difference I was making with cannabis, he came on board. He was intrigued," she said. She thought that her daughters were thinking OK, there goes my mom doing something crazy again. "As far as using the cannabinoids, they began to understand it, and looked at what I was doing. Then they joined me," she added. Being people of color, she said, means that she and her family look at things a little differently anyway. "Why does cannabis work? And what makes it work? And then, we began learning about the endocannabinoid system." Taking the Deep Dive She said that, in her deep dive to figure out more about canna- bis—trying to understand why people would choose this plant and why it worked—she found out about the endocannabinoid system. "It is the backbone to which every other physiological system is based," Dr. Knox said. "It is the system that keeps har- mony and balance between all our physiological systems. We're looking at receptors triggering downstream effects that cause a result. I was shocked. How did I learn physiology in medical school and didn't learn about this system that controls all of that physiology I learned about?" When looking at the bigger picture of the endocannabinoid system like she did, she said, she begin to understand that this really isn't about cannabis. "It's about our understanding that physiology, and how do we explain the function and dys- function of that physiology?," she said. "And that is something that should always come first." That a-ha moment was the impetus for the development of Dr. Knox as a endocannabinologist, a term she coined—meaning a per- son who studies the function and dysfunction of the endocannab- inoid system, and how to clinically apply what has been learned about cannabis and other botanicals as it pertains to the endocan- nabinoid system. The Autoimmune System and Endocannabinoids In discussing the autoimmune system, Dr. Knox has a very specific cannabis-angle viewpoint. "If we understand the things that throw the endocannabinoid system off, then you can start to apply the information that we need, right?," she said. She explained that everything, regardless of the disease pro- cess, or the system that is being discussed, starts at the cellular and sub-cellular level. "The things that throw the endocannabi- noid system off are genetics, the aging process, nutrition, phar- maceutical drugs, environmental stressors—these are all of the things that drove the endocannabinoid system off so it can't do its job." The root cause of throwing off the endocannabinoid system can also be traced to the inflammation that we start to gath- er in our body "probably from day one," she said, because of the world we live in. "A root cause of most disease processes, if not all, is inflammation. But that inflammation leads to oth- er disease processes. How that disease is manifested depends on your genetics and the environment you grew up in." Some people may show cancer, others will show diabetes or an autoimmune disease. "What you try to do regardless of the disease process is to understand the root cause of disease processes," she said. According to a July 2021 study done by Italian researchers (4), the endocannabinoid system (particularly CB2 receptor activation) is a possible target for the treatment of inflamma- tory and the autoimmune diseases related to immune cell ac- tivation. The study concludes that: "In vitro and animal stud- ies of multiple sclerosis have provided convincing evidence of the immunomodulatory properties of cannabis, although there is still a lack of clinical evidence from randomized and controlled clinical trials." In other words, what those researchers found out was just a start—there's much more work to do. If she is talking to somebody with an autoimmune disease, Dr. Knox said that she is going to look at what system is most affect- ed. "For example: Is it the joint system? And then work from there to see which receptors are not working or which are overworking and see how to put a therapy plan or a treatment plan together." If she sees someone with breast cancer, she is going to treat that person differently than someone with an autoim- mune disease (5), or with brain cancer, because different re- ceptors are involved. "Patients come in with this disease process, including au- toimmune disease, whether it's rheumatoid arthritis or pso- riasis, or all kinds of things, such as inflammatory bowel dis- ease," Dr. Knox said. "We try to put the patient in the forefront of their therapy. We can only do so much as they will allow us to do or tell us about, and sometimes they don't even under- stand why they're getting sick." "So, if I'm treating someone with autoimmune disease, I want to know everything about them. I want to know what en- vironment they live in. Is it a food issue or a water issue or an air issue? Is it a soil thing that has triggered their autoim- mune disease? Is it stressors in your apartment? Is it finan- cial stress, emotional stress, and what's happening with their