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28 doctor focus cannabis patient care | vol. 3 no. 2 cannapatientcare.com CBD products for her patients and who had started her own facility. Dr. Hughes' product is now manufactured in a Food and Drug Administration (FDA)-approved facility. In addition to physical barriers, Dr. Hughes has seen so- cial barriers such as bias and misconceptions, obstacles to patients accessing research, and a lack of a push from phar- maceutical companies to promote cannabis as they would other medicine. "I think the most common misconception would be that CBD oil just doesn't work. It's sor t of a de- gree of ignorance, a misconception that it's all hearsay and old wives' tales and there's no data," she said. "In reality, re- ally good, high-quality scientific research has been done to show benefits for this." Fur thermore, Dr. Hughes added that even though the research and data has been done and pub- lished, it has not been made easily accessible to patients, caregivers, and the general non-medical community–it has not been translated into language that's readable without a medical background. Even the medical community itself has displayed bias when encountering or presenting information on cannabis. Dr. Hughes stays up to date not only on medical literature, but also opinion pieces. "There are lots of physician-only informa- tion services that will offer position pieces and commentary, but there is so much there about the potential side effects of cannabis," she said. "Yes, it can cause hyperemesis in a few people, for example, but it's like anything else. You can over- dose on Tylenol, for example, incredibly easily, but we don't stop it–we tell people to not exceed the dose." One example of the consequences of bias Dr. Hughes knows firsthand involved a close friend and emergency med- icine doctor in Washing ton state who was suddenly termi- nated allegedly due to being overheard discussing cannabis with a chronic pain patient. At the time, cannabis was legal in Washing ton. Another potential factor contributing to the challeng- es surrounding cannabis is the lack of a push to promote it in the general public. One possible reason behind this, Dr. Hughes suggested, is that "in cannabis and in CBD is there isn't one big drug manufacturer that has a self-interest in tr ying to conver t this information into something that is eas- ily palatable and has flashy graphics behind it. In contrast, I'm a mom-and-pop shop, a solo person." Without the ex- pensive adver tising and promotion, cannabis remains behind the scenes, relegated to the back pages of search results pages, essentially hidden from anyone looking for alterna- tive treatment options. Looking Toward the Future and Beyond Dr. Hughes wanted to start with the production of a dandruff treatment knowing that no new products have been created for it since the 1990s. Now, when looking toward what's next, she has started to expand her skin care products, looking at whole body treatments as well as spot treatment, especially considering the damage hand sanitizer has wrought during COVID. In terms of cannabis derivatives for her patients and for anyone interested in finding more information on exploring CBD as a treatment option, Dr. Hughes recommends seeking out the advice of a physician who has knowledge around cannabis and CBD medicine, specifically. Patient advocacy groups and publications can give good advice as well. Overall, Dr. Hughes suggests approaching chronic illness and health with an open mind because there is more than one pillar of health. She hopes people will look at physical substances such as CBD and medication, plus the basics such as healthy sleeping habits and nutrition, but also at the mental and emotional factors of a healthy life such as creative outlets, meaningful relation- ships, and finding a purpose. Treatment can sometimes be skin deep, but reclaiming a life of lasting wellness involves looking beyond the basics. "I'm for what works," Dr. Hughes said. "If it's not harming you and you're better, I am for what works. I'm never going to tell a person to stop doing something that is clearly improv- ing their lives." For more information on Dr. Elizabeth Hughes' practice, please visit https://elizabethhughesmd.com.