Urgent Need to Update Medical Textbooks to Include the Endocannabinoid System

Open Letter to Medical Textbook Publisher Elsevier
Subject: Urgent Need to Update Medical Textbooks to Include the Endocannabinoid System
 
Dear Esteemed Publishers, we are writing to you as concerned members of the medical and scientific community to address a significant gap in the current medical education curriculum. The Endocannabinoid System (ECS), a critical regulatory system in human physiology, is conspicuously absent from many of the most widely used medical textbooks.
 
The Importance of the ECS in Human Physiology
The ECS is a complex network of receptors, ligands, and enzymes that modulates various physiological processes such as pain, inflammation, mood, appetite, metabolism, and neuroprotection. Discovered in the early 1990s, the ECS has since been recognized as a fundamental system that interacts with other major physiological systems, including the nervous, immune, endocrine, and cardiovascular systems. The ECS plays a key role in maintaining homeostasis and regulating various physiological responses to internal and external stimuli.
 
It is crucial to emphasize that the ECS is a dietary lipid-based signaling system. Its components, including endocannabinoids like anandamide and 2-AG, are derived from dietary lipids and are involved in a wide range of physiological processes. The ECS's association with cannabis is purely circumstantial, stemming from the discovery of cannabinoid receptors through research on the psychoactive components of cannabis. This association should not overshadow the ECS's broader and more significant role in human physiology.
 
Current State of Medical Textbooks
Despite its critical role, the ECS is largely absent from many leading medical textbooks. For instance, the 'Guyton and Hall: Textbook of Medical Physiology'" a cornerstone in medical education, does not cover the ECS.

Discovery Year Inclusion in “Guyton and Hall: Textbook in Medical Physiology“
Cellular circadian clock 1994 2020 (14th edition)
Ghrelin 1999 2000 (10th edition)
Toll-like receptor 1997 2011 (12th edition)
Adiponectin 1995 2006 (11th edition)
Melanocortins 1980s 2006 (11th edition)
Leptin 1994 2000 (10th edition)
Nitric Oxide (NO) 1987 1996 (9th edition)
Endorphins 1975 1986 (7th edition)
Interleukin-1 1979 1986 (7th edition)
Somatostatin 1973 1976 (5th edition)
Prostaglandins 1971 1976 (5th edition)
Endocannabinoid system 1992 not mentioned
2-AG 1995 not mentioned
Anandamide 1992 not mentioned
CB2 receptor 1993 not mentioned
CB1 receptor 1988 not mentioned
 
This table reveals a significant gap in the coverage of the ECS compared to other physiological discoveries. While some discoveries were included very quickly after their publication, the ECS and its components remain uniquely unaddressed.
 
Implications for Medical Education and Practice
 
The omission of the ECS from medical textbooks has significant implications:

1. Incomplete Education: Medical students and professionals are not receiving a complete education in human physiology, which hinders their understanding of critical regulatory mechanisms.
2. Clinical Practice: Without knowledge of the ECS, physicians may be ill-prepared to diagnose and treat conditions related to ECS dysregulation, such as chronic pain, metabolic disorders, and certain neurological conditions.
3. Therapeutic Potential: The lack of education on the ECS contributes to a general reluctance among physicians to prescribe medical cannabis, despite its potential therapeutic benefits.

 
Call to Action
Given the critical role of the ECS in human health and disease, it is imperative that medical textbooks be updated to include comprehensive coverage of this system. I urge you to consider the following actions:

1. Incorporate ECS Content: Update your textbooks to include detailed information on the ECS, its components (such as CB1 and CB2 receptors, endocannabinoids like anandamide and 2-AG, and related enzymes), and its role in maintaining homeostasis.
2. Educational Resources: Provide supplementary educational resources and training materials to help medical educators integrate ECS knowledge into their curricula.
3. Collaborate with Experts: Work with leading researchers and clinicians in the field of cannabinoid science to ensure that the content is accurate, up-to-date, and reflective of the latest scientific discoveries.

 
Conclusion
The inclusion of the ECS in medical textbooks is not just a matter of academic completeness; it is essential for preparing future physicians to be effective and knowledgeable healers. By updating your textbooks to reflect modern standards, you will be making a significant contribution to medical education and, ultimately, to patient care.
 
Thank you for your attention to this important matter.
 
Sincerely,