May 13, 2019

"Many people have become captivated by the idea of using stem cells to fix their damaged joints, and some claim to have been helped."

"But there is no clear evidence that these treatments work, and their safety has yet to be established. Most researchers, including those at the National Institutes of Health, think that efforts to sell therapies involving adult stem cells, which can develop into different types of cells to replenish tissue, have gotten way ahead of the science. Even so, hundreds of clinics have popped up around the country to meet the demand. Some of the clinics also inject joints with platelet-rich plasma, a solution of platelets extracted from the patient’s own blood.... There is almost no regulatory oversight of orthopedic procedures using bone-marrow extracts or platelets, which are regarded as low risk.... 'I believe strongly that it isn’t ethical to charge patients for unproven therapies like these and raise what are likely to be false hopes,' said Paul S. Knoepfler, a stem cell researcher at the University of California, Davis. He said that some properly conducted studies on platelet-rich plasma suggested it might help, but others did not. As for stem cells extracted from bone marrow, Dr. Knoepfler said well-controlled studies were even scarcer, also with mixed results.... [P]atients rely on testimonials and other informal evidence.... 'The power of anecdotes is just amazing when it just catches on,' said Donna Messner, the president of the Center for Medical Technology Policy, a nonprofit research group. 'This is how snake oil has been sold for generations.'"

From "Stem Cell Treatments Flourish With Little Evidence That They Work/The F.D.A. has taken an industry-friendly approach toward companies using unproven cell cocktails to treat people desperate for relief from aging or damaged joints" (NYT).

30 comments:

RK said...

I'm not "desperate for relief from ageing" yet, but hope to be someday. C'mon stem cells!

Carol said...

Not surprising. The public know a lot of things that just ain't so.

rehajm said...

The heart teams were disappointed by phase III and presented earlier this year. Truly effective therapies have been elusive...

Big Mike said...

Too late for me; I have already had total replacements of both knees. I remember when Michael J. Fox was conned into making political ads for Democrats because of the false belief that embryonic stem cell therapy could cure Parkinson’s. I get his desperation, but sometime one has to wait for real science and not junk science.

Yancey Ward said...

Getting stem cells to grow into actual organs and other tissues is tough. Think about it- at one time you were a single undifferentiated cell, and that one cell became all the different tissues in your body, even though all the cells in your body have the exact same genetic material at their center. Why did one clump of cells become a heart and nearby clump become a liver?

BarrySanders20 said...

Just saw this article earlier today:

https://sciencebasedmedicine.org/patients-blinded-by-stem-cells-update/

Quote from the story: “The resulting biological soup was then injected into both eyes.” Nasty results followed

rhhardin said...

It's good to see free market pricing demonstrated to work in health care.

YoungHegelian said...

In another on-going medical scam, there is Ultrasonic ""Shockwave" therapy for a feller's toy soldier that refuses to stand at attention.

This treatment is being advertised out the wazoo on talk radio, which has a largely male audience.

I asked my urologist how this treatment can be advertised, since it isn't FDA approved, and she (yes, a "she") said that it's "utter bullshit".

Automatic_Wing said...

She Blinded Me With Science

n.n said...

Transplanted (i.e. alien) embryonic and fetal stem cells hold potential as carcinogens and immune response triggers. However, [native] adult stems cells hold a viable potential for medical therapy. Now if we can discern and design the genetic code that dictates spatial orientation and limits.

Fernandistein said...

Why did one clump of cells become a heart and nearby clump become a liver?

It probably sounded like a good idea at the time.

Suzanne Somers, 71, Reveals She ‘Regrew’ A Breast With Stem Cells After Losing One To Cancer (Hollywood Life).

Michael K said...

Why did one clump of cells become a heart and nearby clump become a liver?

There was a young resident at UCI when I used to go to Grand Rounds who was working on an engineered liver.

Not functional yet. The problems are huge but he was working on constructing a skeleton of collagen and trying to ;populate it with hepatocytes.

Still at a primitive stage.

Traditional TE (Tissue Engineered)scaffolds were based on hydrolytically degradable macroporous materials,(collagen) whereas current approaches emphasize on controlling cell behaviors and tissue formation by nano-scale topography that closely mimics the natural extracellular matrix. This review article gives a comprehensive outlook of different organ specific NMs which are being used for diversified TE applications.

Engineered skin grafts are real. That's about as far as it has gotten. The other stuff is hype. Theranos II.

eddie willers said...

Why did one clump of cells become a heart and nearby clump become a liver?

I remember a line from a TV show where hubby comes home and wife is slumped against the sofa, worn out with the house untidied.

Hubby: "What have YOU been doing all day?"
Wife: "Making a liver".

Puts it in perspective.

Jim at said...

I remember when Michael J. Fox was conned into making political ads for Democrats because of the false belief that embryonic stem cell therapy could cure Parkinson’s.

He wasn't conned. He was a willful participant to the point he played the deliberate victim by refusing to take his medication the day he testified in front of Congress.

Leslie Graves said...

The reason that patients are turning to untested and unproven treatments involving stem cells is that after they sought treatment from their local doctor who uses whatever treatments are smiled upon by the medical establishment, they still needed treatment.

It’s not so hard to understand why an older person would want to experiment if they’ve already this, that and the other that their doctor advised they try, and they are still in a world of hurt.

Henry said...

The reason that patients are turning to untested and unproven treatments involving stem cells is that after they sought treatment from their local doctor who uses whatever treatments are smiled upon by the medical establishment, they still needed treatment.

Maybe. But weirdly, joint replacement is ridiculously proven to be effective.

I wonder if a large component of this phenomenon is people scared of surgery.

Nobody said...

I asked my urologist how this treatment can be advertised, since it isn't FDA approved, and she (yes, a "she") said that it's "utter bullshit".

Since I have no ED problems, I might have a hard time with a female urologist. It’s bad enough that one of the two doctors at the place I go to is smokin' hot. I worry if there is ever a need to go there, I am going to have to ask her if I can see her less good looking partner instead.

Nobody said...

OMG, after the above comment, I started getting ED ads!

Jonathan Graehl said...

PRP treatment costs 1/4 of joint replacement. If a high enough slice of people have their complaint 'anecdotally' permanently relieved then it's wise to pay for it as a "before you replace that joint" cost saving measure.

walter said...

Fwiw, Rogan has a podcast with Mel Gibson talking about his and his 90 something father's results from this. Rogan himself has had rounds of it to help his shoulder.

walter said...

Post-op cognitive decline in the elderly is a concern.

donald said...

My Urologist is insanely gorgeous and gets much glee cracking jokes that have nothing to do with the job. She’s just extremely bright and funny. And gorgeous. Really, really gorgeous. I gotta crush on my urologist don’t I? Ewwww.

Leora said...

If it's clearly disclosed that the treatment isn't government approved, I see no reason why people shouldn't be allowed to try it with their own money.

My GP knows a fellow doctor who worked on a major study showing that Glucosamine Choindroitin has no effect. He happened to notice that he was still taking it. When he asked about it, the man said it worked for him. Individuals are best placed to decide if treatments for chronic incurable conditions are beneficial or not.

Richard Dillman said...

I had two prp treatments (platelet rich plasma) for rotator cuff injuries, and they seemed to work. Torn tendons grew by about 70% maximum.

It was better than the recommended reverse shoulder replacement. I would do it again. All of these therapies are part of regenerative
medicine, a hot area for treatment and research. Most major medical schools and major clinics have a regerative medicine department.

For example, the Mayo Clinic has a regenerative medicine department at their Minneapolis sports medicine campus and at its
Rochester, Mn., main campus. They are doing serious research at those locations. I believe that the U. Wisconsin Medical School also
has a department. Many older people have bad surgical experiences, especially with joint replacements, that sometimes need replacement; they are often attracted to these therapies.

Patients need to be extremely well educated about the real potential for these procedures.

Note that most insurances do not cover these procedures, but workers comp. insurance sometimes does cover them.

Regenerative medicine is often part of sports medicine clinics that do non-surgical orthopedics

Milo Minderbinder said...

Ok, here comes a story, a true one. My first cousin, a retired 80 y.o. Gibson Dunn partner, with a degenerative discs, borderline leukemia blood tests, and gum disease went through stem cell treatment with Dr. Lander at the Calif Stem Cell Treatment Center in LA. His stem cells were injected back into his spine with the goal of regenerating disc tissue. "Leftover" stem cells were stored and later reinjected in a second treatment and later into his blood stream. Six months after his second treatment, he was standing almost straight, blood work was completely normal with no leukemia danger signs, and his gum disease had disappeared. I'm a lawyer, too, so you know this has to be 100% true.

cubanbob said...

Anecdote isn't data but that said my little dog and my daughter had rather successful outcomes with adult stem cell therapy. My daughter had neck ligature issue resulting in constant headaches and the treatment has nearly eliminated most of those headaches. In my dogs case, she being a small dog, had her popped out by another much larger dog. Rushed her straight to vet emergency room and the doctor used plasma derived stem cells and saved her sight in that eye. Believe it or not there are veterinary ophthalmologists and that doctor was amazed at the outcome. Said he expected my dog to be blind in that eye and instead she has normal vision in that eye.

Heatshield said...

If a treatment is actually harmful, that should not be permitted. But if it is not clearly harmful and the evidence of efficacy is unclear or inconsistent; then there should be full disclosure and the patient should get to decide. Remember the movie "Dallas Buyers Club"? The FDA was not permitting AIDS drugs that turned out to be helpful. Lots of people died because the FDA has a very long drawn out approval process. Some people just don't have time and if they take an informed risk - that should be fine.

Gretchen said...

I looked into this for one of my kids who suffered a sports injury. Part of the issue is that it is difficult to study orthopedic injuries. A lot of the supposed cures are in tears or wear of the tendons. Arthritis reacts differently than traumatic injuries, and each traumatic injury is different. Age of the patient seems to make a difference too. These therapies did seem to help some patients, it could be that there is some undiscovered factor at work.

lgv said...

The tag is bad science. I don't believe it is bad science, just lacking science. It is because true objective scientific studies are harder to find. My own knowledge of PRP and stem cell therapy is that is does provide benefit....sometimes. The first problem, much like CBD, is that is being sold as remedy for things that it has never been shown to help. Second, positive results have always been inconsistent. This is never explained in the marketing and hype for the treatment. "Please give me tons of money for this treatment. There's a 50% channce it won't do a thing" has never been in any marketing literature.

As I mentioned in another post, stem cells are weird creatures. Growing cultures from the same source always produce random results. That is nature.

daskol said...

People willing to experiment on themselves are an outstanding resource for the rest of us. We've recently had a tough diagnosis to an elder member of my family, and he's willing to try just about anything given that conventional and approved treatments offer no hope at all. That logic makes perfect sense to me, and N=1 science is still a kind of science, and can lead to worthwhile discoveries.