This blog post is a continued post in my series about the stem cell blinding tragedy reported last week. Today I’d like to focus on how academic medical centers are both the source of a lot of criticism of stem cell clinics and responsible for running cash-pay stem cell clinics themselves. As my mama used to say, that’s “the pot calling the kettle black.” Let me explain.
The University Two-Step
For this piece this morning, my focus is on the use of orthobiologics (platelet rich plasma [PRP] and bone marrow concentrate [BMC]) by university physicians to treat orthopedic problems. While arguably we do it much better than anyone else, this is the same underlying technology that makes up any Regenexx procedure. My take is that while there is obviously nothing wrong with the use of orthobiologics to treat orthopedic patients, the issue is that one side of campus is critical of this type of thing while the other is using these technologies in patients outside of any clinical study.
Today’s entry was inspired by a recent dinner I had with an academic orthopedist. This physician has been using orthobiologics for years. In fact, at one point in our discussion, he quoted Schopenhauer:
“All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.”
He then followed that up with a statement that the use of PRP and BMC is now in the self-evident stage. In the same dinner, he also discussed a confrontational meeting he had with a university colleague across campus who is oft quoted as being anti stem cell clinic. Basically, on one side of campus, he is using stem cells to treat athletes and executives, and on the other side of campus, a university talking head is bad-mouthing stem cell use in patients! So while he is in the “self-evident” stage, his biology-professor colleague is in the violent-opposition stage!
How Prevalent Is University-Based Orthopedic Stem Cell Use?
In orthopedics departments in many universities today, PRP and BMC is being used either as part of surgery or through image guidance. For example, I know university physicians at Harvard, Mayo, Stanford, Emory, and elsewhere that use these products to treat patients. My best estimate would be that at more than half of all the major medical schools, you can find the utilization of either PRP or BMC or both.
Why Would One Part of Campus Be at Odds with the Other?
While in the orthopedic department this stuff is being used in patients outside of any clinical trial, the bench research scientists in the biology department are the ones telling reporters that it’s bad news. While some of the criticisms being leveled by bench scientists are quite justified (see this piece on the topic of the stem-cell-clinic problem), others are pure fear mongering. Why? The NIH-grant golden goose will no longer lay eggs for stem cell basic science studies if the use of stem cells become commonplace in medicine. Also, that goose has been laying some serious golden eggs for university biology departments. As one example, we now have 45,825 research papers on mesenchymal stem cells and 272,510 articles on the topic of stem cells. Let that sink in a moment. We have listed in the US Library of Medicine a quarter million separate research studies, each taking 1–3 years of time to complete! If we say half of those are noncancer related and take out the 5% or so that are purely clinical, that still leaves about 150,000 studies. If we assume that each study takes at least 1,000 man hours to complete (a low estimate), then more than 150 million man hours of stem cell research have been funded. Given that the NIH is the world’s largest funder of basic science health research, you can assume that we Americans paid for most of it. Think about that number, as that’s about what it took to get to the moon. Stem cell scientists are arguing that we still don’t have enough research. That’s like NASA stopping midway to the moon and turning around to come back to earth to petition Congress for more funding.
The upshot? The reporters covering stem cell clinics need to start talking to university-based physicians who are using orthobiologics every day in their practices who are at odds with oft quoted university talking heads opposing stem cell use. While the stem-cell-clinic scene is out of control, we need to make sure that at least in orthobiologics, we understand that for a number of university-based physicians, we have entered into the Schopenhauer “self-evident” phase. These doctors need to start screaming at the guys in the biology department to differentiate between crazy stem cell clinics curing every disease known to man and what they offer.