I’m seeing an interesting change in the dialog around the stem cell wild west. One that is so juxtaposed to reality, it brings up all sorts of ethical problems. What could that be? Bench scientists from one side of campus providing quotes for news stories against the use of orthobiologics while on the other side of campus, another university professor exists who would oppose their point of view because he or she is using orthobiologics. So do those bench scientists have an ethical duty to tell reporters that there may be someone else who opposes their view?
The Stem Cell Wild West
The stem cell wild west is unique in medicine. While alternative health practitioners have generally limited themselves to medical care that is non-invasive, offering “stem cell therapy” is the first foray for many chiropractors, naturopaths, and acupuncturists into medical care that could potentially have complications due to an invasive medical procedure. In addition, there’s also something else that’s different about alternative health clinics offering stem cell treatments, there is no large university in this space. Meaning we don’t see “The University of X” or “X University” that has an alternative health practitioner offering fake stem cell treatment by injecting amniotic fluid or umbilical cord tissue.
Right now, we have university professors from medical schools all over the country (and the world) who have decided to begin offering orthobiologics. This usually takes the form of platelet-rich plasma and bone marrow concentrate (BMC). Here are some of the universities which had physicians presenting about their orthobiologics use at the recent TOBI conference in Chicago:
- Mayo Clinic
- Clevland Clinic
- Baylor College of Medicine
- Rush University
- Univ. of Western Australia
- US Army
- Cedars-Sinai Kerlan-Jobe Institute
- University of Colorado School of Medicine
- Instituto Cugat, Barcelona, Spain
This is VERY different than chiropractors offering fake stem cell treatments and running aggressive sales organizations. The following would be true of a university physician offering BMC:
- The treatment being offered has a living stem cell population and the early literature shows that it’s effects are tied to that dose of mesenchymal stem cells.
- The treatment has been used since the 90s to treat orthopedic problems, so the safety profile is robust for this clinical indication.
- The published literature on outcomes is in the same evidence category as multiple other surgical treatments currently offered in medical schools
The Bench Scientist Push Against Stem Cell Therapies
Who are bench scientists in this context? These are basic science researchers, usually in biology, who work in university labs that perform in-vitro or animal experiments using stem cells. Their work is almost exclusively funded with public or private grants. In addition, because of the Bayh-Dole Act of the 1980s, universities can license the discoveries that come from public funds to private companies and keep any financial gains. While this has been a great societal boon, launching countless biotech start-ups that have improved lives, it also makes the universities themselves business interests. They have an interest in seeing more basic science grants, discoveries that come from those grants, and lucrative licensing deals that come from the discoveries.
The bench scientist push against stem cell clinics began with the ISSCR (International Society for Stem Cell Research). The organization began inviting science journalists to its annual meetings more than a decade ago and launched a narrative that greedy doctors were offering unproven stem cell therapies. Given that we had doctors and then alternative health practitioners offering stem cells to treat every known disease with little data and questionable ethics, this messaging hit home. In the end, it was an effective narrative that likely protected patients.
However, more recently, the bench scientist crowd have lumped orthobiologics being used by professors on one end of campus with the chiropractors offering dead stem cells through aggressive sales events. This dilemma in and of itself creates some interesting ethical conundrums for bench scientists. Meaning, when they were commenting negatively on a chiropractor down the street offering faux stem cells, they were offering a public service. However, when they begin going against their colleagues across campus, they are not. Instead, they are just offering an opinion on one side of an ongoing academic debate.
What Duty Do Bench Scientists Have to the Public?
With orthobiologics being used by universities, as discussed, bench scientists are now merely offering an opinion in a debate with two sides. Hence, they now have an ethical duty to the public to inform journalists that their opinion is merely one opinion that would be opposed by other academic professors. If they don’t and pretend that there is no academic debate, then they risk misinforming the public about science, which is a VERY serious problem.
I have yet to see a single bench scientist admit that he or she is only offering one opinion in an academic debate. In the same way, I have yet to see a single story on orthobiologics where the journalist has sourced opinions from both sides of campus. The side that opposes orthobiologic use (bench scientists) and the side that supports it (the orthopedic or sports medicine departments in the medical school). Who will be the first university bench scientist to educate a journalist that they can’t write a balanced story without quotes from both sides of campus?
The upshot? When the bench scientists were supplying quotes to get rid of physicians and chiropractors who were offering treatments for every known disease, they were protecting the public. However, now that they are opposing orthobiologics and that these therapies are being offered by many of the same universities where the bench scientists work, this is now an academic debate. The ethical rules of academic debate are clear, you only offer opinions in the context of a larger debate. So who will be the first university bench scientist to follow those rules?