This past year or so I have lectured at many conferences and taught a few courses on the orthopedic use of stem cells. What I have seen and experienced concerns me greatly. With the explosion in stem cell use this past year, the number of people doing it well has become a smaller and smaller percentage of the total physicians offering the treatment.
First, why is this happening? The race by physicians to adopt stem cells has created a weird educational problem. Physicians that have full practices don’t have a lot of time for education and the companies that sell automated centrifuges or kits to concentrate stem cells have financial incentives to sell as many as possible. Put these together and you get what we see – doctors who don’t have the base training to do this type of work, who are poorly trained.
I can break these stem cell doctors down into a few different categories:
1. “I have no clue how to use guidance”-These physicians include many orthopedic surgeons and family doctors. For example, they know that injecting stem cells into the knee joint accurately is important, but they refuse to use imaging guidance to ensure they’re in the joint. For some, like many orthopedic surgeons it’s arrogance. They believe that despite scientific studies to the contrary, they can accurately access the joint. Other times, it’s just unwillingness to climb the steep educational mountain of learning ultrasound or fluoroscopy and purchase expensive new equipment.
2. “I took a weekend course so now I can advertise that I’m a stem cell expert”-There is a saying, “don’t know what they don’t know” that accurately describes this group. Simple but critical details have been left out of their training. For example, the fact that certain common anesthetics will kill stem cells dead. Or that taking stem cells from only one bone marrow site virtually assures that the total number of stem cells will be less than when multiple sites are drawn.
3. “This is a heck of a business opportunity…”-This group is made up of physicians who are more businessmen than doctors. They simply don’t care if these procedures are being done right or wrong, only that the public sees a slick web-site and anyone who has a credit card is a candidate. They see dollar signs and anything that reduces the bottom line (like extensive training) isn’t a good thing.
4. “I have no idea what I’m injecting, but some sales rep told me it was stem cells…”-These doctors have very little knowledge about stem cells and unlike the doctors above, won’t be bothered to have to buy new equipment or take a course. They simply want something that sits on the shelf that they can inject when somebody with the cash comes by that wants a stem cell injection. In this case an attractive sales rep came to the office and told them that an expensive little vial contained amniotic stem cells. They took the bait hook, line, and sinker – never questioning as we did whether what the sales rep claimed was accurate or simply just a tale told to sell product. Regrettably the vial of amniotic “stem cells” sitting in the freezer doesn’t contain any living cells, let alone stem cells.
5. “I only kind of know what I’m injecting…”-These clinics tend to use bedside centrifuges and have no ability to count the dose of what’s being injected, hence they really have no idea if the stem cell draw was adequate or if they have many or few cells. All this is obviously critical for delivering high quality care.
6. “I only kinda know where I’m injecting…”-These doctors use guidance (unlike the category described as #1 above), but they only use it at the most basic level of competency. So for example, if your ACL ligament in the knee needs stem cells, they would have no idea how to get stem cells to that specific spot, simply how to generally get them inside the knee joint which won’t help your ACL much.
What can you do as a patient to protect yourself as a patient considering orthopedic stem cell therapies? Here are questions to ask your doctor:
1. Do you use imaging guidance to take, and place, cells? If no, then find a provider that does.
2. How many hours of stem cell specific training have you had? How many patients have you treated with stem cells? Be a bit careful here, as the staff won’t know the answer to these questions and the doctor will often give evasive answers. In addition, many doctors will often substitute their experience with platelet rich plasma when they answer the stem cell experience question to make it look like they have more experience than they actually have.
3. Be wary of any clinic that claims they are injecting amniotic stem cells. There is no commercial product that we have tested that contains any viable stem cells and if the doctor is claiming or suggesting that he or she is doing this – their knowledge of stem cells only extends to what the sales rep told them to push product – never a good thing.
4. Ask if the doctor has the ability to count the cells that come out of his machine. Ask to see those exact counts. If they can’t do this – run…
5. Make sure that the stem cell doctor has advanced interventional skills – i.e. has the ability to precisely place the cells where they’re needed. Here’s a question to ask -“How many different structures in the knee can your doctor inject under guidance and can you name them?”. The answer for a high level and sophisticated provider would be: intra-articular, patellar and quadriceps tendons, patello-femoral joints, ACL, PCL, MCL, LCL, pes anserine tendons, medial meniscus, lateral meniscus, etc… If what you hear is that the doctor puts them inside the knee and they know where to go, run…
The upshot? At Regenexx we hand pick doctors who have certain skills and this makes them a 1 in 100 doctor . We then train and support these doctors extensively. The good news for our patients is that they can access physicians all over the country that are highly skilled, the bad news for the average patient who doesn’t do his or her homework is that the likelihood of randomly finding one of those highly skilled doctors is getting lower and lower every year!