Educated by Sales Reps…

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medical sales reps

How do doctors get educated once they leave medical school? You would be surprised to learn the answer. Most people would say medical conferences and courses. In fact, in my experience, many physicians get a good chunk of their continuing medical education via sales reps. That, of course, is like the fox that guards the henhouse teaching the hens about home security. Let me explain.

Medical Education Is Always a Moving Target

What do I mean? When I began medical school, our dean told us that half of what they would teach us would later be confirmed to be wrong. Hence, there is a need to constantly update medical education for new discoveries and trends. The problem is that for physicians in private practice, time away from the office disrupts patient care and can be financially difficult.

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How Industry Influences Medicine

The consumer group ProPublica has been sounding the alarm for years that some doctors are bought and paid for, especially in academia. The issue is that pharma and device companies have figured out how to use “influencer” physicians to push their products at medical conferences or through white papers. It’s frankly not all that different than a pop singer endorsing a company’s products on Instagram. However, in medicine, there is supposed to be a firewall between industry and medical decisions; otherwise, what gets offered to the patient isn’t necessarily the best option. If you want to see if a specific physician you know is on the dole, check out the ProPublica Dollars for Docs website.

The Most Consistent Education Machines in Medicine Are Sales Reps

You would think that doctors get most of their continuing medical education via universities, medical conferences, and courses. However, while for some physicians that’s true, for others, in my experience, an awful lot of it happens in interactions with sales reps about products. For example, this is why Pharma hires attractive people to go into doctor’s offices to push product. Let’s explore that a bit.

The concept of a pharma sales rep is almost a meme at this point. This used to be almost always women who could have easily won a beauty contest, but now that there are many more female physicians, men have joined the ranks. Sometimes these salespeople can have a deep, but narrow, knowledge of a specific topic. In that one area of knowledge, they can know more than the doctor. Other times, they’re as clueless as the physician and worse, their job is to push the product:

Educating Doctors

In regenerative medicine, we have a sales rep problem. Take what happens in other areas of medicine and magnify it times 10. Why? Because doctors have never been taught anything about this field in medical school. They commonly know enough to be dangerous. So when a sales rep walks in and discusses what sounds like common-knowledge facts, these physicians often add this slanted and inaccurate knowledge to their education.

For example, it should be common knowledge to any physician that you can’t thaw living cells at the bedside and have many of them survive. Why? Because in culture expansion and storage facilities, cells need to be recovered from a frozen state via controlled-rate thaw, via a specialized recovery media, and over days of incubation. In fact, this is common knowledge to any four-year-degree cell biologist who freezes, stores, and recovers cells. So why doesn’t your doctor, who went through a decade-plus of school, know this? He or she was never taught anything like this in medical school, residency, or fellowship. Hence, when a sales rep tries to convince your doctor that all he or she needs to do is to warm a frozen vial of cells in the hand and then inject those and the cells will all magically live, that doctor tends to believe what he or she is told.

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How You Can Protect Yourself

I spent the better part of the last two weeks and then this past weekend reformatting our education system for Regenexx network physicians. All I can say is that at the end of that process, we continue to have the world’s most intensive educational process in regen med. Why? Not only do these doctors have to have a certain base level of training in interventional procedures before we accept them, but they also have to progress their way through more than a dozen courses offered through the Interventional Orthopedics Foundation (IOF). Each of those involves didactic lectures, cadaver training (where they have to demonstrate that they know how to perform the procedure being taught), and also a written test. They then need to make it through the educational gauntlet I upgraded this weekend. This is eight Regenexx-specific didactic lectures and then a 132-question online test and then an observation period in the clinic or at a mentor site.

The upshot? At the end of the day, physicians being educated by drug or device reps in regenerative medicine is irresponsible at best and dangerous at worst. The good news is that there are nonprofits out there to educate doctors with noncommercial messages. The bad news? There’s still an army of sales reps trying to use their own spin on “education” to convince doctors that the sky is red. The physicians can, of course, look up and verify the inaccuracy of that information, but most keep their heads down.

This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you.

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9 thoughts on “Educated by Sales Reps…

  1. Lynn Cole

    I’m having a real problem with the tendons in my upper arms and shoulders. I’ve also had up to 4 steroid injections in both my elbows over the years. I associate the two. Yesterday I had an appointment with my Orthopedic doc, and when I suggested the cortisone started my problem, he chuckled. I demanded an MRI and told him that I was going to make and appointment with a Regenexx Clinic for possible stem cell/platelet therapy. Of course he’s never heard of Regenexx and said I could waste my money any way I wanted. Sadly, this is a relatively young doctor (probably 45) who could benefit greatly from a little education in his practice. I refused to allow him to inject my arthritic and bursitis laden shoulders. Still fighting with the insurance company to ok the MRI.

    1. Regenexx Team

      Sounds like he definitely could, as the results of studies are very clear. But…an educated patient is an empowered patient!

  2. Gary Rosner

    I would really appreciate a blog entry discussing what Regenexx is doing or plans to do to increase the number of patients who are considered “good candidates” for the procedure or to learn more about why patients with certain conditions are not ideal candidates. I’m referring mainly to stem cell function issues as opposed to physical injuries or conditions. I realize that certain conditions and injuries are more likely to be treated successfully with stem cell injections. And that mesenchymal stem cell numbers decline with age, etc.

    For example, I’ve seen studies that talk about stem cell dysfunction in certain conditions like autoimmune connective tissue diseases. But some people have mild disease and others have severe disease. Does that translate into stem cell function? Put another way, it sounds like Regenexx trained providers count the number of stem cells when doing a bone marrow aspirate procedure but the assessment of the quality and function of any person’s stem cells is just based on a medical history and review of medical records. Are you working towards being able to stratify patients in a more accurate or precise way by assessing each patient’s stem cells both quantitatively and qualitatively (functionally)? My guess is that right now, the kind of qualitative, functional assessment of stem cell function and dysfunction in certain conditions that has been done in some scientific studies is way beyond practical and cost effective for a clinical practice. Thanks.

    1. Regenexx Team


      We look at stem cell function only as part of the culture expanded procedure offered through the licensed site in Grand Cayman. We see no age effects in our registry data in most areas, the exception being hip OA.

      1. Gary Rosner

        Thank you very much for the reply.

        Have you had any patients that decided against returning to Grand Cayman for the injections after having the BMA procedure there because you found that the patient showed poor stem cell quality or function even though he or she was considered a good candidate prior to the initial trip to Grand Cayman for the extraction of the stem cells? In other words, the stem cell function tests revealed that the patient would likely be wasting his or her money by going through with the second stage of the process even though he or she already spent thousands to have the cells extracted to get to the point of learning that they have dysfunctional stem cells?

        1. Regenexx Team


          That list would likely include patients who undergo culture failure or as we define it those whose cells expand to under 1 million mesenchymal stem cells in culture. The other issue can be clonal karyotype abnormalities within the cells. Between those two issues the rate would be well under 5%. In some cases these patients can get a minimal culture expansion and still get the procedure but sometimes we do cancel the procedure based on these issues.

  3. KM

    Question: I follow with keen interest your work with regenerative medicine having been on the receiving end of some pretty shoddy care in this field despite my due diligence in vetting the providers I saw. I will eventually continue down the path of this field of medicine probably with an IOF certified physician. You have stated many times in the past years amniotic allographs have no LIVE stem cells. This was confusing to me because why would people bother to bank their child’s cord blood or tissues? Recent posts by you now seem to acknowledge allographs have some usefulness when knowledgeably used (Amniofix). According to this post, are you now saying amniotics DO have live stem cells of any significant amount when properly handled? I just read FDA has approved Amniofix for knee oa (Regenerative Medicine Advanced Therapy designated) and will be “closely” working with Amniofix in research/development/production. Scarey for patients either way getting the government involved in regulating RIT procedures of any kind. No disrespect to any of the pioneers in this therapy, but the truth is we have this today because of all the PATIENTS who bared their joints and spines, who took a chance, who said no to cut/burn/install hardware orthopedics, and allowed the results of RIT to manifest its outcome in restored lives, all without begging the governments permission to do so, to try. Pioneer doctors developed the procedures but positive “clinical research” is evidenced in the millions of patients who ignored the AMA and insurance pronouncements of “unproven, experimental and ANECDOTAL” procedures. Even though my procedures were cavalierly performed by veteran providers whose workups, documentation, plan of care and followups were extremely poor, I was still able to achieve a moderate amount of function that I consider equal to patients choosing surgical procedures observed over a 30 year career. Meaning I am still in pain, but I can function with my pain and the gains in functionality with the meager effort of the providers I saw leads me to believe, in the right hands, I could achieve a close to perfect return of function without pain. Back to Amniofix. Live cells or none? Note FDA approval is for knees, not other applications being used by cowboy RIT’s. I ran across their approval while looking at stocks with this company, followed by another stock article warning of all the FDA violations as late as 2016/2017 with copies of FDA warnings on sanitation, qc, mislabeled product etc.

    1. Regenexx Team


      MiMedix has never made any claims that its product Amniofix contains live stem cells. Please see:

    2. Chris Centeno Post author

      No live cells in Amniofx, we use it simply as an ECM, see The other products have no live and functional cells. There is no FDA approval for Amniofx at this point, only a registration. They were granted an RMAT designation for knee OA, which still requires a clinical trial to get approval.

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