“Violence is the last refuge of the incompetent.”
-Issac Asimov, Foundation
As a nerdy teenager reading science fiction books and engaged in science, Issac Asimov was kind of a hero to me in the same way that sports figures were to most kids. His quote above is important to understand how medicine needs to evolve now that regenerative solutions are here and becoming more popular. Except where you see the term “violence” insert terms like fusion, hardware, and ablation. Let me explain.
If you don’t know the sci-fi author Isac Asimov, you may know the Will Smith movie “I, Robot” or the Robin Smith movie “Bicentennial Man”. Both were Asimov classic short stories and both were cerebral science fiction flicks. His best masterpiece, now being turned into a movie by Apple TV is called “Foundation”. The protagonist is a psychologist mathematician who can predict the future of large groups like whole civilizations. He’s the one that utters the quote above. See the trailer below:
I think what Asimov was telling the reader here was that this was an aspirational goal. That everyone in every situation should strive to avoid violence or war and when one has to resort to either, it should always be considered an abject failure, because only then can we evolve as a species. We need to start doing the same in regenerative medicine.
The Future of Regenerative Medicine
When I began injecting stem cells into patients 15 years ago, there were few people on earth doing anything similar. Fast forward a decade and a half and regenerative medicine has become a niche market and a “thing”. Sure it has yet to be adopted by a majority of physicians, but it’s appearing more and more often at many mainstream conferences and is becoming a bigger deal year over year. Hence, what does an Issac Asimov quote have to do with the future of regen med? Let’s dig in.
15 years ago when we first began our regenerative medicine journey with stem cells, we were actually beginning a new medical specialty called “Interventional Orthopedics”. That name has since morphed into ‘Interventional Orthobiologics”. Both terms mean that the doctor uses advanced imaging guidance to precisely place substances capable of healing specific damaged tissues like bone, joints, muscles, nerves, tendons, and ligaments. To see what that’s all about, see my video below:
The Scary Trends
The scary trend that I have seen these past several years is physicians who are using the “Interventional Orthopedics” term that I created, but who are then performing quasi-surgical procedures that go against the grain of regenerative medicine. Meaning these are procedures that use minimally invasive methods to fuse joints, insert metal devices that destroy tissue, ablate nerves, etc… Meaning procedures that clearly destroy tissue rather than repair tissue. Hence, the opposite of “regenerative medicine”.
Why are they doing this? It’s profitable. The companies that make these devices can make a doohickey to implant into a patient or to destroy tissue for tens of dollars and sell it for thousands. Hence, they have huge gobs of cash left over to throw at doctors. Regrettably, cash influences physicians just like it does any other profession.
Substituting Asimov’s Words
So how can we in regenerative medicine use the quote above? As an aspirational guide to define and push our specialty to evolve. Just like getting rid of violence is aspirational, we should also have the same goal for getting rid of fusion, surgeries or other procedures that destroy tissue, or implant devices that take the place of natural tissues. So you can insert the following:
“[Fusion/ablation/hardware/decompression] is the last refuge of the incompetent.”
That doesn’t mean that there aren’t sometimes still needed, they are. However, when we have to resort to using them, we need to view that as a failure of the regenerative method, not something to be celebrated because we helped a medical device rep make his or her sales quota for the month. It’s only then that we will all push harder to expand the boundaries of what regen med can do rather than becoming comfortable because a procedure was covered by insurance and reimbursed well.
The upshot? We’re never going to get where we need to be in regen med and interventional orthobiologics unless we view every case where we couldn’t help using regenerative methods as an abject failure. That includes using a minimally invasive way to replicate the conceptual failures of the surgical method.