NFL Stem Cell Treatments…
NFL athletes have been getting stem cell treatments in order to try and heal difficult injuries more quickly. We’ve treated our share of them through the years. Recently a Rice University professor penned an article that focused negative attention on this issue. So what gives?
My thoughts on the topic are “nuanced” as usual. The Rice professor (Kristin Matthews) wrote a article on the stem cell treatments that NFL players are receiving, painting those in a negative light. The word “unproven” was used. I first became aware of her paper when I was contacted by a reporter for the MIT Technology Review site. My back and forth with that reporter is illustrative of the issues. In the end, the writer, Antonio Regalado, wrote a very balanced piece on the topic.
First, for Matthews to place stem cells used for sports injuries into the “unproven” category, the other side of the coin must first exist in sports medicine-i.e. proven therapies with high levels of research evidence to support their efficacy. Anyone that has read my recent post on how the evidence base behind traditional orthopedic surgery is falling part at the seams knows that the second category really doesn’t exist. To put a finer point on it, this was my position:
“Is it in society’s best interest to only support medical innovation through the university-pharma pathway where high levels of evidence are required before use or is it better to also support physician based innovation where observation of efficacy followed by increasing levels of evidence are the norm? On the one hand, the university approach has the obvious advantage of evidence first, but the obvious problem of a glacially slow and hyper-expensive process to translate therapies to patients. On the other hand, physician driven innovation has the advantage of much faster clinical translation that’s focused on addressing real world clinical needs and the disadvantage that sometimes the evidence base fails to support the care.
[Matthews] also begins with the thesis that it’s the norm in sports medicine to only use therapies that have high levels of evidence, yet this isn’t the case. For example, we have no high levels of evidence to support almost all common orthopedic surgical procedures used in sports medicine including menisectomy, arthroscopic micro fracture, rotator cuff repair, Tommy John elbow surgery, foot/ankle ligament reconstruction surgery, ACL repair, etc… While these procedures have been observed by physicians to work, they lack the type of evidence [Matthews] wants for stem cells…Stem cells in orthopedics have been following that same medical innovation pathway since the 90s when the first papers were published by Hernigou. Where is the evidence base right now for something like knee arthritis? About the same place it is for knee micro fracture. Our self-funded RCTs should hopefully take that level of evidence up a few notches. However, while the concept that level 1 evidence is required before a therapy is used may be a widely held university belief, it’s clearly not a widely held belief in the community of physicians treating orthopedic injuries.”
I also pointed to the wonderful thought experiment published by Cambridge researchers on why we don’t need randomized controlled trails on the use of parachutes to reduce gravitational induced trauma (this is Monty Python funny)! While this research paper obviously pokes fun at the quasi-religious fervor that many academics have when it comes to evidence based medicine, it also raises a very serious point. More evidence is wonderful to have, but as a physician, letting patients suffer because you’re paralyzed by a lack of evidence is also not right.
The upshot? The Matthews paper is based on a flawed thesis that sports injuries are commonly treated with surgeries that have high levels of scientific evidence to support their use. Hence the author uses the logic fallacy known as a “false dilemma”. A false dilemma is a type of informal fallacy in which only limited alternatives are considered, when in fact there is at least one additional option. Here the false duality is that sports medicine care is either “proven” (read good) or “unproven” (read bad). However, the additional option not considered by Matthews is that orthopedic care is frequently used when there is less than high levels of evidence often based on the simple observation that it works. That reality certainly has it’s problems, like care that may be effective may get purchased. However, it would be horribly misleading to let the public believe that the university conceptualization of medical evidence is a widely held belief in orthopedic care, as judging by results, it is clearly not. As a result, placing orthopedic stem cell use in a separate category of “unproven” makes no common sense (or in academic speak-“has no face validity”). If you’re going to do that, you might as well place all orthopedic care in the “unproven” category.