With the explosion in the number of doctors offering stem cell treatments, I’m sure you’ve wondered how to find a doctor that knows what they’re doing. This is a video of a talk I just gave at a stem cell conference in the Bahamas. In it I used five guidelines to define the good, the bad, and the ugly of stem cell therapy. If your provider meets these guidelines, he or she falls under the “good.” If your provider does not, it’s a good idea to keep shopping. These five guidelines for high-quality stem cell care are what patients should be able to expect. And, regrettably, they’re usually not getting these things.
Let me explain these more in depth.
Candidacy grading seems pretty simple. Most every medical procedure ever devised has a candidacy associated with it. Either the patient’s a good candidate, a fair candidate, or a poor candidate. The problem is that most stem cell providers don’t do this; everyone’s a candidate who’s got a credit card that works. This is absolutely insane. We candidacy grade our patients, and all providers should. If you are a poor candidate, your provider should be able to look you in the eye, and say, “You know what? You’re a poor candidate for this procedure. I don’t see any downside to you trying it, but I think it’s unlikely to work.”
Candidacy grading should be based on data that’s being collected. For instance, we know that someone with severe hip arthritis would make someone a poor candidate for same-day stem cell treatments. There are a number of other things that would make a patient a poor candidate, and providers need to be able to communicate this to their patients. Again, no medical procedure ever invented has anything approaching a 100% success rate. THIS INCLUDES STEM CELLS! If your doctor classifies everyone as a good candidate, run…
If you’re going to spend a lot of money on a stem cell procedure, then your doctor had better be an expert in the area he or she is treating. You don’t want your plastic surgeon, who knows how to inject Botox into your face, injecting your knees. You don’t want a family doctor treating a complex neurologic condition that he or she knows little about. You don’t want a burned out ER doctor treating complex cardiac diseases. So in figuring out how to find good stem cell treatment, you should expect that your doctor is an expert in the area that he or she is treating.
Stem cells are not magic pixie dust to be wielded by physicians who have no expertise or advanced knowledge of the disease they’re treating. Specialists in specific areas must remain in the fields they know and understand, and stem cells are no exception!
If you’re going to have stem cell treatment, you really need to expect that there is an animal model showing promising results using that specific stem cell type. This means that the specific stem cell type being used has be shown to be effective in an animal that has that disease. Many times in fat stem cells, otherwise known as stromal vascular fraction (SVF), this isn’t happening. We’re seeing fat stem cells being offered for all sorts of things that we don’t have any idea, using animal modeling, that fat stem cells would be helpful for, which is inappropriate.
Many applications for which SVF is being used have no animal models showing success. One example is SVF for urological care. There are many other examples (see the video for the table I created of medical diseases where have no evidence that SVF will work). There needs to be at least one animal model that shows promising results using the specific cell type (bm-MSCs, ad-MSCs, SVF, BMC, etc.) before a doctor begins treating a patient.
Patients should be tracked at set time points—usually one month, three months, six months, and every single year after treatment. This is called a registry. A registry is not a phone call to the patient after treatment or giving them a form to fill out after treatment; it’s pinging them at set time points to see how the procedure went, and it’s using validated outcome metrics to make sure that what we’re seeing is a real effect.
You need to have a really big team set up to collect registry data correctly. Not only do you need to have an electronic system of pinging patients, you also need to have live people calling the patients who don’t respond or having patients fill out their forms when they are in the clinic.
There should be transparent reporting of data, which we rarely see online. What do I mean by that? All data, not just cherry-picked, needs to be reported online (or explained why it was excluded and what was excluded). We do this once a year and offer tools for our 35 sites to slice and dice their own data versus the overall means reported by all clinics. It takes a lot of energy and effort, but it’s well worth it.
In addition, peer-reviewed publication of data should occur. What does that mean? This means that your doctor needs to publish their data on their stem cell treatment in medical journals. This can begin with lower level studies like case reports leading to case series and comparison trials leading eventually to higher level studies like randomized control trials (RCTs). If your doctor says “I’m not a researcher,” then he or she shouldn’t be offering investigational care like stem cells. If they tell you something like “I don’t have the money,” these types of studies are relatively cheap to perform.
The upshot? Using the five guidelines to determine how to find good stem cell treatment by vetting stem cell providers will help you properly navigate the murky stem cell waters. If you want to dig really deep into the good, the bad, and the ugly of stem cell therapy, including how these guidelines can be enforced, be sure to watch my video (containing the material I covered in my lecture this week at Regenera Global in the Bahamas) included at the top of this post.
About the Author
Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…