Manufacturing Cartilage by Playing with Measurements: More Chiro "Stem Cell" Scams
POSTED ON IN Regenerative Medicine Education BY Chris Centeno
If you read this blog or my posts on social media, you know I have a catch phrase that I often use to describe my reaction to the chiropractic "stem cell" scams that are sweeping the nation. That is, "you just can't make this stuff up." That applies to my post this morning, which is about a woman who had local fake stem cell treatments, had some minimal relief, and then went back in to see her chiropractor. What that chiro did next is what has me appalled.
The Chiro "Stem Cell" Bait and Switch
We have chiropractors all over the country hiring mostly nurses to inject dead amniotic or cord blood tissue and calling this a "stem cell" injection. They usually put on seminars that attract poorer and older patients and then promise them that they will regrow new cartilage in joints that otherwise are "bone on bone." Based on a local news investigation, these practices also take X-rays before the procedure as part of the sales process. To learn more about what's going on, see my video below: [dk-video id="PGbbJJSCJsY" autoplay="false" button="white" title="" show-title="false" width="70%" align="aligncenter"]
What's Possible in Arthritis Patients with Real Stem Cell Treatment?
As the first physician on earth to pioneer using stem cells to treat arthritis, I've used many different cells types, preps, and other adjuncts. The good news is that there are some types of orthopedic problems where you can see improvement on a post-procedure MRI. The bad news is that severe knee arthritis doesn't improve on imaging, despite many of these patients reporting less pain and increased function for extended periods. For example, small cartilage holes, tendons, ligaments, and some types of disc injuries will look better on MRI after appropriate treatment by a highly trained physician using an actual stem cell therapy with highly precise imaging guidance. To learn more about the MRI results that we've collected over almost a decade and a half, see my video below: [dk-video id="p7nExj9CCMM" autoplay="false" button="white" title="" show-title="false" width="70%" align="aligncenter"]
The Chiro Before and After X-ray Scam
Measuring Joint Space Width
I was recently asked to see a patient who had received a dead amniotic tissue injection at a chiro office by a nurse and who was told this was a real stem cell procedure. She had some relief (likely due to the growth factors in the mix) but was still having pain, so she returned. The chiro then performed a three-month postinjection X-ray and made measurements of the "joint space width" (JSW). What's that? When you take an X-ray, it only shows the bone and doesn't show the cartilage. You can try to estimate the amount of cartilage in the joint by drawing a line from one bone surface to the other in the joint. This is called a "joint space width." However, there are a few things that make JSW much less accurate than taking an MRI that does show cartilage. First, the angle of the X-ray beam relative to the joint can increase or decrease this width without any actual changes in the cartilage. For example, see below where I fabricated more width merely by angling the X-ray beam slightly: In the top right image, it looks like the patient has a narrowed JSW. This means arthritis! However, when I angle the beam slightly and get the beam to go straight down the joint, that disappears (in the bottom right image). Magically, the patient now has no arthritis! This is why we always use MRIs to look at cartilage before and after our procedures, as this error doesn't happen with that technology. In addition, you can actually see the cartilage on the image versus here just seeing an empty space where the cartilage lives.
The Chiro Scam Involved Bad Measurements
A magic trick works because your attention is drawn away from where the deception happens. Scams are similar. This is what happens in the before and after X-rays you are about to see. First up, we have this patient's hip. On the left is the before dead stem cell injection X-ray. This image is of poorer quality, but I have drawn yellow dotted lines to show the joint space width (blowup to the far left). Notice the red circle cursors on the computer program used to measure the width. I have placed yellow arrows at the exact point where the cursor was placed, and you can see that relative to the real joint width (yellow dashed lines). So in the before hip X-ray, the joint space width measurement is pretty accurate (yellow arrows mostly track the real joint space width denoted by the yellow dashed lines). Next, we have the after dead stem cell injection image on the right. Note that the chiro is now using a different program or that the software is now set to magnify the measurement (in this case 5.52 mm). This is the magic trick, as this larger measurement number in red draws the eye away from the deception. However, on the far right, I blew up the image, and the space between the yellow dashed lines hasn't changed (meaning no new cartilage). What has changed is that the cursors no longer track the actual joint space width, but have exceeded that real measurement (the yellow arrows are now far apart from the yellow dashed lines). Hence, the chiro scammed this patient by creating a postinjection measurement (5.52) that was inaccurate. The real measurement is still about the same as the old one (2.69). The same monkey business happens with the knee that is above. The before image is on the left and the after image is on the right. Here the pre-dead stem cell measurement was short of the joint line, and the postinjection measurement is too big. This seems to add 3 mm of joint space width, but in fact, the actual width hasn't changed between the two X-rays. So we have a chiro who is playing games with the measurements to make a patient believe that she has grown new cartilage!
Why Did the Patient Get Some Relief?
These products contain growth factors, which can help reduce pain and swelling. Hence, they can provide some relief. However, these growth factor levels are far below the amounts that would be found in platelet-rich plasma made from blood taken from a vein. In addition, PRP is much better studied for its effects on arthritis than dead amniotic and umbilical cord tissues for orthopedic problems and usually costs about one-fifth to one-fourth as much injected by a physician expert as the chiros are charging for a nurse to inject. The upshot? You just can't make this stuff up! This level of graft is criminal. My hope is that our state attorney general here in Colorado (like the one in North Dakota) and other state officials act quickly to shut down these scams before more elderly people lose their life savings.
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