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Turner L, Wang JC, Martinez JR, Najjar S, Rajapaksha Arachchilage T, Sahrai V. US businesses engaged in direct-to-consumer marketing of perinatal stem cell interventions following the Food and Drug Administration's enforcement discretion era. Cytotherapy 2024; 26:393-403. [PMID: 38340106 DOI: 10.1016/j.jcyt.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND AIMS The goal of this study was to analyze online marketing representations made by 300 US businesses selling allogeneic perinatal stem cell products. The study was conducted after a period of enforcement discretion by the US Food and Drug Administration (FDA). METHODS Data mining and content analysis were used to identify, analyze and categorize marketing claims made on the websites of 300 businesses selling perinatal stem cell interventions. RESULTS The study identified types of perinatal interventions companies advertised, geographic locations of clinics selling such products, types of companies operating in this space, diseases and injuries such businesses claim to treat, prices companies charge for such interventions, brand names of advertised perinatal cell products and identities of suppliers. CONCLUSIONS A substantial number of US businesses market unapproved perinatal stem cell products for various indications. This widespread commercial activity occurred following the conclusion of a period of enforcement discretion by the FDA and suggests the need for more robust and comprehensive regulatory responses to businesses selling unapproved perinatal stem cell products.
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Affiliation(s)
- Leigh Turner
- Program in Public Health, University of California Irvine, Irvine, California, USA; Department of Health, Society and Behavior, University of California Irvine, Irvine, California, USA; Sue and Bill Gross Stem Cell Research Center, University of California Irvine, Irvine, California, USA; Department of Family Medicine, University of California Irvine, Irvine, California, USA.
| | - Jia Chieng Wang
- Program in Public Health, University of California Irvine, Irvine, California, USA
| | - Juan Ramon Martinez
- Program in Public Health, University of California Irvine, Irvine, California, USA
| | - Shemms Najjar
- Program in Public Health, University of California Irvine, Irvine, California, USA
| | | | - Victoria Sahrai
- Program in Public Health, University of California Irvine, Irvine, California, USA
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2
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Pang PCI, Munsie M, Chang S, Tanner C, Walker C. Participatory Design and Evaluation of the "Stem Cells Australia" Website for Delivering Complex Health Knowledge: Mixed Methods Study. J Med Internet Res 2023; 25:e44733. [PMID: 37471121 PMCID: PMC10401697 DOI: 10.2196/44733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/20/2023] [Accepted: 06/17/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND The internet has become a commonly used information source for people seeking to understand their health care options. However, inconsistent representation about what stem cell treatments are available and from whom, coupled with the lack of transparency about what has been shown to work or is even safe, can distract and mislead users. Given these challenges, there is a need to develop effective evidence-based tools for delivering information about health care options involving stem cells. OBJECTIVE A need to redesign an existing website in Australia was identified to provide trustworthy information about stem cell research and to counter misinformation. Using a participatory design approach to generate an understanding of what information users need for stem cell treatments, the Stem Cells Australia website serves as a case study for the development and evaluation of websites delivering complex messages about science and health. METHODS This study comprised 3 steps. First, a focus group and several one-on-one interviews with a purposive sample of users (n=12) were conducted to identify their needs and requirements. Second, we designed a new version of the website based on findings from the focus group and interviews. Finally, for evaluating the participatory design process, we collected 180 days of Google Analytics data for both the original and redesigned versions (90 days for each) and compared their differences using 2-sample z tests. RESULTS The feedback from participants was grouped into 3 themes-needed and unwanted information, how and where to obtain information, and their information preferences. These were translated into requirements for rebuilding the website. The redesigned version reached users in other continents, despite the daily numbers of users (-61.2%; P<.001) and sessions (-61.7%; P<.001) decreasing. The redesigned version also showed substantial decrease in daily bounce rate (-97.2%; P<.001), significant increase in the daily average of page reads per session (+110.8%; P<.001), and long daily average for session duration (+22.9%; P=.045). Navigation flow analysis showed more traffic toward web pages related to health conditions in the redesigned version. CONCLUSIONS Websites about stem cell research need to provide content for vulnerable global audiences. Participatory design that addresses knowledge gaps and information needs can produce better performance and engagement, which can be evaluated using Google Analytics, a common web analytics tool used by many websites. Learnings for improving the metrics regarding website identity, research updates, and clinical trials are concluded, which can inform the future design of websites seeking to engage users and provide reliable and accessible science and health information including but not limited to stem cell research and therapies.
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Affiliation(s)
| | - Megan Munsie
- Melbourne Medical School, The University of Melbourne, Parkville, Australia
- Stem Cell Ethics and Policy Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Shanton Chang
- School of Computing and Information Systems, The University of Melbourne, Parkville, Australia
| | - Claire Tanner
- School of Social Sciences, Monash University, Melbourne, Australia
| | - Christine Walker
- Melbourne Medical School, The University of Melbourne, Parkville, Australia
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3
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Lyons S, Salgaonkar S, Flaherty GT. International stem cell tourism: a critical literature review and evidence-based recommendations. Int Health 2021; 14:132-141. [PMID: 34415026 PMCID: PMC8890798 DOI: 10.1093/inthealth/ihab050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/21/2021] [Accepted: 07/27/2021] [Indexed: 01/08/2023] Open
Abstract
Stem cell tourism is an emerging area of medical tourism activity. Frustrated by the slow translation of stem cell research into clinical practice, patients with debilitating conditions often seek therapeutic options that are not appropriately regulated. This review summarises recent developments in the field of stem cell tourism and provides clinicians with the information necessary to provide basic pretravel health advice to stem cell tourists. PubMed and Scopus databases were consulted for relevant publications, using combinations of the terms 'stem cell', 'tourism', 'regenerative medicine', 'international', 'travel medicine' and 'environmental health'. The leading countries in the international stem cell tourism market are the USA, China, India, Thailand and Mexico. As the majority of clinics offering stem cell therapies are based in low- and-middle-income countries, stem cell tourists place themselves at risk of receiving an unproven treatment, coupled with the risk of travel-related illnesses. These clinics do not generally provide even basic travel health information on their websites. In addition to often being ineffective, stem cell therapies are associated with complications such as infection, rejection and tumorigenesis. Physicians, researchers, regulatory bodies, advocacy groups and medical educators are encouraged to work together to improve patient and physician education and address current legislative deficiencies.
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Affiliation(s)
- Samantha Lyons
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Ireland.,Faculty of Health Sciences, University of Ottawa, Ontario, Canada
| | - Shival Salgaonkar
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Ireland
| | - Gerard T Flaherty
- School of Medicine, National University of Ireland Galway, Galway H91 TK33, Ireland.,School of Medicine, International Medical University, Kuala Lumpur, Malaysia
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4
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Rosemann A, Balen A, Nerlich B, Hauskeller C, Sleeboom-Faulkner M, Hartley S, Zhang X, Lee N. Heritable Genome Editing in a Global Context: National and International Policy Challenges. Hastings Cent Rep 2019; 49:30-42. [PMID: 31269262 PMCID: PMC6773219 DOI: 10.1002/hast.1006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A central problem for the international governance of heritable germline gene editing is that there are important differences in attitudes and values as well as ethical and health care considerations around the world. These differences are reflected in a complicated and diverse regulatory landscape. Several publications have discussed whether reproductive uses would be legally permissible in individual countries and whether clinical applications could emerge in the context of regulatory gaps and gray areas. Systematic comparative studies that explore issues related to the governance of this technology from different national and international perspectives are needed to address the lack of knowledge in this area. In this research report, we contribute to filling this gap by presenting views of stakeholders in the United Kingdom on challenges to the governance of heritable genome editing. We present findings from a multistakeholder study conducted in the United Kingdom between October 2016 and January 2018 and funded by the Wellcome Trust. This research included interviews, literature analysis, and a workshop. We involved leading U.K. scientists, in vitro fertilization clinicians, and representatives from regulatory bodies, patient organizations, and other civil societal organizations, as well as fertility companies. Part one of this article explores stakeholder perceptions of possible global developments in heritable genome editing and associated risks and governance challenges. Part two presents a range of policy options that were generated during the workshop in relation to the challenges discussed in part one.
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5
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The Global Emergence of Unregulated Stem Cell Treatments for Respiratory Diseases. Professional Societies Need to Act. Ann Am Thorac Soc 2018; 13:1205-7. [PMID: 27509147 DOI: 10.1513/annalsats.201604-277ed] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Bauer G, Elsallab M, Abou-El-Enein M. Concise Review: A Comprehensive Analysis of Reported Adverse Events in Patients Receiving Unproven Stem Cell-Based Interventions. Stem Cells Transl Med 2018; 7:676-685. [PMID: 30063299 PMCID: PMC6127222 DOI: 10.1002/sctm.17-0282] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 05/18/2018] [Accepted: 05/22/2018] [Indexed: 02/06/2023] Open
Abstract
The promise of stem cell (SC) therapies to restore functions of damaged tissues and organs brings enormous hope to patients, their families, loved ones, and caregivers. However, limits may exist for which indications SC therapies might be useful, efficacious, and safe. Applications of innovative therapies within regulatory boundaries and within the framework of controlled clinical trials are the norm in the scientific and medical community; such a system minimizes patient risk by setting a clear and acceptable safety and efficacy profile for new therapeutics before marketing authorization. This careful clinical validation approach often takes time, which patients suffering from terminal or debilitating diseases do not have. Not validated, unproven stem cell interventions (SCI) that promise a working treatment or cure for severe diseases have therefore found their way into the patient community, and providers of such treatments often take advantage of the public's willingness to pay large amounts of money for the misguided hope of a reliable recovery from their illnesses. We conducted a review of scientific publications, clinical case reports, and mass media publications to assess the reported cases and safety incidents associated with unproven SCI. The review also analyzes the main factors that were identified as contributing to the emergence and global rise of the “stem cell tourism” phenomenon. stemcellstranslationalmedicine2018;1–10
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Affiliation(s)
- Gerhard Bauer
- University of California Davis, Institute For Regenerative Cures (IRC), Sacramento, California, USA
| | - Magdi Elsallab
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charite' - Universitatsmedizin Berlin, Berlin, Germany
| | - Mohamed Abou-El-Enein
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charite' - Universitatsmedizin Berlin, Berlin, Germany
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7
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Rosemann A, Bortz G, Vasen F, Sleeboom-Faulkner M. Global regulatory developments for clinical stem cell research: diversification and challenges to collaborations. Regen Med 2016; 11:647-57. [DOI: 10.2217/rme-2016-0072] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
In this article, we explore regulatory developments in stem cell medicine in seven jurisdictions: Japan, China, India, Argentina, Brazil, the USA and the EU. We will show that the research methods, ethical standards and approval procedures for the market use of clinical stem cell interventions are undergoing an important process of global diversification. We will discuss the implications of this process for international harmonization and the conduct of multicountry clinical research collaborations. It will become clear that the increasing heterogeneity of research standards and regulations in the stem cell field presents a significant challenge to international clinical trial partnerships, especially with countries that diverge from the regulatory models that have been developed in the USA and the EU.
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Affiliation(s)
- Achim Rosemann
- Centre for Education Studies, Faculty of Social Sciences, University of Warwick, Coventry, CV4 7AL, UK
- Centre for Bionetworking, School of Global Studies, University of Sussex, Brighton, BN1 9SJ, UK
| | - Gabriela Bortz
- Institute of Science & Technology Studies, National University of Quilmes (IESCT-UNQ), Roque S. Peña 352, (1876) Bernal, Buenos Aires, Argentina
- National Council of Scientific & Technical Research (CONICET), Godoy Cruz 2290, C1425FQB Buenos Aires, Argentina
| | - Federico Vasen
- Institute of Science & Technology Studies, National University of Quilmes (IESCT-UNQ), Roque S. Peña 352, (1876) Bernal, Buenos Aires, Argentina
- Institute of Social Research, National Autonomous University of Mexico, Circuito Mario de la Cueva s/n, Ciudad Universitaria, Coyoacán, 04510 Ciudad de México, México
| | - Margaret Sleeboom-Faulkner
- Centre for Bionetworking, School of Global Studies, University of Sussex, Brighton, BN1 9SJ, UK
- Department of Anthropology, University of Sussex, Arts C 206, Brighton, BN1 9SJ, UK
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Rosemann A, Chaisinthop N. The pluralization of the international: Resistance and alter-standardization in regenerative stem cell medicine. SOCIAL STUDIES OF SCIENCE 2016; 46:112-39. [PMID: 26983174 PMCID: PMC4748541 DOI: 10.1177/0306312715619783] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The article explores the formation of an international politics of resistance and 'alterstandardization' in regenerative stem cell medicine. The absence of internationally harmonized regulatory frameworks in the clinical stem cell field and the presence of lucrative business opportunities have resulted in the formation of transnational networks adopting alternative research standards and practices. These oppose, as a universal global standard, strict evidence-based medicine clinical research protocols as defined by scientists and regulatory agencies in highly developed countries. The emergence of transnational spaces of alter-standardization is closely linked to scientific advances in rapidly developing countries such as China and India, but calls for more flexible regulatory frameworks, and the legitimization of experimental for-profit applications outside of evidence-based medical care, are emerging increasingly also within more stringently regulated countries, such as the United States and countries in the European Union. We can observe, then, a trend toward the pluralization of the standards, practices, and concepts in the stem cell field.
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Affiliation(s)
- Achim Rosemann
- Centre for Education Studies, University of Warwick, Coventry, UK
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Rosemann A, Sleeboom-Faulkner M. New regulation for clinical stem cell research in China: expected impact and challenges for implementation. Regen Med 2015; 11:5-9. [PMID: 26680327 DOI: 10.2217/rme.15.80] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Achim Rosemann
- Department of Social Sciences, Centre for Education Studies, University of Warwick, Coventry CV4 7AL, UK.,Centre for Bionetworking, School of Global Studies, University of Sussex, Brighton, BN1 9SJ, UK
| | - Margaret Sleeboom-Faulkner
- Centre for Bionetworking, School of Global Studies, University of Sussex, Brighton, BN1 9SJ, UK.,Department of Anthropology, University of Sussex, Arts C 206, Brighton, BN1 9SJ, UK
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10
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Kim SW, Kim KJ, Rhie JW, Ahn ST. Effects of adipose-derived stem cells on keloid fibroblasts based on paracrine function. Tissue Eng Regen Med 2015. [DOI: 10.1007/s13770-015-9109-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Gordie Howe’s Stem Cell ‘Miracle’: A Qualitative Analysis of News Coverage and Readers’ Comments in Newspapers and Sports Websites. Stem Cell Rev Rep 2015; 11:667-75. [DOI: 10.1007/s12015-015-9606-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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12
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Rosemann A. Standardization as situation-specific achievement: regulatory diversity and the production of value in intercontinental collaborations in stem cell medicine. Soc Sci Med 2014; 122:72-80. [PMID: 25441319 DOI: 10.1016/j.socscimed.2014.10.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 10/02/2014] [Accepted: 10/06/2014] [Indexed: 11/30/2022]
Abstract
The article examines the role and challenges of scientific self-governance and standardization in inter-continental clinical research partnerships in stem cell medicine. The paper shows that - due to a high level of regulatory diversity - the enactment of internationally recognized standards in multi-country stem cell trials is a complex and highly situation-specific achievement. Standardization is imposed on a background of regulatory, institutional and epistemic-cultural heterogeneity, and implemented exclusively in the context of select clinical projects. Based on ethnographic data from the first trans-continental clinical trial infrastructure in stem cell medicine between China and the USA, the article demonstrates that locally evolved and international forms of experimental clinical research practices often co-exist in the same medical institutions. Researchers switch back and forth between these schemas, depending on the purposes of their research, the partners they work with, the geographic scale of research projects, and the contrasting demands for regulatory review, that result from these differences. Drawing on Birch's analysis of the role of standardization in international forms of capital production in the biosciences, the article argues that the integration of local knowledge institutions into the global bioeconomy does not necessarily result in the shutting down of localized forms of value production. In emerging fields of medical research, that are regulated in highly divergent ways across geographical regions, the coexistence of distinct modes of clinical translation allows also for the production of multiple forms of economic value, at varying spatial scales. This is especially so in countries with lenient regulations. As this paper shows, the long-standing absence of a regulatory framework for clinical stem cell applications in China, permits the situation-specific adoption of internationally recognized standards in some contexts, while enabling the continuation of localized forms of value production in others.
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Affiliation(s)
- Achim Rosemann
- Department of Anthropology, School of Global Studies, University of Sussex, Arts C 252, Brighton, BN1 9SJ, UK.
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