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Turner L, Martinez JR, Najjar S, Arachchilage TR, Sahrai V, Wang JC. Regulatory claims made by US businesses engaged in direct-to-consumer marketing of purported stem cell treatments and exosome therapies. Regen Med 2023; 18:857-868. [PMID: 37867326 DOI: 10.2217/rme-2023-0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Abstract
Aim: This study investigated whether US businesses engaged in direct-to-consumer online marketing of purported stem cell therapies and stem cell-derived exosome products made claims concerning the regulatory status of these interventions. Methods: We used data mining and content analysis of company websites to examine regulatory-related representations made by US businesses marketing stem cell treatments and exosome therapies. Results: More than two thirds of such businesses did not make explicit representations about the regulatory status of their marketed products. Businesses that made claims about the regulatory status of the stem cell and exosome products they sold used range of representations concerning the legal standing of these interventions. Conclusion: The absence of information addressing the regulatory status of stem cell interventions and exosome products and the use of what appeared to be inaccurate information concerning the regulatory status of numerous products likely complicates efforts by customers to make informed health-related decisions.
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Affiliation(s)
- Leigh Turner
- Program in Public Health, University of California Irvine, UCI Health Sciences Complex, 856 Health Sciences Quad, Room 3543, Irvine, CA 92697-3957, USA
- Department of Health, Society, & Behavior, University of California Irvine, Irvine, CA 92697-3957, USA
- Sue & Bill Gross Stem Cell Research Center, University of California, Irvine, CA 92697-3957, USA
| | - Juan Ramon Martinez
- Program in Public Health, University of California Irvine, UCI Health Sciences Complex, 856 Health Sciences Quad, Room 3543, Irvine, CA 92697-3957, USA
| | - Shemms Najjar
- Program in Public Health, University of California Irvine, UCI Health Sciences Complex, 856 Health Sciences Quad, Room 3543, Irvine, CA 92697-3957, USA
| | - Thevin Rajapaksha Arachchilage
- Program in Public Health, University of California Irvine, UCI Health Sciences Complex, 856 Health Sciences Quad, Room 3543, Irvine, CA 92697-3957, USA
| | - Victoria Sahrai
- Program in Public Health, University of California Irvine, UCI Health Sciences Complex, 856 Health Sciences Quad, Room 3543, Irvine, CA 92697-3957, USA
| | - Jia Chieng Wang
- Program in Public Health, University of California Irvine, UCI Health Sciences Complex, 856 Health Sciences Quad, Room 3543, Irvine, CA 92697-3957, USA
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Chen L, Gao J, Feng R, Peng Y. The variability of judicial decisions in the stem cell industry in China. Cell Stem Cell 2023; 30:1294-1298. [PMID: 37802035 DOI: 10.1016/j.stem.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/08/2023] [Accepted: 09/11/2023] [Indexed: 10/08/2023]
Abstract
As China's stem cell industry continues to develop, increasing disputes concerning stem cell-based interventions have been brought before the courts. Nonetheless, there is variability in the courts' understanding and attitude toward the regulatory attributes of these interventions, which to some extent has multifaceted impacts on the stem cell field.
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Affiliation(s)
- Luxia Chen
- Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China; Beijing Institute for Stem Cell and Regenerative Medicine, Beijing 100101, China
| | - Jianchao Gao
- Office of Clinical Evaluation of Biological Products, Center for Drug Evaluation, National Medical Products Administration, Beijing 100037, China
| | - Ruohan Feng
- Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China; Beijing Institute for Stem Cell and Regenerative Medicine, Beijing 100101, China
| | - Yaojin Peng
- Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China; Beijing Institute for Stem Cell and Regenerative Medicine, Beijing 100101, China; University of the Chinese Academy of Sciences, Beijing 100049, China.
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Turner L, Martinez JR, Najjar S, Arachchilage TR, Sahrai V, Wang JC. Safety and efficacy claims made by US businesses marketing purported stem cell treatments and exosome therapies. Regen Med 2023; 18:781-793. [PMID: 37795701 DOI: 10.2217/rme-2023-0118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
Aim: Examining websites of US businesses engaged in direct-to-consumer advertising of putative stem cell treatments and exosome therapies, this study investigated the marketing claims such companies make about the purported safety and efficacy of these products. Methods: Data mining and content analysis of company websites were used to identify and analyze safety and efficacy claims. Results: Of the 978 businesses analyzed, less than half the companies made identifiable claims about the safety and efficacy of their advertised stem cell and exosome products. We also explored how companies framed the stem cell and exosome products they promoted. Representations ranged from assertions that such products are unproven and investigational to claims they constituted cures. Most advertising frames fell between these poles. Conclusion: Some businesses include in their marketing representations claims about the safety and efficacy of advertised products. Businesses that did not make such assertions use other techniques to attract prospective clients.
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Affiliation(s)
- Leigh Turner
- Program in Public Health, University of California Irvine, UCI Health Sciences Complex, 856 Health Sciences Quad, Irvine, CA 92697-3957, USA
- Department of Health, Society, & Behavior, University of California, Irvine, CA 92697-3957, USA
- Sue & Bill Gross Stem Cell Research Center, University of California, Irvine, CA 92697, USA
| | - Juan Ramon Martinez
- Program in Public Health, University of California Irvine, UCI Health Sciences Complex, 856 Health Sciences Quad, Irvine, CA 92697-3957, USA
| | - Shemms Najjar
- Program in Public Health, University of California Irvine, UCI Health Sciences Complex, 856 Health Sciences Quad, Irvine, CA 92697-3957, USA
| | - Thevin Rajapaksha Arachchilage
- Program in Public Health, University of California Irvine, UCI Health Sciences Complex, 856 Health Sciences Quad, Irvine, CA 92697-3957, USA
| | - Victoria Sahrai
- Program in Public Health, University of California Irvine, UCI Health Sciences Complex, 856 Health Sciences Quad, Irvine, CA 92697-3957, USA
| | - Jia Chieng Wang
- Program in Public Health, University of California Irvine, UCI Health Sciences Complex, 856 Health Sciences Quad, Irvine, CA 92697-3957, USA
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Jeyaraman M, Paul PM, Jeyaraman N, Nallakumarasamy A, Khanna M, Yadav S. Medico-Legal Implications and Regulatory Frameworks of Regenerative Orthopaedics. Cureus 2023; 15:e42557. [PMID: 37637557 PMCID: PMC10460193 DOI: 10.7759/cureus.42557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 08/29/2023] Open
Abstract
Regenerative orthopaedics has revolutionized traditional medicine, which represents a giant leap in science and research. The knowledge of the medico-legal implications and regulatory framework of this branch is vital for clinicians and researchers to go forward smoothly. This systematic review of the literature should shed light on these considerations and provide a comprehensive knowledge of the various implications and laws governing practice and research. The wide plethora of knowledge in the use of regenerative orthopaedics should be complemented by updated regulations and clinicians' grasp of knowledge on regenerative medicine. The review focused on peer-reviewed published articles concerned with the topic and outlined common medico-legal issues and the current regulatory frameworks in various countries. The articles suggest that developed nations like the US have faced several lawsuits in this field, and a few countries in Europe like Italy and Germany, which were frontrunners in this field based on research, have fallen back due to emerging legal and regulatory policies. Undoubtedly, regenerative orthopaedics holds the key to future orthopaedics, but the world is skeptical of this concept, and laws and regulatory frameworks can curb it if not guided well. In India, this field has received prime attention, but at a slow pace when compared to the laws. After reviewing 113 articles, we analysed eight critically in this systematic review to emphasize the comparative global frameworks, daily medico-legal problems, and solutions for the branch of regenerative orthopaedics.
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Affiliation(s)
- Madhan Jeyaraman
- Orthopaedics, ACS Medical College and Hospital, Dr. MGR Educational and Research Institute, Chennai, IND
- Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida, IND
- Regenerative Medicine, Indian Stem Cell Study Group (ISCSG) Association, Lucknow, IND
- Orthopaedics, South Texas Orthopaedic Research Institute (STORI Inc), Laredo, USA
| | - Prince M Paul
- Forensic Medicine, Karuna Medical College, Palakkad, IND
- Orthopaedic Rheumatology, Dr. Ram Manohar Lohiya (RML) National Law University, Lucknow, IND
| | - Naveen Jeyaraman
- Orthopaedics, ACS Medical College and Hospital, Dr. MGR Educational and Research Institute, Chennai, IND
| | - Arulkumar Nallakumarasamy
- Orthopaedics, ACS Medical College and Hospital, Dr. MGR Educational and Research Institute, Chennai, IND
| | - Manish Khanna
- Orthopaedics, Autonomous State Medical College, Ayodhya, IND
| | - Sankalp Yadav
- Medicine, Shri Madan Lal Khurana Chest Clinic, New Delhi, IND
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Dietrich PN, Doolittle J, Brink S, Hanna D, Fitzgerald J, Dadhich P, Sandlow JI, Kansal J, Bajic P. An Online Investigation Into Direct-to-Consumer Men's Health Clinics: The Who, What, and Where. Urology 2023; 174:135-140. [PMID: 36736913 DOI: 10.1016/j.urology.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/28/2022] [Accepted: 01/18/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To characterize direct-to-consumer (DTC) men's health clinics by reviewing their online content. Increasing numbers of patients are seeking treatment for erectile dysfunction (ED) and hypogonadism from DTC "men's health" clinics. Treatments are often used off-label, with lack of transparency of provider credentials and qualifications. METHODS We identified DTC Men's Health Clinics in the United States by internet search by state using the terms, "Men's Health Clinic," and "Low T Center." All stand-alone clinics were reviewed. RESULTS Two hundred and twenty-three clinics were reviewed, with 147 (65.9%) offered ED treatments and 196 (87.9%) offering testosterone replacement, and 120 (53.8%) offering both ED treatment and testosterone replacement. Of those clinics offering ED treatments, 93 (63.3%) advertised shockwave therapy and 84 (57.1%) PRP therapy. There were 56 (38%) who offered shockwave therapy and PRP. ICI was significantly more likely to be offered if there was a urologist on staff (p <.001). Clinic providers represented 20 different medical and alternative medicine specialties. Internal medicine was most common (17.4%), followed by family medicine (11.1%). A nonphysician (nurse practitioner or physician assistant) was listed as the primary provider in 10 clinics (4.5%) and 45 clinics (20.1%) did not list their providers. Urologists were listed as the primary provider in 10.3% of clinics. A naturopathic provider was listed as a staff member in 22 (11.6%) of clinics. CONCLUSION There is significant heterogeneity and misinformation available to the public regarding men's health. Familiarity with and insight into practice patterns of "men's health" clinics will help provide informed patient care and counseling.
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Affiliation(s)
- Peter N Dietrich
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI.
| | | | - Sarah Brink
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | - Daniel Hanna
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | - John Fitzgerald
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | - Pranav Dadhich
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | - Jay I Sandlow
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | - Jagan Kansal
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | - Petar Bajic
- Center for Men's Health, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
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Arthurs JR, Martin Lillie CM, Master Z, Shapiro SA. The Direct to Consumer Stem Cell Market and the Role of Primary Care Providers in Correcting Misinformation. J Prim Care Community Health 2022; 13:21501319221121460. [PMID: 36112830 PMCID: PMC9476238 DOI: 10.1177/21501319221121460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/05/2022] [Accepted: 08/09/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Direct to consumer stem cell and regenerative interventions (SCRIs) for various medical conditions have increased in popularity due to unmet medical needs and the promise of SCRIs to meet those needs. These interventions may have varying levels of safety and efficacy data and many lack sufficient scientific data to be marketed. The direct to consumer SCRI industry has received significant attention due to potential physical, economic, and emotional harms to patients. Patients may seek the counsel of their primary care providers when considering stem cell therapy for their condition. METHODS Here we describe strategies primary care providers can utilize when counseling patients. RESULTS Although we recommend constructing these discussions around individual patients' needs, one can utilize a general approach consisting of 4 parts. First, providers should recognize what information the patient is seeking and what is their understanding of stem cell and regenerative medicine. Next, providers should convey evidence-based information at the level of patients understanding so that they are aware of the risks, benefits, and descriptions of possible procedures. Throughout the conversations, attempts should be made to guide patients to a trusted resource that can provide additional information. Finally, providers should make an effort to address misinformation in a way that is nonjudgmental and patient-centered to make the patient feel safe and comfortable. CONCLUSION Effectively communicating risk information by primary care providers to patients is important given the harms reported from direct-to-consumer SCRIs. Correcting misinformation remains a priority when discussing SCRI's. Providers should strive to offer patients with additional resources such as the opportunity for consultation with a specialist or a consultation service dedicated to informing patients about regenerative medicine.
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Puzzitiello RN, Dubin J, Menendez ME, Moverman MA, Pagani NR, Drager J, Salzler MJ. Public Opinion and Expectations of Stem Cell Therapies in Orthopaedics. Arthroscopy 2021; 37:3510-3517.e2. [PMID: 34126222 DOI: 10.1016/j.arthro.2021.05.058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/03/2021] [Accepted: 05/28/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To explore public opinion, understanding, and preferences regarding the use of stem cell therapies for the treatment of joint and tendon pathologies using online crowdsourcing. METHODS A 30-question survey was completed by 931 members of the public using Amazon Mechanical Turk, a validated crowdsourcing method. Outcomes included perceptions and preferences regarding the use of stem cells therapies for the nonsurgical treatment of orthopaedic conditions. Sociodemographic factors and a validated assessment of health literacy were collected. Inclusion criteria were adult participants 18 years or older, residence within the United States, and a valid Social Security number. Multivariable logistic regression modeling was used to determine population characteristics associated with the belief that stem cells represent the most effective treatment for long-standing joint or tendon disorders. RESULTS Most respondents reported that stem cell therapies have convincing evidence to support their use for orthopaedic conditions (84.5%) and are approved and regulated by the Food and Drug Administration (65%). About three-quarters of respondents reported that stem cells can stop the progression of and alleviate pain from arthritis or damaged tendons, and over half (53.5%) reported that stem cells can cure arthritis. Factors with the greatest influence on respondents' decision to receive stem cell therapies are research supporting their safety and effectiveness and doctor recommendation. However, 63.3% of respondents stated that they would consider stem cells if their doctor recommended it, regardless of evidence supporting their effectiveness, and over half would seek another doctor if their orthopaedic surgeon did not offer this treatment option. CONCLUSIONS The public's limited understanding regarding the current evidence associated with stem cell therapies for osteoarthritis and tendinous pathologies may contribute to unrealistic expectations and misinformed decisions. This study highlights the importance of patient education and expectation setting, as well as evidence transparency, as stem cell therapies become increasingly accessible. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Richard N Puzzitiello
- Department of Orthopaedic Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, U.S.A.; New England Baptist Hospital, Boston, Massachusetts, U.S.A
| | | | - Mariano E Menendez
- Department of Orthopaedic Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, U.S.A.; New England Baptist Hospital, Boston, Massachusetts, U.S.A
| | - Michael A Moverman
- Department of Orthopaedic Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, U.S.A.; New England Baptist Hospital, Boston, Massachusetts, U.S.A
| | - Nicholas R Pagani
- Department of Orthopaedic Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, U.S.A.; New England Baptist Hospital, Boston, Massachusetts, U.S.A
| | - Justin Drager
- Department of Orthopaedic Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, U.S.A
| | - Matthew J Salzler
- Department of Orthopaedic Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, U.S.A..
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Turner L. The American stem cell sell in 2021: U.S. businesses selling unlicensed and unproven stem cell interventions. Cell Stem Cell 2021; 28:1891-1895. [PMID: 34739831 DOI: 10.1016/j.stem.2021.10.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 01/28/2023]
Abstract
In March 2021, 1,480 U.S. businesses operating 2,754 clinics were found selling purported stem cell treatments for various indications. More than four times as many businesses than were identified 5 years ago are selling stem cell products that are not FDA-approved and lack convincing evidence of safety and efficacy.
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Affiliation(s)
- Leigh Turner
- Department of Health, Society, and Behavior, Program in Public Health, Stem Cell Research Center, Institute for Clinical & Translational Science, University of California, Irvine, AIRB, 653 E. Peltason Drive, Room 2034, Irvine, CA 92697-3957, USA.
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Master Z, Matthews KRW, Abou-El-Enein M. Unproven stem cell interventions: A global public health problem requiring global deliberation. Stem Cell Reports 2021; 16:1435-1445. [PMID: 34107243 PMCID: PMC8190665 DOI: 10.1016/j.stemcr.2021.05.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/12/2022] Open
Abstract
The unproven stem cell intervention (SCI) industry is a global health problem. Despite efforts of some nations, the industry continues to flourish. In this paper, we call for a global approach and the establishment of a World Health Organization (WHO) Expert Advisory Committee on Regenerative Medicine to tackle this issue and provide guidance. The WHO committee can harmonize national regulations; promote regulatory approaches responsive to unmet patient needs; and formulate an education campaign against misinformation. Fostering an international dialog and developing recommendations that can be adopted by member states would effectively address the global market of unproven SCIs.
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Affiliation(s)
- Zubin Master
- Biomedical Ethics Research Program and the Center for Regenerative Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Kirstin R W Matthews
- Baker Institute for Public Policy Center for Health and Biosciences, Rice University, Houston, TX, USA
| | - Mohamed Abou-El-Enein
- Division of Medical Oncology, Department of Medicine, and Department of Stem Cell Biology and Regenerative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Joint USC/CHLA Cell Therapy Program, University of Southern California, and Children Hospital Los Angeles, Los Angeles, CA, USA.
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10
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Smith C, Crowley A, Munsie M, DeMartino ES, Staff NP, Shapiro S, Master Z. Academic physician specialists' views toward the unproven stem cell intervention industry: areas of common ground and divergence. Cytotherapy 2021; 23:348-356. [PMID: 33563545 DOI: 10.1016/j.jcyt.2020.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 12/27/2020] [Accepted: 12/29/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS Premature commercialization of unproven stem cell interventions (SCIs) has received significant attention within the regenerative medicine community. Patients considering SCIs may encounter misinformation and seek out guidance from their physicians who are trusted brokers of health information. However, little is known about the perspectives of academic physician specialists toward the SCI industry. The purpose of this study was to capture the attitudes of physician specialists with experience addressing patient questions about unproven SCIs. METHODS The authors undertook 25 semi-structured interviews with academic physicians in cardiology, ophthalmology, orthopedics, pulmonology and neurology primarily from one academic center. RESULTS The authors identified two major themes: concerns and mediators of appropriateness of offering SCIs as therapies to patients. Specialists were generally aware of the industry and reported scientific and commercial concerns, including the scientific uncertainty of SCIs, medical harms to patients, misleading marketing and its impact on patient informed consent and economic harms due to large out-of-pocket costs for patients. All specialists outside of orthopedics voiced that it was inappropriate to be offering SCIs to patients today. These views were informed by previously expressed concerns surrounding safety and properly informing patients, levels of evidence needed prior to offering SCIs therapeutically and desired qualifications for clinicians. Among the specialties, orthopedists reported that under certain conditions, SCIs may be appropriate for patients with limited clinical options but only when safety is adequate, expectations are managed and patients are well informed about the risks and chances of benefit. Most participants expressed a desire for phase 3 studies and Food and Drug Administration approval prior to marketing SCIs, but some also shared the challenges associated with upholding these thresholds of evidence, especially when caring for out-of-option patients. CONCLUSIONS The authors' results suggest that medical specialists are aware of the industry and express several concerns surrounding SCIs but differ in their views on the appropriateness and clinical evidence necessary for offering SCIs currently to patients. Additional educational tools may help physicians with patient engagement and expectation management surrounding SCIs.
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Affiliation(s)
- Cambray Smith
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA; University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Aidan Crowley
- Department of Biological Sciences, College of Science, University of Notre Dame, Notre Dame, Indiana, USA
| | - Megan Munsie
- Department of Anatomy and Neuroscience, Centre for Stem Cell Systems, University of Melbourne, Parkville, Australia
| | - Erin S DeMartino
- Division of Pulmonary and Critical Care Medicine and Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Shane Shapiro
- Department of Orthopedic Surgery and Center for Regenerative Medicine, Mayo Clinic College of Medicine, Jacksonville, Florida, USA
| | - Zubin Master
- Biomedical Ethics Research Program and Center for Regenerative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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11
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West WH, Beutler AI, Gordon CR. Regenerative Injectable Therapies: Current Evidence. Curr Sports Med Rep 2020; 19:353-359. [PMID: 32925374 DOI: 10.1249/jsr.0000000000000751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Regenerative medicine is a growing field of musculoskeletal treatments that focuses on amplifying the body's natural healing properties to improve function and pain after injury. Regenerative treatments are applied locally at the site of injury and work though different mechanisms, some of which are unexplained at this time. Current evidence demonstrates benefit for certain regenerative treatments, but further standardization of treatments and additional studies are required to provide additional data to support specific regenerative treatments. This review seeks to explore the evidence and discuss appropriate use of the most common regenerative treatments including platelet-rich plasma, prolotherapy, autologous mesenchymal stem cells, human-derived allograft products, and saline.
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12
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Richardson E, Akkas F, Master Z. Evaluating the FDA regenerative medicine framework: opportunities for stakeholders. Regen Med 2020; 15:1825-1832. [PMID: 32815780 DOI: 10.2217/rme-2020-0073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Elizabeth Richardson
- Director, Health Care Products Project, The Pew Charitable Trusts, 901 E Street, NW, Washington, DC 20004-2008, USA
| | - Farzana Akkas
- Senior Research Associate, Health Care Products Project, The Pew Charitable Trusts, 901 E Street, NW, Washington, DC 20004-2008, USA
| | - Zubin Master
- Associate Professor, Biomedical Ethics Research Program & Center for Regenerative Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA
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13
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Translating Basic Research into Safe and Effective Cell-based Treatments for Respiratory Diseases. Ann Am Thorac Soc 2020; 16:657-668. [PMID: 30917290 DOI: 10.1513/annalsats.201812-890cme] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Respiratory diseases, such as chronic obstructive pulmonary disease and pulmonary fibrosis, result in severely impaired quality of life and impose significant burdens on healthcare systems worldwide. Current disease management involves pharmacologic interventions, oxygen administration, reduction of infections, and lung transplantation in advanced disease stages. An increasing understanding of mechanisms of respiratory epithelial and pulmonary vascular endothelial maintenance and repair and the underlying stem/progenitor cell populations, including but not limited to airway basal cells and type II alveolar epithelial cells, has opened the possibility of cell replacement-based regenerative approaches for treatment of lung diseases. Further potential for personalized therapies, including in vitro drug screening, has been underscored by the recent derivation of various lung epithelial, endothelial, and immune cell types from human induced pluripotent stem cells. In parallel, immunomodulatory treatments using allogeneic or autologous mesenchymal stromal cells have shown a good safety profile in clinical investigations for acute inflammatory conditions, such as acute respiratory distress syndrome and septic shock. However, as yet, no cell-based therapy has been shown to be both safe and effective for any lung disease. Despite the investigational status of cell-based interventions for lung diseases, businesses that market unproven, unlicensed and potentially harmful cell-based interventions for respiratory diseases have proliferated in the United States and worldwide. The current status of various cell-based regenerative approaches for lung disease as well as the effect of the regulatory environment on clinical translation of such approaches are presented and critically discussed in this review.
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Ethical and Practical Considerations for Integrating Cellular ("Stem Cell") Therapy into Clinical Practice. Curr Rev Musculoskelet Med 2020; 13:525-529. [PMID: 32468421 DOI: 10.1007/s12178-020-09647-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Cellular therapies, also known as "stem cell" interventions (SCI), have undergone a rapid popularization in the USA and worldwide. The current review aimed at outlining (1) the ethical challenges facing the implementation of SCI; (2) the applicability of the currently available SCI; and (3) recommendations to achieve ethical, well-regulated incorporation of SCI in the clinical setting. RECENT FINDINGS Concerns regarding the inadequate characterization, poor adverse effects disclosure, and unorthodox, often inappropriate, market practices have engendered a genuine concern regarding the SCI compliance with ethical standards. Six instances of litigation on the basis of misrepresentation or inappropriate informed consent were recorded between 2012 and 2018. Such concerns have been furthered by the loopholes in the regulatory aspect governing the use of SCI coupled with the unclear literature-reported efficacy and diverse spectrum of profess indications. Similarly, the application of SCI in the clinical field is yet to prove its value. The uncertain efficacy, coupled with obscure true-costs of utilization, impedes a value-based assessment. A multidisciplinary approach involving legislative and medical professional societies should continue to advance regulations that govern SCI. A well-regulated system that allows for the ethical integration of SCI with appositely evidenced-based described benefits and risks should be sought.
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15
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Turner L. Preying on Public Fears and Anxieties in a Pandemic: Businesses Selling Unproven and Unlicensed "Stem Cell Treatments" for COVID-19. Cell Stem Cell 2020; 26:806-810. [PMID: 32464095 PMCID: PMC7203029 DOI: 10.1016/j.stem.2020.05.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In the midst of a global public health emergency, some businesses are taking advantage of widespread fears by marketing purported stem cell treatments for COVID-19. Such businesses target prospective clients with misleading claims, expose patients to potentially risky stem cell-based products, and undermine efforts to develop evidence-based treatments for COVID-19.
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Affiliation(s)
- Leigh Turner
- Center for Bioethics, School of Public Health, and College of Pharmacy, University of Minnesota, 410 Church Street SE, N520, Minneapolis, MN 55455, USA.
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16
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Affiliation(s)
- Zubin Master
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota
| | - Cambray Smith
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota
| | - Jon C Tilburt
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
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17
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Smith C, Martin-Lillie C, Higano JD, Turner L, Phu S, Arthurs J, Nelson TJ, Shapiro S, Master Z. Challenging misinformation and engaging patients: characterizing a regenerative medicine consult service. Regen Med 2020; 15:1427-1440. [PMID: 32319855 PMCID: PMC7466910 DOI: 10.2217/rme-2020-0018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 03/19/2020] [Indexed: 02/06/2023] Open
Abstract
Aim: To address the unmet needs of patients interested in regenerative medicine, Mayo Clinic created a Regenerative Medicine Consult Service (RMCS). We describe the service and patient satisfaction. Materials & methods: We analyzed RMCS databases through retrospective chart analysis and performed qualitative interviews with patients. Results: The average patient was older to elderly and seeking information about regenerative options for their condition. Patients reported various conditions with osteoarthritis being most common. Over a third of consults included discussions about unproven interventions. About a third of patients received a clinical or research referral. Patients reported the RMCS as useful and the consultant as knowledgeable. Conclusion: An institutional RMCS can meet patients' informational needs and support the responsible translation of regenerative medicine.
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Affiliation(s)
- Cambray Smith
- Biomedical Ethics Research Program, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA
| | - Charlene Martin-Lillie
- Center for Regenerative Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA
| | - Jennifer Dens Higano
- Mayo Clinic Alix School of Medicine, 200 First Street, SW, Rochester, MN 55905, USA
| | - Leigh Turner
- Center for Bioethics, School of Public Health & College of Pharmacy, University of Minnesota, N520 Boynton, 410 Church Street SE, Minneapolis, MN 55455, USA
| | - Sydney Phu
- School of History, Philosophy & Religion, Oregon State University, 322 Milam Hall, 2520 SW Campus Way, Corvallis, OR 97331, USA
| | - Jennifer Arthurs
- Center for Regenerative Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Timothy J Nelson
- Center for Regenerative Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA
- Department of General Internal Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA
| | - Shane Shapiro
- Center for Regenerative Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
- Department of Orthopedic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Zubin Master
- Biomedical Ethics Research Program, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA
- Center for Regenerative Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA
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Abstract
Cell therapies hold significant promise for the treatment of injured or diseased musculoskeletal tissues. However, despite advances in research, there is growing concern about the increasing number of clinical centres around the world that are making unwarranted claims or are performing risky biological procedures. Such providers have been known to recommend, prescribe, or deliver so called ‘stem cell’ preparations without sufficient data to support their true content and efficacy. In this annotation, we outline the current environment of stem cell-based treatments and the strategies of marketing directly to consumers. We also outline the difficulties in the regulation of these clinics and make recommendations for best practice and the identification and reporting of illegitimate providers. Cite this article: Bone Joint J 2020;102-B(2):148–154
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Affiliation(s)
- Iain R Murray
- Department of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
| | - Jorge Chahla
- Rush University Medical Center, Chicago, Illinois, USA
| | - Rachel M Frank
- University of Colorado School of Medicine, Aurora, Colorado, USA
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Taliaferro J, Shapiro SA, Montero DP, Shi GG, Wilke BK. Cash-Based Stem-Cell Clinics: The Modern Day Snake Oil Salesman? A Report of Two Cases of Patients Harmed by Intra-articular Stem Cell Injections. JBJS Case Connect 2019; 9:e0363. [PMID: 31815806 DOI: 10.2106/jbjs.cc.19.00363] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
CASE The use of biologics is rapidly expanding. Over the past decade, there has been a significant increase in the number of cash-based "stem cell"/regenerative medicine clinics in the United States. These clinics provide cash-based services touting stem cell injections to cure a myriad of conditions. Largely, these clinics are unregulated and using injections in a non-Food and Drug Administration-approved manner. We report on 2 patients who presented with symptoms suggestive of septic arthritis following stem cell injections by cash-based local stem cell clinics. Case 1 involved a patient who developed septic arthritis following an injection of umbilical cord blood-derived cellular products (Genentech) and required an antibiotic spacer followed by a total hip arthroplasty. Case 2 involved a patient who developed a likely immune-mediated reaction following an injection of morselized human placental allograft tissue by a local chiropractic office at a cost of approximately $8,000. CONCLUSIONS We present these cases to bring increased awareness to the issue and call for increased regulation of this practice.
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Affiliation(s)
- John Taliaferro
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Shane A Shapiro
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Daniel P Montero
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Glenn G Shi
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Benjamin K Wilke
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida
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20
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Regenerative Medicine and Cell Therapy in Orthopedics—Health Policy, Regulatory and Clinical Development, and Market Access. Tech Orthop 2019. [DOI: 10.1097/bto.0000000000000413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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21
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Knoepfler PS. Rapid change of a cohort of 570 unproven stem cell clinics in the USA over 3 years. Regen Med 2019; 14:735-740. [PMID: 31456478 DOI: 10.2217/rme-2019-0064] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Aim: The industry of unproven stem cell clinics has rapidly mushroomed throughout the USA, posing risks to patients and the research field. In this study, the aim was to better define how this industry changes. Methods: I analyzed a large cohort of US stem cell clinic firms and their distinct clinic locations as defined in 2015-2016 for their status now in 2019. Results: About a quarter of the firms no longer marketed stem cells. Some lacked active websites, while others dropped stem cell services. Even so, the total number of clinics in this group increased because some firms greatly expanded their clinic numbers. Conclusion: Overall, the unproven clinic industry is a moving target requiring ongoing study and regulatory oversight.
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Affiliation(s)
- Paul S Knoepfler
- Department of Cell Biology & Human Anatomy, University of California Davis, Davis, CA 95616, USA.,Institute of Pediatric Regenerative Medicine, Shriners Hospital for Children Northern California, Sacramento, CA 95817, USA
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22
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Caulfield T, Murdoch B. Regulatory and policy tools to address unproven stem cell interventions in Canada: the need for action. BMC Med Ethics 2019; 20:51. [PMID: 31383026 PMCID: PMC6683337 DOI: 10.1186/s12910-019-0388-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 07/08/2019] [Indexed: 01/02/2023] Open
Abstract
Background The marketing of unproven direct-to-consumer stem cell interventions is becoming widespread in Canada. There is little evidence supporting their use and they have been associated with a range of harms. Canada has been slower to act against clinics offering these interventions than other jurisdictions, including the United States. Here, we outline the regulatory and policy tools available in Canada to address this growing problem. Main body Health Canada’s regulations governing cell therapies are complex, but recent statements make it clear that Health Canada believes it has jurisdiction over many of the currently marketed stem cell interventions. Still, further regulatory clarity is needed from Health Canada, as are increased directed enforcement efforts on interventions that fall within their scope. The Competition Bureau, via the Competition Act, prohibits advertisers from making materially false or misleading promotional representations. The Competition Bureau could collaborate with the scientific community to analyze the claims of existing clinics in Canada, and impose sanctions upon those who breach the established standard. Professional regulators, including provincial colleges of physicians and surgeons, have considerable power over what products and services their members can offer. Every college of physicians in Canada requires, via policy and codes of ethics, that doctors maintain evidence-based practices. This requirement is incompatible with offering many unproven stem cell interventions. Litigation may be another tool, including the use of fraud, misrepresentation and/or negligence claims for failing to meet the required standard of care. Finally, political pressure on federal and provincial lawmakers could encourage changes to marketing, cell therapy and professional regulations that would allow a more comprehensive response. Conclusions In sum, there are many existing tools that can be used to protect the public from unproven stem cell interventions. Increased bureaucratic will and grassroots efforts are needed in order to effect a positive policy response.
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Affiliation(s)
- Timothy Caulfield
- Health Law Institute, Faculty of Law, University of Alberta, 468 Law Centre, Edmonton, Alberta, T6G 2H5, Canada.
| | - Blake Murdoch
- Health Law Institute, Faculty of Law, University of Alberta, 468 Law Centre, Edmonton, Alberta, T6G 2H5, Canada
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Unproven Stem Cell Therapies in India: Regulatory Challenges and Proposed Paths Forward. Cell Stem Cell 2018; 23:649-652. [DOI: 10.1016/j.stem.2018.10.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
The stem cell and regenerative medicine arena has become increasingly complicated in recent years with thousands of people involved. There are as many as a dozen or more main groups of stakeholders, who together may be viewed as one ecosystem that is now rapidly evolving. The nature of the ecosystem and its evolution have major implications for not just those within it, but also for medicine and society at large. Here, I describe this ecosystem and its evolution, as well as the negative impacts within the ecosystem of a constellation of hundreds of unproven for-profit clinics and related businesses. Finally, I propose approaches for how to positively influence and drive the future of the global stem cell ecosystem.
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Affiliation(s)
- Paul S Knoepfler
- Department of Cell Biology & Human Anatomy, University of California, Davis, 1 Shields Ave, Davis, CA 95616, USA
- Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children Northern California, Sacramento, CA 95817, USA
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25
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Turner L. Direct-to-consumer marketing of stem cell interventions by Canadian businesses. Regen Med 2018; 13:643-658. [DOI: 10.2217/rme-2018-0033] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This study examines marketing claims of Canadian businesses engaged in direct-to-consumer advertising of putative stem cell treatments. Methods: Internet searches were used to locate Canadian businesses selling stem cell interventions. Company websites were subjected to detailed analysis. Results: In total, 30 Canadian businesses sell stem cell interventions provided at 43 clinics. Autologous stem cells are the most common types of products promoted by such businesses. Company websites minimize risks while making strong claims about benefits of stem cell interventions. Discussion: Businesses’ representations could result in patients making health-related decisions informed by marketing claims rather than best available scientific evidence. Conclusion: Although there is absent development of new regulations and guidance, the Canadian direct-to-consumer marketplace for stem cell interventions appears poised for expansion.
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Affiliation(s)
- Leigh Turner
- Center for Bioethics, School of Public Health, College of Pharmacy, University of Minnesota, N520 Boynton, 410 Church Street SE, Minneapolis, MN 55455, USA
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Michie M, Allyse M, Stoll KA, Master Z. Weaponizing Hope: Sources of Hope, Unrealistic Optimism, and Denial. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2018; 18:25-27. [PMID: 30265599 PMCID: PMC6314021 DOI: 10.1080/15265161.2018.1498946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Marsha Michie
- Department of Bioethics, Case Western Reserve University School of
Medicine, 10900 Euclid Avenue, Cleveland, OH 44106-4976
| | - Megan Allyse
- , Biomedical Ethics Research
Program and Department of Obstetrics and Gynecology, Mayo Clinic, Twitter:
@mallyse
| | | | - Zubin Master
- , Biomedical Ethics Research
Program, Mayo Clinic
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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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Knoepfler PS. Too Much Carrot and Not Enough Stick in New Stem Cell Oversight Trends. Cell Stem Cell 2018; 23:18-20. [DOI: 10.1016/j.stem.2018.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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