Last week, a good friend of mine forwarded me a correspondence from the New England Journal of Medicine (NEJM). I was expecting to read about a new drug being tested in clinical trials or maybe a neat scientific perspective on leukemia biology, but what I got instead shocked and saddened me. The title of the article – Glioproliferative Lesion of the Spinal Cord as a Complication of “Stem-Cell Tourism” – is foreboding on its own and highlights the dangers of seeking out unproven (and often completely untested) cell therapies.
The article charts the journey of a man, Jim Gass, who wanted to mitigate his post-stroke complications. He sought various stem cell therapies comprised of mesenchymal, embryonic, and fetal neural stem cells that were injected into his spine in three different clinics across the world (Mexico, Argentina, and China). After receiving these cells, the man developed back pain, problems urinating and paraplegia – a terrifying ordeal. As a stem cell biologist, I cannot even begin to fathom how this was expected to work.
It is an all too common story of stem cell tourism: desperate patient seeks an ‘experimental’ therapy to cure their disease and ends up in a foreign country with a bag full of hope (…and cash). In many cases, nothing much happens (aside from the bag of cash swapping hands) but in some cases, like this one, the consequences are dire. According to the New York Times piece reporting on the same case, Mr. Gass spent $300,000 including travel – just to rub salt in the wound.
But the scariest part of the article for me was when the doctors described what they found inside their patient: “Although the lesion may be considered a neoplasm (i.e., a “new growth”), it could not be assigned to any category of previously described human neoplasm on the basis of the data we gathered.”
Not only had this treatment made this man incredibly unwell, but the cell infusion had created something not before observed in people. As well, the clinical team at Brigham and Women’s Hospital also proved, using several standard lab techniques, that the cells did not come from Mr. Gass. So what the heck were they and where did they come from?
Experiments like the ones reported here will set the legitimate cell therapy field back decades and we need to bring a halt to unproven therapies. This sort of personal story, in the most highly cited medical journal, will bring even more bad press to bogus stem cell therapies and I, for one, hope that it catalyzes the medical and scientific communities to act. This is an extremely serious issue that needs to be addressed.
This particular NEJM correspondence also highlights another important issue for public health care providers and private insurers. If a patient seeks a therapy in a foreign country (in this case three different countries) and significant complications develop, who treats the complications? In many cases, this will fall to the country of residence (especially in a public system) so it seems reasonable that some investment from these countries should also go toward preventing people from seeking/undertaking unproven therapies considering the post-treatment complications can be incredibly expensive.
So what can we, as a community of scientists, do? Well, as I have highlighted on Signals before, the International Society for Stem Cell Research (ISSCR) has created an excellent resource for people to use when considering cell therapies (stem cell or otherwise!) to treat their condition. Particularly useful is the page entitled “Stem Cell Treatments: What to ask” which allows patients to print information and request answers from the clinic where they are seeking therapy. I also recommend reading this patient advisory that contains useful information and links to additional resources, and this one too.
This approach is quite passive though and I would like to advocate for something more proactive that exposes cell therapies that are not bona fide treatments. Let’s create a resource that breaks down cell therapies by type and identifies routine proven therapies and the countries that offer them and also individual organizations that have listed new therapies not on the approved list.
Most would probably be difficult to have a full scouting report on, but the list of clinics with poor outcomes – such as the one in this NEJM correspondence – would continually be growing. An extreme version of this would name any physician involved in the trials (both in administering as well as supporting/referring).
Legally, I imagine this is quite tricky since a society like ISSCR (or any individual for that matter) could find itself in some serious battles with companies/clinics that feel they have been unfairly maligned by the media or by anecdotal patient accounts. But we need to do something; we cannot just sit idly by, as experts in stem cell biology and medicine, and watch these clinics prey on the hopes of desperate patients. (As an aside, it is interesting that the NEJM correspondence does not mention the names of the clinics that treated Jim Gass.)
Readers, what do you think? Can you imagine a sophisticated online tool that could be used to fact check and verify what clinics across the world are promising? I look forward to hearing your ideas.
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