Today an article entitled "Professors Critique Stem Cell Medical Tourism" appeared in the online version of The Harvard Crimson summarizing a recent panel discussion hosted in least in part by Harvard Law School assistant professor I. Glenn Cohen and University of Alberta law professor Timothy Caulfield. The article concludes thusly:
The panelists emphasized that more accurate information should be provided to the public regarding stem cell treatments.
Certainly what Cohen and Caulfield concluded is true. It has now been true for several years. We keep saying it. But are we listening to ourselves? Are we doing anything meaningful to address this? If so, is it enough?
Sadly (in my opinion, of course) the answer is 'not nearly enough'.*
For several years now, experts and organizations in the cell therapy sector have been saying that more must be done to educate and assist patients who are seeking stem cell or other cell-based treatments which do not comply with existing regulation and/or widely accepted medical or clinical research practices (hereafter called "non-compliant cell therapies").
In my opinion, attempts to address this need by the sector's professional organizations, while important, have been unnecessarily feeble, not gone nearly far enough, and legitimately appear by many to be high-minded and pedantic.
Almost all efforts to-date to address this issue by ISSCR, CIRM, ISCT and others including authors such as Caufield - as laudable and needed as they are - have been focused on helping distinguish between compliant and non-compliant treatments (and providers). This is certainly much needed. But what is left, I submit, is an even greater unmet need.
What almost all efforts to-date have failed to recognize or address is that where real help is needed is in helping patients distinguish between the many shades of grey among non-compliant treatments (and providers).
Emerging organizations like ICMS (now in partnership with AABB) have recognized and attempted to address this unmet need through a commitment to create some level of certification, accreditation or standardization of clinics participating in this business of selling non-compliant cell therapies.
While their intentions appear on-target as one meaningful way to address this unmet need and certainly their willingness to tackle this issue in a bold way is to be lauded, the ICMS is inexperienced and underfunded. I remain hopeful that now through their new partnership with AABB they will be able to provide something that really addresses this unmet need but the jury remains out on whether they will succeed.
Anyone who has followed this blog and/or my threads on LinkedIn know I have been thinking about and discussing this issue for some time. In a desire to move to very concrete suggestions, I want to recommend the following 6 steps to my industry colleagues and professional organizations:
1. 50 shades of grey. Let's admit that this issue is not black-and-white but, as is almost always, involves a broad spectrum of grey in the middle.
In addition to helping patients distinguish between compliant and non-compliant treatments (and providers) there are a lot of ways to help patients distinguish between non-compliant cell therapy treatments (and providers) which are more or less risky.
In addition to helping patients distinguish between compliant and non-compliant treatments (and providers) there are a lot of ways to help patients distinguish between non-compliant cell therapy treatments (and providers) which are more or less risky. Let me use examples.
On the one end of the non-compliant spectrum I would put forward a clinical like Okyanos Heart Institute which (as I understand it) intends to provide cell therapy treatments in the Bahamas to US patients using the Cytori system for cardiac conditions as soon as such treatments are perfectly legal and available to European patients but years before such treatments will be available in the US.
Non-compliant? Yes. But certainly no evidence I'm aware of to support a belief that seeking treatment from them would be any more risky than travelling to Europe to receive the same treatment in a manner perfectly compliant with European regulations.
On the other end of the spectrum are the kinds of clinics highlighted recently by 60 minutes or which are the subject of ongoing lawsuits.
2. Step out of the ivory tower. Let's recognize that in certain circumstances patients are going to go pay for non-compliant cell therapies and we must do more to help these patients than simply shake our finger and tell them they mustn't.
For some, helping patients distinguish between the better and worst non-compliant clinics might involve a fair amount of nose-pinching but this is the equivalent of the methadone clinic for heroine addicts. By supporting the better of two evils we are not endorsing it as 'good', we are simply recognizing it is better.
This is a recognition that we cannot just abandon people because they made (or are going to make) decisions with which we ultimately disapprove. It is a recognition that sometimes the most righteous thing to do is not only to help people do what we would ideally want them to do but to help them do the best they can in their circumstances and on their terms - even terms with which we may ultimately disagree.
3. A risk-based strategy. Let's recognize that even the FDA triages their response to non-compliance and we would do well to do the same. As a regulated industry we are perfectly comfortable with risk-based assessments and it should be applied here.
Rather than treating all non-compliance as equally evil, let's apply some risk-based analysis to the situation and develop a strategy to root out the worst (highest-risk) offenders.
4. This is not just about tourism anymore - the problem has come home to roost. Let's recognize that this is no longer just a problem of patients leaving a regulated jurisdiction seeking a non-compliant treatment in a jurisdiction with no or more permissive regulation.
Non-compliant treatments are growing rapidly even in the most highly regulated jurisdictions. No where is this more true than in the United States.
5. Take responsibility. Let's recognize that we cannot expect our regulatory enforcement agencies to do it all. They are under-staffed and under-funded. They - and the people we all serve - need our active participation in dealing with offenders and those risking patient safety.
From a self-interested perspective, we owe it to our industry to help crack down on those who put the credibility and legitimacy of cell therapies at highest risk.
6. Let's grow a pair and call a spade a spade. If a non-compliant clinic is providing treatments that we believe represent a high-risk to patient safety and the industry's credibility, let's have the b*lls to call them on it. They can't sue everyone.
ISSCR backed down on their stem cell tourism initiative after being threatened by lawsuits. Who has stepped up in their absence? Individual bloggers and authors like Paul Knoeplfer, Alexey Bresenev, Leigh Turner, and myself all who have been threatened with litigation several times for having the audacity to call certain non-compliant clinics out for what we deem - in our own risk-based analysis - to be the worst offenders.
By way of example, several of my colleagues have recently committed to doing all they can do to call out David Steenblock and his non-compliant cell therapy treatments, many of which are provided at his clinic in California for a plethora of conditions. In their opinion, many of his treatments represent some of worst examples of non-compliance in the United States right now. There are many faces or fronts to his practice including www.davidsteenblock.com, www.stemcellmd.org, www.strokedoctor.com, www.davidsteenblock.net, etc.
If, as an industry, we act with more cohesion (collaboratively applying a risk-based assessment of non-compliant clinics) and speak with a more cohesive voice in terms of calling out those clinics and treatments which we conclude pose the greatest risk based on an objective set of criterion, this will present a multi-pronged, formidable and existential threat to clinics that they can't ignore or threaten away.
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I will be taking these 6 recommendations to any organization who will listen. I hope you will consider doing the same.
In the meantime - as always - I welcome your comments.
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* This is my opinion not necessarily the opinion of any clients I represent or organizations I serve. Judge me - not them - accordingly.
