Stem cells and medical tourism

An Internet browser search for “stem cell treatment” will bring up an amazing assortment of claims and professionally prepared overt advertisements for therapy of many chronic diseases and disabilities [1, 2]. Among others, the most common include cardiovascular disorders including acute myocardial infarction, stroke, spinal cord injuries, Parkinsonism, multiple sclerosis, Alzheimer disease, cerebral palsy, erectile dysfunction, diabetes, amyotrophic lateral sclerosis, osteoarthritis, burns, facioscapulohumeral muscular dystrophy (LandouzyDejerine syndrome), liver disease, kidney disease, and psychiatric illnesses, including autism. Not only are some so-called “stem cell clinics” promoting treatment of disease, but some are targeting otherwise healthy patients for cosmesis, including hair regrowth, breast augmentation, cosmetic anti-aging treatment, and nonsurgical face lifts, or health enhancement including “enhanced sexual function”, “regain of youthful vigor”, “increased feelings of energy”, and “increased mental capacity”. Currently, only the treatment of well-defined hematological diseases using bone marrow transplantation is widely used in clinical practice [3-6]. This clinical use of stem cells has been approved by responsible government authorities such as the U.S. Food and Drug Administration (U.S. FDA) using approved protocols that are subject to scrutiny and supervision. Other stem cell therapies have been approved by the U.S. FDA or are undergoing registered clinical trials, but their use has been much less widespread [7, 8]. Research in utilizing stem cells for treatment or replacement, also known as regenerative or reparative medicine, is an exciting field. It is. However, it is also still in its infancy, but rapidly evolving and showing great promise. Stem cells can be obtained from blood, bone marrow, tissues (e.g. adipose, skin, and placenta), umbilical cords, fetuses, or embryos, and then cultured. These cells offer much promise for future therapies [3, 9, 10]. Most, if not all, stem cells need to be chemically or physically manipulated or transformed to make them able to perform complex new functions. An undifferentiated stem cell needs to be transformed into a functional cell, such as a nerve, muscle, fat, bone, or blood cell before it is of any use in therapy [11]. Completely new technologies, based on innovative and complex molecular and genetic experimentation, must be developed before the virtual miracle expected in stem cell treatment can be realized. To understand the complexity of what we expect from a stem cell, a colony of such cells, infused intravenously or injected directly into brain or spinal cord, must then find their way to the site where these cells are needed. They must be able to defend themselves or hide from attacks of the patient’s immune system. If infused intravenously, they must not become stuck in the liver or lung on their way to the injured target site. There, they must then be transformed start to reproduce and be able to function. Up to dozens of commercial clinics worldwide are advertising some stem cell treatments without any scientifically acceptable substantiated evidence that the treatments are safe and effective. Such clinics are usually located in countries that have lax laws dealing with such practices, or lax enforcement of existing laws. These countries may not provide for supervision or licensing of such activities allowing the laws to be evaded, corrupted, or skirted around by what is now a very lucrative and growing industry [1, 12, 13]. Documented success and failure data from some such clinics cannot be found in the scientific literature. However, testimonials abound in the media and material offered by such clinics [1, 14]. Testimonials can be elicited from patients, but these alone are not sufficient evidence of effectiveness or safety. The evidence that “some patients seem to have benefited from the treatment” is not sufficient. The evidence must be subject to the stricter rules of scientific enquiry and must be verified, and this can only be done by long-term peer reviewed and unbiased follow-ups. Many of the diseases treated by this group of very profitable providers have slowly progressive natural histories, remissions, and exacerbations. To determine efficacy and safety requires studies of large numbers of patients for long periods of time [15]. Patients who seek “last chance” experimental treatments for terminal or otherwise incurable conditions, after having apparently exhausted other avenues, are especially vulnerable to medical charlatans who openly prey on the vulnerable with Editorial DOI: 10.5372/1905-7415.0801. 255