A week ago, I wrote about a naturopath in Utah named Harry Adelson, who was advertising his use stem cells to treat lumbar and cervical disk problems, including degenerated and dehydrated disks. That alone was bad enough, but what elevated "Not-a-Dr." (my preferred translation of the "ND" that naturopaths like to use after their names to confuse patients because it's so close to "MD") Adelson above and beyond the usual naturopathic quackery is his cosplay of an interventional radiologist, in which he purchased a C-arm to use fluoroscopy to inject his "stem cells" right into the intervertebral disks of patients. In the meantime, I also reiterated just how much damage naturopaths do when they try to treat real diseases like cancer and how sensitive they are to having their quackery called out.
Getting back to naturopaths using what they claim to be "stem cell therapy," Not-a-Dr. Adelson is not alone among naturopaths in opening clinics devoted to isolating who knows what kind of cells from patients' bone marrow and/or adipose tissue and injecting them who knows were without any good evidence that they actually do anything. Sadly, they are like a lot of MDs in "regenerative medicine," only even less concerned about science. Indeed, I soon discovered that there are quite a few naturopaths out there offering prolotherapy and a variety of stem cell therapies, just like unethical MDs do. All I had to do was to Google "stem cells" and "naturopathy" to find a number of examples. For instance, the Stem Cell Rejuvenation Center in Phoenix is run by Not-a-Drs. Timothy Pierce, Jaime Ewald, and Julie Keiffer, who claim to be able to use stem cells derived from adipose tissue or isolated from bone marrow to treat autism, amyotrophic lateral sclerosis (Lou Gehrig's disease), cerebral palsy, degenerative disc disease, heart disease, muscular dystrophy, Parkinson's disease, stroke, spinal cord injuries, and, of course, erectile dysfunction, all for the low, low price of $7,100 for either adipose or bone marrow-derived stem cell treatments or the deal of $9,600 for both. What a bargain for something that hasn't been shown to work in clinical trials! And how on earth are naturopaths allowed to do bone marrow biopsies and liposuction to gather the marrow and adipose tissue, respectively upon which to work their woo? Well, in Arizona, minor surgery is within the scope of practice of naturopaths.
Elsewhere in Arizona, East Valley Naturopathic Doctors also offer "stem cell therapy":
This incredible advancement in natural healing means that stem cells can be harvested from a patient’s fatty tissue and reintroduced into that patient’s body. These stem cells have the ability to travel to areas of the body that have damaged tissues. The stem cells can then either instigate healing or actually transform into the type of cells needed to repair an injured area. The possible benefits of this kind of treatment are staggering!
Because the FDA has yet to approve this therapy, it cannot be said that stem cells are used specifically for the treatment of any disease. However, empirical evidence shows that this therapy is beneficial to people who suffer from many different illnesses, such as:
- Neurological diseases
- Chronic joint pain
- Autoimmune conditions
- Heart disease
- Pulmonary issues
How nice. It's basically a quack Miranda warning for their stem cell facility, Global Health Stem Cell & IV Therapy, run by two of the naturopaths there, Not-a-Dr. Jason Porter and Not-a-Dr. Julie Keiffer. Wait, didn't I just say that Keiffer works at the Stem Cell Rejuvenation Center, too? Wow. More cosplaying of real doctors, she must work at two different practices and out of two different stem cell centers. The ones listed on her website include East Valley Naturopathic Doctors, Valley Medical Weight Loss, and Peace Wellness Center, which appear to be where she sees patients. On her website, she advertises using platelet-rich plasma for the following purposes:
For Hair loss and hair thinning, PRP is injected into the scalp to stimulate the hair follicle strength. In addition to injections, Micropen™ with PRP topically assists with the stimulation of the hair follicle.
For sexual enhancement, the O-Shot® procedure for women and the Priapus Shot ® procedure for men, delivers PRP into the genitalia which may enhance sensitivity, strength and possibly size for men. For more detailed information refer to Patient Resources for links to desired sites.
Oh goody.
I could go on, but you get the idea. I've found naturopaths offering dubious stem cell therapies in Canada, Germany, California, Oregon, and all over. It's apparently becoming such a thing that actual MDs running dubious stem cell clinics are feeling threatened. For instance, here is Dr. Chris Centeno asking, "Should you let a naturopath stick a needle in your spine?" His answer is no, for many reasons that are correct:
Much has been made by naturopaths that their training is now equivalent to that of an MD or DO physician. However, some of the issues that came up in the recent board discussion were reports of naturopaths missing common medical side effects of spinal injections, like a dural leak. In fact, naturopaths were not even able to understand that this was a possible complication of the spinal injection procedure they performed. So how is it possible with all of the hours that naturopaths claim they train that they’re not able to conceptualize or catch a simple and common complication of spinal injection? The reason is contained in a simple statement made by one of our fellows.
A few weeks ago, we had a patient who needed to be checked for a postprocedure infection. I couldn’t see the patient, so I had one of our two fellows check him out. While all of the data looked like the patient didn’t have an infection, what the fellow told me verbally was important. He said that the patient “didn’t look toxic.” What the fellow meant was that after training in a large university medical center where he saw many patients who were infected and toxic, or “sick,” and many who were not, he was using that experience filtered through the large neural network in his head to rule out a pattern of patient characteristics that he had associated with patients who were sick, or toxic. These may be the paleness of the skin, a glassy look in their eyes, how they interact, and so on. Every MD or DO who trained in a large university medical center knows what that fellow meant. The issue with naturopaths, chiropractors, and acupuncturists is that they don’t train in these settings. So when they learn how to perform procedures that may injure patients and make them “toxic,” they have no way of knowing, despite many weekend courses, how a sick patient presents. Why? Most of their training is on well patients with chronic problems, like pain or irritable bowel disease or allergies, not on ill patients undergoing surgery in the hospital.
It's true. One of the most important skills we as physicians learn is how to recognize when a patient "looks sick," and by "looks sick" I mean sick enough that he's about to take a significant turn for the worse if something isn't done very soon. It's very much a skill that involves pattern recognition. It's hard to explain in words how to do it. I can list some of the characteristics we physicians look for, as Dr. Centeno did above, but in practice it's more of a gestalt, the recognition of several observations together that tell you the patient is doing poorly. As I point out, medicine should be based in science, but there are still skills in pattern recognition that are part of the art of medicine. Perhaps one day AI will be able to replicate the ability of an experienced clinician to recognize this constellation of observations that tell us that a patient, even one who might not appear that sick at the moment to an untrained observer, is about to get a lot sicker soon. This skill can't be learned quickly. It takes seeing a lot of patients, ranging from not-so-sick, to teetering on the brink, to having fallen over the cliff into life-threatening decompensation, and naturopaths simply do not see enough sick enough patients to develop that skill. (In fairness, some physician specialties never do, either, and I sometimes worry that it's been so long since I did general surgery that my skills in that area might have become rusty.)
Of course, Dr. Centeno is doing the very same thing naturopaths are doing; so, even as I agreed with everything he said about naturopaths and more, it was hard for me not to get the impression as I read his article that that he was far more about protecting his turf than he was about actually protecting patients. (If that weren't the case, Dr. Centeno wouldn't be selling expensive and unproven stem cell therapies for indications for which they remain largely untested and unproven, would he? He'd be doing real clinical trials to determine if they work, instead of what he is doing now.) Reading his op-ed, I have little doubt that he views these naturopaths offering stem cell therapies more as a threat to his business model, as competitors muscling in on his action, endangering his profits. Even as I agreed with what he wrote about naturopaths, I couldn't help but think that he's no better and in fact might be worse than the naturopaths doing stem cell therapy. After all, he has the training to know better, but apparently does not (or chooses not to). He's decided to forego all that pesky rigorous science and, instead of doing proper clinical trials, to forge right ahead selling his treatments using patient registry data and anecdotes. In this, he has a lot in common with the naturopaths he denigrates.
Indeed, when it comes to stem cells, I fear that we as MDs are teaching naturopaths our worst habits. For instance, look at the excuses made by this stem cell quack named Dr. Mark Berman, complete with a quack Miranda warning about his treatments, for charging big bucks to patients for what he openly admits are unproven therapies:
But a website for his Cell Surgical Network, an umbrella for dozens of stem cell clinics nationwide, lists more than two dozen other conditions the physicians are “currently studying,” including Parkinson’s, amyotrophic lateral sclerosis — more commonly called Lou Gehrig’s disease — congestive heart failure, lung disease, glaucoma, and muscular dystrophy.
The website is careful not to promise that the stem cell injections can cure or treat those diseases, and Berman said he makes it clear to all patients that the work is investigative and not FDA-approved.
Berman acknowledges that he has no published studies to back up his treatment. But he says he’s certain it works and is safe. As proof of his confidence, he notes that he used the therapy to successfully treat his wife for hip pain.
He says critics, including pharmaceutical companies and academics, want to profit by patenting stem cells and fear “disruptive technologies” that come from entrepreneurs rather than from their own incremental research.
I'd say that it's more like Dr. Berman not wanting to wait for that "incremental research" to determine whether the treatments he is providing patients actually work and are safe. He basically admits that he has no evidence other than his certainty that "it works and is safe." That's just not good enough, particularly if you're charging patients close to $9,000 a pop. I consider that to be unbelievably unethical, whether it's a naturopath doing it or an MD like Dr. Berman. They both claim to do tests to demonstrate that stem cells are present, but, absent their publishing their protocols, there's no way of knowing if they actually know what they're doing. I highly doubt they do.
In the end, naturopaths go where the ducks are, but, even more than that, they go where the quacking is the loudest. It doesn't matter if it's really "natural" or not. After all, in functional medicine what is "natural" about doing batteries of blood tests for dozens of hormones, nutrients, and other factors and then providing supplements and intravenous therapies to "correct" them all? What is "natural" about extracting fat and doing all sorts of manipulations to isolate individual cell types or doing bone marrow biopsies and isolating the stem cells, then reinjecting them? Of course, then there's the issue of whether what is being injected are really "stem cells" at all, which in many cases is highly doubtful given the lack of rigorous descriptions of the protocols used to isolate the stem cells. Stem cell clinics have become a profit train for unethical real doctors. Given that naturopaths are quacks who cosplay real doctors, it's not surprising that they'd cosplay the unethical ones too and jump on the gravy train.
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Damn. Arizona truly is a wild west for quacks.
Not-a-doctor Keiffer's biography on her web site is about as emesis-provoking as they come: "Doctor, scholar, humanitarian, athlete, wife and mother, Dr. Juile Keiffer grew up in picturesque rural Michigan.... [read the rest on empty stomach or 40 min s/p ondansetron]
Is there some central location that processes the bone marrow/blood/fat these quacks harvest to give them back their "stem cells"? And why do I have a bad feeling that such a place probably is just as quacky and unregulated as these naturoquacks?
My first thought on reading that: Jade Erick would probably be alive today if the not-a-doctor she was seeing had learned to recognize that pattern.
And I suspect that many of the stem cell treatments gone wrong went wrong because the attending not-a-doctor didn't recognize the pattern.
Speaking of pattern recognition: What is it with these quacks who feel compelled, as Keiffer does, to inform us that she is a "doctor, scholar, humanitarian, athlete, wife, and mother"? Is she trying to cosplay Buckaroo Banzai? Being a scholar might be relevant to being a doctor (Orac is both of those things), but why should I care that the person treating me is also a humanitarian[1], athlete, wife/husband, or mother/father? Those things have nothing to do with the quality (or lack thereof) of the treatment I would get from this provider.
[1]Assuming, of course, that she's not this kind of humanitarian (warning: TVTropes link).
Orac writes,
Perhaps one day AI will be able to...
MJD says,
One day, "Not-a-Dr." artificial intelligence (AI) may be able to invent and patent, compounds, product-by-process', methods, and articles that are revolutionary in the healthcare industry.
In simplicity, AI is a machine that can think, and think, and think to the nth power in a blink.
@ Orac,
Will "Not-a-Dr." AI be able to legitimize naturopathic medicine based on the infinitesimal effort of human naturopaths.
That's an impressive Galactus costume.
Hence they were forced easily by lucrative kickbacks to prescribe toxic drugs that barely worked at symptom suppression and often weakened the entire system plus the underlying cause especially with autoimmune diseases now all shown to be inextricably linked or caused by leaky gut.There would be no money in curing patients so by prescribing drugs that kept people sick big pharma stood to profit....the swathes of mindless mediocre folk who question nothing and believe everything were easily brainwashed by the media where there was limited access to biased information with only two tv channels...the internet has proven to work to their demise however where people are becoming more informed...if pharmaceuticals are the 4th leading cause of disease worldwide and three large independent Cochrane studies two mirroring exact findings in the 80s tconsistently found that only 10 percent of drugs on the market work then science has proven 90 percent of drugs still sold today dont work or kill..."do thy patient no harm" was replaced with "Kill thy patient if we doctors profit" and the Hippocritic oath was to define the entirety of Western medicine, most paradigms which have been totally debunked as bogus....if these watertight trials passed all these drugs as effective when nearly all dont work then science is totally useless at testing a simple drug vs placebo between groups design....yet it claims to be able to test complex heterogenous constructs where in this world most phenomenon exist in shades of grey on a continuum....in order to do a trial so many confounds need to be removed that the construct is completely lost and results meaningless...furthermore with no objective body to oversee the operations of science and disentangle it from the obvious pernicious tentacles of a greedy big pharma,politics,big business,vested interests,data fiddling suppression and only funding trials on drugs with a known likely outcome it is more subjective and biased than the very pseudoscience it critiques like naturopathy with a wide plethora of herbs and supplements clearly shown to work by Cochrane and passed with flying colours with no side effects.....whats more if you want to questiopn science your only option is to ask a scientist and many of them blinded and clouded by a dominant paradigm coupled with pride,ego and status simply ignore conflicting research because boo hoo their theory was wrong all along.Yet science claims to be the only reliable vehicle in the search for the truth...the real truth is that we are sold lies,kept in the dark and case closed medicated with drugs proven to kill...the ultimate quackery...the naturopaths they call quacks simply because they weren't taught about the fundamentals of preventative (and curative)medicine in medical school and because there's no money in natural remedies dont believe in something they know nothing about....a simple google search will inform them that many herbs work but ofcourse its quackery if toxic drugs arent the answer..there are actually hundreds....misteltoe when injected into pancreatic cancer cells in vitro kill this cancer (with a 5 percent mortality rate) dead in its tracks...curcumin and boswellia among other countless herbs reduce joint stiffness and swelling from arthritis ....fish oil thins the blood as effectively as aspirin and warfarin,reduces LDL cholesterol and high lipids,prevents and treats depression,ADHD and many other learning and neurological disorders and the list goes on....Germany leads the world in research on natural remedies where St John's wort only available on prescription effectively relives mild to moderate depression....5htp,Sam-e and Rodiola may be more effective for more severe forms....I could go on for days but the horse is dead and my whip broken...how ironic with all the deaths from pharmaceuticals,untold suffering,billions wasted on research into genetics,epigenetics and stem cell research that the answer to all diseases may just be regular consumption of tasty good quality yogurt.
Narad says,
Have I mentioned that I was an AI grad student? Oh, yes, I have. Even Roger Schank has abandoned the term (although the Yale school did leave behind the legacy of, ah, voice-based phone trees).
If there's anything simple here, MJD, it's to be had by use of a mirror.
In the dreams of its proponents, maybe. Not in the real world.
Computers will always do what you tell them to, not what you want them to. It turns out (and I have experience on this point from my own research) that teaching a computer how to do basic pattern recognition is quite a hard problem, because, as Orac mentions in the OP, it can be difficult to express in words how to recognize the pattern.
This is why I think self-driving cars are overhyped. I'll stipulate that 99% of what a driver does can be automated. The exact value does not matter, only that it is less than 100%. But the other 1% (or whatever the correct percentage is) of the time, you really want to have a human driving that car. There are some patterns to driving that I can explain: for example, if I am approaching a car from behind, I should change lanes if I can to overtake it, or else slow down so that I don't rear-end it. But other aspects are harder to explain, such as how to recognize that the idiot in the left lane will suddenly realize his exit is approaching and move across however many lanes of traffic to take that exit on the right (or vice-versa, if he is expecting an exit on the right and isn't aware that it's on the left). Or how to recognize that a pedestrian or animal is about to try to cross the road (pro-tip: if you are forced to decide between hitting a moose or a brick wall at highway speed, go for the brick wall as you are more likely to survive that collision). There are dozens if not hundreds of other situations a driver, whether AI or human, must be prepared to handle.
For similar reasons, I doubt that AI will replace medical doctors within my lifetime. Yes, there are routine procedures that can be automated. But every once in a while, something goes wrong, and when it does, you want a properly trained MD (not an ND!) available to stabilize the situation.
#5 Can't we at least have some fresh word salad?
@Avi Aronstan: if you have any ideas in that wall-of-text, I don't know what they are because you obviously don't understand enough about basic writing to use paragraphs.
That being the case, if you don't understand things we all learned in grammar school, I see no reason to trust your understanding of advanced educational matters.
Eric, case in point with object ID for self driving car. If system senses two similar size objects and knows it will hit one but avoid other how does it choose which it hits? Objects child and a dog. I don't think we have systems at this point capable of making the correct choice.
AVI you use all that crap, your choice. I'll use science based medicine and live. I am alive today because of science based medicine.
Well, I guess I can see why researchers would be hesitant in that case. What did they die of?
Narad, I wonder if any were named Loki?
@Avi Aronstan: if you have any ideas in that wall-of-text, I don’t know what they are because you obviously don’t understand enough about basic writing to use paragraphs.
I had to wonder whether "Avi" was someone's experiment in using a Markov chain to string together free-associational collections of alt-med Worship Words. It would have been cheating if the programmer had edited the resulting screed for better punctuation and paragraph formatting.
Avi: I wish your whip had broken after the first five words, because your horse is not only dead, it's zombified.
"... pancreatic cancer cells in vitro ..."
Pancreas of Glass Wasn't that a Blondie hit from about 40 years back?
Avi Aronstan: "a simple google search will inform them that many herbs work but ofcourse its quackery if toxic drugs arent the answer..there are actually hundreds"
Proof positive you are a fool. Google searches are not scientific research.
The required XKCD cartoon for Avi's cure for those doomed pancreatic cells in vitro:
https://xkcd.com/1217/
"the swathes of mindless mediocre folk"
We are NOT mediocre. :(
- and I'm sure you do.
.... and it would still be nonsense, Avi.
If only Winslow Homer had taken an interest in anatomy.
ORAC is a fucking moron. If you're only looking at the FDA for treatments to help people, you're dumb as shit. Try looking at what's going on in other countries you stupid bastard. Great article for spreading more big pharma propaganda.
Which country specifically, Matt, and what are they doing that is demonstrably more effective?
Matt, why do you think insults are a valid substitute for actual factual scientific evidence, or should even be part of mature debate?
How much are you being paid by the pharmaceutical industry?
Nothing, Gertrude. Are you paid by naturopaths or stem cell clinics or both?
And more to the point, can you provide any references for blinded controlled trials that show stem cell treatments work for any medical condition?
You mean other countries which are also cracking down on quack treatments?
Rich Bly: Actually Baldur's the one who got killed by mistletoe.
Name calling and put downs does not introduce proof of anything. I received a stem cell injection in my knee and was climbing Mt. Rainer a week later. To your point about Md being the only ones qualified to needle correcrly, that's rubbish. Initials alone does notcreate confidence and competence i an activiyy. Sills are learned through repetition. My shot was administered by a nurse. Dont get full of yourself. Any one with knowledge of anatomy and a steady hand can me at needeling basics in a weekend seminar.
Stem cells seem to have adversely affected your language skills.
The next round of coffee enemas are on Matt!