Patient behavior and precautions in stem cell therapy, the perfect storm

In a recent perspectives article in the New England Journal of Medicine (link below), a warning was issued for the use of stem cell therapy.  “Off label” claims for the benefit of stem cell therapy (for example in orthopedic treatments) currently lack evidence for effectiveness and in some cases (as outlined in the article) stem cell therapy has been shown to be harmful.

When claims for benefit of any treatment are publicly and direct to consumer advertised and viewed by suffering people, the initial reflex is to believe and pursue the treatment. This tendency flushes out 3 types of patient behaviors that challenge and sometimes frustrate clinicians.  The first type is the patient who will honestly ask their health care team for a recommendation regarding pursuing a novel treatment and then in a shared decision making fashion agree upon a measured course of action.   The second type is the patient who is not really influenced by these claims and remains generally skeptical and may ask for health care team input but does not feel the input is needed.  The third type of patient is the one who puts themselves in danger, vicariously practicing medicine upon themselves through their primary health care team by seeing them as rubber referral stamp for whatever it is they want to pursue, or worse, pursuing the treatment on their own and expecting the primary team to post validate whatever may be needed in terms of testing, follow up or complication management (especially if the experimental treatment happens out of town).

In considering the stem cell therapy precautions from the FDA in this article, it may be helpful to reflect on which type of patient we are;  reasoned, disinterested or prejudiced. A “flashy” treatment being pursued by a prejudiced patient is truly the medical perfect storm.

The FDA on stem cell treatments

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