Ath­letes us­ing unproven stem cell ther­apy

The Prince George Citizen - - Sports - Liz SZABO Kaiser Health News

Base­ball su­per­star Max Scherzer ,whose back in­jury will pre­vent him from pitch­ing for the Wash­ing­ton Na­tion­als un­til Mon­day, is the lat­est in a long list of pro­fes­sional ath­letes to em­brace unproven stem cell in­jec­tions in an at­tempt to ac­cel­er­ate their re­cov­ery.

But many doc­tors and ethi­cists worry that pro ath­letes who have played a key role in pop­u­lar­iz­ing stem cells are mis­lead­ing the pub­lic into think­ing the costly, con­tro­ver­sial shots are an ac­cepted, ap­proved treat­ment.

“It sends a sig­nal to all the fans out there that stem cells have more value than they re­ally do,” said James Rick­ert, pres­i­dent of the So­ci­ety for Patient Cen­tered Ortho­pe­dics, which advocates for high-qual­ity care. “It’s ex­tremely good PR for the peo­ple sell­ing this kind of thing. But there’s no ques­tion that this is an unproven treat­ment.”

Stem cells and re­lated ther­a­pies, such as platelet in­jec­tions, have been used for the past decade by top ath­letes like golfer Tiger Woods, ten­nis pro Rafael Nadal, hockey leg­end Gordie Howe, bas­ket­ball player Kobe Bryant and NFL quar­ter­back Pey­ton Man­ning. Stem cells are of­fered at roughly 1,000 clin­ics and some of the most re­spected hos­pi­tals na­tion­wide. De­pend­ing on the treat­ment, the cost can range from hun­dreds to thou­sands of dol­lars. In­sur­ance does not cover the treatments in most cases, so pa­tients pay out of pocket.

Yet for all the hype, there’s no proof it works, said Paul Knoepfler, a pro­fes­sor of cell bi­ol­ogy and hu­man anatomy at the Univer­sity of Cal­i­for­nia at Davis School of Medicine. Re­fer­ring to Scherzer, Knoepfler said, “There’s re­ally not much ev­i­dence that it’s go­ing to help him, other than as a psy­cho­log­i­cal boost or as a placebo ef­fect.”

Scherzer, 35, said he re­ceived a stem cell shot Fri­day for a mild strain in his up­per back and shoul­der. Ac­cord­ing to a news story on the Ma­jor League Base­ball web­site, Scherzer also pre­vi­ously had a stem cell in­jec­tion to treat a thumb in­jury.

If Scherzer’s di­ag­no­sis is cor­rect, it should com­pletely heal it­self with 10 days of rest and he would prob­a­bly feel ready to play by Mon­day even with­out the stem cells, Rick­ert said. “The risk from the stem cell pro­ce­dure is that it could give some­one a false sense of con­fi­dence, and they could go back to play too early,” and rein­jure them­selves, he said.

A spokes­woman for the Wash­ing­ton Na­tion­als de­clined to pro­vide in­for­ma­tion about Scherzer’s treat­ment, such as the type of stem cells used or the name of the clin­i­cian who ad­min­is­tered them.

Clin­ics that of­fer stem cell treatments pre­pare in­jec­tions by with­draw­ing a per­son’s fat or bone mar­row, then pro­cess­ing the cells and in­ject­ing them back into aching joints, ten­dons or mus­cles.

An­other pop­u­lar treat­ment in­volves con­cen­trat­ing platelets, the cells that help blood clot. Many peo­ple con­fuse platelet in­jec­tions with stem cell in­jec­tions, per­haps be­cause the shots are pro­moted as treatments for sim­i­lar con­di­tions, said Kelly Scol­lon-Grieve, a phys­i­cal medicine and re­ha­bil­i­ta­tion spe­cial­ist at Premier Orthopaedi­cs in Haver­town, Pa.

When it comes to pain, in­jec­tions can act as pow­er­ful place­bos, partly be­cause suf­fer­ing pa­tients put so much faith in treat­ment, said Ni­cholas DiNu­bile, an or­tho­pe­dic sur­geon and former consultant for the Phil­a­del­phia 76ers. In a re­cent anal­y­sis, more than 80 per cent of pa­tients with knee arthri­tis per­ceived a no­tice­able im­prove­ment in pain after re­ceiv­ing a placebo of sim­ple salt­wa­ter shots.

Team doc­tors of­ten treat ath­letes with a va­ri­ety of ther­a­pies, in the hope of get­ting them quickly back on the field, said Arthur Ca­plan, direc­tor of the divi­sion of med­i­cal ethics at New York Univer­sity School of Medicine. Ath­letes may as­sume that stem cells are re­spon­si­ble for their re­cov­ery, when the real credit should go to other reme­dies, such as ice, heat, non­s­teroidal an­ti­in­flam­ma­tory med­i­ca­tions, cor­ti­sone shots, mas­sage, phys­i­cal ther­apy or sim­ple rest.

“These are the richest, most highly paid ath­letes around,” Ca­plan said. (Scherzer and the Nats agreed to a $210 mil­lion, seven-year con­tract in 2015.) “So any­thing you can think of, they’re get­ting. But I wouldn’t use them as a role model for how to treat in­juries.”

While ath­letes of­ten talk about their stem cell treatments, Ca­plan said he won­ders, “Would the in­flam­ma­tion or prob­lem have just gone away on its own?”

Sports fans shouldn’t ex­pect to have the same re­ac­tion to stem cells – or any med­i­cal in­ter­ven­tion – as a pro­fes­sional ath­lete, DiNu­bile said.

In gen­eral, ath­letes re­cover far more rapidly than other peo­ple, just be­cause they’re so young and fit, DiNu­bile said. The genes and train­ing that pro­pelled them to the ma­jor leagues may also aid in their re­cov­ery. “They have ac­cess to the best care, night and day,” DiNu­bile said.

When­ever a top ath­lete is treated with stem cells, word spreads quickly on so­cial me­dia. Fans of­ten end up do­ing the stem cell in­dus­try’s mar­ket­ing for them: A 2015 anal­y­sis found that 72 per cent of tweets about Gordie Howe’s stem cell treatments were pos­i­tive. Of 2,783 tweets stud­ied, only one men­tioned that Howe’s treat­ment, de­liv­ered in Mex­ico after Howe’s stroke, was un­proved and not ap­proved by the U.S. Food and Drug Ad­min­is­tra­tion. Howe died in 2016.

The Mexican stem cell clinic pro­vided Howe’s treat­ment at no charge. Clin­ics use such do­na­tions as a form of mar­ket­ing, be­cause they gen­er­ate price­less pub­lic­ity, said Leigh Turner, an as­so­ciate pro­fes­sor at the Univer­sity of Min­nesota’s Cen­ter for Bioethics who has pub­lished ar­ti­cles de­scrib­ing the size and dy­nam­ics of the stem cell mar­ket.

“Clin­ics pro­vide free stem cell treatments or of­fer pro­ce­dures at a discounted rate, and in re­turn they can gen­er­ate YouTube tes­ti­mo­ni­als, press re­leases and pos­i­tive me­dia cov­er­age,” Turner said. “It’s also a good way to build re­la­tion­ships with wealthy in­di­vid­u­als and get them to re­fer friends and fam­ily mem­bers for stem cell pro­ce­dures.”

AP PHOTO

Wash­ing­ton Na­tion­als start­ing pitcher Max Scherzer throws to the Colorado Rock­ies in the third in­ning of a base­ball game July 25.

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