I recall in the 1967 movie, "The Graduate" someone slips Dustin Hoffman's character of a recent college graduate a tip about what will be hot in the future. The older man whispers, "Plastics." I imagine now that any doctor-in-training, or new medical school graduate, might hear a similar phrase, "Stem Cells." If you google those two words you will get 80,700,000 link suggestions. That's not as many "joint replacement" or "Donald Trump", but still impressive. Having graduated from medical school 43 years ago, I have had to read about this more on-line than in medical journals. A stem cell is an undifferentiated cell of a multicellular organism that is capable of giving rise to indefinitely more cells of the same type, and from which certain other kinds of cells arise by differentiation. So like the stem of a tree it can grow more stems, leaves, and fruits. However, these primitive cells can also be stimulated in the proper environment to grow into different mature or adult cells. Kind of like asking the stem of an orange tree to produce mangos. Which brings me to my knee.
Being physically active has taken its toll on my joints. I recently tore a meniscus, (of which there are two), in my right knee. After a steroid injection and an MRI, I found out the other meniscus was shot as well. Think of the menisci as shock absorbing tissues or plates between your upper and lower leg. Without them you will have bone crunching on bone when you stand walk, jog, bike or just about anything where you ask your legs to bear weight; so they are kind of important. It has been estimated that over 30% people over the age of 65 have at least one torn meniscus and don't know it. Although rehab and injections help, over the past few decades it has become popular for an Orthopedic surgeon to stick a scope in your knee joint and clean and trim parts of the meniscus. Actual repair is more difficult and is usually left to younger athletes. But if you are removing part of the shock absorber, how does that help your joint and pain?
As it turns out, multiple studies now show that when compared to conservative therapy, that is rehab, Tai Chi, etc vs meniscus surgery, the results were about the same. My first orthopedist said he could operate; however, since he failed to tell me about my second chronically torn meniscus after reading my MRI, I did not have a great deal of confidence in him. My next stop was to a local medical school university hospital staff member who said he wouldn't operate on me unless all else failed and I could isolate my pain to one spot. I could not.
Thus we now come to stem cells. As a doctor and scientist, I abhor anecdotes. I prefer rigorous trials to see if something works on a disease or ailment. However, my pain and limited activity upstaged my medical mind. I got to reading and hearing cases where stem cell injections into joints gave new "life" to affected patients. Since stem cells can be harvested in three ways, it is difficult to do controlled studies. Say for example you wanted to see if a cholesterol pill lowered cholesterol levels and prevented heart attacks and death, you just do a trial or study. You would take a known medication and quantity and give it, or a placebo, to patients in similar groups and follow them. Cholesterol levels, heart attacks and death rates are pretty "hard" or objective study endpoints. But how do you study joint pain? It is known that giving someone a placebo, or sugar pill, helps ~50% patients. And although stem cells have been "approved" by the FDA, that just means they are determined to be safe when used in narrow conditions, and only when harvested from a certain source. And how do you know if the product you are taking really contains stem cells? And how many are there going into your joint? In two words, "you don't." Injections are not covered by most insurances and are very expensive. The FDA is in fact trying to crack down on rogue clinics with many charlatans now hawking the treatment as curing everything from autism to erectile dysfunction. Some scammers have already been fined millions of dollars for fraudulent claims and injections.
My knee was injected ten days ago with stem cells harvested from amniotic fluid during a C-section. The hope is that these tiny guys will stay in my knee joint and volunteer to become new meniscus cells and then eventually tissue. It does feel better, but I am continuing Tai Chi and exercises hoping for the best. I will keep you posted.