Honestly, I don’t like to talk much about stem cell politics, ethics, regulations and big business. I’d love to focus on analysis of scientific work or clinical studies. But sometimes, some things piss me off so badly, so, I can’t keep my mouth shut. Commercialization or branding of name “stem cell” is one of these things.
Making the “stem cell” label
Stem cells are everywhere guys. Everywhere you go, everywhere you look. There are “stem cell nutrition” and “stem cell cosmetics”. There are “stem cell business” and “stem cell treatments” available anywhere around the world. Each scientific and clinical conference includes a “stem cell” section now. Every second doctor thinks of it or gets asked about it by patients. Our brains are entirely washed by “stem cell marketing” somewhat aggressively selling us this “panacea/ magic/ breakthrough/ revolution”. It’s so obvious to me that “stem cell” label has become a very powerful marketing tool. Just put this label everywhere if you want to increase sales of your product.
While sitting in the morning session at the Understanding Stem Cell Controversies course currently taking place in Calgary, I was introduced to a new adjective in the stem cell lexicon — branded (and, oddly enough, this descriptor was used by two presenters, Brian Kwon and Timothy Caulfield). Can a word, typically attached to such concepts as corporate identity and customer loyalty, be used in relation to the broad field of stem cells? Of course it can. There may not be a logo to solidify that brand, but the adjectives I listed are, in essence, the brand of stem cells.
At the heart of this morning’s discussions was the use (or misuse) of the stem cell brand not just to sell stem cell products such as face creams and spa treatments, but also to instil a belief that stem cell therapies are a routinely available and the best choice to be made in treating otherwise incurable injuries or disease. As an orthopaedic surgeon, Brian Kwon noted that “every one of my patients asks about stem cell treatment”. (watch video here)
Marketers and mass media
I’d say bogus “stem cell therapy” clinics and mass media reporters contribute the most to “stem cell branding”. First of all, therapy sellers, motivated by profit, quickly figured out that if they put a “stem cell” label everywhere, sales will increase. Doesn’t really matter what they inject, they use the notion that any cell suspension from any organ or tissue must contain stem cells. And of course if it heals, it’s because of stem cells in suspension. More than that, even if they don’t inject any cells at all, they can claim that they boost your endogenous stem cells (aka “natural healing power”). Yet another extreme of this business – “stem cell cosmetics” and “stem cell nutrition”. In other words – the use of the label. Unfortunately, some category of people, at some period of time will buy this bullshit. In order to get a sense of the scale of “selling power of stem cells” for profit, I’ll refer you to Douglas Sipp’s review:
The concept of stem cells has been adopted in an aggressive and widespread manner by providers of unproven medical treatments.
Use of the term ‘stem cells’ has evolved into a powerful meme in the marketing of human or animal cell-based treatments, supplements and cosmetics, with associations of health, youth and beauty. Over the past 10 years, a new alternative medicine sector has sprung up to meet consumer demand for healthcare, nutritional and esthetic ‘stem cell’ products, and it appears that business is for the most part, good. This may be in part due to the acceleration of demand by incautious statements by scientists in the field, or uncritically positive descriptions of the therapeutic potential of stem cells in the mass media.
A huge involvement of mass media in this marketing scam, I’ll illustrate by two fresh examples:
1. Recent (Fibrocell) approval of autologous fibroblasts for wrinkle treatment was presented by Bloomberg as “stem cell therapy breakthrough”.
2. Spray-on device for application of skin cells on the burn surface. In the video episode, National Geographic’s reporter (marketer) and patient (brain washed victim) call it “stem cell therapy”. But scientist-developer is avoiding this and use more accurate term “skin cells”.
The bottom line: Mass media and “stem cell clinics” presented any kind of “cell therapy” as “stem cell therapy”. This is entirely wrong and directed only for increased sales and audience attention.
The role of professionals (clinicians and scientists)
I am really puzzled by the widespread use of the term “stem cells” for the cell therapies utilized total mononuclear cell (MNC) fraction of bone marrow or cord blood. Physicians love to call it “stem cell therapy” when they use bone marrow MNC, even though they have no evidence whatsoever what type of cells underlie the therapeutic effects. The presence of stem cells in the cell suspension that you injecting into the patient, does not make it “stem cell therapy”! For example, even though there are some circulating hematopoietic stem cells in one unit of banked blood product, blood transfusion is not a “stem cell therapy”. The same thing applies to cord blood and bone marrow. I believe that many therapeutic effects of MNC could be explained by presence of lymphoid cells, monocytes, endothelial cells and progenitors, but not just stem cells. Unfortunately, many physicians naively rely on the presence of CD34+ or cells expressing mesencymal stem cell markers in MNC. Again, the presence of cells in suspension, carrying CD34 or MSC, doesn’t make it “stem cell therapy”.
Scientists seem to understand the difference between stem cells, progenitors and mature specialized cells. But, for some reason, some of them would pitch “stem cell” label everywhere. Some of them would say: “Stem cells and progenitors is a continuum, what is the point to define them and call by different names for public?” There are many points guys, but at least for sake of anti-marketing, please admit a difference between stem cells and progenitors and use the appropriate terms.
Couple of examples:
1. Conventional rotator cuff repair complemented by the aid of mononuclear autologous stem cells. The authors use “stem cell” term in the title, but in procedure clearly describe isolation of total bone marrow MNC by density centrifugation.
2. Long-term follow-up of patients with ischemic heart disease treated with stem cell therapy. The same thing here – “treated with stem cells” in the title, but “treated with bone marrow MNC” in the description.
But there are many examples of correct use of terms – look at this trial.
To illustrate how professionals exploited “stem cell” label in clinical trials database, I’d quote a part of Sipp’s review, where he linked to the article of bioethicist Chris Scott – The Language of Hope: Therapeutic Intent in Stem-Cell Clinical Trials
Scott et al. found that descriptive terminology in registered clinical trials of the use of stem cells in heart failure tended to be more likely to foster “therapeutic misconception,” in which an experimental procedure of undetermined clinical efficacy is described in such a way as to suggest that it is efficacious, than drug trials for the same condition.
I wonder why professionals can’t come to consensus and use the same language? By not doing it they are fueling marketers and mass media with misleading statements. Marketers are very good at picking up “stem cell in the title mistakes” and transforming it in profitable business.
Recently, I was happy to learn that some professional societies actually worry about this widespread “stem cell branding” trend. For example, American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS) recently has released a position, where they highlighted the importance of appropriate use of terms:
– Terms such as “stem cell therapy” or “stem cell procedure” should be reserved to describe those treatments or techniques where the collection, concentration, manipulation, and therapeutic action of the stem cells is the primary goal, rather than a passive result, of the treatment. For example, standard fat grafting procedures that do transfer some stem cells naturally present within the tissue should be described as fat grafting procedures, not stem cell procedures.
– The marketing and promotion of stem cell procedures in aesthetic surgery is not adequately supported by clinical evidence at this time.
I’m with you guys!
Guys, please use “cell therapy” term if you’re not sure what type of cells in your suspension underlie the mechanism of therapeutic action. All cells in suspension together could do the “magic”, but again, it’s not the reason to call it “stem cell therapy”. Please don’t use “stem cell therapy” term for bone marrow or cord blood MNC in regenerative medicine, unless you provide the evidence. Please, raise these questions at professional meetings and conferences. Please, facilitate discussions and come to consensus of using the same professional language around the world. I’m proposing anti-marketing movement here. I don’t want a “stem cell” to become a label and marketing tool. I think, it discredits science and evidence-based medicine relying on therapeutic use and promise of stem cells.