Stem cell therapy: It's getting rave reviews...but where's the data?
It’s getting towards the end of the year. That means lots of top ten lists and product reccs in advance of the holidays. This list, over at FastCompany magazine’s website, took things a little further by including whiz-bang veterinary products and services along with pricey niceties like GPS collars and pet-dedicated flights. Nestled among these was Vet-Stem’s product: stem cell therapy for the dog that has everything...even osteoarthritis.
It seems stem cell therapy for ailing pets continues to gain momentum as as way to treat painful joints not amenable to surgical intervention or when surgery is deemed too invasive or stressful. Its success in the equine world for the same indications means that there’s reason to believe it’ll work for pets. Problem is, the literature is still sketchy.
Part of the problem is that we have only a very rudimentary understanding of how stem cells––harvested from a patient’s own fat and injected back into joints––can help reduce the pain and swelling located there. It makes some sense from a 30,000 foot vantage point...but not so much at the nit-picky cellular level.
But the larger problem lies in the lack of evidence on behalf of the product's efficacy. While a reasonable cluster of these exists for the equine community, only two canine studies have thus far been conducted. And I’m less than impressed. Though peer-reviewed, both were undertaken by the company that holds the patent on the process (Vet-Stem): One on the efficacy of the procedure in canine elbows included only 14 patients, while the hip disease study boasted little better with a sample size of 21. Each found the statistics as favoring the procedure...but not by a wide margin.
And still clients clamor for it. Even upon learning that stem cell therapy is an expensive, hit-or-miss prospect with very little research to back up its success in dog joints, they demand it.
And why shouldn’t they? If the alternatives don’t sound appetizing and the risk of the procedure (a two-step anesthetic process for fat collection and subsequent joint injection) seems more about their wallets than its inherent dangers to their pets, I can see why Fluffy’s owners might prefer it to a full-on hip replacement. But then, we know a whole lot more about hip replacements than we do about stem cells.
Which gets me to wondering...why is the state of veterinary research in such sad shape that we have to rely on companies to fund their own studies? I understand the economics that lie beneath, but I can’t help think there has to be a better way.
For example: With as many canine patients receiving stem cell therapy for their joints, how is it that they’ve not been tracked and monitored and their anonymous data compiled by an independent source? After all, owner reluctance would almost certainly prove no barrier.
While I certainly understand the high price of conducting prospective studies, it would seem that veterinarians, owners and the company would all have a stake in furthering research and share the burden to varying degrees. I mean, how hard is it to creatively organize a decent trial...with a reasonable sample sizes...with acceptable control groups (e.g., dogs who receive NSAIDs instead of stem cells)?
It’s a problem that dogs human medicine along with our side of things. And yet it’s rare that creative solutions arise to tackle even the seemingly simple task of compiling outcome data retrospectively. And why? In my opinion it’s largely because medicine prefers to outsource the study of emerging therapies like this one to the capitalist projects perceived to have most to gain from their outcome. But this represents a catch-22, doesn’t it? Who among us would wholly respect clinical data when it’s compiled by the most financially invested party?
In Vet-Stem’s case it’s their downfall in my eyes. But it needn’t be their undoing. What would it take to require that company-certified (yet independent) clinicians collect key data points in exchange for certification? That’s how Penn-HIP works. That’s the kind of initiative some vaccine companies take before they widely distribute their biologicals.
To my way of seeing things, our veterinary research needs to get lots more creative before we can get to where we’re going with a minimum of R&D outlays that serve only to raise the price of the product at the expense of the data’s credibility. Maybe what the veterinary industry needs is the occasional workings of a practical brain to dot their DVM/VMD ranks with a dash of simple strategic thinking. Maybe then veterinarians like me would be more willing to recommend the potentially masterful bit of veterinary innovation Vet-Stem offers.