What are your thoughts on stem cell therapy for joints, and also Mesoblast?

[Alakazam123]

I've been lurking on this end of the forum, and have been keeping up to date with pharma research in my spare time. It seems that stem cells are the general direction in which things are headed (as Siddhartha Mukherjee predicted a few years back).

However, I've seen stem cell therapies for joints and orthopedic conditions to be met with skepticism on this forum. May I know what it is that bothers you about it?

Do you feel that "interventional orthopedics" will ever become a thing? Or is this the next Theranos level scam?

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[studentdocg]

So far the evidence shows that it works mostly as a strong anti-inflammatory. We have much cheaper anti-inflammatory medicines to offer people. Right now it's an exponential increase in cost for a small fractional improvement in benefit.

 

[Alakazam123]

So far the evidence shows that it works mostly as a strong anti-inflammatory. We have much cheaper anti-inflammatory medicines to offer people. Right now it's an exponential increase in cost for a small fractional improvement in benefit.

Thank you!! So basically, to early to say anything huh?

Do you think "interventional orthopedics" will be a thing? Like what happened between cardiology and CT surgery, only this time between PM&R and Orthopaedics?

 

[DOctorJay]

it's already a thing
https://interventionalorthopedics.org/

 

[Alakazam123]

it's already a thing
https://interventionalorthopedics.org/

Will this do to ortho what interventional cards did to CT surgery?

 

[drusso]

Will this do to ortho what interventional cards did to CT surgery?

Can you imagine an alternative?

 

[Alakazam123]

Can you imagine an alternative?

Can I PM you?

 

[drusso]

Can I PM you?

Sure, but I think it’s a rich and productive conversation to have in public too.

 

[Ferrismonk]

So far the evidence shows that it works mostly as a strong anti-inflammatory. We have much cheaper anti-inflammatory medicines to offer people. Right now it's an exponential increase in cost for a small fractional improvement in benefit.

I've been reading and going down the rabbit hole here too, although I currently don't do any regenerative stuff. Maybe someone else can clarify, but I believe the whole point is to promote (healthy) inflammation, not be "anti-inflammatory".

 

[Alakazam123]

Sure, but I think it’s a rich and productive conversation to have in public too.

PM'd you. check ur inbox.

 

[studentdocg]

I've been reading and going down the rabbit hole here too, although I currently don't do any regenerative stuff. Maybe someone else can clarify, but I believe the whole point is to promote (healthy) inflammation, not be "anti-inflammatory".

Immunosuppression by mesenchymal stem cells: mechanisms and clinical applications

Everything I've read has stem cells decreasing inflammation. Lots of stuff calls it immunomodulatory, but then the modulation is always a decrease. Could be wrong though

 

[Gauss]

Will this do to ortho what interventional cards did to CT surgery?

last time I checked CT surg wasn't making their PA's do caths while they're in the OR cracking chests. ortho will never give up anything that can generate money

 

[drusso]

last time I checked CT surg wasn't making their PA's do caths while they're in the OR cracking chests. ortho will never give up anything that can generate money

The cost of orthopedic surgery is unsustainable given the outcomes...

 

[nvrsumr]

Ortho Surgeons have the most effective lobby in medicine

 

[Alakazam123]

Do you think they'll ultimately incorporate any "interventional" methods into their day-to-day practice? Much like how NSG has incorporated interventional neuroradiology, and all.

 

[Ducttape]

they already do.

 

[Gauss]

Ortho Surgeons have the most effective lobby in medicine

most effective lobby in hospitals & health systems. admin literally craps their pants when they see their OR and office billing. Add in their midlevels doing interventional and cash based procedures in office while they're in the OR and you have admin begging for more orthos.

The cost of orthopedic surgery is unsustainable given the outcomes...

irrelevant, nothing will change so long as they are a cash cow. look at spine surgery, when will that change? we've been waiting for 20-25 years. and that is US healthcare in a nutshell

 

[drusso]

most effective lobby in hospitals & health systems. admin literally craps their pants when they see their OR and office billing. Add in their midlevels doing interventional and cash based procedures in office while they're in the OR and you have admin begging for more orthos.



irrelevant, nothing will change so long as they are a cash cow. look at spine surgery, when will that change? we've been waiting for 20-25 years. and that is US healthcare in a nutshell

Hardly irrelevant...intervening early in the course of MSK injuries, offering aggressively conservative care, orthobiologics if indicated, and supervised rehab spares patients unnecessary surgery and the risk of poor outcomes.

How Employers Are Fixing Health Care

"Almost half of the Walmart associates who had spine surgery or a medical evaluation without surgery from 2015 to 2018 did so at a COE site. That group, totaling 2,300 patients, was divided equally between men and women, and most were 50 to 64 years old."

"Eighteen percent of the Walmart associates who had joint replacement surgery from 2015 to 2018 had it at a COE site. Roughly two-thirds of these 1,836 patients were women, and most were 50 to 64 years old. Here, too, COE specialists headed off unnecessary procedures, having determined that many patients would not benefit more from surgery than from more-conservative treatments, such as physical therapy, or had health reasons that rendered surgery inadvisable."

 

[dmk5n]

Wow, the family docs out-donate the ortho docs.
Lobbying Spending Database Health Professionals, 2018 | OpenSecrets

 

[oreosandsake]

In this context, it may be best to remove the words "inflammatory" and "anti-inflammatory" out of your vocabulary.

better words would be Anabolic and Catabolic.

the healing cascade starts with an inflammatory process. but that is a non-specific term for "on fire" there is a lot going on that was poorly described/understood when these terms were put into the vernacular.

if you get an infected wound, and part of the tissue becomes necrotic... you will need to breakdown and take away that necrotic tissue. at some point, there is wound healing, tissue remodeling, and deposition of new tissue.

the same happens when someone survives a myocardial infarction.

 

[Alakazam123]

In this context, it may be best to remove the words "inflammatory" and "anti-inflammatory" out of your vocabulary.

better words would be Anabolic and Catabolic.

the healing cascade starts with an inflammatory process. but that is a non-specific term for "on fire" there is a lot going on that was poorly described/understood when these terms were put into the vernacular.

if you get an infected wound, and part of the tissue becomes necrotic... you will need to breakdown and take away that necrotic tissue. at some point, there is wound healing, tissue remodeling, and deposition of new tissue.

the same happens when someone survives a myocardial infarction.

The question remains on what happens to ortho as a field, and if it's going to shrink and succumb to the advent of interventional therapies.

 

[drusso]

The question remains on what happens to ortho as a field, and if it's going to shrink and succumb to the advent of interventional therapies.

 

[blockstar]

This field has SOOOOOO far to go before putting a dent in ortho.

All Ive seen is either BM aspirate or lipo spin and add some enzymes to extract cells which are then immediately injected. Damn near seems like voodoo.

Until more advancements are made to increase amt of cells and quality of cells injected doesnt seem to be a threat to surgery.

 

[Alakazam123]

I guess they can incorporate it into their practice as NSG has with interventional neuroradiology/endovascular neurosurgery.

 

[lobelsteve]

Elite Hospitals Plunge Into Unproven Stem Cell Treatments

Critics are concerned about the explosion in controversial stem cell procedures offered by clinics — and, increasingly, respected hospitals.

news.doximity.com

 

[deleted131481]

ASIPP has a pretty good review article looking at biologics and evidence for spine interventions (mostly weak as expected).

PubMed

PubMed® comprises more than 38 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full text content from PubMed Central and publisher web sites.

www.ncbi.nlm.nih.gov

:::::Pain Physician:::::

I think the evidence is stronger for joints but not sure. I've come across a few articles here and there. Does anyone have a good review article for biologics and joint injections?