Athletes’ Use of Unproven Stem Cell Therapies: Adding to Inappropriate Media Hype?

Few areas of research have received as much attention from the popular press as stem cells. And it is no wonder. Stem cell research is extraordinarily promising, with the potential to produce groundbreaking therapies for a range of ailments. In addition, it has generated an exceptional amount of public policy controversy, attracting attention from presidents, prime ministers, legislators, and religious leaders throughout the world. Combined, the representations of the promise and perils of this area of scientific inquiry have made stem cell research nothing short of a pop culture phenomenon. But many have speculated that this hype can be a less than constructive force,1Caulfield T Condit C Science and the sources of hype.Public Health Genomics. 2012; 15: 209-217Crossref PubMed Scopus (89) Google Scholar contributing to numerous science policy challenges—including the growing market for unproven stem cell therapies. Over the past few years, a new dimension of science hype has emerged: the well-publicized use of stem cell therapies by high-profile athletes. Starting with the 2011 story of New York Yankee pitcher Bartolo Colon receiving cell therapy for a chronic shoulder injury2Kovaleski SF Baseball gets records on pitcher's procedure.New York Times. 2011; (13 July)Google Scholar and gaining momentum with the announcement of Peyton Manning's neck treatment in Germany,3Armstrong K Peyton Manning, Colts QB, underwent stem cell therapy in Europe for nagging neck injury: report.New York Daily News. 2011; (18 September)Google Scholar stories of athletes using stem cell treatments as a recovery aid have become common. This trend is problematic on a number of levels. As noted by numerous scholars, only a few stem cell therapies are currently supported by good scientific data.4Weissman I Stem cell therapies could change medicine…if they get the chance.Cell Stem Cell. 2012; 10: 663-665Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar,5Lau U Ogbogu B Taylor T Stafinski D Menon D Caulfield T Stem cell clinics online: the direct-to-consumer portrayal of stem cell medicine.Cell Stem Cell. 2008; 3: 591-594Abstract Full Text Full Text PDF PubMed Scopus (256) Google Scholar,6Regenberg A Hutchinson L Schanker B Mathews D Medicine on the fringe: stem cell–based interventions in advance of evidence.Stem Cells. 2009; 27: 2312-2319Crossref PubMed Scopus (104) Google Scholar However, despite this clinical reality, unproven stem cell therapies are being marketed to patients throughout the world. The clinics that offer these services often operate outside of ethical or regulatory oversight and exploit individuals at their most vulnerable by offering unproven treatments for incurable and debilitating diseases. Most professional athletes would try anything that promises a more speedy recovery after acute injury or the chance for “one more season” for those with chronic soft-tissue problems. This has given rise to an industry that has been roundly condemned by numerous scientific and professional organizations7Baker M Stem cell society condemns unproven treatments.Nat Rep Stem Cells. 2008; (26 June http://www.nature.com/stemcells/2008/0806/080626/full/stemcells.2008.98.html)Google Scholar yet profits from unsubstantiated claims of individual benefit. Media portrayals of athletes and public figures such as Bartolo Colon, Peyton Manning, and even Texas governor Rick Perry not only drive the market of stem cell therapies but also influence public opinion and science policy by implying the legitimacy of unproven and often unregulated treatments. What are the media saying? To get a sense of how the popular press is portraying this phenomenon, we did a search (using the Factiva database) for newspaper coverage of athletes who have used stem cell therapies. We found 88 original articles between 12 May 2011(the date of the first report, in the New York Times, of Bartolo Colon's procedure in the Dominican Republic) and 31 May 2012. The majority of articles (86%) were from the United States, but the trend also received coverage in Canada and the United Kingdom. Most of the articles (73%) do not even touch on whether there was evidence of efficacy. Given that these stories are generally about the use of stem cells as a therapy or training aid, silence on the evidence could be viewed as implying potential efficacy. Although several articles note that the treatment was probably ineffective (or unproven), an equal number (10%) explicitly describe the treatment as being effective. A large number of the articles (42%) mention a specific benefit—again, implying efficacy—and several (13%) quote a stem cell provider in support of the treatment. Only five articles (6%) mention any possible risk or safety concern, such as tumor growth, with stem cell treatment. In general, the use of stem cell therapies by athletes is portrayed in an uncritical manner and often as a cutting-edge therapy with career-changing potential (Box 1). Although there seems to be an increasing number of media reports that present a skeptical view of stem cell clinics and therapies, research has found that the popular press often present unproven therapies in a relatively positive light.8Zarzeczny A Rachul C Nisbet M Caulfield T Stem cell clinics in the news.Nat Biotechnol. 2010; 28: 1243-1246Crossref PubMed Scopus (53) Google Scholar Given the role of the popular press in the dissemination of information about health and science,9Bubela T Nisbet MC Borchelt R Brunger F Critchley C Einsiedel E et al.Science communication reconsidered.Nat Biotechnol. 2009; 27: 514-518Crossref PubMed Scopus (280) Google Scholar this tendency raises a number of challenging policy issues. Increased interest in the market for unproven therapies The market for unproven stem cell therapies is substantial. Although it is difficult to obtain data on the exact size of the industry, some have estimated that it has already affected tens of thousands of patients throughout the world (including a large percentage of children) and is worth hundreds of millions of dollars.10Nolen S The stem-cell black market: Delhi doctor claims wonder cure.Globe and Mail. 2010; (19 September)Google Scholar,11Kiatpongsan S Sipp D Offshore stem cell treatments.Nat Rep Stem Cells. 2008; (3 December < http://www.nature.com/stemcells/2008/0812/081203/full/stemcells.2008.151.html)Google Scholar In addition, it has been noted that, despite recent policy actions to address the problem—including steps by the US Food and Drug Administration12US Food and Drug Administration 2012 FDA warns about stem schemes http://www.fda.gov/forconsumers/consumerupdates/ucm286155.htmGoogle Scholar and international science organizations such as the International Society of Stem Cell Research7Baker M Stem cell society condemns unproven treatments.Nat Rep Stem Cells. 2008; (26 June http://www.nature.com/stemcells/2008/0806/080626/full/stemcells.2008.98.html)Google Scholar—the industry continues to thrive. One of the reasons, of course, is patient demand. This demand may be facilitated by media representations that promise potential benefits, even if the science does not support such claims. Research has shown that “famous athletes can have an important influence on the [public's] health-related knowledge, attitudes, and behavioral intentions.”13Brown WJ Basil MD Bocarnea MC The influence of famous athletes on health beliefs and practices: Mark McGwire, child abuse prevention, and androstenedione.J Health Commun. 2003; 8: 41-57Crossref PubMed Scopus (132) Google Scholar News coverage of baseball player Mark McGwire's use of steroids, for example, resulted in an increase in the stated interest in the substance.13Brown WJ Basil MD Bocarnea MC The influence of famous athletes on health beliefs and practices: Mark McGwire, child abuse prevention, and androstenedione.J Health Commun. 2003; 8: 41-57Crossref PubMed Scopus (132) Google Scholar Publicized use by well-known athletes can also influence perceptions of efficacy and safety.14Kuehn BM Teen steroid, supplement use targeted.JAMA. 2009; 302: 2301-2303Crossref PubMed Scopus (5) Google Scholar,15Perko M Bartee R Dunn M Wang M Eddy JM Giving new meaning to the term “taking one for the team”: influences on the use/non-use of dietary supplements among adolescent athletes.Am J Health Studies. 2000; 16: 99-106Google Scholar,16Rosenfield C The use of ergogenic agents in high school athletes.Am J Lifestyle Med. 2011; 5: 320-327Crossref Scopus (9) Google Scholar Indeed, it is likely that the reported use of stem cell therapies by athletes adds to the allure of the technology, making it appear more innovative and currently useful. This seems particularly true given the absence of critical analysis in most of the recent stories. Box 1Sample quotations from news media“The resurgence of one previously out-of-work major league pitcher has increased demand for a controversial new procedure utilizing stem cells that could usher in advances in athletic-injury treatment so effective they seem to turn back the clock.”—Erik Malinowski, “Stem cells hold promise for injured athletes, but questions remain,” Wired, 24 May 2011“I know it worked for him, and maybe people will be motivated to bring it over here.”—Susan Slusser, “A's Colon is an entertaining set of contradictions,” San Francisco Chronicle, 31 May 2012“‘A lot of National Football League players, and Olympic athletes as well, get the one-day procedure done so they can play the rest of the season and come back in the off-season to get the more mature stem cells,’ Graves pointed out.”—Dwayne Erickson, “Graves earns special invite,” Calgary Herald, 5 April 2012“There have been comments that within two to three years there won’t be any need for knee and hip replacements; that stem cell therapy will become a viable alternative.”—Dwayne Erickson, “Graves counts on stem cell therapy to repair ankle,” Calgary Herald, 13 March 2012“‘I feel in my heart and my soul, his performance has been because of the treatment,’ Liriano said. ‘You see that his fastball is about 95 or 96 miles per hour. It is a miracle, no?’”—Serge F. Kovaleski, “Pitcher's treatment draws scrutiny,” New York Times, 12 May 2011 (first reported story of athlete getting stem cell therapy) “The resurgence of one previously out-of-work major league pitcher has increased demand for a controversial new procedure utilizing stem cells that could usher in advances in athletic-injury treatment so effective they seem to turn back the clock.” —Erik Malinowski, “Stem cells hold promise for injured athletes, but questions remain,” Wired, 24 May 2011 “I know it worked for him, and maybe people will be motivated to bring it over here.” —Susan Slusser, “A's Colon is an entertaining set of contradictions,” San Francisco Chronicle, 31 May 2012 “‘A lot of National Football League players, and Olympic athletes as well, get the one-day procedure done so they can play the rest of the season and come back in the off-season to get the more mature stem cells,’ Graves pointed out.” —Dwayne Erickson, “Graves earns special invite,” Calgary Herald, 5 April 2012 “There have been comments that within two to three years there won’t be any need for knee and hip replacements; that stem cell therapy will become a viable alternative.” —Dwayne Erickson, “Graves counts on stem cell therapy to repair ankle,” Calgary Herald, 13 March 2012 “‘I feel in my heart and my soul, his performance has been because of the treatment,’ Liriano said. ‘You see that his fastball is about 95 or 96 miles per hour. It is a miracle, no?’” —Serge F. Kovaleski, “Pitcher's treatment draws scrutiny,” New York Times, 12 May 2011 (first reported story of athlete getting stem cell therapy) Legitimization of unproven therapies When athletes or professional sports teams work with clinics or suppliers, it may serve to legitimize unproven treatments in the eyes of the public. It can help to create the impression that these are efficacious treatments that, for a number of reasons (such as allegedly inappropriate regulatory hurdles), are available only to those with the resources to access them. This view is facilitated by commentary in the sports media17Perez AJ Athletes go to great lengths for recovery.Fox Sports. 2011; (7 October < http://msn.foxsports.com/nfl/story/American-athletes-go-to-great-lengths-to-recover-from-injury-100611)Google Scholar and the blogosphere. For example, the author of an editorial on a popular sports website, Bleacher Report, states that he has observed a number of athletes get “stem cell treatments and universally each one improved dramatically.”18Barling M Stem cell and platelet-rich plasma (PRP) treatments.Bleacher Report. 2011; (http://bleacherreport.com/articles/857012-stem-cell-and-platelet-rich-plasma-prp-treatments)Google Scholar He also suggests, with a bit of conspiratorial flavor, that “thanks to a ban on stem cell research in the United States, American medicine is 10–15 years behind stem cell research in Europe” and that “in an effort to cut off athletes from embarrassing American medicine, doctors are questioning stem cell and other sports medicine procedures.” Such accusations are ridiculous, of course. But they serve to create a narrative that can be used by clinics to market unproven treatments. Clinic websites throughout the world often refer to the use of stem cell therapies by famous athletes. For example, one links to an example of “Professional Athletes Seeking Stem Cell Treatment Abroad,”19Affordable Stem Cell Therapy 2011 Retired NFL great Bart Oates has joined the lineup of professional athletes seeking stem cell treatment abroad http://www.affordablestemcelltherapy.com/cell-medicine/retired-nfl-great-bart-oates-has-joined-the-lineup-of-professional-athletes-seeking-stem-cell-treatment-abroad.phpGoogle Scholar and another states that stem cell procedures allowed an injured player to return to the National Football League.20Regenexx Jarvis Green gets contract with Houston Texans, attributes it to Regenexx stem cell injections. 2010; (http://www.regenexx.com/2010/12/jarvis-green-gets-contract-with-houston-texans-attributes-it-to-regenexx-stem-cell-injections)Google Scholar One company's website goes so far as to suggest that stem cell therapy will play a significant role in the performance of “American athletes vying for the gold.”21Martin A Coxe F Stem cell therapy plays a crucial role for athletes in the 2012 Olympic games: Kobe Bryant, Dara Torres, and David Payne.MetroMD Inst Regen Med. 2012; (http://metromd.net/stem-cell-therapy-plays-a-crucial-role-for-athletes-in-the-2012-olympic-games)Google Scholar Conclusion It is well known that professional athletes will do almost anything to keep a competitive edge or speed recovery from an injury. These characteristics make them an ideal market (and, one could argue, a vulnerable market) for unproven treatments such as those promoted by stem cell clinics throughout the world. Although use of these therapies creates a range of problems for the athletes in question (e.g., safety concerns), the trend has broader policy ramifications. The problems associated with the promotion of unproven stem cell therapies have been well documented.5Lau U Ogbogu B Taylor T Stafinski D Menon D Caulfield T Stem cell clinics online: the direct-to-consumer portrayal of stem cell medicine.Cell Stem Cell. 2008; 3: 591-594Abstract Full Text Full Text PDF PubMed Scopus (256) Google Scholar,6Regenberg A Hutchinson L Schanker B Mathews D Medicine on the fringe: stem cell–based interventions in advance of evidence.Stem Cells. 2009; 27: 2312-2319Crossref PubMed Scopus (104) Google Scholar,22Ryan KA Sanders AM Wang DD Levine AD Tracking the rise of stem cell tourism.Regen Med. 2010; 5: 27-33Crossref PubMed Scopus (96) Google Scholar Indeed, it has emerged as one of the most significant science policy issues in the realm of regenerative medicine and stem cell research. There seems little doubt that the publicized use of these therapies by famous athletes helps to promote use and legitimize both the procedures and the relevant clinics. This seems particularly worrisome at a time when public representations of efficacy have already been confused by ongoing public debates about how best to translate and regulate the use of emerging stem cell technologies.23Lysaght T Campbell A Regulating autologous adult stem cells: the FDA steps up.Cell Stem Cell. 2011; 9: 393-396Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar The scientific community needs to provide a clear and consistent message—as many are now doing4Weissman I Stem cell therapies could change medicine…if they get the chance.Cell Stem Cell. 2012; 10: 663-665Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar—about the actual, nascent state of stem cell research. In addition, we need independent and accurate information for both the public and health professionals about the risks and limitations associated with the services provided by stem cell clinics. And, given the uniquely influential position of high-profile athletes in this context, the scientific community should consider reaching out to professional sports teams and sport associations. Given that they have much to gain from proven and efficacious therapies, these organizations should be encouraged to support scientific research and to counter unjustified media hype by responsibly communicating to the public what we currently know and don’t know about stem cells. We thank Malcolm Brenner for encouraging this piece; Christen Rachul, Zubin Master, and Lisa Belanger for their research assistance; and the Stem Cell Network (Networks of Centres of Excellence Canada) and the Cancer Stem Cell Consortium for funding support.

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