I’ll start posting something relevant at your benefit. Actually I posted similar things in the past in this very same forum, maybe even in this very same thread, but I don’t mind repeating.A Case Study In Aggressive Quackery Marketing
With some degree of sadness I recently “outed” a former co-resident of mine who has turned to the dark side and begun putting money-making before truth and science. Without any clear evidence of benefit beyond placebo, platelet-rich plasma (PRP) is now being marketed aggressively as a cure-all for sports injuries. And at about $300 per injection (the NYT reports $2000/treatment), there’s plenty of money to be made.
Like the fake “stem cell” clinics in Russia (where, according to Sanjay Gupta’s recent book, Chasing Life, a person’s fat cells are harvested, washed, and re-injected into their blood stream), PRP also involves injection of autologous body fluids. Essentially, a small amount of blood is drawn from the patient, centrifuged, and the plasma supernatant is then injected directly into tendons and/or joints. After a series of 3 injections (one/month), most sports injuries are “cured.” Of course, most injuries would heal themselves in three months anyway.
It was bothersome enough that Steve Sampson, D.O., began a practice in Los Angeles, catering to those who could afford to do more than the usual RICE (rest, ice, compression, elevation) therapy for sports injuries. But now a nation-wide marketing initiative has begun, using sports celebrities as guinea pigs.
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Notice how this wonderful treatment is not only useful for superstar athletes, but also for seniors and weekend warriors. Yes, the market for PRP is almost unlimited! And aren’t I lucky, there’s a “leading practitioner” of PRP right here in Washington, DC. Now I too can jump start and strengthen my body’s natural curative signals.
Ugh.
As with the most successful forms of pseudoscience, there may be a grain of plausibility here. Knowing that human plasma does in fact contain growth factors that are implicated in wound healing – it’s not complete fantasy that injection of said factors may improve injuries in some way. So I decided to take a fresh look at Medline to see what sort of evidence there may be for the therapy. In my search I found:
1. One abstract discussing PRP’s use in degenerative knee arthritis. The study is not available for review in its entirety – but the abstract suggests that an improvement was noted at 6 months (in pain scores) with a significant worsening at month 12. No control group.
2. One small study that did not find a benefit to ACL healing in the presence of PRP.
3. Quite a number of studies related to the treatment of bone defects (mostly periodontal) with PRP. Most of those showed no improvement or a fleeting, temporary improvement with PRP.
Overall it seems that the dental and oral and maxillofacial surgery literature has found no use for PRP, and the orthopods simply haven’t paid too much attention to it.
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A Case Study In Aggressive Quackery Marketing | Science-Based Medicine
’PRP an unproven option, agree forum experts
By Mary Ann Porucznik
An international group of orthopaedic surgeons, clinician scientists, and researchers agreed that, for many orthopaedic conditions, administration of platelet-rich plasma (PRP) may be an option, but its efficacy is unproven.
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’About Stem Cell Treatments
1. Are stem cell treatments dangerous? Can stem cells cause cancer?
Every medical procedure has risks. A goal of clinical trials is to determine if the possible benefit of a treatment outweighs the risks. A possible risk of some stem cell treatments may be the development of tumors or cancers. For example, when cells are grown in culture (a process called expansion), the cells may lose the normal mechanisms that control growth or may lose the ability to specialize into the cell types you need. Also, embryonic stem cells will need to be directed into more mature cell types or they may form tumors called teratomas. Other possible risks include infection, tissue rejection, complications arising from the medical procedure itself and many unforeseen risks
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4 4. I talked with a clinic that said it would be isolating a type of stem cell called a mesenchymal stem cell from bone marrow, fat or blood. The doctor says that these cells will turn into the type of cells that are needed to treat my condition (heart cells/brain cells/liver cells). Is that correct?
Mesenchymal stem cells are known to form cartilage, bone and fat. What other roles these cells may have is controversial in the scientific community. There is insufficient evidence to show that these cells can differentiate into other cell types, and they have not been shown to be to be safe and effective for many of the conditions for which some clinics claim to utilize them.
2. Are treatments using my own (autologous) stem cells safe? Why should these be regulated?
While your own cells are less likely to be rejected by your immune system, this does not necessarily mean the cells are safe to use as a therapeutic treatment. The methods used to isolate, modify, grow or transplant the cells may alter the cells, could cause infection or introduce other unknown risks. Transplanting cells into a different part of the body than they originated from may have unforeseen risk, complications or unpredictable outcomes………’
Phys Ed: Does Platelet-Rich Plasma Therapy Really Work?
By GRETCHEN REYNOLDS
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Several new studies have examined whether P.R.P. is effective outside the lab, and as Leon Creaney, a sports-medicine consultant in London and the author of one of the papers, said, “the evidence has not been favorable” for P.R.P.
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Perhaps the most telling of the new studies, by Dr. Creaney and his colleagues, has been accepted by The British Journal of Sports Medicine and will published online soon. In it, scientists treated people suffering from refractory tennis elbow with either P.R.P. or injections of whole blood. Whole blood contains far fewer growth factors than P.R.P. Presumably, then, injections of blood would not accelerate and amplify healing in the same way as P.R.P. But the whole blood turned out to be as effective as P.R.P. at treating tennis elbow after three months, and more so at six months. Both treatments reduced pain in most volunteers (whose tennis elbows had not responded to physical therapy). But in the end, the lower concentration of platelets and growth factors in the whole blood was better. “ ‘Less,’ ” the authors write, “may in fact be ‘more.’ ”
This finding is in line with that of another study reported this month in The British Journal of Sports Medicine. The sequel to a much-discussed experiment from last year, it re-examined patients with Achilles tendinopathy (an overuse injury of the Achilles tendon) who had been randomly assigned to receive injections of either P.R.P. or a placebo of saline solution. In the original study, the patients were assessed after six months and the researchers found no statistical difference between the two groups’ recoveries. Now an additional six months later (meaning a year after treatment), the results were the same. Salt water worked as well as high-tech P.R.P., prompting the authors to conclude that there is “no evidence for the use of platelet-rich plasma injection in chronic Achilles tendinopathy…..”
Phys Ed: Do Blood Injections Help Sports Injuries? - The New York Times
