Costa Rica’s Health Ministry has shut down the ICM Clinic (aka Cell Medicine), an enterprise that has served as a popular medical tourism site and treated more than 400 non-Costa Rican patients with stem cells since it opened in 2006. According to Reuters, the Health Ministry’s Research Council chief, Dr. Ileana Herrera, made the decision based on the lack of scientific proof for the therapies used at the clinic. According to Cell Medicine, the institute “pro-actively and independently” made the decision to close the clinic in response to the “unpredictable and arbitrary regulatory landscape.” In any case, Cell Medicine is not out of business, and plans to move its patient load to its larger facilities in Panama City. I think this case is a perfect example of how government regulation can only shift, not stop, the spread of stem cell medical tourism.
Medical tourism is already a billion dollar industry, with millions of patients around the world traveling outside their country of origin in search of quicker, cheaper, or less than legal treatments. As we discussed earlier in the year, stem cell therapies are beginning to become regular features at medical tourism sites, granting access to the technology ahead of regulatory approval from agencies like the US FDA. The trend demonstrates that growing public demand cannot be met by current supplies of government approved stem cell therapies, which in many parts of Europe and the US are only available as part of clinical trials. Clearly patients are going to push for access to stem cell therapies in the face of what they see as a slow-moving and restrictive approval process.
Of course, the question remains as to what medical tourists will actually receive when they travel for stem cell therapies in other countries. In the case of the ICM Clinic/Cell Medicine, it’s not easy to tell. Like many such facilities, they have plenty of anecdotal evidence to support their treatments, with a YouTube channel full of testimonials. They have a decent list of peer-reviewed papers on their site (many published in Translational Medicine). And their disclaimer page, though a little buried in the site design, is upfront about the expectations and limitations of their treatments. I couldn’t independently verify costs for the procedure, but Reuters quotes a patient at having spent around $30,000 on their visit to the Costa Rican facility.
However, it’s clear that their main mode of operation is to extract stem cells, isolate them, and then re-inject them all in the same session. In other words, there seems to be no multiplication/culturing of stem cells to reach a higher dose level (judging by statements in the FAQ and elsewhere on the Cell Medicine site). I am clearly unqualified to comment on whether or not culturing of stem cells is required for optimal therapy, but it seems that most of the successful stem cell research I’ve seen has either a) used growth factors/proteins to attract stem cells to a site in the body or b) cultured high number of stem cells (millions or more) and then injected them into the target area. Again, it’s just my layman opinion, but if you’re not doing a) or b) then I don’t see how you are providing the body with something it did not already have in the same levels before the treatment. Perhaps Cell Medicine’s process is raising the concentration (but not total level) of stem cells in a particular region of the body? Again, it’s a little unclear.
Whether or not Cell Medicine’s approach to stem cell therapy makes sense to me, they have enough anecdotal evidence to fuel continued interest in their facilities. The newer location in Panama City has attracted more than 150 guests since it opened in 2007, and the Cell Medicine site mentions intentions to expand. Related projects are likewise set for expansion. Neil Riordan, one of ICM’s founders, is also behind Aidan Products, which sells a supplement to increase blood stem cells. He’s also the founder of MediStem, a US company looking to commercialize stem cell therapies derived from menstrual blood. Cell Medicine and the clinics in Costa Rica and Panama look to be international off shoots of MediStem.
It matters quite a bit to the individuals who participate in stem cell medical tourism as to whether or not they are receiving an effective treatment. To the rest of the world, however, it is not the success (or failure) of these treatments which mark their importance, it is the growing investment in and demand for their use. Costa Rica applied pressure to shut down the Cell Medicine facility in that country and in response the company simply shifted their focus to their even bigger facility in the next country over. Governments around the world are unlikely to be able to keep their citizens from accessing these technologies in some fashion or another.
It would seem to be an economic truth that sufficient demand will create a ‘black market’ for any product even in the face of government regulation. Stem cell treatments are clearly in that realm for the present time. It’s really hard to know whether these cutting edge facilities that provide these stem cell opportunities are pioneers or pirates. I have seen a few clinics (such as the one in Colorado) which are very likely providing a real scientifically-based therapy, but the majority are likely to be frauds (either through implicit or self-deception).
Which seems to be a good reason for regulatory agencies to do their absolute best to speed up the research into stem cells. Don’t get me wrong, approving treatments prematurely would be a mistake, but providing patients with access to clinically tested stem cell therapies as soon as possible seems to be the only way to keep them from trying more dubious treatments. I hope that Costa Rica’s decision to shut down the ICM Clinic is met by an equally decisive action to fund and accelerate research into stem cell therapies. The same goes for the rest of the world. Our citizens want these treatments, and if we are to shut down access in one facility because of health concerns we also have a duty to do our best to quickly open new facilities which can provide stem cell therapies backed by all the rigors of science. Realistically, it may take years for that to happen, but let’s aim to make it as few years as possible.