Medical tourism is a new phenomenon that has been widely misunderstood. At its core, patients who need a specific and often expensive type of medical care─ such as surgery or cancer treatment─ will sometimes leave their domestic health network to have the procedure performed abroad. In the United States, this is an attractive option for people who cannot afford domestic medical fees. Conversely, patients in other countries may travel to medically-advanced countries, such as the United States, to receive a higher-quality or uncommon treatment. When properly informed, these patients receive a great standard of care.
Recently, the advent of stem cells has shifted the discussion regarding medical tourism. Stem cells are the body’s means of regeneration, and they naturally exist within many organs. They can be artificially derived from adult tissues (i.e. bone marrow) but also from embryos that are unused in in-vitro fertilization (IVF). Because many diseases are the result of cell death or improper cell programming, the use of stem cells as a tool to create healthy cells within the body has limitless possibilities.
While stem cells are an object of fascination among scientists and the general public, the FDA-approved treatments that directly use stem cells are meager. These treatments use multipotent stem cells in umbilical cord blood to exclusively treat blood-related diseases. Other treatments, such as CAR-T and cartilage injections, are stem-cell-derived, meaning that the injected cells are no longer stem cells. There are also clinical trials that test new stem cell treatments for certain ailments, though these trials are infrequent and often highly selective.
Thus, a large market is created by people seeking to have their diseases cured by stem cells. Thousands have traveled across the world in recent years to receive clinical treatments that are both costly and are not necessarily effective. Athletes seek out bone and muscle treatments, while others look for solutions to grim prognoses from spinal cord injury, psychological disorders, and other diseases.
These treatments are costly, risky, and exist in a legal gray area.
This new, stem-cell-specific medical tourism involves the injection of patient-derived or external stem cells to boost regeneration and repair within the body. Most of these stem cell injections were considered harmless for years; because the human body is inclined to kill off foreign cells, stem cells from a different organ or from another person would be ineffective. Stem cell clinics usually embellish their treatments to maximize the placebo effect, giving their customers a false sense of satisfaction. In the event that a patient sees through the facade, the extensive use of waivers keeps these clinics out of any legal confrontation.
Unfortunately, a recent study by UConn Health says otherwise. An AAN approved survey of 204 neurologists reports that 88.8% have encountered patients who are interested in stem cell therapies. Of these professionals, 64.5% have encountered patients who have actually undergone these therapies. Neurologists have reported dozens of negative outcomes from these therapies, including malignant tumors, sepsis, and worsening of existing conditions. Yet, many of them don’t feel equipped to advise patients about stem cell tourism.
Neurological treatments, while not entirely representative of “stem cell tourism” as a whole, provide insight into the main reason these treatments exist: a last resort. For diseases like spinal cord injury, multiple sclerosis, and Alzheimer’s Disease, there are few FDA-approved options for treatment. The available treatments tend to be either time-intensive or an incomplete cure. Thus, it is natural for a patient to come across a clinic website advertising the mystifying power of stem cells and jump at the opportunity. While it is not as prevalent in stem cell tourism, a large theme in medical tourism is the inability to afford domestic treatments. Patients with chronic conditions, however, often see stem cell tourism as a one-time cost to alleviate a permanent financial burden.
Stem cell tourism has grown into an issue that extends past science and into the spheres of policy, education, and law. The first line of defense against these unauthorized clinics is medical societies, governed by the Oath of Hippocrates. The Code of Ethics for the American Society for Biochemistry and Molecular Biology encourages “practices that enhance the public interest or well-being,” which can be interpreted in multiple ways by physicians. Many physicians feel empowered in administering treatments that patients can’t find anywhere else, a practice prevalent in stem cell tourism.
Suggestions from the sideline won’t be enough to remedy the situation; a global system of accountability is necessary for patient safety. For example, the International Council on Harmonisation (ICH) is an organization that already links translational research scientists to develop international standards of care. Special attention by the ICH and similar organizations toward cell therapies can create stronger regulation. The International Society for Stem Cell Research (ISSCR) has published at length about the dangers of stem cell tourism. While it has a strong reputation on the international stage, organizations are at the mercy of individual governments to make change.
There is much work to be done on both the U.S. national and international fronts to uphold the integrity of science against stem cell tourism. When doctors fly above the law to administer unapproved treatments, especially in the field of stem cells, they take advantage of patients that are desperate for treatment. This will require collaboration between countries at all levels of economic development to generate a unified effort to protect patients. The international organizations are already positioned to give widespread oversight to the issue; the responsibility lies with legal agents across the world to recognize the severity of this issue and address it with the available means.