Stem cell tourism and Canadian family physicians.

The provision of unproven stem cell–based treatments by clinics in countries around the world—a phenomenon that has been called stem cell tourism— is a growing trend with implications for both the practice of family medicine and the health and safety of the Canadian public.1* Canadians place trust in their family physicians, who have a central role in continuity of care. This empowers Canadian family physicians to address many of the social and clinical challenges created by stem cell tourism. When individuals interested in pursuing these treatments consult their family physicians, an invaluable opportunity is presented to provide information about the treatments’ very real potential harms and limitations. This exchange is necessary for physicians seeking to act in the best interests of their patients and to support patient autonomy in decision making, particularly in light of the poor quality of information made available by many of the clinics offering such treatments. Discussion of relevant considerations in assessing unproven therapies is particularly important when children or other individuals without decision-making capacity are involved. These groups are particularly vulnerable, and children appear to account for a meaningful proportion of the individuals receiving these treatments.2 Few areas of biomedical inquiry hold as much potential as stem cell research. If research in this area progresses as hoped, cell-based therapies for a range of disorders might one day become available. However, at the current time, apart from a few limited applications (eg, hematopoietic stem cell transplants for leukemia, epithelial stem cell–based transplants for burns, some treatments of corneal disease or injury), stem cells are not ready for routine clinical use. Indeed, while the promise is immense, a “large gap still exists between scientifi c knowledge and clinical translation for safe and effective stem cell–based therapies.”3 Despite this scientifi c reality, clinics around the world are leveraging the high profi le of this exciting fi eld and advertising unproven stem cell–based treatments for a range of conditions in a direct-to-consumer manner, usually via Internet marketing. There is no credible peer-reviewed evidence that the treatments offered by these clinics are safe or effective.4 They come at considerable fi nancial cost, averaging around $30 000 per treatment,5 often excluding the cost of travel and accommodation. Given the early state of stem cell science and the large amount of money involved in the stem cell tourism market, it seems safe to conclude that many of these clinics are knowingly exploiting vulnerable individuals by providing misleading or insuffi cient information about the effi cacy (or lack thereof) and potential risks of the treatments offered. In some cases this conduct is likely fraudulent, in others reckless, and in others perhaps merely irresponsible. At the very least, until there is credible evidence of the safety and effi cacy of these treatments, it remains a highly questionable and concerning practice. It is unlikely that many Canadian physicians have had the opportunity to become equipped with sufficient knowledge of the stem cell tourism phenomenon to be able to offer their patients meaningful advice. In this brief commentary, we provide key points Canadian physicians can use to arm both themselves and their patients with the information necessary to make decisions that are as informed as possible. These points draw both on the existing literature on stem cell tourism and on emerging policy statements and patient resources (Boxes 1 and 2). It is not possible to address all potentially relevant topics in this forum. As is true in other areas, it is important that physicians act within the limits of their knowledge, skill, and judgment, which might mean acknowledging a lack of relevant expertise and working with patients to identify the appropriate experts and resources to consult. Ultimately, physicians who encounter the issue of stem cell tourism should strive to remain continually cognizant of their professional, legal, and ethical duties to their patients, particularly to minor patients and patients without decision-making capacity.