Many clinicians are providing patients with unproven stem cell interventions, according to a research letter published in JAMA, and many of these interventions are outside of the scope of the clinician’s training.

Researchers used data from a 2016 study that conducted a systematic internet search and content analysis to determine the characteristics and scope of training of clinicians who were performing unproven stem cell procedures in the direct-to-consumer marketplace. The initial study identified 351 companies marketing unproven stem cell procedures at 570 clinics. These clinics were primarily concentrated in California, Florida, and Texas. The researchers excluded companies that had stopped marketing these procedures by January 2018. Using company websites, researchers extracted characteristic and training data for identified professionals. State medical board-licensing databases were compared with data from the Federation of State Medical Board Physician Data Center to confirm qualifications.

In total, 166 of 183 identified companies continued to advertise unproven stem cell procedures in 2018. These companies accounted for 608 identified clinicians, of whom 66% were physicians (91.5% men, 80.5% with US medical training).

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The most common nonphysicians associated with these clinics were physician assistants, nurses, and complementary and alternative medicine practitioners. Five of the clinics were only staffed with podiatrists, 2 with naturopaths, 1 with dentists, and 1 with practitioners who had unclear qualifications. Four of the 20 total types of physician residencies were identified, including orthopedics, anesthesiology, physical medicine and rehabilitation, and family medicine (30.8%, 15.9%, 10.8%, and 10.4%, respectively). Twenty-five different fellowships were also represented, including orthopedics, sports medicine, and pain medicine (28.5%, 24.3%, and 21.8%, respectively).

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Only 52% of the 157 companies with physicians on staff had at least 1 physician who had been formally trained in the conditions the companies claimed to treat. Orthopedic-focused practices typically had 1 or more physicians with the appropriate specialty training (77% of practices).

Limitations of the study included the assessment of data from only 3 states and the lack of inclusion of physicians who entered the marketplace after 2016. Additionally, the scope of training was potentially underestimated.

The researchers of the study concluded that “State medical boards should consider investigating licensees suspected of violating professional standards when providing unproven stem cell interventions, especially those advertising treatment outside their scope of training.”


Fu W, Smith C, Turner L, Fojtik J, Pacyna JE, Master Z. Characteristics and scope of training clinicians participating in the US direct-to-consumer marketplace for unproven stem cell interventions. JAMA. 2018;321(24):2463-2464.