Editor’s note: The following content was published in the AAOS Now Special Edition and distributed in June 2020. The content was originally scheduled for the AAOS Now Daily Edition, which publishes each year onsite at the AAOS Annual Meeting but this year’s meeting in March was canceled due to COVID-19. Despite the cancellation, members can access virtual content from the Annual Meeting by visiting the Academy’s Annual Meeting Virtual Experience webpage.

More healthcare practices are offering stem cell therapy (SCT) as part of their services for musculoskeletal treatments. A recent study evaluated the currently available information provided in direct-to-consumer (DTC) advertising of these therapies that target patients with musculoskeletal pathologies. The researchers came to the conclusion that a lot of misinformation regarding SCT exists in DTC advertising. The results of the study were presented as part of the Annual Meeting Virtual Experience.

“The concept for this study was born four years ago out of frustration with the website content of practitioners offering what they call ‘SCT,’” study author Joanne Halbrecht, MD, of Coeur d’Alene Orthopedics and Sports Medicine, told AAOS Now. “Misinformation regarding mechanism of action, injection content, indications, and efficacy was abundant. It was clear that those who are not surgeons try to create fear of surgical complications or lack of trust in surgeons to convince patients to receive unproven and, in many cases, illegal therapies, making wild promises to ‘grow a new joint,’ prevent the need for ever having surgery, or promising ‘100 percent success.’”

As research began to unearth the potential for misinformation surrounding SCT in the musculoskeletal sphere, Dr. Halbrecht said, “We sought to assess these claims and concerns in more detail to increase physician and consumer awareness by classifying, quantifying, and analyzing them.”

The study authors expanded on a list of keywords from a study by Turner et al., to conduct a Google search. A single rater assessed the relevance of each site’s URL, title tag, and short description. A subset of 30 websites was randomly selected and evaluated by three independent raters, and each site underwent a more in-depth assessment by one of the three raters. Relevant websites advertised the use of SCT in any form to U.S. patients with musculoskeletal pathology. Websites were excluded if they advertised practices outside of the United States, SCT use for nonmusculoskeletal pathology only, veterinary practices, or nonclinical companies.

The 95 keywords yielded 20,685 evaluable search results; final analysis included 896 unique practice websites. Nearly all of the practice websites (95.9 percent) featured at least one statement of misinformation (mean, 4.65). About a third of practices (34.0 percent) were orthopaedic surgery.

“Based on the sample of practices included in this study, a third of the practices offering ‘SCTs’ for musculoskeletal pathology are associated with an orthopaedic surgeon,” study author Matthew T. Kingery, BA, of NYU Langone Orthopedics, told AAOS Now. “The included practices were also frequently associated with physical medicine and rehabilitation and internal medicine physicians. However, a significant percentage of the marketing was found to be from practices associated with physicians whose scope of specialization does not include musculoskeletal pathology, as well as nonphysicians such as chiropractors and ‘naturopaths.’”

When controlling for effects of other specialties, practices associated with an orthopaedic surgeon had about 22 percent fewer statements of misinformation compared to practices without an associated orthopaedic surgeon.

A limitation of the study is that it did not include every practice with relevant DTC advertising information; however, the researchers believe their study evaluated a representative sample.

Mr. Kingery’s coauthors of Paper 244, “Online Direct-To-Consumer Advertising of Stem Cell Therapy for Musculoskeletal Injury and Disease: Misinformation and Violation of Ethical and Legal Advertising Parameters,” are Lauren Schoof, BS; Eric J. Strauss, MD; and Joseph A. Bosco, MD.

Kaitlyn D’Onofrio is the associate editor for AAOS Now. She can be reached at kdonofrio@aaos.org.

References 

1. Turner L, Knoepfler P: Selling stem cells in the USA: assessing the direct-to-consumer industry. Cell Stem Cell 2016;19:154-7.