Bartolo Colon, Stem Cell Pioneer?

According to the New York Times report, Colon received stem cell therapy treatment last April in the Dominican Republic from Joseph Purita, a Florida-based orthopedic surgeon. The cells in question were bone marrow stem cells, reportedly taken from Colon’s hip (so none of the ethical issues involved with embryonic stem cells are present in the Colon case).

Let’s get a couple of issues out of the way first. Baseball has no rule prohibiting a player from receiving stem cell treatment. Stem cells are not classified as performance-enhancing drugs, not by baseball or by any other sport.  The only possible controversy here is that Dr. Purita admits to treating other patients with Human Growth Hormone (HGH).  Dr. Purita denies treating Colon (or for that matter, any other professional athlete) with HGH. There’s no evidence that Colon received HGH.

So: why would the New York Times use the term “disputed treatment” to describe the stem cell treatment received by Colon?  In order to seek an answer to this question, let’s dive deeper into the story.

Let’s start with stem cells. Stem cells are the body’s “master cells” – they are unspecialized cells that under the right conditions can become more specialized cells, such as blood, brain, heart, muscle or bone cells.  Stem cells have received attention because they may someday be used to replace damaged cells for patients with spinal injuries, burns, heart disease, diabetes and other serious diseases. But stem cells may also become useful in treating less life-threatening conditions, such as those that imperil the careers of athletes like Colon.

The theory behind the treatment given to Colon appears to be this: stem cells may cause an injured body part to heal itself mostly with normal cells, and with reduced formation of scar tissue. Stem cells appear to work this way when they are used to treat tendon injuries in horses. In humans, two of the more promising stem cell therapies for injured athletes are treatment of the anterior cruciate ligament in the knee and the treatment tried by Colon, on the shoulder’s rotator cuff.

As I mentioned above, stem cells are not considered to be a “performance-enhancing drug” (PED). But stem cells do share properties associated with certain PEDs: specifically, stem cells may allow athletes to recover more quickly from injury. In this sense, stem cells may provide the kind of benefit that Andy Pettitte reportedly was looking for when he used HGH in 2002 to try to recover from an elbow injury.

Of course, it’s possible for athletes today to use PEDs to recover from injury, or to treat a legitimate medical condition. All the athlete needs is a ”therapeutic use exemption” – a properly documented doctor’s note substantiating the athlete’s medical need to take the otherwise prohibited drug. Problem is, PEDs like HGH have never been proven to help athletes recover from injury, so no therapeutic use exemption will be approved today for an injured athlete to use HGH.

The situation with stem cells is different because, as we noted above, stem cells are not classified as performance-enhancing drugs, so MLB has (as far as I can tell) nothing to say about them. In contrast, the U.S. government has a great deal to say about stem cells, and as a result there are presently few forms of stem cell therapy available for patients in the United States. So in order to receive stem cell therapy, many U.S. patients travel to clinics or hospitals outside of the United States.

(Please note, I am not an expert on stem cell therapy, or the laws governing stem cell therapy. The law here is more than I can possible master in an evening! There appears to be some controversy over the legality of a U.S. doctor treating a patient with the patient’s own stem cells. I cannot say for certain that Colon’s treatment could not have been performed legally in the United States, and indeed, Dr. Purita appears to believe that he could have provided this treatment to Colon in the United States.)

UPDATE: If any of you are truly interested in the U.S. law governing stem cell treatments like the one received by Colon, you might try to work your way through this piece. If there’s enough general interest in the law governing this area, I’ll try to write a post addressing this topic.

Colon received his stem cell treatment in his native Dominican Republic. While Colon’s was a journey home, many Americans seeking stem cell treatment journey to countries that are completely strange to them. China is one popular destination, though there are stem cell clinics soliciting American patients in countries such as Panama, Mexico, Germany and Malaysia.  Some of these overseas hospitals and clinics may be responsible and legitimate; others may be selling false hope to incurable patients desperate for help. The International Society for Stem Cell Research warns that stem cell therapies are “nearly all new and experimental”, and that many of these therapies are being offered “before they have been proven safe and effective.”

There are risks associated with stem cell therapy, such as infection, immune system rejection and possibly cancer.

This is where the therapy received by Colon can properly be regarded as disputed. The therapy may be dangerous. Also, the therapy may not work.

I need to stress the latter point, because some early reports have reached a different conclusion. For example, our friend Evan Brunell (formerly of Firebrand of the A.L.) has published a terrific report with the unfortunate headline “Colon owes resurgence to stem-cell treatment.”

But quite simply, there is no proof that Colon got any benefit from his treatment.  All we have is the correlation of two facts: Colon received this treatment, and he is now pitching better than anyone would have expected. But correlation is not causation. It’s possible that something else cured Colon’s shoulder, or that it got better on its own. We’ve only seen Colon pitch for a month or so; we cannot even conclude that his shoulder has truly healed or that he can keep up his current terrific level of performance for an entire season.

Please do not misunderstand. I truly hope that Colon was healed by stem cell injection –and not because it’s all that important in the grand scheme of things for a guy to be able to throw a baseball 95 miles an hour. No, instead what I’m thinking about are the burn victims, the Alzheimer’s patients, the babies born without sight – all the potential beneficiaries of stem cell treatment. If Colon can pitch thanks to stem cells, then that gives us hope that others will walk, and see, and remember.

In the meantime, we should be cautious about reaching sweeping conclusions.  The most we can say is, maybe the treatment helped Colon.  For his part, even Dr. Purita is cautious. “This is not just about what we did,” he said. “We gave him the means, but he has the focus and desire, the killer instinct. He worked his tail off to get back in the game. That is something stem cells cannot fix.”

9 thoughts on “Bartolo Colon, Stem Cell Pioneer?

  1. Those risks with stem cells also exist for other operations (like organ transplantation). I can't foresee any controversy here. This is very interesting news, a positive story for stem cell treatment. This field needs more research and funding. The potential of it is staggering.

    But as for it being against MLB policy in any tangential way, I doubt it. The case for it would be iffy at best, and trying to penalize a player for it could lead to a bigger controversy than MLB would desire.

  2. For a good video on stem cell organ replacement visit: http://www.ted.com/talks/lang/eng/susan_lim.html

    I just happened to watch that video yesterday before reading this article. Seems to me there is very little MLB can do, unless they decide to ban Tommy John surgery as well. Nice job Larry, not much else to add!

  3. can we give Hughes some stem cems too? Maybe inject the bats with them while we're at it.

  4. Agreed. Though you wouldn't look at Colon and think, there's a guy on the cutting edge of good health!