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. DustyYF

    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.

    • LarryAtIIATMS

      From the little I've read that new this morning, the MLB concern seems to be over the possible use of HGH in this procedure. But as I've said, there's no evidence that HGH was used. As Andrew Marchand put it, "At this point, MLB does not have any evidence that Colon has done anything wrong. They are just responding after The Times' report."

      Absolutely right, there are risks in nearly every medical procedure. We don't have the information yet to put into context the possible risks of stem cell therapy.

      As for the eventual MLB response: there may well be some debate over the possible use of stem cells to ENHANCE performance. For example, should MLB permit a perfectly health baseball player to use stem cells because he believes (or his doctors believe) that the stem cells will promote new muscle growth? There may and perhaps will need to be future rules addressing stem cells as a PED. The issue of using stem cells to treat an injury falls into a different category, though the line between the two categories can get blurry.

      Thanks for the comment.

      • It is a little ridiculous that any time a player goes to a doctor who may use HGH with other patients suddenly it is assumed that is why the player went to him/her. It is as if these people aren't medical professionals, but drug dealers (though that might be more accurate for a few of them).

        The way these topics have been covered in sports makes it seem like there is no legit use for these drugs or procedures, even for people outside of sports. to me it just seems like these sort of stories exemplify some of the witch hunts that continue since the steroids era. There may be occasions where it is warranted, but is I question the necessity of an investigation based mostly on the fact that the doctor has used HGH with other patients, especially if the doctor has already said he did not use it with Colon. That often means the investigation will be fruitless. If they want to know more about the procedure, that makes sense. If they are looking for HGH it seems like a waste of time.

  2. mikeNicoletti

    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!

    • LarryAtIIATMS

      Mike, thanks! This is a terrific video, well worth watching. I highly recommend the video to any of you who were sufficiently motivated to read this far. I learned a lot from it.

      As for what MLB can do? That's a deep dive into a hugely difficult area. Please do not misunderstand, I see nothing wrong (in fact, I see many things right) with Colon having received stem cell therapy — that is, assuming that the risks were fully explained to him and that he agreed to take those risks. (At some later time, I might have more information and I might change my mind here — for example, I don't think that a baseball player should be allowed to voluntarily take the risk of playing without a helmet.)

      But rationally, I have to point out that the line grows blurry between "legitimate" medical therapies and the "cheating" use of certain performance-enhancing drugs. This is in part because PEDs have evolved so that they replicate or mimic natural body functions, and in part because new medical techniques are evolving to "enhance" the body's natural ability to heal itself. There are striking parallels between use of stem cells and use of anabolic steroids: the body already uses anabolic steroids for muscle growth, same way as the body already uses stem cells for healing — stem cell therapies and anabolic steroid regimes both seek to take what the body does naturally and amp it up to achieve a bigger and better result.

      The distinction between stem cell therapies and anabolic steroid use is that the former is performed for a legitimate medical purpose (or at least, what we think is a legitimate medical purpose). But this distinction is not as sharp as it used to be. We now understand that doctors can legitimately treat perfectly health people to "enhance" the quality of their lives. A person with sight can receive Lasix treatment; people can receive "cosmetic" treatments even if they have not been disfigured by injury. In a few years, it may be medically legitimate to receive a shot of stem cells to, say, improve one's sexual performance, or even one's golf game. To complicate things further, it may become the case that the treatments we use to treat legitimate injuries may both heal the injury AND improve the capability of the injured body part beyond what that part could do before the injury.

      Of course, these are problems we WANT to have — let's promote the best and most advanced medical techniques, and let pro sports figure out what rules to adopt to address those techniques.

  3. Mat

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

    • LarryAtIIATMS

      Interesting thing, they don't want to use stem cells on younger athletes at this point. If Hughes used stem cells and recovered his old form, we might not believe that the improvement was caused by the stem cells. With Colon, it's harder (some believe) to argue that the improvement might have been caused by anything else.

      Also … in case the stem cell treatment did more harm than good, a guy like Colon would have less to complain about, since it was widely believed that his career was over.

  4. LarryAtIIATMS

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

  5. Anna McDonald

    Great article Larry.

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