Worker’s comp is one of those insurance company types that, more often than not, has been covering PRP. However, a colleague recently sent a “Guideline” issued by the California workers comp that removes PRP coverage. Today, I want to dive deeply into this document and explain why it’s more of a magic trick than a well-researched systematic review. Magic 101 Magic is all about distracting people. You do something over here to distract, then perform the trick when they’re not paying attention. Let’s dive into how this California worker’s comp guideline trick is done. The State of California Wo ..read more

If you read this blog, you know I often write as a type of catharsis. I see something in our medical care system that seems so nutty that if I don’t write about it, I’ll explode. This morning, a poor, dizzy patient in Australia was being treated like he lived in the last century, not this one. Let’s dig in. Writing as Catharsis When my mother would get upset at something, she used to say that this was “getting her vinegar up,” a phrase she used interchangeably with “getting her Pollack up.” That meant that since her background was Polish, that she was pissed off. I’ll see something so silly a ..read more

Interventional orthobiologics research continues to advance at a furious pace. Last year, I published a blog that attempted to look ahead a bit at studies and products that may be available and posited a timeline for when that could happen. This year, I went deeper to search product studies/FDA trials and some key research studies that could impact the field. Why is Any of this Important To Physicians and Patients? I focused here on finding studies that could change the field or alter or confirm what providers do daily with orthobiologics. For example, if a company gets FDA approval for SVF ..read more

If you have read this blog for years, you probably remember Stem Cell Institute of America. They were a chiro clinic that bombed the airwaves across the country, selling miracle cure “stem cell” treatments offered at chiropractic offices by midlevels. A new entry has been logged in that saga, with the FTC winning its case against the company and seeking 17M in damages. Yes, you read that right, that’s $17,000,000! Let’s dig in. What Was Stem Cell Institute of America? Stem Cell Institute of America (SCIA) was a chiropractic clinic chain owned by two chiropractors: Steven Peyroux and Brent Det ..read more

Physicians who read the orthobiologics literature and follow the latest and greatest have caught onto a message I’ve been delivering for almost two decades. The most critical aspect of PRP is the dose and concentration of platelets delivered to the patient. A new study published last week adds more fuel to that fire. Let’s dig in. PRP Dose Since I did my impromptu analysis of PRP study failure related to low doses, a supporting study has been published (2). Before that, a few authors (including us) shouted from the hilltops that dose is critical if you want a good patient outcome (3-5). Despit ..read more

One of my jobs at Regenexx is ensuring that our corporate partners spend insurance money wisely on orthobiologics. Basically, the money they’re spending is helping patients avoid more expensive procedures. One of the more popular add-ons to PRP is hyaluronic acid (HA). Is this worth the additional cost? If it makes PRP better, how much better? HA and PRP What is hyaluronic acid? Basically, it’s a component of normal synovial fluid that helps lubricate the knee. Doctors have used HA injections since the late 90s to help knee arthritis patients. PRP is platelet-rich plasma created by concentrati ..read more

If you read this blog, you know that I often write about what I experience daily. This past weekend an orthopedic surgeon on Linkedin was promoting test tube PRP at 3-4X concentration. Like others I have seen, his focus was on the total dose delivered to a knee and not on the concentration. Meaning he posited that injecting a high volume of low-dose PRP in a knee was as good as injecting a low volume of high-dose PRP. So let’s explore this idea today to see why focusing on total dose may cause problems. Let’s dig in. PRP Concentration 101 If you had to come up with one-way patients who get pla ..read more

This has been a tough few months for the interventional orthobiologics field. First, we lost Arnie Caplan, and now, this week, Greg Lutz. I knew Greg well, as he was one of my favorite people in this field. Let me share with you the Greg Lutz I knew. Meeting Greg I first met Greg around the time he invited me to speak at HSS in 2013. I was warmly received by Greg and the PMR department at HSS and got to see firsthand what he was doing with PRP and discs. I was amazed that he was already performing an RCT. While lecturing about our then 8-year experience with culture-expanded MSCs in front of ..read more

It’s hard to believe that about 15 years ago, I began seeing patients in Grand Cayman several times a year and that this is my last trip. Not that the Cayman advanced treatment site will be any worse for wear. In fact, the Cayman site is about to get a big upgrade with a CSC fellow moving his practice and family here full-time. So, let’s dig into a little history and why this is my last visit. The Grand Cayman Site In 2005, I began using culture-expanded mesenchymal stem cells derived from bone marrow as part of an IRB-approved study. It’s crazy how far ahead that procedure was almost two dec ..read more

There’s a battle brewing based on a new stem cell law that looks likely to pass in Utah. You can bet that this will result in the FDA getting involved and ignoring this new state law. It’s also reasonable to assume that this law will get quoted as the main ammunition to support that Utah physicians should be able to use placental-derived stem cells. Let’s dig in. The New Utah State Law Utah Senate Bill 199 was sent to me by a colleague this past week. It’s an interesting blend of other state laws requiring patient disclosure of the use of stem cell therapy and a law that pits the state o ..read more