The following is a transcript of the podcast episode:
Rachael Robertson: Hey everybody. Welcome to MedPod Today, the podcast series where 鶹ý reporters share deeper insight into the week's biggest healthcare stories. I'm your host, Rachael Robertson.
Today we're talking with Kristina Fiore about how stem cell companies are marketing to long COVID patients. Then I'll discuss a rare case of abdominal ectopic pregnancy where the patient and baby both survived. After that, Michael DePeau-Wilson shares his reporting on how Americans are using emerging cannabinoids.
Clinics have long been marketing unproven stem cell treatments to patients for a range of health conditions. When COVID hit, some said their products could prevent or treat the disease. Now, those companies have turned their attention to people with long COVID. Kristina Fiore is here to tell us more.
So Kristina, how many clinics are selling these treatments for long COVID? How pervasive is this?
Kristina Fiore: Yeah, these researchers tracked down 36 businesses that were selling stem cell and exosome treatments for long COVID. They were connected to 60 brick-and-mortar clinics, and most of the businesses were in the U.S. and Mexico. The team behind the research, led by Leigh Turner, PhD, at the University of California Irvine, has been tracking stem cell clinics in the U.S. for years. So they went back and looked at some 1,500 clinics that they've been following to see if any of those had been using COVID to their advantage. And sure enough, they were. Turner told me that this is a very vulnerable population that's suffering a lot. And these companies know that these patients may try anything to try to feel better.
Robertson: What are the risks here? What can go wrong for these patients if they try these unproven therapies?
Fiore: Turner says that a lot can go wrong. These treatments are experimental, so there's no evidence that they actually work in long COVID. Patients may not be helped at all. Then there are examples of stem cell and exosome products causing infections that can be severe, leading people to go to the hospital. There is even one report of people going blind after intravitreal stem cell injections. And on top of that, there's an "obvious possibility for financial scams," Turner told me. The average price for these treatments was $11,000. "It's not like going to the drugstore and buying some dietary supplements," Turner said.
Robertson: That is so expensive. Are regulators going after these companies?
Fiore: Yes, both the FDA and the FTC have gone after stem cell companies in the past, and they've mostly issued warning letters. And Turner said that while these agencies have done quite a lot, there's still a "massive marketplace." Turner said that he'd like to see regulators get tougher on these businesses that are marketing stem cells for long COVID. Since there are only 36 companies, Turner thinks that a crackdown seems pretty manageable. It's just not clear how likely that would be.
In the meantime, patients just need to be vigilant about the fact that these procedures are experimental, that there's not much evidence behind any of them, and that they aren't going to be guaranteed to relieve the varied symptoms of long COVID.
Robertson: Thanks for that update, Kristina.
Fiore: Thanks, Rachael.
Robertson: Now, Kristina will take the host seat to ask me a few questions.
Fiore: As many of our listeners know, the New England Journal of Medicine has an "images in clinical medicine" series that showcases unusual images from clinical practice. One of those recent images was of a highly rare abdominal ectopic pregnancy. Even more rare – both the neonate and mother survived. Rachael is here to tell us more about it.
So Rachael, can you describe the image?
Robertson: So the image is an ultrasound of a woman's torso. You can see the side profile of a fairly large fetus with an umbilical cord. And Guillaume Gorincour, MD, PhD, and his co-authors describe the fetus as being at 23 weeks' gestation. But the catch is the fetus is in the abdomen. Below the fetus is a completely empty uterus where the fetus should be growing. And because the fetus is outside the uterus, it's an ectopic pregnancy. Most ectopic pregnancies occur in the fallopian tubes. Gorincour told me that the abdominal ectopic pregnancies make up less than 1% of all ectopic pregnancies.
Fiore: Wow, super, super rare. So what do we know about the patient? How did this pregnancy get so far along with the fetus growing in the wrong place?
Robertson: When the patient went to the emergency room, she was 37 years old, and she had been experiencing abdominal pain for 10 days. She was from a remote island and had already delivered two babies before. She had also miscarried once. After doctors realized that she had an abdominal ectopic pregnancy, she was transferred to a tertiary care hospital and then a few weeks later at 29 weeks' gestation, the fetus was surgically removed. Two weeks after that, the placenta was surgically removed too. The mother was in the hospital for about a month and then the neonate was there for about 2 months. Remarkably, both of them survived to discharge, though unfortunately, they were both lost to follow up, so we don't know anything about their current status.
Fiore: Wow, that's, that's amazing. So tell us more about why this case is so unusual.
Robertson: So in addition to being really rare, it's also dangerous for abdominal ectopic pregnancies to continue so far. Gorincour told me that technically, abdominal ectopic pregnancies are the only ectopic pregnancies that can continue beyond 20 weeks. But there are huge risks, including placental hemorrhage.
I spoke with a maternal fetal medicine doctor, David Hackney, MD, and he emphasized that in this situation, the patient was really, really lucky. Generally, you would identify an abdominal ectopic pregnancy much earlier than 23 weeks' gestation. And Hackney said that the standard recommendation is that those pregnancies are just too dangerous to advance. He also made it clear that this one case, which he called, "the rarest of the rare," is not grounds for abdominal ectopic pregnancies to be considered viable.
Gorincour told me that the maternal mortality rate for these pregnancies are more than seven times higher than other ectopic pregnancies, which are already dangerous. So while it's amazing that this patient and her baby survived, it could have gone really, really badly.
Fiore: Really amazing story. Thanks, Rachael.
Robertson: Thank you, Kristina. I will take the next segment.
Our final story takes a look at a new study that shows more Americans are using so-called emerging cannabinoids. That includes cannabidiol, also commonly called CBD, cannabigerol, cannabinol, and delta-8-THC. The study surveyed more than 1,000 people on whether they had heard about these products or used them over the past year -- and the results were a little surprising. Michael DePeau-Wilson is here to tell us more about that.
So Michael, let's just start with this. What are emerging cannabinoids?
Michael DePeau-Wilson: Yeah, so these are products that are derived from hemp, which was re-categorized as a legal crop in the Farm Bill Act of 2018. And in the years that followed that change, an entire industry emerged selling various products that are now known as emerging cannabinoids. Now, the researchers of this study emphasize that these products tend to lack industry standards and are mostly unregulated, which means that there's very little known about the prevalence of their use in the U.S., even though a lot of Americans appear to be aware of their availability. One example of that in the survey is that about 70% of people are aware of the availability of CBD.
Robertson: But the study's focus was on the actual use of these products, right? What did they find?
DePeau-Wilson: Right, so the study asked people both about their awareness and their use of these products in the past year. And about a quarter of survey respondents said they had used one of these products in that time period. So this was surprising for researchers. You know, for comparison, the survey also showed that about 26% of survey respondents had used cannabis in that same time period. So of course, CBD, which was also the most well known of these products, was the most commonly used emerging cannabinoid. According to this study, around 20% of survey respondents reported using it. But many participants did report using some of the lesser known cannabinoids as well, for example, almost 12% reported using delta-8-THC over that same time period as well.
Just to give you an idea of who's using these products, the researchers reported that younger participants -- people between the ages of 18 and 39 -- were more than twice as likely to use delta-8-THC. They also showed that non-Hispanic Black Americans were far less likely to use any of these products compared to white Americans.
Robertson: You mentioned before that these products don't have strong industry standards, which I imagine could be a problem with younger people being more likely to use them. What did the researchers say about this lack of standards?
DePeau-Wilson: So the researchers said that the focus of this study was to create a foundation of data to help identify who is using the products. They did emphasize that the survey results do support the need for continuous public health surveillance efforts around emerging cannabinoids, rather than just relying on these snapshots in time, like this study was able to show.
And in the end, the researchers said that they hope that the data leads to more research into the use of these products, you know, such as why people are using them, the general perception around the safety of these products, and any negative health outcomes that may be related to them.
Robertson: Thanks for this report, Michael.
DePeau-Wilson: Thank you, Rachael.
Robertson: And that's it for today. If you like what you heard, leave us a review on or , or wherever you listen to podcasts -- and hit subscribe if you haven't already. See you again in the new year.
This episode was hosted by me, Rachael Robertson. Sound engineering by Greg Laub. Our guests were 鶹ý reporters Kristina Fiore, Rachael Robertson, and Michael DePeau-Wilson. Links to their stories are in the show notes.
MedPod Today is a production of 鶹ý. For more information about the show, check out medpagetoday.com/podcasts.