Naturopathic Physicians Are Uniquely Qualified to Perform Stem Cell Procedures
As a Naturopathic Doctor (ND), I am uniquely qualified to employ modalities that launch the body’s natural healing response. Naturopathic medicine is based on the philosophy of “Vis Medicatrix Naturae,” or “the Healing Power of Nature.” For the past 20 years, my area of focus has been the use of Regenerative Injection Therapy. For the last 10 years, it has been the use of my patient’s own stem cells for the treatment of chronic musculoskeletal pain.
Chronic musculoskeletal pain is the leading cause of disability worldwide and it’s the number one reason people visit the doctor. Stem cell therapy is in perfect harmony with the principles of naturopathic medicine. It fits cleanly within its scope of practice in certain U.S. states, and it is part of the naturopathic curriculum at certain naturopathic colleges.
When I first learned how to perform stem cell therapy in 2010, there was only a small number of doctors in the U.S. using stem cells, and I was the first naturopathic doctor. Today, there are thousands of doctors, of all pedigrees, using stem cells therapeutically.
However, there currently exists only one formal pathway to becoming a trained stem cell doctor. There is only one nationally accredited, two-year residency program in regenerative medicine. These residents are formally trained in the harvesting of stem cells and injecting them into the joints and spine using X-ray and ultrasound guidance.
Neil Riordan Center for Regenerative Medicine
Can you guess which U.S. Department of Education-recognized institution is forward-looking enough to host this program? Harvard Medical School, perhaps? Stanford? No. The only residency in regenerative medicine and formal pathway to becoming a stem cell doctor is hosted by the Southwest College of Naturopathic Medicine, within the Neil Riordan Center for Regenerative Medicine.
Not so surprising when you consider that MD and DO medical schools and residency programs are heavily subsidized by the pharmaceutical industry. In contrast, naturopathic schools are mandated to employ therapies that harness the healing power of nature.
I was the first ND to perform stem cell therapy. This is my personal story.
In 1995, at the age of 25, I was in my first year of four years at the National College of Naturopathic Medicine, and I tore the cartilage in my shoulder while rock-climbing. This threatened to force the cancelation of my upcoming climbing trip to France that summer.
I consulted with a surgeon. He told me that he could put a scope in my shoulder and cut out the torn cartilage. He said that it would help in the short term, but would likely cause me problems later in life. He also gave me another choice; to inject a steroid into my shoulder. This would take the pain away for a few months but would threaten to harm the integrity of my ligaments and joint surfaces. Plus, there were many side effects that went along with this procedure.
This made no sense to me. Here I was, young and healthy. I was in naturopathic medical school being taught naturopathic philosophy, which holds at its core “Vis Medicatrix Naturae.” I was unwilling to take no for an answer. I couldn’t believe that my only choices were surgery or steroid injections. There had to be some way to kick-start my body’s natural healing ability.
My mentor and friend Rick Marinelli, ND
It was then that I was introduced to Rick Marinelli, ND, LaC, in the early 1980s, when Rick had first opened his practice in Portland, Oregon. He befriended an Austrian orthopedic surgeon named John Gerhardt, MD who was looking for a clinic in which to practice. Rick invited him to share his office space. In exchange, Dr. Gerhardt taught Rick the art of injecting natural substances into damaged connective tissues in order to trick the body into thinking it has been re-injured. This unique procedure didn’t cause any tissue damage, thereby launching the body’s natural healing cascade. This system is called regenerative injection therapy (RIT), or prolotherapy.
Naturopathic medicine is defined by its principles, and not by its modalities. No naturopathic doctor before Rick had done RIT/prolotherapy. Because it so cleanly aligned with these principles, Rick immersed himself in learning this valuable skill and provided it to his patients, as it was intended to trigger the healing power of nature.
Rick soon taught other Oregon NDs the practice of RIT/prolotherapy. At the time, RIT/prolotherapy was considered alternative medicine, and this small group of NDs were warmly welcomed into the only National Association for RIT/prolotherapy — the American Association of Orthopaedic Medicine (AAOM).
In 1995, Rick treated my shoulder injury with RIT/prolotherapy and it resulted in a complete cure. My climbing trip to France was splendid. Rick became my mentor, and this group of ND prolotherapists became my peers. My life’s path unfolded before me!
I practiced RIT/prolotherapy for six years. The first two years, I practiced during my hospital-based residency and faculty appointment at a naturopathic school, and then during my first four years of private practice. I loved RIT/prolotherapy for its simplicity and efficacy. It required multiple treatments to get people to where they wanted to be. However, more people got better than didn’t. As a naturopathic prolotherapist, I was very much “in my lane.” No feathers were ruffled and no eyebrows raised. I was a member of the AAOM and regularly attended their meetings.
Then, in 2004, platelet rich plasma (PRP) hit the scene. PRP is the concentration of a patient’s own blood platelets — the very substance that signal tissue healing after injury. The injections are identical to prolotherapy, but instead of injecting natural substances from a vial, we inject a fraction of a patient’s own blood. It is customary to use ultrasound cameras for needle-guidance with PRP injections. PRP generally requires fewer treatments for the benefit than prolotherapy.
Mike Cronin, ND, the founder of the Southwest College of Naturopathic Medicine, put a call out to the most influential ND prolotherapists. He believed that this totally drugless therapy, which harnesses the body’s own natural healing response, fit perfectly within the guidelines of naturopathic medicine. He encouraged our circle of NDs to make PRP a naturopathic modality, and many NDs in the U.S. and Canada incorporated PRP into their practices.
However, there was a different feel to PRP compared to RIT/prolotherapy. It required some expensive equipment to process. It is generally accepted to be done with some form of needle guidance (either ultrasound or X-ray). Put simply, it’s fancier.
Orthopedic surgeons were interested in PRP to use both with surgery and for conditions for which there is no good surgery (such as tennis elbow) and started interacting with the RIT/prolotherapy community. For the first time, NDs felt a chill from the AAOM and other members of the RIT community. But still, no bricks were thrown.
In 2010, a patient of mine — whom I had helped with prolotherapy and PRP to a point but could not seem to get her totally better — asked me to inject stem cells from her bone marrow into her knee. I had heard of the use of bone marrow stem cells. It was nearly identical to PRP; but, instead of blood, you use bone marrow. Bone marrow contains stem cells in addition to platelets. However, no ND had crossed the threshold to aspirating bone marrow. I would be the first, and I knew I would draw heavy criticism for it. I told her, “I know an MD in Missouri who can do it for you.” She said, “I don’t want your friend to do it. I want you to do it.” I told her, “But I don’t know how.” She said, “So? Learn!”
At the time, there was only a small handful of MDs injecting bone marrow stem cells in a prolotherapy-style manner. I found one who was willing to teach me. I visited him and watched him work.
I was struck with two things. First, without a doubt, I knew with all my heart that this was the natural progression, evolution, and future of regenerative injection therapy. Second, I didn’t feel confident enough in my ND degree to get me where I saw the field going.
So what did I do? Something I rarely do. I gave up. I turned my practice over to a friend. I moved back to my hometown of New York City, and I enrolled to retake my pre-med coursework (the ones I took for ND school 12 years prior were too far in the past to count) and started studying for MCATs. I was going to go to MD school!
One semester into this, I told my friend and mentor, Ross Hauser, MD, (who is the most famous prolotherapist in the world) of my plan. Ross, who is normally very mild-mannered, positively flipped his lid! “WHY ON EARTH WOULD YOU WANT TO BECOME AN MD? DO YOU KNOW THAT THE “M” DOESN’T STAND FOR “MAGIC”!?!”. He went on to tell me of all the problems that he had encountered as a MD practicing prolotherapy. He was investigated by his specialty board and investigated by the American Medical Association. He went on, “You’re MUCH better off doing stem cell therapy as an ND. NDs are SUPPOSED to do weird stuff!!!”
His words sunk in. I looked at my licensing law in Utah. It clearly allowed me to perform bone marrow aspiration. It allowed me to use X-ray needle guidance. It allowed me to inject ligaments, tendons, muscles, and joints (as I had been doing done for the eight years prior).
He was right. I gave up my plan to become an MD and moved back to Utah to reopen my practice as the first ND to practice stem cell medicine.
As I had predicted, stem cell medicine became the natural progression, evolution, and future of RIT/prolotherapy. From the viewpoint of “mechanism of action,” there is nothing that I do differently today than I did back in 1998 when I was first learning prolotherapy. Yes, it is a lot more complex, there is a lot more equipment, and it is more expensive to perform. But it is still all based on “Vis Medicatrix Naturae,” the healing power of nature. It is totally drugless medicine that is entirely reliant on the patient’s own healing response.
This is not, as my detractors say, infringing upon an MD practice. This is a brand new field. In the MD world, there is no formal pathway to becoming a stem cell doctor. Insurance does not pay for it and it is still solidly in the “alternative” realm. Who is better suited to perform an alternative modality that is a form of RIT/prolotherapy than an ND like me?
Since I did my first bone marrow aspiration in 2010, many NDs have learned various forms of stem cell therapy. None are doing quite what I’m doing as far as more advanced injections into discs and the epidural space, but that will soon change. Thanks to a large grant from Neil Riordan Ph.D., the Southwest College of Naturopathic Medicine has launched a Center for Regenerative Medicine that will include research and clinical training in stem cell medicine.
They have created a two-year post-graduate residency program in stem cell medicine that is chaired by an MD anesthesiologist, specializing in interventional pain management. This is the first formal residency training in stem cell medicine ever provided — MD or otherwise. NDs are at the forefront of formalizing training programs in stem cell medicine.
Unfortunately, the days of NDs being welcome among the MD RIT/prolotherapists are gone. The AAOM has thrown the NDs under the bus. This natural progression of our RIT practices is viewed as an existential threat to the sanctity of medicine. Because stem cell medicine has the potential to be so massively disruptive and represents such market value in the much-cherished world of cash-based procedures, NDs are now “persona non grata.” Our participation labels stem cell therapy as “alternative,” the very reason we used to be welcome with open arms by the AAOM.
And then, of course, there are my detractors, who motivated me to write this piece. This is my response to them.
They call me a threat to public safety. If that’s so, why are there no skeletons in my closet? Why have the only complaints to my board been from other stem cell doctors who view me as competition? Why are my only negative online reviews from either competing stem cell doctors or “quack-busters” who have never set foot in my clinic?
They say I’m breaking the law. This is an outright lie; or as it is called today, an alternative fact. I have endured two investigations by the licensing board. My case went all the way up to the State of Utah Attorney General’s office. I was found to be practicing within my scope, and the case was dismissed as unfounded (click here for a letter from the investigator stating this).
We don’t have to look far back in history to remember what life used to be like for Doctors of Osteopathy, or DOs (If you do not know what a DO is, click here for an explanation). Once labeled as quacks, the AMA issued a position paper in the 1960s, that it was unethical for an MD to consult with a DO. Of course, things have changed, and now there is virtually no difference between MDs and DOs.
NDs will never be like MD/DOs, as our training does not include hospital medicine (my hospital-based residency was a rare exception). However, the practice of medicine evolves and the practice of naturopathic medicine evolves.
As I type these words, I am a guest in the home of my patient and friend, Mark Hyman, MD. Mark is a central figure in the functional medicine movement (functional medicine is the MD-version of naturopathic medicine that seeks to directly address the cause of illness rather than merely manage symptoms). Mark believes that the monopoly on information and the responsibility for public health is falling away from the hands of the MD, and landing squarely onto the shoulders of the patient. He envisions a time in the near future where healthcare will be largely automated and patients will become their own primary advocate for health. The only constant, it appears, is change.
Taken from Mark’s clinic website: “The system of medicine practiced by most physicians is oriented toward acute care — the diagnosis and treatment of trauma or illness that is of short duration and in need of urgent care, such as appendicitis or a broken leg. Physicians apply specific, prescribed treatments such as drugs or surgery that aim to treat the immediate problem or symptom. Unfortunately, the acute-care approach to medicine lacks the proper methodology and tools for preventing and treating complex, chronic disease. In most cases, it does not take into account the unique genetic makeup of each individual or factors such as environmental exposures to toxins and the aspects of today’s lifestyle that have a direct influence on the rise in chronic disease in modern Western society.”
The treatment of chronic pain is complex. In a small number of cases, the cause is a single pain generator, but much more often, the pain generator is a single part of a patient’s complex, chronic disease, as Mark describes it. Who better to deliver holistic pain care than an ND?
In addition to being trained to treat the whole person, address the cause, and harness the healing power of nature, NDs have a rich history in RIT/prolotherapy/PRP. NDs are currently the first of any of the health professions to develop formal pathways to be trained in stem cell medicine.
NDs are the obvious choice to perform stem cell procedures for the treatment of pain.
As such, it is not surprising that arrows are being fired at me, as the guy out at the very front of the movement.
There are two timeless quotes that help me to endure the railing of my detractors.
The first quote is: “All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.” As the first ND to practice full-scope stem cell medicine, I find myself squarely on the business end of the second stage, much as the DOs did in my lifetime.
The second quote is: “There is a principle which is a bar against all information, which is proof against all argument and which cannot fail to keep a man in everlasting ignorance. This principle is contempt prior to examination.” Although my hardiest detractors think they know a great deal about me, they have never set foot in my clinic. They have never heard the expressions of sincere gratitude from my patients for whom stem cell therapy, delivered by my hand, has given them back their quality of life.
My detractors choose to spend their time outside of the clinic trying to destroy my reputation and trying to take my livelihood away from me. However, I’ve chosen to spend my time outside of the clinic, sharing what I’ve learned over 20 years of full-time RIT/prolotherapy practice and 10 years of full-time stem cell practice.
I host MDs to come to observe my work (click here to see what they think). I visit my MD friends to learn from them. I present at stem cell meetings. I constantly evaluate my limitations, remaining safely within my skill set and what my Utah license grants me the privilege to perform. I’m quick to say “I don’t know” and then learn from someone who does.
A true expert knows never to call him/herself an expert, but numbers don’t lie, and as the saying goes, “if it’s true, it ain’t bragging.” Anyone who has injected more intervertebral discs with stem cells (over 800 at the time of this writing) and done more stem cell epidurals (over 1,500, both without serious complications), please stand up. Better yet, come visit me and I’ll come visit you — I’d love to learn from you!
In the spirit of sharing information, and transparency, I allow cameras in my procedure suite and give patients the option of posting pictures and videos of their procedures on the Internet. Of course, this makes me an easy target for criticism from those who allow no such cameras and post no such videos.
While my detractors spread fear and anger, I strive to spread hope, love, and relief from the causes of pain.
In this age of the Internet, health care consumers are highly educated and highly motivated. They smell bogus guidelines designed to maximize industry profit a mile away.
All the while, NDs have been quietly honing their skills. Naturopathic colleges are light and fast, able to adapt to the ever-shifting landscape in response to the latest advances and the changing times. NDs are gaining state licensure with momentum, and I predict that in my lifetime, NDs will be licensed in all 50 states. Coincidently, there are people suffering from chronic pain in all 50 states.
Won’t you join me as we shift from just managing pain to curing the cause of it by harnessing the healing power of nature? Unfortunately, there is no shortage of people in pain. There is, however, a massive shortage of doctors able to effectively provide relief to those in pain. Let’s work together for the noble cause of eliminating suffering. Please join me.