It’s a European (Medical) Vacation
Kobe Bryant, Alex Rodriguez and Peyton Manning are among a growing number of athletes who have gone abroad to seek treatments that are not yet approved for use in the United States. From the pages of Athlon Sports Monthly, Michael Bradley has the details.
When Kobe Bryant’s cranky knee was bothering him too much to ignore during last offseason, he did what any top-shelf professional athlete would do: Turn to Hollywood.
Actually, Bryant turned to Lakers trainer Gary Vitti, the one with all the movie industry friends. Vitti had heard from “several” people he knew in the biz that arthritis pain — the kind Bryant was suffering from in his right knee — could be relieved with a process invented by an orthopaedic surgeon from Dusseldorf, Dr. Peter Wehling. After speaking with Vitti and recommending that another Laker head abroad to undergo the procedure, Vitti encouraged Bryant to do it as soon as Dallas dispatched L.A. in last year’s playoffs. So, Bryant flew to Germany and received an Orthokine injection in his knee.
“When our season ended early last year, I pushed Kobe to do it right away,” Vitti said in an e-mail. “In case we didn’t get a favorable result, we would have enough time to do something else.”
Given the length of the NBA lockout, Bryant would have had sufficient time to undergo a knee replacement had the Germany junket not gone well. But, according to Vitti, it did, and by heading to Europe, Bryant became one of a growing list of athletes who have gone abroad to seek treatments that are not yet approved for use in the U.S. In the past six months, Bryant, Broncos quarterback Peyton Manning, Yankees third baseman Alex Rodriguez and former NFL receiver Terrell Owens — among others — have sought to relieve pain and facilitate healing by undergoing Orthokine and stem cell therapies — with mixed results. In the process, they have agitated some members of the American medical community, who fear that decisions made by high-profile athletes will lead ordinary folks to pursue similar avenues that could be burdensome financially, provide false hope for recovery and, worse, lead to some unhealthy side effects.
“Inadvertently, athletes who claim to have gotten better doing these things, while I’m sure their intentions are good, will fuel this sort of behavior in others,” says Dr. Larry Goldstein, a neuroscientist and director of the Stem Cell Program at the University of California San Diego. “I wish they would be more cautious and think about what they say.”
In reality, Bryant and others are not crowing about the magically restorative powers of the treatments they have received, although they are not hiding the fact that they have sought them, either. The fear for many in the medical community is that as more and more players seek relief overseas, especially big names like Bryant, Manning and A-Rod, people will think the treatments are indeed panaceas, when they remain largely in the experimental stage and have limited evidence of success — not to mention their lack of the necessary governmental imprimaturs in this country.
If you read or hear anything said by Wehling, the molecular scientist who created the Orthokine treatment, it’s hard not to be sold. Wehling announced in late 2011 that he had “found a way to cure arthritis,” a fairly brazen claim, given the years and countless dollars that have been devoted to eliminating the joint scourge. A steady stream of athletes and celebrities has flowed toward Wehling — including Bryant and A-Rod — giving him tremendous cachet and more than a little notoriety.
Wehling’s procedure is based on his belief that arthritis is not a degenerative condition, but rather a disease caused by Interleukin-1, a protein in the body that promotes joint inflammation and a breakdown of cartilage. Wehling reports that he has discovered that another protein, Interleukin-1RA (Interleukin-1 receptor antagonist), can offset arthritis’ effects and bring about healing. So, he isolates the Interleukin-1RA from a patient’s blood and injects it into the afflicted area.
To do that, Wehling removes blood from a patient and incubates it (at 98.6 degrees Fahrenheit) for a day, “spinning” it in a centrifuge to isolate the Interleukin-1RA. He then injects it into the affected area. “He has a tight handle on the technology,” says Dr. Steve Yoon, an orthopaedic surgeon who is part of the Kerlan-Jobe Clinic in Southern California. When Bryant was searching for relief of his aching knee, Vitti listened to his celebrity friends, did some research and referred Bryant to Wehling.
“(It’s) always better to go to the source,” Vitti said in a second e-mail. “He invented the procedure and has done more than anyone in the world. … He’s simply the best!”
Bryant was so pleased with the results that he gave Rodriguez Wehling’s number. Before heading to Germany, Rodriguez checked with the Yankees, who contacted Major League Baseball for a ruling to make sure Rodriguez would not return to a storm of accusations that he was blood doping or using another unapproved treatment. Dr. Gary Green, MLB’s medical director, expressed no trepidation, provided the treatment did not violate local or state laws.
It doesn’t, although there is concern from some corners regarding the process that separates the receptor antagonist from the blood. In late 2011, the Food and Drug Administration issued some extremely direct advisories that warned orthopaedists not to engage in any procedures that incubate blood for more than a couple hours. Despite those directives, Wehling has started an Orthokine clinic in Los Angeles, with among others, Dr. Chris Renna, who provided the “cream” to notorious BALCO founder Victor Conte. That doesn’t mean Orthokine has any relation to performance-enhancing drugs, but it does bring into question Wehling’s choice of associates. Further, since the FDA has not approved daylong incubation of blood to enhance its ability to heal, any Orthokine treatments done in SoCal could be considered unlawful.
People also sometimes confuse Orthokine with platelet-rich plasma (PRP) injections, which are done fairly regularly throughout the U.S. and are usually more successful on the tendon and ligament problems in the elbow and shoulder, although they have also been used in athletes’ ankles and knees. The process involves removing about 30 cc of a patient’s blood and spinning it in a centrifuge for about 15 minutes to separate approximately 3 cc of plasma with a high platelet concentration. This hazy “buffy coat” is then injected into the affected area. The goal is to let the platelets’ powerful growth and restorative properties trigger healing in a far less invasive way than surgery would provide. But it is not a generic cure-all.
“The bottom line is that it will work for certain indications, but it won’t work for others,” says Dr. Allan Mishra, associate professor of orthopaedic surgery at Stanford University, and a pioneering researcher in the field.
When Manning went abroad, he wasn’t looking for Orthokine or PRP. Desperate for relief from the disk problems he was experiencing in his neck and impatient with the progress he was making after his latest surgical procedure and subsequent physical therapy, he underwent late last summer an experimental stem-cell injection that had no substantive track record of providing relief for patients with his problem. The results were not favorable.
“There is some evidence that transplantation of some stem cells into joints could improve conditions, but in humans, it’s all experimental at this point,” Dr. Goldstein says.
“By and large (Manning) was participating in unknown medical experimentation.”
The optimism about stem cells is that they can be manipulated to take the form of many different cells in the bodies and “programmed” to direct cells to behave in a certain way. Manning had stem cells taken from one part of his body and injected into his neck, in the hopes a healing chain reaction would occur. It didn’t, and Goldstein isn’t surprised. He has been working with stem cells in mice since 1993 and in humans since ’98. He says the field is still in its nascent days and that despite some successes related to stem-cell treatments, it’s still unknown whether injections like the one Manning had were directly responsible for good outcomes or merely a small part of a larger picture that included surgery, rehab and the body’s own natural healing process.
“When there is a new medical area that has a lot of potential, fraudulent claims can spring up all around,” Goldstein says. “The real danger is that if (an athlete) does something and claims that he got better but doesn’t really know, kids in high school and college will say, ‘It worked for (the athlete), so I’m going to do it.’”
Even if they don’t have big-time Hollywood contacts.