A California Scientist's Eight-Year Journey into the Byways of Dubious 'Stem Cell' Clinics

You could call it the "Knoepfler Effect."

It has bounced noticeably around the country in recent months, leading to headlines in the Washington Post, the Atlanta Constitution, the Los Angeles Times and other outlets in Florida, Seattle and elsewhere.

It involves the activities of dubious, so-called "stem cell clinics" -- enterprises once ignored by the mainstream media, the Food and Drug Administration as well as other regulators, including California lawmakers, and much of the established stem cell scientific community.

Not so today. Here is a sampling of the recent news coverage:

• "How ‘stem cell’ clinics became a Wild West for dodgy treatments"
• "Unregulated stem-cell clinics are proliferating across the United States"
• “There's a problem with stem cell therapy in Florida”
• "Patient lawsuits, federal investigations and a 'virtual' PhD: Inside a would-be stem cell empire"

Paul Knoepfler
UC Davis photo 

Over the last several months, these "stem cell" businesses have come under increasing scrutiny by media and regulators. Much of the credit for the attention must go to Paul Knoepfler, a stem cell researcher and blogger at UC Davis. About eight years ago, he began writing -- largely alone and in isolation -- on his blog about the problem. 

He was convinced that the persons lured into the "clinics" were paying large sums for so-called treatments that did not fulfill their promise and that, in fact, could be dangerous. In one case, Knoepfler went undercover -- sort of. He later tangled politely with the leading newspaper in California's state capital about how it was carrying full page ads from an unregulated clinic.

The watershed moment came in 2016 when Knoepfler and Leigh Turner of the University of Minnesota put a number to the matter -- 570 dubious "stem cell" firms nationwide with California leading the nation with 113. That was the key. Readers and regulators like solid numbers. They help focus attention, providing a hook for action and creating a new understanding.  Knoepfler and Turner's peer-reviewed scientific journal piece was the biggest stem cell story in the country that week.

Knoepfler also learned about the media game. He promptly returned media emails and calls and couched his responses in plain English -- "good quotes," as they are known in the trade.

Knoefler persisted even while some of his peers looked disparagingly at his blogging.  Back in 2012, one told Knoepfler that he was "skeptical of scientific social media with its 'twitting and the blobs(cq)'."

In California, however, his work helped to lead to a new law that forces the "stem cell" enterprises to inform their customers more fully about the nature of what might happen to their bodies.

It is a ticklish business to credit a specific individual with triggering a fresh wave of public attention to new and complex issues, such as stem cells and their dubious exploitation. Turner and others have been involved as well and deserve considerable credit. But Knoepfler was at the forefront and did, in fact, take a few arrows for his work.

The California Stem Cell Report asked Knoepfler for his brief thoughts about his stem cell adventures. He replied,

"Some highlights include times when patients decided not to get risky stem cells for themselves or their kids. I also have enjoyed getting to know so many cool people from diverse backgrounds all over the world I’ve only met because of the blog.

"Seeing things like the new California stem cell clinic law sprout up is exciting too, especially as now other states are trying to follow our state's lead it seems and maybe pass even better legislation. I’m also hopeful to have positive impact at the national level such as by somehow working a miracle to get the FDA to do more overall, but we’ll see how that turns out. 

"If that all sounds too cheery, then as my grandma might have said back in the 70s, 'It’s not all peaches and cream.' 

"There have been downsides too like various threats from clinics or their fans. I also feel like at times I’ve stepped in it with something I wrote or said when I could have avoided headaches if I had been wiser. Anyone can do that, but when you do it publicly such as on a blog then it’s got more bite to it. Doing all this stuff has risks to it. But overall it’s been worth it."  

A final note: People often shrug at the likelihood that they can make change in society. Many scientists as well shy from speaking out publicly, surrendering the public arena to snake oil peddlers. But the "Knoepfler Effect" stands as evidence that persistence and first-class work can, in fact, make a real difference in science and public policy. 

California Moves to Protect Patients Seeking Unregulated Stem Cell Treatments

Beginning next year, California will have a new law that imposes the first-ever disclosure requirements on currently unregulated stem cell clinics that offer therapies that have not been approved by the Food and Drug Administration.

UC Davis stem cell scientist Paul Knoepfler, who for years has raised concerns about such clinics, wrote an item yesterday about the new law for his blog. It was headlined:

"Groundbreaking new California stem cell law gives consumer protections on clinics"

Ed Hernandez, Daily News photo

The measure is the first of its kind in California and probably the entire nation.  Authored by state Sen. Ed Hernandez, D-West Covina, it will require clinics to specifically notify its customers that he or she is about to undergo a treatment not approved by the FDA. The notification also must include advice encouraging customers to consult their primary care physician prior to undergoing a stem cell therapy.

A legislative analysis of the bill, SB512, cited a statement from the Center for Public Interest Law that said, 

"It is critical to patient safety that these individuals are not misled into believing they are partaking in an FDA-approved clinical trial and assuming serious health and financial risks in the process. The disclosure notices required by this bill are an important step in ensuring that patients have the information they need before making such monumental decisions about their treatment."

Paul Knoepfler, UC Davis photo

Knoepfler co-authored a research paper in 2015 that documented  the presence of nearly 600  unregulated clinics nationwide with California leading the way. He wrote on his blog, 

"Taken together, the provisions of this law will help consumers learn more about the stem cell clinic industry, make better decisions about their health and that of their loved ones, and delineate the difference between stem cell clinics versus compliant researchers conducting stem cell clinical trials with FDA approval.

"In the big picture, this new California law plus a more active FDA on the stem cell front together give me more hope that the wild west of stem cell clinics can be reined in sooner rather than later! Perhaps other states will follow suit with new laws and state medical boards will get more involved in overseeing stem cell therapies. With more 570 stem cell clinics in the US and more than 100 here in California alone, more efforts like these are needed on the consumer protection and educational outreach front."

Knoepfler deserves great credit for his efforts regarding unregulated clinics. It is fair to say that without his work, California would not have seen this law at this time. He was the first to document the size of the industry with the 2015 article, co-authored by Leigh Turner of the University of Minnesota.  Their work makes it abundantly clear that scientists can make a real difference on public policy issues if they are persistent and effective. One of Knoepfler's key tools was blogging, a practice that some scientists think is less than dignified. Nonetheless, his blogging helped to elevate the issue and served as a source for the news media as they looked into the matter. 

Like most new state laws, the law takes effect Jan. 1, 2018.

Scripps' Loring Picked as Stem Cell Person of the Year

Jeanne Loring (center with sunglasses) and her lab team at Scripps in La Jolla

Jeanne Loring, head of the stem cell program at the Scripps Research Institute, last week was named Stem Cell Person of the Year.

The award was made by UC Davis researcher Paul Knoepfler, who funds the $2,000 prize personally. Loring, however, has declined the cash, and Knoepfler is looking for a cause to donate the money to.

Writing on his blog, The Niche, Knoepfler said that overall Loring “has had a transformative,

positive impact at least in part via taking risks and thinking outside the box.”

Knoepfler said,

“Jeanne came out as the winner for her exceptional contributions in 2015 and throughout her many years in the field. She not only has made numerous advances scientifically, but also gone the extra mile in many respects as an advocate and educator.

“Her scientific contributions include outstanding research on human stem cells and in particular in stem cell epigenetics. See her publications on GoogleScholar.  She has been a great mentor to her trainees. You can visit her lab page here.

“She has also been a creative leader in producing IPS cells from endangered species, an area with huge potential ecologically and at a societal level in terms of preventing extinctions.

“Jeanne has mobilized patient advocates and catalyzed exciting work in the clinical pipeline in a number of areas including most prominently in the last few years for Parkinson’s Disease.”

As for the destination of the $2,000 award, Knoepfler wrote,

“I’m currently considering whether to donate the funds to a charity or put them towards a novel educational outreach project in the stem cell field.”

Nominations for Stem Cell Person of the Year Being Taken This Week

Now is the time nominate a few good men or women for the 2015 Stem Cell Person of the Year.

UC Davis researcher Paul Knoepfler is collecting names for the annual award that he funds with a $2,000 prize. He is looking for the person who had “the biggest positive impact in the stem cell and regenerative medicine world in 2015.”

Knoepfler wrote last week,

 “This award is unique in a number of ways. For example, anyone in the world is eligible to be nominated: both scientists and non-scientists alike. The nominee should also be someone who thought outside the box and took risks, which are novel areas of emphasis for this stem cell and regenerative medicine award.” 

Paul Knoepfler, CIRM photo

The deadline for making nominations is Oct. 13. The finalists will be selected from the nominees by an Internet vote. However, Knoepler himself will choose the ultimate winner. Nominations should be emailed directly to Knoepfler at knoepfler@ucdavis.edu.

Knoepler listed the previous winners last week.

“Dr. Masayo Takahashi won in 2014 and this year also received the inaugural Ogawa-Yamanaka Stem Cell Prize.

“Dr. Elena Cattaneo received the award in 2013 and went on to get the ISSCR Public Service Award in 2014 along with colleagues.

“In 2012 the winner was top stem cell patient advocate Roman Reed, who went on in 2013 to receive the GPI Stem Cell Inspiration Award.”

California Stem Cell CEO Search: More Names Surfacing­

While the $3 billion California stem cell agency awaits help from an executive search firm, more names are being mentioned as possibilities to become the new president of the organization.

Keep in mind that these are names that the public is bandying about, not any sort of official CIRM directors' list, which may not exist at this point.

UC Davis researcher Paul Knoepfler triggered the discussion of possibilities this week when he posted a list of a dozen names that people in the field have suggested might be considered. As a result, Knoepfler ­received suggestions from his readers of additional possibilities.

They include Ellen Feigal, the No. 2 person at the agency, and Arlene Chiu of Cedars-Sinai, who was chief scientific officer at the agency until she left in 2007.

Knoepfler also emphasized that the dozen names he listed do not constitute any sort of CIRM list. If some readers may think he is floating trial balloons for the agency, that does not appear to be the case.

Knoepfler's entry into this obviously speculative arena, however, is worthy. Bringing specific names into the discussion could well help sharpen both the focus in the search and the understanding of the type of trade-offs that are likely to be necessary. It also may stimulate comments from people in the stem cell field about what is needed in a new president. Those comments can either be forwarded to the agency or laid out in public commentary either here or on Knoepfler's blog.

As for the executive search firm, the agency hopes to have a contract signed by Dec. 16. But it is certain that some agency board members have already put out tentative feelers to suitable persons.

On Oct. 16, CIRM President Alan Trounson announced his plans to depart and no doubt is increasingly focused on returning to Australia and his family, especially as the holiday season approaches.

Primer and Paean: Consumer Guide to Stem Cells

The article today on xconomy.com had some intriguing elements: “secret online communities,” $100,000 payments to scam artists and talk of New York Times best-sellers – not to mention stem cells.

The article was about UC Davis researcher Paul Knoepfler and his new book, “Stem Cells: An Insider's Guide.” The story was written by Bernadette Tansey, a former San Francisco Chronicle reporter. Tansey said that Knoepfler's book “may never break into the New York Times best-seller ranks, but he still might make some publishing history.” She wrote,

“Knoepfler could be the only biology researcher ever to write a comprehensive consumer guide about the health care treatments being developed in his own field—complete with safety cautions.”

Tansey summarized Knoepfler's book as “a scientific primer and a paean to the promise of stem cell research.” She also said the stem cell researcher sees

“a growing network of secret online communities, as well as overt advertisements, (that) have spurred US patients to pay fortunes out of pocket to ill-trained physicians, who perform experimental procedures backed by little or no evidence.”

Knoepfler's greatest concern, Tansey said, “is for patients who have been lured by the false claims of dubious for-profit clinics to pay as much as $100,000 for unproven 'stem cell treatments.' These injections, he says, may actually consist of cells culled from pigs, cows, or sheep, and bear unknown risks such as contamination or immune system reactions.”

The California Stem Cell Report carried an item last month on Knoepfler and his book. We agree that it is quite helpful and accessible, especially for persons seeking more information about undergoing stem cell treatments.

Midnight Deadline for Stem Cell Person of the Year

Today is more than showdown day for the functioning of the federal government. It is the last day to submit nominations for the Stem Cell Person of 2013.


This is the second year for the contest, which carries a $1,000 prize provided by UC Davis stem cell researcher Paul Knoepfler. He runs the contest and is the ultimate arbiter on who wins.


You have until midnight to submit your nominations. Here are links to more details.

Inside Stem Cells: A Guide from a UC Davis Researcher

The Sacramento Bee today published an article on UC Davis stem cell researcher Paul Knoepfler and his new book, which explores the basics of stem cells and how to make good judgments concerning possible treatments.

The book, “Stem Cells: An Insider's Guide,” is aimed at a general audience while at the same time exploring the nuances of stem cell science.

Below is a copy of the article, which appeared on the main page of The Bee Web site early today and which was written by yours truly. In the print version of The Bee, the Knoepfler piece appeared on the same page as a New York Times story dealing with dubious stem cell treatments(Here is a link to the original version of the Times' piece.).

The Knoepfler story was also the No. 1 article that turned up this afternoon when the Google news category was searched using the term “stem cell.” It is likely to be published elsewhere in the coming weeks as it is circulated by the McClatchy News Service. 

UC Davis stem cell researcher warns consumers to beware of unproven or dangerous stem cell treatments

By David Jensen

Bee correspondent

PUBLISHED SUNDAY, SEP. 15, 2013

In his day job, UC Davis scientist Paul Knoepfler probes the inner workings of stem cells and cancer cells and what makes them behave the way they do.

On the side, the father of three daughters blogs about costly, unproven stem cell treatments and provides guidance for those seeking experimental therapies.

Knoepfler is a rare stem cell researcher who regularly explores the most problematic aspects of stem cell therapies on the Internet in full public gaze. He considers himself an advocate for patients as well as a scientist, having survived an aggressive form of prostate cancer at the age of 42.

Now 46, Knoepfler began his blog in 2010, shortly after his cancer was diagnosed. His blogging has encountered resistance from some colleagues, who are uncomfortable with such public endeavors. But he has polished and expanded the blog to the point that it has received international recognition. He will receive an award in December at the World Stem Cell Summit in San Diego for his advocacy efforts.

This month he moved beyond cyberspace and published “Stem Cells: An Insider’s Guide” (World Scientific Publishing). The book covers stem cells from A to Z and is aimed at the general reader, especially people considering stem cell therapy for themselves, a family member or friend.

The book comes during what has been described by Christopher Scott, a senior research scholar at Stanford University, as “an epidemic of transplant clinics offering so-called cures and therapies” both here and abroad. The international stem cell medical tourism business, widely promoted on the Internet, is taking in roughly $1 billion annually, according to an estimate in Stanford Medicine, a publication of the Stanford medical school.

Knoepfler is a believer in the potential and power of stem cells. But he says that some of the dubious stem cell treatments now being offered have resulted in deaths and injuries. Other unpleasant issues arise as well in stem cell research, including the tendency of some stem cells to generate cancer cells, and Knoepfler wants to talk about them.

“Too often in the academic section of the stem cell field, people pussyfoot around the most important issues or do not even dare talk about them at all,” says Knoepfler.

He is “not on some crusade to dissuade people from getting risky stem cell procedures,” but says safety and training need to be encouraged. Reckless behavior endangers the entire field, he says.

“There is no better illustration of the risks of unlicensed stem cell treatments administered by untrained doctors than the recently reported case of a woman who received a stem cell facelift, only to have bone grow in her eye,” he said, referring to a Scientific American report involving a Beverly Hills clinic.

To help patients, Knoepfler’s book begins with the basics: What are stem cells? He moves on to topics ranging from whether stem cells can treat baldness to whether they can help with afflictions such as Alzheimer’s, autism and arthritis. Along the way, he discusses the potential for regenerating limbs, made-to-order organ transplants and curing spinal paralysis, none of which have reached the stage where patients can be assured of using the techniques safely and effectively.

Stem cell treatments are not exactly new. They were first used in the 1950s in bone marrow transplants. More recently, what has excited researchers and the public are pluripotent stem cells, which have the ability to transform themselves into any part of the body. The full range of stem cells, however, includes adult, fetal, embryonic and induced pluripotent cells (iPS), which are also known as reprogrammed adult stem cells.

“Each type of stem cell has clinical promise for specific diseases, but also certain weaknesses. Some stem cells also stir controversy. For example, embryonic stem cells have been at the center of ethical debates for more than a dozen years,” Knoepfler writes.

Embryonic stem cells are derived from an embryo only a few days after fertilization and require destruction of the embryo. It was that type of process that triggered the federal restrictions – now rescinded by President Barack Obama – on federal funding of research using human embryonic stem cells. Some people believe that the process amounts to killing a human being, while others do not.

Knoepfler has come up with a battery of questions and “rights” that persons considering a stem cell treatment should address as they contemplate spending tens of thousands of dollars for treatments.

His “patient bill of rights” includes the right to treatment by a trained provider, the right to continuing follow-up and the right not to be charged to participate in a clinical trial.

Just this month, he added on his blog, ipscell.com, the top 10 questions that patients should ask. They include such areas as the details of the methods to be used and costs, the cell numbers and types, regulatory compliance by the provider, data supporting the cellular product’s effectiveness and data supporting its safety.

As for mainstream media reports and research papers that seem to promise miraculous cures, Knoepler says, “My advice to patients is to be cautious when reading papers on the clinical use of stem cells. Do not believe everything you read and avoid placing too much weight on any one paper. If something is real, it should be reproducible by multiple groups.”

One of the areas of Knoepfler’s research involves cancer stem cells, a topic of special interest to him because of his own encounter with the disease. “Even with something as wonderful as stem cells, there also can too much of a good thing. Stem cells can cause cancer and in certain conditions they can make cancer especially hard to cure,” he explains.

In the case of embryonic stem cells, he cites their ability to form an unusual tumor called a teratoma. Knoepfler, who was an English literature major as an undergraduate, says, “The name ‘teratoma‘ literally means ‘monster tumor,’ and there is good reason for that nomenclature. These tumors look monstrous when observed by eye, akin to an animal put into a developmental blender.”

Knoepfler did not use stem cell therapy to treat his cancer, but he says that as a cancer survivor he understands all too well why patients turn to it when they’re dealing with a life-threatening or life-changing medical condition.

“If you feel that your disease has put you in a place for which patience is not an option,” he says, “talk with your physician. Get second and maybe even third and fourth opinions before deciding whether or not to proceed.”

Knoepfler’s advice may not be appreciated by some of the firms he writes about, but others think well of him.

Jonathan Thomas, chairman of the $3 billion California stem cell agency, says the field needs more scientists like Knoepfler.

“It's hard to overstate the value of what Paul does,” Thomas said in an email.
“Paul is a powerful advocate for helping the public understand what research is being done, and why it is important. He is gifted at taking complex science and turning it into plain English so that anyone can understand what he's talking about.”

Knoepfler has received $2.2 million from the stem cell agency for his research, which is also funded by the federal government and other sources. He has been at UC Davis since 2006, part of the campus’ stem cell program, which has received $131 million in grants from the state stem cell agency since 2005, generating 333 research-related jobs.

Knoepfler, whose father was a physician and mother a counselor, sees a bright future for stem cells, indeed a “medical revolution.”

“Stem cells are today’s new frontier of medicine that will no doubt have an unimaginable impact on our lives, but even more so on the lives of many of our kids and grandchildren,” he said.

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Jensen is a retired Sacramento Bee journalist and has produced the California Stem Cell Report (californiastemcellreport.blogspot.com) on the Internet since 2005, writing nearly 3,600 items.