Cover PRP and Stem Cell Injections Under Provincial Heath Care And Provide More Funding To Regenerative Medicine Research

We, the undersigned, would like to provoke discussion regarding the issue of platelet rich plasma therapy, stem cell therapy and the ability of these therapies to reduce financial strain on our current healthcare system. While stem cell research is often a controversial topic, We hope to address some of the counterarguments and provide reasonable evidence in support of this critical and groundbreaking research. Loosening restrictions on and providing more funding to scientists performing stem-cell research in addition to covering platelet rich plasma therapy and stem-cell injections under provincial health care, paves the way for a new era of discoveries in the field of regenerative medicine. We can ease both the economic strain of joint replacement surgery on our economy and vastly improve the wellbeing of patients.
Claims against stem-cell research are often unfounded and based solely on principles of religion and pro-life activism. The belief that life starts at the moment of conception, when a sperm fertilizes an egg, creates an ethical debate on the harvesting of embryonic stem cells. Many religious organizations believe the destruction of an embryo is the destruction of a human life. Anti-abortion groups also oppose research on stem cells derived from aborted fetuses. Unfortunately these counterclaims are unfounded by medicine and often based only on interpretations of holy scripture. One particular verse that is often cited by those of the belief that life that life starts at the moment of conception reads "When Elizabeth heard Mary’s greeting, the baby leaped in her womb, and Elizabeth was filled with the Holy Spirit…[saying] ‘As soon as the sound of your greeting reached my ears, the baby in my womb leaped for joy'" (Luke 1:41-44, NIV) In order to better refute these biblical counterarguments, we must often do so in a manner understood by their supporters with the following passage from the old testament: “Then the LORD God formed man of dust from the ground, and breathed into his nostrils the breath of life; and man became a living being” (Genesis 2:7, NIV) suggesting that life enters the body at first breath rather than the moment of conception. The concept of life and the human condition is one which theologians and scientists have battled over for centuries, yet there is no scientific basis for claims that life starts at conception.
A more viable and realistic counterargument is the cost of stem cell research and therapies. While it is indisputable that most new medical technologies are expensive, the cost of a procedure decreases exponentially in inverse correlation to how often these technologies are used. A good example is bone marrow transplantation, which was initially very costly. Yet only a few decades later, bone marrow transplantation has become a routine procedure that is used for the treatment of numerous diseases. Furthermore, stem cells are now far more easily harvested using blood from the umbilical cord that can be donated to researchers by new mothers or even from the bone marrow and blood of healthy adults. It is my opinion that rather than giving the option of cord blood donation to new parents, they should be given the option of opting out of cord blood donation rather than opting in, thus increasing the amount of research materials available to scientists and thus partially decreasing the cost of stem cell research in the interim.
Stem cell therapy has been shown to improve the condition of patients suffering from all manner of ailments, including (but not limited to) autoimmune diseases, spinal cord injury, neurological disorders, chronic pain sufferers, and even Alzheimer's disease. A very recent study published in PLoS ONE states that the introduction of amniotic fluid derived stem cells in patients suffering from neuropathic pain, possibly by modulation of inflammation.1 The ability of stem cell therapy to modulate the human body’s inflammatory response has applications in all areas of medicine, as literally tens of thousands of conditions from food allergies, sinusitis and asthma to ulcers, tuberculosis and rheumatoid arthritis are caused by inflammation in the body.2
Counterclaims in regards to PRP therapies are (thankfully) rooted more so in science than religious ethics. The safety of platelet rich plasma therapy is often questioned to be an issue as increases in growth factor in localized areas may promote cancer. Another concern is the use of bovine thrombin in activating the PRP release causing blood clots or immunogenic reactions. However, these claims are often outdated in medical research with most of them dating back over a decade. With recent advancements in medical research and technology we have seen many more studies pointing to the safety and efficacy of PRP therapy in both human and animal test subjects. While it is true that many randomized controlled studies have not found any difference between the use of PRP and placebo, this may be because most of these studies did not have specific age ranges, defined methods to evaluate objectively the effects of the PRP on healing tissues, and the fact that the ideal concentration of platelet concentrations and ratios have not been defined. Thus, we require the funding of more research into these areas of regenerative medicine with more clearly defined variables. A recent study conducted at the The Glen Sather Sport Medicine Clinic, Edmonton, Canada points to the effectiveness of PRP therapy, reporting significant improvements in the pain of those patients receiving PRP while patients receiving placebo reported no change.3 Another recent study found that PRP therapy in conjunction with TiO2 improved both the formation of new bone and biomechanical stability of titanium surgical implants in ovariectomized rats, supporting the success of aforementioned implants in osteoporotic bone.4
Several professional athletes of note have been the recipients of platelet rich plasma therapy, including Tiger Woods, Alexander Rodriguez and Kobe Bryant. According to Dr. Robert F. LaPrade, Chief Medical Research Officer at the Steadman Philippon Research Institute and Partner at The Steadman Clinic specializing in complex knee injuries, “Biological treatments to treat cartilage, muscle, and tendon injuries from sports injuries or aging have been recognized as one of the up and coming frontiers of sports medicine.”5
According to the Canadian Institute for Health Information, a high volume of these procedures are performed annually, resulting in significant health care costs and, for some patients, longer-than-desired wait times for their surgeries. The number of these surgeries being performed has grown steadily over several years (a 19.1% increase in hip replacements since 2009–2010 and a 22.9% increase in knee replacements since 2009–2010).6 When all types of joint replacements are considered (including primary and revisionary surgeries, unilateral and bilateral, elective and emergency), the total in-hospital cost of hip and knee replacements in Canada is estimated at $963 million, using CIHI’s Patient Cost Estimator.7
A recent study published in the journal Pain states that many patients who have undergone knee or hip replacement surgery are still taking prescription opioid painkillers up to six months after the operation and Science Daily reports that the researchers at the University of Michigan who conducted the study on 574 patients undergoing knee or hip replacement surgery found that about 30 percent of patients were taking opioids before their surgery. Of this group, 53 percent of knee replacement patients and 35 percent of hip replacement patients were still taking opioids six months after the operation.8
In conclusion, we urge the Alberta government to increase funding research into stem cell and platelet rich plasma therapies, as well as covering these therapies under provincial healthcare. We hope to decrease our current society's dependence on opioid and other narcotic pain medications that are often prescribed for the pain stemming from joint injury and deterioration as well as from the surgeries themselves. By assisting the injured tissues to heal properly of the body’s own accord we can reduce if not almost entirely eliminate the financial strain on our healthcare system caused by joint replacement surgeries while reducing the number of lives destroyed by opioid addiction caused by the over-prescription of these substances. Once regenerative medicine gains traction in the medical community we will see drastic decreases in the cost of recovery centres and mental health addictions programs, accidental overdoses, street crime and the general well being of patients across our province and set a positive trend for the rest of Canada to follow.

Thank you for your time and consideration.


Resources:
1 Chiang, C., Liu, S., Sheu, M., Chen, F., Chen, C., Su, H., & Pan, H. (2016). Feasibility of Human Amniotic Fluid Derived Stem Cells in Alleviation of Neuropathic Pain in Chronic Constrictive Injury Nerve Model. PLoS ONE, 11(7). doi:10.1371/journal.pone.0159482 
2@. (2013, March 07). Inflammation Affects Every Aspect of Your Health. Retrieved October 05, 2016, from http://articles.mercola.com/sites/articles/archive/2013/03/07/inflammation-triggers-disease-symptoms.aspx 
3 Wesner, M., Defreitas, T., Bredy, H., Pothier, L., Qin, Z., Mckillop, A. B., & Gross, D. P. (2016). A Pilot Study Evaluating the Effectiveness of Platelet-Rich Plasma Therapy for Treating Degenerative Tendinopathies: A Randomized Control Trial with Synchronous Observational Cohort. PLoS ONE, 11(2). doi:10.1371/journal.pone.0147842 
4 Zhu, S., Jiang, N., Du, P., Qu, W., Li, L., & Liu, Z. (2016). The synergistic effect of TiO2 nanoporous modification and platelet-rich plasma treatment on titanium-implant stability in ovariectomized rats [Abstract]. International Journal of Nanomedicine, Volume 11, 4719-4733. doi:10.2147/ijn.s113375 
5 @. (n.d.).Kobe Bryant Benefit of PRP Therapy | Biologic Treatments for Sports Injuries | Colorado. Retrieved October 05, 2016, from http://drrobertlaprademd.com/kobe-bryant-among-high-level-athletes-who-believe-in-the-benefit-of-prp-therapy-dr-robert-laprade-comments-on-the-use-of-biologic-treatments-for-sports-injuries/
6 Types of Care Hip and Knee Replacements in Canada: Canadian Joint Replacement Registry 2015 Annual Report (Rep.). (2015, September). Retrieved https://secure.cihi.ca/free_products/CJRR_2015_Annual_Report_EN.pdf 
7 Canadian Institute for Health Information. Patient Cost Estimator. http://www.cihi.ca/cihi-ext-portal/internet/en/applicationnew/spending+and+health+workforce/spending/cihi020209. 
8 Goesling, J., Moser, S. E., Zaidi, B., Hassett, A. L., Hilliard, P., Hallstrom, B., . . . Brummett, C. M. (2016). Trends and predictors of opioid use after total knee and total hip arthroplasty. Pain, 157(6), 1259-1265. doi:10.1097/j.pain.0000000000000516