Are Stem Cells Really Effective? Everything You Need To Know w/ Dr. David Wilson (SSOF Ep 92)

Dr. David Wilson2:21

Stem cell is a really nice middle step between the conservative. So physiotherapy, training, chiropractic. So you start with those. And if they don't work, maybe you try some tablets, pills, if you want to try for a short-term response from your GP.

But then finally, after that, you would start to look into maybe stem cells in the middle there before you go to operation. Because once you get an operation, really, you've decided and you've taken the knife, and it's hard to go back from that. So stem cells are a pre-surgical option, in my opinion, and really should be considered as a stop between surgery and medicine, whereas you try normal conservative, honestly, cheaper alternatives first. And then as things move on, you would go toward stem cell before surgery.

James de Lacey3:17

Gotcha. Are there certain types of, I guess, injuries that stem cells are best, I guess, used for?

Dr. David Wilson3:17

It's most common. Most of the research right now is focused around arthritis, actually, and wear and tear. And the reason for that is because it's a massive problem. One in two people over the age of 50 have some form of arthritis. So the need for a treatment to try and help these people before they would go for an operation is massive. And that means that most of the research is being done on knees, hips, ankles, and we're seeing more and more now for prolapses and back pain, those kind of debilitating conditions. But in general, most of the research points towards wear and tear.

You could say that outside of the research, more for athletes, you would be looking at people who have injuries that can't be trained back on their own or who must have an immediate or a rapid response. Maybe you're going to compete. If you're going to compete at a high level, you would have a lower threshold for stem cell because you want to try and get all of your treatment as soon as possible.

James de Lacey4:13

So how quickly does stem cells work? You mentioned obviously immediate treatment. Is it something that relieves pain or starts to, I guess, repair an injury relatively quickly?

Dr. David Wilson4:13

Yes. So the repair process starts immediately upon injection. However, the more damage you have done, the longer time you would have to consider before you would be considered treated or or have received whatever outcome you're maybe going to get. So although you might find an immediate relief for pain and swelling, that can go down very quickly, you might also find that you're going to need weeks, two months, to really get the best benefits of.

So if you have a shoulder, let's say, for example, and you treat it today, you might have less pain tomorrow or the day after or in a week's time. You should be seeing some improvement. But really, long-term improvements are only going to be after you've gotten to the weeks-to-months stage. So 6 to 12 weeks, maybe even 3 to 6 months.

James de Lacey5:06

And I know we talked a little bit about there's obviously been some research out, I think recently, that's kind of, I'm not going to say pooh-poohing stem cells, but more so is this mechanism really effective for improving pain, injury, and healing, etc.? Let's just dive into a little bit of that and kind of address what's going on there.

Dr. David Wilson5:06

Yeah, so that question has a lot of different levels, and there's a lot of depth to the question. So it's a good question. If we start in the basics and we say, okay, does stem cell offer any benefit? When we look at stem cell, we can see there's plenty of evidence showing that stem cells can regenerate, and the risk with an autologous stem cell treatment, so from your body for your body, is very low. That being the case, the risk-to-reward benefit there is absolutely in favor of trying it out.

The reason some people will report either not the effect they want or no effect is because everyone is individual. And especially if you're otherwise sick, so people with diabetes, maybe people who have other chronic illness, or people who even have acute illness at the time of treatment are going to have a much lower chance of success because the body's already working on something else at the same time.

Another real consideration is age and the state of the joint. And you said yourself, we always have to be careful not to go too early, but we also don't want to wait too late. Because if you have a joint that's completely shot by the time you get your treatment with stem cell, you might get some pain relief. You're probably not going to get a lot of functional improvement.

And the same would be true then in terms of other ongoing sickness. So if you had the flu, I would say, look, wait until you're better. If you had cancer, I'd say wait until you're better. Because in those cases, your body has more than enough to do before you get a treatment.

And I think when you look at some of the papers that suggest that these treatments are not as effective, usually you'll find that either the population may have had other concomitant diseases, or you'll find that maybe they're just not as good responders. And there's definitely going to be a genetic thing there, too.

Another thing maybe to mention just is that there are different types of stem cell treatment, and not every stem cell treatment is the same. So in my practice, I tend to do fat-based, so adipose-derived stem cell, and that gives you an awful lot of stem cells per milliliter of tissue. But a lot of people are doing bone marrow-derived, and that gives you less stem cells. However, the stem cells are maybe more alert.

So it's one of these balancing acts. What if you give the patient the wrong kind for what they specifically maybe should have needed? Then you're going to end up with a so-called failure to treat. So it is a possibility, and the research is still ongoing, and we do need more. However, I would say that a lot of the time when you find failure to treat, you might actually be able to find a reasonably good answer fairly quickly: concomitant disease, so something going on at the same time, or other causes of, what would you say, physiological impairment of function.

So maybe even someone who works out too much, just to even throw that out there. If you get a treatment and then you go and start lifting weights the day after, your stem cells are going to suffer.

James de Lacey8:06

Oh, that was actually going to be my next question. Because you mentioned obviously about almost like competing resources with the stem cell. So if someone is getting stem cells, would be wise to take it easy for a couple of weeks? Do you usually have a protocol you usually tell your patients?

Dr. David Wilson8:31

Yes. So if we take joints as our sort of first and most straightforward injection, if you have an intra-articular injection, so if let's say it's a knee joint and you're putting it into the space between the two bones, in general we say to people that they should take it really easy for a...

Few days, maybe four or five days, and they should try not to train for four to six weeks at a minimum. And the reason for that is because if you train while those stem cells, which are alive, remember they're your cells, are alive and they're now trying to find, they're trying to find a way to grow into that surface. So you have this lovely cartilage that's maybe damaged in some places and it's trying to, the stem cells are trying to get grown in and become part of that tissue, part of that environment.

Well, if you then start going and really burdening yourself and lifting weights and carrying things, you're going to squish them before they ever get a chance to get grown in and start producing good repair.

James de Lacey9:16

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So if someone is contemplating stem cell therapy, what can someone expect? Because I think from the outside looking in, a lot of it seems like hey, I just go in, I get my one injection and I'm fixed. I'm assuming it's not that way. Don't be, dive into what someone could potentially expect. Obviously there are a range of responses, but just in general.

Dr. David Wilson11:05

Yes, and every clinic will have their own sort of in-house protocols as well, so it is going to differ from clinic to clinic. I should also mention that especially in the US, a lot of clinics have been focusing on allogenic stem cells, where they take stem cells from another source outside your own body and they offer those.

Now in Europe, that's actually less common because over here we're much more regulated in terms of allogenic stem cell, but we're less regulated in terms of your own stem cell from your body for your body. So that means that the first thing you'll have to decide is, do you want stem cells from, for example, the umbilical cord from a newborn? Those are very healthy cells, they're young, they have, they're fresh, but they're not yours and your body might not accept them and they may disappear within about six months.

If you take some stem cell from yourself for yourself, they will hopefully hang around for longer, but you never know because after all we're all aging and as we age we're going to get weaker and our cells are maybe not going to perform as optimally.

The other thing to then say is you talk about what the process would be like. Well, if you go for a stem cell, you should get a good examination, you should really be well informed, you should know what you're going to. You would hope that the doctor would then tell you, okay, here are your options, and give you a different individualized treatment plan.

So for example, maybe you haven't been good at going to the physiotherapist, get to physiotherapy. Maybe the doctor thinks, well, you know what, we'll do an ultrasound. Oh, you've actually, you don't have a joint problem in your shoulder, you have a tendon. Maybe your infraspinatus or your supraspinatus are giving you trouble. Let's give you some exercises for that and come back and get a review in some weeks.

If that then doesn't solve the problem, or if you're not a candidate for that, you've already tried, really then your doctor would be trying to set you up for a stem cell. And it is a relatively straightforward procedure. It takes maybe a few hours or half a day at worst, where the patient comes in and you harvest the tissue, you get it in the lab, and then you inject it into the target area.

And results will vary and practical procedures vary a little bit. So in my clinic, we tended to previously offer a stem cell followed up by two rounds of platelet-rich plasma. So that's the blood-based anti-inflammatory. So you take blood and you take the platelets and put it in afterwards, and we did that depending on the patient's needs between two and six weeks, and you would do that twice.

As it stands today, we actually now mix the platelets, so the platelet-rich plasma and the stem cell immediately, and we give a double dose as our first treatment. So our first round actually, maybe I would say gives us a better effect than the previous first two we used to do, at least in my experience. And that means then that we would have follow-up after three to six months.

It depends on the joint in question. If you're talking knees or hips, they tend to be, I don't want to say straightforward, it's not the most simple thing in the world, but you kind of wait and see because some people will have a gradual progression. And if you're on the right curve, if you're starting to do better and better week by week, actually we just wait and see because one treatment might be enough.

Spine, neck, and in my opinion shoulder, and then your other smaller joints like wrists and ankles, they tend to be definitively must be checked after your three to six months. And often patients come in for a repeat treatment just to try and get them beyond that early improvement phase.

And improvement do vary, but you would be hoping to see, I often say to people, if you've less than 25% improvement or you have more than 75% improvement, wait. Because if you're not getting anything, it's maybe a waste of money, and if you're nearly better, it's maybe a waste of money. If you're in that middle phase, sort of between 25 to 75% better, you actually do want to consider is this, is it time for a refill to see if we can get more out of it.

And that being the case, the biggest hindrance with stem cells is that they do take some time because it's a growth. And just like, I mean, here I have a cut in my thumb. I'm sure everyone wanted to see that, but I can't expect this to disappear by next, what day is today? Today's Monday. I can't expect this to disappear by Thursday. This will take a couple of weeks. This is a deep cut because I'm foolish and I cut myself with a Stanley blade.

So I have a deep cut and I can't expect that to improve before probably about two weeks really, it should be completely gone. Well, for a joint, you're talking three to six months in general for that cartilage to have been resurfaced. Now you can never guarantee, but we tend to say to people, if you've gone 10 weeks and you're feeling like you're not 100% sure, just try and take it easy, wait and see, eat healthy, sleep plenty, give yourself all the things you would normally do to improve regeneration.

And if that works, then hopefully things get improving. But if not, you can always get a refill because at the end of the day, a stem cell treatment should be very low risk.

James de Lacey15:29

Nice. So what is actually happening in the joint? You obviously mentioned there that the cartilage is resurfacing from the stem cells. Is it too basic or crude to say that you're generating more cartilage and your cartilage can get thicker and you have more of a cushion, or is it something more advanced than that?

Dr. David Wilson15:53

So no, that's actually very good and that is, you are at least partially correct. So we have different types of joints, but let's take a standard knee joint. Well, in the knee then you would have, you have your bony plate comes up from the tibia and you have the femur coming down. And in the middle here we have a meniscus, or the meniscus, which is the cartilage cushions if we want to say that.

Now we have no nerves in them, so your cartilage inside the knee that is beyond the bony surface, the cushions, they have no nerves. So you will never feel pain in those, which means that when you have discomfort or pain or loss of function, usually you've actually scraped the other surface.

So if this is your articular surface here and your knee is going to flex, and in the middle you have these cushions, the cushion can be completely destroyed and you wouldn't really know. But when you get pain, it's like a tooth. Once you start to scrape through the surface, so in the one hand there are studies which show that cartilage can regrow and we can have improved thickening, as you say, and improved cushioning. And that...

Is actually quite good for protective future, but as for current pain and current discomfort, it's these injuries on the surface of the actual bone that comes down that gives us the pain and the initial problems that make us limp or not function properly. So we also want the stem cells, for example a mesenchymal stem cell from fatty tissue, it can turn into cartilage or bone, it can also turn into muscle and fat.

Well, in the joint space, maybe this hole that's up into the knee surface is so deep that it's like a tooth egg. Well, some of those cells will probably become bony cells and actually try and grow a new body layer first and then cartilage on top, as well as hopefully improving the meniscus and its quality.

But actually getting improvement off of the bone, so in the meniscus is more difficult because there's less circulation and less resources available for any stem cells that do decide to try and grow on there. So it's a resource management issue for the body as well.

James de Lacey18:07

Gorgeous. So if someone had their meniscus or most of it taken out because of old injuries and things, could stem cells help regenerate that back or is that already too far gone?

Dr. David Wilson18:07

It's theoretically possible, but I think in reality it's probably too far gone without having some kind of lattice to grow. So there are researchers doing this at the moment in labs where they try and grow them in a sky and then set it in. That would be probably a reasonable enough treatment methodology, but I think an injection of stem cell, probably there wouldn't really be much for them to seed onto so they're not going to know even how to get started, if that makes sense.

James de Lacey18:33

Yeah, yeah, that makes sense. Almost like there's no code there for them to work with. But you mentioned as well, stem cells obviously can help regenerate cartilage and muscle, etc. So tendon pain is out of the question then? So if you have, for example, patellar tendon pain or people have, you wouldn't use stem cells to help relieve that pain or repair a tendon?

Dr. David Wilson18:57

You could, although in general my experience here is that actually we have had very good results with the platelet-rich plasma, PRP. So that's a blood-based treatment and in general is a good deal cheaper. It's also very highly anti-inflammatory. So platelets are not living cells, they're part of your blood. So I suppose as we are alive they're kind of alive, but they're actually cell fragments floating around, their little bubbles floating through the bloodstream.

And they provide healing when we cut ourselves, they're what give us scabs and issues. Well, if you put that into a tendon which is injured or damaged or has a chronic inflammation, even an acute inflammation to be honest, you can actually very quickly have a very potent anti-inflammatory effect. And really what you're doing there is you're fooling the body, you're cheating the body into thinking that you've been badly injured so the immune system comes in in full force to try and find this problem.

Generally speaking, maybe you'll centrifuge 50 or 100 mls of blood down to a small volume and you inject that in. Well, the body interprets that signal as oh, we've had a bleed of 100 mls into this really small space, it must be terrible. And so you fool the body into helping to repair.

Now you could do stem cells, but just because of the price difference, you're talking maybe an 8 to 10 times price difference in these two treatment levels, that because of that it really isn't right or I think ethical to offer a patient without having tried the honestly cheaper, probably 80% as effective for that type of problem, solution.

James de Lacey20:16

Does the way PRP is administered differ between countries? Because I remember, so in New Zealand I'm pretty sure it's just like a straight injection into the tendon or whatever the problem area is. My wife had PRP done in Romania and she said it was the most painful thing ever, that the way she was describing it was like that doesn't sound normal. They were basically like jabbing her with the needle like in and out and like into different places. And the quad tendon in her thumbs and I was like, I've never heard of that before. Is it different in different countries?

Dr. David Wilson20:46

Yes, and you are going to get different. So let's start with the simplest question, there are different types of PRP as well. So as you can see, I have, I've lost a lot of hair and I've actually been sort of playing around with PRP for hair loss on myself. That's a very weak dose. So you take blood and you can centrifuge down, let's say, 100 mls to 50 mls of product, but for a knee joint you'd be centrifuging down maybe 100 mls to 7 or 6 or 5 mls of product. So that's a much more concentrated.

So that's the first thing is that different PRP concentrations will affect the outcome you can expect. It will also unfortunately affect the amount of pain you have on injection, because of the platelets as they activate, whether it's here or in your joints or in your fingers or wherever it is, platelets that activate immediately cause a pain response.

And either you can mix it with local anesthetic if you want to try and take that down, but not everyone does. And in Europe actually, just as you suggest, we tend to have a, I would say we have a 50/50 whether you get it mixed with local anesthetic or not, maybe not even, to be honest quite. I used to not and now I do because it was so painful for patients, so I decided that it was more humane to give a mix.

The reason that they don't mix it in some clinics is because that local anesthetic can actually slow down your immune response a little bit. But when you start to really look at the literature, you'll find that any slowdown, you're talking 4 to 6 hours. Well, the PRP effect is going to be hopefully somewhere in the region of 10 to 20 days really.

Is that first 4 to 6 hours important? And that's where the discussion and the disagreement comes from. So some of us think, well, just in case you get an, you eke out an extra 4 hours of effect, it's worth it to give the patient more discomfort. But I would say more and more we're actually going towards trying to give local in advance so that it's not as painful.

James de Lacey22:49

I swear it must be an Eastern European thing to not add the local anesthetic. Because even with my wife, she, I think it was an ingrown toenail. Now she went to a place and whenever I've had ingrown toenail stuff done in New Zealand, would always have some kind of local anesthetic. I mean, that was pretty, usually severe stuff.

This was just kind of like, it wasn't a full surgery, but it was kind of moving stuff away, and they were going at it with just like, just straight up no anesthetic, with the scalpel and everything. And I was like, we just, like, what the hell? This must be something a little different over here.

Dr. David Wilson23:12

That's crazy. They used to be torture, like it was used as torture before, so it is wildly painful. It's crazy. So now I think local anesthetic is definitely quite the invention, like should be used more for sure.

James de Lacey23:35

As someone's listening to us and thinking about, okay, maybe they're going to do some research on who offers stem cells, are there any red flags that someone should watch out for in their research?

Dr. David Wilson23:35

You want to try and see what the person you're looking at is offering and take a good look at if they're open to saying there's pros and cons. The risks for stem cell are low, but people shouldn't be sweeping that under the rug and saying it's zero risk. We don't say that. They shouldn't be offering you the sun and the moon and all the stars. They should be saying, look, this is a realistic treatment, we expect realistic results, in other words improvement, but not necessarily full, not necessarily 100%.

You want to find someone who's going to be open with you and tell you kind of that, well look, it ought to work. There's a theory here that says it works, but not all the research shows that it works every time. So if people feel, if you feel like the doctor or the clinician's trying to hide something or they're trying not to show you the downsides, and like I said, there aren't massive downsides, but at the end of the day if you're using your money, your hard-earned cash on this, it's an investment and that means you should be well informed.

So I would say the biggest red flag for me is if you have someone who's either you feel trying to misinform you or trying to be overly positive without telling you the ups and downs. And you can usually find it out by asking a few simple questions, like what's your experience with this? Do people always get better? Anyone who starts speaking in absolutes I would be careful of.

That also being said, you have to be careful that they don't, and I know of one clinic who mismarket it, so they will tell you you're getting stem cells but they'll take your blood. That's not a stem cell, that's probably PRP or PRF or one of these other platelet-based treatments. And that's a real, I get very frustrated with that because then you have patients dissatisfied, thinking they've been given this stem cell treatment, this wonderful new cutting-edge treatment, and actually what they've gotten was their own blood centrifuged.

And essentially a concentrated anti-inflammatory.

James de Lacey25:37

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You mentioned as well with the different types that you can get from say an umbilical cord, which is from a source outside your body versus inside your body, and you mentioned obviously USA and Europe is kind of different, what's regulated. I guess is there like, I don't want to say a best place to potentially look to do this, but are there certain places that you would typically lean towards maybe doing some kind of therapy like this because of those regulations?

Dr. David Wilson26:59

Yes, it depends on your need. So for your indication, if you're thinking musculoskeletal, I would say, sort of price to what you get, Europe is actually very competitive. So if you can get to Europe, you could probably fly to Europe, get a treatment, and be back cheaper than you would get in North America or Middle America, maybe even more so. But if you're looking for more experimental or cutting edge techniques that might not just be as widely accepted globally, you're going to be looking towards Central America.

So even Mexico, Panama, I have, I know of a few clinics down there who are doing exceptionally good work, very, very interesting work. But part of the reason they can do that is because they're not as tightly regulated, so they're able to actually do things that really for us just would be off the table.

So if it's, if you're looking for value, I would say Europe is probably a really good choice. If you're looking for cutting edge, maybe you have something that's less common or there isn't good enough research to offer it here in Europe, then you're going to be looking towards sort of Middle America. Asia are really starting to come ahead as well. So I have colleagues in India who I'm friendly with and they do a lot of very good work, but it's somewhere in the middle regulation-wise.

So India would be maybe not quite as tightly regulated as Europe, but it's not just as free as sort of Central and Southern America. Over there it seems like you can do mostly, I don't want to say anything, but they seem to do a lot more than the rest of the world.

James de Lacey28:38

And you mentioned at the beginning as well, obviously there's different types of stem cell treatments. So we talked mainly around musculoskeletal injury, but you mentioned there's potentially treatments for other diseases, things. So maybe dive into a little bit of what the research is showing now, even some kind of practical stuff that you have been doing around stem cells and these diseases, maybe how that treatment even differs, because obviously it's not injected straight into the joint.

Dr. David Wilson29:03

So if we were to look at some of the most promising research that I've seen coming out in terms of low-risk, high-reward, there are currently ongoing studies into intravenous stem cell treatments for neurodegenerative diseases. So that's things like ALS or motor neuron disease, that's what Stephen Hawking had. You're looking at MS, multiple sclerosis, you're looking at Alzheimer's, dementia, and actually maybe in the future, maybe anti-aging as a as a topic.

I know that's not a medical diagnosis, but we've kind of accepted up until now that it just happens and we all get older and we're going to age. But there might be a way to tell the cells to turn back and actually help promote youthfulness in people.

The biggest difference then is where do you source the cells? I would say the Americans are very much leaning towards so-called allogeneic or not from yourself, so trying to get from umbilical cord or other young sources, because that's kind of, I suppose, in one way it's an easy way to get young cells and to try and encourage youthfulness because they're from a younger source.

On the other hand, the risks with those are just that you might end up rejecting them. And as an intravenous, I think there are higher risks there because an intravenous stem cell treatment will obviously can go anywhere in the body, and if you do start to get some kind of rejection, it could cause issues.

On the other hand, the patient's own cells, maybe they have a predisposition, a genetic weakness, a susceptibility that's going to mean that the treatment isn't nearly as successful. So there are all these things to weigh up. That means then that source for stem cells is one of the current hot topics, and I reckon that we're going to see a very clear division in the future between certain stem cells are considered approved or good for certain conditions.

Like musculoskeletal, I think you could maybe use both, but I of course, maybe because of my own past practice, I think from your body for your body is a good place to start.

But then if you start looking into dementia or Alzheimer's or some of these diseases that might have a genetic link, maybe getting someone's cells from a donor or from an umbilical cord, if they're tested and you know you're not going to reject them, and you do that with something called HLA testing, if that's the case, that might actually be a good way to try and improve health and longevity. So I think we're probably going to see a mix coming in the future.

James de Lacey31:19

Do you think these IV bars that have popped up all over the states will probably start offering stem cells as part of that then?

Dr. David Wilson31:19

I think they would love to, if the regulation was such that they were able to. I think you would find people being able to drop in because it takes what you can get to a whole new level. So for example, let's say you had, you played sports and you got a head injury, but it was years ago and you haven't thought about it.

Well, that will still have left a mark on your neurons. You will have some kind of scar in, it might be microscopic, but you will have scarring in some way, because if you've had an injury, you're always going to have sequelae or results from that which hang around.

An IV stem cell, the stem cells, actually they're attracted, it's called chemotactically. So it's almost like magnets, except instead of going metal to metal or magnet to metal, it's the chemicals of injury attract stem cells. So they actually get attracted to the places where injuries are, and they will start to work and see, hopefully, see improvement for patients. So this is what we're seeing with these chronic degenerative diseases, that people are actually finding. And the biggest challenge we have is, how do we get the cells to go where we want?

Well, in some ways it's kind of, you hope. You put them in and you hope they go to the right place, because maybe, maybe we give you a stem cell for that brain injury you had 15 years ago that was just tiny, it's not much, but maybe it gives you a little bit of fogginess in your thoughts sometimes when you're tired or something similar to that.

But then what happens if actually at the same time you've had a lung injury you don't even know about? Well, you might end up having better lung function and not getting the improvement you thought you would in the brain, because we can't really direct at the moment where the cells go to.

But I think if we were seeing IV bars where people could give stem cells, that would actually be a reasonable treatment. I think you would see people living longer, better health in general, and I think we'd see across the board maybe a higher bar of function, an actual higher threshold before people would get sick. But these are just my thoughts. I can't say that there's enough evidence to say that. I just suspect.

James de Lacey33:18

Fair enough. And regarding prices, maybe give us some just ballpark figures of what someone could potentially expect for a treatment of stem cells for say a musculoskeletal injury, maybe just for example like a knee.

Dr. David Wilson33:18

So in Europe, you can expect to pay anywhere between, I'm just trying to think of the conversion rates, let's say probably anywhere between about €3,000 to 4,000 or 5,000 probably is a for a standard single joint injection. Some clinics will offer then, and if you need two, you can get the second one for a much reduced price, because really the equipment costs aren't much more. If you're going to look at more expensive locations like Dubai, you could be paying €10,000. You could be paying tens of thousands of dollars for treatments. And intravenous tends to be much more.

Expensive. So these places which are offering those are probably going to be offering those at tens of thousands of dollars and up. And again, I have to say that I've noticed that the closer you get to the U.S., the higher the price. So if you're in countries that are further away from the U.S. or don't have a private healthcare industry, prices tend to be lower.

So European prices—I mean, I was looking at this even in the UK. So I'm in the UK mainland, or UK at the moment. Compared here to Norway where I have my clinic, Norwegian prices are about half of UK prices. And the reason for that is because the UK is starting to move towards a privatized, or at least semi-privatized healthcare model. So people are more willing to pay, and as the market tolerates higher prices, prices go up.

But then you go to places like Eastern Europe, Scandinavia—I like Scandinavia, of course. I work there. But you go to somewhere like that, you can find very high quality clinics which are offering very reasonable rates. And the reason for that is because the populace in Scandinavia particularly are used to very good free healthcare at the point of access, which means then they're not interested in reaching into the wallet and paying out big money for treatments.

So I think Australia, New Zealand also, if you can find clinics there—I think there's quite a lot of regulation there also, but they tend to be reasonable in terms of price compared to North America, in my experience.

James de Lacey35:32

Perfect. Perfect. I think that's a good way to finish up this podcast. Where can people find you and follow you and see what you're up to?

Dr. David Wilson35:32

So I'm working on getting my Instagram back in order—Dr. Stem Cells, dr.stemcells. I have drstemcells.com. I also have a clinic in Norway. It's maybe not as relevant for people outside of Norway or Scandinavia, but it's Phoenix, like our English spelling of Phoenix, helse, because that's the Norwegian word for health—H-E-L-S-E dot N-O. But like I say, that's more of a Norwegian kind of thing.

So drstemcells.com or dr.stemcells on Instagram, and you'll see me there. And I also have YouTube, but it's a work in progress.

James de Lacey36:12

Perfect. I'll link those up in the description as well. I just followed you on Instagram so I can do that, and I'll put your website there too. But thanks for coming on, David. I really appreciate it.

Dr. David Wilson36:12

Thank you very much. And let me know if you have anything, and I'll see you around.