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Be the change you wish to see – or walk away. Money at NIH



A Turning Point


$$$$$ MONEY $$$$$


at NIH


May not come this way again


NIH developing

5-year NIH-wide Strategic Plan




Donate to organizations, below

They can provide feedback to NIH via the

RFI Submission site




John C. Liebeskind, 1935 – 1997, distinguished scholar and researcher, past president of the American Pain Society, had the radical idea that pain can affect your health.


Research decades ago by an Israeli team at UCLA and others had shown “that pain can accelerate the growth of tumors and increase mortality after tumor challenge.” Decades ago Professor Liebeskind lectured all over the country: Pain kills.


He wrote an editorial in 1991, summarizing a life’s work:


“Pain and stress can inhibit immune function.”



Quoting John Bonica, the father of modern pain management, he wrote:


“Bonica has long argued that the term ‘chronic benign pain’ (used in distinction to pain associated with cancer) is seriously misleading.  Chronic pain is never benign, he contends; “it is a ‘malefic force’ that can devastate its victims’ lives and even lead to suicide.”



Liebeskind continues, “It appears that the dictum ‘pain does not kill,’ sometimes invoked to justify ignoring pain complaints, may be dangerously wrong.”


Pain mediates immune function




  Opioids mediate the suppressive effect of stress on natural killer cells,


 published in 1984, immune system.


Alcohol increases tumor progression, 1992, immune system.


It used to be news.

He did not live to see change.


People just want to go on doing what they’re doing.

They want business as usual.



After 1991, we saw the great discoveries of neuroinflammation, pioneered by Linda Watkins, PhD, the early understanding of the innate immune system, its involvement in chronic pain and depression, and a few weeks ago, a British team showed neuroinflammation in teens with early signs of schizophrenia and DNA markers.



Major Depression has the same neuro-inflammation found in chronic pain, often responding to same medications, in particular glial modulators – immune modulators. Now, perhaps early schizophrenia will respond to glial modulators, reducing inflammation seen on scan in teens, before they become homeless and burned out by antipsychotic drugs


Inflammation out of control destroys neurons


Fire on the brain



We must be the change we wish to see


It’s not just the Bern. It’s been starting. Forces are finally coming together. We want change. It’s been too much. Too long.


We won’t take it anymore.


I figure if I tell you about it, you might just mention it to someone to pass it on. That is all. One small action may lead to change. Activate inputs to the NIH strategic plan.



~ Action needed ~


Prices of drugs becoming unaffordable

No new drugs for pain or major depression

Research to repurpose existing drugs

Expose the politics destroying our compounding pharmacies


Above all

The #1

Major Priority:

Request NIH to solicit priority call for research on

Glial modulators of the

Innate immune system





Glia modulate

chronic pain, major depression

and almost every known disease


Glia are your innate immune system


Inflammation kills




 Stress kills. Inflammation kills.



Pain kills


In the 1970’s, Professor Liebeskind and an Israeli team at UCLA injected cancer cells to two groups of rats that had sham surgery. Cancer spread much faster and killed far sooner in the group with poor treatment of surgical pain.



~ Pain kills ~


He lectured all over the country


Forty five years ago



I’m gonna be dead before I see this country do anything but unaffordable opioids and the magical ineffective trio of gabapentin, Lyrica, Cymbalta to treat chronic pain. The devastating, blind, nationwide emphasis does nothing to address the cause: inflammation, the innate immune system gone wild.



Innate immune system in action


Untreated pain suppresses the hormone systems too.


Untreated depression – same inflammation kills lives.


Where’s the money?


We are the change we wish to see. It’s pitiful I am so lazy. Suddenly, too late, we may need something, but, aha, no new drugs in the pipeline.




~ Make a joyful cry to NIH ~


They are soliciting input from professional societies


If your condition has failed all known drugs for pain or major depression, then make a joyful cry to NIH, now, before they give away all that nice new $$$$$money$$$$$.



Follow and join


American Pain Society



International Association for Pain

celebrating 40 years of pain research



Reflex Sympathetic Dystrophy Syndrome Association

help for CRPS/RSD  




The key to CRPS/RSD pain will apply to all forms of chronic pain, in particular the most difficult form, neuropathic pain. RSDSA funds research into all forms of chronic pain, not only Complex Regional Pain Syndrome (CRPS/RSD). Their scientific board members are not funded by opioid money.





what is the annual cost of care

as fraction of GDP

for the growing population of Americans on opioids

for one year, for lifetime?



People are dying from prescription opioids and those who need them find they don’t work well enough. Prescriptions opioid costs must be a huge fraction of the medical costs in the United States GDP. You are required  to see a doctor every single month each year, often lifelong, just for one opioid, 12 months a year x 30 years x tens of millions of people and increasing – a growth industry. Not even counting $600 a day for the opioid, what the cost of monthly visits for 30 years? Not counting the army of DEA, FDA, CDC agents watching the opioids like a hawk. We all have to be sharp, addiction is growing. Addiction aside, deaths from prescription opioids are shaking up the CDC forcing urgent change this coming month.




Opioids do not work well for chronic pain

We need better

It’s not just the $600/day price

They just don’t work






Raise a joyful noise at NIH now or write back at us readers with comments and better suggestions. Tell others what you’d like to see. Which politicians do you know would be most interested in this at national levels and organizations?


You may never see this change unless you do it now. Other forces will get this new money.



Turning point now

May not return



We are at a turning point and we will fail to catch the sail that’s coming fast to carry all research money in their shiny big stem cell direction. They never look back.



There is so many medications we can use today, FDA approved drugs that can be re-purposed and applied to recent cutting edge science. Someone must pay to do the work to study this.



Re-purpose old drugs



Stanford just showed a popular generic drug improved recovery of stroke paralysis in mice to begin at 3 days rather than 30. Old drug, new purpose, of course more years of testing to confirm in humans. Brilliant team applying new science.



NIH to solicit a

Special Invitation

for 30 good protocols to

repurpose old drugs



Hundreds of old drugs, already approved, could be involved in mechanisms we have recently learned about. Speak up or money will go to shiny new stem cells. None for chronic pain or major depression. No company will find this profitable – it must be funded by NIH. A popular generic sleeping pill can bring astonishing return from stroke paralysis.



Congress has not opened this new money to NIH in many long years. How often will there be extra money?






Lawrence A. Tabak, D.D.S., Ph.D.
Principal Deputy Director, NIH, solicits you to

Review the NIH Strategic Initiative Plan and their

Request for Information (RFI) and the NIH website

and provide your feedback via the RFI Submission site



This is for “stakeholder organizations (e.g., patient advocacy groups, professional societies) to submit a single response reflective of the views of the organization/membership as a whole. We also will be hosting webinars to gather additional input. These webinars will be held in early to mid-August.




Be the change you wish to see

Donate to those organizations

to solicit the change you wish to be




Happy New Year


There’s money at NIH







The material on this site is for informational purposes only.

It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

Relevant comments are welcome.

If any questions, please schedule an appointment with my office.

This site is not for email.


For My Home Page, click here:  Welcome to my Weblog on Pain Management!





Stem Cells from Your Own Fat Tissue for Osteoarthritis of Knee and Hip


Human Adipose Tissue Is a Source of

Multipotent Stem Cells


Molecular Biology of the Cell
Vol. 13, 4279–4295, December 2002


Although “… its application in vivo is necessary, the results presented in this study suggest that adipose tissue may be another source of pluripotent stem cells with multi-germline potential.”


The abstract below, from a 2002 publication out of UCLA, appears to be the start of the research into stem cell injections of joints that I came to receive four months ago.


My fat was taken behind my back via quick liposuction by a highly qualified plastic surgeon and the aspirate was handed over to the orthopedic team. It remained in a fully enclosed system that isolated my own stem cells with their growth factors and PRP (platelet rich plasma) and then, under strict ultrasound guidance, injected into both knees and right hip. I am speaking of stem cells for osteoarthritis of joints, not for autoimmune disease.


This is not covered by insurance; it is not an approved procedure. The injections were my own self-funded research in medicine and the trust of my orthopedic surgeon. Of course I interviewed others who had had the injections. There was so much potential to gain and I have benefited greatly.


In my decision to receive injections, I decided I’d rather invest in my own self-funded research than to take time from work for total hip replacement, and someday total knee replacements. Then revisions of those surgeries in another 15 years. I chose instead to receive injections of my own stem cells into these joints. The work was done by The San Diego Stem Cell Treatment Center that is an affiliate of Cell Surgical Network. The group consists of some of the country’s finest orthopedic surgeons in a few private clinics across the country who are working to do this clinical research. The San Diego Center is headed by Peter B. Hansen, MD. who has one of those rare CV’s, an ideal CV. Local boy, first in his class, chief of service, chief of staff, voted best in San Diego by peers. Similarly, the CV’s of the orthopedists who head the other centers across the country, anyone can easily see they are among the best.


Some of us are conservative with our patient’s care, but we will risk for our own lives for a reasonable cause. In the interest of medicine, and, in my case because all surgery has risks, I decided the unknown risk of stem cells. The other option, since I may live another 30 years, was total joint replacement in hip and knees, followed by how many revisions that will have to be made in 15 or 20 years, at what risk again and again?




Patricia A. Zuk,*† Min Zhu,* Peter Ashjian,* Daniel A. De Ugarte,* Jerry I. Huang,* Hiroshi Mizuno,* Zeni C. Alfonso,‡ John K. Fraser,‡
Prosper Benhaim,* and Marc H. Hedrick*

*Departments of Surgery and Orthopedics, Regenerative Bioengineering and Repair Laboratory,
UCLA School of Medicine, Los Angeles, California 90095; and ‡Department of Medicine and the
Jonsson Comprehensive Cancer Center, Division of Hematology and Oncology, UCLA School of
Medicine, Los Angeles, California 90095

Submitted February 25, 2002; Revised June 21, 2002; Accepted August 23, 2002
Monitoring Editor: Martin Raff



Much of the work conducted on adult stem cells has focused on mesenchymal stem cells (MSCs)
found within the bone marrow stroma. Adipose tissue, like bone marrow, is derived from the
embryonic mesenchyme and contains a stroma that is easily isolated. Preliminary studies have
recently identified a putative stem cell population within the adipose stromal compartment. This
cell population, termed processed lipoaspirate (PLA) cells, can be isolated from human lipoaspirates
and, like MSCs, differentiate toward the osteogenic, adipogenic, myogenic, and chondrogenic
lineages. To confirm whether adipose tissue contains stem cells, the PLA population and
multiple clonal isolates were analyzed using several molecular and biochemical approaches. PLA
cells expressed multiple CD marker antigens similar to those observed on MSCs. Mesodermal
lineage induction of PLA cells and clones resulted in the expression of multiple lineage-specific
genes and proteins. Furthermore, biochemical analysis also confirmed lineage-specific activity. In
addition to mesodermal capacity, PLA cells and clones differentiated into putative neurogenic
cells, exhibiting a neuronal-like morphology and expressing several proteins consistent with the
neuronal phenotype. Finally, PLA cells exhibited unique characteristics distinct from those seen in
MSCs, including differences in CD marker profile and gene expression.




So, adipose tissue has stem cells that are multi-potent, and perhaps even pluri-potent.


There is a stem cell researcher at UC Davis who, in his blog, waxes rather shrill in absolute opposition to any self-funded clinical research projects with stem cells until more is known. I presume that is his main attack and I apologize if that is incorrect. How many years do we wait until we can know it is safe 100%? Nothing is 100% predictable. Surgery isn’t safe either. Falling and hip fracture alone with surgical repair has a mortality of 18 to 48% in the six months after fracture. We don’t know why.


Well, they cannot do all the work in work academia. Researchers can’t get the funding for one thing. This alternate clinical approach is self funding, not covered by insurance. And if you think that is enriching the orthopedists, you have no idea what it costs to do any decent research, build specialized clinics, technology, equipment. If it’s medical, the ultra sound equipment alone will be $50,000 not $500. And are these centers in low cost neighborhoods where no one can afford the choice? Then overhead is deserving of every bit of the cost of what I see. Who will pay these pioneers for the time invested to design these studies and put it together with data, nurses, technicians, physicians, surgery center overhead? Surgeons cannot makes millions on this because it cannot be patented, like pharmaceutical companies. Doctors do not make the fortunes that business men do by patenting albuterol, the old asthma inhaler for example, so they can charge $100 instead of $15 a few years ago. Or the nasal spray selling for more than $250 a month by prescription, is over the counter in Europe for less than $7. Greed can destroy medicine. But these stem cell injections are minor procedures like the injections done all the time, but now injecting a small fraction of your own fat’s stem cells.


Medicine is always built on clinical trials. And off label medications or procedures. That’s how it evolves. We all know that what they see in mice does not always correlate in humans. If we wish to take the risk in our own joint space with our own cells, it is not the same as thinking that something injected into a vein or into spinal fluid will do a specific job to cure some degenerative disease in the brain. Is that magical thinking? This is a joint space for Pete’s sake. We can watch it, to some extent, with ultrasound. We can take a history. Can I now take a step without fear of the hip giving out? absolutely liberated! Every step I took for months was an absolute focus to avoid falling. And for 18 months, I was not able to stand on one leg to dress. All that resolved two weeks after stem cell injections, those were no longer problems. Every day since then has been better, now at four months I can sit in semi lotus almost comfortably. I can feel that improve. 


He wonders how many NFL players in the Super Bowl have had stem cell injections.


According to a recent, very important article by Kirstin R.W. Matthews and Maude L. Cuchiara stem cell therapies are quite common amongst NFL players. See Table 1 from their paper above that just shows the players who have publicly acknowledged getting stem cells treatments. Last year’s Seahawks player Sidney Rice apparently had a stem cell therapy.


Given how common stem cells are in the NFL, it’s interesting again to consider how many players in the Super Bowl might have had them.


We also do not know of course whether such stem cell interventions are safe or effective yet because to my knowledge there is no data on how much players have done after their “treatments”. Many so-called “stem cell treatments” may in addition not even involve actual stem cells.


Of course another issue with the NFL and stem cells is one looking to the future when there is hope that evidence-based stem cell treatments may be proven safe and effective for traumatic brain injury, a condition so common amongst ex-NFL players.


Harvard had to retract their stem cell spaper published one year ago. Their stem cells do not produce the slightest amount of insulin, despite all the headlines they received and no doubt all the funding that was thrown at them by private and agency sources to do more of this miracle research. We are all familiar with the claims to fame of academics who had their papers retracted and those who committed suicide. The field is rife with hope and greed.


Using my own cells, to spin down to the stem cell fraction and inject into my own joints, in a closed system with nothing added to it, that is very exciting and, in a sense, very basic clinical research indeed. I can hardly wait to see the combined results from the affiliates of Cell Surgical Network. But regardless of the results, even if a tiny percentage improved, for myself, I’d do it again if I had to choose.


My results so far are worth everything to feel the confidence that I will not fall with every step I take; to be able to walk up and down stairs, usually without hesitation, when I could not do that for months and months. These orthopedists have my full support. I am not willing to say we need to wait for more proof on this one, let’s just begin the work. No matter what, it will take years to learn. Let’s begin now, twelve years after that seminal paper from UCLA with the revolution in stem cell research that has already shown results in dogs.


While you all wait to do more sophisticated dazzling stem cell work in academia, the population is living longer than ever, with less than dazzling aging of major joints. Runners, you have it really bad before you are 60.


There are more joint replacements and revisions than ever before imaginable, and high mortality from hip fractures. It’s time to be realistic and a bit more open minded in this conservative field.


Someone else will do this work clinically unless the best take it on themselves?


Will we let the “flashers” start doing these? The flashy surgeons who are the worst, the most untrustworthy? Or will the work be done by this outstanding group of the best orthopedic surgeons joining together on a very smart question that afflicts millions of us every day for years of disability and pain?







The material on this site is for informational purposes only.
It is not legal for me to provide medical advice without an examination.

It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.


This site is not for email and not for appointments.

If you wish an appointment, please telephone the office to schedule.



For My Home Page, click here:  Welcome to my Weblog on Pain Management!


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