By Wale Akinola
Dr David Ikudayisi, the Managing Director/CEO of Glory Wellness and Regenerative Centre, is the pioneer of regenerative medicine in Nigeria, a new branch of medicine that does not require treatment of patients with the use of drugs but blood and stem cells. Ikudayisi, in this interview, speaks on regenerative medicine among other issues in Nigeria’s health sector. Excerpts:
You don’t need to be told that there are so many things wrong with Nigeria’s health care system. How bad do you think the situation is?
There are many factors involved here like shortages of medical supplies, inadequate facilities, poor quality control, issue of brain drain, etc., and all these leading to recording poor health indices. Another reason for recording poor health indices is that most Nigerians do not embrace preventive medicine. We do not go to the hospital or medical clinic until our conditions have gotten far. We promote but do not practice the ideology that ‘Prevention is better than Cure’. It is worth mentioning that regenerative medicine can help address health care challenges in Nigeria. Regenerative medicine, as in Platelet Rich Plasma (PRP) Therapy & Adult Stem Cell (ASC) Therapy, can help reduce our mortality rate in Nigeria, thereby recording better health indices.
Two of the issues bedevilling the health sector are medical tourism to which foreign exchange is being lost and brain drain. Only recently, Saudi officials were in Nigeria for instance to recruit doctors. How significant are these issues to the attainment of good health care in Nigeria?
Brain drain is a big issue that is affecting our health care in Nigeria, allowing our talented doctors to find well-paying job opportunities outside Nigeria. Young doctors are being offered better opportunities to practice in environments with better technologies and other doctors that may have experienced advanced techniques. We need our highly skilled doctors back here at home to attain good healthcare. There is nothing wrong if a doctor is travelling abroad to obtain additional education, and those that chose to be recruited by other countries like Saudi should not be faulted. The issue is that these talented doctors may not want to come back home after all the investment in their education and training in Nigeria by Nigerians around them. And this means a loss of significant resources to Nigeria with the benefit of going to the recruiting countries.
When you talk of medical tourism, Nigeria is a departure country, and this does not help us in attaining good healthcare. This has a negative effect on our Gross Domestic Product (GDP). Some of our doctors practising abroad are already coming back home and these doctors are providing world-class medical services because of Nigerian people worth it. I personally believe that Nigeria will become a centre for medical tourism if government embraces regenerative medicine to the fullest before other countries in Africa do.
Is Nigeria budgeting enough for the health sector?
No. Although our government is striving to make Nigerians healthy by increasing the 2019 recurrent expenditure to N 315.62 billion for the sector, more money needs to be allocated. Under the ‘Abuja Declaration’ in 2001 when Nigeria hosted the Heads of State of member-countries of the African Union (AU), the leaders pledged to commit at least 15 per cent of their annual budgets to improving their health sector. Nigeria is still far from that number. The United States spends about 17-18 per cent of GDP yearly on health. The wealth of a nation is determined by the health of the nation.
You just pioneered the clinically proven safe aspect of the practice of regenerative medicine in Nigeria. What is this aspect of medicine all about and how is it different from conventional medicine?
Regenerative medicine is a branch of medicine that aims to restore normal function by repairing or replacing damaged or malfunctioning cells and tissues in patients who have lost tissue or organ function due to age, disease, or congenital defects. It comprises different components including but not limited to: Platelet Rich Plasma (PRP) Therapy which involves using the patient’s own whole blood (autologous); Adult Stem Cell (ASC) Therapy that involves use of patient’s own fat, own bone marrow or umbilical cord blood from a donor; Embryonic Stem Cell (ESC) Therapy that has ethical and religious controversy and not allowed in some countries; Induced Pluripotent Stem Cell (iPSC) Therapy which uses cells that are produced in the laboratory by reprogramming adult cells to express embryonic stem cells characteristics. It is important to understand that only the first two therapies (PRP & ASC) are currently available in clinically settings today, proven and considered safe for practical use in humans. And the use of Platelet Rich Plasma (PRP) Therapy has been going on in Nigerian university teaching hospitals and government hospitals for many years, just that they are using first generation equipment.
Regenerative medicine, as in Platelet Rich Plasma (PRP) Therapy and Adult Stem Cell (ASC) Therapy, differs from conventional medicine as it exerts its effectiveness and efficacy by following the natural healing cascade without use of drugs (especially autologous) but in an accelerated pattern without any risk of rejection (autologous) except the allogenic treatment that has some risk of rejection. Also, regenerative medicine is considered a game-changing area of medicine with the potential to fully heal damaged tissues and organs, offering solutions and hope for people who have conditions that today are beyond repair.
For how long has regenerative medicine been in practice in other parts of the world?
The term ‘regenerative medicine’ was first used in a 1992 article on hospital administration by Leland Kaiser. The practice of regenerative medicine has been going on for over 20 years in other parts of the world. It is in the last decade or two that it is fast gaining popularity.
What benefits does to it have in solving the common and the not-so-common ailments?
Any disease where there is tissue degeneration, Adult Stem Cell Therapy can help regenerate the damaged tissue. Though Adult Stem Cells (ASCs) may be able to treat most common and uncommon diseases as they do not know a patient’s diagnosis, they still have their limitations. The ASCs do not kill viruses, they cannot reattach or repair a complete torn ligament or repair a compound fractured of the bone. The Adult Stem Cells (ASCs) home to the areas of degeneration or tissue damage and, through paracrine effect, they start stimulating cellular proliferation and tissue regeneration. Conditions that may benefit from include but not limited to diabetes, arthritis, sexual dysfunction in female and male, joint and back pain, autoimmune disorders, and some neurological disorders.
Let’s talk about the side effects.
For PRP Therapy, where the patient’s own blood is used, there is no side effect; also Autologous Adult Stem Cell Transplantation using the patient’s own stem cells as the donor/source, there is no risk of rejection or side effect; Although for Allogenic Adult Stem cell Transplantation using a donor’s stem cells, the risk of rejection is small if a compatible match is found, and the other possible side effects will be that of the accompanied Radiotherapy and Chemotherapy. At the centres where I work, we do Autologous Adult Stem Cell Therapy which has been clinically proven to be safe and has no risk of rejections and our patients go home the same day, both in USA and Nigeria.
How receptive are Nigerians to regenerative medicine? Tell us what your experience has been.
Better receptive than I had anticipated. Some Nigerians are very knowledgeable about Adult Stem Cell Therapy, and not confusing it with the ‘Double Stem Cell’ tablets that are not true Stem Cells because a living cell cannot exist in form of tablet or powder. Some Nigerians have been to Indian and China in search of Stem Cell Therapy, but more education still needs to be done. I have delivered grand round lectures at National Hospital in Abuja, LASUTH in Lagos, delivered lectures at national conference of AGPMPN in Lokoja in 2018, Physician Weeks in Lagos and Abuja, etc.
How affordable is this aspect of medicine?
One of the aspects of regenerative medicine that is currently clinically available to patients all over the world is Adult Stem Cell Therapy. This treatment is time-consuming and costly. Is it worth it? For its safety and effectiveness, yes. Health is wealth and you cannot put a price on life. The good news is that, finally, scientists have found a way to make induced pluripotent stem (iPS) cell therapy safe in models, and, last year, the FDA (Food and Drug Administration) in the US approved the move to clinical stage 1 trial in humans, testing a stem cell-derived natural killer cell immunotherapy in people with incurable cancer. When the clinical trial has been completed passing through all the phases, the use of iPS cells will make Stem Cell Therapy very affordable. And it may take another 10 years before we get to that point.
In what ways do you think government can collaborate with practitioners of regenerative medicine for the benefit of Nigerians and in aid of the health sector?
There are Nigerian practitioners of regenerative medicine in UK, Canada, US that can collaborate with the Nigerian government. A former President of Nigeria Medical Association was invited from Nigeria to US to champion a research about using Stem Cell Therapy for treating infertility due to premature ovarian failure. The research is already in clinical phases. Since we may not have facilities to currently compete on a high level with Stem Cell Research Centers in the developed countries, government should provide funds and access to drugs needed to do clinical trials at a level that is feasible for a start. At least a few very influential people are already benefiting from Adult adipose-derived Stem Cell (ADSC) Therapy in Nigeria. The best part is that Autologous Adult Stem Cell (ASC) Therapy is the safest of ALL the different types of Stem Cell Therapy and, when combined with a currently clinically safe drug, it can treat advanced solid tumours, even tumour with metastasis. This is in a clinical trial now and about going on to Phase 3. There has been no side effect reported so far. The best part is that the ‘Blue Print’ and the training for this trial has been promised to Nigeria along with Poland to be number 4 or 5 in the world having this clinical trial centres. Talk is already going on about this with the appropriate bodies in Nigeria. And this is why government needs to step in big as this requires the release of the drug needed and funding, it will not come cheap. As we all know, the health of a nation is the wealth of a nation.
Tell us the challenges in the practice of regenerative medicine? Does it have a future in a country like Nigeria?
The major challenges are that the term regenerative medicine is not known to many, including the educated ones; people do not understand that there are different types of Stem Cell Therapy; that cloning and Embryonic Stem Cell Therapy is totally different from Adult Stem Cell Therapy; and also the sale of the so-called ‘Double Stem Cell’ tablets that really has absolutely nothing to do directly with Stem Cell Therapy has created doubt in people’s mind about the effectiveness of Adult Stem Cell Therapy, which is just a sub-branch of regenerative medicine. I strongly believe that regenerative medicine has a future in Nigeria. Some hospitals in Nigeria are already using Platelet Rich Plasma (PRP) Therapy, some have mentioned to me that they are not getting the adequate result to which the advice given to them is to step up from the first-generation equipment to the newer version.
I will like to reiterate that regenerative medicine is not the answer to everything yet, it has its limitations. The good thing is that when the orthodox medicine says it is over, regenerative medicine says there may still be hope. And there is currently real evidence of this all over the world, including Nigeria.