Doctors in South Korea and Japan pioneered the fat-based stem cell technique, using it to supposedly enhance face lifts and breast augmentation. For years, U.S. patients would travel to hospitals in Asia, Latin America and Eastern Europe—places where regulation is more lax than in the United States—to have these procedures as part of the international "stem cell tourism" trade.
Plastic surgeons in the U.S. quickly realized the financial potential of the fat they were already taking out of patients' bellies and backsides through liposuction—something that had been disposed of previously. Berman calls it "liquid gold."
Some early adopters have expanded into chains, offering doctors across the country a chance to join the franchise after buying some equipment and attending a seminar. These doctors sometimes appear on local TV news broadcasts, drumming up new business from patients and stoking interest from other doctors.
One national chain markets itself online with accounts of celebrity athletes who have been treated with its stem cell procedures. Prospective patients are then directed to a call center, where sales representatives try to match them with stem cell doctors over the phone.
Berman spent over 30 years as a Beverly Hills cosmetic surgeon before co-founding the Cell Surgical Network in 2012. He and his business partner, a urologist, adapted equipment and techniques from Asia into a liposuction-based procedure.
Today, the Cell Surgical Network is the largest stem cell chain in the nation, with 67 locations and a roster of more than 100 doctors in 22 states. Doctors who join the network generally charge about $9,000 per procedure; they pay Berman and his partner $25,000 to $30,000 for a South Korean cell-separating machine and other equipment.
Stem cells have long been recognized for their ability to reproduce and transform into other cell types. Because of their ability to repair and replace tissue, they are thought to hold potential for treating many diseases and injuries.
Embryonic stem cells are the most versatile because they have the ability to form all the various cell types in the body, but their use in medicine is considered controversial by some because it involves the destruction of human embryos.
Adult stem cells are less versatile, but can be easily harvested from various tissues in the body, including bone marrow and fat. For decades, they have been routinely transplanted, first in bone marrow transplants and then in procedures that transfer the cells alone. They have been useful in combating leukemia, lymphoma and other blood diseases, saving the lives of tens of thousands of people each year.
The stem cell clinics, though, promise results far beyond those currently considered prudent by mainstream medicine.
"I think responsible professionals have a broad consensus that marketing of these unproven interventions is premature and unprofessional, if not unethical," says Dr. George Daley, a founding executive of the Harvard Stem Cell Institute and professor at Harvard Medical School
Julia Matsumoto, of Fountain Valley, Calif., claims stem cell injections have helped maintain her eyesight four years after being diagnosed with chronic relapsing neuropathy, which causes inflammation of the optic nerves and can lead to blindness.
Berman has treated her on a monthly basis since 2012, free of charge, because Matsumoto cannot afford repeat procedures. Berman liposuctions fat from her abdomen then processes it with a spinning centrifuge machine and a drug, before filtering it and infusing the mixture into an injection site in Matsumoto's chest.
"Things were so vivid and bright literally 30 minutes after the stem cells were given to me," Matsumoto says, recalling her first treatment. "I started crying on the way home."
Such patient anecdotes are not considered reliable medical evidence. And because stem cell clinics have not published large, rigorous studies of their techniques, it's virtually impossible to evaluate their record of success.
Berman calls his business model "patient-funded research," and says he plans to soon publish the results of a 1,000-patient study demonstrating its safety. Cell Surgical has hired consultants to follow up with patients over the phone and survey how they are feeling.
But Leigh Turner, a professor of bioethics at the University of Minnesota, says charging patients to participate in medical research is bizarre and unethical. He calls the approach "unauthorized, for-profit human experimentation," and has asked the Food and Drug Administration to investigate Berman, arguing that his business amounts to selling unapproved, experimental drugs.
Some practitioners point to early-stage laboratory and animal studies which have been published in scientific journals. But academics say such findings cannot be applied to humans and don't provide critical information about potential side effects like infections, tumors and blood clots.
"This field, sadly, is contaminated by lots of poor-quality data that people are using to move forward and actually treat patients," says Daley, of Harvard Medical School.