Regenerative medicine in Thailand: what clinics offer, the rules and how to choose

For a patient flying in, regenerative medicine in Thailand means one of three quite different things. The first is hospital medicine: blood stem cell transplants for blood cancers, thalassaemia and bone marrow failure, and stem cell transplants that repair a damaged surface of the eye, done in large university and private hospitals. The second is a group of same-day injections made from your own blood, bone marrow or fat, mostly platelet-rich plasma, given by orthopaedic, sports medicine, dermatology, hair and fertility clinics. The third is a market of cultured and donor stem cells, exosomes, intravenous drips, peptides and anti-ageing programmes sold to international patients in Bangkok and Phuket, often as packages with a hotel, and mostly without the trial evidence a regulator would need. Thai rules draw the line in the same place: the Medical Council accepts only the first group as standard stem cell treatment, and treats other stem cell uses as research.

A regenerative treatment makes sense to have in Thailand when the diagnosis is settled before you fly, the product has a name and a legal status you can check, the procedure takes a day or two and the follow-up can happen at home. That fits PRP and same-day injections for a joint or tendon, and PRP added to a hair or skin treatment you were planning anyway. It does not fit a course of cultured cells for diabetes, a neurological condition or ageing, however the package is presented.

• Joints and tendons

  PRP, marrow or fat injections for knee or hip osteoarthritis, tennis elbow, Achilles and rotator cuff problems, after physiotherapy has not been enough. A short procedure, so weigh a long flight against a modest and variable benefit.

• Hospital transplants

  Blood stem cell transplants in the transplant units of Thailand's large hospitals, for patients referred by a haematologist. Weeks in or near the hospital, with long follow-up afterwards.

• Hair, face and skin

  PRP for thinning hair and facial skin, common in Bangkok and Phuket aesthetic clinics. Repeated over months, so the cost of each long-haul trip can outweigh the saving.

• What should stay in a trial

  Cultured or donor cells, exosomes and cell drips for diabetes, back pain, spinal cord injury, Parkinson's, stroke, autism or ageing. In Thailand these uses are research, and belong in a registered study, not in a paid package.

• Bangkok. Most of the clinics on this page, the large private hospital groups and university hospitals with transplant units, and the densest cluster of aesthetic, wellness and cell clinics. The most flights, and the most choice to sort through.
• Phuket. An island with private hospitals and a cluster of anti-ageing, wellness and aesthetic clinics popular with visitors combining treatment and a holiday, where it is worth checking the medical side of a package with extra care.
• Chiang Mai. A northern city with a university hospital and private hospitals, and wellness and longevity retreats aimed at longer stays.
• Pattaya. A resort city south-east of Bangkok with international private hospitals and aesthetic clinics, within reach of the capital's airports.

• Infection. Any injection into a joint or tendon can introduce infection, and a joint infection that starts after you land will be treated at home, not in Bangkok.
• Unverified products. Cells grown or stored outside a controlled laboratory can carry bacteria or be something other than the label says, and tumours and abnormal growths have been reported after unregulated cell treatments.
• Reactions to donor material. Donor cells, cord tissue and exosomes can cause fever, allergic reactions and immune responses that your own cells would not.
• Harm from where it is injected. Injections into the eye, the spine, the fluid around the brain or the bloodstream carry risks of their own, including blood clots, and are the ones most often sold for neurological conditions.
• A long flight after a procedure. Thailand is a long-haul trip from Europe, the Americas and Australia, and a long flight soon after a harvest or injection adds to the risk of blood clots; ask about walking, fluids and compression stockings.
• Packages that hide the medicine. Hotels, transfers, spa days and VIP extras can make a quote look complete while the product, the dose and the number of sessions stay vague.
• Follow-up and insurance at a distance. After you fly home, the clinic can advise by message, but any examination or treatment of a complication happens where you live, and travel insurance excludes planned treatment.

• The clinic's licence. Ask for the clinic or hospital licence under the Sanatorium Act, in the clinic's own name, and check that the address on it is where you will be treated.
• The doctor's licence. Ask for the treating doctor's full name and Medical Council licence number, and check them on the Medical Council of Thailand's online register before you pay.
• An accepted use or a registered study. For any cell product, ask whether it is one of the uses the Medical Council accepts or part of a registered study with an ethics approval, and why you are being charged for it if it is a study.
• A named product and laboratory. Product name, source, processing, cell count or dose, the laboratory and a batch record you can take home.
• A specialist in your condition. An orthopaedic surgeon or sports physician for a joint, a dermatologist for hair and skin, a fertility specialist for the ovaries, a haematologist for a transplant. A doctor whose only specialty is the product is a warning sign.
• Image-guided injections and records in your language. Ultrasound or X-ray guidance for joints and tendons, a written consent before you pay and a discharge summary afterwards that your own doctor can read.
• Warning signs. One product for many unrelated diseases, stem cells for beauty or ageing, testimonials instead of studies, pressure to book quickly, discounts for paying in advance, and claims that your own cells cannot harm you.

• Medical Council of Thailand, regulation on medical ethics concerning stem cell transplantation for treatment.
• Medical Council of Thailand, announcement on standards of medical practice for cell therapy in blood diseases and blood cancers.
• Thailand Ministry of Public Health, notification on standards of medical cell services in health facilities for cells used in treatment.
• Thailand Department of Health Service Support, Sanatorium Act and its rules on licensing and advertising by health facilities.
• US Food and Drug Administration, consumer alert on regenerative medicine products including stem cells and exosomes.
• International Society for Stem Cell Research, the ISSCR guide to stem cell treatments and its questions to ask a provider.
• Thai Food and Drug Administration, framework for advanced therapy medicinal products, including cell therapy, under the Drug Act.