There is a brief scene in the 1976 movie The Outlaw Josey Wales in which a snake-oil salesman offers Clint Eastwood's character a bottle of a cure-all elixir.

Only $1 a bottle.

"It works wonders on wounds," the salesman says. "It can do most anything."

Eastwood's character gives the huckster a withering glare, casually spits a long stream of tobacco juice on the man's smart white suit and snarls, "How is it on stains?"

That might sum up orthopedist Dr. Owen Tabor Jr.'s view of some providers of regenerative stem cell therapy.

"It's not only very hot in the sports medicine world, but also in the world of snake-oil salesmen," says Dr. Tabor. "There are lots of providers who offer stem cells for primarily older people with some arthritis in their joints and charging them thousands of dollars for an unproven technology. Cash only. No insurance."

Stem cell treatment itself, however, can be a legitimate and effective treatment, but generally as a last option before joint replacement to an informed patient who can afford to take a chance, Dr. Tabor says.

"The numbers of people who have sheepishly walked into my office and admitted they've dropped five grand on stem cell injections for their two arthritic knees is disheartening," he adds. "I have personally used it on probably a dozen occasions, mainly for tendinitis of the elbow or Achilles, and have had good results about 80 percent of the time.

"I think it probably is a great option for a chronic tendon problem that is not responding to the usual treatment of rest, focused therapy, and anti-inflammatories. It makes sense that stem cells would help speed the process of natural healing."

In fact, he said there are multiple ongoing research projects to assess whether stem cell therapy works, but there is no conclusive data yet.

"We have recently begun offering a full range of regenerative therapy options (stem cells, platelet-rich plasma, etc), but are making it clear to patients that it is experimental.

"My problem with it is how some providers are promoting it as an early treatment for arthritic joints," Dr. Tabor said, "I'm not saying it doesn't work, because we don't really know yet, but I don't think many people honestly believe it will re-grow cartilage in a worn out knee, any more than it will re-grow hair on my head.

"There are a lot of people out there who are just using patients' hopes as a way to line their pockets, and that's disheartening. "If anyone is thinking about stem cell injections, I would recommend they get a couple of opinions about it because if it sounds too good to be true, it probably is."

-Lawrence Buser