We currently do not treat diabetes in Panama, but it’s a very interesting area of potential treatment. Diabetes affects 29.1 million people in the United States, or 9.3 percent of the U.S. population.1 Of those, 8.1 million are undiagnosed. Prediabetes, the precursor to diabetes type 2, affects 37 percent of adults aged 20 years or older and 51 percent of those aged 65 years or older Arthroscopy for Orthopedic Injuries Arthroscopy is a surgical procedure performed with the aid of an arthroscope, a small camera-like optical instrument that allows the surgeon to see the interior of an affected joint. This procedure usually requires two small incisions, one for the arthroscope and the other for the surgical instrument, making it a minimally invasive intervention under local, regional, or general anesthesia. Arthroscopy may be used in cases of ankle, wrist, shoulder, or elbow damage, but is most commonly used for the knee in meniscal tears or anterior cruciate ligament (ACL) reconstructions. The improvisation sometimes involves using materials that are not approved but that the surgeon “feels” will work well in the situation he faces. For example, human decellularized skin from dead people was approved for topical applications for ulcerated wounds in diabetic patients. But these “membranes” are fabulous for closing abdominal surgical wounds in hernia repair operations and have changed the way such closures are done. This surgical improvision, originally performed by a “cowboy” surgeon, is now the standard of care. We move forward in medicine by the skill and insightful work of pioneers—some with IRB approval and some not. Riordan’s procedures with MSCs currently have IRB approvals. In a sense of transparency, let me say that I have accepted honoraria from Neil Riordan and gifts of hotel rooms, meals, and, indeed, infusions of MSCs. These all have monetary value, but none influences my opinion. At our clinic in Panama we treat many people who have chronic conditions that their doctors have told them they have little hope of curing, but none of these diseases engages my heart the way autism does. Many people who come down with chronic diseases are shattered by how it changes their lives and rearranges plans for the future. Unlike diseases that come late in life, with autism the shattering is often more brutal and almost always affects the entire family.