It’s All About the Viewpoint, or One’s Perception is Their Reality.

Dear Readers:

Over the years, we have moved from the term artificial skin to skin substitutes, and then we seemed secure with referring to them as cellular/acellular and tissue products or CTPs. However, in the last 18 months, we have been presented with the term CAMPs, or cellular, acellular, and matrix-like products. For some of us, the switch to this most recent term is a change of little importance. For those tasked with teaching, categorizing, and explaining, this more inclusive definition is helpful and thoughtful, if not fully adopted. However, to some in industry, the term represents an unwanted inclusion of synthetic products and a dilution of brand and the “uniqueness” of their product(s).

The creation of the term CAMPs has occurred for many reasons, not all of which this Editor pretends to be privy to. There are definitely many political forces behind the change, which include but are not limited to: enhancing publication opportunities, having clinicians determine nomenclature rather than regulatory bodies, membership-based organizations fracturing, and most importantly, a desire to describe, define, and better understand the materials we place on chronic wounds. Interestingly, some in industry feel the addition of the nomenclature occurred due to a primary driver of competition to the biologics. They do not see the added term as an attempt by clinicians to have a comprehensive nomenclature that they use to define and categorize a group of products that they treat. I for one do not know if this is a minority or majority opinion, but I do know it is an opinion. 

In general, the perspective of some in industry to feel they are being attacked by the term CAMPs is a matter of the separation of “Church and State.” Clinicians have taken oaths to treat diseases with all tools at their disposal. We wish to have at our “beck and call” all the tools we need, and we want to be able to have access to them when we need them, but we do not care all that much how they are categorized. We treat hypertension with “antihypertensives”; this is a massive category that includes diuretics, beta blockers, calcium channel blockers, ACE inhibitors, venous dilators, etc. None of the companies that make these products is concerned that their products are grouped with other companies’; actually, they seem pleased to be a category with a huge footprint. 

I will admit the addition of a group of synthetics that facilitate the healing pathways has been somewhat disruptive. After more than 20 years of learning, studying, and understanding biologic tissue, extracellular matrix, apoptosis, and the attraction of CD34 precursor cells, among others, it is often hard to understand the mechanism of action of synthetics. There are some caveats, including that some synthetics need to actually be explanted; should that requirement exclude those products from the category? I am not sure. However, this could also be said of allografts in some situations.

Overall, CAMPs or other more inclusive nomenclatures are here, in part to stay and help to support a next iteration. Inclusivity always wins; companies may wish to argue against the term, but they will have to show a plurality. The educator and clinician value the inclusive and descriptive nomenclature. I am glad that a group of clinicians spent their time thinking and creating the term CAMPs, which I am sure will morph in the next several years. It is easy to use and descriptive. It was not determined by a regulatory body, nor industry, but by those of us who needed it.  

John C. Lantis II, MD
Editor-in-Chief, Wounds
woundseditor@hmpglobal.com