The Elixir of Life?

Pregnant women in UK were warned in June 2006 not to use companies that offer to store stem cells from their babies' umbilical cords as the companies' claims of providing the ultimate insurance against future disease are "extremely speculative". The Royal College of Obstetricians and Gynecologists (RCOG) has issued an updated version of its Scientific Opinion Paper on Umbilical Cord Blood Banking. The report finds that there is little evidence to recommend the practice whereby private companies collect and store umbilical cord blood for up to twenty years - at a charge of up to £1500 - for possible future use. The National Health Service (NHS) currently collects cord blood from selected centers in the UK, where women are approached during the maternity period and offered the opportunity to donate. Essentially, their stance remains unchanged from the one taken in their previous opinion paper published in 2001. The RCOG stands firm in its decision not to support commercial storage where no history of medical illness exists, but continues to back both public donation to banks such as the NHS Cord Blood Bank for non-directed use and directed donations for at-risk families.

Stem cells from umbilical cord blood (UCB) have been used since the first successful transplant in 1988 on Matthew Farrow, a five-year-old boy who suffered from Fanconi's Anemia. Medical experts carried out the procedure at a hospital in Paris using the stem cells harvested from the cord blood of his newborn sister, Alison. This was to become the first of over 6,000 UCB transplants worldwide, treating disorders such as thalassemia, immunodeficiency, inherited metabolic diseases, aplastic anemia and acute leukemia. Today, Matthew remains durably grafted and living proof that UCB has enormous future potential.

Cord blood advocates are keen to point out the benefits of using UCB for transplant purposes as an alternative to the traditional method of bone marrow. Unlike its bone marrow counterpart, UCB stem cells need not be an exact match and are less likely to be rejected by the recipient. Cord blood is a readily available resource, collected at the moment of delivery without pain or relative risk to mother and baby. Furthermore, stem cells collected from this routinely discarded waste product fail to raise the same moral, social and religious objections associated with the procurement of stem cells from aborted fetuses and embryos created via assisted reproductive technology. So, what reasons are being given for ignoring a resource with such great potential?

Within the public sector, the logistics of collection from multiple hospitals and subsequent cost implications involved in collection and storage are obvious reasons given against routine collection, which would inevitably draw heavily on an already cash-starved public health services model. With regard to the private sector, many legal and ethical issues are raised. In spite of its potential, the RCOG purport that there remains insufficient evidence to recommend UCB collection in low-risk families. Expectant families are targeted by the use of emotive advertising literature in maternity clinics and the Internet. Critics of commercial banking argue that the costs of this service, which fall in the region of £1,200 for a 15-20 year storage term, are out of proportion in terms of the odds associated with their potential future use, currently estimated at between 1 in 20,000 and 1 in 2,700 for personal use.

Furthermore, personal banking may not be deemed necessary for certain conditions as alternative resources may be available from UK and international public cord blood banks and bone marrow registries. Critics also argue that personally banked UCB may contain disorders already present in the patient at birth, but as yet undetected, and the low number of cells within a unit means they may only be used at present for transplants in children and young adults. Concerns over storage conditions and longevity of the cells are also raised.

Although opinion remains divided over the need for parents to privately bank their baby's cord blood, those on either side of the debate agree on one thing - stem cells are the future - and, in particular, UCB stem cells show great promise.

Cord blood stem cells have been useful in the treatment of cancers such as leukemia. The NHS public bank collects 1700 to 2000 samples each year, which may be accessed by those in need. Cord blood storage is also offered to families affected by specific genetic disorders that may be treatable with a transplant, for example Fanconi anemia. Critics say that private companies play on parent’s fears, with the offer of future speculative treatments for many conditions not currently treatable with cord blood. Some promote their service to parents through leaflets provided in GP clinics and antenatal clinics.
Professor Peter Braude, head of the Department of Women's Health at King's College London and chair of the RCOG expert group commented, 'The likelihood of use is extremely small and some of the uses are extremely speculative'. Professor Braude went on to say that, 'Most people are unaware there is an NHS cord blood bank and most transplants are done with bone marrow'.

The major use for cord blood stem cells has been in the treatment of cancers such as leukemia in children. But some companies claim the stem cells may also be used in the future to treat conditions such as Parkinson's disease.

MARKETING PHRASES
'Unimaginable possibilities'
'A once in a lifetime opportunity'
'Like freezing a spare immune system'
Slogans used in promotional material by companies offering cord blood storage

The Royal College of Obstetricians and Gynecologists said there was "insufficient evidence" to recommend the practice for families at low risk of passing on blood diseases such as leukemia or genetic disorders. Those who believed they were obtaining "the elixir of life" for their child should realize that claims that stem cells can produce future cures for Alzheimer's, diabetes, and ovarian cancer are "in the realm of speculation".

"The ability to use it for diabetes or Parkinson's is like insuring against aircraft crashes," said Peter Braude, chairman of the college's scientific advisory committee. The warning came as the college issued fresh guidelines for obstetricians and midwives concerned about how to deal with an escalating interest in the storage of umbilical cord stem cells. The demand for private cord blood banks - such as the UK Cord Blood Bank, Smart Cells and Future Health - has grown in the past year with about 11,000 British couples reported to have paid around £1,500 to store the blood for 20 years. The footballer Thierry Henry and the dancer Darcey Bussell are among the celebrities who have paid for the service. The college said collecting stem cells for families at risk of genetic disorders, or from women donating altruistically, was acceptable but that this should be done through the NHS.

We have a similar advertising avalanche in India promising “The Elixir Of Life” that seems to have targeted family physicians and obstetricians. How about the Indian College of Obstetricians & Gynecologists or the Media taking a stand with an Indian Opinion Paper?