A quick search on cord blood reveals a number of articles citing a senior consultant obstetrician, Dr. Leroy Edozien, commenting on cord blood collection. I felt that the headlines proclaiming that he was totally against cord blood collection is unfairly represented by the press, as his actual comments relate mostly to the cord blood collected in public hospitals and its logistic issues poses to the doctors.
My analysis of the comments that I could find are as follows:
His concern: "Time spent on collecting cord blood is time away from the care of this mother, the baby, and, critically, other patients."
This may be true in government facilities as staff numbers are sometimes limited and due to the overwhelming load of patient deliveries, doctors and nurses often have to manage multiple ladies in various stages of labor. However, the time spent also does depend on the method of cord blood collection. Some companies provide syringes (cheaper) and expect the doctor to load the anti-coagulant prior to collection. However, StemLife makes this as easy as possible for one doctor/ nurse to perform the collection with sterile, pre-loaded blood bags with anti-coagulant which saves time and manipulation.
He adds: ""As well as being given a realistic assessment of the value of cord blood banking, parents need to know how their care, and the care of other women, can be affected by cord blood collection and what could go wrong during collection. There could also be risks that the cord blood could be contaminated or mislabeled, which could lead to legal action."
True, except that all cord blood stem cell banks should have already signed agreements with parents and counselled them sufficiently to understand that the collection of cord blood is never guaranteed. Some mothers may have emergency deliveries where it may be deemed that cord blood cannot be safely collected. Dr. Edozien's specialty is managing mothers with pregnancy problems and if these ladies requested cord blood collections, this may have bearings on the delivery process.
And not only do cord blood volumes vary from baby to baby (think small, large, long, short umbilical cords) but also despite thorough cleaning of the cord by the doctor, a single bacteria which may remain on the cord may enter the blood bag and contaminate the unit. This is not the doctor's fault nor the cord blood banks' as bacteria exist naturally everywhere, in the mucosa, vaginal tract and also in the digestive tract. All it would take would be a small amount of urine, poo or fart* to get the bacteria onto the cord and perhaps into the blood.
Cord blood banks do not usually accept contaminated units in accordance with good banking practices (StemLife does not, although I understand that there are some in asia who do...) and will discard them after informing the parents of the result. In this event, StemLife provides a full refund to the client and this happens in a small number of collections each month. I suppose if there was no refund involved, then not only would the client have lost the opportunity to bank the stem cell unit but also some money (the sum which is involved in the processing and testing of the unit).
Dr. Edozien also poses the concern of mislabelling but StemLife addresses this issue in 2 ways: 1) pre-labelling the cord blood kit with the mother's name prior to the birth of the baby and 2) ensuring that our collection team member checks on the name of the mother against our delivering database. I'm curious as to how the UK cord blood banks manage this point.
He says: "Even if the rapid pace of technological advancement results in today's speculation becoming tomorrow's reality, risk management, medicolegal, ethical, and public policy considerations militate against commercial collection of cord blood in NHS maternity units. It should therefore be NHS policy not to facilitate umbilical cord blood collection by its staff."
-If I had a child with thalassemia major and my next baby's cord blood could help treat the condition, would you prevent me from collecting the cord blood?
Can you guarantee a matching unit for my child in the public cord blood bank?-
....Its pretty tragic if no exceptions can be made in the NHS hospitals as there may be mothers who really require the service although they may not necessarily know it at the birth of their child. Private cord blood stem cell banks have already facilitated transplants for these patients and the numbers continue to grow.
He admits:"Increasing numbers of women in maternity units across the United Kingdom are requesting collection of umbilical cord blood at delivery to enable storage of stem cells for possible autologous transfusion in the future."
There is no denying that many mothers will come to know about cord blood stem cells. UK Mothers who wish to have cord blood stem cells collected may need to go to private centers. That would be a pity as it would be a step back from making another simple procedure routinely available for all mothers. I'm no expert on the NHS policies and I'm sure the doctors are doing the best they can under the circumstances available, but perhaps they could consider having those mothers who wish to have their cord blood collected check in to specific rooms and pay a small procedural fee to have a doctor, nurse or trained cord blood bank staff perform the collection. This may also provide some financial alleviation on the healthcare budget of the hospital.
*please excuse my use of this colloquialism
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2 comments:
Great post - thanks for the clarifications! It would be great to see a study that evaluated doctors' opinions on stem cells with a correlation to their age. My gut feeling it is often the older (and hence also more senior in the bureaucracies) that are occasionally resistant to new stem cell services and therapies (except when it comes to experimenting with stem cells on themselves, where they behave like kids in a candy factory).
In part, they may be still reacting to the hype surrounding stem cells 15 to 20 years ago, where costs were much higher and less therapies were proven - by nature, humans don't enjoy changing their publicly stated opinions even when the world around them has changed! Another concern I think is of ownership. Doctors feel threatened by stem cell therapies that they are not able to administer entirely on their own - they have a ridiculous unfounded fear that their "ownership" of the patient will diminish.
Lastly they have a genuine concern about how companies offering stem cell services are selling their solutions, with a concern that they are using used-car salesman tactics (or to put it more politely, insurance agent tactics). This is a valid concern. Unfortunately, there will surely be some companies offering stem cell services that will cheat customers, just as there is a man from Nigeria who sent me an e-mail today saying he is Rockerfeller's illegitate nephew and has a huge stash of cash he wants to move with my help (any of you want to give me a bank account number?).
This is an issue of building brand loyalty for ethical behaviour and also of players in the industry keeping an eye open for unscrupulous behaviour by desperate competitors.
Some of these critics of stem cell therapies have obviously not taken the time to read the contracts they make their patients sign before operations. There's no such thing as a guarantee in ANY medical procedure.
Great post - thanks for the clarifications! It would be great to see a study that evaluated doctors' opinions on stem cells with a correlation to their age. My gut feeling it is often the older (and hence also more senior in the bureaucracies) that are occasionally resistant to new stem cell services and therapies (except when it comes to experimenting with stem cells on themselves, where they behave like kids in a candy factory).
In part, they may be still reacting to the hype surrounding stem cells 15 to 20 years ago, where costs were much higher and less therapies were proven - by nature, humans don't enjoy changing their publicly stated opinions even when the world around them has changed! Another concern I think is of ownership. Doctors feel threatened by stem cell therapies that they are not able to administer entirely on their own - they have a ridiculous unfounded fear that their "ownership" of the patient will diminish.
Lastly they have a genuine concern about how companies offering stem cell services are selling their solutions, with a concern that they are using used-car salesman tactics (or to put it more politely, insurance agent tactics). This is a valid concern. Unfortunately, there will surely be some companies offering stem cell services that will cheat customers, just as there is a man from Nigeria who sent me an e-mail today saying he is Rockerfeller's illegitate nephew and has a huge stash of cash he wants to move with my help (any of you want to give me a bank account number?).
This is an issue of building brand loyalty for ethical behaviour and also of players in the industry keeping an eye open for unscrupulous behaviour by desperate competitors.
Some of these critics of stem cell therapies have obviously not taken the time to read the contracts they make their patients sign before operations. There's no such thing as a guarantee in ANY medical procedure.
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