Wednesday, June 04, 2008

Mrs. Baker's Paper-DRAFT!!!

Is My Child’s Future Health Worth the Cost of a Flat Screen T.V.?

I first became aware of the topic of Cord Blood Banking in 2004 prior to the birth of my daughter, Sydney. I recall reading several magazine articles about CBB, looking into the cost of private banking, and ultimately deciding not to store the cord blood. As I approach the birth of my second daughter, I would like to make an informed decision based on current research. From what I understand, cord blood stem cells can be used to treat life-threatening diseases, and there is an option of donating your baby’s cord blood to a public bank. I attended a “Baby Fair” at Griffin Hospital last weekend and was able to interview a Viacord representative. She was quick to mention to me that people don’t think twice about spending money on flat-screened televisions and other material possessions, yet they put a price on what could potentially be a life saving procedure for a loved one. Is there truth to this statement, or is this a clever salesperson who knows exactly how to tug at a vulnerable mother’s heartstrings? With only a few weeks left to make a decision, this research paper was the perfect opportunity to get the facts.

First, I needed to get some background on the various properties of cord blood that make it so desirable to save. I learned that after a baby is born and the umbilical cord is cut, some blood remains in the blood vessels of the placenta and the portion of the umbilical cord that remains attached to it. After birth, the baby no longer needs this extra blood. This blood is called placental blood or umbilical cord blood: "cord blood" for short. According to the National Cord Blood Program, “Cord blood contains all the normal elements of blood - red blood cells, white blood cells, platelets and plasma. But it is also rich in hematopoietic (blood-forming) stem cells, similar to those found in bone marrow. This is why cord blood can be used for transplantation instead of bone marrow. Cord blood is being used increasingly on an experimental basis as a source of stem cells, as an alternative to bone marrow. Most cord blood transplants have been done to treat diseases of the blood and immune system. It has also been used to restore the functional deficiencies of several genetic metabolic diseases. To date, more than 70 different diseases have been treated with cord blood transplants.” So far, doctors have found the most promise in cord blood for conditions such as blood cancers, leukemia and sickle-cell anemia. But last year, an ongoing study at the University of Florida showed cord-blood cells could also be effective at treating type-1 diabetes. Many doctors also believe that these transplants will eventually prove useful in regenerative medicine, helping patients suffering from heart disease, spinal bifida or even traumatic brain injuries. (Kingsbury) Despite the claim by the National Marrow Donor Program (NMDP) that more than 10,000 new patients each year could benefit from cord-blood stem-cell transplants, most umbilical cords currently end up as medical waste. (Kingsbury) I found enough evidence to convince me that cord blood had amazing properties, but most of the evidence I found showed that people would most often be better helped by the cord blood of a stranger, than their own cord blood.

I also wanted to know whether or not the procedure for removal and storage of the blood was dangerous in any way. According to Verter, “The commonly used methods (for removal) are: letting the blood drip out by gravity -versus- pulling it out with a syringe. Both collection methods are adequate, but the syringe method yields a higher volume on average. Both collection methods can be used with bag storage, whereas vial storage requires syringe collection.” Several articles cautioned that the cord should not be clamped too soon after birth. I found the following cautionary information from the Royal College of Obstetricians and Gynecologists Scientific Advisory Committee to be worthwhile to discuss with my doctor if I do elect to bank, “Collection imposes a considerable logistic burden on the obstetrician or midwife. In addition to consent, parental blood collection, and the associated packaging and paperwork, a large volume of blood has to be collected from the umbilical vessels in utero, requiring multiple syringes under aseptic technique. This may distract professionals from their primary task of caring for the mother and baby at this risky time or, more generally, divert delivery room staff from attending others.” I recall how much attention needed to be on both myself and Sydney after her birth, and I wouldn’t want to distract the doctor from these important tasks.
Since cost is a factor, I looked into the various fees associated with this procedure. I was able to determine from a table on Verter’s site that most private companies charge a collection fee, typically $1,000–$2,200, which includes testing for pathogens and genotyping. Samples are maintained in a frozen state for around $100-$150.00 a year. The Cord Blood Registry, one of the largest private cord blood banks in the world, charges an initial fee of $2,150 and an annual storage fee of $125. It says it has “stored the cord blood of more than 200,000 children since its inception in 1992. Since then, only 67 of its clients have withdrawn the cord blood for medical use (either for the child who donated the cord blood or a relative).” (Davis) An additional $15,000–$25,000 is charged if a sample is used for transplantation which is usually covered by health insurance. Although public banking is “free.” Some doctor’s will charge a fee to complete this procedure which often exceeds $100.00.
I was curious as to the position that reputable doctors and major medical organizations seemed to take. I began by interviewing my OB-GYN, Dr. Lima. When Dr. Lima’s six year old child was born, Dr. Lima was offered the opportunity to bank his child’s cord blood for free. Seeing this as a conflict of interest, he declined. Dr. Lima was hesitant to recommend a particular bank, but mentioned that Kim, the patient educator, would be happy to give me a packet of materials to review. I asked about public banking options, but was told that there weren’t any real options in our area. Dr. Lima estimated that 10% of his patients elect to bank, and they were from various socio-economic backgrounds. He described CBB as an “insurance policy.” I really appreciated Dr. Lima’s honesty. I was surprised and slightly relieved that my doctor, someone who could afford to bank and knew the facts, made the decision not to.

Next, I looked into the positions of some of the major medical organizations. Several articles mentioned that both the American Academy of Pediatrics and the American Medical Association encourage, in most cases, public donation over private banking. A recent article published in the LA Times, “Private Banking as Insurance,” quoted a 2007 policy statement from the American Academy of Pediatrics “(they) discouraged private cord-blood banking, except for families in which there is a sibling with a medical condition that could potentially benefit from cord-blood transplantation.” (Davis) The probability of using privately banked cord blood to treat a child or a family member is very low -- about 1 in 2,700 individuals, according to a recent committee opinion issued by the American College of Obstetricians and Gynecologists. (Davis) After reading these statements, I started to look further into public banking despite not being able to find any hospitals or public banks in CT.
So, what did I decide? Just last night, I came across two private banks that accept public donations; it does not seem like this research will end. According to Vermeer, “Cryobanks International is one of only two banks that accept donations mailed in from anywhere. They started as a private cord blood bank, but their current business is primarily oriented towards accepting donations.” This bank participates in the National Marrow Donor Program (NMDP) cord blood bank network. I have a doctor’ s appointment on Thursday, and so I plan to ask my doctor what he thinks about making a public donation to a private corporation, and what the fee would be.
Initially, my overall question was whether or not families should make the investment to bank their newborn’s umbilical cord blood. I now realize that this is a personal decision, and that I can only decide what it right for my family. I consulted several sources/ articles, interviewed my OB-GYN (Dr. Lima), and met with representatives from ViaCord and CBR (two private storage companies). I was also helped tremendously by Dr. Frances Verter’s amazingly comprehensive website “Parents Guide to Cord Blood Foundation.” ( Vermeer states, “In an ideal world, all babies would have their cord blood harvested at birth (with parental permission) and stored in public registries, much like public blood banks.” But since this isn’t the current situation, do I return the flat-screened T.V., and take out the “life insurance policy”? or can I find a way to make a public donation? To be continued…

1 comment:

  1. We really expected better Mrs. baker... not your best work. I hope in your future writing you put a little more into it.

    Jake, Tay and Andrew
    Period 1